RN- NCLEX exam

1. Intimate partner violence. 2. Substance abuse. 3. Depression. 4. Glucose tolerance screening test.

A 17-year-old gravid client presents for her regularly scheduled 26-week prenatal visit. She appears disheveled, is wearing ill-fitting clothes, and does not make eye contact with the nurse. Which items should the nurse discuss with the client? Select all that apply.

2. Yes it is true. How does that make you feel?

A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can't believe I am going to have a baby!" Which of the following responses by the nurse would be most appropriate at this time?

2. Chorionic villus sampling can be performed earlier in pregnancy.

A 40 year-old client at 8 weeks gestation has a 3-year-old child with Down syndrome. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening methods for the expected baby. The nurse is confident that the teaching has been understood when the client states which of the following?

1. Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers.

A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that:

3. Disseminated intravascular coagulation.

A client in the triage area who is at 19 weeks gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifies her as being at the highest risk for developing which problem?

1. Walk in the hospital room. 2. Use slow chest breathing. 4. Lightly massage her abdomen.

A client is experiencing pain during the first stage of labor. What should the nurse instruct the client to do to manage her pain? Select all that apply:

2. Class 2

A client with a past medical history of ventricular septal defect defect repaired in infancy is seen at the prenatal clinic. She has dyspnea with exertion and is very tired. Her vital signs are 98, 80, 20, BP 116/72. She has +2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac functional classification?

1. Another method of contraception is needed until the sperm count is 0. Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual and laboratory analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need for follow-up after verification that there is no sperm in the system.

A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?

4. Guilt

A dilatation and curettage (D&C) is scheduled for a primigravid client admitted to the hospital at 10 weeks gestation with abdominal cramping, bright red vaginal spotting, and passage of some of the products of conception. The nurse should assess the client further for the expression of which of the following feelings?

4. Maternal blood.

A multigravid client at 32 weeks gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The nurse should prepare the client for frequent antibody titer evaluations obtained from which of the following?

2. Take frequent rest periods with the legs elevated above the hips.

A multigravid client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks gestation, stating, The varicose veins in my legs have really been bothering me lately. Which of the following instructions would be helpful?

3. One possible adverse effect is absence of a menstrual period. With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. Other adverse effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occurr within 5 days after menses.

A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching?

3. Normal ambivalence.

A newly diagnosed pregnant client tells the nurse, "If I'm going to have all of these discomforts, I'm not sure I want to be pregnant!" The nurse interprets the client's statement as an indication of which of the following?

1. A single mother at 4 months postpartum fearful of shaking her baby when he cries. 2. An antenatal client at 16 weeks gestation who has occasional sharp pain on her left side radiating from her symphysis to her fundus.

A nurse is assigned to the obstetrical triage area. When beginning the assignment, the nurse is given a report about four clients waiting to be seen. Place the clients in the order in which the nurse should see them:

4. Increased levels of AFP are associated with neural tube defects

A primigravid adolescent client at approximately 15 weeks gestation who is visiting the prenatal clinic with her mother is to undergo alphafetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following?

2. The volume of amniotic fluid needed for testing will be available by 15 weeks.

A primigravid at 8 weeks gestation tells the nurse that she wants an amniocentesis because there is history of hemophilia A in her family. The nurse informs the client that she will need to wait until she is at 15 weeks gestation for the amniocentesis. Which of the following provides the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks gestation?

3. If my baby does not move, I need to call my health care provider.

A primigravid client at 16 weeks gestation has had an amniocentesis and has received teaching concerning signs and symptons to report. Which statement indicates that the client needs further teachings?

4. Herpes genitalis.

A primigravid client at 8 weeks gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed flulike symptoms, enlarged lympth nodes, and clusters of vesicles on her vagina. The nurse refers the client to a primary health care provider because the nurse suspects which of the following sexually transmitted diseases?

1. Hepatitis B immune globulin at birth. 2. Series of three hepatitis B vaccinations per recommended schedule. 5. Universal precautions for mother and infant.

A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include which of the following? Select all that apply.

1. The maximum blood loss considered within normal limits is 500 ml.

A primigravid client in a preparation for parenting class asks how much blood is lost during an uncomplicated birth. The nurse should tell the woman:

1. We must view the gross anatomy of the fetus. 2. We need to determine gestational age.

A primiparous client at 10 weeks gestation questions the nurse about the need for an ultra-sound. She states "I don't have health insurance and I can't afford it. I feel fine, so why should I have the test?" The nurse should incorporate which statements as the underlying reason for performing the ultrasound now? Select all that apply.

