Ob final

how is endometrosis diagnosed?

- Bimanual examination - Fixed, tender, retroverted uterus - Palpable nodules in cul-de-sac Diagnosis confirmed by laparoscopy

define and list characteristics for endometriosis

- Pelvic pain - related to menstrual cycle - Dyspareunia - painful intercourse - Abnormal uterine bleeding

define and list characteristics of intraductal papilloma

- Prevalent during menopause - Have the potential to become malignant - Most frequent cause of nipple discharge in nonpregnant, nonlactating females Small ball-like solitary nodules

how is endometreosis treated?

- Surgical removal of visible endometrial tissue - Surgical removal of uterus and ovaries - Hormonal therapy Women with minimal symptoms - observation, analgesics, nonsteroidal and anti-inflammatory drugs

list the 2 types of IUD

- The Copper T380A (ParaGard) is non hormonal - LNG-IUS

what are risk factors for endometriosis

- Use of superabsorbent tampons - Use of cervical cap or diaphragm during menses - Colonization of Staphylococcus aureus

fibrocystic breast changes

- caused by an imbalance in progesterone and estrogen - breast tissue thickens

list barrier methods of contraceptives

- condom - female condom - diaphragm - cervical cap - vaginal sponge

what are signs and symptoms of Toxic shock symptoms

- fever - rash on trunk - Desquamation of the skin, especially the palms and soles; occurs 1 to 2 weeks after onset of symptoms - Hypotension and dizziness - Systemic symptoms - vomiting, diarrhea, severe myalgia, and inflamed mucous membranes - consciousness, disorientation, and coma

how is TSS treated

- hydration - broad antibiotics - prevention through education - do not use tampons for first 6-8 weeks after childbirth

1. The client is making her first visit to the contraceptive clinic to discuss her options for birth control. When teaching the client about family planning, the nurse should include information on which of the following? Select all that apply. 1. Male condoms and spermicide should be used together 2. Depomedroxyprogesterone acetate (DMPA) 3. Oral contraceptives 4. Screening for possible birth defects 5. Semen analysis

1. Male condoms and spermicide should be used together 2. Depomedroxyprogesterone acetate (DMPA) 3. Oral contraceptives Rationale: A client interested in contraception should be informed about all options available to her before choosing one. Among these options are male condoms with spermicide, DMPA, and oral contraceptives. Screening for birth defects and semen analysis are not services helpful for birth control.

what is the treatment of fibrocystic breast changes

Na and caffeine

list the warning signs and symptoms of IUD

PAINS P = Period late (pregnancy), abnormal spotting or bleeding A = Abdominal pain, pain with intercourse I = Infection exposure (STI), abnormal vaginal discharge N = Not feeling well, fever >100.4°F, chills S = String missing, shorter or longer than usually felt

list the warning signs and symptoms of Cervical cap, diaphragm, and contraceptive sponge

Toxic Shock Syndrome • Elevation of temperature >101.4°F • Diarrhea and vomiting • Weakness and faintness • Muscle aches • Sore throat • Sunburn-type rash • Difficult or painful urination • Abdominal or pelvic fullness • Foul-smelling vaginal discharge

10. A pregnant client asks the nurse when the fetal heart will begin beating. The nurse tells the client even though the fetal heart is not fully developed it begins to beat at gestational week _____.

Answer: 4 Rationale: By the end of 28 days (4 gestational weeks) the tubular heart is beating at a regular rhythm and circulating primitive red blood cells through the main blood vessels.

7. When reviewing the assessment data of the client, what data would lead the nurse to recommend a method of contraception other than oral contraceptives? 1. Family history of ovarian cancer 2. Type 1 diabetes mellitus 3. History of iron-deficiency anemia 4. Fibrocystic breast disease

2. Type 1 diabetes mellitus Rationale: Oral contraceptives place the client at decreased risk for iron-deficiency anemia, ovarian cancer, and fibrocystic breast disease. Oral contraceptives can decrease the effectiveness of insulin.

9. The client is a long-distance runner, with 9.0% body fat. Which findings would the nurse expect to assess in this client? 1. Regular menses, and a BBT that indicates ovulation 2. Irregular menses, and a BBT that shows ovulation 3. Regular menses, and a BBT that indicates lack of ovulation 4. Irregular menses, and a BBT that indicates lack of ovulation

4. Irregular menses, and a BBT that indicates lack of ovulation Rationale: Fourteen percent body fat is considered adequate to have regular menses and regular ovulation. A client with less than 10% body fat will ovulate and menstruate very irregularly if at all

6. Following a teaching session on how to use the diaphragm as a contraceptive method, the nurse evaluates the client's understanding. Which statement made by the client demonstrates the need for additional teaching? 1. "If I choose a diaphragm, I won't need to use any spermicide." 2. "I will need to inspect the diaphragm after I take it out and clean it." 3. "When I want to get pregnant, I can just stop using my diaphragm." 4. "I need to leave the diaphragm in for at least six hours after having intercourse." 5. The diaphragm should remain in place for at least six hours after coitus.

1. "If I choose a diaphragm, I won't need to use any spermicide." Rationale: A spermicidal cream or jelly is applied to the rim and dome of the diaphragm before inserting the device to increase the contraceptive effectiveness of the device. The other statements, needing to inspect the diaphragm after it is removed, being able to stop using the diaphragm at will, and needing to leave the diaphragm in for at least six hours after use, reflect correct client knowledge.

10. The client is a 43-year-old nullipara who is in for her first intrauterine insemination of her partner's washed semen. The nurse determines that client teaching has been effective when the client makes which statement about basal body temperature (BBT)? 1. "If I get pregnant, I'll see an increase in my BBT." 2. "If I do not become pregnant, I'll see an increase in my BBT." 3. "If I get pregnant, I'll see a decrease in my BBT." 4. "If I do not get pregnant, I'll see a dip and an increase in my BBT."

1. "If I get pregnant, I'll see an increase in my BBT." Rationale: Pregnancy is characterized by a 0.5 to 1.0°F persistent increase in BBT. The incorrect responses do not follow this trend.

8. A nurse evaluates understanding of fetal development in a prenatal class. The nurse concludes that more teaching is required when one of the group members make which statement? 1. "Smoking will help me have an easy labor because the baby will be small." 2. "I should not smoke at all during pregnancy." 3. "Infants born to mothers who smoke may suffer lung problems." 4. "Chemicals from smoking pass through the placenta to the fetus."

1. "Smoking will help me have an easy labor because the baby will be small." Rationale: Smoking causes vasoconstriction that can interfere with placental circulation. The infant may suffer negative effects including intrauterine growth restriction. Any chemical the mother is exposed to during pregnancy has the potential to pass through the placenta to the fetus.

6. A woman at seven months of pregnancy says that her 8-year-old daughter talks to the fetus and this calms the fetus when kicking her in the ribs. She asks the nurse if this is a possibility. What is the best response by the nurse? 1. "This may very well be the case because the fetus begins to hear at 24 weeks." 2. "We really don't know at what age the fetus begins to hear." 3. "This is unlikely since the fetus doesn't hear until eight months' gestation." 4. "You are both right and wrong. The fetus is able to hear, but it is silly to think your daughter's voice calms the fetus.

1. "This may very well be the case because the fetus begins to hear at 24 weeks." Rationale: The ears ossify at 20 weeks' gestation and the fetus has the ability to hear at 24 weeks. Telling the client that it's uncertain when the fetus begins to hear or that the fetus does not hear until eight months' gestation is factually incorrect. Telling the client that she is "silly" to think the fetus can be calmed by a sibling's voice creates distance between client and nurse from possibly offensive language

7. A client at eight months' gestation is diagnosed with oligohydramnios. She asks the nurse if this can harm the fetus. What is the nurse's best response? 1. "Well, the reduced fluid around the fetus can allow for umbilical cord compression." 2. "Yes, it means the fetus swallowed too much fluid." 3. "No, this commonly occurs toward the end of pregnancy." 4. "No, this is a sign that the lungs are maturing."

