OB Exam6

GIFT

this requires a woman have 1 normal fallopian tube. - ovulation is induced, egg is aspirated via laparoscopy. - semen is collected, ova and sperm are transferred to a uterine tube permitting *natural fertilization*

mumps

this sickness after adolescence can permanently damage the testes.

true

true/false: male obesity decreases quality of sperm

true

true/false: risks of ART include increased risk of high-risk pregnancy, preeclampsia, ectopic pregnancies, and multifetal pregnancies.

inversion

turning of the uterus inside out after birth

von Willebrand disease

type of hemophilia; it is among the most common congenital clotting defects in North american women of childbearing age

urinary incontinence

uncontrollable leakage of urin

placenta increta

unusual placental adherence in which there is deep penetration of the myometrium by the placenta

placenta percreta

unusual placental adherence in which there is penetration of the uterus by the placenta

plcental accreta

unusual placental adherence in which there is slight penetration of the myometrium by placental trophoblast

ovulation kit

what is an indirect/presumptive way to detect ovulation? - looks for LH surge 24-36 hrs prior to ovulation.

The nurse instructs a nursing student to administer clomiphene (Clomid) to a patient in order to conduct a clomiphene citrate challenge test (CCCT). What instruction should the nurse give to the nursing student before giving this medication to the patient? To administer: 1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. 2 A 500-mg initial dose of clomiphene (Clomid) to the patient. 3 Clomiphene (Clomid) to the patient on the 12th day of the menstrual cycle. 4 Clomiphene (Clomid) to the patient on the 15th day of the menstrual cycle.

1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. The clomiphene citrate challenge test is used to assess follicle-stimulating hormone (FSH) levels. From this test, the nurse can determine whether the patient has an adequate ovarian reserve. The nurse instructs the student nurse to administer a 100-mg dose of clomiphene (Clomid) to the patient, as it is the standard dosage. Administering 500 mg may lead to an overdose and side effects in the patient. Therefore, the nurse should not instruct the nursing student to administer 500 mg of clomiphene (Clomid) as the initial dosage. Administering clomiphene (Clomid) on the 12th or 15th day of the menstrual cycle may not be effective and does not affect the levels of follicle-stimulating hormone

A patient wants to have an abortion during the 18th week of pregnancy. What abortion technique should the nurse suggest to the patient? 1 Dilation and evacuation 2 A surgical (aspiration) abortion 3 Administration of methotrexate (Trexal) 4 Administration of mifepristone (Mifeprex)

1 Dilation and evacuation The patient is in her second trimester of pregnancy. Therefore, the nurse should suggest the dilation and evacuation method of abortion. This method is safe and can be used until 20 weeks of gestation. Surgical (aspiration) methods and use of medications such as methotrexate (Trexal), mifepristone (Mifeprex), and misoprostol (Cytotec) are effective for abortion during the first trimester of pregnancy. These methods are not suitable as the patient is in the 18th week of pregnancy.

The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is: 1 In vitro fertilization 2 Tubal embryo transfer 3 Therapeutic insemination 4 Gamete intrafallopian transfer

1 In vitro fertilization In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer involves placing the sperm and ova in the fallopian tube.

Which medication should the nurse expect to find in the patient's medication profile for the treatment of uterine fibroid tumors? 1 Leuprolide acetate (Lupron) 2 Ganirelix acetate (Antagon) 3 Progesterone (Prometrium) 4 Clomiphene citrate (Clomid)

1 Leuprolide acetate (Lupron) Gonadotropin-releasing hormone (GnRH) agonists like leuprolide acetate (Lupron) are used for the treatment of uterine fibroids. These medications desensitize the GnRH agonist receptors and decrease the production of follicle-stimulating hormone (FSH) and ovarian function. Ganirelix acetate (Antagon) is a GnRH antagonist and is used for infertility treatment. Progesterone (Prometrium) is used for treatment of luteal phase inadequacy. Clomiphene citrate (Clomid) is used for ovulation induction and treatment of luteal phase inadequacy.

What are the side effects of gonadotropin-releasing hormone (GnRH) agonists? Select all that apply. 1 Myalgia 2 Arthralgia 3 Lactic acidosis 4 Vaginal dryness 5 Liver dysfunction

1 Myalgia 2 Arthralgia 4 Vaginal dryness Gonadotropin-releasing hormone (GnRH) agonists are used for the treatment of endometriosis and uterine fibroids. Myalgia, arthralgia, and vaginal dryness are the side effects of gonadotropin-releasing hormone (GnRH) agonists. These side effects are usually reversible within 12 to18 months after the treatment. Lactic acidosis and liver dysfunction are side effects of metformin, which is an oral hypoglycemic agent.

A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman? Select all that apply. 1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. 4 Take two pills then resume one tablet daily. 5 Use a backup contraceptive for the next seven days.

1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary.

The nurse is reviewing the laboratory results for a patient who has undergone semen testing. The nurse notices that the patient is in the subfertile stage. What is the next step that the nurse should take? 1 Plan to have the test repeated 2 Arrange for hormone level tests 3 Schedule a scrotal ultrasound 4 Counsel about infertility issues

1 Plan to have the test repeated A minimum of two seminal analyses are recommended before determining the cause of infertility or referring for further testing. If abnormalities are found during the first test, the nurse should plan for a second seminal analysis after a sufficient interval. If the second semen test also finds the patient to be in the subfertile range, then further investigation is needed. This can include assessing hormonal levels and sending the patient for an ultrasound. The nurse should proceed to counsel the patient only after all the diagnostic tests reveal infertility, not after the initial semen examination.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? 1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram

1 Semen Analysis Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to evaluate the structure and patency of the uterus and tubes.

After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to the patient to prevent conception? 1 The couple should abstain from sexual intercourse from days 10 through 17. 2 The couple should abstain from sexual intercourse from days 6 through 19. 3 It is safe to have unprotected sexual intercourse from days 11 through 17. 4 It is safe to have unprotected sexual intercourse from days 12 through 16.

1 The couple should abstain from sexual intercourse from days 10 through 17 The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.

The nurse is assessing a patient who is taking oral contraceptives and reports severe pain in the legs. What symptoms should the nurse primarily assess for in the patient? 1 Thrombus formation 2 Severe muscle spasms 3 High creatinine levels 4 Hyperglycemic events

1 Thrombus Formation Patients who take oral contraceptives are at a high risk of developing thromboembolism or blood clots. Therefore the nurse would primarily assess for calf pain warmth and tenderness which indicates thromboembolism. Muscle spasms are not side effects that develop with oral contraceptives. Although the pain is severe in the case of muscle spasms, it can be resolved easily with the help of analgesics. Creatinine levels increase when the kidneys fail to function properly. Oral contraceptives have no effect on kidney function. Oral contraceptives have no effect on blood glucose levels

A patient approaches the primary health care provider due to ovulation problems. The nurse instructs the patient to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? 1 To assess the levels of progesterone in the patient 2 To determine the thickness of the uterine lining 3 To evaluate the viscosity of the cervical mucus 4 To assess the follicle-stimulating hormone (FSH) level

1 To assess the levels of progesterone in the patient Serum progesterone levels are tested seven days before the onset of the next estimated menstrual cycle. This test would help identify the progesterone levels in the patient. It helps to assess the corpus luteum and midluteal-phase progesterone levels as progesterone plays a role in ovulation and the menstrual cycle. The uterine cavity is observed by using an X-ray film during a hysterosalpingogram. This test does not need to be conducted at a particular time. The viscosity of the cervical mucus is assessed to determine if it is conducive for the penetration of the sperm. This can be checked at any point in time. Follicle-stimulating hormone (FSH) levels are determined on day 3 of menstruation to determine ovarian reserve.

The nurse is counseling a patient who has had multiple miscarriages. The nurse explains to the patient that she has developed endometriosis. In which category would this be placed as a cause of infertility? 1 Tubal factors 2 Ovarian factors 3 Uterine factors 4 Cervical factors

1 Tubal factors A series of steps are required for successful conception. Interference in any one of the steps may result in infertility. Tubal factors would be the cause of this patient's infertility. The fertilized embryo was unable to reach the uterus by passing through the fallopian tubes because of the patient's endometriosis. Ovarian factors that cause infertility impair the process of production of healthy oocytes during the menstruation cycle. A successfully formed fertilized embryo signifies that oocytes are healthy. This patient does not have uterine factors that cause infertility since the patient is able to successfully conceive. The uterine factors may affect the process of implantation and nourishment of the embryo in the uterus. The fertilized egg is unable to reach the uterus. Any change in the anatomy of the cervix that affects the movement of the sperm into the uterus indicates a cervical factor. In this patient, the embryo was fertilized. This indicates that the sperm were able to pass through the uterus and fertilize the egg. Therefore it is not a cervical factor.

Which statement by a client could indicate a potential problem for a couple planning to use coitus interruptus? 1. "I really don't want to get pregnant right now, so we need a very effective method." 2. "I think I can always pull out before I ejaculate." 3. "We don't have any other sex partners." 4. "We want a contraceptive method that is inexpensive and completely natural."

1. "I really don't want to get pregnant right now, so we need a very effective method." Rationale: Because some semen is released before ejaculation, coitus interruptus has an 18% failure rate and would not be considered a very effective method for a cou- ple wanting to avoid pregnancy. An ability to withdraw before ejaculation is necessary for coitus interruptus to be effective, so the client's statement would be consistent with successful use of this method. Not having other sex partners has no effect on choice of coitus interruptus as a contracep- tive method. Coitus interruptus has no cost and is com- pletely natural.

Which statement indicates to the nurse that a couple is coping with the stress of infertility treatment? 1. "We are trying to maintain a little romance in our relationship." 2. "My wife was so upset she threw a syringe at me yesterday." 3. "My husband couldn't have an erection when he was sup- posed to." 4. "We have two or glasses of wine each night to help us relax."

1. "We are trying to maintain a little romance in our relationship." Rationale: Maintaining a healthy relationship, such as romance, is important during infertility treatments, which can be very stressful. Emotional outbursts, decreased libido, and regular use of alcohol to relax warrant further investigation as possible signs of excess stress.

The nurse working in an infertility clinic explains to an infertile couple that they will likely have which tests ordered? Select all that apply. 1. Semen analysis 2. Papanicolaou smear 3. Colposcopy with endocervical biopsy 4. Sexually transmitted infection testing 5. Hysterosalpingogram

1. Semen analysis 5. Hysterosalpingogram Rationale: The most common causes of infertility are inadequate number or motility of sperm and tubal anomaly or blockage. Semen analysis will provide information on number of and motility of sperm. Hysterosalpingogram will detect uterine or tubal anomalies or blockage. A Papanicolaou smear tests for abnormal cervical cells. Colposcopy and testing for sexually transmit- ted infections will not directly test for causes of infertility.

What information would the nurse gather before schedul- ing a client's endometrial biopsy? 1. Usual length of menstrual cycle 2. Blood type and Rh factor 3. Presence of any metal implants 4. Last type of birth control used

1. Usual length of menstrual cycle Rationale: The nurse assesses the first day of the last normal menstrual period and the menstrual cycle length. Endometrial biopsy is performed on day 21-27 of the menstrual cycle to assess endometrial response to progester- one and development of luteal phase endometrium. It is unnecessary to assess for blood type and Rh factor, metal implants, or most recent type of birth control used.

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: 1 "The lubricant prevents vaginal irritation." 2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." 3 "The additional lubrication improves sex." 4 "Nonoxynol-9 improves penile sensitivity."

2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 does not provide protection against sexually transmitted infections. Nonoxynol-9 may cause vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications? The patient should increase: 1 Iron intake. 2 Calcium intake. 3 Protein intake. 4 Potassium intake.

2 Calcioum intake Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need not suggest that the patient eat a diet rich in protein or potassium.

Which symptom in a woman who is using oral contraceptives should be reported to the physician immediately? 1. 5-lb weight gain in a month 2 Leg pain and edema 3 Decrease in menstrual flow 4 Increased pigmentation of the face

2 Leg pain and edema Oral contraceptives increase clotting factors that may place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain in the first month is a common finding. A decrease in menstrual flow is an expected finding. An increased pigmentation of the face is a common finding.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to: 1 ejaculate into a sterile container. 2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. 3 transport specimen with container packed in ice. 4 ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

The client couple is planning intracytoplasmic sperm injection, followed by intrauterine embryo transfer. Which statement indicates the nurse's teaching was effective? 1. Whether or not the couple has medical insurance 2. How infertility is affecting their lives 3. Whether the man has seafood allergies 4. Whether the woman works outside the home

2. How infertility is affecting their lives Rationale: The psychological, cultural, and social ramifications of infertility can be extensive. These areas are assessed to determine if the couple needs assistance in coping with infertility and treatment. Payment for infertility workup is an area of concern, but is not the priority of the nurse when interviewing the couple. Seafood allergies of the man are not of concern, although they may be of concern for the woman if having tests that involve dye injection. Working outside the home is not a priority con- cern of the nurse during the interview.

A client who has a complete bicornuate uterus with two vaginas is considering getting pregnant. The nurse would include in discussions with the client which associated concerns? Select all that apply. 1. Inability to ever achieve pregnancy 2. Increased risk for preterm labor 3. Need for artificial insemination to conceive 4. Need for cesarean delivery 5. Risk for multiple pregnancy loss

2. Increased risk for preterm labor 5. Risk for multiple pregnancy loss Rationale: A complete bicornuate uterus is two complete and separate unicornuate uteri. Because the uteri are long and narrow (instead of pear-shaped), the maximum uterine volume is often less than that of a normally shaped uterus. Risks of bicornuate uterus include multiple preg- nancy losses, preterm labor, and breech presentation. Becoming pregnant is not an issue; carrying the pregnancy to term is the problem.

The client has an obstruction between the uterus and fal- lopian tubes. In obtaining a health history, the nurse col- lects information about which possible etiology? 1. Rubella infection prior to adolescence 2. Pelvic inflammatory disease caused by gonorrhea 3. Smoking two packs of cigarettes per day 4. Ingestion of 2 ounces of alcohol daily

2. Pelvic inflammatory disease caused by gonorrhea Rationale: Infectious processes of the reproductive tract such as PID may result in tubal scarring and therefore tubal blockage. Rubella infection in childhood usually results in the development of active immunity to the disease. Smoking and alcohol present health risks to the woman but not related to tubal patency.

The client is unable to become pregnant after she has had one full-term pregnancy. The nurse should develop a plan of care for which health problem? 1. Primary infertility 2. Secondary infertility 3. Unexplained infertility 4. Combined factor infertility

2. Secondary infertility Rationale: Secondary infertility is the term for couples that have had one pregnancy but are unable to conceive again. Primary infertility describes the inability to conceive even once. Unexplained and combined factor infertility are not terms used when discussing fertility.

A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is: 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests your problem will be resolved." 3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "Once you've identified your problem, you may want to look at the option of adoption."

3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples" Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts.

Which contraceptive method provides protection against sexually transmitted infections? 1 Oral contraceptives 2 Tubal ligation 3 Male or female condoms 4 Intrauterine device (IUD)

3 Male or female condoms Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections.

Which symptom should the nurse expect in a female patient who presents with elevated androgen levels? 1 Skin rashes and acne 2 Loss of body hair 3 Pigmentation changes 4 Decreased body weight

3 Pigmentation changes An increase in androgen (male sexual hormone) levels causes pigmentation changes in the patient. This is because the epidermis becomes coarse and thick. Increased androgen levels do not cause hypersensitivity or acne breakouts. Therefore, the patient may have neither skin rashes nor acne. Due to an increase in androgen levels, the patient may have an excessive growth in body hair. Androgen levels do not affect body weight.

What factors should the nurse assess in the patient with anovoluation? Select all that apply. 1 Endometriosis 2 Vaginal infections 3 Thyroid disorders 4 Pituitary gland disorders 5 Pancreatic gland disorders

3 Thyroid disorders 4 Pituitary gland disorders Thyroid disorders and pituitary gland disorders are the primary factors causing anovulation. Abnormal activity of these glands could restrict the formation of ova. Endometriosis is the condition that affects peritoneal factors. This condition does not affect the formation of ova, nor does it restrict it. Vaginal infections are treated with medications and have no relation to the ovaries or their functioning. The pancreas secretes insulin and glucagon, which is not related to ovarian activity either.

A 26-year-old woman is considering Depo-Provera as the contraception that is best for her because she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse should tell her that Depo-Provera: 1 is a combination of progesterone and estrogen. 2 is a small adhesive hormonal birth control patch that is applied weekly. 3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. 4 has an effectiveness rate in preventing pregnancy of 96% when used correctly.

3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. The effectiveness rate is 99% or greater over 5 years.

The client couple is planning intracytoplasmic sperm injection, followed by intrauterine embryo transfer. Which statement indicates the nurse's teaching was effective? 1. "His sperm swim too fast for me to become pregnant." 2. "My eggs have thick walls and don't let his sperm in." 3. "Any extra embryos can be frozen for implantation later." 4. "We will have to wait several weeks to see if any eggs get fertilized."

3. "Any extra embryos can be frozen for implantation later." Rationale: In vitro fertilization usually creates multiple embryos, of which up to four are implanted. Cryopreservation of excess embryos is common, and they can be implanted at a later date. Slow sperm motility could adversely affect fertilization. The thickness of the wall of the egg does not impede sperm penetration. It does not take several weeks to determine whether eggs are fertilized with intracytoplasmic sperm injection.

Which statement by a client being treated for infertility indicates the need for additional teaching? 1. "I should come back for a postcoital test 1-2 days before I expect to ovulate." 2. "I should schedule my hysterosalpingogram for the week after ovulation." 3. "We should abstain for 14 days prior to coming back for the sperm penetration test." 4. "I should schedule my endometrial biopsy for the last week of my menstrual cycle."

3. "We should abstain for 14 days prior to coming back for the sperm penetration test." Rationale: The sperm penetration test, which tests for the ability of sperm to penetrate an egg, should be performed after 2-7 days of abstinence. Having a post-coital test before ovulation is not useful. A hypersalpingogram would be scheduled in the proliferative phase before ovulation to avoid early pregnancy or secretory changes in endometrium after ovulation, which could obstruct dye passage. Endometrial biopsy should not be scheduled earlier than 10 to 12 days after ovulation to accurately detect effects of progesterone and endometrial sensitivity.

Which statements indicate to the nurse that a male client understands how to correctly apply a condom? Select all that apply. 1. "I need to put it on before the penis is erect." 2. "I should unroll the condom, then place it on the penis." 3. "When putting on the condom, I need to leave some space at the tip to collect the sperm." 4. "I can use oil-based lubricants if needed." 5. "I can use a water-based lubricant if needed."

3. "When putting on the condom, I need to leave some space at the tip to collect the sperm." 5. "I can use a water-based lubricant if needed." Rationale: The male condom is placed when the penis is erect, then rolled down. Leaving space at the end of the condom to collect semen can prevent breakage or spill- age after ejaculation. Water-based lubricants can be used to provide additional comfort, if needed. Oil-based lubricants are contraindicated.

Which client being seen in the outpatient clinic would be the best candidate for insertion of an intrauterine device (IUD)? 1. A client who is married, has one child, and wants to get preg- nant in about 6 months 2. A client who is unmarried, has no children, and has numerous sexual partners 3. A client who is married, has two children, and does not want more children for at least 3 years 4. A client who is unmarried, has one child, and has a history of pelvic inflammatory disease (PID)

3. A client who is married, has two children, and does not want more children for at least 3 years Rationale: An IUD is a long-term method of contraception usually recommended for women who have been pregnant and are in a monogamous relationship so that they are at a low risk for sexually transmitted infection. The clients in the incorrect options have one or more factors that should guide them to select a different contraceptive method.

The client has been diagnosed with Trichomonas vaginitis. The nurse explains during client teaching that this infec- tion can affect fertility by which mechanism? 1. Using glycogen in vaginal secretions, leaving no nutrition for spermatozoa 2. Blocking fallopian tubes, which prohibits spermatozoa from reaching an ovum 3. Decreasing pH of vaginal secretions, thus destroying most spermatozoa 4. Increasing temperature inside the vagina, which decreases sperm motility

3. Decreasing pH of vaginal secretions, thus destroying most spermatozoa Rationale: Vaginal fluid pH is slightly alkaline, as is semen. Spermatozoa cannot survive in an acidic environ- ment. Trichomonas vaginitis increases the acidity of the vaginal and cervical secretions, thus reducing the number of viable sperm.

In planning care for the infertile client, the nurse should take which actions? Select all that apply. 1. Encourage client to seek additional formal education. 2. Restrict the amount of information given so as not to over- whelm client. 3. Facilitate client's self-esteem through use of careful wording and avoiding blame. 4. Aid client in finding a relaxing vacation spot to improve the chances of conception. 5. Explain that fertility testing process is lengthy and results will not be instantaneous.

3. Facilitate client's self-esteem through use of careful wording and avoiding blame. 5. Explain that fertility testing process is lengthy and results will not be instantaneous. Rationale: Self-esteem can be threatened by the inability to conceive a child. Care must be taken to avoid placing blame on the person whose body is not functioning as expected. Fertility testing takes a long time and there- fore results are not instantaneous. The amount of formal education does not affect fertility or treatments for infertility. Information should be given when appropriate and not limited or withheld. The need to take a relaxing vacation to conceive is a potentially expensive myth.

The client, who is married and has three children, has come to the family planning clinic asking about a birth control method that is most effective and sanctioned by the Roman Catholic Church. What would be the nurse's best recommendation? 1. Billings or cervical assessment method 2. Ovulation testing kit 3. Symptothermal method 4. Basal body temperature (BBT) method

3. Symptothermal method Rationale: The symptothermal method combines cervical mucus and BBT measurements and results in a lower failure rate than either BBT or cervical mucus as a single assessment of the fertile period. This method is com- pletely natural and congruent with beliefs of this religious group. Ovulation testing kits do not give enough warningof ovulation to prevent pregnancy.

Which response by the nurse is most appropriate when a woman asks, "What contraceptive do you think I should use?" 1 "Your health care provider will know what is best for you." 2 "The male condom is probably the easiest for you to use." 3 "Because you are younger than 40, you should use oral contraceptives." 4 "I can discuss the various methods so you can decide what is best for you."

4 "I can discuss the various methods so you can decide what is best for you." The nurse should provide the woman with all the necessary information to make an informed decision, but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the patient? 1 Danazol (Danocrine) and glipizide (Glucotrol) 2 Bromocriptine (Parlodel) and glyburide (Diabeta) 3 Progesterone (Prometrium) and acarbose (Precose) 4 Clomiphene (Clomid) and metformin (Glucophage)

4 Clomiphene (Clomid) and metformin (Glucophage) The patient has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone. Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the patient. Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on patients with insulin resistance. Bromocriptine (Parlodel) is used for patients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of endometriosis. Acarbose (Precose) works in the gastrointestinal tract on carbohydrates for diabetes mellitus.

What is the significance of the clomiphene citrate challenge test (CCCT)? To assess: 1 If the fallopian tubes are open and patent 2 for the presence of uterine abnormalities 3 The amount of progesterone production 4 Follicle-stimulating hormone (FSH) levels

4 Follicle-stimulating hormone (FSH) levels The clomiphene citrate challenge test (CCCT) is used to assess follicle-stimulating hormone (FSH) levels. In this test, 100 mg of clomiphene (Clomid) is administered to the patient from day 3 to day 10 of the menstrual cycle. Follicle-stimulating hormone (FSH) levels are assessed on the 3rd day and the 10th day after clomiphene (Clomid) is administered. FSH levels greater than 20 indicate that the pregnancy will not occur with the woman's own eggs. FSH levels less than 15 suggest an adequate ovarian reserve in the patient. Patency in the fallopian tubes is assessed by hysterosalpingogram, hysterosalpingo-contrast sonography, and chlamydia immunoglobulin G antibodies. Uterine abnormalities are assessed by hysterosalpingogram and hysterosalpingo-contrast sonography. Progesterone production is assessed by the serum progesterone test.

The nurse administers leuprolide acetate (Eligard) followed by gonadotropin therapy to a patient and schedules the patient for daily ultrasounds. What is the rationale for this referral? To check for: 1 Fibrocystic breast tissue changes. 2 Stimulation of the endometrium. 3 Blockage in the fallopian tubes. 4 Hyperstimulation of both ovaries.

4 Hyperstimulation of both ovaries. Leuprolide acetate (Eligard) followed by gonadotropin is the most powerful medication to induce ovulation. These medications require daily ovarian ultrasounds and checking of estradiol levels in order to assess for hyperstimulation of the ovaries. Breast tissue changes, endometrial stimulation, and fallopian tube blockage are not side effects related to gonadotropin drugs. Progesterone may cause breast enlargement and endometrial stimulation. Fallopian tube blockage must be corrected surgically.

On reviewing the laboratory report of the patient, the nurse finds that the patient is subfertile. Which nursing advice is helpful for the patient to resolve this condition? 1 Start taking cold baths or showers daily. 2 Take flaxseed oil in order to stimulate fertility. 3 Add periwinkle powder to your tea once a day. 4 Use water-soluble lubricants during intercourse.

4 Use water-soluble lubricants during intercourse. Commonly used lubricants contain spermicides or have spermicidal properties that can kill sperm. Therefore the nurse should advise the patient to use water-soluble lubricants during intercourse. The nurse should advise the patient to take hot baths or use saunas instead of cold baths and showers. This increases the basal body temperature, which helps in increasing spermatogenesis. Flaxseed and periwinkle herbal products should not be used, as most herbal remedies are not clinically proven. Hence, they may not be safe

The nurse is caring a patient who is pregnant as a surrogate mother. What condition would the biological mother have in order to need to use a gestational surrogate? 1 Ovarian failure 2 Tubal blockage 3 Early menopause 4 Uterine myoma

4 Uterine Myoma The patient who carries the fetus for another couple is referred to as a surrogate mother. In conditions like uterine myomas, the fertilized ova cannot be impregnated in the uterus of the biological mother. Therefore, the couple would need a surrogate mother to carry the fetus. A female with ovarian failure can still carry the fetus after in vitro fertilization of the donor oocyte. The genetic investment from the male parent can possibly be observed in the embryo when the oocyte is donated and fertilized with the parent sperm. In conditions like tubal blockage, a female can carry the fetus after it is fertilized in vitro. Genetic investment is possible from both the parents for the embryo. Early menopause is the condition where a female may require a donor oocyte to conceive and can still carry the embryo in her own uterus.

The nurse is assessing a couple for infertility problems. After reviewing the patient's history and laboratory results, the nurse finds that the patient is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the patient to increase the sperm count? 1 Bromocriptine (Parlodel) 2 Progesterone (Prometrium) 3 Depot medroxyprogesterone acetate (DMPA) 4 Intracytoplasmic sperm injection (ICSI)

4 intracytoplasmic sperm injection The patient may require intracytoplasmic sperm injection (ICSI). This treatment is preferred for treating patients who have a low sperm count or reduced spermatogenesis. In this process, one sperm cell is selected and injected directly into the egg to achieve fertilization. Bromocriptine (Parlodel) is used to reduce excess prolactin levels. Progesterone (Prometrium) is used for the treatment of endometriosis. Progestin (DMPA) injections are used to impair fertility by inhibiting ovulation. These medications are not prescribed for infertility problems in males.

Which client statement indicates that teaching about cervical mucus changes as an indicator of ovulation has been understood? 1. "If my cervical mucus is yellowish and thick, I am probably fertile." 2. "The thin, clear mucus will block sperm from getting to my cervix." 3. "If my cervical mucus is thick and white, I will need to avoid intercourse or use a backup method of contraception." 4. "If my cervical mucus is thin and stretchable, I am probably fertile."

4. "If my cervical mucus is thin and stretchable, I am probably fertile." Rationale: Thin and clear cervical mucus indicates a rising level of estrogen and impending ovulation. Stretchability of the cervical mucus, or spinnbarkeit, is indicative of the fertile period and promotes motility of the sperm. Thick cervical mucus occurs during the infertile period when sexual intercourse is unlikely to result in preg- nancy.

The nurse is teaching a class in the community on com- mon myths regarding fertility and infertility. Which state- ment made by a class participant indicates teaching has been successful? 1. "If my husband works out everyday, he won't be able to make a baby." 2. "If we have intercourse standing up, we won't be able to conceive." 3. "If we have intercourse on the even days after ovulation, we will conceive a girl." 4. "If my husband sits in the hot tub every night, his sperm count will decrease."

4. "If my husband sits in the hot tub every night, his sperm count will decrease." Rationale: Hot tubs, saunas, and tight underwear can raise the temperature of the testes too high for efficient sper-matogenesis and lead to decreased sperm numbers and motility. Exercise by the male partner does not affect fertility. A standing position does not prevent conception. Sex of a fetus is not affected by whether intercourse occurs on an odd or even day.

The women's health clinic nurse determines that which clients would be appropriate candidates for use of emer- gency postcoital contraception? Select all that apply. 1. Had unprotected intercourse 4 days ago 2. Took her oral contraceptive 7 hours late 3. Removed her cervical cap 40 hours after intercourse 4. Had her last Depo-Provera injection 4 months ago 5. Had been sexually assaulted the previous day

4. Had her last Depo-Provera injection 4 months ago 5. Had been sexually assaulted the previous day Rationale: Emergency contraception must be initiated within 72 hours of unprotected intercourse, sexual assault, or method failure. Oral contraceptives may be taken up to 12 hours late and cervical caps may be left in up to 48 hours without compromising safety. Depo-Provera is given every 80-90 days, after which a repeat dose is needed or emergency contraceptive protection is indicated.

The nurse is concerned that which viral infection, if experienced by an adult male, may cause infertility? 1. Varicella zoster 2. Rubella 3. Influenza 4. Mumps

4. Mumps Rationale: Mumps in adult males can cause permanent blockage of the vas deferens, contributing to or resulting in infertility. Varicella, rubella, and influenza do not have this effect.

B

A woman must assess herself for signs that ovulation is occurring. Which of the following sign is associated with ovulation? A. reduction in level of LH in the urine 12-24 hrs prior to ovulation B. Spinnbarkeit C. Drop in basal body temp following ovulation D. Increased thickness of cervical mucus

C

A woman taking human menopausal gonadoptropin for infertility should understand which of the following regarding this med? A. she should take the med PO, once a day before breakfast B. this med stimulates the pituitary gland to produce FSH and the LH C. she must report for ultrasound testing as scheduled to monitor follicular development D. Progesterone should be administered after 7 doses of the gonadotropins have been taken

A couple is requesting fertility counseling. The nurse practitioner has identified the factors listed below in the woman's health history, and knows which of them could be contributing to the couple's infertility? 1. The client is 38 years old. 2. The client was 13 years old when she started her menses. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles a day.

Answer: 1 Explanation: 1. As the eggs of older women age, their fertility is reduced.

The nurse is teaching an infertile couple about the causes of infertility. The nurse tells them that infertility can be caused by which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Immunological responses 2. Congenital anomalies 3. Patent fallopian tubes 4. Hypothyroidism 5. Favorable cervical mucus

Answer: 1, 2, 4 Explanation: 1. Immunological responses, such as antisperm antibodies, can cause infertility. 2. Congenital anomalies, such as a septate uterus, can cause infertility. 4. Hypothyroidism is a cause of infertility.

The nurse in the OB-GYN clinic counsels a couple that in autosomal dominant inheritance, which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. An affected individual might have an affected parent. 2. The affected individual has a 75% chance of passing on the abnormality. 3. Males and females are equally affected by the gene. 4. A father can pass the defective gene to a son. 5. There are no variances in the genetic pattern for autosomal dominant disorders.

