PrepU Reproduction test
After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which client statement indicates a need for further teaching?
"If I gain or lose 20 lb (9 kg), I can still use the same diaphragm."
A client who has been treated for infertility is now pregnant. During a routine ultrasound at 8 weeks' gestation, she learns that five fetuses are visualized. The client's husband is concerned that five infants will not survive and that his wife may not be able to handle the stress of the pregnancy, so he asks the nurse about selective reduction. What is the nurse's best response?
"It has been used to decrease the possibility of complications."
A nurse is caring for a male client who has gonorrhea. Which statement indicates that the client needs additional instruction?
"It is not possible to be contagious as long as I take all of my antibiotics as prescribed."
A client is a gravida 2 para 1 and is currently 12 weeks gestation. She states that she drank beer throughout her last pregnancy. The client asks the nurse if it is okay to have a few drinks during this current pregnancy. Which response by the nurse would be most appropriate?
"It is not safe to consume alcohol during pregnancy."
The nurse is discharging a client at 35 weeks' gestation after a reactive nonstress test. The client asks the nurse how the fetus is doing. What is the nurse's best response?
"The fetal heart rate went up twice during the test, so your fetus is doing well."
A client is 10 weeks pregnant and asks the nurse if feeling like she has to "go to the bathroom every 5 minutes" is normal. Which is the best response?
"The growing uterus puts pressure on the bladder so urinary frequency is normal."
A client is a long-distance runner and is 8 weeks pregnant with her first baby. The client tells the nurse that she would like to continue running throughout the pregnancy and asks the nurse if there are any safety risks. Which response by the nurse correctly identifies musculoskeletal changes in pregnancy that may be a safety risk to the client?
"The joints of the pelvis relax."
A primigravid client in a preparation for parenting class asks how much blood is lost during an uncomplicated vaginal birth. What should the nurse should tell the client?
"The maximum blood loss considered within normal limits is 500 ml."
A pregnant client and her partner come to preregister at the hospital and take a tour of the labor and delivery suite. The mother has a detailed birth plan she wants honored while in labor. How should the nurse best respond to this information?
"The nurses taking care of you will do their best to respect your wishes."
A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can not believe I am going to have a baby!" Which response by the nurse would be most appropriate at this time?
"Yes it is true. How does that make you feel?"
A client scheduled for a vasectomy asks the nurse how soon after the procedure he can have sexual intercourse without using an alternative birth control method. How should the nurse respond?
"You can safely have unprotected intercourse when your sperm count indicates sterilization."
The nurse observes late decelerations on the fetal heart tracing of a woman in labor. Which interventions are most appropriate for the nurse to take to correct this situation? Select all that apply.
-IV hydration - maternal position change -oxygen administration
A nurse is caring for a client who is scheduled for amniocentesis. What will the nurse teach the client about this procedure?
She needs to empty her bladder prior to the procedure.
The nurse is caring for a client that has been in labor for 6 hours. When does the nurse document that the client has ended the third stage of labor?
when the placenta has been birthed
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?
"Another method of contraception is needed until the sperm count is 0."
A client who is 6 months postpartum asks the nurse about an effective method of birth control. What is the nurse's most appropriate response?
"Barrier approaches, such as condoms or cervical caps, will not interfere with breastfeeding."
A client in active labor asks the nurse why her blood pressure is being monitored so frequently. What is the most appropriate response by the nurse?
"Changes in your blood pressure can affect the fetus."
A nurse is providing care for a pregnant 16-year-old client. The client says that she is concerned she may gain too much weight and wants to start dieting. What information will the nurse provide the client as most accurate about nutrition and pregnancy?
"Good nutrition supports the changes in your body and fetal growth and development."
The nurse is conducting a routine risk assessment at a prenatal visit. Which question would be the best to screen for intimate partner violence?
"How safe do you feel in your home?"
The nurse is teaching a G2P1 client about her upcoming labor. Which response would indicate to the nurse that further teaching is necessary?
"I can wait until my contractions are every 2 minutes to contact the physician because my first labor was so long."
A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement?
"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy."
The nurse teaches 17-year-old girl with has a severe gonorrheal infection about her disease. The nurse realizes that the girl understands the implications of her disease when the client makes which statement?
"I could have trouble getting pregnant."
The nurse is teaching a young female about using oxcarbazepine to control seizures. The nurse determines teaching is effective when the client makes which statement?