1. "Well, the reduced fluid around the fetus can allow for umbilical cord compression. Rationale: Oligohydramnios is an insufficient amount of amniotic fluid, which impairs the normal functions of the fluid, resulting in potential complications such as fetal skin and skeletal abnormalities, pulmonary hypoplasia, and umbilical cord compression. It does not indicate that the fetus has swallowed too much amniotic fluid. It is an abnormal condition occurring when amniotic fluid volume is less than expected for a given stage of pregnancy. Oligohydramnios is not a sign of maturing lungs

8. A client has decided to use a cervical cap for contraception. In providing instruction to the client on the correct use of this method, the nurse should tell the client to do which of the following? 1. Apply a spermicide to the inside of the cap. 2. Insert the cap no longer than four hours prior to intercourse. 3. Remove the cap within six hours of sexual activity. 4. Reapply spermicide with repeated acts of intercourse.

1. Apply a spermicide to the inside of the cap. Rationale: Spermicide should be applied to the inside of the cervical cap. The device has no time limit between insertion and sexual activity, and may be left in place up to 48 hours after sexual activity. Reapplication of spermicide with repeated acts of intercourse is not needed.

1. Which intervention would be most effective in teaching a client with low literacy skills how to insert a diaphragm? 1. Assess the client's understanding of how a diaphragm works. 2. Give the client a printed handout explaining use of the diaphragm. 3. Provide the client with an opportunity to practice inserting and removing the diaphragm. 4. Use an audiotape to explain use of the diaphragm.

1. Assess the client's understanding of how a diaphragm works. Rationale: Assessing the client's knowledge should be performed before the teaching session, not during instructions on insertion. Printed materials may not be appropriate to the client's reading ability. An audiotape does not allow the client to see the insertion technique, while visual cues are provided by demonstration of the procedure. Practice sessions provide the nurse with an opportunity to give positive and corrective feedback integrating visual, auditory, and tactile senses.

6. The nurse would include which nursing intervention when planning care for an infertile couple? 1. Assistance in dealing with feelings of guilt and shame 2. Helping to determine which partner is to blame 3. Referral to a financial counselor to plan for their child's future 4. Discussion of the advantages of adoption instead of infertility treatment

1. Assistance in dealing with feelings of guilt and shame Rationale: Infertile couples must deal with guilt, shame, and other psychosocial issues. The nurse's role is to be supportive, facilitate sharing of feelings between the couple, and provide guidance through the infertility assessment and treatment process. Although it can occur, it is not helpful to blame one partner or the other for the infertility problem. There is no indication that the couple needs financial counseling. There is no evidence that the couple is ready to talk about other parenting options such as adoption.

1. Which of the following should the nurse include when developing the plan of care for an infertile client? 1. Assistance in resolving feelings of guilt 2. Past year medical and surgical history of both partners 3. Brief answers to questions asked and issues raised 4. Referral to another clinic for a second opinion

1. Assistance in resolving feelings of guilt Rationale: Either partner may experience feelings of guilt when faced with infertility. If the problem is with one partner, that partner's feelings of guilt are often more intense. Taking a medical and surgical history of both partners relates to the clients' histories, not the plan of care. Only giving brief answers to questions asked and raised is nontherapeutic. Referring the clients to another clinic for a second opinion is not the role of the nurse

3. A client with a history of toxic shock syndrome comes to the reproductive clinic seeking contraception. Based on this information, which method should the nurse avoid recommending for this client? 1. Cervical cap 2. Female condom 3. Spermicide 4. Implanted progestin rod (Implanon)

1. Cervical cap Rationale: The cervical cap increases the risk of toxic shock syndrome because it may be left in place for up to 48 hours. The female condom, spermicide, and an implanted progestin rod pose no additional risk to this client based on her history and could be considered for contraception.

1. Two married clients have one child with Tay-Sachs disease, but neither of the clients has the disease. They are in the clinic for genetic counseling prior to conceiving another child. The nurse formulates which nursing diagnosis that most likely applies to this couple? 1. Decisional Conflict related to knowledge deficit 2. Posttrauma Syndrome related to care of a disabled child 3. Powerlessness related to transmission of genetic disease 4. Ineffective Health Maintenance related to ineffective family coping

1. Decisional Conflict related to knowledge deficit Rationale: Families with genetic disease are faced with difficult decisions regarding pregnancy. One of the purposes of genetic counseling is to provide the best information available so families can make knowledgeable decisions. The fact that the family is seeking professional help is evidence that they feel some power regarding the situation. There is no evidence one way or another regarding their coping abilities with a disabled child. There is no evidence to support posttrauma syndrome

9. The nurse manager of the maternal-child unit is evaluating how well the unit met the ACOG (American College of Obstetrics and Gynecology) standard of starting a cesarean section within 30 minutes of the decision for surgery. What is the best way for the nurse manager to assess if the standard is met? 1. Do a chart review for documentation of time of decision and time surgery began and compare to the national standard. 2. Interview the nurses involved in the case as to how long it took from decision to surgery. 3. Assume that all emergency cesarean sections are done within the recommended 30 minutes. 4. Ask the obstetricians how long it took from the time they ordered the surgery until they made the first cut.

1. Do a chart review for documentation of time of decision and time surgery began and compare to the national standard.

2. The nursery nurses prefer keep newborns in the nursery except for feeding times, saying they can monitor newborns better in the nursery. They justify this action by saying that the infants need to be available for pediatricians whenever they might make rounds. What type of views are the nursery nurses expressing? 1. Ethnocentric views 2. Culturally aware views 3. Culturally sensitive views 4. Culturally diverse views

1. Ethnocentric views Rationale: The views of the nursery nurses are ethnocentric and based on the culture of the Western health care system where convenience for the pediatricians is of primary importance and only the nurses can adequately monitor the clients. The terms culturally aware, culturally sensitive, and culturally diverse imply an appreciation of other cultures and their preferences surrounding childbirth.

7.A client taking oral contraceptive pills calls the clinic and reports the presence of chest pain and shortness of breath. The nurse should instruct the client to do which of the following? 1. Go to the nearest emergency room to be evaluated. 2. Wait for the physician to return a telephone call to the client. 3. Stop taking the pills and use a nonhormonal contraceptive method. 4. Eat smaller meals more frequently to prevent gastric distention.

1. Go to the nearest emergency room to be evaluated. Rationale: Shortness of breath and chest pain can indicate a serious complication associated with the use of oral contraceptives and require immediate evaluation. Waiting for a return telephone call could delay evaluation and treatment, jeopardizing the client's health. Changing the contraceptive method or food intake pattern does not reduce the immediate health risk to the client.

2. The client is scheduled for a hysterosalpingogram (HSG). What information should the nurse obtain during the preoperative assessment? 1. History of pelvic inflammatory disease (PID) 2. Allergy to peanuts 3. Presence of metal implants 4. Difficulty swallowing

1. History of pelvic inflammatory disease (PID) Rationale: A recurrence of PID can occur following HSG, so this data should be assessed before the procedure so that prophylactic antibiotics can be prescribed. A water-or oil-based dye is instilled into the uterus and watched on x-ray to detect uterine anomalies or lack of tubal patency; however, a peanut allergy is of no concern with the use of contrast media. The presence of metal implants or difficulty swallowing will not affect the test

list the warning s&s of Oral contraceptives

ACHES A = Abdominal pain C = Chest pain, cough, and/or shortness of breath H = Headaches, dizziness, weakness or numbness E = Eye problems (blurring or change in vision) and speech problems S = Severe leg, calf, and/or thigh pain

7. A nurse is the defendant in a lawsuit brought by a client who had a postpartum hemorrhage requiring transfusion of 15 units of blood and a hysterectomy after delivery of her third child. The client had an epidural before delivery and had persistent uterine atony with heavy bleeding immediately after delivery of the placenta. In the immediate postpartum period, the client's uterus continued to get boggy and the client had a heavy, bright rubra lochial flow. The nurse is being sued for not providing appropriate care. Which of the following nursing actions would demonstrate upholding the standard of care for a client experiencing a postpartum hemorrhage? 1. Palpate the fundus every 10-15 minutes and if boggy, massage to expel clots. 2. Have the client empty her bladder only when she has the urge to void. 3. Discontinue the pitocin IV when the uterus is firm and 4 cm above the umbilicus. 4. Do assessments every 30 minutes as indicated on the postpartum flow sheet.