Answer: 1, 3, 4 Explanation: 1. The family pedigree usually shows multiple generations having the disorder. 3. Males and females are equally affected in autosomal dominant disorders. 4. In autosomal dominant disorders, the father can pass the defective gene to a son.

A nurse counsels a couple on sex-linked disorders. Both the man and the woman are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse's best response? 1. "If you have a daughter, she will not be affected." 2. "Your son will be affected because the father has the disorder." 3. "There is a 25% chance that your son will have the disorder because the mother has the disorder." 4. "There is a 50% chance that your son will be a carrier only."

Answer: 4 Explanation: 4. There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected.

A nurse working in an infertility clinic should include which information in her discussions with the clients? 1. It is important to know the statistics surrounding couples who never learn why they are infertile. 2. Couples should understand the legal controversy concerning therapeutic insemination. 3. Couples should seek marriage counseling before undergoing fertility treatments. 4. Couples should discuss therapeutic insemination and in vitro fertilization as alternatives.

Answer: 4 Explanation: 4. This is the correct answer. This information should be presented to clients so that they are aware of all the alternatives and can make an informed decision.

A client has been diagnosed with fallopian tube obstruction and told that her best option for becoming pregnant is with in vitro fertilization. The client asks the nurse about the procedure. What is the nurse's best explanation of this procedure? 1. "In vitro fertilization (IVF) occurs over a full menstrual cycle." 2. "In IVF, a woman's ovaries are stimulated by a combination of egg and sperm donations." 3. "After ovarian stimulation, you will be inseminated with your partner's sperm." 4. "The oocytes are aspirated from the ovaries and fertilized in the laboratory."

Answer: 4 Explanation: 4. This is true. The oocytes are aspirated from the client's ovaries and fertilized in the laboratory.

A

Lifestyle and sexual practices can affect fertility. Which of the following practices could enhance a couple's ability to conceive? A. Use balanced nutrition and exercise to achieve a normal BMI B. abstain from alcohol C. avoid use of lubricants during intercourse D. relax in a hot tub every day before bed

D

Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? A. Risk of multiple gestation B. Whether or how to disclose the facts of conception to offspring C. Freezing embryos for later use D. Financial ability to cover the cost of treatment

B

The rate of fertility declines dramatically after age 35. While explaining the cause of this rapid decline in fertility to the client, the nurse is aware that the primary reason for this is related to: A. endometriosis B. abnormalities of oocytes C. infection D. metabolic disease

D

When caring for a woman who is scheduled for a hysterosalpingogram, the nurse should do which of the following? A. ensure the woman is in the secretory phase of her menstrual cycle B. explain to the woman that the procedure will allow her to conceive C. report any uterine cramping immediately because it may indicate the woman's uterus was perforated during the procedure D. change the woman's position if she complains of shoulder pain following the procedure.

C, D, E

Which of the following could affect female fertility? (select all that apply) A. Partner relationship status B. financial history C. Clinical dx of anemia D. bicornate uterus E. uterine abnormality F. Cephalopelvic Disproportion

A

an infertile woman is given clomiphene citrate to achieve which of the following therapeutic outcomes? A. stimulate the pituitary gland to secrete FSH and LH B. enhance the development of a secretory endometrium C. induce the formation of the corpus luteum D. increase secretion of favorable cervical mucus to enhance sperm viability.

thinner

does cervical mucus usually get thinner or thicker during ovulation?

sterility

inability to conceive.

35

infertility increases with age, particularly women > ______

40

men decline slower, usually after age ______

7

pH > ____ (alkaline) helps support sperm and permits transportation.

undescended testes

this can contribute to too high of temperature of sperm. - also tight clothing and saunas.

varicocele

varicose veins of scrotum that can lead to infertility.

The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching? 1 "The patient should be instructed to masturbate to obtain the semen sample." 2 "A cold environment or low temperature is suitable for storing the semen sample." 3 "The test must be performed within 2 hours of collecting the semen sample." 4 "A spermicide-free plastic sheath must be used to collect the semen sample."

"A cold environment or low temperature is suitable for storing the semen sample."

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include? 1 "Because this is a repeat procedure, you are at the lowest risk for complications." 2 "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." 3 "Because this is your second cesarean birth, you will recover faster." 4 "You will not need preoperative teaching because this is your second cesarean birth."

"Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."

subfertility

prolonged time to conceive. This is usually what infertility is implying.

azoospermia

term that means NO sperm cells produced.

Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the client's blood glucose levels? A) Nifedipine B) Betamethasone C) Magnesium sulfate D) Indomethacin

B) Betamethasone

ICSI

this makes fertilization possible with few or poor-quality sperm by introducing sperm beneath zona pellucida directly into egg. - can be genotyped beforehand. - good option for sperm that lacks motility or lacks enzymes

transrectal ultrasound

this may be used to examine ejaculatory ducts, vesicles, and obstructions.

scrotal ultrasound

this may be used to examine the testes for varocele, spermatic cord abnormailites

bromocriptine

this med may be used to treat anovulation associated with hyperprolactinemia

late PPH

blood loss that occurs more than 24 hours after birth but less than 6 weeks after the birth

A postpartal woman is developing a thrombophlebitis in her right leg. Which assessment should the nurse no longer use to assess for thrombophlebitis?

"It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness." Explanation: After a vaginal birth, the client should be encouraged to void every 4 to 6 hours. As a result of anesthesia and trauma, the client may be unable to sense the filling bladder. It is premature to catheterize the client without allowing her to attempt to void first. There is no need to contact the care provider at this time as the client is demonstrating common adaptations in the early postpartum period. Allowing the client's bladder to fill for another 2 to 3 hours might cause overdistention.

The nurse is educating a patient to palpate the cervix to assess changes that indicate ovulation. Which statement by the woman indicates the need for further teaching? 1 "The cervical os becomes slightly dilated during ovulation." 2 "The cervical mucus is watery and clear during ovulation." 3 "The cervix softens and rises in the vagina during ovulation." 4 "The cervical mucus is copious and thick during ovulation."

"The cervical mucus is watery and clear during ovulation."

The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment? 1 "You might be at risk for preterm labor." 2 "Your baby might have spina bifida." 3 "You may be at risk of having a miscarriage." 4 "Your baby might have delayed tooth eruption."

"You might be at risk for preterm labor."

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." The nurse's most appropriate response is: 1 "This probably means you're pregnant." 2 "Don't worry; it's probably nothing." 3 "Have you been sick this month?" 4 "You probably didn't ovulate during this cycle."

"You probably didn't ovulate during this cycle."

Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. Which factors are possible causes for female infertility? (Select all that apply.)

- Congenital or developmental - Hormonal or ovulatory - Tubal or peritoneal - Uterine Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors. Although the diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress, these are not considered factors associated with infertility. Feelings connected with infertility are many and complex. Resolve is an organization that provides support, advocacy, and education for both clients and health care providers.

Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are accurate? (Select all that apply.)

- Donor eggs are fertilized with the male partners sperm. - Donors are under 35 years of age. - Recipient undergoes hormonal stimulation. Oocyte donation is usually provided by healthy women under the age of 35 years, who are recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are fertilized in a laboratory with the male partners sperm. The woman undergoes hormonal stimulation to allow the development of the uterine lining. Embryos are then transferred. A donor that is inseminated with the male partners semen or receives the fertilized ovum and then carries it to gestation is known as a surrogate mother.

Which procedure falls into the category of micromanipulation techniques of the follicle? (Select all that apply.)

- Intracytoplasmic sperm injection (ISCI) - Assisted hatching ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by introducing sperm beneath the zone pellucid into the egg. Another micromanipulation technique is assisted hatching. An infrared laser breaks through the thick or tough zone pellucid, enabling the blastocyst to hatch.

A probable cause for increasing infertility is the societal delay in pregnancy until later in life. What are the natural reasons for the decrease in female fertility? (Select all that apply.)

- Ovulation dysfunction - Organ damage from toxins - Endometriosis - Tubal infections All of these factors may result in a cumulative effect, decreasing fertility in women. Male infertility is more often caused by unfavorable sperm production attributable to endocrine dysfunction or cumulative metabolic disease.

embryo donation

this occurs when couples decide they don't want their frozen embryos from IVF and release for adoption to infertile couples.

a,c,d,e

. Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply): a. Rupture of membranes at or near term. b. Convenience of the woman or her physician. c. Chorioamnionitis (inflammation of the amniotic sac). d. Post-term pregnancy. e. Fetal death.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? 1 Incomplete uterine relaxation 2 Maternal fatigue and exhaustion 3 Maternal sedation with narcotics 4 Administration of tocolytic drugs

1 A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow. Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order? 1 Intravenous (I.V.) propranolol (Inderal) 2 1 g I.V. calcium gluconate 3 Oral dose of 20 mg of nifedipine (Adalat) 4 500 mg of I.V. calcium chloride for 30 minutes

1 Terbutaline (Brethine) is a beta-adrenergic agonist that is used as a tocolytic to reduce uterine contractions (UCs) in preterm labor. The patient has a heart rate of 135 beats/min, which implies that the patient has intolerance to the drug and has tachycardia. Therefore the patient should be administered a beta-adrenergic blocker, such as propranolol (Inderal), to reverse the adverse effects of terbutaline (Brethine). Administering calcium gluconate, nifedipine (Adalat), and calcium chloride does not help to reduce the adverse effects of terbutaline (Brethine) in the patient. Rather, 1 g of calcium gluconate and 500 mg of calcium chloride are administered in case of magnesium sulfate toxicity. Nifedipine (Adalat) is a calcium channel blocker, which should not be given after terbutaline (Brethine) because it affects the patient's heart rate and blood pressure.

The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion? 1 Blood pressure of 80/60 mm Hg 2 Short episode of hyperglycemia 3 Irregular episodes of dysrhythmias 4 Heart rate of less than 120 beats/min

1 Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the patient develops tachycardia greater than 130 beats/min, then the treatment should be stopped.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse is to: 1 assess the fetal heart rate (FHR) pattern. 2 perform a vaginal examination. 3 inspect the characteristics of the fluid. 4 assess maternal temperature.

1 The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). Performing a vaginal examination, inspecting fluid characteristics, and assessing maternal temperature should be done after the FHR and pattern are assessed.

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? 1 Suggesting that the patient lie on her side 2 Infusing Ringer's lactate solution intravenously 3 Increasing the terbutaline (Brethine) concentration 4 Encouraging drinking a full glass of water periodically

1 The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? 1 Placing the woman in the knee-chest position. 2 Covering the cord in a sterile towel saturated with warm normal saline. 3 Preparing the woman for a cesarean birth. 4 Starting oxygen by face mask.

1 The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although preparing the woman for a cesarean birth is an appropriate intervention, relieving pressure on the cord is the nursing priority. If the cervix is fully dilated, the nurse should prepare for immediate vaginal birth. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer O2 by facial mask at 8 to 10 L/min until birth is complete. This intervention should be initiated after pressure is relieved on the cord.

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy? 1 Suggest that the patient avoids smoking and consuming alcohol. 2 Suggest that the patient increases physical activity to prevent risk. 3 Administer progesterone (Prometrium) suppositories to the patient. 4 Administer a 17-alpha hydroxyprogesterone injection to the patient.

1 To prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the patient get proper rest and care at home. The nurse should not suggest that the patient increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation.

A client delivered 90 minutes ago. She is alert and physically active in bed. She states that she needs to go to the bathroom. What is the nurse's most appropriate response? 1. "I'll walk you to the bathroom and stay with you." 2. "I'll get a bedpan for you." 3. "It's important that you wipe yourself from front to back after urinating." 4. "Wipe the stitches back and forth to increase circulation."

1. Clients are at risk for orthostatic hypotension, especially right after delivery. The nurse should stay with the client the first time she ambulates after delivery to promote safety. Early ambulation prevents circulatory stasis in the lower extremities and should be encouraged. The perineum should be patted (not wiped) dry from front to back to avoid trauma, discomfort, and contamination with bacteria from the anal region. It is unnecessary to use a bedpan.

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe? Select all that apply. 1 Antibiotics 2 Glucocorticoids 3 Synthetic oxytocin 4 Magnesium sulfate 5 Progesterone supplementations

1, 2 The onset of labor during 34 weeks' gestation indicates that the patient has preterm labor. In such a condition, antibiotics and glucocorticoids should be prescribed and administered to the patient. Antibiotics are prescribed to prevent neonatal group B streptococcal infection. Glucocorticoids are prescribed to reduce the neonatal morbidity and mortality. Synthetic oxytocin is administered in patients to induce labor. Therefore synthetic oxytocin will not be prescribed to the patient because of the onset of labor. Magnesium sulfate is administered when the labor is induced before 32 weeks' gestation. Progesterone supplementation is administered before the onset of labor to prevent preterm birth.

The home-care nurse is caring for a postpartal client and suspects the development of postpartum psychosis. Which client findings support the nurse's judgment? SELECT ALL THAT APPLY 1. Has a history of a bipolar (manic-depressive) disorder 2. Reports voices telling her the baby is evil and must die 3. Can't remember details of delivery or when the infant fed last 4. Is tearful without an identifiable reason 5. Is calm and remains seated during the home visit

1, 2, 3. Postpartum psychosis usually becomes evident within three months of delivery. Delusions and hallucinations are common. The risk for suicide or infanticide is increased by the psychotic woman's distorted thoughts about herself or the baby. The psychotic woman would typically display agitation, hyperactivity, and confusion. Adjustment reaction with depressed mood, commonly known as maternal or baby blues occurs in 50-70% of women and is characterized by feelings of fatigue, anxiety, or being overwhelmed by the new maternal role. A key feature is episodic tearfulness without reason that typically occurs within a few days of birth and resolves spontaneously about the 10th postpartal day.

The nurse would assess for which common causative factor in a client who shows signs of retarded uterine involution? SELECT ALL THAT APPLY 1. The use of general anesthesia 2. Overdistended urinary bladder 3. Mother is a primigravida 4. Uterine infection 5. Prolonged labor

1, 2, 4, 5. Among the factors contributing to uterine subinvolution are prolonged labor (frequent contractions), general anesthesia (muscle relaxant), over distended urinary bladder and uterine infection, among others. Being a primigravida is not necessarily associated with subinvolution.

Which intervention should be included when caring for a client with a midline episiotomy with a third-degree laceration? SELECT ALL THAT APPLY 1. Increase fiber in diet. 2. Administer bisacodyl (Dulcolax) suppository. 3. Increase fluid intake. 4. Administer an oral stool softener. 5. Administer an enema.

1, 3, 4. A third- or fourth-degree perineal laceration involves the rectal sphincter, therefore suppositories, enemas, and rectal exams are contraindicated until the rectum heals. Increased fiber and fluids or use of stool softeners are appropriate to promote bowel elimination in all postpartum clients.

The nurse should monitor which postpartum clients who are at high risk for thrombophlebitis? SELECT ALL THAT APPLY 1. A client who had a cesarean delivery 2. A client of normal pre-pregnant weight 3. A client who has five children 4. A client who smokes cigarettes 5. A client who kept active during pregnancy

1, 3, 4. The postpartal woman is prone to develop superficial thrombophlebitis from increased clotting factors, increased number and adhesiveness of platelets during the postpartal period. Numerous factors place clients at risk. Among the most common are cesarean deliveries, lack of mobility, obesity, cigarette smoking, previous history, trauma such as leg stirrups during birth, varicosities, diabetic mothers, multiparas, and anemia.

This is the first postoperative day for a client who had a cesarean delivery. The client asks the nurse why she has to get up and walk when it hurts her incision so much. What would the nurse include in a response? 1. Walking decreases the risk of blood clots after surgery. 2. Walking encourages deep breaths to blow off the anesthetic from surgery. 3. Early ambulation is important to stimulate milk production. 4. Walking will decrease the occurrence of afterpains.

1. Clients who have had a cesarean delivery are at risk for complications of surgery, including thrombophlebitis. Early ambulation can significantly decrease the risk of blood clots and other postoperative complications.

Which laboratory finding should the nurse assess further on a client 24 hours after delivery? 1. Hemoglobin 7.2 g/dL 2. WBC count 20,000/mm^3 3. Trace to 1+ proteinuria 4. Hematocrit 35%

1. A client with a hemoglobin of 7.2 g/dL would most likely have significant signs and symptoms of anemia, and this could be life-threatening. It would be important to determine if the client had a large estimated blood loss during delivery or if she is currently bleeding excessively. The hematocrit is within normal limits, and mild proteinuria or leukocytosis up to 30,000/mm^3 are common in early postpartum.

Which assessment should alert the nurse to withhold the scheduled dose of methylergonovine maleate (Methergine) for a postpartum client and notify the health care provider? 1. Blood Pressure 142/86 2. Apical Pulse 56 3. Blood type O positive 4. Mother is planning to breastfeed

1. A potential side effect of Methergine is hypertension. If a client's blood pressure is elevated, the nurse should withhold the scheduled dose and notify the physician. An apical heart rate of 56 is within normal limits postpartum. Blood type and Rh factor are not related to the use of Methergine. The chosen method of feeding is not impacted by the use of Methergine.

A new mother complains of "afterpains." The nurse's first action should be to do which of the following? 1. Administer an analgesic. 2. Advise her to stop breastfeeding until the pain stops. 3. Encourage her to empty her bladder. 4. Assess her vital signs.

1. Afterpains are anticipated in the postpartum client and are effectively treated with analgesics. It is unnecessary to stop breastfeeding, empty the bladder, or assess vital signs.

Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause. A. Ovarian B. Tubal or peritoneal factors C. Uterine D. Vaginal-cervical factors E. Other factors 1. Endometrial or myometrial tumors 2. Anorexia 3. Isoimmunization 4. Thyroid dysfunction or obesity 5. Endometriosis

1. C (Endometrial or myometrial tumors= Uterine) 2. A (Anorexia= Ovarian) 3. D (Isoimmunization= Vaginal-cervical factors) 4. E (Thyroid dysfunction or obesity= Other factors) 5. B (Endometriosis= Tubal or peritoneal factors) Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

338. The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? 1. Changes in vital signs 2. Signs of heavy bruising 3. Complaints of intense pain 4. Complaints of a tearing sensation

1. Changes in vital signs Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma. Option 2 (heavy bruising) may be seen, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues.

hysterosalpingography

this procedure involves introducing dye into the uterus to see if it travels through tubes. - patency of fallopian tubes, can open a blocked tube - 2-5 days before menstruation

The nurse interprets that which factor in a client's history places the woman at greatest risk for postpartum endometritis? 1. Cesarean delivery after 24 hours of labor and failure to progress 2. Use of external fetal monitoring during labor 3. Ruptured membranes for four hours prior to delivery 4. Spontaneous vaginal delivery after eight hours of labor

1. Factors contributing to postpartum endometritis include the introduction of pathogens with invasive procedures, prolonged labor, and prolonged rupture of membranes. The risk of endometritis is greater after a cesarean delivery, especially after a long labor and prolonged rupture of membranes. The other options are neither invasive nor do they increase the client's risk for infection.

After delivery of a large-for-gestational-age infant the nurse notes bright red blood continuously trickling from the client's vagina. Her fundus is firm and midline. The nurse suspects which of the following as the most likely cause of bleeding? 1. Lacerations 2. Hematoma 3. Uterine atony 4. Retained fragments of conception

1. Suspect lacerations if the client is bleeding and the fundus is firm. If the cause were uterine atony, the fundus would not be firm. When there are fragments of the placenta or the membranes, the uterus will not contract effectively.

A client has a temperature of 100.2F four hours after delivery. What is the appropriate action for the nurse to take? 1. Encourage increased fluid intake. 2. Do nothing since this is an expected finding at this time. 3. Check the physician's orders for an antibiotic to treat the client's infection. 4. Medicate the client for pain.

1. Temperature elevation immediately after delivery is often caused by dehydration during labor. Increasing the client's fluid intake will usually decrease the temperature to within normal limits. There is no indication for analgesia or antibiotics at this time. If the fever persists beyond 24 hours or the client has clinical signs of infection, then further investigation and perhaps treatment is warranted.

The client is a 36-year-old woman, gravid 6 and para 6, who delivered a 7 pound, 14 ounce baby girl at term after an eight-hour labor. The client's vital signs are stable, and her lochia is bright red, heavy, and contains various clots; some are half dollar size. The nurse would consider the client to be at high risk for uterine atony for which reason? 1. Grandmultiparity 2. Large for gestational age baby 3. Labor of long duration 4. Advancing maternal age

1. Women that are parity of six or above (grandmultiparity) are at the greatest risk of uterine atony because of repeated distention of uterine musculature during pregnancy. Labor leads to muscle stretching, diminished tone, and muscle relaxation. The client's age is not a factor in uterine atony, the length of labor is not considered to be prolonged or precipitous, and the size of the baby is considered appropriate for gestational age, and is not considered to be macrosomic.

While assessing a patient, the nurse finds that the patient's shortest and longest amount of time between menstrual periods is 25 and 28 days, respectively. The nurse teaches the patient the method to calculate the fertile period. The nurse then asks the patient which day carries the maximum chances of conception. Which response by the patient indicates effective learning? 1 2nd day 2 6th day 3 10th day 4 19th day

10th day

Which technique is least effective for the woman with persistent occipitoposterior position? 1 Squat 2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees

2 Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipitoanterior. Rocking the pelvis encourages rotation from occipitoposterior to occipitoanterior.

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? 1 Calcium gluconate to the pregnant patient 2 Magnesium sulfate to the pregnant patient 3 Glucocorticoid drugs to the pregnant patient 4 Antibiotic medications to the pregnant patient

2 Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk as it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore administering glucocorticoids to the pregnant patient would help to prevent the risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

The nurse admits a pregnant woman into the Labor and Delivery room with PPROM at 28 weeks gestation not in labor. The nurse understands that which of the following medications will be administered as a PRIORITY? Antibiotics Magnesium Sulfate loading dose Betamethasone (Celestone) 12mg IM nifedipine (Procardia)

Betamethasone (Celestone) 12mg IM

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? 1 Infuse nifedipine (Adalat) along with terbutaline (Brethine). 2 Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. 3 Provide a glass full of orange juice before administering nifedipine (Adalat). 4 Provide the patient with calcium supplements before administering nifedipine (Adalat).

2 Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required.

The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the: 1 Heart rate of the fetus 2 Blood pressure of the patient 3 Respiration rate of the patient 4 Blood sugar levels in the patient

2 The nurse should monitor the blood pressure of the patient after administering nifedipine (Adalat). It is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. Nifedipine (Adalat) does not alter fetal heart rate or respiration rate and blood sugar levels of the patient. Heart rate of the fetus is monitored when other classes of tocolytics are administered. Respiration rate is monitored when oxytocin (Pitocin) is administered to the patient. Blood sugar levels are monitored in patients with diabetes who are receiving glucocorticoid therapy.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? 1 Buccal oxytocin (Pitocin) 2 Terbutaline sulfate (Brethine) 3 Calcium gluconate (Calgonate) 4 Magnesium sulfate (Magnesium sulfate)

2 The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.

The perinatal nurse knows that an early pregnancy loss occurs before _____ weeks, and a late pregnancy loss is one that occurs between 12 and ________ weeks.

2, 20

The nurse is preparing to administer dexamethasone (Decadron) to a pregnant patient. Which nursing intervention should the nurse perform for safe administration of the drug? Select all that apply. 1 Monitor blood pressure of the patient. 2 Inform the patient that it will be painful. 3 Assess blood glucose levels in the patient. 4 Administer the drug by intramuscular injection. 5 Administer the oral form if patient refuses injection.

2, 3, 4 Dexamethasone (Decadron) is a glucocorticoid used to promote fetal lung maturation. The drug can also increase blood sugar levels in the patient. Therefore the nurse should monitor the blood sugar levels to assess the need for an increased insulin dose. The drug should be given by intramuscular injection in the ventral gluteal or vastus lateralis muscle for better absorption. The patient should be informed that the injection will be painful, because this type of truthfulness promotes patient cooperation. The drug does not affect blood pressure levels, and it does not need to be monitored. The oral form is not beneficial in promoting fetal lung maturation and should not be administered.

A pregnant patient is suspected to have preterm labor. The nurse is preparing to collect the vaginal discharge for conducting the fetal fibronectin test. What interventions are necessary before collecting the sample to ensure accuracy of the test? Select all that apply. 1 Instruct the patient to drink 2 glasses of water. 2 Check for the presence of vaginal bleeding in the patient. 3 Ask about history of sexual intercourse in the past 24 hours. 4 Ask the patient to empty the bladder before collecting the sample. 5 Assess the patient to see if the amniotic membranes have ruptured.

2, 3, 5 The fetal fibronectin test is performed to determine whether the patient has preterm labor. Amniotic fluid can affect the accuracy of the test. Therefore the nurse should check to see if the amniotic membranes are intact before collecting the vaginal secretions. Vaginal bleeding can also result in negative results and should be identified before collecting the sample. The nurse should also check whether the patient has had sexual intercourse in the past 24 hours, because it may reduce the accuracy of the results and cause a false-negative result. Drinking water and emptying the bladder have no effect on the test results. Therefore these interventions are not necessary before conducting the test.

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. 1 Fluid intake 2 Respiratory status 3 Body temperature 4 Level of consciousness 5 Deep tendon reflexes

2, 4, 5 Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

The client is interested in using female condoms and wants to know if there are any disadvantages. What is the nurse's best response? 1. "The female condom provides good protection against preg- nancy but not against sexually transmitted infections (STIs)." 2. "The female condom may be difficult to insert and may be uncomfortable to both partners." 3. "The female condom is very effective; let me arrange to get you a prescription." 4. "The female condom is made of latex and should not be used by those with latex allergies."

2. "The female condom may be difficult to insert and may be uncomfortable to both partners." Rationale: Made of polyurethane, the female condom does not require a prescription but can be difficult to insert, and can cause discomfort. It is effective against both STIs and pregnancy.

If the nurse suspects a uterine infection in the postpartum client, the nurse should make which priority assessment? 1. Pulse and blood pressure 2. Odor of the lochia 3. Episiotomy site 4. The abdomen for distention

2. An abnormal odor of the lochia indicates infection in the uterus. The vital signs may be affected by an infection, but that is not definitive enough to suspect a uterine infection. A distended abdomen usually indicates a problem with gas, perhaps a paralytic ileus. Inspection of the episiotomy site would not provide information regarding a uterine infection.

A new mother with mastitis is concerned about breastfeeding while she has an active infection. How should the nurse respond to the client's concern? 1. The infant is protected from infection by immunoglobulins in the breast milk. 2. The infant is not susceptible to the organisms that cause mastitis. 3. The organisms that cause mastitis are not passed in the milk. 4. The organisms will be inactivated by gastric acid.

3. The organisms are localized in breast tissue and are not excreted in the breast milk. The other answers are factually incorrect.

330. The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss? 1. A temperature of 100.4 ° F 2. An increase in the pulse rate from 88 to 102 beats/ minute 3. A blood pressure change from 130/ 88 to 124/ 80 mm Hg 4. An increase in the respiratory rate from 18 to 22 breaths/ minute

2. An increase in the pulse rate from 88 to 102 beats/ minute During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. A slight increase in temperature is normal. The blood pressure decreases as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage. The respiratory rate is slightly increased from normal.

The infant of a breastfeeding client was transferred to the neonatal intensive care unit because of respiratory distress. The nurse interprets that follow-up teaching has been effective when the client states which reason to pump the breasts? 1. Prevent breast engorgement 2. Stimulate the milk supply 3. Remove the infected milk 4. Keep the uterus contracted

2. Breast-milk production is based on supply and demand. The more the breasts are stimulated to produce milk, by nursing the baby or pumping the breasts, the more milk will be produced.

337. A postpartum client is diagnosed with cystitis. The nurse should plan for which priority nursing action in the care of the client? 1. Providing sitz baths 2. Encouraging fluid intake 3. Placing ice on the perineum 4. Monitoring hemoglobin and hematocrit levels

2. Encouraging fluid intake Cystitis is an infection of the bladder. The client should consume 3000 mL of fluids per day if not contraindicated. Sitz baths and ice would be appropriate interventions for perineal discomfort. Hemoglobin and hematocrit levels would be monitored with hemorrhage.

A client who had a vaginal delivery had an episiotomy prior to birth. The maternal newborn nurse would evaluate the client's perineum following delivery using which method? 1. REDA - redness, edema, discharge, approximation 2. REEDA - redness, edema, ecchymosis, discharge, approximation 3. REAA - redness, edema, approximation, assessment 4. RED - redness, edema, discoloration

2. Nursing assessment of the perineum includes the following observations, which are abbreviated as REEDA: redness, edema, ecchymosis, discharge, and approximation.

A client's vital signs following delivery are: (Day 1) BP 116/72, T 98.6, P 68; (Day 2) BP 114/80, T 100.6, P 76; (Day 3) BP 114/80, T 101.6, P 80. The nurse should suspect which of the following about the client's status? 1. Is dehydrated 2. May have an infection 3. Has normal vital signs 4. Is going into shock

2. The vital signs are not normal. An elevation in body temperature greater than 100.4F after the first 24 hours postpartum could indicate maternal infection. An elevated temperature within the first 24 hours is usually related to dehydration, although the possibility of infection still exists. Rising pulse and falling blood pressure rather than rising temperature is an indicator of hypovolmeic shock.

While assessing the incision of a client two days after cesarean delivery, the nurse notes the skin edges around the incision are red, edematous, and tender to the touch. A scant amount of purulent drainage is noted. What is the most appropriate initial action by the nurse? 1. Cleanse the wound with providone iodine (Betadine). 2. Notify the physician. 3. Document this expected response. 4. Observe the incision closely for the next 24 to 48 hours.

2. This client has signs of an incisional infection. The physician needs to be notified first so that treatment can be started as soon as possible. Betadine has not yet been ordered. Documentation should follow reporting. Continued observation would be an ongoing intervention.

The nurse is assessing a client's fundus and finds it firm, two centimeters above the umbilicus, and displaced to the right. What is the most appropriate intervention at this time? 1. Massage the fundus until firm. 2. Have the client void and reassess the fundus 3. Notify the physician 4. Start a pad count

2. This client's fundus is already firm, so it is not appropriate to massage the fundus. It is also higher in the abdomen than expected, and it is displaced to the right, which is probably caused by a distended bladder. Having the client void may return the uterus to the expected position; palpating the fundus after voiding will confirm this finding. A pad count would be appropriate if bleeding is increasing; no information given implies that this action is indicated.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? 1 Internal version 2 Vaginal delivery 3 Cesarean section 4 External cephalic version

3 Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has: 1 A stillbirth. 2 Placental abruption. 3 Prolonged pregnancy. 4 Elevated uterine contractions (UCs)

3 Meconium is the stool of the neonate, which is usually observed after the birth. When meconium is observed in amniotic fluid, it signifies that the patient has prolonged pregnancy. A stillbirth signifies the death of the fetus, which is not related to the presence of meconium in the amniotic fluid. Placental abruption causes early birth, whereas lowered estrogen levels cause prolonged birth. Elevated UCs is a sign of labor, which does not cause meconium in the amniotic fluid.

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with: 1 Shoulder dystocia. 2 Umbilical cord prolapse. 3 Aspiration pneumonia. 4 Brachial plexus injury

3 Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia.

The nurse is caring for a 32-year-old pregnant patient who had an onset of labor during 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the patient as to the etiology of the newborn's LBW? 1 Preterm labor 2 Maternal age 3 Diabetic condition of the patient 4 Intrauterine growth restriction (IUGR

3 The LBW of the newborn is the result of IUGR, a condition of inadequate fetal growth. It may be caused by various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the LBW. The onset of labor is at 40 weeks' gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for the LBW of the child. Infants born to patients with diabetes would have a high birth weight, not a low one.