"I'll use one of the barrier methods of contraception."
On a client's second postpartum visit, a health care provider reviews the chart. What's the best term for the lochia described?
rubra
A client who tells the nurse that she would like to use the basal body temperature method for family planning receives instructions about the method. Which client statement indicates to the nurse that the teaching has been successful?
"It's important to take my temperature at about the same time every morning before arising."
A 16-year-old female approaches a nurse and discloses that she is 11 weeks pregnant. The client asks the nurse how she can obtain a therapeutic abortion. What is the best response by the nurse?
"Let me refer you to a counselor who can assist you with making your decision."
The nurse is caring for a client in the first stage of labor who states, "I am scared. The last time I gave birth, I was in labor for 32 hours, it was awful." What is the nurse's best response?
"Let's talk about options that can keep you more comfortable this time."
A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which client statement indicates effective teaching?
"My fallopian tubes will be tied off through a small abdominal incision."
A client who is planning a pregnancy asks the nurse about ways to promote a healthy pregnancy. What is the nurse's best response?
"Start taking folic acid, 400 mcg daily until you conceive."
A client is in the first stage of labor. She asks the nurse what the best physical position is to promote labor progression and efficient uterine contractions. What response by the nurse is most appropriate?
"The best option at this stage is to ambulate."
A client who is 24 weeks pregnant and diagnosed with preeclampsia is sent home with orders for bed rest and a referral for home health visits by a community health nurse. Which comment made by the client indicates to the nurse that the client understands the reasons for home health visits?
"The community health nurse will check me and my baby and talk with my physician."
A couple has completed testing and is a candidate for in vitro fertilization. The nurse is reviewing the procedure with them and realizes that further instruction is needed when the client makes which statement?
"The fertilization procedure can be done anytime during my cycle."
The nurse is working in the mother-baby unit. To which client would the nurse anticipate giving Rho(D) immune globulin (human)?
the Rh-negative mother with an Rh-positive baby
A nurse in a prenatal clinic is assessing a client who is 28 weeks' pregnant. Which findings lead the nurse to suspect that the client has mild preeclampsia?
1+ protein, blood pressure 142/92 mmHg
At what gestational age should a primigravida expect to start feeling quickening?
18 to 20 weeks
A woman who has preeclampsia is receiving magnesium sulfate 20 grams per 500 mL of lactated Ringers via infusion pump. The prescribed rate of infusion is 2 grams/hour. How many mL/hour should the nurse set the infusion pump for? Record your answer using a whole number.
50
During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply?
7 days after fertilization
Which client would benefit most from information explaining the importance of receiving an annual Papanicolaou (PAP) test?
A client infected with the human papillomavirus (HPV)
Which of the following is a priority nursing diagnosis for the client presenting with pelvic inflammatory disease?
Acute pain.
A 16-year-old primigravida at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What should the nurse do upon the client's arrival?
Admit the client to a quiet, darkened room.
The nurse is assisting a client who just received an epidural during the first stage of labor. Which medication does the nurse know may be needed at this time?
Oxytocin
A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which information would the nurse expect to include in the client's teaching plan?
As ovulation approaches, cervical mucus is abundant and clear.
The nurse is assessing a client who is 4 hours postpartum. Based on the findings documented by the nurse, which action is most appropriate at this time?
Ask the client to empty her bladder.
A laboring client is experiencing increased pain and asks the nurse when she can have an epidural. Which would be a priority intervention by the nurse to establish whether the client can have an epidural?
Assess cervical dilation.
A client at 39 weeks' gestation comes to the labor and delivery suite. The client states the membranes ruptured 12 hours ago. What priority assessment will the nurse perform?
Assess fetal heart rate (FHR).
A client is admitted for an amniocentesis. Initial assessment findings include 16 weeks' gestation, vital signs within normal limits, hemoglobin 12.2 g/dL (122 g/L), hematocrit 35% (0.35), and type O-negative blood. Which action would the nurse complete first after amniocentesis has been completed?
Assess fetal heart rate and compare to pre-procedure baseline.
A client who is 2 months' pregnant has become more introverted, stopping most social activities. What action would the nurse take upon learning this information?
Assess the client for depression using an approved depression screening tool
A nurse is caring for a woman who gave birth to her baby boy 2 hours ago. The nurse notes the woman's perineal pad contains some small clots and a moderate amount of lochia has accumulated under her buttocks. What is the first action the nurse should take at this time?