2. Refer the client to her health care provider for evaluation and treatment of the pain.

A woman at 22 weeks gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which of the following nursing measures is the highest priority for this client?

4. Bronchodilators should be used only when necessary because of the risk they present to the fetus.

A woman with asthma controlled through the consistent use of medication is now pregnant for the first time. Which of the following client statements concerning asthma during pregnancy indicates the need for further instruction?

2. Schedule an appointment at the clinic for an examination.

After a preparation for parenting class session, a pregnant client tells the nurse that she has had some yellow-gray frothy vaginal discharge and local itching. The nurse's best action is to advise the client to do which of the following?

4. Congenital anomalies.

After conducting a presentation to a group of adolescent parents on the topic of adolescent pregnancy, the nurse determines that one of the parents needs further instruction when the parent says that adolescents are at great risk for which of the following?

4. Human chorionic gonadotropin (hCG).

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 of the following hormones is evaluated by this test?

4. Testosterone.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which of the following hormones is produced by the placenta?

4. Pelvic tilt exercises.

After instructing participants in a childbirth education class about methods for coping with discomforts in the first stage of labor, the nurse determines that one of the pregnant clients needs further instruction when she says that she has been practicing which of the following?

4. If i need to have a bowel movement, sennosides (Ex-Lax) are preferred.

An antenatal client receives education concerning medications that are safe to use during pregnancy. The nurse evaluates the client's understanding of the instructions and determines that she needs further information when she states which of the following?

4. It's not uncommon to have dreams about the baby, particularly in the third trimester.

During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks gestation and is now in her third trimester states, "I've been having strange dreams about the baby. Last week I dreamed he was covered with hair." The nurse should tell the mother:

4. Control of the growth of pathologic bacteria.

Examination of a primigravid client having increased vaginal secretions since becoming pregnant reveals clear, highly acidic vaginal secretions. The client denies any perineal itching or burning. The nurse interprets these findings as a response related to which of the following?

1. Handwashing or antiseptic use when entering and leaving a room. 2. Use of two client identifiers when initiating contact with a client. 4. Conduct preprocedure verification asking for client name and procedure to be performed.

The nurse is working in an ambulatory obstetrics setting. What are emphasized client safety procedures for this setting? Select all that apply.

Because the fetus is determined to be in an LOA, a vertex position, the convex portion of the fetus lying closest to the uterine wall would be located in the lower left quadrant of the abdomen. Placing the Doppler ultrasound over that area would produce the loudest fetal heart sounds.

The nurse performed Leopold's maneuvers and determined that the fetal position is LOA. Identify the area where the nurse would place the Doppler to most easily hear fetal heart sounds.

1. Absence of nausea.

When providing care to the client who has undergone a dilatation and curettage (D&C) after a spontaneous abortion, the nurse administers hydroxyzine as prescribed. Which of the following is an expected outcome?

1. Eat smaller and more frequent meals during the day.

Which of the following recommendations would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks gestation who is experiencing occasional heartburn?

1. This usually disappears after childbirth.

Which of the following statements by the nurse would be most appropriate when responding to a primigravid client who asks. What should I do about this brown discoloration across my nose and cheeks?

2. Diaphragms should not be used if the client develops acute cervicitis. The teaching plan should include the caution that a diaphragm should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in a place for at least 6 hours but no longer than 24 hours after inter course. More spermicidal jelly or cream should be used if intercourse is repeated during this period.

Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning?

1. Prepare to witness an informed consent for surgery.

While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should:

4. Consume liquids only between meals

During a visit to the prenatal clinic, a pregnant client at 32 weeks gestation has heartburn. The client needs further instruction when she says she must do what?

1. Spinach.

When developing a teaching plan for a client who is 8 weeks pregnant, which of the following foods would the nurse suggest to meet the client's need for increased folic acid?

1. Pregnant adolescents are at high risk for pregnancy-induced hypertension.

Which of the following statements best identifies the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client?

1. The client states the need to maintain blood glucose levels between 70 and 110 mg/dL (3.9 to 6.2 mmol/L). 2. The client describes her planned walking program while pregnant. 3. The client will strive to maintain a hemoglobin A1C of less than 6% (0.06). 5. The client will continue her prenatal vitamins, iron, and folic acid.

The antenatal clinic nurse is educating a gestational diabetic soon after diagnosis. Outcome evaluation for this client session will include which of the following? Select all that apply.

4. Ask the client if the baby is or has been moving. 3. Obtain different equipment and recheck. 2. Explain that the fetal heart beat could not found at this time. 1. Call the health care provider.