Upon assessment of a pregnant patient, the nurse concludes that the patient is less likely to have a preterm delivery. Which patient clinical finding led the nurse to conclude this? 1 Previous cesarean birth 2 Preexisting diabetes mellitus 3 Cervical length of more than 30 mm 4 Symptoms of chronic hypertension

3 The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself in terms of effacement and dilation. Patients having cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus may not increase the risk of preterm labor.

The nurse observes that a pregnant patient at 36 weeks' gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation? 1 Monitor the blood glucose levels in the patient on a regular basis. 2 Ensure that the propranolol (Inderal) is available for administration. 3 Prepare to administer intravenous magnesium sulfate (Epsom salt). 4 Assess fetal ductus arteriosus and neonatal pulmonary hypertension.

3 This patient at 36 weeks' gestation is considered preterm based on a cervical dilation of 5 cm. With membranes intact, the therapeutic plan of care would include stopping the labor process. Magnesium sulfate (Epsom salt) may be administered to the patient to prevent cerebral palsy of the fetus that may occur due to preterm birth. Therefore the nurse has to prepare for the administration of magnesium sulfate intravenously to the patient. Assessment of blood glucose levels is not useful to prevent preterm birth. Propranolol (Inderal) is used to reverse the adverse effects of terbutaline (Brethine), and it is not useful to prevent preterm birth. Assessment of fetal ductus arteriosus and neonatal pulmonary hypertension is useful when indomethacin (Indocin) is administered to the patient but not before administering magnesium sulfate (Epsom salt) to the patient.

The home health nurse is making a home visit to a postpartal client. The nurse would document and report which of the following as a symptom of infection? 1. Lochia that is pink tinged 2. Apical pulse of 68 3. Generalized abdominal tenderness 4. Oral temperature of 99.2F

3. The signs of a postpartal infection would include a temperature of greater than 100.4F on two successive days after the first 24 postpartal hours, tachycardia, foul-smelling lochia, and pain and tenderness of the abdomen. The pinkish lochia is normal, and the temperature might indicate a cold or breast milk coming in. Bradycardia would be an unrelated finding.

The nurse is caring for a client who has decided not to breastfeed. What should the nurse include in client teaching to promote lactation suppression? SELECT ALL THAT APPLY 1. Applying warm compresses 2. Pumping the breasts 3. Applying ice bags 4. Using medication to suppress lactation 5. Binding the breasts, either with a snug bra or binder

3, 5. Binding the breasts, either with a snug bra or binder, and applying cold to the breasts will help suppress lactation. Milk supply is stimulated by expressing milk and applying heat to the breasts. Medications to suppress lactation are not recommended.

The nurse is preparing to instruct a new mother on resuming sexual intercourse postpartum. The nurse should include which of the following in the teaching plan? SELECT ALL THAT APPLY 1. Pregnancy is not possible prior to the first menses postpartum. 2. An IUD is an appropriate method of birth control in the early postpartum period. 3. Wait until the episiotomy has healed and the lochia has stopped before resuming intercourse. 4. Refrain from intercourse until the first menstrual period after delivery is completed. 5. A water-soluble lubricant may be used if necessary.

3, 5. Having sexual intercourse before the episiotomy is healed or the lochia has stopped increases the risk of infection. Water-soluble lubricants can be used, if necessary. An IUD is contraindicated during the early postpartum period.

Which intervention, if medically prescribed and then carried out by the nurse, would have the most direct effect on reducing postpartum hemorrhage? 1. Continuous fundal massage to decrease bleeding and contract the uterus 2. Trendelenburg position to facilitate cardiac function 3. Bladder catheterization to maintain uterine contraction 4. Administration of a tocolytic drug

3. A full bladder may cause uterine atony and contribute to bleeding. If a client has hemorrhaged, a Foley catheter may also be needed to allow accurate measurement of urine output, which is an indicator for kidney function. Overly aggressive stimulation of the fundus may cause decreased uterine tone; this is detrimental because overstimulation of the uterine muscle fibers can contribute to uterine atony. Avoid the Trendelenburg position because it has been reported to interfere with cardiac and respiratory function by increasing pressure on chemoreceptors and decreasing the area for lung expansion. A tocolytic agent relaxes the uterus; in this case, an oxytocic drug to contract the uterus would be indicated.

On the client's third postpartum day, the nurse enters the room and finds the client crying. The client states that she does not know why she is crying and she cannot stop. What is the most appropriate reply by the nurse? 1. "There is no need to cry, you have a healthy baby." 2. "Are you dissatisfied with your care? I will see that any issues are addressed." 3. "Many new mothers have shared with us their same confusion of feelings, would you like to talk about them?" 4. "This happens to lots of mothers, and be reassured that it will pass with time."

3. Creating an environment where a client and her family can discuss emotional concerns is essential. Sharing time with the new mother to discuss thoughts and feelings is important to clients. Responding with patronizing answers does nothing to assist the mother to talk about her thoughts and feelings and may increase her sense of isolation and feelings of inadequacy and despair.

333. The postpartum nurse is assessing a client who delivered a healthy infant by cesarean section for signs and symptoms of superficial venous thrombosis. Which sign would the nurse note if superficial venous thrombosis were present? 1. Paleness of the calf area 2. Coolness of the calf area 3. Enlarged, hardened veins 4. Palpable dorsalis pedis pulses

3. Enlarged, hardened veins Thrombosis of superficial veins usually is accompanied by signs and symptoms of inflammation, including swelling, redness, tenderness, and warmth of the involved extremity. It also may be possible to palpate the enlarged, hard vein. Clients sometimes experience pain when they walk. Palpable dorsalis pedis pulses is a normal finding.

Which sign of thrombophlebitis should the nurse instruct the postpartum client to look for when at home after discharge from the hospital? 1. Muscle soreness in her legs after exercise 2. Enlarging varicose veins in her legs 3. Localized posterior leg tenderness, heat, and swelling 4. New areas of ecchymosis

3. These are classic signs of thrombophlebitis that appear at the site of inflammation; the other signs listed are not.

The nurse is reviewing infection control policies with a nursing student. The nurse knows that the teaching has been effective when the student states, "The best way to prevent postpartum infection starts 1. in the recovery room with strict use of sterile technique when palpating the fundus." 2. on the postpartum unit by teaching the client the principles of perineal care." 3. by limiting the number of sterile vaginal exams during labor." 4. when the client goes home by avoiding tub baths until the lochia stops."

3. Even when perfect sterile technique is used when doing a vaginal exam, organisms present on the perineum are transported into the vagina and close to the cervix. By limiting the number of vaginal exams, the risk is decreased. The option discussing technique is incorrect because clean technique, not sterile technique, is used when palpating the fundus. Teaching the client the principles of perineal care and avoiding tub baths until the lochia stops are correct answers, but not the earliest intervention a nurse could perform.

340. On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? 1. Elevate the client's legs. 2. Document the findings. 3. Massage the fundus until it is firm. 4. Push on the uterus to assist in expressing clots.

3. Massage the fundus until it is firm. If the uterus is not contracted firmly (i.e., it is soft and boggy), the initial intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. Elevating the client's legs would not assist in managing uterine atony. Documenting the findings is an appropriate action but is not the initial action. Pushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage.

A woman who delivered three weeks ago calls the postpartum unit with breastfeeding questions. She wants to know if she can continue to breastfeed while she has the flu. She states that she feels achy all over and has chills and a fever of 103F. What other question is important for the nurse to ask? 1. "Have you been sleeping well?" 2. "Are you still experiencing vaginal flow?" 3. "Do you have any reddened areas or tenderness on your breasts, or unusual breast discharge?" 4. "Do you have any swelling in your legs or visual disturbances?"

3. Mastitis most frequently occurs at two to four weeks after delivery with initial flu-like symptoms plus breast tenderness and redness. The client may be describing symptoms of a breast infection. Sleep, lochia, and edema with visual disturbances are not associated with breast problems.

335. The nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm, but that bleeding is excessive. Which should be the initial nursing action? 1. Record the findings. 2. Massage the fundus. 3. Notify the health care provider (HCP). 4. Place the client in Trendelenburg's position.

3. Notify the health care provider (HCP). If bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm would not assist in controlling the bleeding. Trendelenburg's position should be avoided because it may interfere with cardiac and respiratory function. Although the nurse would record the findings, the initial nursing action would be to notify the HCP.

339. The nurse is developing a plan of care for a postpartum client with a small vulvar hematoma. The nurse should include which specific action during the first 12 hours after delivery? 1. Assess vital signs every 4 hours. 2. Measure fundal height every 4 hours. 3. Prepare an ice pack for application to the area. 4. Inform the health care provider of assessment findings.

3. Prepare an ice pack for application to the area. A hematoma is a localized collection of blood into the tissues of the reproductive sac after delivery. Vulvar hematoma is the most common. Application of ice reduces swelling caused by hematoma formation in the vulvar area. Options 1, 2, and 4 are not interventions that are specific to the plan of care for a client with a small vulvar hematoma.

It is most important for the nurse to have which drug readily available when the client is being treated with heparin therapy for thrombophlebitis? 1. Calcium gluconate 2. Vitamin K 3. Protamine sulfate 4. Ferrous sulfate

3. Protamine sulfate is the drug used to combat bleeding problems related to heparin overdose. One option raises serum calcium levels; another is the antidote for warfarin, and the other option is an iron supplement.

The nurse is assessing a client 24 hours after delivery and finds the fundus to be slightly boggy and two centimeters above the umbilicus. What should be the nurse's priority nursing intervention? 1. Document this expected finding and check lochia. 2. Assess the mother's vital signs. 3. After having the mother void, gently massage the fundus until firm. 4. Notify the physician and document.

3. The fundus should remain firm after delivery to decrease the risk of postpartum hemorrhage and decrease one centimeter below the umbilicus each day. All nursing interventions presented are appropriate, but massaging the fundus until firm is the most important to prevent hemorrhage. Full urinary bladders can interfere with uterine contraction.

331. The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1. Wear a supportive bra. ** 2. Rest during the acute phase. ** 3. Maintain a fluid intake of at least 3000 mL. ** 4. Continue to breast-feed if the breasts are not too sore. *** 5. Take the prescribed antibiotics until the soreness subsides. 6. Avoid decompression of the breasts by breast-feeding or breast pump.

331. 1, 2, 3, 4 Rationale: Mastitis is an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3000 mL/ day (if not contraindicated), and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breast-feeding or breast pump is important to empty the breast and prevent the formation of an abscess.

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation? 1 Administer propranolol (Inderal). 2 Administer intravenous fluids. 3 Administer 1 g calcium gluconate. 4 Inform the primary health care provider (PHP).

4 A heart rate of 140 beats/min and chest pain indicates that the patient is having tachycardia, which is an adverse effect of terbutaline (Brethine). Therefore the nurse should report this to the PHP to obtain further instructions on the treatment. Propranolol (Inderal) is administered to reverse the cardiovascular adverse effects of terbutaline (Brethine). However, it needs to be prescribed by the PHP. Calcium gluconate is administered to reverse the effect of magnesium sulfate. Serum potassium should be monitored in the patient receiving terbutaline therapy; however, it is not a priority intervention. The patient has tachycardia and is not in a state of hypovolemic shock. Therefore intravenous fluids need not be administered to the patient.

The nurse is assisting a pregnant patient who is in labor. The nurse finds that the umbilical cord is protruding out from the vagina. With a gloved hand, the nurse attempts to put the umbilical cord into the vagina. The nurse continues to monitor the fetal heart rate, administers oxygen therapy to the patient, and increases the drip rate of the intravenous (IV) fluid. Which nursing action can lead to fetal and maternal complications? 1 Increasing the drip rate of the IV fluid 2 Monitoring fetal heart rate continuously 3 Administering oxygen therapy to the patient 4 Attempting to place the umbilical cord bac

4 A prolapsed umbilical cord can compromise the fetal perfusion. Therefore the nurse should act quickly to prevent fetal complications. The nurse should not attempt to replace the umbilical cord, as the cord can get compressed by the presenting part of the fetus, which could result in fetal hypoxia and death. Fetal heart rate should be monitored continuously to determine fetal perfusion. Oxygen therapy should be administered to the patient to promote fetal oxygenation. The drip rate of the IV fluid should be increased to promote fetal perfusion.

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? 1 Give the medication by oral route. 2 Assess platelet levels after drug administration. 3 Administer increased doses of insulin with the drug. 4 Follow a strict time interval of 24 hours between two doses

4 Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered.

The nurse is caring for a pregnant patient who has been recommended for an external cephalic version. What would the nurse do as part of the procedure? 1 Place the patient in a side position. 2 Administer oxytocin (Pitocin) intravenously. 3 Place a pillow under the maternal abdomen. 4 Administer terbutaline (Brethine) intravenously.

4 External cephalic version is the changing of the position of the fetus by the primary health care provider (PHP). As part of the procedure, the PHP advises the nurse to administer terbutaline (Brethine) to soothe the muscle activity. Patients are usually placed in supine position while performing the procedure. Therefore the nurse should not place the patient in a side-lying position. Oxytocin (Pitocin) is contraindicated as it increases the muscle activity, which may again disturb the procedure. A pillow is not encouraged while performing this procedure.

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? 1 A primigravida who is 17 years old 2 A 22-year-old multiparous woman with ruptured membranes 3 A primigravida who has requested no analgesia during her labor 4 A multiparous woman at 39 weeks of gestation who is expecting twins

4 Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

The nurse is preparing to perform a fetal fibronectin test for a pregnant patient. Which intervention should the nurse perform to collect the sample for the test? 1 Take a blood sample from the forearm. 2 Take a sample of the patient's amniotic fluid. 3 Ask the patient to provide a urine sample. 4 Collect the vaginal secretions using a swab.

4 The fetal fibronectin test is conducted to assess whether a patient is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. In order to conduct the test, the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, as they may not contain adequate glycoprotein levels.

The nurse is about to perform a vaginal examination in order to determine cervical dilation of a patient in early labor. The patient informs the nurse that as of her last provider appointment, the baby was in a breech position. This alerts the nurse that she needs to place the patient in a supine position in order to perform the digital examination. Other maternal positions may inadvertently result in: 1 Shoulder dystocia. 2 Version. 3 Increased risk of infection. 4 Membrane rupture.

4 The patient who has a fetal breech malposition should always be examined in the supine position. If the fetus is a breech malpresentation, there is a predisposition that the patient may experience rupture of membranes if a digital examination is performed while she is in the semi-Fowler position. Should the membranes rupture in early labor, the risk for a prolapsed cord increases. A version from breech to vertex position would not occur as a result of a digital examination. Scrupulous hand hygiene and standard precautions should always be performed before the examination to prevent the spread of infection in patients. A shoulder dystocia would occur during the birth, not during a vaginal examination.

Which of the following actions by a lactating client would the nurse support to help the client prevent mastitis? SELECT ALL THAT APPLY 1. Apply vitamin E cream to soften the nipples. 2. Wear a tight, supportive bra. 3. When the client's nipples are sore, offer the infant a bottle. 4. Encourage the client to breastfeed her infant frequently. 5. Teach breastfeeding techniques soon after birth and reinforce as needed.

4, 5. Preventing stasis of the milk and emptying the breast frequently will help prevent mastitis. Vitamin E cream will not help to prevent mastitis. A supportive bra is helpful, but a bra that is tight will not be comfortable. Offering a bottle will reduce the milk supply if it occurs frequently and will not help mastitis.

Because postpartum depression occurs in 3 to 30% of postpartum women, the prenatal nurse assesses clients for risk factors for postpartum depression during the prenatal period. Which clients would the nurse consider to be at risk for postpartum depression? SELECT ALL THAT APPLY 1. A client who is an unmarried primipara with family support 2. A client who has previously had postpartum blues 3. A client who is primipara with documented ambivalence about her pregnancy in the first trimester 4. A client who is a primipara with a history of depression and lack of a supportive relationship 5. A client who is a primipara living alone and was consistently ambivalent about pregnancy

4, 5. Risk factors for postpartum depression include primiparity, ambivalence about maintaining the pregnancy throughout the pregnancy, history of previous depression or bipolar illness, lack of a stable support system, lack of a stable relationship with parents or partner, poor body image, and lack of a supportive relationship with parents, especially her father as a child. Ambivalence regarding pregnancy is a normal response in the first and into the second trimester, but should be resolved by the third trimester. Postpartum blues occurs in approximately 50 to 80% of postpartum women; the blues does not particularly indicate that a woman will develop postpartum depression.

332. The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn. Which client statement would indicate a need for further instruction? 1. "I should breast-feed every 2 to 3 hours." 2. "I should change the breast pads frequently." 3. "I should wash my hands well before breast- feeding." 4. "I should wash my nipples daily with soap and water."

4. "I should wash my nipples daily with soap and water." Mastitis is inflammation of the breast as a result of infection. It generally is caused by an organism that enters through an injured area of the nipples, such as a crack or blister. Measures to prevent the development of mastitis include changing nursing pads when they are wet and avoiding continuous pressure on the breasts. Soap is drying and could lead to cracking of the nipples, and the client should be instructed to avoid using soap on the nipples. The mother is taught about the importance of hand-washing and that she should breast-feed every 2 to 3 hours.

336. The nurse is preparing to care for four assigned clients. Which client is at highest risk for hemorrhage? 1. A primiparous client who delivered 4 hours ago 2. A multiparous client who delivered 6 hours ago 3. A primiparous client who delivered 6 hours ago and had epidural anesthesia 4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction

4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction The causes of postpartum hemorrhage include uterine atony; laceration of the vagina; hematoma development in the cervix, perineum, or labia; and retained placental fragments. Predisposing factors for hemorrhage include a previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention of the uterus from polyhydramnios, multiple gestation, a large neonate, infection, multiparity, dystocia or labor that is prolonged, operative delivery such as a cesarean or forceps delivery, and intrauterine manipulation. The multiparous client who delivered a large fetus after oxytocin induction has more risk factors associated with postpartum hemorrhage than the other clients. In addition, there are no specific data in the client descriptions in options 1, 2, and 3 that present the risk for hemorrhage.

A postpartum client develops a temperature during her postpartum course. Which temperature measurement indicates to the nurse the presence of postpartum infection? 1. 99.0F at 12 hours post delivery that decreases after 18 hours 2. 100.2F at 24 hours post delivery that decreases the second postpartum day 3. 100.4F at 24 hour post delivery that remains until the second postpartum day 4. 100.6F at 48 hours post delivery that continues into the third postpartum day

4. A temperature elevation greater than 100.4F on two postpartum days not including the first 24 hours meets the criteria for infection. This criterion is the most common standard in the United States. It is not abnormal for a postpartum client to run a low-grade fever in the first 24 hours. This can be caused by the body's reaction to labor, dehydration, or a reaction to epidural anesthesia. Postpartum nurses should assess other signs and symptoms of infection in addition to fever and WBCs when evaluating the possibility of infection in mothers who had epidural analgesia.

334. A client in a postpartum unit complains of sudden sharp chest pain and dyspnea. The nurse notes that the client is tachycardic and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should be the initial nursing action? 1. Initiate an intravenous line. 2. Assess the client's blood pressure. 3. Prepare to administer morphine sulfate. 4. Administer oxygen, 8 to 10 L/ minute, by face mask.

4. Administer oxygen, 8 to 10 L/ minute, by face mask. If pulmonary embolism is suspected, oxygen should be administered, 8 to 10 L/ minute, by face mask. Oxygen is used to decrease hypoxia. The client also is kept on bed rest with the head of the bed slightly elevated to reduce dyspnea. Morphine sulfate may be prescribed for the client, but this would not be the initial nursing action. An intravenous line also will be required, and vital signs need to be monitored, but these actions would follow the administration of oxygen.

Which instruction should the nurse include in the discharge teaching plan to assist the postpartum client to recognize early signs of complications? 1. Expect to pass clots, which occasionally can be the size of a golf ball. 2. Report a decrease in the amount of brownish-red lochia. 3. Palpate the fundus daily to make sure it is soft. 4. Notify the health care provider of increased lochia or bright red bleeding.

4. An increase in lochia or a return to bright red bleeding after the lochia has changed to pink indicates a complication. The other statements are false.

A client delivered a 9 pound, 10 ounce infant assisted by forceps. When the nurse performs the second 15-minute assessment, the client reports increasing perineal pain and a lot of pressure. What action should the nurse take? 1. Apply ice to the client's perineum, reassuring the client that this is normal. 2. Call for assistance from another nurse. 3. Assess the fundus for firmness. 4. Check the perineum for a hematoma.

4. Bleeding into the connective tissue beneath the vulvar skin may cause the formation of vulvar hematoma, which develop as a result of injury to tissues with spontaneous as well as operative deliveries (use of forceps). One of the first signs of a hematoma may be complaint of pressure, pain, or an inability to void. An ice pack to the perineum can be used to reduce swelling, but a hematoma is abnormal and should be reported to the physician. The fundus should be assessed, but the client's complaints warrant perineal or vaginal assessment.

Despite the nurse's attempt to massage a boggy fundus, a postpartum client continues to pass several large clots in the presence of bright red lochia. The uterine fundus remains boggy and fundal massage and oxytocin (Pitocin) are not successful. What medication does the nurse expect to be prescribed next? 1. Dinoprostone (Cervidil) 2. Terbutaline sulfate (Brethine) 3. Magnesium sulfate 4. Carboprost (Prostin 15-M or Hemabate)

4. Cervidil is used to ripen the cervix before labor, terbutaline sulfate is a tocolytic, and could cause further muscle relaxation; magnesium sulfate is used to decrease contractions or prevent seizures; and Hemabate is a prostaglandin, used to manage uterine atony. Oxytocin remains the first-line drug, the prostaglandins now are more commonly used as the second-line drug, and Hemabate is the most commonly used uterotonin. As many as 68% of clients respond to a single Hemabate injection, with 86% responding by the second dose.

A client is in the immediate postpartal period after delivery of a 9-pound, 14-ounce baby. The client is a gravid 6, para 5. The nurse notices some new blood stains on the top sheet and discovers the client lying in a pool of blood. The fundus is located above the umbilicus and is boggy. What would be the nurse's priority action? 1. Take the client's blood pressure 2. Have the client empty her bladder 3. Start an IV 4. Massage the uterus

4. Of the options given the only one that immediately affects the bleeding is uterine massage. It might be important to start an IV with oxytocin at a rapid rate, and to allow the client to empty her bladder; however, the first action is to massage the uterus to stop or slow down the blood flow.

The nurse is caring for a woman who gave birth to a daughter yesterday, but greatly desired a son. Today she seems withdrawn, staying in bed and staring at the wall. What is the most appropriate intervention? 1. Monitor this normal response after delivery. 2. Refer the client for a psychiatric consultation. 3. Tell the client she should be thankful her baby is healthy. 4. Encourage the mother to verbalize her disappointment.

4. The client should be encouraged to verbalize her disappointment as the first step in resolving her negative feelings. The other responses are incorrect. This is not a normal response nor is it one that requires a psychiatric referral.

A client's prenatal laboratory findings reveal that she is not immune to rubella. The healthcare provider prescribes rubella vaccine prior to discharge. The nurse concludes that teaching about this medication is effective when the client makes which statement? 1. "I'll need another shot in one month and again in six months." 2. "This shot may cause a fever and make me vomit." 3. "I'll need another shot after each baby I have with Rh-positive blood." 4. "I should not get pregnant for at least three months after the vaccine."

4. The rubella vaccine is a live virus. If a client becomes pregnant within the first three months after administration, her fetus is at risk for congenital anomalies related to the virus. Women who are not rubella immune should be vaccinated postpartum, prior to discharge. Teaching should include an effective method of birth control and the importance of avoiding pregnancy for the next three months.

The perinatal nurse knows that nausea and vomiting are common in pregnancy and usually resolve by ______ weeks gestation. The severe form of this condition is __________________.

6, hyperemesis gravidarum

Before the physician performs an external version, the nurse should expect an order for a: a. Tocolytic drug. b. Contraction stress test (CST). c. Local anesthetic. d. Foley catheter

A (A tocolytic drug will relax the uterus before and during version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. The bladder should be emptied; however, catheterization is not necessary.)

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. Stimulate fetal surfactant production. b. Reduce maternal and fetal tachycardia associated with ritodrine administration. c. Suppress uterine contractions. d. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

A (Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.)

With regard to the process of augmentation of labor, the nurse should be aware that it: a. Is part of the active management of labor that is instituted when the labor process is unsatisfactory. b. Relies on more invasive methods when oxytocin and amniotomy have failed. c. Is a modern management term to cover up the negative connotations of forceps-assisted birth. d. Uses vacuum cups.

A (Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods. Forceps-assisted births and vacuum-assisted births are appropriately used at the end of labor and are not part of augmentation.)

Which patient status is an acceptable indication for serial oxytocin induction of labor? a. Past 42 weeks' gestation b. Multiple fetuses c. Polyhydramnios d. History of long labors

A (Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus and make induction of labor high risk. Polyhydramnios overdistends the uterus, again making induction of labor high risk. History of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.)

The nurse is caring for a pregnant client who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the client. Which client condition leads the nurse to such a conclusion? A. Blood pressure of 80/60 mmHg. B. Short episode of hyperglycemia. C. Irregular episodes of dysrhythmias. D. Heart rate of less than 120 beats/min.

A (Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the client develops tachycardia greater than 130 beats/min, then the treatment should be stopped.)

In evaluating the effectiveness of oxytocin induction, the nurse would expect: a. Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. b. The intensity of contractions to be at least 110 to 130 mm Hg. c. Labor to progress at least 2 cm/hr dilation. d. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

A (The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.)

During a prenatal visit, the nurse finds that the client has decreased mobility and symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? A. Teach gentle lower extremity exercises to the client. B. Suggest the client to lie in the supine position in bed. C. Provide a calm and soothing atmosphere to the client. D. Give tocolytic medications as per the physician's prescription.

A (The health care provider may recommend reduced activity for the client experiencing preterm labor, depending on the severity of the symptoms. As a result, the client may be at risk for thrombophlebitis due to limited activity. The nurse should teach the client how to perform gentle exercises of the lower extremities. Suggesting that the client lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the client lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the client's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the client to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.)

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? A. Teach gentle lower extremity exercises to the patient. B. Suggest that the patient lie in the supine position in bed. C. Provide a calm and soothing atmosphere to the patient. D. Give tocolytic medications as per the physician's prescription.

A (The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.)

Immediately after the forceps-assisted birth of an infant, the nurse should: a. Assess the infant for signs of trauma. b. Give the infant prophylactic antibiotics. c. Apply a cold pack to the infant's scalp. d. Measure the circumference of the infant's head.

A (The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would put the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.)

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a. Viral b. Periodontal c. Cervical d. Urinary tract

A (The infections that increase the risk of preterm labor and birth are all bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, it is important for the client to participate in early, continual, and comprehensive prenatal care. Evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent infection. Cervical infections of a bacterial nature have been linked to preterm labor and birth. The presence of urinary tract infections increases the risk of preterm labor and birth.)

The nurse is assessing a pregnant client who takes nifedipine (Adalat). What instruction does the nurse provide to ensure the client's safety? A. Consume adequate fluids. B. Take medication on an empty stomach. C. Avoid eating foods high in carbohydrates. D.. Administer medication under medical supervision.

A (The potent vasodilator effect of nifedipine (Adalat) causes variations in the blood pressure of a pregnant client. So, the nurse advises the client to consume adequate fluids to maintain blood pressure. Nifedipine (Adalat) is best tolerated when taken with food. Hence, the nurse does not ask the client to take the medication on empty stomach. Clients on glucocorticoids are advised to avoid carbohydrate-rich foods, because glucocorticoids increase glucose levels in the body, and are unrelated to nifedipine (Adalat). Nifedipine (Adalat) is taken orally and does not require medical supervision to administer it.)

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

A (The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.)

b

A maternal indication for the use of vacuum extraction is: a. A wide pelvic outlet. c. A history of rapid deliveries. b. Maternal exhaustion. d. Failure to progress past 0 station.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? A. Placing the woman in the knee-chest position. B. Covering the cord in a sterile towel saturated with warm normal saline. C. Preparing the woman for a cesarean birth. D. Starting oxygen by face mask.

A (The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although preparing the woman for a cesarean birth is an appropriate intervention, relieving pressure on the cord is the nursing priority. If the cervix is fully dilated, the nurse should prepare for immediate vaginal birth. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer O2 by facial mask at 8 to 10 L/min until birth is complete. This intervention should be initiated after pressure is relieved on the cord.)

The nurse is assessing a pregnant client with multifetal gestation. Upon reviewing the medical history, the nurse finds that the client had preterm delivery during the first pregnancy. What will the nurse do to help prevent preterm delivery in the client during the second pregnancy? A. Suggest that the client avoid smoking. B. Suggest that the client increase physical activity to prevent risk. C. Administer progesterone (Prometrium) suppositories to the client. D. Administer a 17-alpha hydroxy progesterone injection to the client.

A (To prevent preterm labor the nurse can suggest health promotion activities to the client, such as avoiding smoking. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the client get proper rest and care at home. The nurse should not suggest that the client increase physical activity, which could even worsen the condition. Progesterone supplements, like progesterone (Prometrium) suppositories and 17-alpha hydroxy progesterone injections, are ineffective in preventing preterm birth in clients with multifetal gestation. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.)

Before the physician performs an external version, the nurse should expect an order for a: a. Tocolytic drug b. Contraction stress test (CST) c. Local anesthetic d. Foley catheter

A A tocolytic drug will relax the uterus before and during version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. The bladder should be emptied; however, catheterization is not necessary.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. Stimulate fetal surfactant production. b. Reduce maternal and fetal tachycardia associated with ritodrine administration. c. Suppress uterine contractions. d. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

A Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks gestation. An appropriate nursing action would be to: Select all answers that apply. A) Assess the fetal heart rate B) Obtain urine for culture and sensitivity C) Assess Kerry's blood pressure and pulse D) Palpate Kerry's abdomen for contractions

A Assess the fetal heart rate B Obtain urine for culture and sensitivity D Palpate Kerry's abdomen for contractions

The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include: Select all answers that apply. A) Chorioamnionitis B) Abruptio placentae C) Operative birth D) Cord prolapse

A Chorioamnionitis B Abruptio placentae D Cord prolapse

The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes: Select all answers that apply. A) Encouraging regular, ongoing prenatal care B) Reporting symptoms of urinary frequency and burning to the health care provider C) Coming to the labor triage unit if back pain or cramping persist or become regular D) Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

A Encouraging regular, ongoing prenatal care B Reporting symptoms of urinary frequency and burning to the health care provider C Coming to the labor triage unit if back pain or cramping persist or become regular

In evaluating the effectiveness of oxytocin induction, the nurse would expect: a. Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. b. The intensity of contractions to be at least 110 to 130 mm Hg. c. Labor to progress at least 2 cm/hr dilation. d. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

A The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a. Viral b. Periodontal c. Cervical d. Urinary tract

A The infections that increase the risk of preterm labor and birth are all bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, it is important for the client to participate in early, continual, and comprehensive prenatal care. Evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent infection. Cervical infections of a bacterial nature have been linked to preterm labor and birth. The presence of urinary tract infections increases the risk of preterm labor and birth.

9. A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? A. Place the woman in the knee-chest position. B. Cover the cord in a sterile towel saturated with warm normal saline. C. Prepare the woman for a cesarean birth. D. Start oxygen by face mask.