Check fundus for position and consistency.
The nurse is caring for a primagravida in active labor. The provider performs an amniotomy to augment labor. What is the nurse's priority action after the procedure is completed?
Check the fetal heart rate for bradycardia.
Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement?
Continue previous contraceptive use even if you're experiencing amenorrhea.
While observing a new mother interact with her first baby, the nurse observes that the client appears hesitant to care for the neonate. Which action would be most important for the nurse to do?
Continue to provide praise and support to the client.
A client has stress incontinence. Which data from the client's history contributes to the client's incontinence?
the client's history of three full-term pregnancies
The team on an antepartum unit consists of two registered nurses (RN), one licensed vocational nurse (LVN), and one nursing assistant. Which one of the following clients would be appropriate to assign to the LVN?
a client with placenta previa
A client and her partner, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as:
the inability to conceive after 1 year of unprotected attempts.
A client who is 5 cm dilated reports that she has the urge to push. Which is the appropriate response by the nurse?
Have client blow out breath to keep from pushing.
A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews prescriptions (see chart). Which prescription should the nurse initiate first?
Initiate fetal and contraction monitoring.
During an annual checkup, a client tells the nurse that she and her partner have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end?
It should begin before conception and end 3 months after childbirth.
At an initial prenatal visit, the client tells the nurse that her last menstrual period started April 14. Using Naegele's rule, the nurse determines the woman's estimated due date is when?
January 21
A woman who gave birth to her last infant by caesarean birth is admitted to the hospital at term with contractions every 5 minutes. The health care provider (HCP) intends to have her undergo "a trial labor." What does the nurse explain to the client that trial of labor means?
Labor progress will be evaluated continually to determine appropriate progress for a vaginal delivery
The nurse who is assessing the position, presentation, and lie of the fetus of a 9-month-pregnant client performs what action?
Leopold's maneuver
During the fourth stage of labor, a nurse notes that the client's fundus is boggy and located above the umbilicus. What is the nurse's priority intervention?
Massage the client's fundus.
A primigravid client at 38 weeks' gestation comes to the labor room because "my water broke." The health care provider (HCP) asks the nurse to verify spontaneous rupture of membranes using nitrazine paper. The nurse observes that the nitrazine paper turns bright blue. What action should the nurse take next?
Notify the HCP that the membranes are ruptured.
After receiving large doses of an ovulatory stimulant such as menotropins, a client comes in for her office visit. Assessment reveals the following: 6-lb (3-kg) weight gain, ascites, and pedal edema. Based on this assessment, what should the nurse do next?
Notify the healthcare provider.
The nurse is caring for a laboring client with pregestational diabetes mellitus who is in active labor. The client reports nausea and "feeling flushed." The nurse notes a fruity odor to the client's breath. What is the nurse's priority intervention?
Obtain the client's blood glucose level.
A nurse and an LPN are working in the labor and birth unit. Of the activities that must be done immediately, which should the nurse assign to the LPN?
Perform a straight catheterization for protein analysis.
When instructing a client about the proper use of condoms for pregnancy prevention, the nurse should include which instructions to ensure maximum effectiveness?
Place the condom over the erect penis before coitus.
The nurse is caring for a client in active labor and notes minimal variability on the external fetal monitor tracing. What are the nurse's priority interventions?
Position to left lateral, O2 per nonrebreather mask at 10 L.
The nurse is caring for a primigravida client who has been admitted to the labor and birth unit. Assessment reveals fetal malpresentation, green amniotic fluid, and a fetal heart rate (FHR) of 98 beats/minute. What is the nurse's priority intervention?
Prepare for an emergency cesarean birth.
The nurse caring for the laboring client performs a sterile vaginal exam. Exam results are dilated 10 cm, effaced 100%, and +2 station. What is the priority nursing intervention?
Prepare for birth of the neonate.
The nurse is working in the labor and birth unit when a client with active herpes simplex virus-Type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care is anticipated?
Prepare the client for a cesarean section.
The nurse is caring for a client who is attempting a trial of labor (attempt a vaginal birth after cesarean). Contractions are 1.5 minutes apart with a duration 75 to 90 seconds. The client reports a "sharp, tearing" pain, and the electronic fetal monitor (EFM) is no longer recording contractions. What is the priority nursing action?
Prepare the client for an emergency cesarean birth.