1. Palpate the fundus every 10-15 minutes and if boggy, massage to expel clots. Rationale: Standard of care for clients experiencing a postpartum hemorrhage requires frequent assessments (every 10-15 minutes) of vital signs, uterine tone and placement, characteristics and amount of lochia, condition of the perineum, urinary elimination, and level of pain. Massaging the uterus helps to ensure that the uterus stays firm, empty, and involutes toward the umbilicus. Immediately after delivery the client might not have an urge to void and needs to be encouraged to do so, especially when the uterus is rising above the umbilicus. The IV should be maintained until there is no further risk of postpartum hemorrhage.

5. Following an amniocentesis the parents discover that their fetus has Down syndrome. What should the nurse do at this time? 1. Provide information about Down syndrome in an empathetic and respectful manner. 2. Discuss the possibility of intrauterine surgery. 3. Refer the parents for karyotyping. 4. Refer the parents to their local public health agency.

1. Provide information about Down syndrome in an empathetic and respectful manner. Rationale: The nurse is in an ideal position to provide information, educate families, and review what has been discussed in genetic counseling sessions. The nurse provides information about Down syndrome. Karyotyping is not indicated because they have a diagnosis. Intrauterine surgery cannot cure a chromosomal anomaly. Referral to public health may be indicated after the parents make a decision regarding the pregnancy.

10. A client from the Gusii tribe in Kenya presents in active labor. As the nurse does a vaginal exam she realizes that the client has been circumcised and the vaginal opening is not large enough to admit two fingers. The nurse believes female circumcision is a type of mutilation. What should the nurse do to be able to continue to give appropriate, supportive care? 1. Recognize that her personal beliefs and values differ from those of the client. 2. Report the finding of the circumcision to the primary care provider. 3. Avoid entering the client's room and making further assessments. 4. Accept that personal values and beliefs will interfere with the provision of care.

1. Recognize that her personal beliefs and values differ from those of the client. Rationale: Personal values and beliefs clarification is the first step in appreciating that personal ethical views may differ greatly from the client's value system. Understanding the differences allows the nurse to remain objective when providing care and when serving as a consultant for decision making by the client. Reporting the finding to the physician focuses on physiological needs. Avoiding entering the room does not address the need to provide the appropriate standard of care. Assuming that personal values and beliefs will interfere with care does not address the need to provide appropriate supportive care

5. The nurse working in an infertility clinic explains to an infertile couple that they will likely have which tests ordered as a part of their original work-up? Select all that apply. 1. Semen analysis 2. Mammogram 3. Colposcopy 4. Nonstress test 5. Hysterosalpingogram

1. Semen analysis 5. Hysterosalpingogram Rationale: Inadequate number or motility of sperm and tubal anomaly or blockage are the most common causes of infertility. Semen analysis will provide information on number of and motility of sperm, and hysterosalpingogram will detect uterine or tubal anomalies or blockage. Mammogram, colposcopy, and a nonstress test do not diagnose infertility problems.

9. The nurse is teaching a client how to correctly use progestin-only oral contraceptives. The nurse should include which information in the teaching plan? 1. Take one pill at the same time each day. 2. Take the pills with calcium-rich foods to promote absorption. 3. Skip five days between the end of one pill cycle and the beginning of the next. 4. An additional method of contraception is not needed through the end of the cycle if a pill is missed.

1. Take one pill at the same time each day. Rationale: Every pill contains a low dose of hormone and should be taken daily; consistency in taking the pills ensures a constant serum level of the hormone to maximize effectiveness. The pills are absorbed with or without the presence of calcium. If a pill is missed, it should be taken immediately and an additional method of contraception utilized through the remainder of that cycle. There is a seven-day period between the end of one pill cycle and the beginning of the next.

3. An unlicensed assistant asks the maternal-newborn nurse why the nurse needs to sign a client's consent form as a witness. The nurse responds that the signature affirms which of the following? 1. That the client agreeing to the procedure was the person who signed the consent. 2. That the client understood the information about the procedure before making a decision. 3. That the physician explained all components of the informed consent. 4. That the nurse explained all the components of the informed consent.

1. That the client agreeing to the procedure was the person who signed the consent Rationale: A nurse signs the consent form as witness to the client's signature. The nurse's signature does not attest to the client's understanding of the procedure, or that the physician fully explained all aspects of the procedure. It is not the nurse's role to explain a procedure to the client, only to reinforce information provided by the physician and clarify any misunderstandings.

3. A woman decides to use natural family planning as a means of contraception and states, "The ovum is fertile for 48 hours after ovulation, the same as sperm." What is the nurse's best response? 1. "Correct; avoid intercourse during this time." 2. "Sperm are fertile for 48 hours, while the ovum is fertile for 24 hours." 3. "Actually, the ovum is fertile for 36 hours and sperm for 24 hours." 4. "Let me explain again, the ovum may be fertile up to 72 hours.

2. "Sperm are fertile for 48 hours, while the ovum is fertile for 24 hours." Rationale: Ova are capable of being fertilized for 24 hours after ovulation. Sperm live for 48 to 72 hours after coitus but are most capable of fertilization in the first 24 hours.

2. Following an ultrasound at six weeks' gestation, the pregnant client comments, "The embryo doesn't look human. When will it begin to look like a baby?" Which of the following is the best response by the nurse? 1. "In one more week the embryo will take on a human appearance." 2. "The embryo looks like a baby already. Let me show you again." 3. "The embryo becomes a fetus and looks more human after about eight weeks' gestation." 4. "You are right, the embryo doesn't look human. Is this important to you?"

2. "The embryo looks like a baby already. Let me show you again." Rationale: The embryonic phase of development is a time of organogenesis. By the end of eight weeks' gestation, all of the tissue and organ foundations have developed. Once this occurs, the embryo appears human and enters the fetal phase. The fetal phase is one of organ maturation. Agreeing with the client and asking about an additional question does not answer the client's original question.

2. A nurse is counseling a couple about fertility awareness. The nurse determines they understand the ideal time for conception when the clients make which statement? Select all that apply. 1. "Ovulation occurs seven days after the beginning of the menstrual cycle." 2. "The ovum survives for 24 hours after ovulation." 3. "It is best to have intercourse 24 to 48 hours after ovulation." 4. "The ovum must be in contact with sperm for 48 hours in order for fertilization to occur." 5. "Sperm are most capable of fertilization 24 hours after intercourse."

2. "The ovum survives for 24 hours after ovulation." 5. "Sperm are most capable of fertilization 24 hours after intercourse." Rationale: The ovum survives 24 hours after ovulation. Sperm are most capable of fertilization 24 hours after introduction into the female's reproductive tract. Ovulation usually occurs 14 days prior to the first day of the menstrual period. If sperm are introduced 24 hours after ovulation the ovum cannot be fertilized. The ovum does not need to be in contact with the sperm for 48 hours for fertilization to occur.