A A. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. B. If the cord is protruding from the vagina it may be covered with a sterile towel soaked in saline. Although this is an appropriate intervention, relieving pressure on the cord is the nursing priority. C. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete. D. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.

check her perineum

A 28-year-old multipara delivered a 9 pound, 3 ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take?

use warm blankets and change perineal pads

A client diagnosed with endometritis is prescribed clindamycin (Cleocin). What comfort measures does the nurse teach the client?

inserting a fist into the vagina

A client who has postpartum bleeding due to uterine subinvolution has not recovered from drug therapy. Which procedure would be helpful in managing the bleeding in this client?

natural removal of the placenta

A client who is 32 weeks pregnant visits a maternal clinic for a routine health checkup. The ultrasound and magnetic resonance imagining (MRI) reveal that the woman is at risk of placenta accreta. Which intervention should be performed during the delivery to ensure client's safety?

Three 30-week-gestation clients are on the labor and delivery unit in preterm labor. For which of the clients should the nurse question an order for terbutaline (Brethine)? A client with hypothyroidism A client with history of cardiac arrhythmias A client with asthma A client who is pregnant with twins

A client with history of cardiac arrhythmias

Massage the uterine fundus

A nurse is making rounds on a client who recently delivered via the vaginal route, and suspects that the client is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time?

endometritis

A postpartum client who had undergone a cesarean reports to the nurse about fever, loss of appetite, pelvic pain, and foul-smelling lochia. Upon assessment, the nurse finds that the client has an increased pulse rate and uterine tenderness. The laboratory reports indicate significant leukocytosis. What clinical condition should the nurse suspect based on these findings

intravascular fluid overload

A postpartum client with hemorrhagic shock is administered intravascular colloids. The nurse monitors the client carefully throughout the colloid administration. What risk factor in the client should the nurse be aware of?

b

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate? a. "After the baby is born." b. "When we can stabilize your preterm labor and arrange home health visits." c. "Whenever the doctor says that it is okay." d. "It depends on what kind of insurance coverage you have."

a

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

c

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia.

d

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.

a

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. Stimulate fetal surfactant production. b. Reduce maternal and fetal tachycardia associated with ritodrine administration. c. Suppress uterine contractions. d. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

B

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate for instructing the woman about which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility."

c

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a. Prolonged latent phase c. Arrest of active phase b. Protracted active phase d. Protracted descent

The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks gestation. The nurse is preparing to administer the second dose of β-methasone prescribed by the physician. Marilyn asks: "What is this injection for again?" The nurse's best response is: A) "This is to help your baby's lungs to mature." B) "This is to prepare your body to begin the labor process." C) "This is to help stabilize your blood pressure." D) "This is to help your baby grow and develop in preparation for birth."

A) "This is to help your baby's lungs to mature."

The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include: Select all answers that apply. A) Cocaine use B) Tobacco use C) Previous caesarean birth D) Previous use of medroxyprogesterone (Depo-Provera)

A) Cocaine use B) Tobacco use C) Previous caesarean birth

Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? A) Increasing abdominal girth measurements B) Profuse vaginal bleeding C) Bradycardia with an aortic thrill D) Hypothermia with chills

A) Increasing abdominal girth measurements

Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)? A) Risk for deficient fluid volume B) Risk for family process interrupted C) Risk for disturbed identity D) High risk for injury

A) Risk for deficient fluid volume

A patient with hypertension who is receiving intravenous magnesium sulfate therapy has requested an epidural anesthetic. The perinatal nurse should first review the patient's complete blood count results for evidence of a decreased platelet count. A) True B) False

A) True

The perinatal nurse knows that the laboring diabetic patient's blood glucose level should always be less than 120 mg/dL. A) True B) False

A) True

The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%. A) True B) False

A) True

The perinatal nurse knows that the survival rate for infants born at or greater than 28-29 gestational weeks is greater than 90%. A) True B) False

A) True

The perinatal nurse observes the placental inspection by the health care provider after birth. This examination may help to determine whether an abruption has occurred prior to or during labor. A) True B) False

A) True

For the patient with which of the following medical problems should the nurse question a physician's order for beta agonist tocolytics? A) Type 1 diabetes mellitus B) Cerebral palsy C) Myelomeningocele D) Positive group B streptococci culture

A) Type 1 diabetes mellitus

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply): a. Rupture of membranes at or near term. b. Convenience of the woman or her physician. c. Chorioamnionitis (inflammation of the amniotic sac). d. Post-term pregnancy. e. Fetal death.

A, C, D, E (These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation.)

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply): a. Rupture of membranes at or near term. b. Convenience of the woman or her physician. c. Chorioamnionitis (inflammation of the amniotic sac). d. Post-term pregnancy. e. Fetal death.

A, C, D, E These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation.

A primary health care provider orders an ultrasound for a pregnant client before attempting external cephalic version (ECV). Upon assessing the client's ultrasound report, the nurse suspects that the primary health care provider will not attempt ECV. Which findings support the nurse's expectation? Select all that apply. A. The client has a nuchal cord. B. The client is Rh negative. C. The client has oligohydramnios. D. The fetal heart rate is 120 beats per minute. E. The client has uterine anomalies

A, C, E (ECV is performed to change the fetus from a breech to a vertex presentation by applying pressure on the abdomen. ECV is contraindicated in certain conditions, including the presence of a nuchal cord, oligohydramnios, and uterine anomalies. ECV should be avoided if the ultrasound shows any of the complications mentioned. ECV is not contraindicated in Rh-negative client. Patients with an Rh-negative blood group are administered Rh immunoglobulin before performing ECV. A fetal heart rate of 120 beats per minute is considered normal, and ECV is not contraindicated in this condition. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.)

Which manifestation does the nurse relate to hypoglycemia in a diabetic client? A. Clammy skin B. Rapid breathing C. Nausea or vomiting D. Increased urination

A. Clammy skin

What are the manifestations associated with hypoglycemia? (Select All that Apply) A. Dizziness B. Fruity Breath C. Blurred Vision D. Excessive Hunger E. Presence of acetone in urine

A. Dizziness C. Blurred Vision D. Excessive Hunger

The nurse is caring for a pregnant client with gestational diabetes. What does the nurse teach the client about diet during pregnancy? A. Eat three meals a day with two or three snacks. B. Avoid meals or snacks just before bedtime. C. Use artificial sweeteners instead of sugar. D. Avoid foods that are high in dietary fiber

A. Eat three meals a day with two or three snacks.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring? (Select all that apply.) A. Estriol is found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm. E. Fetal heart rate of 150 beats/minute

A. Estriol is found in maternal saliva. D. The cervix is effacing and dilated to 2 cm. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. E. Fetal heart rate is normal.

3. In the fourth stage of labor, a full bladder increases the risk for A. Hemorrhage B. Dissesminated intravascular coagulation C. Infection D. Shock

A. Hemorrhage A full bladder displaces the uterus and prevents contraction of the uterus and uterine atony is the primary cause of postpartum hemorrhage. Shock, infection and DIC are not related to bladder distention

What is the procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus? A. In vitro fertilization B. Tubal embryo transfer C. Therapeutic insemination D. Gamete intrafallopian transfer

A. In vitro fertilization

A 25-year-old client has been unable to conceive after being diagnosed with chlamydia. What infertility treatment would help the client conceive? A. In vitro fertilization therapy (IVF) B. Menotropin (Pergonal) therapy C. Zygote intrafallopian transfer (ZIFT) D. Gamete intrafallopian transfer (GIFT)

A. In vitro fertilization therapy (IVF)

Which postpartum conditions are considered medical emergencies that require immediate treatment? A. Inversion of the uterus and hypovolemic shock B. Hypotonic uterus and coagulopathies C. Subinvolution of the uterus and idiopathic thrombocytopenic purpura D. Uterine atony and disseminated intravascular coagulation (DIC)

A. Inversion of the uterus and hypovolemic shock Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.

The blood glucose level of a pregnant client is 325 mg/dl. Which test should be performed on the patient to assess the risk of maternal or intrauterine fetal death? A. Ketones in Urine B. Glucose in Urine C. Arterial Blood Gases D. Abdominal Ultrasound

A. Ketones in Urine

The nurse is teaching a client diagnosed with phenylketonuria (PKU) about foods to be avoided in the daily diet. Which foods can have an adverse effect on the mother and fetus? A.Milk B.Eggs C.Nuts D.Fruits E.Vegetables

A. Milk B. Eggs C. Nuts

6. The nurse assesses a client who delivered 24 hours ago. Which of the following suggests the need for further assessment? A. Scant lochia rubra B. Chills C. Thirst and fatigue D. A temperature of 100.2oF (37.9oC)

A. Scant lochia rubra During the early postpartum period, lochia rubra should be moderate to significant. Scant lochia may indicate that large clots are blocking the flow. Thirst, fatigue and a temperature up to 100.4oF (38oC) are normal within the first 24 hours. Immediately after delivery, vasomotor changes may cause a shaking chill.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? A. Semen analysis B. Testicular biopsy C. Endometrial biopsy D. Hysterosalpingogram

A. Semen Analysis

The nurse is assessing a pregnant client at 16 weeks of gestation. Which diagnostic test should the nurse say is used to identify neural tube defects in the fetus? A. Serum alpha-fetoprotein B. Fetal echocardiography C. Glycosylated hemoglobin D. Nonstress test (NST)

A. Serum alpha-fetoprotein

8. A woman with a past history of varicose veins has just delivered and the nurse suspects she has developed a pulmonary embolism. Which of the data below would lead to this nursing judgment? A. Sudden dyspnea and confusion B. Hypertension C. Chills and fever D. Leg pain

A. Sudden dyspnea and confusion Rationale: Sudden dyspnea, diaphoresis and confusion are the classic signs of the dislodgment of a thrombus (stationary blood clot) from a varicose vein and its travel to and its becoming enlodged in the pulmonary circulation. Chills and fever would indicate infection. A person with a pulmonary embolism would be hypotensive and not hypertensive.

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? (Select all that apply.) A. Unstable coronary artery disease B. Previous cesarean birth C. Placenta previa D. Initial blood pressure of 132/87 E. History of three spontaneous abortions

A. Unstable coronary artery disease B. Previous cesarean birth C. Placenta previa

Nursing care management for mothers and fathers suffering grief from the loss of their baby includes: (Select all that apply.) A. Using therapeutic communication and caring techniques. B. Listening as parents tell their story of loss and grief. C. Avoiding asking any questions about the loss of parents. D. Giving advice from personal experiences. insisting parents name the baby in order to be remembered.

A. Using therapeutic communication and caring techniques. B. Listening as parents tell their story of loss and grief. The nurse should utilize therapeutic communication and caring techniques. The nurse should listen patiently while people tell their story of loss and grief. It may be necessary to ask questions that help people talk about their grief. The nurse should resist the temptation to give advice or use clichés in offering support. A caution about naming is important. Naming is an individual decision that should never be imposed on parents. Beliefs and individual needs vary greatly, sometimes based upon cultures and religious preferences as well.

1. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states: a. "I will need to increase my insulin dosage during the first 3 months of pregnancy." b. "Insulin dosage will likely need to be increased during the second and third trimesters." c. "Episodes of hypoglycemia are more likely to occur during the first 3 months." d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

ANS: A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin. Insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy. During the first trimester maternal blood glucose levels are reduced and the insulin response to glucose is enhanced; therefore, this is when an episode of hypoglycemia is most likely to occur. For the nonbreastfeeding mother insulin levels return to normal within 7 to 10 days. Lactation uses maternal glucose; therefore, the mother's insulin requirements remain low during lactation. On completion of weaning the mother's prepregnancy insulin requirement is reestablished.

3. A perinatal nurse caring for a postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by: a. Subinvolution of the uterus b. Defective vascularity of the decidua c. Cervical lacerations d. Coagulation disorders

ANS: A Late PPH may be the result of subinvolution of the uterus. Recognized causes of subinvolution include retained placental fragments and pelvic infection. Although defective vascularity of the decidua may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. Although cervical lacerations may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. Although coagulation disorders may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.

5. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for: a. Macrosomia b. Congenital anomalies of the central nervous system c. Preterm birth d. Low birth weight

ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.

11. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that: a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy b. Hydramnios occurs approximately twice as often in diabetic pregnancies c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being

ANS: A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

4. In teaching a woman with pregestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level, such as before breakfast, is in the range of: a. 65 to 95 mg/dl b. 130 to 140 mg/dl c. <120 mg/dl d. 150 to 180 mg/dl

ANS: A Target glucose levels premeal or during a fasting period are 65 to 95 mg/dl. A glucose level of 130 to 140 mg/dl is consistent with expected levels 1 hour postmeal. A glucose level of <120 mg/dl is consistent with expected levels of glucose 2 hours postmeal. A glucose level of 150 to 180 mg/dl is considered elevated for a fasting glucose level and indicates poor glycemic control.

1. A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: a. Uterine atony b. Uterine inversion c. Vaginal hematoma d. Vaginal laceration

ANS: A Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman were experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding is pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage; however, it is more likely that profuse bleeding will result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

1. Medications used to manage postpartum hemorrhage (PPH) include (choose all that apply): a. Oxytocin b. Methergine c. Terbutaline d. Hemabate e. Magnesium sulfate

ANS: A, B, D Oxytocin, methergine, and hemabate are medications used to manage PPH. Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens

1. A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is thyroid storm, which may occur in response to stress such as infection, birth, or surgery. Symptoms of this emergency disorder include (choose all that apply): a. Fever b. Hypothermia c. Restlessness d. Bradycardia e. Hypertension

ANS: A, C Fever, restlessness, tachycardia, vomiting, hypotension, and stupor are symptoms of a thyroid storm. Fever, not hypothermia; tachycardia, not bradycardia; and hypotension, not hypertension, are symptoms of thyroid storm.

10. Lacerations of the cervix, vagina, or perineum are also causes of PPH. Factors that influence the causes and incidence of obstetric lacerations of the lower genital tract include all except: a. Operative or precipitate birth b. Adherent retained placenta c. Abnormal presentation of the fetus d. Congenital abnormalities of the maternal soft parts

ANS: B Abnormal adherence of the placenta occurs for reasons unknown. Attempts to remove the placenta in the usual manner are unsuccessful and laceration or perforation of the uterine wall may result. This disorder does not influence lower genital tract lacerations. Lacerations of the perineum are the most common of all lower genital tract injuries and often occur with both precipitate and operative births. These are classified as first, second, third, and fourth degree. Abnormal presentation, position of the fetus, and relative size of the presenting part and the birth canal may contribute to lacerations of the lower genital tract. Congenital abnormalities, previous scarring from infection or injury, and a contracted pelvis may influence injury to the lower genital tract followed by hemorrhage

8. The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: a. Washing the nipples and breasts with mild soap and water once a day b. Using proper breastfeeding techniques c. Wearing a nipple shield for the first few days of breastfeeding d. Wearing a supportive bra 24 hours a day

ANS: B Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis. Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.

14. An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life rather than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. The most appropriate diagnosis at this time is: a. Risk for injury, to the fetus related to birth trauma b. Deficient knowledge, related to diabetic pregnancy management c. Deficient knowledge, related to insulin administration d. Risk for injury, to the mother related to hypoglycemia or hyperglycemia

ANS: B Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears to have greater concern for changes to her social life than to adopting a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come much later in the pregnancy. At this time the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made and may not participate in the plan of care until understanding takes place.

7. Maternal phenylketonuria (PKU) is an important health concern during pregnancy because: a. It is a recognized cause of preterm labor b. The fetus may develop neurologic problems c. A pregnant woman is more likely to die without dietary control d. Women with PKU are usually retarded and should not reproduce

ANS: B Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of uncertain etiology, or who have given birth to microcephalic infants.

8. A nurse caring for a woman hospitalized for hyperemesis gravidarum expects that initial treatment will involve: a. Corticosteroids to reduce inflammation b. IV therapy to correct fluid and electrolyte imbalances c. An antiemetic, such as pyridoxine, to control nausea and vomiting d. Enteral nutrition to correct nutritional deficits

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not the initial treatment for this client.

4. Which client is at greatest risk for early postpartum hemorrhage (PPH)? a. A primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. A multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. A primigravida in spontaneous labor with preterm twins

ANS: B Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress does not indicate risk factors or causes of early PPH. A multiparous woman with an 8-hour labor does not indicate risk factors or causes of early PPH. A primigravida in spontaneous labor with preterm twins does not indicate risk factors or causes of early PPH.

13. A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? a. Hyperthyroidism b. Phenylketonuria c. Hypothyroidism d. Thyroid storm

ANS: B Phenylketonuria (PKU) is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine and should therefore elect not to breastfeed. A woman with hyperthyroidism would have no particular reason not to breastfeed. A woman with hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism and is not a contraindication to breastfeeding.

2. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with: a. Frequent episodes of maternal hypoglycemia b. Congenital anomalies in the fetus c. Polyhydramnios d. Hyperemesis gravidarum

ANS: B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

2. A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: a. Establish venous access b. Perform fundal massage c. Prepare the woman for surgical intervention d. Catheterize the bladder

ANS: B The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Although this may be a necessary intervention, the initial intervention is fundal massage. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention is to assess the uterus. After uterine massage the nurse may want to catheterize the client to eliminate any bladder distention that may be preventing the uterus from contracting properly.

6. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern

ANS: B This client's clinical cues include weight loss, which supports a nursing diagnosis of imbalanced nutrition: less than body requirements. No clinical signs or symptoms support a nursing diagnosis of deficient fluid volume. This client reports weight loss, not weight gain. Although the client reports nervousness, the most appropriate nursing diagnosis, based on the client's other clinical symptoms, is imbalanced nutrition: less than body requirements.

9. In terms of the incidence and classification of diabetes, maternity nurses should know that: a. Type 1 diabetes is most common b. Type 2 diabetes often goes undiagnosed c. Gestational diabetes mellitus (GDM) means that the woman will receive insulin treatment until 6 weeks after birth d. Type 1 diabetes may become type 2 during pregnancy

ANS: B Type 2 often goes undiagnosed because hyperglycemia develops gradually and often is not severe. Type 2, sometimes called adult-onset diabetes, is the most common. GDM refers to any degree of glucose intolerance first recognized during pregnancy. Insulin may or may not be needed. People do not go back and forth between type 1 and type 2 diabetes.

3. During a prenatal visit a nurse is explaining dietary management to a woman with pregestational diabetes. The nurse evaluates that teaching has been effective when the woman states: a. "I will need to eat 600 more calories per day because I am pregnant." b. "I can continue with the same diet as before pregnancy as long as it is well balanced." c. "Diet and insulin needs change during pregnancy." d. "I will plan my diet based on results of urine glucose testing."

ANS: C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be based on blood, not urine, glucose changes.

12. A nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc: a. Is done for all pregnant women, not just those with or likely to have diabetes b. Is a snapshot of glucose control at the moment c. Levels should remain at less than 7 d. Is done on the woman's urine, not her blood

ANS: C Hemoglobin Alc levels greater than 7 indicate elevated glucose during the previous 4 to 6 weeks. This is an extra test for diabetic women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood.

11. A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect ______ and should confirm the diagnosis by ________. a. Disseminated intravascular coagulation (DIC); asking for laboratory tests b. von Willebrand disease (vWD); noting whether bleeding times have been extended c. Thrombophlebitis; using real-time and color Doppler ultrasound d. Thrombocytopenic purpura; drawing blood for laboratory analysis

ANS: C Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common noninvasive way to confirm diagnosis. The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of a slight trauma such as a venipuncture site. Symptoms of vWD, a type of hemophilia, include recurrent bleeding episodes, prolonged bleeding time, and Factor VIII deficiency. A risk for postpartum hemorrhage (PPH) exists and does not present as a warm or reddened area in an extremity. Idiopathic or immune thrombocytopenic purpura (ITP) is an autoimmune disorder in which the life span of antiplatelet antibodies is decreased. Increased bleeding time is a diagnostic finding and the risk of postpartum uterine bleeding is increased.

10. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that: a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus d. Maternal insulin requirements steadily decline during pregnancy

ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy.

6. The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy? a. Large doses of vitamin C during pregnancy b. Prophylactic antibiotics c. Strict aseptic technique, including handwashing, by all health care personnel d. Limited protein and fat intake

ANS: C Strict adherence by all health care personnel to aseptic techniques during childbirth and the postpartum period is very important and the least expensive measure to prevent infection. Good nutrition to control anemia is a preventive measure. Increased iron intake assists in preventing anemia. Antibiotics may be given to manage infections; they are not a cost-effective measure to prevent postpartum infection. Good nutrition to control anemia is a preventive measure. Limiting protein and fat intake does not help prevent anemia or prevent infection.

The nurse is caring for a patient who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? 1 Presence of infection 2 Blockage in the fallopian tubes 3 Decrease in ovarian reserve 4 Abnormal endometrial tissue

Blockage in the fallopian tubes

9. Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance: a. PPH is easy to recognize early; after all, the woman is bleeding b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH c. If anything, nurses and doctors tend to overestimate the amount of blood loss d. Traditionally, PPH has been classified as early or late with respect to birth

ANS: D Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH. Unfortunately, PPH can occur with little warning and often is recognized only after the mother has profound symptoms. Traditionally, a 500-ml blood loss after a vaginal birth and a 1000-ml blood loss after a cesarean birth constitute PPH. Medical personnel tend to underestimate blood loss by as much as 50% in their subjective observations.

5. When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: a. Absence of cyanosis in the buccal mucosa b. Cool, dry skin c. Diminished restlessness d. Urinary output of at least 30 ml/hr

ANS: D Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool, pale, clammy skin is associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness.

12. It is important for the perinatal nurse to be knowledgeable regarding conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta and decidua. Which classification of separation is not recognized as an abnormal adherence pattern? a. Placenta accreta b. Placenta increta c. Placenta percreta d. Placenta abruptio

ANS: D Placenta abruptio is premature separation of the placenta as opposed to partial or complete adherence. This occurs between the twentieth week of gestation and delivery in the area of the decidua basalis. Symptoms include localized pain and bleeding. Placenta accreta is a recognized degree of attachment. With placenta accreta there is slight penetration of the trophoblast into the myometrium. Placenta increta is a recognized degree of attachment that results in deep penetration of the myometrium. Placenta percreta is the most severe degree of placental penetration that results in deep penetration of the myometrium. Bleeding with complete placental attachment occurs only when separation of the placenta is attempted after delivery. Treatment includes blood component therapy and in extreme cases, hysterectomy may be necessary.

7. One of the first symptoms of puerperal infection to assess for in the postpartum woman is: a. Fatigue continuing for longer than 1 week b. Pain with voiding c. Profuse vaginal bleeding with ambulation d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth

ANS: D Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. Fatigue is a late finding associated with infection. Pain with voiding may indicate a urinary tract infection (UTI), but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.

Postpartum Hemorrhage (PPH)

After reviewing the medical reports of a client, the nurse finds that the client has multifetal gestation. What could be the most likely complication associated with this?

Placenta accreta

After reviewing the medical reports of a client, the nurse finds that the client has submucosal uterine fibroids. Which postpartum complication of pregnancy is the client likely to have?

hysteroscopy

this procedure involves using a camera to look at uterine cavity structures through the cervix. - definitive method to evaluate fibroids + adhesions. Most expensive and invasive!! - *not 1st line*

What should the nurse include when educating a patient about the side effects of depot medroxyprogesterone acetate (DMPA) prior to administration? Select all that apply. 1 Breast changes 2 Increased libido 3 Weight loss 4 Thromboembolism 5 Irregular vaginal spotting

Breast changes Thromboembolism Irregular vaginal spotting

A client and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them about the infertility workup. Which statement by the client would indicate that the instructions have been successful? 1. "The first test that we need to schedule is a semen analysis." 2. "We need to schedule the Pap smear test first." 3. "We need to schedule an appointment with the social worker in order to adopt." 4. "We need to schedule an appointment with a marriage counselor."

Answer: 1 Explanation: 1. A semen analysis is one of the first diagnostic tests, prior to doing invasive procedures.

preimplantation genetic diagnosis

this requires a single cell removed from each embryo after 3-4 days. - early genetic testing to screen for inherited disease. - transfer embryo that does not have disease genes.

What type of testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG? 1. Chlamydia trachomatis IgG antibody testing 2. Preimplantation genetic testing 3. Noninvasive prenatal testing (NIPT) 4. DNA testing

Answer: 1 Explanation: 1. Chlamydia trachomatis IgG antibody testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG.

The nurse is planning to teach couples factors that influence fertility. Which factor should not be included in the teaching plan? 1. Sexual intercourse should occur every day of the week. 2. Get up to urinate 1 hour after intercourse. 3. Do not douche. 4. Institute stress-reduction techniques.

Answer: 1 Explanation: 1. It is optimal if sexual intercourse occurs every other day during the fertile period.

The nurse in a fertility clinic is working with a woman who has been undergoing infertility treatment with clomiphene citrate. Which statement would the nurse expect the woman to make? 1. "I feel moody so much of the time." 2. "If this doesn't work, I think my husband will leave me." 3. "This medication will guarantee a pregnancy." 4. "My risk of twins or triplets is the same as for the general population."

Answer: 1 Explanation: 1. Mood swings are a side effect of clomiphene citrate.

A pregnant client asks the nurse, "What is this "knuckle test" that is supposed to tell whether my baby has a genetic problem?" What does the nurse correctly explain? 1. "In the first trimester, the nuchal translucency measurement is added to improve the detection rate for Down syndrome and trisomy 18." 2. "You will need to ask the physician for an explanation." 3. "It tests for hemophilia A or B." 4. "It tests for Duchenne muscular dystrophy."

Answer: 1 Explanation: 1. Screening tests, such as nuchal translucency ultrasound are designed to gather information about the risk that the pregnancy could have chromosome abnormalities or open spina bifida.

The nurse is talking with a couple who have been trying to get pregnant for 5 years. They are now at the fertility clinic seeking help. The nurse assesses their emotional responses as part of the workup. Which responses would the nurse expect to hear? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Experiencing a sense of loss of status 2. Feelings of failure because they cannot make a baby 3. Healthy relationship with healthcare partners 4. Stress on the marital and sexual relationship 5. Feelings of frustration

Answer: 1, 2, 4, 5 Explanation: 1. The couple may experience feelings of loss of status and ambiguity as a couple. 2. Feelings of failure are common. 4. The couple may experience stress on the marital and sexual relationship. 5. Tests and treatments may heighten feelings of frustration or anger between partners.

The clinic nurse assesses a newborn that is not progressing as expected. Genetic tests are ordered. The nurse explains to the parents that the laboratory tests to be done include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Chromosome analysis 2. Complete blood count 3. Phenylketonuria 4. Enzyme assay 5. Antibody titers

Answer: 1, 4, 5 Explanation: 1. Laboratory analysis includes chromosome analysis. 4. Laboratory analysis includes enzyme assay for inborn errors of metabolism. 5. Laboratory analysis includes antibody titers for infectious teratogens.

A woman who is admitted to labor and delivery at 30 weeks gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? A) Temperature B) Pulse C) Respiratory rate D) Blood pressure

C) Respiratory rate

The nurse is planning a group session for clients who are beginning infertility evaluation. Which statements should be included in this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Infertility can be stressful for a marriage." 2. "The doctor will be able to tell why you have not conceived." 3. "Your insurance will pay for the infertility treatments." 4. "Keep communicating with one another through this process." 5. "Support organizations can be helpful to deal with the emotional issues associated with infertility."

Answer: 1, 4, 5 Explanation: 1. Often an intact marriage will become stressed by the intrusive but necessary infertility procedures and treatments. 4. Communication is important; clients should communicate verbally and share feelings and support. 5. Referral to mental health professionals is helpful when the emotional issues become too disruptive in the couple's relationship or life. Couples should be made aware of infertility support and education organizations, which may help meet some of these needs and validate their feelings.

Methods to increase fertility awareness include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Home assessment of cervical mucus 2. Pharmacologic agents 3. Therapeutic insemination 4. IVF 5. Basal body temperature (BBT) recordings

Answer: 1, 5 Explanation: 1. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings. 5. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings.

Approximately 80% of anovulatory women have which condition? 1. Turner syndrome 2. Polycystic ovary syndrome (PCOS) 3. Klinefelter syndrome 4. Fragile X syndrome

Answer: 2 Explanation: 2. Approximately 80% of anovulatory women have polycystic ovary syndrome (PCOS), causing insulin resistance and hyperinsulinemia.

A client is to receive fertility drugs prior to in vitro fertilization. What is the expected action of this medication? 1. Prolonging of the luteal phase 2. Stimulation of ovulation 3. Suppression of menstruation 4. Promotion of cervical mucus production

Answer: 2 Explanation: 2. In IVF, a woman's ovaries are stimulated by a combination of medications, one or more oocytes are aspirated from her ovaries and fertilized in the laboratory, and then they are placed into her uterus after normal embryo development has begun.

A couple who have sought fertility counseling have been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which condition occurs? 1. The vas deferens is ligated. 2. Male obesity is present. 3. The prostate gland is enlarged. 4. The flagella are segmented.

Answer: 2 Explanation: 2. Male obesity is associated with poor spermatogenesis and increased amount of time to conception.

Couples at risk for having a detectable single gene or chromosomal anomaly may wish to undergo which procedure? 1. Preimplantation genetic screening (PGS) 2. Preimplantation genetic diagnosis (PGD) 3. Intracytoplasmic sperm injection (ICSI) 4. Gamete intrafallopian transfer (GIFT)

Answer: 2 Explanation: 2. Preimplantation genetic diagnosis (PGD) is a term used when one or both genetic parents carry a gene mutation and testing is performed to determine whether that mutation or unbalanced chromosomal compliment has been passed to the oocyte or embryo.

The nurse is reviewing assessment data from several different male clients. Which one should receive information about causes of infertility? 1. Circumcised client 2. Client with a history of premature ejaculation 3. Client with a history of measles at age 12 4. Client employed as an engineer

Answer: 2 Explanation: 2. Premature ejaculation is a possible cause of infertility.

An infertile couple confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which nursing strategy would be most appropriate? 1. Refer them to a marriage counselor. 2. Provide them with information and instructions throughout the diagnostic and therapeutic process. 3. Express concern and caring. 4. Inquire about the names they have chosen for their baby.

Answer: 2 Explanation: 2. The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic processes.

A male client visits the infertility clinic for the results of his comprehensive exam. The exam indicated oligospermia. The client asks the nurse which procedure would assist him and his wife to conceive. The nurse's best response would include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You might want to consider adoption." 2. "An option you might consider is in vitro fertilization." 3. "Surrogacy might be your best option." 4. "Many couples utilize therapeutic husband insemination." 5. "The GIFT procedure has had much success."

Answer: 2, 4 Explanation: 2. The in vitro fertilization procedure is used in cases in which infertility has resulted from male infertility. 4. Therapeutic husband insemination is generally indicated for such seminal deficiencies as oligospermia.

The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? 1. Wife is 30 years old, husband is 31 years old 2. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old 3. Wife's family has a history of hemophilia 4. Single 32-year-old woman is using donor sperm

Answer: 3 Explanation: 3. For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%.

A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We are at low risk for having a baby with Down syndrome." 2. "Our children are more likely to have genetic defects." 3. "Children born to parents this age have sex-linked disorders." 4. "The tests for genetic defects can be done early in pregnancy." 5. "It will be almost impossible for us to conceive a child."

Answer: 2, 4 Explanation: 2. Women 35 or older are at greater risk for having children with chromosome abnormalities. 4. Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester.