An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which nursing intervention is most appropriate at this time?
Recommend a pregnancy test after acknowledging the client's distress.
A 23-year-old client diagnosed with schizophrenia cheerfully announces, "My mom and I are so excited that I'm pregnant. She's willing to help us take care of the baby too." Which reason should cause the nurse to be concerned about this situation?
Symptom management will be difficult in early pregnancy without medications.
The nurse is performing a health history for a client in her first trimester of pregnancy who lives alone with two cats. What education should the nurse provide so that the client can protect herself from illness?
The client should wear disposable gloves to clean the litter box and wash hands with soap and warm water after cat litter exposure.
A client who is Rh-factor negative has given birth to a healthy infant who is Rh-factor positive. What teaching will the nurse provide to the client?
The client will need Rh immunoglobulin injection within 72 hours.
During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 15 beats/minute, each lasting 15 seconds. These increases occur only with fetal movement. How should the nurse interpret this finding?
The fetus is not in distress at this time.
A client in labor received an epidural for pain management. Before receiving the epidural, the client's blood pressure was 124/76 mm Hg. Ten minutes after receiving the epidural, the client's blood pressure is 98/56 mm Hg, and the mother is vomiting. Before calling the health care provider (HCP), what should the nurse do?
Turn the client to her side.
A client is 9 days postpartum and breast-feeding her neonate. The client experiences pain, redness, and swelling of her left breast and is diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information?
Use a warm moist compress over the painful area.
Four hours after cesarean birth of a neonate weighing 8 lb, 13 oz (4,000 g), the primiparous client asks, "If I get pregnant again, will I need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean (VBAC) on which standard of practice?
VBAC may be possible if the client has not had a classic uterine incision.
A client is at 24 weeks' gestation. The nurse is reviewing the report of laboratory tests. The nurse should report which of these results to the health care provider?
VDRL
A pregnant client late in her first trimester comes to the clinic for a follow-up visit. The woman tells the nurse that she has been having morning sickness, but she "tried using this band on her wrist," and it helped cut down on the number of episodes she was having. The nurse interprets this therapy as an example of
acupressure.
A client at 7 weeks' gestation is being treated for a ruptured ectopic pregnancy in the emergency department. The client's vital signs are blood pressure 84/45 mmHg, heart rate 122 beats/min, respiratory rate 26 breaths/min, temperature 98.6°F (36.8°C). What is the nurse's priority?
administering fluid resuscitation and preparing the client for surgery
A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member?
an 8-year-old with Rubella
A parent brings a 2-month-old infant to the clinic for a well-baby checkup. To best assess the interaction between the parent and infant, the nurse should observe them:
as the parent feeds the infant.
A client diagnosed with testicular cancer expresses concerns about fertility. The client and his spouse desire to eventually have a family, and the nurse discusses the option of sperm banking. What should the nurse tell the couple about the best time to donate the sperm?
before treatment is started
The nurse is assessing a 39-year-old client during her 32-week prenatal checkup. The client has attended regular prenatal checkups throughout the pregnancy. Which assessment data is a priority for the nurse to complete?
blood pressure
A client who is 6 weeks' pregnant comes to the clinic for her first prenatal visit. What is the most immediate need for the nurse to address for this client?
the schedule of prenatal visits
A client with a gravida 1 para 0 term pregnancy was discharged home last evening in false labor. The client returns to the hospital stating she has had strong contractions for the past 2 hours. Which assessments will indicate to the nurse that the client is in true labor?
cervical dilatation and effacement
The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section?
client at 38 weeks' gestation with active herpes lesions
Which client is the best candidate for a vaginal birth after a caesarean (VBAC)?
client who had a breech presentation in her last pregnancy, and this pregnancy is a vertex pregnancy
The nurse would question the prescription for a fetal scalp electrode on which client?
client with an HIV infection
The nurse is managing a pregnant client's second stage of labor. The nurse should intervene when observing which action?
closed glottis pushing
A nulliparous client tells the nurse that during her last pelvic examination, the health care provider said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which complication?
difficulty conceiving a child
A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?
deep tendon reflexes
The end of the third stage of labor is marked by what event?
delivery of the placenta
A client wants to avoid methods of birth control that contain estrogen. Which method would be the nurse recommend?
depot medroxyprogesterone acetate injection
A nulliparous client says that she and her husband plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
destruction of spermatozoa before they enter the cervix
Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which information about a change the client can anticipate in the first trimester?