3. The client, who has been married for three years and is sexually active but not yet ready to begin having children, has expressed a desire to use a natural method of family planning. Based on this information, which of the following would be the best choice for this client? 1. Total abstinence 2. Basal body temperature method 3. Male condoms 4. Female condoms with a spermicide

2. Basal body temperature method Rationale: Condoms, used with or without a spermicide, are mechanical methods of contraception. While abstinence is a natural method, since the woman is sexually active it will increase compliance if she only needs to be abstinent during fertile periods. Therefore, using the basal body temperature method permits her to be sexually active at certain times

5. The nurse should instruct the client who has had an intrauterine device (IUD) inserted to do which of the following as part of follow-up self-care? 1. Have the IUD replaced every three years. 2. Check for the string periodically. 3. Use another method of contraception for two weeks after insertion. 4. Use a vinegar douche weekly for four weeks to decrease the risk of infection.

2. Check for the string periodically. Rationale: Specific information about the type of IUD inserted is not provided; Progestasert needs to be replaced annually, Mirena is effective for up to 5 years, and the Copper T380A can be left in place for 10 years. The string should be checked once a week for the first month, then after the menses thereafter. Contraceptive effectiveness begins when the IUD is inserted. Although douching is sometimes used to treat vaginal infections, it is not a recommended practice to prevent infection

3. The nurse explains to a male client with a vas deferens blockage to expect which of the following problems? 1. Frequent urination 2. Decreased sperm in seminal fluid 3. Inability to achieve or maintain an erection 4. Decreased sexual drive

2. Decreased sperm in seminal fluid Rationale: A vas deferens blockage will prevent the sperm from being ejaculated, resulting in a deficiency of sperm in the seminal fluid (oligospermia). Frequent urination, the inability to achieve or maintain an erection, and decreased sexual drive do not occur as a result of the blockage

4. When picking up the dinner tray, the maternal-newborn nurse notices that a Vietnamese client did not eat any roast beef or mashed potatoes. Later, her family members brought in some steamed fish and vegetables with rice, which she ate. The nurse draws which conclusion about why the client prefers the food the family brought in? 1. The client is acculturated to American foods and prefers hamburgers and french fries. 2. Eating culturally desired foods is preferable to eating strange or taboo foods. 3. The foods on the dinner tray are considered hot foods and should be avoided. 4. The client's appetite was decreased because of her recent delivery.

2. Eating culturally desired foods is preferable to eating strange or taboo foods. Rationale: When clients can eat the foods they prefer, they are more satisfied and recover more quickly. Foods that are provided by the hospital kitchen might be unknown to the client. When one is under stress or ill, there is a longing for foods that are known and liked and culturally accepted. There is no indication that the client wishes to avoid foods that are considered hot. There is no basis for assuming the client has a decreased appetite due to delivery or prefers hamburgers and french fries

2. A client who has had pelvic inflammatory disease (PID) caused by Chlamydia trachomatis is at risk for which of the following? 1. Anovulatory menstrual cycles 2. Ectopic pregnancy 3. Multifetal pregnancy 4. Cervical dysplasia

2. Ectopic pregnancy Rationale: Chlamydial PID causes scarring of the fallopian tubes, thus increasing the incidence of ectopic pregnancy. Anovulatory menstrual cycles, multi-fetal pregnancy, and cervical dysplasia do not reflect the true possible consequence of chlamydial PID.

3. A client, who is a gravida 14, para 10-3-0-16, gave birth to all her children vaginally. She presents in labor and upon vaginal examination the obstetrician discovers the infant is in footling breech position. The obstetrician plans to do a cesarean section immediately but the client adamantly refuses. How can the nurse help resolve the dilemma? 1. Follow the physician's orders and prepare the client for surgery. 2. Help identify all the options, taking action on the best option for all concerned. 3. Side with the client and refuse to prepare her for surgery. 4. Call the supervisor so she can mediate the dispute.

2. Help identify all the options, taking action on the best option for all concerned. Rationale: One step in an ethical decision-making framework is to identify the options. The next step is to resolve the dilemma by deciding on the best option for action based on the views of all concerned. Since this client has successfully delivered vaginally numerous times, there are options available to the client. Using an ethical decision-making framework is a good way to resolve the dilemma. Siding with either the client or physician does not respect the view of the other. Calling a nursing supervisor is unnecessary and does not hold the nurse accountable for participation in decision making.

7. The nurse reinforces the physician's explanation that a client with fallopian tube blockage would be a candidate for which method of achieving pregnancy? 1. Natural family planning 2. In vitro fertilization 3. Tubal ligation 4. Sperm washing

2. In vitro fertilization Rationale: Tubal blockage will prohibit sperm from traveling through the fallopian tubes to reach an ovum and fertilize it. In vitro fertilization involves harvesting ova and placing them with sperm in a petri dish. The resultant embryos are then returned to the uterus. Natural family planning and sperm washing would not help this couple to achieve pregnancy because of the tubal blockage. Tubal ligation is used to stop pregnancy from occurring

8. The client is interested in having an intrauterine device (IUD) inserted. As part of maintaining a standard of quality care, the nurse would ensure that the client is aware of which side effect of this therapy? 1. Fewer episodes of dysmenorrhea 2. Increased risk of pelvic inflammatory disease 3. Increased production of thin cervical and vaginal mucus 4. Incomplete emptying of the bladder

2. Increased risk of pelvic inflammatory disease Rationale: IUDs do not cause incomplete emptying of the bladder or increased production of cervical or vaginal mucus. IUDs do have the potential to increase the risk for pelvic inflammatory disease and possibly increase episodes of dysmenorrhea.

6. A nursing student who is pregnant asks the antenatal nurse why childbearing is considered a developmental crisis for a family. What should be included in a response by the nurse? 1. It is an abnormal experience in the process of growth and development. 2. It is a period of physical, psychological, and social change causing a sense of disorganization. 3. It is a stressful, unexpected event caused by external factors. 4. The family has already mastered the tasks of this maturational stage

2. It is a period of physical, psychological, and social change causing a sense of disorganization. Rationale: Childbearing is a developmental crisis because it is a normal period of growth and development. As new roles are learned and assumed, the changes may cause disturbances in life's patterns and a sense of disorganization. External factors cause situational crises, not developmental crises. Family mastery of a task of a maturational stage does not indicate any type of crisis

6. What interpretation should the nurse make about a client who has a complete bicornate uterus with two vaginas? Select all that apply. 1. She will be unable to ever achieve pregnancy. 2. She will be at increased risk for preterm labor. 3. She will need artificial insemination to conceive. 4. She will need to have a cesarean delivery. 5. She will be at risk for multiple pregnancy loss.

2. She will be at increased risk for preterm labor. 5. She will be at risk for multiple pregnancy loss. Rationale: A complete bicornate uterus is two complete and separate unicornate uteri. Because of the shape of the uteri being long and narrow (instead of pear-shaped), the maximum uterine volume is often less than a normally shaped uterus. Risks of bicornate uterus include multiple pregnancy losses, preterm labor, and breech presentation. Becoming pregnant is not an issue; carrying the pregnancy to term is the problem. A cesarean delivery may or may not be needed

8. During labor the nurse notices that the husband of a Ukrainian client just sits beside the bed and is not actively involved with the client. While the nurse interprets this as not being very supportive, how might the client interpret her husband's actions? 1. The client would prefer more active involvement in coaching from her husband. 2. The client interprets her husband's presence in the labor room as caring. 3. The client would like him to leave the room so her mother could be there instead. 4. The client wants to labor alone with only the hospital staff present.

2. The client interprets her husband's presence in the labor room as caring. Rationale: As Ukrainian men become more acculturated they are learning to be supportive of and involved with their wives during pregnancy and labor. The women tend to interpret the presence of their spouses as an indication of care. The other options indicate a client preference rather than an interpretation of the husband's behavior.