A client calls the urologist's office to receive instructions about semen analysis. What does the nurse instruct the client to do? 1. Avoid sexual intercourse 24 hours prior to obtaining a specimen. 2. Use a latex condom to collect the specimen. 3. Expect that a repeat test might be required. 4. Expect a small sample.

Answer: 3 Explanation: 3. A repeat semen analysis might be required to adequately assess the man's fertility potential.

A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which chromosomal abnormality? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26

Answer: 3 Explanation: 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).

The physician has prescribed the medication clomiphene citrate (Clomid) for a client with infertility. What should the nurse's instructions to the woman include? 1. "Have intercourse every day of 1 week, starting 5 days after completion of medication." 2. "This medication is administered intravenously." 3. "Contact the doctor if visual disturbances occur." 4. "A contraindication is kidney disease."

Answer: 3 Explanation: 3. Side effects of clomiphene citrate include visual symptoms such as spots and flashes.

A couple is seeking advice regarding what they can do to increase the chances of becoming pregnant. What recommendation can the nurse give to the couple? 1. The couple could use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The woman should be on top during intercourse.

Answer: 3 Explanation: 3. This is the correct answer, as douching can alter sperm mobility.

The OB-GYN nurse is assessing a pregnant client, and recognizes genetic amniocentesis will be indicated. The nurse makes this conclusion because the indications for genetic amniocentesis include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Maternal age under 35 2. Fetus with no abnormalities on ultrasound 3. One child with a chromosome abnormality 4. A family history of neural tube defects 5. Both parents with an abnormal chromosome

Answer: 3, 4, 5 Explanation: 3. Couples who have had a child with trisomy 21, 18, or 13 have approximately a 1% risk or their age-related risk, whichever is higher, of a future child having a chromosome abnormality. 4. Family history of neural tube defects is an indication for genetic amniocentesis. 5. If both parents carry an autosomal recessive disease, they have a 25% chance with each pregnancy that the fetus will be affected.

Which couples may benefit from prenatal diagnosis? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Couples including women under the age of 35 2. Couples with an unbalanced translocation 3. Couples with a family history of known or suspected single-gene disorder 4. Couples including women with a teratogenic risk secondary to an exposure or maternal health condition 5. Family history of birth defects and/or intellectual disability

Answer: 3, 4, 5 Explanation: 3. Couples with a family history of known or suspected single-gene disorder (e.g., cystic fibrosis, hemophilia A or B, Duchenne muscular dystrophy) may benefit from prenatal diagnosis. 4. Women with a teratogenic risk secondary to an exposure or maternal health condition (e.g., diabetes, seizure disorder) may benefit from prenatal diagnosis. 5. Family history of birth defects and/or intellectual disability (mental retardation) (e.g., neural tube defects, congenital heart disease, cleft lip and/or palate) may benefit from prenatal diagnosis.

A nurse working with couples undergoing genetic testing recognizes which of the following as nursing responsibilities? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Allowing the family to interact with the genetic counselor without interference 2. Giving information about support groups when asked 3. Identifying families at risk for genetic problems 4. Aiding families in coping with the crisis 5. Ensuring continuity of nursing care to the family

Answer: 3, 4, 5 Explanation: 3. The nurse has a responsibility to identify families at risk for genetic problems. 4. The nurse should aid families in coping. 5. The nurse needs to ensure continuity of care to the family.

The couple at 12 weeks' gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping? 1. "We knew we were both carriers of sickle cell. We shouldn't have tried to have a baby." 2. "If we had been healthier when we conceived, our baby wouldn't have this disease now." 3. "Taking vitamins before we got pregnant would have prevented this from happening." 4. "The doctor told us there was a 25% chance that our baby would have sickle disease."

Answer: 4 Explanation: 4. A true statement indicates coping. When both parents are carriers of an autosomal recessive disease, there is a 25% risk for each pregnancy that the fetus will be affected.

A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, "Which of us passed on the gene that caused the disorder?" Which answer should the nurse tell them? 1. The female 2. The male 3. Neither 4. Both

Answer: 4 Explanation: 4. An affected individual can have clinically normal parents, but both parents are generally carriers of the abnormal gene.

A client scheduled a laparoscopy. After the procedure, what does the nurse instruct the client to do? 1. Stay on bed rest for 48 hours. 2. Expect to have shoulder and arm pain. 3. Purchase a rectal tube to relieve the gas. 4. Lie on her back to relieve the gas pain after the procedure.

Answer: 4 Explanation: 4. Assuming a supine position may help relieve residual shoulder and chest discomfort caused by any remaining gas.

During the initial visit with the nurse at the fertility clinic, the client asks what effect cigarette smoking has on the ability to conceive. What is the nurse's best response? 1. "Smoking has no effect." 2. "Only if you smoke more than one pack a day will you experience difficulty." 3. "After your first semen analysis, we will determine whether there will be any difficulty." 4. "Smoking can affect the quantity of sperm."

Answer: 4 Explanation: 4. The quantity and quality of male sperm are affected by cigarette smoking.

c

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. b. There are no important maternal (as opposed to fetal) contraindications. c. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first?

Assess the woman's fundus. Explanation: In order to have a suggested idea of the location of the bleeding the nurse would need to assess the funds of the client first. Although all actions may be appropriate, they would not have the priority of fundal assessment.

A client receiving terbutaline (Brethine) through an intravenous infusion calls out complaining of shortness of breath. The nurse's initial reaction should be: Nothing - this is a normal side effect of this medication. Call the doctor immediately. Auscultate lungs Order a chest x-ray stat.

Auscultate lungs

A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instructions in her discharge teaching?

Avoid over-the-counter (OTC) salicylates. Explanation: Discharge teaching should include informing the client to avoid OTC salicylates, which may potentiate the effects of anticoagulant therapy. Iron will not affect anticoagulation therapy. Restrictive clothing should be avoided to prevent the recurrence of thrombophlebitis. Shortness of breath should be reported immediately because it may be a symptom of pulmonary embolism.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include? a. "Because this is a repeat procedure, you are at the lowest risk for complications." b. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." c. "Because this is your second cesarean birth, you will recover faster." d. "You will not need preoperative teaching because this is your second cesarean birth."

B ("Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures" is the most appropriate statement. It is not accurate to state that the woman is at the lowest risk for complications. Both maternal and fetal risks are associated with every cesarean section. "Because this is your second cesarean birth, you will recover faster" is not an accurate statement. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed, regardless of whether the client has already had this procedure.)

A maternal indication for the use of vacuum extraction is: a. A wide pelvic outlet. b. Maternal exhaustion. c. A history of rapid deliveries. d. Failure to progress past 0 station.

B (A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.)

While assisting a primary health care provider performing amniotomy, the nurse observes part of the umbilical cord protruding from the client's vagina. The nurse immediately positions the client in the Trendelenburg position and inserts a finger into her vagina. What additional care does the client need to prevent complications? A. Perform large-bore catheter suction. B. Prepare for an emergency C-section. C. Administer calcium gluconate intravenously. D. Administer terbutaline (Brethine) subcutaneously.

B (Amniotomy may cause prolapse of the umbilical cord, in which the cord lies below the presenting part of the fetus. A prolapsed cord causes fetal hypoxia, because the supply of oxygen to the fetus is reduced. A cesarean birth should be performed to prevent further complications. Large-bore catheter suction is performed to remove the aspirated meconium from the newborn, and is unrelated to cord prolapse. Calcium gluconate is administered to a pregnant client who develops magnesium sulfate toxicity. Calcium gluconate is unrelated to cord prolapse. Terbutaline (Brethine) is administered to treat tachysystole in the pregnant client and is unrelated to cord prolapse. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.)

The nurse questions an order for indomethacin (Indocin) based on which of the following assessment findings? Client has polyhydramnios Client is contracting every 5 minutes at 29 weeks gestation Cervical examination: 2cm - 50% - -3 Client is 33 weeks gestation

Client is 33 weeks gestation

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: A. uterine contractions occurring every 8 to 10 minutes. B. a fetal heart rate (FHR) of 180 with absence of variability. C. the woman needing to void. D. rupture of the woman's amniotic membranes.

B (An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured.)

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of what? A. Uterine contractions occurring every 8 to 10 minutes. B. A fetal heart rate (FHR) of 180 with absence of variability. C. The woman needing to void. D. Rupture of the woman's amniotic membranes.

B (An FHR of 180 with absence of variability is nonreassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is nonreassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.)

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a. Ripening the cervix usually results in a decreased success rate for induction. b. Labor sometimes can be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor.

B (Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.)

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: a. The terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. c. Low birth weight is anything below 3.7 pounds. d. In the United States early in this century, preterm birth accounted for 18% to 20% of all births.

B (Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.)

The nurse administers magnesium sulfate (Epsom salts) to stop labor in a pregnant client. Which symptoms should the nurse monitor to ensure the client's safety? A. Swollen legs B. Respiratory rate C. Eating patterns D. Maternal chills

B (Magnesium sulfate (Epsom salts) is administered to a pregnant client to stop labor. Magnesium sulfate (Epsom salts) causes respiratory depression as a toxic effect. Therefore, the nurse should monitor the respiratory rate of the client. Swollen legs or edema is acommon observation during labor, which is caused by increased abdominal contents. Edema is unrelated to magnesium sulfate. Magnesium sulfate (Epsom salts) does not alter a client's eating habits. Maternal chills are observed in clients with membrane rupture and are unrelated to magnesium sulfate (Epsom salts). Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.)

A pregnant client experienced preterm labor at 30 weeks gestation. Upon assessing the client the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? A. Calcium gluconate. B. Magnesium sulfate. C. Glucocorticoid drugs. D. Antibiotic medications.

B (Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the client can prevent this risk, because it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore, administering glucocorticoids to the pregnant client would help to prevent risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.)

Which drug is used for treating a client with severe postpartum bleeding? A. Nifedipine (Adalat) B. Oxytocin (Pitocin) C. Propranolol (Inderal) D. Metronidazole (Flagyl)

B (Oxytocin (Pitocin) is a synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. Nifedipine (Adalat) is a calcium channel blocker that is used intocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse intolerable cardiovascular effects of terbutaline (Brethine). Metronidazole (Flagyl) is a broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean birth.)

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth."

B (Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.)

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? a. Assessing deep tendon reflexes (DTRs) b. Assessing for chest discomfort and palpitations c. Assessing for bradycardia d. Assessing for hypoglycemia

B (Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations. Assessing DTRs would not address these concerns. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.)

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate? a. "After the baby is born." b. "When we can stabilize your preterm labor and arrange home health visits." c. "Whenever the doctor says that it is okay." d. "It depends on what kind of insurance coverage you have."

B (The client's preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a woman with preterm labor is multifactorial; the goal is to prevent delivery. In many cases this may be achieved at home. Care of the preterm client is multidisciplinary and multifactorial. Managed care may dictate earlier hospital discharges or a shift from hospital to home care. Insurance coverage may be one factor in the care of clients, but ultimately client safety remains the most important factor.)

The nurse is caring for a client with premature rupture of membranes (PROM). How should the nurse instruct the client to manage the situation? A. "Consume excess amounts of fluids." B. "Assess fetal movement on a daily basis." C. "Monitor the skin for any discoloration." D. "Place yourself in Trendelenburg position."

B (The nurse should instruct a pregnant client with PROM to perform daily fetal movement counts. Reduction in fetal movements indicates fetal dysfunction. Clients who are administered tocolytic agents, such as nifedipine (Adalat), are instructed to consume excess fluids to prevent effects of vasodilatation. Consumption of excess fluids is unrelated to the management of PROM. Skin discoloration is observed in conditions like jaundice, but not in clients with PROM. The nurse places the client in Trendelenburg position if the client has symptoms of umbilical cord prolapse. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.)

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? A. Propranolol (Inderal) B. Clindamycin (Cleocin) C. Morphine (MS Contin) D. Terbutaline (Brethine)

B (The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor.)

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? A. Buccal oxytocin (Pitocin) B. Terbutaline sulfate (Brethine) C. Calcium gluconate (Calgonate) D. Magnesium sulfate (Magnesium sulfate)

B (The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The client must be hospitalized for magnesium therapy because of the serious side effects of this drug.)

The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of: a. Uterine contractions occurring every 8 to 10 minutes. b. A fetal heart rate (FHR) of 180 with absence of variability. c. The client's needing to void. d. Rupture of the client's amniotic membranes.

B (This FHR is nonreassuring. The oxytocin should be discontinued immediately, and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that are occurring every 8 to 10 minutes do not qualify as hyperstimulation. The client's needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.)

A maternal indication for the use of vacuum extraction is: a. A wide pelvic outlet b. Maternal exhaustion c. A history of rapid deliveries d. Failure to progress past 0 station.

B A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? a. Assessing deep tendon reflexes (DTRs) b. Assessing for chest discomfort and palpitations c. Assessing for bradycardia d. Assessing for hypoglycemia

B Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations. Assessing DTRs would not address these concerns. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.

5. A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: A. Uterine contractions occurring every 8 to 10 minutes B. A fetal heart rate (FHR) of 180 with absence of variability C. The client needing to void D. Rupture of the client's amniotic membranes

B A. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. B. This FHR is nonreassuring. The oxytocin should be immediately discontinued and the physician should be notified. C. This is not an indication to discontinue the oxytocin induction immediately or to call the physician. D. Unless a change occurs in the FHR pattern that is nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.

3. With regard to small-for-gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that: A. In the first trimester, diseases or abnormalities result in asymmetric IUGR B. Infants with asymmetric IUGR have the potential for normal growth and development C. In asymmetric IUGR, weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA D. Symmetric IUGR occurs in the later stages of pregnancy

B A. In the first trimester, diseases or abnormalities result in symmetric IUGR. B. IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development. C. In asymmetric IUGR the head circumference remains within normal limits, whereas the birth weight falls below the 10th percentile. D. The symmetric form of IUGR occurs in the first trimester. The asymmetric form occurs in the later stages of pregnancy.

A nurse is working with a diabetic patient who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the patient throughout the pregnancy, the nurse would include: (Select all that apply.) A. Family practice physician B. Dietician C. Perinatologist D. Occupational therapist E. Nephrologist F. Speech therapist

B. Dietician C. Perinatologist E. Nephrologist

12. With regard to dysfunctional labor, nurses should be aware that: A. Women who are underweight are more at risk B. Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted C. Hypertonic uterine dysfunction is more common than hypotonic dysfunction D. Abnormal labor patterns are most common in older women

B A. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. B. Precipitous labor lasts less than 3 hours. C. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. D. Abnormal labor patterns are more common in women younger than 20 years of age.

4. In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth."

B A. This statement is not accurate. Maternal and fetal risks are associated with every cesarean section. B. This statement is the most appropriate. C. This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. D. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

A woman at 10 weeks gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see? A) Platelet count of 550,000/ mm3 B) Dark brown vaginal bleeding C) White blood cell count 17,000/ mm3 D) Macular papular rash

B) Dark brown vaginal bleeding

Immediately postpartum, the insulin needs in diabetic women increase dramatically. A) True B) False

B) False

The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%. A) True B) False

B) False

During pregnancy, poorly controlled asthma can place the fetus at risk for: A) Hyperglycemia B) IUGR C) Hypoglycemia D) Macrosomia

B) IUGR

While educating the client with class II cardiac disease, at 28 weeks gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions? A) Emotional stress at work B) Increased dyspnea while resting C) Mild pedal and ankle edema D) Weight gain of 1 pound in 1 week

B) Increased dyspnea while resting

A labor nurse is caring for a patient, 39 weeks gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? A) Type and cross match her blood. B) Insert an internal fetal monitor electrode. C) Administer an oral stool softener. D) Assess her complete blood count.

B) Insert an internal fetal monitor electrode.

Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension? A) Total urine protein of 200 mg/dL B) Total platelet count of 40,000 mm C) Uric acid level of 8.0 mg/dL D) Blood urea nitrogen 24 mg/dL

B) Total platelet count of 40,000 mm

A 34-week gestation multigravida, G3 P1 is admitted to the labor suite. She is contracting q 7 minutes ⋅ 40 seconds. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture? A) Kyphosis B) Urinary tract infection C) Congestive heart failure D) Cerebral palsy

B) Urinary tract infection

Complications and risks associated with cesarean births include (Select all that apply): a. Placental abruption. b. Wound dehiscence. c. Hemorrhage. d. Urinary tract infections. e. Fetal injuries.

B, C, D, E (Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section.)

Complications and risks associated with cesarean births include (Select all that apply): a. Placental abruption. b. Wound dehiscence. c. Hemorrhage. d. Urinary tract infections. e. Fetal injuries.

B, C, D, E Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section.

The nurse is teaching a group of pregnant clients about early identification of preterm labor. What signs and symptoms of preterm labor should the nurse include in the teaching? Select all that apply. A. Upper abdominal pain B. Increased vaginal discharge C. Presence of vaginal bleeding D. Decreased urinary frequency E. Painful uterine contractions (UCs)

B, C, E (Any pregnant client runs the risk of having preterm labor and should be educated to identify its signs and symptoms. Painful uterine contractions (UCs) are a sign of preterm labor, caused by the body's attempt to deliver the baby. The client may show signs of vaginal bleeding due to a rupture of the membranes. Preterm labor can also be identified by changes in the color or amount of vaginal discharge. During labor the vaginal discharge usually increases and becomes brown to red in color. Preterm labor is also characterized by an increase in urine frequency and pain in lower abdomen. Therefore a decrease in urine frequency and upper abdominal pain do not indicate preterm labor.)

The nurse is caring for a pregnant client who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. A. Fluid intake B. Respiratory status C. Body temperature D. Level of consciousness E. Deep tendon reflexes

B, D, E (Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.)

a

Before the physician performs an external version, the nurse should expect an order for a: a. Tocolytic drug. c. Local anesthetic. b. Contraction stress test (CST). d. Foley catheter.

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)? a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c. Uterine tone <20 mm Hg d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

B, D, E (Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.)

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)? a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c. Uterine tone <20 mm Hg d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

B, D, E Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.

The nurse is teaching the nursing student about semen analysis. Which statement by the student indicates the need for further teaching? A. "The client should be instructed to masturbate to obtain the semen sample." B. "A cold environment or low temperature is suitable for storing the semen sample." C. "The test must be performed within 2 hours of collecting the semen sample." D. "A spermicide-free plastic sheath must be used to collect the semen sample."

B. "A cold environment or low temperature is suitable for storing the semen sample."

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth

B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." This statement is not accurate. Maternal and fetal risks are associated with every cesarean section. This statement is the most appropriate. This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

10. A ten-day postpartum breastfeeding client telephones the postpartum unit complaining of a reddened, painful breast and elevated temperature. Based on assessment of the client's complaints, the nurse tells the client to: A. "Stop breastfeeding because you probably have an infection." B. "Notify your physician because you may need medication." C. "Continue breastfeeding because this is a normal response in breastfeeding mothers." D. "Breastfeed only with the unaffected breast."

B. "Notify your physician because you may need medication." Rationale: Based on the signs and symptoms presented by the client (especially the elevated temperature), the physician should be notified because the client probably has mastitis, an infection in the breast. An antibiotic that is tolerated by the infant as well as the mother may be prescribed. The mother should continue to nurse on both breasts but should start the infant on the unaffected breast while the affected breast lets down.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate for instructing the woman about which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C."You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility.

B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive."

The rate of fertility declines dramatically after the age of 35. While explaining the cause of this rapid decline in fertility to the client, the nurse is aware that the primary reason for this is related to what? A. Endometriosis B. Abnormalities of oocytes C. Infection D. Metabolic disease

B. Abnormalities of oocytes

4. The client has just given birth to a healthy, full-term infant. The client is Rho(D) negative and her baby is Rho(D) positive. Which intervention will take place to reduce the possibility of isoimmunization? A. Administering Rho(D) immune globulin to the baby, IM, within 72 hours B. Administering Rho(D) immune globulin to the mother, IM, within 72 hours C. Administering Rho(D) immune globulin to the mother, IM, at her 6-week visit D. Administering Rho(D) immune globulin to the mother, IM, within 3 months

B. Administering Rho(D) immune globulin to the mother, IM, within 72 hours Rho(D) immune globulin (RhoGam) is given to the Rho(D)-negative mother, within 72 hours after delivery of an Rho(D)-positive baby (if the Coombs is negative). RhoGam is never given to the baby.

A pregnant patient experiences thyroid storm following delivery of her infant. What interventions would the nurse anticipate to be ordered by the physician? (Select all that apply.) A. Restriction of intravenous fluids to prevent fluid overload B. Administration of oxygen C. Antipyretics D. Synthroid E. PTU

B. Administration of Oxygen C. Antipyretics E. PTU

The nurse is caring for a client who is scheduled to undergo a hysterosalpingogram. What possible abnormalities can be detected through the procedure? A. Presence of infection B. Blockage in the fallopian tubes C. Decrease in ovarian reserve D. Abnormal endometrial tissue

B. Blockage in the fallopian tubes

9. A client gives birth to a stillborn infant at 36 weeks. When caring for this client, which strategy by the nurse would be most helpful? A. Be selective in providing the information that the client seeks B. Encourage the client to see, touch and hold the dead infant C. Provide information about the possible causes of the stillbirth only if the client requests it D. Let the child's father decide what information the mother receives.

B. Encourage the client to see, touch and hold the dead infant 8. Rationale: When caring for a client who has suffered perinatal loss, the nurse should provide opportunity for her to bond with the dead infant and for the infant to become part of the family unit. Parents not given that opportunity may have fantasies about the infant that are worse than reality. If the child has gross deformities, the nurse should prepare the client for these. If the client doesn't ask about her child, the nurse should encourage her to do so and provide any information she seems ready to hear. The client needs a full explanation of all factors related to the experience so she can grieve appropriately. Allowing the father to determine which information the client is given is inappropriate.

The priority nursing intervention for a woman who suffered a perineal laceration is to: A. Apply a cold compress. B. Establish hemostasis. C. Administer analgesia. D. Administer a stool softener.

B. Establish hemostasis. Bleeding should be stopped first. After bleeding has been controlled, the care of the woman with lacerations of the perineum includes analgesia administration, hot or cold applications, and stool softeners. Stool softeners may be used to assist the woman in reestablishing bowel habits without straining and putting stress on the suture lines.

The nurse is caring for a client in the first trimester of pregnancy who is prescribed propylthiouracil (PTU) for hyperthyroidism. What are the side effects of this medication? A. Facial anomalies B. Hepatic toxicity C. Esophageal atresia D. Developmental dela

B. Hepatic toxicity

5. A client with cardiac disease delivers a baby. Afterwards, the nurse assesses the client for signs of cardiac decompensation. During the postpartum period, which condition can cause cardiac decompensation? A. Increased pain B. Increased cardiac output C. Decreased renal function D. Decreased hepatic blood flow

B. Increased cardiac output Rationale: Cardiac output increases immediately after delivery as blood that had been diverted to the uterus reenters the central circulation. A client who cannot tolerate these changes may experience cardiac decompensation and cardiac failure. After delivery, renal function increases. There is usually not an increase in pain after delivery except for small increments attributable to uterine cramps, perineal discomfort and breast tenderness. Although hepatic blood flow decreases to normal levels after delivery, this does not affect cardiac function.

A pregnant client with pregestational insulin-dependent diabetes is going for a week's vacation to another state. What should the nurse ask the client to carry with her in order to prevent complications? (Select all that apply) A. Antibiotics B. Insulin vials C. Glucose tablets D. Antihypertensives E. Blood glucose meter

B. Insulin Vials C. Glucose Tablets E. Blood Glucose Meter

The priority assessment in evaluating a pregnant woman with severe nausea and vomiting is: A.Fasting blood glucose level. B. Ketonuria. C. Bilirubin. D. White blood cell count.

B. Ketonuria

Which of the following findings is not likely to be seen in a pregnant patient who has hypothyroidism? A. Miscarriage B. Macrosomia C. Gestational hypertension D. Placental abruption

B. Macrosomia

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to do what? A. Ejaculate into a sterile container B. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days C. Transport specimen with container packed in ice D. Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

B. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days

Thromboembolic conditions that are of concern during the postpartum period include (Select all that apply.) A. Amniotic fluid embolism (AFE) B. Superficial venous thrombosis C. Deep vein thrombosis D. Pulmonary embolism E. Disseminate intravascular coagulation (DIC)

B. Superficial venous thrombosis C. Deep vein thrombosis D. Pulmonary embolism An AFE occurs during the intrapartum period when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs. DIC is an imbalance between the body's clotting and fibrinolytic systems. It's a pathologic form of clotting that consumes large amounts of clotting factors.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. At birth, the neonate of a diabetic mother is no longer in any greater risk.

B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Diabetes in pregnancy puts the fetus at risk in several ways. What should nurses be aware of? A. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. At birth, the neonate of a diabetic mother is no longer at any greater risk.

B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Which of the following assessments would indicate instability in the client hospitalized for placenta previa? A) BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPM B) FHR moderate variability without accelerations C) Dark brown vaginal discharge when voiding D) Oral temperature of 99.9°F

BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPM

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. Measuring urinary output. b. Increasing infusion rate every 30 minutes. c. Monitoring uterine response. d. Evaluating cervical dilation.

C (Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is also important; however, it is not the top priority during the administration of Pitocin. The infusion rate may be increased after proper assessment that it is an appropriate interval to do so. Monitoring labor progression is the standard of care for all labor patients.)

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? A. Internal version B. Vaginal delivery C. Cesarean section D. External cephalic version

C (Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.)

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. b. There are no important maternal (as opposed to fetal) contraindications. c. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given.

C (Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.)

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware of what? A. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. B. There are no important maternal (as opposed to fetal) contraindications. C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. D. If the client develops pulmonary edema while on tocolytics, IV fluids should be given.

C (Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.)

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? A. Vaginal delivery B. Vacuum-assisted delivery C. Cesarean section delivery D. Forceps-assisted delivery

C (Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.)

The nurse is teaching a group of pregnant clients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching? A. "I will empty my bladder immediately." B. "I will drink 2 to 3 glasses of water or juice." C. "I will lie in the supine position for 1 hour." D. "I will go to hospital if symptoms continue."

C (If there are signs and symptoms of preterm labor, the client should lie down on her side for 1 hour, because it helps improve placental and fetal circulation. The client should empty her bladder immediately, because a full bladder may sometimes irritate the uterus. Dehydration may also irritate the uterus. Therefore, the client should drink 2 to 3 glasses of water or juices. The patient should go to the hospital if the symptoms of preterm labor do not subside.)

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: a. Enhance uteroplacental perfusion in an aging placenta. b. Increase amniotic fluid volume. c. Ripen the cervix in preparation for labor induction. d. Stimulate the amniotic membranes to rupture.

C (It is accurate to state that Prepidil will be administered to ripen the cervix in preparation for labor induction. It is not administered to enhance uteroplacental perfusion in an aging placenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.)

The primary health care provider prescribes magnesium sulfate (Epsom salts) for a client to prevent preterm labor. Following administration, the nurse observes that the client has a respiratory rate of 10 breaths/minute and deep tendon reflexes. Based on these findings, what interventions would help to prevent complications in the client? A. Give an oral dose of 10 mg nifedipine (Adalat). B. Administer propranolol (Inderal) intravenously. C. Infuse 500 mg of calcium chloride intravenously for 30 minutes. D. Administer 6 mg of dexamethasone (Decadron) intramuscularly.

C (Magnesium sulfate is a tocolytic that is administered to the patient at 24 to 32 weeks of gestation to prevent the risk of preterm birth. A respiratory rate of 10 breaths/minute (below 12 breaths/minute) and deep tendon reflexes are intolerable adverse effects of the drug. Therefore, 500 mg of calcium chloride is infused intravenously for 30 minutes to reverse the magnesium sulfate (Epsom salt) toxicity. Nifedipine (Adalat) is a calcium channel blocker that should not be administered concurrently with magnesium sulfate (Epsom salt), because it results in skeletal muscle blockade. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.)

A newborn's heart rate is 80 beats per minute. The nurse learns that during labor, the amniotic fluid was meconium stained. What further assistance should the nurse provide to the newborn? A. Provide a large-bore suction catheter and bulb syringe. B. Place the baby in an incubator, providing frequent backrubs. C. Provide endotracheal tube suction assistance with ventilation. D. Administer 5 mg of sucrose solution within the first five hours of birth.

C (Oxytocin may cause uterine tachysystole, which may lead to meconium-stained amniotic fluid. Meconium contains waste products of the fetus. Meconium-stained amniotic fluid increases the risk of fetal meconium aspiration. Therefore, the newborn should be provided endotracheal suction to help remove the meconium aspirated into the lungs. The newborn's heart rate of 80 beats per minute indicates reduced heart rate that should be managed by providing ventilation support to the newborn. A large-bore suction catheter and bulb syringe are used to remove meconium ingested by the baby if the heart rate of the newborn is more than 100 beats per minute. The nurse should remove the ingested meconium first. Incubating the newborn and providing backrubs would not help to remove the meconium. A sucrose solution of 5 mg is administered to newborns with hypoglycemia. Sucrose solution is unrelated to meconium aspiration.)

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins

C (Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.)

In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

C (Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.)

Upon assessment of a pregnant client, the nurse concludes that the client is less likely to have a preterm delivery. Which client clinical finding led the nurse to conclude this? A. Previous cesarean birth. B. Preexisting diabetes mellitus. C. Cervical length is more than 30 mm. D. Symptoms of chronic hypertension.

C (The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself, in terms of effacement and dilatation. Clients having a cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus might not increase the risk of preterm labor.)

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm b. Cephalic presentation c. -2 station d. Right occiput posterior position

C (The dilation of the cervix must be great enough to determine labor. The presenting part of the fetus should be engaged and well applied to the cervix before the procedure in order to prevent cord prolapse. Amniotomy is deferred if the presenting part is higher in the pelvis. ROP indicates a cephalic presentation, which is appropriate for an amniotomy.)

The least common cause of long, difficult, or abnormal labor (dystocia) is: a. Midplane contracture of the pelvis. b. Compromised bearing-down efforts as a result of pain medication. c. Disproportion of the pelvis. d. Low-lying placenta.

C (The least common cause of dystocia is disproportion of the pelvis.)

The nurse providing care to a woman in labor should understand that cesarean birth: a. Is declining in frequency in the twenty-first century in the United States. b. Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients. c. Is performed primarily for the benefit of the fetus. d. Can be either elected or refused by women as their absolute legal right.

C (The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States in this century. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.)

A nurse providing care to a woman in labor should be aware of which fact about cesarean birth? A. It is declining in frequency in the United States. B. It is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. C. It is performed primarily for the health of the mother and fetus. D. It can be either elected or refused by women as their absolute legal right.

C (The most common indications for cesarean birth are to preserve the health of the mother and fetus. Cesarean births are increasing in the United States. Women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean birth is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.)

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Arrest of active phase d. Protracted descent

C (With an arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.)

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia.

C (Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.)

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins

C Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.

The perinatal nurse knows that tocolytic agents are most often used to: Select all answers that apply. A) Prevent maternal infection B) Prolong pregnancy to 40 weeks gestation C) Prolong pregnancy to facilitate administration of antenatal corticosteroids D) Allow for transport of the woman to a tertiary care facility

C Prolong pregnancy to facilitate administration of antenatal corticosteroids D Allow for transport of the woman to a tertiary care facility

In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm b. Cephalic presentation c. -2 station d. Right occiput posterior position

C The dilation of the cervix must be great enough to determine labor. The presenting part of the fetus should be engaged and well applied to the cervix before the procedure in order to prevent cord prolapse. Amniotomy is deferred if the presenting part is higher in the pelvis. ROP indicates a cephalic presentation, which is appropriate for an amniotomy.