The nurse assesses a woman at 24 weeks gestation and is unable to find the fetal heart beat. The fetal heart beat was heard at the client's last visit 4 weeks ago. According to priority, the nurse should do the following tasks in which order?

3. Egg yolks and squash.

The nurse instructs a primigravid client about the importance of sufficient vitamin A in her diet. The nurse knows that the instructions have been effective when the client indicates that she should include which of the following in her diet?

2. At about the level of the client's umbilicus.

When measuring the fundal height of a primigravid client at 20 weeks gestation, the nurse will locate the fundal height at which of the following points?

2. Determine what is in the fundus.

When performing Leopold's maneuvers on a primigravid client at 22 weeks gestation, the nurse performs the first maneuver to do which of the following?

4. Experiencing ambivalence about pregnancy.

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 of the following information about changes the client can anticipate in the first trimester?

3. I'm truly sorry you lost your baby.

On entering the room of a client who has undergone a dilatation and curettage (D&C) for a spontaneous abortion, the nurse finds the client crying. Which of the following comments by the nurse would be most appropriate?

4. Development of Rh-positive antibodies.

Rho (D) immune globulin (RhoGAM) is prescribed for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that this drug is used to prevent which of the following?

2. Synthesis of proteins, nucleic acids, and fats.

The nurse instructs a primigravid client to increase her intake of foods high in magnesium because of its role with which of the following?

1. Left occipital transverse.

The nurse is assessing fetal position for a 32-year-old client in her 8th month of pregnancy. As shown below, the fetal position can be described as which of the following?

3. Experimenting with mothering roles. 4. Realignment of roles and tasks. 5. Trying various caregiver roles. 6. Concern about labor and birth.

The nurse is developing a teaching plan for a client entering the third trimester of her pregnancy. The nurse should include which of the following in the plan? Select all that apply:

2. Multigravid who had a positive oxytocin challenge test.

The nurse is reviewing results for clients who are having antenatal testing. The assessment data from which client warrants prompt notification of the health care provider and a further plan of care?

2. I may have anemia because my family is of Asian descent.

The nurse is teaching a new prenatal client about her iron deficiency anemia during pregnancy. Which statement indicates that the client needs further instructions about her anemia?

3. You should abstain from drinking alcoholic beverages.

A primigravid client asks the nurse if she can continue to have a glass of wine with dinner during her pregnancy. Which of the following would be the nurse's best response?

2. Increased risk for urinary tract infections.

The topic of physiologic changes that occur during pregnancy is to be included in a parenting class for primigravid clients who are in their first half of pregnancy. Which of the following topics would be important for the nurse to include in the teaching plan?

3. Couvade syndrome.

A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these findings as suggesting that the client's husband is experiencing which of the following?

2. Protable.

A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings reflect this woman is experiencing a cluster of which signs of pregnancy?

4. Normal because multiparous clients can experience quickening between 14 and 20 weeks gestation.

A 34-year-old multiparous client at 16 weeks gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. The nurse interprets this as which of the following?

4. Estimate the fetal growth.

A 36-year-old primigravid client at 22 weeks gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client's fundal height to:

3. The clinic social worker.

A client at a prenatal clinic has missed two appointments. The client calls the nurse to report that she has difficulty with consistent transportation. The nurse should refer the client to:

1. Engagement. 2. Flexion. 3. Descent. 4. Internal rotation.

During a 2-hour childbirth preparation class focusing on the labor and birth process for primigravid clients, the nurse is describing the maneuvers that the fetus goes through during the labor process when the head is the presenting part. In which order do these maneuvers occur?

1. Pelvic rocking.

During a childbirth preparation class, a primigravid client at 36 weeks gestation tells the nurse, "My lower back has really been bothering me lately." Which of the following exercises suggested by the nurse would be most helpful?

4. True labor contractions are felt first in the lower back, then the abdomen.

During a preparation for parenting class, one of the participants asks the nurse, "How will I know if I am really in labor?" The nurse should tell the participant which of the following about true labor contractions?

1. Take a mild analgesic if needed for menstrual pain. The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual pain or "cramps" are present. The client should also eat foods rich in iron and should continue moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the male partner should wear condom to prevent expose to blood.

Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate?

3. Straighten the knee and flex the toes toward the chin.

Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks gestation who has leg cramps?

2. Bicornuate uterus.

A 24-year-old woman is being assessed for a malformation of the uterus . The figure below indicates which of the following uterine malformations?

1. External genitalia.

When developing a series of parent classes on fetal development, which of the following should the nurse include as being developed by the end of the third month (9 to 12 weeks)?