6. In planning education for a client who has decided to use a diaphragm for contraception, the nurse should include which items of information in the teaching plan? Select all that apply. 1. An oil-based lubricant should be used to facilitate insertion. 2. The diaphragm should be washed with mild soap and water after each use. 3. One teaspoonful of spermicidal cream or jelly should be applied around the rim and inside the cup. 4. The diaphragm may be used during the menstrual period. 5. The diaphragm should remain in place for at least six hours after coitus.

2. The diaphragm should be washed with mild soap and water after each use. 3. One teaspoonful of spermicidal cream or jelly should be applied around the rim and inside the cup. 5. The diaphragm should remain in place for at least six hours after coitus. Rationale: Oil-based lubricants and cleaning agents other than soap and water can damage the rubber of the diaphragm. The chemical barrier (spermicidal cream or jelly) supplements the mechanical barrier (diaphragm) to increase the effectiveness of this contraceptive method. It takes at least six hours for the spermicidal cream or jelly at the rim to destroy sperm deposited in the vagina. Use during the menses increases the risk of toxic shock syndrome and should be avoided

1. A client who is 38 weeks pregnant with a history of hypertension and proteinuria is admitted with severe upper abdominal pain, nausea, and a persistent headache. The nurse notes an elevated blood pressure (BP) on two readings 20 minutes apart. When notifying the physician 20 minutes after the second BP reading, the nurse reported the elevated BP, abdominal pain, nausea, and inability to void. The nurse did not report the client's headache, so the physician concluded the client had gastric disturbance from the flu. Later, the client had a grand mal seizure. Why would the nurse be considered negligent in this situation? 1. The nurse did not maintain clear, concise, and accurate documentation of the client's condition. 2. The nurse was not thorough in reporting assessment data to the physician. 3. The nurse did not develop a positive empowering relationship with the client. 4. The nurse told another nurse of not knowing that headache was a symptom of preeclampsia.

2. The nurse was not thorough in reporting assessment data to the physician. Rationale: Reporting all information gathered, such as the headache, may have heightened the physician's concern about progressing preeclampsia. It is the nurse's responsibility to report all information from an assessment. The nurse furthered the negligence by not recognizing all the signs of preeclampsia, an accepted standard of maternal-newborn practice, but the immediate concern of this situation was not reporting all information to the physician. There is no evidence that the nurse failed to document correctly or develop a positive relationship with the client.

8. After delivery the nurse examines the umbilical cord. The nurse records the presence of a normal umbilical cord by documenting that the umbilical cord has which of the following? 1. One artery and two veins 2. Two arteries and one vein 3. Two arteries and two veins 4. One artery and one vein

2. Two arteries and one vein Rationale: There are two umbilical arteries that carry blood from the fetal common iliac artery to the placenta. These two arteries are twisted around a large umbilical vein that carries blood from the placenta to the fetal heart. About 1% of umbilical cords contain only two vessels. This condition is more likely to be associated with congenital malformations. Having an umbilical cord with one artery and two veins or two arteries and two veins does not occur.

2. Which statement demonstrates 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. "After 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. "After 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: Leaving space at the end of the condom to collect the semen can prevent breakage or spillage after ejaculation. The male condom is placed when the penis is erect, then rolled down. Water-based lubricants can be used to provide additional comfort, if needed. Oil-based lubricants are contraindicated

4. Which statement by a male client would indicate that he understands the instructions for use of a condom? 1. "I should lubricate the condom with an oil-based product to avoid friction that could rupture the condom." 2. "I should unroll the condom and check it for holes before applying it." 3. "I should hold the rim of the condom while withdrawing my penis from the vagina to avoid leakage." 4. "I should begin sexual intercourse without the condom and don the condom just before ejaculation."

3. "I should hold the rim of the condom while withdrawing my penis from the vagina to avoid leakage." Rationale: Oil-based lubricants can break down latex condoms. The condom should be unrolled onto the penis, starting at the tip of the penis. Holding the rim keeps the condom from slipping off and leaking semen into the vagina. Small amounts of semen are released before ejaculation and can result in pregnancy

5. After counseling a client about several contraception options, the client tells the nurse that she has decided to use female condoms. The nurse evaluates that the client understood the information when the client makes which statement? 1. "I understand that I shouldn't apply the condom more than one hour before having sex." 2. "I understand that if I develop a latex allergy I will need to find a different type of birth control." 3. "I understand that this will provide protection against sexually transmitted diseases for me and my partner." 4. "I understand that my doctor will measure me for the condoms, and then I will purchase them at the drug store."

3. "I understand that this will provide protection against sexually transmitted diseases for me and my partner." Rationale: Female condoms can be applied up to eight hours before intercourse, are not made of latex, and do not require that the client be measured for proper fit. Both partners are protected from STIs during intercourse

3. A female client is considering in vitro fertilization and gamete intrafallopian transfer (GIFT). Which statement indicates the client needs additional information? 1. "I will give myself injections of medications to cause my ovaries to ripen more than one egg." 2. "My husband will need to produce a sample of his sperm the day my eggs are retrieved." 3. "I will be in the hospital overnight for this procedure." 4. "I can expect to have some discomfort after the procedure."

3. "I will be in the hospital overnight for this procedure." Rationale: Ova retrieval and GIFT are outpatient procedures. The client will not be hospitalized overnight. The other statements are correct and do not require any follow-up by the nurse.

5. A client appears in the clinic for her first prenatal visit at 26 weeks of pregnancy. She states, "I didn't see any point in coming sooner since I felt fine." The nurse makes which statement to explain why prenatal care in the first trimester is important? 1. "We want to get to know our patients better. This gives us time to collect an accurate history and plan for potential problems." 2. "We need to monitor fetal lung maturity and fetal movement in case you go into labor early." 3. "Important cellular growth happens in the first trimester. Early assessment and education promotes a healthy pregnancy during this time." 4. "The most important thing is to see if you are even pregnant. Many women mistake a missed period for pregnancy."

3. "Important cellular growth happens in the first trimester. Early assessment and education promotes a healthy pregnancy during this time." Rationale: The primary reason for early prenatal care relates to the critical periods of development that occur in the first trimester and to promote safety during this particularly vulnerable time of pregnancy. While it is important to establish a relationship with clients and verify pregnancy, monitoring client and fetal safety during the first trimester is of highest importance. Fetal movements are usually felt in the second trimester, and viability is not possible until 24 weeks, when fetal lung maturity would arise as a concern.

7. At 36 weeks' gestation, a primigravida enters the birthing unit in labor and is concerned about delivering early. The nurse reassures the client by making which statement? 1. "Luckily, there is no need to worry; you are at term." 2. "Most likely everything is going to be fine. Your baby has a strong heart rate." 3. "Many babies born at this age have lungs that are just about mature." 4. "This is nothing to be excessively concerned about. We deliver babies at this age very often."

3. "Many babies born at this age have lungs that are just about mature." Rationale: Surfactant with a lecithin: sphingomyelin ratio of 2:1 is required for mature lung function. This occurs at about 36 weeks' gestation. An infant born prior to 38 weeks' gestation is considered preterm. A reassuring fetal heart rate is not indicative of lung maturity. Stating there is nothing to be excessively concerned about ignores the client's concern and is not reassuring.

10. A pregnant client, who is considering a tubal ligation following her delivery, asks the nurse about the effectiveness of the method. What is the best response by the nurse? 1. "Like all methods of contraception, the effectiveness depends on client compliance." 2. "Effectiveness depends on whether the tubes are clipped, banded, or plugged." 3. "The method is very effective. Only 1 to 4 women per 1000 get pregnant after a tubal ligation." 4. "If you have a tubal ligation, you won't ever have to worry about getting pregnant again because the procedure is 100% effective."