6. A nurse providing care to a woman in labor should be aware that cesarean birth: A. Is declining in frequency in the United States B. Is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do C. Is performed primarily for the benefit of the fetus D. Can be either elected or refused by women as their absolute legal right

C A. Cesarean births are increasing in the United States. B. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. C. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. D. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

10. A 33-year-old woman presents to the Women's Health Center at 33 weeks of gestation for a routine obstetric visit. The woman had prior vaginal deliveries 10 and 8 years ago. This is the woman's third pregnancy, and she states that this pregnancy is "much different from the other pregnancies." She says that the baby moves frequently and that she has difficulty sleeping because of increased movement at night. She also states that she urinates every hour and feels that it interferes with her daily activities. She complains of heartburn after eating big meals and uses Tums (calcium carbonate) for relief. Her abdominal skin itches, and she has a large amount of striae on her abdomen and breast. For the past two days, she has been leaking clear fluid from the vagina that requires her to use sanitary napkins. She also complains of lower back pain after standing for long periods of time. Which finding is *not* normal in a 33-week pregnant woman? A. Difficulty sleeping B. Heartburn C. Clear fluid from the vagina D. Lower back pain

C A. Difficulty sleeping is a common occurrence during late pregnancy and can be alleviated by taking naps during the day. B. Heartburn occurs during pregnancy because of relaxation of the cardiac sphincter and pressure from the gravid uterus. C. Clear fluid from the vagina is not a normal finding in a 33-week pregnant woman and could signify rupture of membranes. This finding requires further assessment by her health care provider. D. Lower back pain is also a common discomfort in the last trimester of pregnancy because of lordosis which occurs due to the expanding uterus.

11. With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: A. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks B. There are no important maternal (as opposed to fetal) contraindications C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids D. If the client develops pulmonary edema while on tocolytics, IV fluids should be given

C A. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. B. There are important maternal contraindications to tocolytic therapy. C. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. D. Tocolytic-induced edema can be caused by IV fluids.

After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? A) "I could get an STI even if I just have oral sex." B) "Girls over 16 are less likely to get STDs than younger girls." C) "The best way to prevent an STI is to use a diaphragm." D) "Girls get human immunodeficiency virus (HIV) easier than boys do."

C) "The best way to prevent an STI is to use a diaphragm."

A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health care practitioner? A) Presence of chloasma B) Presence of severe heartburn C) 10-pound weight gain in a month D) Patellar reflexes +1

C) 10-pound weight gain in a month

A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications: A) Premature rupture of membranes B) Gestational diabetes C) Ectopic pregnancy D) Pregnancy-induced hypertension

C) Ectopic pregnancy

A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? A) Pyelonephritis B) Pregnancy-induced hypertension C) Gestational diabetes D) Abruptio placentae

C) Gestational diabetes

Karen, a 22-year-old woman with vaginal bleeding, has come to the triage unit for assessment and pain medication. She has missed one period and, following a transvaginal ultrasound, her pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The most appropriate therapy would be: A) Partial salpingectomy B) Laparoscopic salpingostomy C) Methotrexate D) Salpingectomy by laparotomy

C) Methotrexate

A woman at 32 weeks gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? A) Rise in serum creatinine B) Drop in serum protein C) Resolution of thrombocytopenia D) Resolution of polycythemia

C) Resolution of thrombocytopenia

A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? A) Patellar and biceps reflexes of +4 B) Urinary output of 50 mL/hr C) Respiratory rate of 10 rpm D) Serum magnesium level of 5 mg/dL

C) Respiratory rate of 10 rpm

A client had a previous cesarean birth. What are the criteria in order to try having a vaginal birth during the second pregnancy? Select all that apply. A. A history of postpartum hemorrhage B. A previous classical vertical incision C. Clinically adequate pelvis D. Previous low transverse incision E. No history of uterine rupture

C, D, E (A vaginal birth is possible after a previous caesarean delivery if the pelvis is found to be adequate to provide room for childbirth. A previous low transverse incision poses less risk of rupture and a vaginal delivery may be possible. A client with no history of uterine rupture would have less risk of uterine rupture during the vaginal delivery. A history of postpartum hemorrhage may not affect the risk associated with a second vaginal delivery in women with a history of first caesarean delivery. A previous vertical incision on the uterus increases the risk of uterine rupture.)

If a pregnant client suspects signs and symptoms of preterm labor, which conditions would lead the client to go to hospital immediately? Select all that apply. A. Nausea and vomiting B. Upper back pain C. Fluid leakage from vagina D. Presence of vaginal bleeding E. Contractions every 10 minutes

C, D, E (Fluid leakage from the vagina indicates rupture of the amniotic membranes. The client should seek immediate medical attention, because ruptured amniotic membranes can compromise fetal health. Presence of vaginal bleeding may indicate onset of labor or placental hemorrhage, which may compromise fetal perfusion. Therefore the client should go to the hospital immediately. Uterine contractions (UCs) after every 10 minutes indicate active labor and the client should go to the hospital immediately. Nausea and vomiting and upper back pain do not indicate labor. The client need not seek immediate medical attention for these conditions. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.)

A nursing student is reviewing information relative to cultural beliefs about infertility. Which statement if made by a client would require intervention? A. "I want to consult my rabbi before going any further with an infertility work up." B. "I will not be able to use IVF therapies, because it is against my Roman Catholic religion as." C. "I have to take full responsibility for my failure to conceive." D. "I may consider having infertility treatments but I have to talk this over with my husband first."

C. "I have to take full responsibility for my failure to conceive."

Which of the following could affect female fertility? (Select all that apply.) A. Partner relationship status B. Financial history C. A clinical diagnosis of anemia D. Bicornate uterus E. Uterine abnormality Correct F. Cephalopelvic disproportion (CPD

C. A Clinical diagnosis of anemia D. Bicornate Uterus E. Uterine abnormality

Herbal remedies have been used with some success to control PPH after initial management. Some herbs have homeostatic actions, whereas others work as oxytocic agents to contract the uterus. What herbal remedy is a commonly used oxytocic agent? A. Witch hazel B. Lady's mantel C. Blue cohosh D. Yarrow

C. Blue cohosh Witch hazel is a homeostatic herb. Lady's mantle is a homeostatic remedy. Blue cohosh, cotton root bark, motherwort, and shepherd's purse are oxytocic agents that promote uterine contraction. Yarrow is not an oxytocic agent, it is a homeostatic.

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: A. Cryoprecipitate B. Factor VIII and vWf C. Desmopressin D. Hemabate

C. Desmopressin Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products, such as factor VIII and vWf, are an acceptable option for this client. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

The nurse is assessing a client for gestational diabetes mellitus (GDM) using the oral glucose tolerance test (OGTT). What intervention by the nurse is appropriate while caring for this client? A. Teach the client to eat an unrestricted diet the day before the test. B. Instruct the client to avoid caffeine for 6 hours before the test. C. Draw blood for a fasting blood glucose level just before the test. D. Obtain the plasma glucose level an hour after a 50 g oral glucose load.

C. Draw blood for a fasting blood glucose level just before the test.

A cesarean birth is planned for a diabetic client with fetal macrosomia. Which intervention by the nurse is appropriate when preparing the client for surgery? A. Instruct the client to avoid insulin the night before the surgery. B. Administer a full dose of insulin on the morning of the surgery. C. Ensure the client has nothing by mouth on the morning of the surgery. D. Infuse intravenous 5% dextrose if the client's glucose level is below 100 mg/dl

C. Ensure the client has nothing by mouth on the morning of the surgery

Which of the following, if found in both the male and female of a couple, could present an issue with regard to the couple's fertility? A.Male and female are the same age, 35. B. Both partners have had children in their past marriage. C. History of endocrine problems. D. History of hypertension

C. History of endocrine problems

b

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? a. Assessing deep tendon reflexes (DTRs) b. Assessing for chest discomfort and palpitations c. Assessing for bradycardia d. Assessing for hypoglycemia

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of what? A. Intranasal spray B. Vaginal suppository C. Intramuscular injection D. Tablet

C. Intramuscular injection

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? A. Endometritis B. Wound infections C. Mastitis D. Urinary tract infections (UTIs)

C. Mastitis Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia.

What are maternal and neonatal risks associated with gestational diabetes mellitus? A. Maternal premature rupture of membranes and neonatal sepsis. B. Maternal hyperemesis and neonatal low birth weight. C. Maternal preeclampsia and fetal macrosomia. D. Maternal placenta previa and fetal prematurity.

C. Maternal Preeclampsia and fetal macrosomia

2. During the early postpartum period, the nurse is evaluating a client's attachment to her neonate. Which type of parent has the most difficulty attaching to her newborn? A. One who has little knowledge of parent-infant attachment B. One who recently lost a job C. One whose father recently died D. One who is an only child

C. One whose father recently died A parent that is grieving over a recent loss (in the process of detachment) will have the most difficulty bonding with the new baby. Knowledge of parent-infant attachment or being an only child are not related to successful bonding. A job loss does not have the impact that death of a family member does.

7. A woman is experiencing an early postpartum hemorrhage. Which of the following actions would be inappropriate? A. Insertion of an indwelling urinary catheter B. Fundal massage C. Pad count D. Administration of oxytocics

C. Pad count Rationale: Since the client is already hemorrhaging, it is inappropriate to initiate a pad count. Fundal massage and administration of oxytocics would be indicated if the hemorrhage is due to uterine atony. If a full bladder is displacing the uterus and preventing it from contracting, insertion of an indwelling catheter would be an appropriate response.

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: A. Call the woman's primary health care provider B. Administer the standing order for an oxytocic C. Palpate the uterus and massage it if it is boggy D. Assess maternal blood pressure and pulse for signs of hypovolemic shock

C. Palpate the uterus and massage it if it is boggy The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied.

A client who is pregnant already has type 2 diabetes and a hemoglobin A1c of 7. What does the nurse would categorize this client as having? A. Gestational diabetes B. Insulin-dependent diabetes complicated by pregnancy. C. Pregestational diabetes mellitus D. Non-insulin-dependent diabeteswith complications

C. Pregestational diabetes mellitus

A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The nurse would categorize this patient as having: A. Gestational diabetes. B. Insulin-dependent diabetes complicated by pregnancy. C. Pregestational diabetes mellitus. D. Non-insulin-dependent diabetes with complications

C. Pregestational diabetes mellitus.

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What is the primary goal of her treatment at this time? A. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours B. Reduce emotional distress by encouraging the woman to discuss her feelings C. Reverse fluid, electrolyte, and acid-base imbalances D. Restore the woman's ability to take and retain oral fluid and foods

C. Reverse fluid, electrolyte, and acid-base imbalances

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to: A. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours. B. Reduce emotional distress by encouraging the woman to discuss her feelings. C. Reverse fluid, electrolyte, and acid-base imbalances. D. Restore the woman's ability to take and retain oral fluid and foods.

C. Reverse fluid, electrolyte, and acid-base imbalances.

A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she will be able to breastfeed her baby. Which reaction by the nurse indicates accurate information? A. The patient can breastfeed the baby as long as she continues to maintain a PKU-restricted diet. B.The patient should alternate breastfeeding with bottle feeding in order to reduce PKU levels provided to the baby. C. The patient should be advised to not breastfeed the infant because her breast milk will contain large amounts of phenylalanine. D. The patient can breastfeed for the first 3 months without any untoward effects on the infant.

C. The patient should be advised to not breastfeed the infant because her breast milk will contain large amounts of phenylalanine.

A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications? The patient should increase: 1 Iron intake. 2 Calcium intake. 3 Protein intake. 4 Potassium intake.

Calcium intake.

Placement of suture to mechanically close a weak cervix

Cervical Cerclage

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? 1 Vaginal delivery 2 Vacuum-assisted delivery 3 Cesarean section delivery 4 Forceps-assisted delivery

Cesarean section delivery

It is discovered that a new mother has developed a puerperal infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition?

Client's temperature remains below 100.4° F or 38° C orally. Explanation: As fever would accompany a puerperal infection, a likely expected outcome would be to reduce the client's temperature and keep it in a normal range. The other expected outcomes do not pertain as directly to puerperal infection as does the reduced temperature.

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? 1 Propranolol (Inderal) 2 Clindamycin (Cleocin) 3 Morphine (MS Contin) 4 Terbutaline (Brethine)

Clindamycin (Cleocin)

After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the patient? 1 Danazol (Danocrine) and glipizide (Glucotrol) 2 Bromocriptine (Parlodel) and glyburide (Diabeta) 3 Progesterone (Prometrium) and acarbose (Precose) 4 Clomiphene (Clomid) and metformin (Glucophage)

Clomiphene (Clomid) and metformin (Glucophage)

A patient is being treated for a defect in the luteal phase. The nurse instructs the patient to start taking the drug on the fifth day of menstruation and continue for the next 5 days. Which drug is prescribed for the patient? 1 Progesterone (Camila) 2 Clomiphene citrate (Clomid) 3 Nafarelin acetate (Synarel) 4 Metformin (Glucophage)

Clomiphene citrate (Clomid)

b,c,d,e

Complications and risks associated with cesarean births include (Select all that apply): a. Placental abruption. b. Wound dehiscence. c. Hemorrhage. d. Urinary tract infections. e. Fetal injuries.

The nurse is titrating the maintenance dose of the Magnesium Sulfate infusion following the initial bolus dose to stop preterm labor. The nurse will continue to increase the infusion rate until which of the following assessments is noted? Decrease of blood pressure to 120/80 mm Hg Respiratory rate of 10 breaths/minute Contractions are no longer present Loss of patellar reflexes

Contractions are no longer present

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: A. Mother's age. B. Number of years since diabetes was diagnosed. C. Amount of insulin required prenatally. D. Degree of glycemic control during pregnancy

D. Degree of glycemic control during pregnancy

Male fertility declines slowly after age 40 years; however, no cessation of sperm production analogous to menopause in women occurs in men. What condition is not associated with advanced paternal age?

Down syndrome Paternal age older than 40 years is associated with an increased risk for autosomal dominant disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down syndrome can occur in any pregnancy, it is often associated with advanced maternal age.

The nurse is preparing to assist with administration of amnioinfusion (AI). Which of the following nursing interventions is appropriate? A. Obtain a solution of warmed, sterile normal saline B. Monitor the fetal heart rate through intermittent electronic fetal monitoring (EFM) C. Ensure that fluids infused into the uterus are not expelled D. Assist the patient with hourly ambulation

Correct answer: A - Obtain a solution of warmed, sterile normal saline (true) - Monitor the fetal heart rate through intermittent electronic fetal monitoring (EFM) (false) - Ensure that fluids infused into the uterus are not expelled (false) - Assist the patient with hourly ambulation (false)

Regarding vaginal birth after cesarean (VBAC), which of the following statements is true? A. Prostaglandin agents are contraindicated in women attempting a VBAC B. After one successful VBAC, there remains an increased risk of neonatal and maternal complications in subsequent attempts C. Research shows no significant correlation between maternal weight and successful VBAC D. Healthcare costs are considerably higher for women who have a VBAC than for those who have a repeat cesarean birth

Correct answer: A - Prostaglandin agents are contraindicated in women attempting a VBAC (true) - After one successful VBAC, there remains an increased risk of neonatal and maternal complications in subsequent attempts (false) - Research shows no significant correlation between maternal weight and successful VBAC (false) - Healthcare costs are considerably higher for women who have a VBAC than for those who have a repeat cesarean birth (false)

A nurse is reviewing the charts of four patients in the birthing unit. Which patient has an increased risk for an episiotomy? A. The patient laboring in a lithotomy position B. The patient with a fetus in an occiput-anterior position C. The patient with abruptio placentae D. The patient with pregnancy-induced hypertension

Correct answer: A A patient laboring in the lithotomy position or having a fetus in an occiput-posterior position would be at increased risk for having an episiotomy. A patient with abruptio placentae is at increased risk for a cesarean birth. Pregnancy-induced hypertension is not a risk factor having an episiotomy.

A nurse is caring for a patient during an amnioinfusion. Which fetal heart rate (FHR) pattern would be an expected outcome of a successful amnioinfusion? A. A decrease in variable decelerations. B. FHR pattern of 100-110 beats per minute. C. An increase in variable decelerations. D. FHR pattern of 160-180 beats per minute.

Correct answer: A Variable decelerations should decrease, not increase, following an amnioinfusion, because the fluid buffers the cord from being compressed. There should be no bradycardia or tachycardia.

The nurse educator is creating an inservice for student nurses who are completing their OB-GYN clinical rotation. When discussing misoprostol (Cytotec), which of the following components is incorrect and should be omitted from the educational content? A. The initial dosage of misoprostol for induction is 25 mcg B. Recurrent administration of misoprostol should exceed dosing intervals of more than 3 to 6 hours C. Pitocin should not be administered less than 4 hours after the last misoprostol dose D. Misoprostol should only be administered where uterine activity can be monitored continuously for an initial observation period

Correct answer: B - The initial dosage of misoprostol for induction is 25 mcg (false - this is correct) - Recurrent administration of misoprostol should exceed dosing intervals of more than 3 to 6 hours (true - this is incorrect) - Pitocin should not be administered less than 4 hours after the last misoprostol dose (false - this is correct) - Misoprostol should only be administered where uterine activity can be monitored continuously for an initial observation period (false - this is correct)

The nurse is caring for a prenatal patient at 38 weeks gestation whose ultrasound reveals approximately 3000 mL of amniotic fluid. She complains of shortness of breath and has 2+ pitting edema in her lower extremities. The nurse anticipates preparation for: A. Delivery by cesarean. B. Amniocentesis. C. Intravenous antibiotics. D. Amnioinfusion.

Correct answer: B Amniocentesis would draw fluid off and provide relief in a patient with excess amniotic fluid. A cesarean section delivery is contraindicated, because it could be dangerous to give anesthesia to a patient with respiratory distress. Intravenous antibiotics would not be indicated, as it has not been established that the patient has an infection. Amnioinfusion (instilling fluid into the uterus) is inappropriate for a patient with excess amniotic fluid.

A nurse in the birthing unit is caring for a patient following an amniotomy. What is an appropriate nursing intervention? A. Assess cervical dilation every two hours. B. Monitor temperature every two hours. C. Encourage ambulation every one to two hours. D. Replace expelled amniotic fluid every one to two hours

Correct answer: B Due to an increased risk of infection, the nurse should monitor temperature every two hours following an amniotomy. Vaginal exams are kept to a minimum to decrease the chance of infection. Bed rest is maintained unless the presenting part is engaged. Replacing expelled amniotic fluid every one to two hours is unnecessary, as amniotic fluid is constantly produced.

A nurse is planning an educational seminar on medical (allopathic) vs. natural methods of cervical ripening. The nurse teaches that the medical method uses: A. Blue/black cohosh herbs. B. Misoprostol (Cytotec). C. Evening primrose oil. D. Sexual intercourse.

Correct answer: B Misoprostol (Cytotec) is used in the allopathic method of cervical ripening, whereas blue/black cohosh herbs, primrose oil, and sexual intercourse are considered natural methods.

A nurse is caring for a patient with an oxytocin infusion. What is the correct nursing action prior to increasing the oxytocin rate? A. Assess cervical dilation B. Monitor fetal heart tones C. Evaluate the need for analgesia D. Assess maternal temperature

Correct answer: B Monitoring fetal heart tones before increasing the oxytocin rate is crucial when caring for a patient with an oxytocin infusion. Assessing cervical dilatation is done after contractions have been established. When evaluating the need for analgesia, a vaginal exam should be performed to avoid giving the medication too early. Maternal blood pressure and pulse, not maternal temperature, should be measured to assess the effects of oxytocin.

A nurse is preparing a prenatal patient with a breech presentation for an external cephalic version (ECV). What condition must be met prior to this procedure? A. Mild labor contractions B. 34 weeks gestational age C. Reactive nonstress test D. Fetal breech must be engaged in the pelvis

Correct answer: C The fetus must be more than 36 weeks gestation, with a reactive nonstress test, and not engaged in the pelvis.

Which of the following conditions is an indication for interruption of preterm labor (PTL)? A. Severe preeclampsia B. Chorioamnionitis C. Poorly controlled diabetes mellitus D. Fetal maturity

Correct answer: D - Severe preeclampsia (false) - Chorioamnionitis (false) - Poorly controlled diabetes mellitus (false) - Fetal maturity (true

The nurse is providing prenatal care to a patient pregnant with twins. How much weight should the nurse counsel this patient to gain? A. 15 to 20 pounds B. 25 to 30 pounds C. 30 to 35 pounds D. 40 to 45 pounds

Correct answer: D 40 to 45 pounds is the expected weight gain for a patient with twins. There should be a weight gain of 15-20 pounds by 20 weeks gestation.

The nurse is assessing a prenatal patient at 30 weeks gestation who was admitted to the hospital with complaints of severe nausea and vomiting, elevated alpha-fetoprotein, and a fundal height of 38 cm. What diagnosis should the nurse anticipate? A. Abruptio placentae B. Oligohydramnios C. Placenta previa D. Multiple pregnancy

Correct answer: D A prenatal patient at 30 weeks gestation with complaints of severe nausea and vomiting, elevated alpha-fetoprotein, and a fundal height of 38 is likely to have a multiple pregnancy. A patient with abruptio placentae would complain of vaginal bleeding. A patient with oligohydramnios is characterized by a decrease in amniotic fluid. A patient with placenta previa would complain of painless vaginal bleeding

The nurse is assessing a prenatal patient diagnosed with possible placenta previa. What signs and symptoms should the nurse expect this patient to demonstrate? A. Dark red vaginal bleeding B. Severe abdominal pain C. Absence of fetal heart sounds D. Bright red vaginal bleeding

Correct answer: D Bright red vaginal bleeding is a sign that a prenatal patient has possible placenta previa. Severe abdominal pain, possible absence of fetal heart sounds, and dark red vaginal bleeding are true of abruptio placentae.

The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include: Select all answers that apply: A) Cocaine use B) Tobacco use C) Previous caesarean birth D) Previous use of medroxyprogesterone (Depo-Provera)

abc

A nurse is assisting the physician with a forceps-assisted birth. When should the nurse indicate for the physician to apply traction with the forceps? A. After a contraction B. Prior to a contraction C. After a decrease in fetal heart rate D. During a contraction

Correct answer: D The nurse advises the physician when a contraction is present because traction is applied only with a contraction, not prior to or following a contraction. The patient should not be pushing during the application of forceps. Transient mild bradycardia resulting from head compression may occur as traction is applied to the forceps. Implement

The nurse is caring for a third-trimester prenatal patient admitted with bright red painless vaginal bleeding. What nursing intervention is not recommended? A. Intravenous fluids with lactated Ringer's B. Bed rest with bathroom privileges C. Application of an internal uterine pressure catheter D. Vaginal exams

Correct answer: D Vaginal exams are contraindicated on a patient with placenta previa. This is due to the increased risk of perforating the placenta. Nursing management may include intravenous fluids with lactated Ringer's; bed rest with bathroom privileges; and monitoring vital signs, contractions, bleeding, and fetal heart rate.

The nurse is monitoring a pregnant client after amniotomy. Which observation would indicate a likelihood of umbilical cord compression? A. The fetal heart rate (FHR) confirms tachycardia. B. The client's vaginal drainage has a foul-smell. C. The client has maternal chills frequently. D. The fetal heart rate (FHR) has variable decelerations.

D (Amniotomy is performed in a pregnant client in order to rupture the membranes artificially. After the procedure, the nurse should closely monitor the FHR. Reduced FHR and variable decelerations in FHR indicate that the client's umbilical cord is compressed. The nurse should immediately inform the primary health care provider of the client's condition. Tachycardia or increased FHR are common manifestations observed after amniotomy. Tachycardia does not require immediate clinical action. Maternal chills and foul-smelling vaginal discharge after amniotomy indicate infection of the ruptured membranes. However, this would not be a reason to expect umbilical cord compression.)

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.

D (Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.)

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? A. Estriol is not found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm.

D (Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes.)

Which statement is most likely to be associated with a breech presentation? A. Least common malpresentation B. Descent is rapid C. Diagnosis by ultrasound only D. High rate of neuromuscular disorders

D (Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound.)

With regard to the care management of preterm labor, nurses should be aware that: a. Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

D (Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor.)

Nurses should be aware that the induction of labor: a. Can be achieved by external and internal version techniques. b. Is also known as a trial of labor (TOL). c. Is almost always done for medical reasons. d. Is rated for viability by a Bishop score.

D (Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.)

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: a. Fetus from a breech to a cephalic presentation before labor begins. b. Fetus from a transverse lie to a longitudinal lie before cesarean birth. c. Second twin from an oblique lie to a transverse lie before labor begins. d. Second twin from a transverse lie to a breech presentation during vaginal birth.

D (Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.)

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? A. A primigravida who is 17 years old B. A 22-year-old multiparous woman with ruptured membranes C. A primigravida who has requested no analgesia during her labor D. A multiparous woman at 39 weeks of gestation who is expecting twins

D (Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction, because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.)

Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Post-term gestation

D (Post-term gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.)

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse? a. Fetal heart rate of 116 beats/min b. Cervix dilated 2 cm and 50% effaced c. Score of 8 on the biophysical profile d. One fetal movement noted in 1 hour of assessment by the mother

D (Self-care in a post-term pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. Normal findings in a 42-week gestation include fetal heart rate of 116 beats/min, cervix dilated 20 cm and 50% effaced, and a score of 8 on the biophysical profile.)

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/min B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D (Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks.)

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/minute B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D (Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If the mother has felt fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrant evaluation. A fetal heart rate of 116 beats/minute is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. A score of 8 on the BPP is a normal finding in a 42-week gestation pregnancy. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.)

The nurse is preparing to perform a fetal fibronectin test for a pregnant client. Which intervention should the nurse perform to collect the sample for the test? A. Take a blood sample from the forearm. B. Take a sample of patient's amniotic fluid. C. Ask the patient to provide a urine sample. D. Collect the vaginal secretions using a swab.

D (The fetal fibronectin test is conducted to assess whether a client is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. In order to conduct the test the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, because they may not contain adequate glycoprotein levels. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).)

The priority nursing intervention after an amniotomy should be to: a. Assess the color of the amniotic fluid. b. Change the patient's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

D (The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Secondary to FHR assessment, amniotic fluid amount, color, odor, and consistency is assessed. Dry clothing is important for patient comfort; however, it is not the top priority.)

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified FSH (Metrodin). The nurse instructs her that this medication is administered in the form of what?

Intramuscular (IM) injection Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or a vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by mouth in tablet form.

Which nursing action should be initiated first when there is evidence of prolapsed cord? A. Notify the health care provider. B. Apply a scalp electrode. C. Prepare the woman for an emergency cesarean birth. D. Reposition the woman with her hips higher than her head.

D (The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority.)

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: a. A gravida 3 who has had two low-segment transverse cesarean births. b. A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. c. A gravida 5 who had two vaginal births and two cesarean births. d. A gravida 4 who has had all cesarean births.

D (The risk of uterine rupture increases for the patient who has had multiple prior births with no vaginal births. As the number of prior uterine incisions increases, so does the risk for uterine rupture. Low-segment transverse cesarean scars do not predispose the patient to uterine rupture.)

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Urine output of 160 mL in 4 hours b. Deep tendon reflexes 2+ and no clonus c. Respiratory rate of 16 breaths/min d. Serum magnesium level of 10 mg/dL

D (The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.)

The nurse examines a client at 30 weeks of gestation for cervical dilation. The nurse understands that the infant may be at risk of cerebral palsy if it is born preterm. Which intervention would help to prevent cerebral palsy? A. Shifting the client to an obstetric facility B. Administering antibiotic medications to the client C. Administering antenatal glucocorticoids to the client D. Administering magnesium sulfate (Epsom salts) to the client

D (When preterm birth appears inevitable, magnesium sulfate (Epsom salts) is administered to the client at 24 to 32 weeks of gestation to prevent the risk of cerebral palsy. Clients in preterm labor should be shifted to a healthcare facility that is well-equipped to handle emergencies and take care of preterm infants. Antibiotics are administered to prevent infections. Antenatal glucocorticoids are administered to pregnant clients to prevent the risk of respiratory depression in the fetus, caused by structurally and functionally immature lungs. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.)

Nurses should be aware that the induction of labor: a. Can be achieved by external and internal version techniques. b. Is also known as a trial of labor (TOL). c. Is almost always done for medical reasons. d. Is rated for viability by a Bishop score.

D Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: a. Fetus from a breech to a cephalic presentation before labor begins. b. Fetus from a transverse lie to a longitudinal lie before cesarean birth. c. Second twin from an oblique lie to a transverse lie before labor begins. d. Second twin from a transverse lie to a breech presentation during vaginal birth.

D Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.

1. The clinic nurse is caring for a woman who is suspected of developing postpartum psychosis. Which of the following statements characterizes this disorder: A. Symptoms start within several days of delivery B. The disorder is common in postpartum women C. Suicide and infanticide are uncommon in this disorder D. Delusions and hallucinations accompany this disorder

D. Delusions and hallucinations accompany this disorder Rationale: A woman that develops postpartum psychosis usually does so within four weeks of delivery. Only 1% of women develop this disorder. Suicide and infanticide are common and the disorder is considered a medical emergency. Delusions and hallucinations accompany the disorder and the woman usually has a past history of a psychiatric disorder and treatment.

Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Post-term gestation

D Post-term gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.

8. For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/min B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D A. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. B. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. C. A score of 8 on the BPP is a normal finding in a 42-week gestation pregnancy. D. Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation.

7. Which statement is most likely to be associated with a breech presentation? A. Least common malpresentation B. Descent is rapid C. Diagnosis by ultrasound only D. High rate of neuromuscular disorders

D A. Breech is the most common malpresentation affecting 3% to 4% of all labors. B. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. C. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound. D. Fetuses with neuromuscular disorders have a higher rate of breech presentation perhaps because they are less capable of movement within the uterus.

2. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? A. Estriol is not found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm.

D A. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. B. Irregular, mild contractions that do not cause cervical change are not considered a threat. C. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes. D. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation.

Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? A) "During the second stage of labor you will need to bear down." B) "You should ambulate in the halls at least twice each day." C) "The doctor will likely induce your labor with oxytocin." D) "Please promptly report if you experience any bleeding or feel any back discomfort."

D) "Please promptly report if you experience any bleeding or feel any back discomfort."

The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician? A) 15 weeks, denies feeling fetal movement B) 20 weeks, fundal height at the umbilicus C) 25 weeks, complains of excess salivation D) 30 weeks, states that her vision is blurry

D) 30 weeks, states that her vision is blurry

According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: A) Take the patient's blood pressure every 6 hours B) Encourage the patient to rest on her back C) Notify the physician of a urine output greater than 30 mL/hr D) Administer magnesium sulfate according to agency policy

D) Administer magnesium sulfate according to agency policy

A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to insure client safety. A) Assess uterine contractions continuously. B) Assess fetal heart rate continuously. C) Assess urinary output. D) Assess respiratory rate.

D) Assess respiratory rate.