experiencing ambivalence about pregnancy
A client has her first prenatal visit at 15 weeks' gestation. The client weighs 144 lb (65.5kg) and states this is a 4-pound weight gain. Which assessment finding requires further investigation?
fundal height of 18 cm
A 29-week gestation client arrives in the labor and birth suite for an emergency cesarean section. The neonate is born and artificial surfactant is administered. Which action best explains the main function and goal of surfactant use?
helps lungs remain expanded after the initiation of breathing improving oxygenation
After instructing a female client about the radioimmunoassay pregnancy test, the nurse determines that the client understands the instructions when the client states that which hormone is evaluated by this test?
human chorionic gonadotropin (hCG)
A 31-year-old multigravid client at 39 weeks' gestation admitted to the hospital in active labor is receiving intravenous lactated Ringer's solution and a continuous epidural anesthetic. During the first hour after administration of the anesthetic, the nurse should monitor the client for which adverse reaction?
hypotension.
When teaching a group of pregnant adolescent clients about reproduction and conception, the nurse is correct when stating that fertilization occurs:
in the first third of the fallopian tube.
A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn?
increased amounts of vernix
The nurse is caring for a 15-year-old adolescent mother after birth. The adolescent lives at home with her parents and has a boyfriend who is also 15 years old. Neither is currently working, and they both have plans for higher education. When addressing the psychosocial issues that may occur after the birth of the child, which of the following would be the most important for the nurse to include in client teaching?
increased stress for new mothers
The nurse is caring for a postpartum client with an episiotomy. The nurse assesses the client closely for what complication that the client is at greatest risk of developing?
infection
A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which information is most important for the nurse to discuss?
infection control
The nurse is caring for a client at 36 weeks' gestation with a temperature of 101.2°F (38.4°C). Examination indicates that the client is leaking amniotic fluid. What is the nurse's priority concern based on these findings?
intrauterine infection
A nurse is planning care for an adolescent client who is 12 weeks' gestation. The nurse will monitor this client closely for the development of which complication during this stage of the pregnancy?
iron-deficiency anemia
A nurse is caring for a multiparous client in the fourth stage of labor. Assessment reveals a boggy uterus. Which nursing intervention has the highest priority?
massaging the uterus
The nurse is caring for a client in labor. How would the nurse report the frequency of each contraction?
measuring the length of time from the start of one contraction to the start of the next
A primigravida, currently about 8 weeks pregnant, and her husband ask when they should begin the preparation for childbirth classes that discuss maternal nutrition during pregnancy. Which time would be most appropriate for the nurse to suggest that they begin the classes?
now during the first trimester of pregnancy
A client has expressed her desire to give birth with minimal intervention. She is now moving into the active phase of labor. What intervention by the nurse would be the priority of care?
offering support by reviewing the short-pant form of breathing
A nurse is caring for a premenopausal client who had precancerous cells found during a routine Papanicolaou (Pap) test. At which time during the menstrual cycle would the nurse schedule a cervical biopsy?
one week after the end of the menstrual period
A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note, which postpartum complication has the client developed?
postpartum hemorrhage
The nurse is caring for a woman who gave birth vaginally to a healthy 6 pound (2.72 kg) newborn after a 2-hour labor at 37 weeks gestation. For which complication will the nurse assess as a priority due to the increased risk in this client?
postpartum hemorrhage
A 44-year-old client has been experiencing spotting, nausea, vomiting, and fatigue. A positive pregnancy test and an ultrasound confirm a 13 week gestation. The client had three prior miscarriages with no term births. What does the nurse recognize as the greatest risk factor for the client at this time?
pregnancy loss
A pregnant woman at 39 weeks' gestation comes to the labor and birth suite in early labor. The woman is a member of the local Muslim community. When developing the culturally appropriate plan of care for this client, which aspect would the nurse identify as the priority?
protecting the client's modesty
The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be
red and moderate.
nurse is caring for a client in labor. The nurse notes variable decelerations on the fetal monitor strip. What is the nurse's priority intervention?
repositioning the client to the other side
A 15-year-old primigravid client at approximately 16 weeks' gestation tells the nurse that she has been experiencing an occasional sharp pain from the fundus to her pubic bone on the left side. The nurse determines that the client is most likely experiencing which complication?
round ligament pain