3. "The method is very effective. Only 1 to 4 women per 1000 get pregnant after a tubal ligation. Rationale: The pregnancy rate following tubal ligation is 1 to 4 per 1000 women. Reversal of the procedure, not effectiveness, is affected by the method used for the procedure. The effectiveness of the method is not related to client behavior.

8. The client has been scheduled to have a hysterosalpingogram. Which question does the nurse need to ask? 1. "Do you douche?" 2. "Have you used any type of lubricant with intercourse?" 3. "When was the first day of your last menstrual cycle?" 4. "What was your age at menarche?"

3. "When was the first day of your last menstrual cycle? Rationale: Hysterosalpingograms are performed in the follicular phase of the cycle to avoid interrupting an early pregnancy, so the nurse needs to establish the client's phase of the menstrual cycle. Douching, using lubricant during intercourse, and the age at the start of menarche do not address the need to become familiar with the client's menstrual cycle

8. The nurse has explained to the client that the results of her hysterosalpingogram revealed bilateral tubal blockage. The nurse realizes that further education about the results of the hysterosalpingogram is needed when the client asks which question? 1. "Will the surgery to unblock my tubes be done in the hospital or the surgery center?" 2. "Will the acupuncture treatments I am getting interfere with the surgical procedure?" 3. "Will this plug in my fallopian tubes go away forever after I become pregnant?" 4. "Will long-distance running and a low percentage of body fat affect the success of the surgery?"

3. "Will this plug in my fallopian tubes go away forever after I become pregnant?" Rationale: Bilateral tubal blockage requires surgical intervention. The client will not become pregnant until the tubes are cleared surgically; a pregnancy cannot occur and "unblock" the tube. This statement indicates that the client does not understand her situation and requires further education. The other options contain statements that indicate understanding of the need for surgical treatment.

7. The nurse determines that which of the following clients in the infertility clinic needs to be seen first? 1. A 27-year-old woman being seen for an initial infertility exam 2. A 34-year-old man in for semen analysis results 3. A 32-year-old woman taking human chorionic gonadotropin (hCG) who reports severe abdominal pain 4. A 30-year-old woman in for a pregnancy test following implantation as part of in vitro fertilization

3. A 32-year-old woman taking human chorionic gonadotropin (hCG) who reports severe abdominal pain Rationale: Severe abdominal pain during a cycle of induced ovulation may indicate hyperstimulation of the ovaries. The ovaries could potentially rupture, leading to death. The risk of this complication takes precedence over any clients requiring routine care. The woman being seen for an initial infertility exam, the man waiting for semen analysis results and the woman coming in for a pregnancy test require routine care

3. After completing a health history in a prenatal clinic, the nurse concludes that which client has the greatest risk for potential birth anomalies? 1. A 23-year-old pregnant woman at seven months' gestation with a urinary tract infection 2. A 15-year-old primigravida with a sister who has Down syndrome 3. A 35-year-old multigravida at 16 weeks' gestation with a yeast infection 4. A 42-year-old multigravida at 5 months' gestation with a cold

3. A 35-year-old multigravida at 16 weeks' gestation with a yeast infection Rationale: The risk of Down syndrome increases markedly after the age of 40. The 42-year-old woman is at greatest risk, the 23-year-old is at lesser risk, and the 15-year-old is at least risk related to age. Infection is more likely to result in a birth anomaly if it occurs in the first trimester.

10. The nurse manager of the maternal-child unit is evaluating how well the unit met the ACOG (American College of Obstetrics and Gynecology) standard of starting a cesarean section within 30 minutes of the decision for surgery. What is the best way for the nurse manager to assess if the standard is met? 1. Do a chart review for documentation of time of decision and time surgery began and compare to the national standard. 2. Interview the nurses involved in the case as to how long it took from decision to surgery. 3. Assume that all emergency cesarean sections are done within the recommended 30 minutes. 4. Ask the obstetricians how long it took from the time they ordered the surgery until they made the first cut.

3. Assume that all emergency cesarean sections are done within the recommended 30 minutes. Rationale: It is the nurse's responsibility to report the situation to the nurse's supervisor when the physician does not act on information from the nurse regarding concerns about client safety. The nurse also needs to document that the obstetrician was notified, the obstetrician's response, and the nurse's further actions in reporting to the supervisor. Relying on the obstetrician's judgment fails to uphold the standard of care. Another physician is not responsible for the client's care and may have no influence over the decisions of another care provider. Telling the client to take legal action against the obstetrician is not part of maintaining own legal accountability

10. A client comes to the family planning clinic for contraceptive advice. She states she has never used contraception before and does not know what options are available to her. The nurse determines that the priority nursing diagnosis for this client would be which of the following? 1. Anxiety related to fear of pregnancy 2. Ineffective Coping related to unprotected intercourse 3. Deficient Knowledge related to lack of information about contraceptives 4. Fear related to potential complications of contraception

3. Deficient Knowledge related to lack of information about contraceptives Rationale: This client has a need for information about the various contraceptive methods available to her and their risks and benefits. No information is provided to determine if the client fears pregnancy or is engaging in unprotected sexual intercourse. If the client does not know what contraceptive methods are available, it is unlikely she knows or fears potential complications from using a method of contraception

4. A 30-year-old woman who is pregnant with twins tells the nurse that twins run in her family. She has a twin brother, her mother is a twin, and many relatives have twins. The nurse explains that which type of twinning most likely relates to her situation? 1. Identical 2. Monozygotic 3. Dizygotic 4. Monoamniotic

3. Dizygotic Rationale: Dizygotic twins, also known as fraternal or nonidentical, do run in families. The pregnancy results from the fertilization of two different ova by two different sperm. The zygotes develop separately and carry their own distinct genetic code and develop their own placentas and amniotic sacs. Monozygotic, also known as identical, result from a single fertilized ovum. They share the same genetic code and often share placentas and amniotic sacs. This type of twinning occurs at random

2. The client has come to the family planning clinic to discuss the use of contraceptives. The nurse should do which of the following to facilitate a productive discussion? 1. Discuss contraceptive options with the married client only if her partner is present. 2. Instruct the client in which contraceptive option she should use. 3. Inform the client about use, side effects, and effectiveness of different contraceptive options so that the client can select one that meets her needs. 4. Avoid discussion of side effects as this might frighten the client and result in her not using a contraceptive.

3. Inform the client about use, side effects, and effectiveness of different contraceptive options so that the client can select one that meets her needs. Rationale: Contraceptive counseling involves assessing the client's needs, desires, and risk factors. This will result in a contraceptive method that best suits the needs and health of the client. The client's partner does not need to be present to discuss contraceptive options. The information should be given without prejudgment on the nurse's part. The nurse would not be doing his or her job properly without giving the client all the information about possible side effects.

9. A newly employed public health nurse learns that the United States has a high infant mortality rate and that preterm labor and delivery of low-birth-weight infants (which lead to infant mortality) can be linked to the lack of prenatal care. The nurse suspects which of the following as a reason why many clients are unable to obtain prenatal care? 1. Health care and other services are well coordinated for needy clients. 2. All uninsured pregnant women are eligible for Medicaid. 3. Prenatal care services and providers are not available in certain areas. 4. Many health care providers are willing to provide care in subsidized clinics.

3. Prenatal care services and providers are not available in certain areas. Rationale: Many barriers to prenatal care have been identified including the lack of available prenatal care services and providers in many areas of the country. The other options would likely help improve the infant mortality rate over time.

4. A 16-year-old female client who lives in a state without an emancipated minor law needs to have a dilatation and curettage (D&C) after manual delivery of the placenta. Who can legally give informed consent for the client to have this procedure? 1. The client herself 2. The client's physician 3. The client's mother 4. The client's best friend

3. The client's mother Rationale: In a state with no emancipated minor law, the client's parents are granted the authority and responsibility to give consent for their minor children. The client, physician, and best friend have no authority in this situation.