A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? A) Serum potassium level increases B) Diarrhea C) Urticaria D) Complaints of nervousness

D) Complaints of nervousness

The nurse is caring for a woman at 28 weeks gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? A) Human relaxin levels B) Amniotic fluid levels C) Alpha-fetoprotein levels D) Fetal fibronectin levels

D) Fetal fibronectin levels

A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? A) High leukocyte count B) Explosive diarrhea C) Fractured pelvis D) Low platelet count

D) Low platelet count

A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? A) Postpartum hemorrhage B) Neonatal hyperglycemia C) Postpartum oliguria D) Neonatal macrosomia

D) Neonatal macrosomia

The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? A) The patient with placenta previa B) The patient whose vagina is colonized with group B streptococci C) The patient who is hepatitis B surface antigen positive D) The patient with eclampsia

D) The patient with eclampsia

1. The nurse is caring for a 27-week pregnant 30-year-old woman who has arrived to labor and delivery complaining of increased pelvic pressure, vaginal bleeding, and cramping. The woman has a cerclage that was placed at 16 weeks of gestation, and she has not had any complications this pregnancy. She has a history of a 22-week fetal loss due to an incompetent cervix. The nurse applies the fetal heart monitor, which shows a baseline FHR of 140 BPM and contractions every 8 minutes. The contractions are of moderate intensity and last 50 seconds. The physician performs a sterile vaginal exam and determines that the woman is experiencing preterm labor. After being admitted to a labor and delivery room, the nurse starts an infusion of magnesium sulfate as ordered. Two hours after the magnesium sulfate infusion is started, the nurse examines the woman and finds the following: contractions every 15 minutes, FHR of 130 BPM, BP 98/76, respirations 8 breaths per minute, pulse 68 BPM, and temp 98.1 degrees Fahrenheit. Which of the following interventions should be done by the nurse first? A. Immediately draw a magnesium blood level. B. Notify the physician of the findings. C. Perform a sterile vaginal exam. D. Stop the magnesium sulfate infusion.

D. A. A stat magnesium should be done after the magnesium infusion is stopped. B. After the magnesium level is stopped, the nurse should notify the woman's health care provider of the assessment findings. C. Performing a vaginal exam does not address the woman's decreased respiration rate. D. The woman has a decreased respiration rate, which is a sign of magnesium toxicity. The nurse's first action should be to stop the magnesium infusion.

A client who has undergone several failed attempts at in vitro fertilization discusses her feelings with the nurse. If the client says that her inability to conceive does not affect her worth as a human being, what behavioral characteristic is the client showing? A. Guilt B. Denial C. Depression D. Acceptance

D. Acceptance

After checking the laboratory report of a client, the nurse reports to the primary health care provider findings that the client has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the client? A. Danazol (Danocrine) and glipizide (Glucotrol) B. Bromocriptine (Parlodel) and glyburide (Diabeta) C. Progesterone (Prometrium) and acarbose (Precose) D. Clomiphene (Clomid) and metformin (Glucophage)

D. Clomiphene (Clomid) and metformin (Glucophage)

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: a. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. b. Dietary modifications and insulin are both required for adequate treatment c. Glucose levels are monitored by testing urine four times a day and at bedtime d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

D. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? A. Risk of multiple gestation B. Whether or how to disclose the facts of conception to offspring C. Freezing embryos for later use D. Financial ability to cover the cost of treatment

D. Financial ability to cover the cost of treatment

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect: A. Bladder distention. B. Uterine atony. C. Constipation. D. Hematoma formation.

D. Hematoma formation. Bladder distention would result in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony would result in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

Which examination is useful in detecting the luteinizing hormone (LH) surge 12 to 36 hours prior to ovulation? A. Endometrial biopsy B. Sonohysterography C. Hysterosalpingogram D. Ovulation detection kit

D. Ovulation detection kit

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to: A. Acidify the urine by drinking three glasses of orange juice each day. B. Maintain a fluid intake of 1 to 2 L/day. C. Empty her bladder every 4 hours throughout the day. D. Perform perineal care on a regular basis.

D. Perform perineal care on a regular basis. Urine is acidified with cranberry juice. The woman should drink at least 3 L of fluid each day. The woman should empty her bladder every 2 hours to prevent stasis of urine. Keeping the perineum clean will help prevent a urinary tract infection.

The nurse is caring for a client with insulin-dependent diabetes mellitus in the first trimester of pregnancy. The client feels dizzy and lethargic and her blood glucose level is 50 mg/dl. What should the nurse do first in this situation? A. Ask the dietician to recommend a sugar free diet to the client. B. Assess the client for symptoms of retinopathy and nephropathy. C. Assess the serum progesterone and estrogen levels in the client. D. Provide the client a dose of glucose gel or a few glucose tablets

D. Provide the client a dose of glucose gel or a few glucose tablets

The nurse finds that the blood pH of a pregnant client who is diabetic is 6.5. What should the nurse administer to normalize the client's blood pH? A. Dextrose solution B. Normal saline solution C. Sodium citrate solution D. Sodium bicarbonate solution

D. Sodium bicarbonate solution

The nurse is caring for a pregnant client prescribed levothyroxine for hypothyroidism. The client is also prescribed an iron supplement. What information does the nurse provide the client about taking these medications? A. Take both medications together in the morning. B. Take levothyroxine 1 hour after taking the iron supplement. C. Take the iron supplement 2 hours after taking levothyroxine. D. Take the two medications at different times of the day.

D. Take the two medications at different times of the day

A 35-year-old client with one child does not respond to ovulation-inducing drugs. On assessing the client's medical history, the nurse suspects early menopause. What could be the reason for the nurse's suspicion? A. The client has taken methyldopa. B. The client had a cranial injury. C. The client had a major surgery. D. The client had undergone chemotherapy.

D. The client had undergone chemotherapy.

The insulin dose of a client in the second trimester of pregnancy has been increased. When does the nurse expect the client's prepregnant dose of insulin to be recommended again? A. When the client starts lactating B. When the client delivers the baby C. When the client is in the third trimester D. When the client weans the baby from breastfeeding

D. When the client weans the baby from breastfeeding

A labor nurse is caring for a client, 30 weeks gestation who was admitted for premature rupture of membranes (PROM) and is not in labor. Which of the following orders would the nurse question? Daily vaginal exams Prophylactic antibiotics Daily kick counts Administer betamethasone (Celestone) 12 mg IM daily times 2.

Daily vaginal exams

A patient wants to have an abortion during the 18th week of pregnancy. What abortion technique should the nurse suggest to the patient? 1 Dilation and evacuation 2 A surgical (aspiration) abortion 3 Administration of methotrexate (Trexal) 4 Administration of mifepristone (Mifeprex)

Dilation and evacuation

Significant advances have been made with most reproductive technologies. Which improvement has resulted in increased success related to preimplantation genetic diagnosis?

Embryos are transferred at the blastocyst stage. Preimplantation genetic diagnosis can be performed on a single cell removed from each embryo after 3 to 4 days. With the availability of extended culture mediums, embryos are transferred at the blastocyst stage (day 5), which increases the chance of a live birth, compared with the older practice of transferring embryos at the cleavage stage (day 3). No more than two embryos should be transferred at a time.

The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, Deficient knowledge, related to lack of understanding of the reproductive process with regard to conception. Which nursing intervention does not apply to this diagnosis?

Evaluate the couples support system. Evaluating the couples support system would be a nursing action more suitable to the diagnosis, Ineffective individual coping, related to the ability to conceive.

A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional testing is needed?

FSH level This scenario does not indicate that the woman has had any testing related to her irregular menstrual cycles. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of the womans irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the case because the husband has already produced children, antisperm antibodies may be produced by the man against his own sperm. Examination for testicular infection would be performed before semen analysis. Furthermore, infection would affect spermatogenesis.

Over 75% of women who give birth experience postpartum depression.

False Explanation: Although almost every woman notices some immediate (1 to 10 days postpartum) feelings of sadness (postpartal "blues") after childbirth, these feelings develop into postpartum depression in about 20%.

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives to enable couples to make informed decisions about their choice of treatment. Which concern is unnecessary for the nurse to address before treatment?

Financial ability to cover the cost of treatment Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that multifetal reduction may be needed. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, donor oocytes, sperm, embryos, or a surrogate mother may be needed. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

During a vaginal delivery, the obstetrician declares that shoulder dystocia is occurring. Which of the following actions by the nurse should be implemented? Administer oxytocin intravenously per order. Flex the woman's thighs sharply toward her abdomen. Apply oxygen using a tight-fitting facial mask Apply downward pressure on the woman's fundus.

Flex the woman's thighs sharply toward her abdomen.

The nurse is preparing to administer intravenous MgSO4 (magnesium sulfate) to a multipara who has been admitted for pre-term labor. What are the initial side effects that are expected to occur with the bolus dose that the nurse should explain to the patient? Hypotension, decreased respirations. Hyporeflexia and flaccid paralysis. Flushing, sweating, and irritability. Tinnitus and diarrhea

Flushing, sweating, and irritability.

What is the significance of the clomiphene citrate challenge test (CCCT)? To assess: 1 If the fallopian tubes are open and patent 2 for the presence of uterine abnormalities 3 The amount of progesterone production 4 Follicle-stimulating hormone (FSH) levels

Follicle-stimulating hormone (FSH) levels

d

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse? a. Fetal heart rate of 116 beats/min b. Cervix dilated 2 cm and 50% effaced c. Score of 8 on the biophysical profile d. One fetal movement noted in 1 hour of assessment by the mother

The nurse is caring for a 28-year-old client after the delivery of a healthy neonate. What would the nurse expect to find when assessing this client's fundus?

Fundus 1 cm above the umbilicus 1 hour postpartum Explanation: Within the first 12 hours postpartum, the fundus is usually approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by postpartum day 3. The fundus shouldn't be palpated in the abdomen after day 10. A uterus that isn't midline or is above the umbilicus on postpartum day 3 might be caused by a full, distended bladder or a uterine infection.

A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurses most appropriate response?

Get involved with a support group. Ill give you some names. Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs. However, depending on where the other couple is in their own recovery process, limiting their interactions may not be of assistance to them. Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

A primiparous woman has been admitted at 35 weeks gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? A) Hematocrit dropped to 28%. B) Platelets increased to 300,000 cells/mm3. C) Red blood cells increased to 5.1 million cells/mm3. D) Sodium dropped to 132 mEq/dL.

Hematocrit dropped to 28%.

When using the basal body temperature method of family planning, the woman should know that: 1 She will remain fertile for five days after ovulation. 2 She should take her temperature each night before going to bed. 3 Her temperature will increase about 0.4° to 0.8° F after ovulation. 4 Her temperature is normally lower during the second half of her cycle.

Her temperature will increase about 0.4° to 0.8° F after ovulation.

The nurse becomes concerned when noting which of the following past obstetric histories of a woman who plans to have a vaginal delivery after a cesarean section? Documented low transverse incision on the uterus History of previous cesarean sections 5 years ago and 3 years ago History of a cesarean section 3 years ago History of vaginal birth less than 18 months ago

History of previous cesarean sections 5 years ago and 3 years ago

A disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters and a vast proliferation of trophoblastic tissue

Hydatiform mole/Gestational trophoblastic disease

The nurse administers leuprolide acetate (Eligard) followed by gonadotropin therapy to a patient and schedules the patient for daily ultrasounds. What is the rationale for this referral? To check for: 1 Fibrocystic breast tissue changes. 2 Stimulation of the endometrium. 3 Blockage in the fallopian tubes. 4 Hyperstimulation of both ovaries.

Hyperstimulation of both ovaries.

a

Immediately after the forceps-assisted birth of an infant, the nurse should: a. Assess the infant for signs of trauma. b. Give the infant prophylactic antibiotics. c. Apply a cold pack to the infant's scalp. d. Measure the circumference of the infant's head.

d

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Urine output of 160 mL in 4 hours b. Deep tendon reflexes 2+ and no clonus c. Respiratory rate of 16 breaths/min d. Serum magnesium level of 10 mg/dL

a

In evaluating the effectiveness of oxytocin induction, the nurse would expect: a. Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. b. The intensity of contractions to be at least 110 to 130 mm Hg. c. Labor to progress at least 2 cm/hr dilation. d. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

b

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include? a. "Because this is a repeat procedure, you are at the lowest risk for complications." b. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." c. "Because this is your second cesarean birth, you will recover faster." d. "You will not need preoperative teaching because this is your second cesarean birth."

c

In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? 1 Incomplete uterine relaxation 2 Maternal fatigue and exhaustion 3 Maternal sedation with narcotics 4 Administration of tocolytic drugs

Incomplete uterine relaxation

The nurse is assessing a patient with menstrual cycle irregularity. While speaking with the patient, the nurse learns the patient is an athlete. What should the nurse suggest to the patient so as to promote a regular menstrual cycle? 1 Undergo aromatherapy treatments 2 Increase intake of food and water 3 Perform aerobic exercise regularly 4 No strenuous exercise for 5 months

Increase intake of food and water

No expulsion of the products of conception, but bleeding and dilation of the cervix such that a pregnancy is unlikely

Inevitable abortion

The nurse is assessing a couple for infertility problems. After reviewing the patient's history and laboratory results, the nurse finds that the patient is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the patient to increase the sperm count? 1 Bromocriptine (Parlodel) 2 Progesterone (Prometrium) 3 Depot medroxyprogesterone acetate (DMPA) 4 Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI)

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order? 1 Intravenous (I.V.) propranolol (Inderal) 2 1 g I.V. calcium gluconate 3 Oral dose of 20 mg of nifedipine (Adalat) 4 500 mg of I.V. calcium chloride for 30 minutes

Intravenous (I.V.) propranolol (Inderal)

To provide adequate care, the nurse should be cognitive of which important information regarding infertility?

Is perceived differently by women and men. Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a womans age, especially after age 40 years. Of cases with an identifiable cause, approximately 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a prolonged time to conceive.

Which technique is least effective for the woman with persistent occipitoposterior position? 1 Squat 2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees

Lie supine and relax

The nurse instructs a student nurse to administer depot medroxyprogesterone acetate (DMPA) to a patient. What precaution should be taken by the student nurse to ensure safe administration of the drug? Do not: 1 Massage the site after the administration. 2 Administer the injection at the deltoid muscle. 3 Administer the injection subcutaneously. 4 Aspirate a blood return prior to the injection.

Massage the site after the administration.

Which of the following assessments would cause the nurse to hold the scheduled dose of terbutaline (Brethine)? (SELECT ALL THAT APPLY). Maternal pulse of 122 bpm FHR of 170 bpm Maternal blood pressure 88/56 Audible rales Absence of contractions in the last hour

Maternal pulse of 122 bpm Maternal blood pressure 88/56 Audible rales

The nurse is about to perform a vaginal examination in order to determine cervical dilation of a patient in early labor. The patient informs the nurse that as of her last provider appointment, the baby was in a breech position. This alerts the nurse that she needs to place the patient in a supine position in order to perform the digital examination. Other maternal positions may inadvertently result in: 1 Shoulder dystocia. 2 Version. 3 Increased risk of infection. 4 Membrane rupture.

Membrane rupture.

A pregnancy that ends before 20 weeks gestation

Miscarriage

A patient has just undergone a cerclage procedure and is now in recovery. Which of the following interventions will the nurse include in the plan of care? (SELECT ALL THAT APPLY) Continuous fetal monitoring Monitor for uterine cramping Fetal kick count Monitor for vaginal bleeding Monitor for rupture of membranes

Monitor for uterine cramping Monitor for vaginal bleeding Monitor for rupture of membranes

d

Nurses should be aware that the induction of labor: a. Can be achieved by external and internal version techniques. b. Is also known as a trial of labor (TOL). c. Is almost always done for medical reasons. d. Is rated for viability by a Bishop score.

b

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: a. The terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. c. Low birth weight is anything below 3.7 pounds. d. In the United States early in this century, preterm birth accounted for 18% to 20% of all births.

During the first stage of labor, a pregnant patient complains of having severe back pain. What would the nurse infer about the patient's clinical condition from the observation? 1 Oligohydramnios 2 Chorioamnionitis 3 Frank breech presentation 4 Occipitoposterior position of the fetus

Occipitoposterior position of the fetus

Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate?

Ova and sperm are transferred to one tube. Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal tube. Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is collected before laparoscopy. The ova and sperm are then transferred to one uterine tube, permitting natural fertilization and cleavage.

The labor and delivery nurse is reviewing the chart of a client in labor and notes that the client has been 2-3 cm for the last 7 hours despite painful and frequent contractions. The nurse is concerned and calls the health care provider expecting an order for which of the following? Pain medication and sedation Have the Resident perform an amniotomy Get the operating room ready for a cesarean section Send the woman home and tell her to come back in the morning

Pain medication and sedation

A condition where the the placenta attaches to the lower uterine segment of the uterus

Placenta previa

pulmonary embolism

complicaiton occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? 1 Placing the woman in the knee-chest position. 2 Covering the cord in a sterile towel saturated with warm normal saline. 3 Preparing the woman for a cesarean birth. 4 Starting oxygen by face mask.

Placing the woman in the knee-chest position.

Perform perineal care on a regular basis.

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to what?

c

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: a. Enhance uteroplacental perfusion in an aging placenta. b. Increase amniotic fluid volume. c. Ripen the cervix in preparation for labor induction. d. Stimulate the amniotic membranes to rupture.

Which factor should alert the nurse to the potential for a prolapsed umbilical cord? 1 Oligohydramnios 2 Pregnancy at 38 weeks of gestation 3 Presenting part at a station of -3 4 Meconium-stained amniotic fluid

Presenting part at a station of -3

Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has: 1 A stillbirth. 2 Placental abruption. 3 Prolonged pregnancy. 4 Elevated uterine contractions (UCs)

Prolonged pregnancy.

On interacting with a patient, the nurse finds that the patient uses lubricants that contain nonoxynol-9 (N-9) at least twice a day. The nurse instructs the patient to not use N-9. What is the reason for giving such advice to the patient? Because frequent use of this medication: 1 Can cause a significant decrease in the patient's libido. 2 Increases the patient's progesterone and estrogen levels. 3 Reduces bone mineral density and causes osteoporosis. 4 Raises the patient's risk of sexually transmitted infections.

Raises the patient's risk of sexually transmitted infections.

Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. 4 Reposition the woman with her hips higher than her head

Reposition the woman with her hips higher than her head

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. 1 Fluid intake 2 Respiratory status 3 Body temperature 4 Level of consciousness 5 Deep tendon reflexes

Respiratory status Level of consciousness Deep tendon reflexes

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps: 1 Ripen the cervix." 2 Prevent vaginal infections." 3 Reduce the risk of preterm labor." 4 Improve uterine contractions (UCs).

Ripen the cervix."

When assessing a client who is 5 days pospartum, which of the following would alert the nurse to suspect that the client is experiencing late postpartum hemorrhage?

Rubra colored lochia Explanation: The nurse should monitor for rubra colored lochia, malodorous vaginal discharge, and increased uterine cramping when actual hemorrhage occurs in a client experiencing late postpartum hemorrhage. Fundal tenderness is a sign of endometritis. Oliguria is suggestive of bacteremia in clients. Increased rectal pressure is a sign of postpartal hematoma in a client

Specks or spots in the vision where the patient cannot see; "blind spots"

Scotomata

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. Which guidance should the nurse provide?

Smoking can reduce the quality of your sperm. Cigarette smoking has detrimental effects on sperm and has been associated with abnormal sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a smoking cessation program to increase the fertility of the male partner. Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. Marijuana use may depress the number and motility of sperm. Smoking is indeed a causative agent for lung cancer.

What are the symptoms of toxic shock syndrome? Select all that apply. 1 Sore throat 2 Constipation 3 Decrease in libido 4 Sudden onset of high fever 5 Arthralgia and myalgia

Sore throat Sudden onset of high fever Arthralgia and myalgia

d

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: a. A gravida 3 who has had two low-segment transverse cesarean births. b. A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. c. A gravida 5 who had two vaginal births and two cesarean births. d. A gravida 4 who has had all cesarean births.

The perinatal nurse knows that a __________ hemorrhage is limited to the uterus, and a _________ hemorrhage moves blood toward and through the cervix.

concealed, revealed

A couple arrives for their first appointment at an infertility center. Which of the following is a noninvasive test performed during the initial diagnostic phase of testing?

Sperm analysis Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of testing for male infertility. Radiographic film examination allows visualization of the uterine cavity after the instillation of a radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure, during which a small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful to view the pelvic structures intraperitoneally and is an invasive procedure.

Identify the hallmark of placenta previa that differentiates it from abruptio placenta. A) Sudden onset of painless vaginal bleeding B) Board-like abdomen with severe pain C) Sudden onset of bright red vaginal bleeding D) Severe vaginal pain with bright red bleeding

Sudden onset of painless vaginal bleeding

c

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy c. Transcervical catheter b. Intravenous Pitocin d. Vaginal insertion of prostaglandins

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? 1 Teach gentle lower extremity exercises to the patient. 2 Suggest that the patient lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the patient. 4 Give tocolytic medications as per the physician's prescription.

Teach gentle lower extremity exercises to the patient.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? 1 Buccal oxytocin (Pitocin) 2 Terbutaline sulfate (Brethine) 3 Calcium gluconate (Calgonate) 4 Magnesium sulfate (Magnesium sulfate)

Terbutaline sulfate (Brethine)

A woman, G4 P0030 at 12 weeks gestation has just been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? The client will gain less than 25 pounds during the pregnancy The client will deliver after 38 weeks gestation The client will have normal blood glucose levels throughout the pregnancy The client will deliver a baby that is appropriate for gestational age

The client will deliver after 38 weeks gestation

a

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a. Viral c. Cervical b. Periodontal d. Urinary tract

What laboratory finding would indicate that the nurse should inform the patient about egg donation? 1 The follicle-stimulating hormone (FSH) level is 25. 2 The follicle-stimulating hormone (FSH) level is 8. 3 The progesterone level is 10. 4 The progesterone level is 30.

The follicle-stimulating hormone (FSH) level is 25.

With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information?

The investigation will take several months and can be very costly. Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment. Both partners are systematically and simultaneously assessed, first as individuals and then as a couple. Semen analysis is for men; however, the postcoital test is for the couple.

c

The least common cause of long, difficult, or abnormal labor (dystocia) is: a. Midplane contracture of the pelvis. b. Compromised bearing-down efforts as a result of pain medication. c. Disproportion of the pelvis. d. Low-lying placenta.

The nurse observes that a pregnant patient has a high temperature and a foul smell of amniotic fluid during labor. Which possible complications would the nurse find in the patient and in the neonate after the delivery? Select all that apply. 1 The neonate may have pneumonia. 2 The patient may have a pelvic abscess. 3 The patient may have impaired lactation. 4 The patient may have supine hypotension. 5 The neonate may have bacteremia and sepsis.

The neonate may have pneumonia. The patient may have a pelvic abscess. The neonate may have bacteremia and sepsis.

Bright red blood

The nurse is assessing a client with postpartum hemorrhage (PPH). During the physical assessment, the nurse finds that there are deep lacerations in the cervix. Which observation allows the nurse to conclude that the PPH is due to cervical lacerations?

Assess for hypovolemia and notify the primary health care provider

The nurse is assessing a postpartum client 4 hours after delivery. The nurse observes that the client has cool, pale, and clammy skin with severe restlessness and thirst. What should the immediate nursing intervention be?

b

The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of: a. Uterine contractions occurring every 8 to 10 minutes. b. A fetal heart rate (FHR) of 180 with absence of variability. c. The client's needing to void. d. Rupture of the client's amniotic membranes.

oocyte donation

this is usually done by women < 35. - donor eggs are fertilized with male partner's sperm. - hormonal stimulation to develop uterine lining.

c

The nurse providing care to a woman in labor should understand that cesarean birth: a. Is declining in frequency in the twenty-first century in the United States. b. Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients. c. Is performed primarily for the benefit of the fetus. d. Can be either elected or refused by women as their absolute legal right.

b,d,e

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)? a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c. Uterine tone <20 mm Hg d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

c

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. Measuring urinary output. b. Increasing infusion rate every 30 minutes. c. Monitoring uterine response. d. Evaluating cervical dilation.

d

The priority nursing intervention after an amniotomy should be to: a. Assess the color of the amniotic fluid. b. Change the patient's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

In vitro fertilizationembryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. Which explanation regarding the procedure is most accurate?

The procedure begins with collecting eggs from your wifes ovaries. A womans eggs are collected from her ovaries, fertilized in the laboratory with the partners sperm, and transferred to her uterus after normal embryonic development has occurred. Transferring a donor embryo to the womans uterus describes the procedure for a donor embryo. Inseminating the woman with donor sperm describes therapeutic donor insemination. Telling the client not to worry discredits the clients need for teaching and is not the most appropriate response.

d

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: a. Fetus from a breech to a cephalic presentation before labor begins. b. Fetus from a transverse lie to a longitudinal lie before cesarean birth. c. Second twin from an oblique lie to a transverse lie before labor begins. d. Second twin from a transverse lie to a breech presentation during vaginal birth.

An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurses most appropriate response?

This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins? The incidence of multiple pregnancies with the use of these medications is higher than 25%. The clients concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the clients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is inaccurate. Furthermore, the clients concern is discredited with a statement such as, dont worry.

Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)?

Thyroid dysfunction Synthroid is administered for anovulation associated with hypothyroidism. For women with polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have insufficient progesterone and require exogenous progesterone until placental production is sufficient.

c

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm c. -2 station b. Cephalic presentation d. Right occiput posterior position

A client is on magnesium sulfate for preterm labor. The nurse notes the following assessment at 8:00 am: Urine output 100 ml; 98.6F, 88, 10, 120/70; absent patellar reflexes; decreased level of consciousness. The nurse's first action should be: Call the health care provider Administer calcium gluconate Turn the magnesium sulfate off Apply oxygen per facial mask at 8-10 liters/minute

Turn the magnesium sulfate off

Hematoma

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect what?

Which test is performed around the time of ovulation to diagnose the basis of infertility?

Ultrasonography Ultrasonography is performed around the time of ovulation to assess pelvic structures for abnormalities, to verify follicular development, and to assess the thickness of the endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

anesthesia

Upon assessment the nurse finds that the client who has undergone a cesarean delivery is at risk of postpartum hemorrhage (PPH). What would be the most likely cause of PPH in this client?

On reviewing the laboratory report of the patient, the nurse finds that the patient is subfertile. Which nursing advice is helpful for the patient to resolve this condition? 1 Start taking cold baths or showers daily. 2 Take flaxseed oil in order to stimulate fertility. 3 Add periwinkle powder to your tea once a day. 4 Use water-soluble lubricants during intercourse.

Use water-soluble lubricants during intercourse.

The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed?

Uterine fibroids Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy.

A condition where the umbilical cord is implanted into the membranes rather than the placenta

Vasa previa

Hypercoagulation

What is the primary cause of thromboembolic disease?

Desmopressin

What is the treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage?

palpate the uterus and massage is its boggy

When a nurse observes profuse postpartum bleeding, the first and most important nursing intervention is to what?

Inversion of the uterus and hypovolemic shock

Which PPH conditions are considered medical emergencies that require immediate treatment?

d

Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Post-term gestation

polyhydramnios, prolonged labor, fetal macrosomia

Which condition in the client may lead to uterine atony?

Client complains of headache and reaction time increases to asking questions

Which indicator would lead the nurse to suspect that the postpartum client experiencing hemorrhagic shock is getting worse?

Aspirin

Which medication is contraindicated in a client who is on anticoagulant therapy?

a

Which patient status is an acceptable indication for serial oxytocin induction of labor? a. Past 42 weeks' gestation c. Polyhydramnios b. Multiple fetuses d. History of long labors

Mastitis

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?

3:1

Which ratio would be used to restore effective circulating volume in a postpartum client who is experiencing hypovolemic shock?

placental percreta

Which term is used to describe perforation of the uterus due to placental adherence to the uterine walls?

broad spectrum antibiotics

While assessing a postpartum client the nurse finds that the client has excessive foul smelling lochia. What medication would be helpful in treating the condition?

b

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a. Ripening the cervix usually results in a decreased success rate for induction. b. Labor sometimes can be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor.

The nurse is assessing a patient who is planning to conceive. While reviewing the patient's laboratory reports, the nurse notices a decrease in hypothalamic hormone levels. What should the nurse interpret from this? The patient: 1 Will not be able to successfully produce any ova. 2 Demonstrates impairment in fallopian factors. 3 Has an increased risk of fetal congenital anomalies. 4 Has a family history of fetal hemorrhagic disorders

Will not be able to successfully produce any ova.

b

With regard to dysfunctional labor, nurses should be aware that: a. Women who are underweight are more at risk. b. Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. c. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. d. Abnormal labor patterns are most common in older women

d

With regard to the care management of preterm labor, nurses should be aware that: a. Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

a

With regard to the process of augmentation of labor, the nurse should be aware that it: a. Is part of the active management of labor that is instituted when the labor process is unsatisfactory. b. Relies on more invasive methods when oxytocin and amniotomy have failed. c. Is a modern management term to cover up the negative connotations of forceps-assisted birth. d. Uses vacuum cups.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when informing the client on which herbal preparations may improve ovulation induction therapy

You may want to try black cohosh or phytoestrogens. Ovulation therapy may have better outcomes when supplemented by black cohosh, progesterone, or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10, and ginseng have been shown to improve male fertility. Although most herbal remedies have not been clinically proven, many women find them helpful. They should be prescribed by a health care provider who has knowledge of herbalism.

grief (bereavement)

a cluster of painful responses experienced by individuals coping with the death of someone with whom they had a close relationtionship, generally a relative or clsoe friend

2-5

a hysterosalpingography is performed ___-___ days before menstruation to avoid flushing a fertilized egg.

surrogate mother

a woman can be inseminated with infertile woman's partner, or an ovum can be retrieved from the infertile woman and fertilized with partner's sperm then implanted to carry baby.

8. Which of the following behaviors illustrates engrossment? a. A father is sitting in a rocking chair, holding his new baby boy, touching his toes, and making eye contact. b. A mother tells her friends that her baby's eyes and nose are just like hers. c. A mother picks up and cuddles her baby girl when she begins to cry. d. A grandmother gazes into her new grandson's face, which she holds about 8 inches away from her own; she and the baby make eye-to-eye contact.

a. A father is sitting in a rocking chair, holding his new baby boy, touching his toes, and making eye contact.

16. A woman experiencing heavy postpartum bleeding asks her nurse if there are any herbal remedies she can use as part of her treatment regimen. Which of the following would the nurse discuss with the woman? (Circle all that apply.) a. Blue cohosh b. Shepherd's purse c. St. John's wort d. Lavender tea e. Lady's Mantle f. Red raspberry leaves

a. Blue cohosh b. Shepherd's purse e. Lady's Mantle f. Red raspberry leaves

10. The nurse responsible for the care of postpartum women should recognize that the first sign of puerperal infection would most likely be which of the following? a. Fever with body temperature at 38° C or higher after the first 24 hours following birth b. Increased white blood cell count c. Foul-smelling profuse lochia d. Bradycardia

a. Fever with body temperature at 38° C or higher after the first 24 hours following birth

12. Which of the following would be a priority question to ask a woman experiencing postpartum depression? a. Have you thought about hurting yourself? b. Does it seem like your mind is filled with cobwebs? c. Have you been feeling insecure, fragile, or vulnerable? d. Does the responsibility of motherhood seem overwhelming?

a. Have you thought about hurting yourself?

14. A newborn, at 5 hours old, wakes from a sound sleep and becomes very active and begins to cry. Which of the following signs if exhibited by this newborn would indicate expected adaptation to extrauterine life? (Circle all that apply.) a. Increased mucus production b. Passage of meconium c. Heart rate of 160 beats per minute d. Respiratory rate of 24 breaths per minute and irregular e. Retraction of sternum with inspiration f. Expiratory grunting with nasal flaring

a. Increased mucus production b. Passage of meconium c. Heart rate of 160 beats per minute

13. A woman gave birth to twin girls, one of whom was stillborn. Which of the following nursing actions would be least helpful in supporting the woman as she copes with her loss? a. Remind her that she should be happy that one daughter survived and is healthy. b. Assist the woman in taking pictures of both babies. c. Encourage the woman to hold the deceased twin in her arms to say good-bye. d. Offer her the opportunity for counseling to help her with her grief and that of her surviving twin as she gets older.

a. Remind her that she should be happy that one daughter survived and is healthy.