3. The procedure involves the insertion of a thin catheter into my uterus

Which of the following statements by a primigravid client scheduled for chorionic villi sampling indicates effective teaching about the procedure?

3. As ovulation approaches, cervical mucus is abundant and clear. As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white Ovulation generally occurs 14 days (±2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.

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 of the following statements would the nurse expect to include in the client's teaching plan?

1. Seminal fluid with an alkaline pH. The client needs further instruction when he says that one cause of male infertility is decreased sperm count due to seminal fluid that has an alkaline pH. A slightly alkaline pH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. An alkaline pH is not associated with decreased sperm count. However, seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Frequent exposure to heat sources, such as saunas and hot tubs, can decrease sperm production, as can abnormal hormonal stimulation. Immunologic factors produced by the man against his own sperm (autoantibodies) or by the woman can cause the sperm to clump or be unable to penetrate the ovum, thus contributing to infertility.

A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause?

4. The father of the baby is irritated that the mother is not like she was before pregnancy.

A new antenatal G 6, P 4, Ab 1 client attends her first prenatal visit with her partner. The nurse is assessing this couple's psychological response to the pregnancy. which of the following requires the most immediate follow-up?

3. Taking the trip is okay if you stop every 1 to 2 hours and walk.

A primigravid client at 28 weeks gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hours away. Which of the following recommendations by the nurse would be best?

2. I can hold my baby several different ways during feedings. 4. If I breast-feed, my uterus will return to pre-pregnancy size more quickly. 6. I need to feed my baby when I see feeding cues and not wait until she is crying

A primigravid client at 32 weeks gestation is enrolled in a breast-feeding class. Which of the following statements indicate that the client understands the breast-feeding education? Select all that apply.

4. Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average.

After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which of the following?

2. Possible premature labor.

After the nurse reviews the primary health care provider's explanation of amniocentesis with a multigravid client, which of the following indicates that the client understands a serious risk of the procedure?

1. Milkshake or yogurt with fresh fruit or granola bar. 3. Cheese pizza with spinach and mushroom topping. 4. Peanut butter with crackers and a juice drink.

The nurse is discussing dietary concerns with pregnant teens. Which of the following choices are convenient for teens yet nutritious for both the mother and fetus? Select all that apply.

4. February 17.

Using Nagele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of childbirth would be which of the following?

1. Calcium.

When caring for a primigravid client at 9 weeks gestation who immigrated to North America from Vietnam 1 year ago, the nurse would assess the client's diet for a deficiency of which of the following?

2. Empty her bladder.

When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy?

2. Cardiac output increases by 25% to 50% during pregnancy.

When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy should the nurse include in the teaching plan?

3. Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. For a client with a typical menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5 F to 1.0 F (0.28 C to 0.56 C) when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.

Which of the following would be important to include in the teaching plan for the client who wants more information on ovulation and fertility management?

3. Colostrum is usually secreted by about the 16th week of gestation.

Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client?

1. Leafy green vegetables. 2. Strawberries. 3. Beans. 5. Sunflower seeds. 6. Lentils. The pregnancy requirement for folic acid is 600 mcg/day. Major sources of folic acid include leafy green vegetables, strawberries and oranges, beans, particularly black and kidney beans, sunflower seeds, and lentils. Milk and fats contain no folic acid.

A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which of the following foods? Select all that apply.

1. Practice relaxation techniques before bedtime.

A primigravid client at 36 weeks gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which of the following suggestions would be most helpful?

1. It has a high degree of accuracy within 1 week after ovulation.

When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay pregnancy test, the nurse should tell the client which of the following about this test?

4. The thyroid enlarges with an increase in basal metabolic rate.

When preparing a prenatal class about endocrine changes that normally occur during pregnancy, the nurse should include information about which of the following subjects?

1. My fallopian tubes will be tied off through a small abdominal incision. Tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure. The ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.

A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching?

4. If I gain or lose 20 lb (9.1 kg), I can still use the same diaphragm. The client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 lb (9.1 kg). Gaining or losing more than 15 lb (6.8 kg) can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 or 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and childbirth because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching?

4. Ovarian cancer. The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis.

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which of the following as an adverse effect?

4. If there is discharge from my nipples, I should call my health care provider. The nurse determines that the client has understood the instructions when the client says that she will notify her primary health care provider if she notices discharge or bleeding because this may be symptomatic of underlying disease. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this time. The client should perform breast self-examination on the same day each month only if she has stopped menstruating (as with menopause). The client's breasts should mirror each other. If one breast is significantly larger than the other, or if there is "pitting" of breast tissue, a tumor may be present.