10. The nurse interprets that partner sperm intrauterine insemination is likely to be indicated for a couple when which of the following has occurred? 1. The male partner has a varicocele. 2. The female partner has irregular menses. 3. The female partner produces anti-sperm antibodies. 4. The male partner has human immunodeficiency virus.

3. The female partner produces anti-sperm antibodies. Rationale: Anti-sperm antibodies can develop in the vaginal and cervical secretions. Inserting the sperm directly into the uterus via intrauterine insemination bypasses the secretions so that the sperm are not destroyed. Sperm intrauterine insemination will not necessarily increase the chances of the couple getting pregnant when the male partner has a varicocele or the human immunodeficiency virus, or the female partner has irregular menses.

6. A pregnant client who is trying to select a health care provider during pregnancy asks the antenatal clinic nurse to explain the difference between midwifery and obstetrics. What should the nurse tell the client? 1. Midwifery and obstetrics have always been practiced simultaneously. 2. Midwifery is practiced in the home while obstetrics is practiced in the hospital. 3. The focus of midwifery is being with women and assisting the family in childbirth. 4. The primary focus of obstetrics is the management of low-risk pregnancies.

3. The focus of midwifery is being with women and assisting the family in childbirth. Rationale: Midwifery is the branch of nursing that deals with the practice of assisting women and their families in childbirth. It has been practiced since very early times. Obstetrics was not introduced to medicine until the late 1800s and primarily focuses on high-risk circumstances in pregnancy, labor, and postpartum. Only a small percentage of nurse-midwives currently practice in the home.

5. The mother of a client who delivered a healthy infant four hours ago tells the nurse that the labor and delivery unit "is nothing like when I had my children 20-plus years ago." The nurse expects that this family will have increased satisfaction with the birth experience because of which changes in the care setting over the last few decades? 1. The expectant mother is transferred to multiple rooms during the birth process. 2. The father of the baby is allowed to be present for the delivery. 3. The infant will remain in the room with the family as long as it is well. 4. Newborns are routinely separated from their parents immediately after birth.

3. The infant will remain in the room with the family as long as it is well. Rationale: As maternity care has become more family centered, efforts are made to keep the family together all the time. This is done by providing single-room maternity care, letting the client define her family and designate who she wants to have present at the birth, and encouraging the family to keep the infant with them in the room so they have more opportunity for bonding and learning about each other.

9. A male client has come to the clinic to discuss having a vasectomy. Which client statement indicates the client understands the procedure? 1. "I will be able to return to my job as a construction worker immediately following the procedure." 2. "The procedure should be performed in a hospital, preferably under general anesthesia." 3. "It will be safe for me to have unprotected sex one week following the procedure." 4. "The procedure will not affect my sexual function."

4. "The procedure will not affect my sexual function." Rationale: The procedure will not affect the client's sexual function. It is usually performed in a clinic under local anesthesia, and is not effective for four to six weeks. The client should rest with minimal activity for 48 hours following the procedure.

7. Several ethnic groups advise expectant mothers not to reach over the head because the umbilical cord will wrap around the infant's neck. What should the nurse tell a client about this type of belief? 1. This is a health promotion belief and may be a concern at this time in her pregnancy. 2. This is a prescriptive belief and may be a worry but it is not really true. 3. This is a restrictive belief and may reflect cultural beliefs about what to avoid to have a positive pregnancy outcome. 4. This is a taboo belief and you may regret doing this later if you have problems during the pregnancy.

3. This is a restrictive belief and may reflect cultural beliefs about what to avoid to have a positive pregnancy outcome. Rationale: Restrictive beliefs and practices are those things an expectant mother should not do or should avoid so that she will have a positive pregnancy outcome. This type of belief does not promote healthy outcomes, does not prescribe what to do, and does not represent a cultural taboo according to the usual definition of the word.

4. A nurse discusses teratogens with a client during pre-conceptual counseling. The client demonstrates understanding by making which statement? 1. "I should stop taking all my medications while I am pregnant." 2. "The fetus is at greatest risk for developing anomalies during the first 16 weeks of pregnancy." 3. "After 12 weeks the placenta protects the fetus from teratogens." 4. "Exposure to teratogens poses the greatest risk during the first eight weeks."

4. "Exposure to teratogens poses the greatest risk during the first eight weeks." Rationale: Organogenesis and cell differentiation occur during the first eight weeks of pregnancy, making the embryo particularly sensitive to teratogens during this time. Although medications may have teratogenic effects, each medication's risk versus benefit needs to be evaluated by the health care provider.

9. Which statement made by the client scheduled for in vitro fertilization would indicate the need for additional teaching? 1. "The egg retrieval procedure may be uncomfortable, but medication will be available for me." 2. "The fertilized eggs will be implanted into my uterus two to three days after the egg retrieval." 3. "I will need to limit my activities the day of the egg retrieval and the day of implantation." 4. "I will have 10 embryos implanted to maximize my chance of carrying a baby to term."

4. "I will have 10 embryos implanted to maximize my chance of carrying a baby to term." ationale: A large number of embryos implanted in the uterus or fallopian tube following IVF increases the chance of achieving pregnancy; however, it also increases the risk of multifetal pregnancy. Placing 10 embryos via IVF would be unethical because of the possibility of high multiples. Understanding discomfort of egg retrieval procedure, that the fertilized eggs will be implanted two to three days after egg retrieval, and the need to limit physical activity on the days of the egg retrieval and implantation are items of correct information and do not require follow-up by the nurse.

5. Which statement made by a female client indicates that she and her husband are having difficulty coping with their infertility regimen? 1. "I am never going to consider pregnancy a spontaneous event again." 2. "I don't like giving myself shots, but I'll do it to get pregnant." 3. "We had to take out a home equity loan to pay for these treatments." 4. "My husband just hates having to plan when we make love.

4. "My husband just hates having to plan when we make love. Rationale: To maximize the chances of conception through achieving the greatest number of motile sperm, couples must abstain for two to three days prior to expected ovulation and then have intercourse on the day of ovulation or the date of artificial insemination or in vitro fertilization. Because of this, the client's husband must be a willing participant in the infertility regimen. The other statements indicate the client has motivation and a realistic view of the fertility regimen.

9. A client is pregnant with twins, a boy and a girl, and asks if they will be identical. What is the nurse's best response? 1. "They are not identical because the ultrasound showed one was bigger than the other." 2. "I'll discuss this with the doctor and give you a call later." 3. "We won't know until the babies are delivered." 4. "The twins are not identical. Identical twins are virtually always the same sex."

4. "The twins are not identical. Identical twins are virtually always the same sex." rationale: Twins of opposite sex are always fraternal because it indicates two sperm were involved in fertilization, one carrying a Y chromosome and one carrying an X chromosome. Identical twins develop from one ovum and one sperm. Therefore, the genotype is the same, including sex. Identical twins may be different sizes because one twin may receive a greater amount of placental circulation than the other. It is unnecessary to discuss this with the health care provider; the question requires a simple factual answer.

1. A couple visits the genetic counseling clinic regarding a family history of cystic fibrosis, an autosomal recessive disorder. They ask the nurse, "What are the chances that we will have a child with cystic fibrosis if we are both carriers?" Which response by the nurse is best? 1. "It would be better not to have children because they will all have cystic fibrosis." 2. "The disorder occurs at random and there is no way to calculate the risk." 3. "There is a 50% chance that you will have a child with cystic fibrosis." 4. "There is a 25% chance that you will have a child with cystic fibrosis.