9. A radiant warmer will be used to help a newborn girl to stabilize her temperature. The nurse implementing this care measure should do which of the following? a. Undress and dry the infant before placing her under the warmer. b. Set the control panel between 35° to 38° C. c. Place the thermistor probe on her abdomen just below her umbilical cord. d. Assess her rectal temperature every hour until her temperature stabilizes.

a. Undress and dry the infant before placing her under the warmer.

10. A nurse is evaluating a woman's breastfeeding technique. Which of the following actions would indicate that the woman needs further instruction regarding breastfeeding to ensure success? (Circle all that apply.) a. Washes her breasts and nipples thoroughly with soap and water twice a day b. Massages a small amount of breast milk into her nipple and areola before and after each feeding c. Lines her bra with a thick plastic-lined pad to absorb leakage d. Positions baby supporting back and shoulders securely and then brings her breast toward the baby, putting the nipple in the baby's mouth e. Feeds her baby every 2 to 3 hours f. Inserts her finger into the corner of her baby's mouth between the gums before removing him from the breast

a. Washes her breasts and nipples thoroughly with soap and water twice a day c. Lines her bra with a thick plastic-lined pad to absorb leakage d. Positions baby supporting back and shoulders securely and then brings her breast toward the baby, putting the nipple in the baby's mouth

8. The expected outcome for care when methylergonovine (Methergine), an oxytocic, is administered to a postpartum woman during the fourth stage of labor would be which of the following? The woman will: a. demonstrate expected lochial characteristics. b. achieve relief of pain associated with uterine cramping. c. remain free from infection. d. void spontaneously within 4 hours of birth.

a. demonstrate expected lochial characteristics.

15. When assessing a newborn boy at 12 hours of age, the nurse notes a rash on his abdomen and thighs composed of reddish macules, papules, and small vesicles. The nurse would: a. document the finding as erythema toxicum. b. isolate the newborn and his mother until infection is ruled out. c. apply an antiseptic ointment to each lesion. d. request nonallergenic linen from the laundry.

a. document the finding as erythema toxicum.

The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes: Select all answers that apply: A) Encouraging regular, on-going prenatal care B) Reporting symptoms of urinary frequency and burning to the health care provider C) Coming to the labor triage unit if back pain or cramping persist or become regular D) Lying on the right side, withholding fluids and counting fetal movements if contractions occur every five minutes

abc

Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks gestation. An appropriate nursing action would be to: Select all answers that apply: A) Assess the fetal heart rate B) Obtain a urine for culture and sensitivity C) Assess Kerry's blood pressure and pulse D) Palpate Kerry's abdomen for contractions

abd

The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include: Select all answers that apply: A) Chorioamnionitis B) Abruptio placentae C) Operative birth D) Cord prolapse

abd

The perinatal nurse knows that specific testing is provided to a woman who has had three or more perinatal losses in the first twenty weeks. Appropriate tests may include: Select all answers that apply: A) Cervical cultures B) Sickle cell screening C) Maternal/paternal karyotype D) Thyroid stimulating hormone (TSH) levels

acd

postpartum depression

an intense an pervasive sadness with sever and labile mood swings; it is more serious and persistent than postpartum blues. Intense fears, anger, anxiety, an despondency that persist past the babys first few weeks are not a normal part of postpartum blues

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: A uterine atony b lacerations of the genital tract c perineal hematoma d infection of the uterus

b

An multifarious woman is admitted to the postpartum unit after a rapid labor and birth of a 4000g infant. Her fundus is boggy, lochia heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remain difficult to find and the rubra lochia remains heavy. The nurse should: A. continue to massage the fundus b notify the physician c recheck vital signs d. insert a Foley catheter

b

The nurse is assessing a woman who delivered an hour ago. She notes the uterus is boggy. What should be the first intervention for this woman? A notify the nurse-midwife b. massage the uterus until firm c administer Pitocin d have the woman void

b

The nurse knows that late postpartum hemorrhage can be prevented by: A administering broad spectrum antibiotics b inspecting the placenta after delivery c manually removing the placenta d pulling on the umbilical cord to hasten the delivery of the placenta

b

15. A 17-year-old woman experiences a miscarriage at 12 weeks of gestation. When she is informed about the miscarriage she begins to cry, stating that she was upset about her pregnancy at first and now she is being punished for not wanting her baby. Which of the following would be the nurse's best response? a. "You are still so young, you probably were not ready for a baby right now." b. "This must be so hard for you. I am here if you want to talk." c. "At least this happened early in your pregnancy before you felt your baby move." d. "God must have a good reason for letting this happen."

b. "This must be so hard for you. I am here if you want to talk."

5. During a home visit, the mother of a 1-week-old infant son tells the nurse that she is very concerned about whether her baby is getting enough breast milk. The nurse would tell this mother that at 1 week of age a well-nourished newborn should exhibit which of the following? a. Weight gain sufficient to reach his birthweight b. A minimum of three bowel movements each day c. Approximately 10 to 12 wet diapers each day d. Breastfeeding at a frequency of every 4 hours or about 6 times each day

b. A minimum of three bowel movements each day

11. A breastfeeding woman's cesarean birth occurred 2 days ago. Investigation of the pain, tenderness, and swelling in her left leg led to a medical diagnosis of deep vein thrombosis (DVT). Care management for this woman during the acute stage of the DVT would involve which of the following actions? (Circle all that apply.) a. Explaining that she will need to stop breastfeeding until anticoagulation therapy is completed b. Administering heparin via continuous intravenous drip c. Placing the woman on bed rest with her left leg elevated d. Encouraging the woman to change her position frequently when on bed rest e. Teaching the woman and her family how to administer warfarin (Coumadin) subcutaneously after discharge f. Telling the woman to use acetaminophen (Tylenol) for discomfort

b. Administering heparin via continuous intravenous drip c. Placing the woman on bed rest with her left leg elevated d. Encouraging the woman to change her position frequently when on bed rest f. Telling the woman to use acetaminophen (Tylenol) for discomfort

10. A newborn male has been scheduled for a circumcision. Essential nursing care measures following this surgical procedure would include which one of the following? a. Administer oral acetaminophen every 6 hours for a maximum of 4 doses in 24 hours. b. Apply petroleum jelly or A&D ointment to the site with every diaper change. c. Check the penis for bleeding every 15 minutes for the first 4 hours. d. Teach the parents to remove the yellowish exudate that forms over the glans using a diaper wipe.

b. Apply petroleum jelly or A&D ointment to the site with every diaper change.

8. A breastfeeding woman asks the nurse about what birth control she should use during the postpartum period. Which is the best recommendation for a safe, yet effective method during the first 6 weeks after birth? a. Combination oral contraceptive that she used before she was pregnant b. Barrier method using a combination of a condom and spermicide foam c. Resume using the diaphragm she used prior to getting pregnant d. Complete breastfeeding—baby only receives breast milk for nourishment

b. Barrier method using a combination of a condom and spermicide foam

14. During the acute distress phase of the grief response parents are most likely to experience which of the following? (Circle all that apply.) a. Fear and anxiety about future pregnancies b. Difficulty with making decisions c. Search for meaning d. Sadness and depression e. Denial and disbelief f. Guilt and helplessness

b. Difficulty with making decisions d. Sadness and depression e. Denial and disbelief

12. When assessing postpartum women during the first 24 hours after birth, the nurse must be alert forsignsthat could indicate the development of postpartum physiologic complications.Which ofthe following signs would be of concern to the nurse? (Circle all that apply.) a. Temperature—38° C b. Fundus—midline, boggy c. Lochia—3/4 of pad saturated in 3 hours d. Anorexia e. Voids approximately 150 to 200 ml of urine for each of the first three voidings after birth.

b. Fundus—midline, boggy d. Anorexia

7. The nursing care management of a newborn whose mother is HIV positive would most likely include which of the following? (Circle all that apply.) a. Isolating the newborn in a special nursery b. Implementing standard precautions immediately after birth c. Telling the mother that she should not breastfeed d. Wearing gloves for routine care measures such as feeding e. Initiating treatment with antiviral medication(s) as soon as the newborn is confirmed to be HIV positive f. Preparing to administer antibiotics to prevent the newborn from developing opportunistic infections

b. Implementing standard precautions immediately after birth c. Telling the mother that she should not breastfeed

10. When caring for a preterm infant born at 30 weeks of gestation, the nurse should recognize which of the following as the newborn's primary nursing diagnosis? a. Risk for infection related to decreased immune response b. Ineffective breathing pattern related to surfactant deficiency and weak respiratory muscle effort c. Ineffective thermoregulation related to immature thermoregulation center d. Imbalanced nutrition: less than body requirements related to ineffective suck and swallow

b. Ineffective breathing pattern related to surfactant deficiency and weak respiratory muscle effort

8. A newborn male has been designated as large for gestational age. His mother was diagnosed with gestational diabetes late in her pregnancy. The nurse should be alert for signs of hypoglycemia. Which of the following assessment findings would be consistent with a diagnosis of hypoglycemia? a. Hyperthermia b. Jitteriness c. Loose, watery stools d. Laryngospasm

b. Jitteriness

7. Which of the following nursing actions would be least effective in facilitating parent attachment to their new infant? a. Referring the couple to a lactation consultant to ensure continuing success with breastfeeding b. Keeping the baby in the nursery as much as possible for the first 24 hours after birth so the mother can rest c. Extending visiting hours for the woman's partner or significant other as they desire d. Providing guidance and support as the parents care for their baby's nutrition and hygiene needs

b. Keeping the baby in the nursery as much as possible for the first 24 hours after birth so the mother can rest

11. The doctor has ordered that a newborn receive a hepatitis B vaccination prior to discharge. In fulfilling this order, the nurse should do which of the following? (Circle all that apply.) a. Confirm that the mother is hepatitis B positive before the injection is given. b. Obtain parental consent prior to administering the vaccination. c. Inform the parents that the next vaccine in the series would need to be given in 1 to 2 months. d. Administer the injection into the vastus lateralis muscle. e. Use a 1-inch, 23-gauge needle. f. Insert the needle at a 45-degree angle

b. Obtain parental consent prior to administering the vaccination. c. Inform the parents that the next vaccine in the series would need to be given in 1 to 2 months. d. Administer the injection into the vastus lateralis muscle.

8. Methylergonovine (Methergine) 0.2 mg is ordered to be administered intramuscularly to a woman who gave birth vaginally 1 hour ago for a profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with intravenous magnesium sulfate at 1 g/hr. Her blood pressure, measured 5 minutes ago, was 155/98. In fulfilling this order, the nurse would do which of the following? a. Measure the woman's blood pressure again 5 minutes after administering the medication. b. Question the order based on the woman's hypertensive status. c. Recognize that Methergine will counteract the uterine relaxation effects of the magnesium sulfate infusion the woman is receiving. d. Tell the woman that the medication will lead to uterine cramping.

b. Question the order based on the woman's hypertensive status.

9. A woman has determined that bottle-feeding is the best feeding method for her. Instructions the woman should receive regarding this feeding method should include which of the following? a. Provide the infant with supplemental vitamins along with the iron-fortified formula. b. Sterilize water by boiling, then cool and mix with formula powder or concentrate. c. Expect a 2-week-old newborn to drink approximately 30 to 60 mL of formula at each feeding. d. Microwave refrigerated formula for about 2 minutes before feeding the newborn.

b. Sterilize water by boiling, then cool and mix with formula powder or concentrate.

9. Preterm infants are at increased risk for developing respiratory distress. The nurse should assess for signs that would indicate that the newborn is having difficulty breathing. Which of the following are signs of respiratory distress? (Circle all that apply.) a. Use of abdominal muscles to breathe b. Tachypnea c. Periodic breathing pattern d. Suprasternal retraction e. Nasal flaring f. Acrocyanosis

b. Tachypnea d. Suprasternal retraction e. Nasal flaring

9. A woman expresses a need to review her labor and birth experience with the nurse who cared for her while in labor. This behavior is most characteristic of which of the following phases of maternal postpartum adjustment? a. Taking-hold (dependent-independent phase) b. Taking-in (dependent phase) c. Letting-go (interdependent) d. Postpartum blues (baby blues)

b. Taking-in (dependent phase)

12. The nurse is preparing to administer erythromycin ophthalmic ointment 0.5% to a newborn after birth. Which of the following nursing actions would be appropriate? (Circle all that apply.) a. Administer the ointment within 30 minutes of the birth. b. Wear gloves. c. Cleanse eyes if secretions are present. d. Squeeze an ointment ribbon of 1 to 2 inches into the lower conjunctival sac. e. Wipe away excess ointment after 1 minute. f. Apply the ointment from inner to outer canthus

b. Wear gloves. c. Cleanse eyes if secretions are present. e. Wipe away excess ointment after 1 minute. f. Apply the ointment from inner to outer canthus

16. A breastfed full-term newborn girl is 12 hours old and is being prepared for early discharge. Which of the following assessment findings, if present, could delay discharge? a. Dark green-black stool, tarry in consistency b. Yellowish tinge in sclera and on face c. Swollen breasts with a scant amount of thin discharge d. Blood-tinged mucoid vaginal discharge

b. Yellowish tinge in sclera and on face

7. A woman, 24 hours after giving birth, complains to the nurse that her sleep was interrupted the night before because of sweating and the need to have her gown and bed linen changed. The nurse's first action would be to: a. assess this woman for additional clinical manifestations of infection. b. explain to the woman that the sweating represents her body's attempt to eliminate the fluid that was accumulated during pregnancy. c. notify her physician of the finding. d. document the finding as postpartum diaphoresis.

b. explain to the woman that the sweating represents her body's attempt to eliminate the fluid that was accumulated during pregnancy.

9. A nurse is preparing to administer RhoGAM to a postpartum woman. Before implementing this care measure the nurse should: a. ensure that medication is given at least 24 hours after the birth. b. verify that the Coombs' test results are negative. c. make sure that the newborn is Rh negative. d. cancel the administration of the RhoGAM if it was given to the woman during her pregnancy at 28 weeks of gestation.

b. verify that the Coombs' test results are negative.

The perinatal nurse explains to the student nurse who is assessing the abdomen of a 32-week pregnant woman with placenta previa that it would not be unusual to find the fetus in a ________ or ________ position.

breech, transverse

The clinic nurse assesses Marijke, a 30-year old primigravid woman at 15 weeks gestation. Marijke's blood pressure, measured twice at intervals one hour apart, is 146/96. This finding is best described as: A) Preeclampsia B) Pregnancy-induced hypertension C) Chronic hypertension D) Transient hypertension

c

Which woman is at greater risk for early postpartum hemorrhage? A. a gravida 1 who delivered a 7lb baby boy b. a gravida 3 who delivered a 5lb baby girl c.a gravida 1 who delivered mature twins d. a gravida 2 who delivered a premature baby girl

c from overdistention of the uterus

10. Before discharge, a postpartum woman and her partner ask the nurse about the baby blues. "Our friend said she felt so let down after she had her baby, and we have heard that some women actually become very depressed. Is there anything we can do to prevent this from happening to us or at least to cope with the blues if they occur?" The nurse could tell this couple: a. "Postpartum blues usually happen in pregnancies that are high risk or unplanned, so there is no need for you to worry." b. "Try to become skillful in breastfeeding and caring for your baby as quickly as you can." c. "Get as much rest as you can and sleep when the baby sleeps, because fatigue can precipitate the blues or make them worse." d. "I will call your doctor before you leave to get you a prescription for an antidepressant to prevent the blues from happening."

c. "Get as much rest as you can and sleep when the baby sleeps, because fatigue can precipitate the blues or make them worse."

11. The nurse is caring for a newborn whose mother had gestational diabetes. His estimated gestational age is 41 weeks, and his birthweight is 4800 g. When assessing this newborn, the nurse should be alert for which of the following? a. Fracture of the femur b. Hypercalcemia c. Blood glucose level less than 40 mg/dL d. Signs of a congenital heart defect

c. Blood glucose level less than 40 mg/dL

7. The nurse evaluates the laboratory test results of a full term newborn who is 4 hours old. Which of the following results would require notification of the pediatrician? (Circle all that apply.) a. Hemoglobin 20 g/dL b. Hematocrit 54% c. Glucose 34 mg/dL d. Total serum bilirubin 3.1 mg/dL e. White blood cell count 24,000/mm3 f. Calcium 6 mg/dL

c. Glucose 34 mg/dL f. Calcium 6 mg/dL

11. A new breastfeeding mother asks the nurse how to prevent nipple soreness. The nurse tells this woman that the key to preventing sore nipples would be which of the following? a. Limiting the length of breastfeeding to no more than 10 minutes on each breast until the milk comes in b. Applying lanolin to each nipple and areola after each feeding c. Using correct breastfeeding technique d. Using nipple shells to protect the nipples and areola between feeding

c. Using correct breastfeeding technique

7. The nurse is prepared to assess a postpartum woman's fundus. The nurse would tell the woman to: a. elevate the head of the bed. b. place her hands under her head. c. flex her knees. d. lie flat with legs extended and toes pointed.

c. flex her knees.

18. When assessing a newborn after birth, the nurse notes flat, irregular, pinkish marks on the bridge of the nose, nape of neck, and over the eyelids. The areas blanch when pressed with a finger. The nurse would document this finding as: a. milia. b. nevus vasculosus. c. telangiectatic nevi. d. nevus flammeus.

c. telangiectatic nevi.

The perinatal nurse knows that tocolytic agents are most often used to: Select all answers that apply: A) Prevent maternal infection B) Prolong pregnancy as long as possible C) Facilitate administration of antenatal corticosteroids D) Allow for transport of the woman to a tertiary care facility

cd

postpartum, puerperal infection

clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. In the USA it is defined as a temperatur of 38C or more on 2 successive days of the first 10 postpartum days (not counting the first 24 hours after birth)

superficial venous thrombosis; DVT

clot involves the superficial saphenous venous sytsem. ??? clot involvement can extend from the foot to the iliofemoral region.

idiopathic thrombocytopenic purpura

coagulopahty resulting from an autoimmune disorder in which antiplatelet antibodies decrease the life span of the platelets

pelvic hematoma; vulvar hematomas; vaginal hematomas

collection of blood in the connective tissue as a result of blood vessel damage.??? are the most common type. ??? are usually associated with a forceps-assisted birth and episiotomy or primigravidity

The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks gestation in her first pregnancy. She is worried about having her baby "too soon" and she is experiencing uterine contractions every 10-15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health care provider reveals that that the cervix is closed, long, and posterior. The most likely diagnosis would be: A) Preterm labor B) Term labor C) Back labor D) Braxton-Hicks contractions

d

The perinatal nurse knows that the term to describe a woman at 26 weeks gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: A) Preeclampsia B) Chronic hypertension C) Gestational hypertension D) Chronic hypertension with superimposed preeclampsia

d

Which condition is transient, self-limiting mood disorder, that affects new mothers after childbirth> A postpartum depression b postpartum psychosis c postpartum bipolar disorder d. postpartum blues

d

6. During the final phase of the claiming process of a newborn, which of the following might a mother say? a. "She has her grandfather's nose." b. "His ears lay nice and flat against his head, not like mine and his sister's, which stick out." c. "She gave me nothing but trouble during pregnancy, and now she is so stubborn she won't wake up to breastfeed." d. "He has such a sweet disposition and pleasant expression. I have never seen a baby quite like him before.

d. "He has such a sweet disposition and pleasant expression. I have never seen a baby quite like him before.

11. Prior to discharge at 2 days postpartum, the nurse evaluates a woman's level of knowledge regarding the care of her second degree perineal laceration. Which of the following statements if made by the woman would indicate the need for further instruction before she goes home? (Circle all that apply.) a. "I will wash my stitches at least once a day with mild soap and warm water." b. "I will change my pad every time I go to the bathroom—at least 4 times each day." c. "I will use my squeeze bottle filled with warm water to cleanse my stitches after I urinate." d. "I will take a sitz bath once a day before bed for about 10 minutes." e. "I will apply the anesthetic

d. "I will take a sitz bath once a day before bed for about 10 minutes." e. "I will apply the anesthetic

6. An Rh-negative woman (2-2-0-0-2) just gave birth to a healthy term Rh-positive baby boy. The direct and indirect Coombs' test results are both negative. The nurse should do which of the following? a. Prepare to administer Rho(D) immune globulin (RhoGAM) to the newborn within 24 hours of his birth. b. Observe the newborn closely for signs of jaundice appearing within 24 hours of birth. c. Recognize that RhoGAM is not needed because both Coombs' test results are negative. d. Administer Rho(D) immune globulin intramuscularly to the woman within 72 hours of her baby's birth.

d. Administer Rho(D) immune globulin intramuscularly to the woman within 72 hours of her baby's birth.

6. A woman is trying to calm her fussy baby daughter in preparation for feeding. She exhibits a need for further instruction if she does which of the following? a. Swaddles the baby b. Dims lights in the room and turns off the television c. Gently rocks the baby and talks to her in a low voice d. Attempts to get the baby to latch on immediately

d. Attempts to get the baby to latch on immediately

6. A nurse has assessed a woman who gave birth vaginally 24 hours ago. Which of the following findings would require further assessment? a. Bright to dark red uterine discharge b. Midline episiotomy—approximated,moderate edema, slight erythema, absence of ecchymosis c. Protrusion of abdomen with sight separation of abdominal wall muscles d. Fundus firm at 1 cm above the umbilicus and to the right of midline

d. Fundus firm at 1 cm above the umbilicus and to the right of midline

9. A postpartum woman in the fourth stage of labor received prostaglandin F2a (Hemabate) 0.25 mg intramuscularly. The expected outcome of care for the administration of this medication would be which of the following? a. Relief from the pain of uterine cramping b. Prevention of intrauterine infection c. Reduction in the blood's ability to clot d. Limitation of excessive blood loss that is occurring after birth

d. Limitation of excessive blood loss that is occurring after birth

17. As part of a thorough assessment, the newborn should be checked for hip dislocation and dysplasia. Which of the following techniques would be used? a. Check for syndactyly bilaterally b. Stepping or walking reflex c. Magnet reflex d. Ortolani's maneuver

d. Ortolani's maneuver

7. The nurse should teach breastfeeding mothers about breast care measures to preserve the integrity of the nipples and areola. Which of the following should the nurse include in these instructions? a. Cleanse nipples and areola twice a day with mild soap and water. b. Apply vitamin E cream to nipples and areola at least four times each day before a feeding. c. Insert plastic-lined pads into the bra to absorb leakage and protect clothing. d. Place a nipple shell into the bra if nipples are sore.

d. Place a nipple shell into the bra if nipples are sore.

8. Which of the following women at 24 hours after giving birth is least likely to experience afterpains? a. Primipara who is breastfeeding her twins that were born at 38 weeks of gestation b. Multipara who is breastfeeding her 10-pound fullterm baby girl c. Multipara who is bottle-feeding her 8-pound baby boy d. Primipara who is bottle-feeding her 7-pound baby girl

d. Primipara who is bottle-feeding her 7-pound baby girl

6. A newborn male is estimated to be at 40 weeks of gestation following an assessment using the New Ballard scale. Which of the following would be a Ballard scale finding consistent with this newborn's full-term status? (Circle all that apply.) a. Apical pulse rate of 120 beats per minute, regular, and strong b. Popliteal angle of 160 degrees c. Weight of 3200 g, placing him at the 50th percentile d. Thinning of lanugo with some bald areas e. Testes descended into the scrotum f. Elbow does not pass midline when arm is pulled across the chest

d. Thinning of lanugo with some bald areas e. Testes descended into the scrotum f. Elbow does not pass midline when arm is pulled across the chest

17. The nurse caring for a women experiencing postpartum depression would question which of the following medication orders if a woman is breastfeeding? a. citalopram (Celexa) b. venlafaxine (Effexor) c. paroxetine (Paxil) d. doxepin (Sinequan)

d. doxepin (Sinequan)

10. When teaching a postpartum woman with an episiotomy about using a sitz bath, the nurse should emphasize: a. using sterile equipment. b. filling the sitz bath basin with hot water (at least 42° C). c. taking a sitz bath once a day for 10 minutes. d. squeezing her buttocks together before sitting down, then relaxing them.

d. squeezing her buttocks together before sitting down, then relaxing them.

subinvolution

delayed return of the enlarged uterus to normal size and function

pessary

device that can be inserted into the vagina for the purpose of supporting the uterus and holding it in the correct position

Mary, a G3 TPAL 0020 woman at 20 weeks gestation, has had a transvaginal ultrasound. Mary has been informed that she has cervical incompetence. The perinatal nurse explains that this diagnosis means that her cervix has ______ without ______ contractions.

dilated, regular

direct

direct or indirect way of detecting ovulation? - pregnancy - aspirating an egg from fallopian tube after released.

TDI

donated sperm when male partner has no sperm or very low count < 20 million/mL - couple has genetic defect - antisperm antibodies

uterine prolapse

downward displacement of the uterus, with degrees of displacement from mild to complete

hemorrhagic (hypovolemic) shock

emergency situation in which profuse blood loss can result in severly compromised perfusion of body organs. Death may occur

before

encourage intercourse a day ___________ ovulation and day of ovulation to maximize chance of pregnancy.

early PPH

excessive blood loss that occurs within 24 hours after birth and is often caused by marked uterine hypotonia

ZIFT

fertilization occurs in vitro (outside of body) and the zygote is placed in the uterine tube. - instead of egg and sperm, it's already a zygote that is implanted.

thrombosis

formation of a blood clot or clots inside a blood vessel

bitersweet grief

grief response that occurs with reminders of the lossl typically happens on birthdays, death days, and anniversaries, at school events; during changes in the seasons; and during the time of year when the loss occurred

A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would question the woman about which symptom?

hardening of an area in the affected breast Explanation: Mastitis is characterized by a tender, hot, red, painful area on the affected breast. An inverted nipple is not associated with mastitis. With mastitis, the breast is distended with milk, the area is inflamed (not ecchymotic), and there is breast tenderness.

no

have herbal remedies been clinically proven to be safe or promote fertility?

rectocele

herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum

mastitis

infection of the breast affecting approximately 2% to 10% of women, soon after childbirth, most of whom are first-time breastfeeding mothers; it almost always is unilateral and develops well after lactation has been established

endometritis

infection of the lining of the uterus; is the most common cause of postpartum infection and usually begins as a localized infection at the placental site

thrombophlebitis

inflammation of a vein with clot formation

A nurse providing care to a woman in labor should be aware that cesarean birth: 1 is declining in frequency in the United States. 2 is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. 3 is performed primarily for the health of the mother and fetus. 4 can be either elected or refused by women as their absolute legal right.

is performed primarily for the health of the mother and fetus.

yes

is referred shoulder pain for 12-14 hours normal after a hysterosalpingography?

postpartum hemorrhage; PPH

loss of 500 ml or more of blood after vaginal birth or 1000 ml or more after cesarean birth

uterine atony

marked hypotonia of the uterus; the uterus fails to contract well or maintain contraction

ovulation

metformin & dexamethasone help support ___________.

semen analysis

most basic and noninvasive test for assessment of male infertility. - looks at #, shape, and motility - leukocytes, agglutination from antibodies

The nurse is getting ready to discharge a patient to home who was admitted for preterm labor that was halted by the use of Magnesium Sulfate. The nurse understands that which of the following medications will now be used to prevent another episode of preterm labor? methylergonoavine (Methergine) Betamethasone (Celestone) Antibiotics Therapy nifedipine (Procardia)

nifedipine (Procardia)

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to: 1 ejaculate into a sterile container. 2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. 3 transport specimen with container packed in ice. 4 ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days.

Disseminated intravascular coagulation

pathologic form of clotting that is diffuse and consumes large amounts of clotting factors

vesicovaginal fistula

perforation between the bladder and the genital tract

rectovaginal fistula

perforation between the rectum or simoid colon and the vagina

urethrovaginal fistula

perforation between the urethra and the vagina

fistula

perforations between genital tract organs

A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition?

postpartum psychosis Explanation: The client's signs and symptoms suggest that the the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the infant, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that her life is rapidly tumbling out of control. The client thinks of herself as an incompetent parent. Emotional swings, crying easily—often for no reason, and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristics of postpartum blues.

mood disorders

predominant classification of mental health disorders in the postpartum period

intrauterine insemination

prepared sperm is put into a syringe and introduced directly into uterus. - if sperm quality is low, unfavorable mucus/endometriosis

Birth prior to 37 completed weeks of pregnancy is .

preterm birth

assisted hatching

process where an infrared laser creates a hole in the zona pellucida so the embryo can break through and implant.

cystocele

protrusion of the bladder downward into the vagina that develops when supporting structures in the vesicovaginal septum are injured

The perinatal nurse encourages Colleen, who has just been discharged from the hospital for intravenous therapy for severe nausea and vomiting, to ensure that she _______ often, eats frequent ____ meals and avoids _______ odors.

rests, small, cooking

gonadotropins

selective estrogen receptor modulators that are injected IM daily for ovarian follicular growth and maturation. - FSH, LH

2-5

semen analysis occurs after ____-____ days of abstinence from ejaculation. - kept at body/room temp and taken to lab within 1 hour of ejaculation

15

sperm number should be at least _____ million/mL with normal morphology, forward moving, and normal volume.

anterior colporrhaphy

surgical procedure used to repair large symptomatic cystoceles

posterior colporrhaphy

surgical procedure used to repari large symptomatic rectoceles

postpartum psychosis

syndrome most often characterized by depression, delusion, and thoughts by the mother of harming either herself or her infant

oligospermia

term that means FEW sperm cells are produced.

4

testes > _____ cm in diameter is favorable for fertility.

12-14

the basal body temperature usually elevates _____-_____ days before menstruation which indicates ovulation.

alcohol

this habit can lead to erectile dysfunction in men.

smoking

this habit decreases the quality and number of sperm.

clomiphene

this is a PO med that is taken on set days early in the cycle for ovulation induction. - it's a selective estrogen receptor modulator. - ovarian stimulation drug

laparoscopy

this is a procedure that involves creating a small incision in the abdomen and looking at the outside structures (peritoneum, fibroids, endometriosis, adhesions). - indicated for women with *symptoms* to rule out endometriosis or long-term fertility for an unknown reason

transvaginal ultrasound

this is a tool used to look at pelvic structures and detect abnormalities like tumors and cysts.

hormone analysis

this is often used to see if there is communication between the hypothalamus and pituitary. - when cycles are irregular or absent

IVF-ET

this is the most invasive ART. - when blockage or endometriosis is suspected - sperm and egg are outside of body, embryo created and introduced into uterus for implantation. - 2 procedures (egg retrieval, embryo transfer)

A client who is hypertensive and who received corticosteroids during pregnancy gave birth by cesarean and subsequently developed endometritis. Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. What is the most important aspect of post hospital care the nurse should teach her?

wound care and hand washing Explanation: The use of systemic corticosteroids prior to birth has increased her risk for development of an infection. She has been treated for endometritis and is now at greater risk for infection. Hand washing is the best defense again transmission of any infection. While adherence to antibiotic therapy, proper perineal care, and use of warm compresses and sitz baths may be indicated, they would not be a higher priority than wound care and hand washing.