4. "There is a 25% chance that you will have a child with cystic fibrosis. Rationale: A carrier for cystic fibrosis is an individual who does not have the illness but is heterozygous for the abnormal gene. It is not until two carriers mate and produce children that the abnormal gene will be manifested in the offspring. The risk can be calculated. The affected offspring must carry two of the abnormal genes to be affected. There is a 25% chance of this occurring, a 50% chance that the offspring will be a carrier without the disease, and a 25% chance of not having the gene at all.

9. During a prenatal class the nurse discusses weight gain in pregnancy. The nurse explains that the amniotic fluid in the third trimester weighs approximately how much? 1. 1.5 kilograms 2. 250 grams 3. 500 grams 4. 1 kilogram

4. 1 kilogram Rationale: At term the amniotic fluid volume ranges from 700 to 1000 milliliters (mL). Each mL weighs about 1 gram, so the amniotic fluid contributes about 700 to 1000 grams to the weight of pregnancy. This is the same as 0.7 to 1 kilogram, since 1000 gram equals a kilogram.

8. A 26-year-old client who is pregnant for the first time is low risk and is very interested in being involved with care decisions and learning all she can about pregnancy and childbirth. Which type of health care provider would the nurse recommend for prenatal care and birth? 1. An obstetrician 2. A family practice resident 3. A physician's assistant 4. A certified nurse-midwife

4. A certified nurse-midwife Rationale: Certified nurse-midwives are prepared to manage independently the care of women and their families who are at low risk for complications during pregnancy and birth. They take a holistic approach to assessment and identification of needs, providing education and information to empower the expectant mother and her family for active involvement during the reproductive years. An obstetrician, family practice resident, and physician's assistant practice using a medical model are examples in which the health care provider is a primary decision maker about care.

1. A client who has diabetes mellitus that is difficult to regulate is seeking to get pregnant. The nurse working in a primary care provider's office suggests that which health care provider would be an optimal choice? 1. A certified nurse-midwife 2. A family nurse practitioner 3. An obstetrician 4. A maternal-fetal medicine specialist

4. A maternal-fetal medicine specialist Rationale: A person who has diabetes mellitus that is difficult to regulate is considered high risk and will need to be monitored closely. Family nurse practitioners and certified nurse-midwives do not have the expertise to manage complicated cases such as these. Many obstetricians have expertise in management of medical complications but will also recognize situations such as this when the client needs referral to a maternal-fetal medicine specialist.

4. The nurse concludes that a client being treated for infertility needs further teaching when the client makes which statement about what the couple needs to do to achieve pregnancy? 1. Have intercourse on the 14th day of the menstrual cycle. 2. Have intercourse when basal body temperature rises. 3. Have intercourse every other day during the week before and after ovulation. 4. Abstain from intercourse for the month prior to the month they want to conceive.

4. Abstain from intercourse for the month prior to the month they want to conceive. Rationale: Having intercourse on the 14th day of the menstrual cycle, when the basal body temperature rises, and every other day during the weeks before and after ovulation increase the likelihood of conception by timing intercourse around the expected time of ovulation. Abstaining from intercourse for the month prior to planned conception does not increase the likelihood of becoming pregnant and indicates a need for further teaching

4. The rationale for the nurse to ensure that a client gives informed consent for contraception prior to use is based on which fact about contraceptive methods? 1. Are usually invasive procedures 2. Require a surgical procedure 3. May not be reliable 4. Have potentially dangerous side effects

4. Have potentially dangerous side effects Rationale: Ethical and legal considerations dictate that clients are knowledgeable of the benefits and risks of the contraceptive method. This empowers the client in making an informed decision. Not all contraceptive methods are invasive or require a surgical procedure. Informed consent is not related to the effectiveness of a method.

4. The client is seeking to become pregnant through artificial insemination using donor sperm. In teaching the client about this procedure, which information should the nurse plan to include? 1. Processing procedures to prevent transmission of genetic defects or infectious disease are optional. 2. There is an unlimited number of pregnancies per donor. 3. Donor sperm need to be frozen and quarantined for a year to prevent risk of disease transmission. 4. Informed consent must be obtained from all parties.

4. Informed consent must be obtained from all parties. Rationale: When sperm are donated for use in artificial insemination, informed consent must be obtained from all parties. Processing procedures to prevent transmission of genetic defects or infectious disease are mandatory. Guidelines have been established to limit the number of pregnancies per donor. Donor sperm must be frozen and quarantined for six months to prevent risk of disease transmission.

2. The newborn nursery nurse is working with a client who has given birth and is planning on placing the infant for adoption. When considering the legal issues of this situation rather than the ethical aspects, the nurse would look to which of the following? 1. Values and beliefs 2. Motives, attitudes, and culture 3. What is good for the individual 4. Rules and regulations

4. Rules and regulations Rationale: The legal system is founded on rules and regulations that are external to oneself and that guide society in a formal and binding manner. Ethical issues are subject to an individual's values, beliefs, culture, and interpretation. What is good for a particular individual may vary from person to person, while the law contains rules that guide all who are in the same situation.

5. The maternal-newborn nurse is making a home visit to a client who delivered an infant 48 hours ago. The other young children of the client address the woman who stays in their home three days a week as "Auntie." Why would she most likely be considered part of the family unit? 1. She may be the client's closest colleague. 2. She lives in the same neighborhood the other four days a week. 3. She has no children of her own. 4. She has strong emotional ties with the children.

4. She has strong emotional ties with the children. rationale: A family can be defined as a group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another's lives. They may or may not be related or live together on a permanent basis. There is not enough information in the question to support the other conclusions

6. A pregnant client asks about the functions of the placenta. What items of information should the nurse include in the teaching plan? Select all that apply. 1. The placenta filters fetal urine. 2. Fetal and maternal blood mix in the placenta to exchange nutrients. 3. The placenta filters alcohol from the mother's blood. 4. Substances are exchanged by the placenta without mixing maternal and fetal blood. 5. Fetal respiration, nutrition, and excretion are carried out by the placenta.

4. Substances are exchanged by the placenta without mixing maternal and fetal blood. 5. Fetal respiration, nutrition, and excretion are carried out by the placenta. Rationale: Fetal gas exchange occurs in the intervillous spaces of the placenta through simple diffusion of oxygen, carbon dioxide, and carbon monoxide. Substance exchange between the maternal and fetal blood occurs without mixing of the blood. Fetal waste products are excreted via the placenta, but urine is excreted by the fetus into the amniotic fluid. While the placenta is capable of filtering some substances, most substances consumed by the mother are exchanged with the fetus, including alcohol

what is the treatment for (Comedomastitis)

Drug therapy for symptom relief or surgical removal

list the warning s&s of Vasectomy

Fever >100.4°F Excessive pain Difficulty urinating Redness, swelling, bruising, drainage, or skin edges of the incision that are not closed Bleeding at the site

list the warning s&s Tubal ligation

Fever >100.4°F Excessive pain Difficulty with defecation or urination Nausea or vomiting Redness, swelling, bruising, drainage, or skin edges of the incision that are not closed

10. A pregnant client asks the nurse when the fetal heart will begin beating. The nurse tells the client even though the fetal heart is not fully developed it begins to beat at about _____ days of gestation.

answer: 28 Rationale: By the end of 28 days (four gestational weeks) the tubular heart is beating at a regular rhythm and circulating primitive red blood cells through the main blood vessels.

list the symptoms of fibrocystic breast changes

cyclic increased breast tenderness and swelling before menses

what is the treatment of intraductal papilloma?

excision and followup care

define and list characteristics of Duct Ectasis (Comedomastitis

inflammation of duct behind nipple - occurs during or near menopause - thick sticky nipple discharge - burning pain, pruritus, inflammation - nipple retraction

what is an IUD?

safe, effective, long-acting, reversible contraceptive that is designed to be inserted into the uterus by a qualified healthcare provider and left in place for an extended period,