After the nurse instructs a 20 year old nulligravid client on how to perform a breast self-examination, which of the following client statements indicates that the teaching has been successful?

A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.

When teaching a primigravid client at 24 weeks gestation about the diagnostic tests to determine fetal well-being, which of the following should the nurse include?

3. Strengthen the perineal muscles.

When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome of these exercises is to:

4. a-fetoprotein (AFP) testing.

Which diagnostic test would be the most important to have for a primigravid client in the second trimester of her pregnancy?

3. I should sit in a hot tub for 20 minutes to relax after working.

Which of the following client statements indicates a need for additional teaching about self care during pregnancy?

4. Severe cramping may occur when the IUD is inserted. Severe cramping and pain may occur as the evice is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common adverse effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopicpregnancy may occur. The IUD has rate of 98%), Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.

Which of the following instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?

2. Fetal nutrients are provided by the amniotic fluid.

Which of the following statements by a primigravid client about the amniotic fluid and sac indicates the need for further teaching?

3. Women of African descent are at the greatest risk for osteoporosis. Small-boned, fair-skinned women of northern European descent are at the greatest risk for osteoporosis, not women of African descent. One standard serving of yogurt is the equivalent of one glass of milk. Women who do not eat dairy products, such as women who are lactose intolerant, should consider using calcium supplements. Inadequate lifetime intake of calcium is a major risk factor for osteoporosis. Estrogen therapy, or some of the newer medications that are not estrogen based, can greatly reduce the incidence of osteoporosis.

After instructing a 40-year-old woman about osteoporosis after menopause, the nurse determines that the client needs further instruction when the client states which of the following?

1. I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time.

An antenatal client is discussing her anemia with the nurse in the prenatal clinic. After a discussion about sources of iron to be incorporated into her daily meals, the nurse knows the client needs further instructions when she responds with which of the following?

4. Group B Streptococcus.

An antenatal primigravid client has just been informed that she is carrying twins. The plan of care includes educating the client concerning factors that put her at risk for problems during the pregnancy. The nurse realizes the client needs further instructions when she indicates carrying twins puts her at risk for which of the following?

2. Monozygotic twins occur by chance regardless of race or heredity.

A primigravid client attending parenthood classes tells the nurse that there is a history of twins in her family. What should the nurse tell the client?

3. Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections. Ceftriaxone sodium (Rocephin) may be used to treat N. gonorrhoeae infections and is commonly combined with doxycycline hyclate (Vibramycin). Both the client and her partner should be treated if gonorrhea is present. Acyclovir (Zovirax) can be used to treat herpes genitalis; however, the drug does not cure the disease. C. trachomatis infections are usually treated with antibiotics such as doxycycline or azithromycin (Zithromax). Metronidazole (Flagyl) is used to treat trichomoniasis vaginitis, not condylomata acuminata (genital warts).

When developing a teaching plan for an 18-year-old client who asks about treatments for sexually transmitted diseases, the nurse should explain that:

1. Place the condom over the erect penis before coitus. To ensure maximum effectiveness, the condom should always be placed over the erect penis before coitus. Some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom. The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise sperm may escape from the condom, providing an opportunity for possible fertilization. Rather than having the condom pulled tightly over the penis before coitus, space should be left at the tip of the penis to allow the condom to hold the sperm. The client does not need a prescription for a condom with nonoxynol 9 because these are sold over the counter.

When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness?

1. Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy. Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after after ovulation (days 15 through 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility that fertilization can occur. Before fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality.

After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective?

3. Breast - or bottle-feeding plan. Birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding her infant. The maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. Low-dose oral contraceptives would be the exception. Use of estrogen-/progesterone-based pills and progesterone-only pills are commonly initiated from 4 to 6 weeks postpartum because the milk supply is well established by this time. Prior experiences with birth control methods have an impact on the method chosen as do to preferences of the client's partner; however, they are not the most influential factors. Desire to have another child in two years would make some methods, such as an IUD, less attractive but would still be secondary to the choice to breast-feed.

An antenatal G2, T1, P0, Ab0, L1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options?

2. Hypertension. Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency, anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia.Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives commonly improves facial acne.

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following?

3. Cervical mucus is carefully monitored for changes. The symptothermal method is a natural method of fertility management that depends on knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 or 2 days in either direction, the symptothermal method requires daily basal body temperature assessments plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approximately 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1 through 10). Typically, the failure rate for this method is between 10% and 20 %. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning.

A 20-year-old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan?

4. What is it that concerns you about pregnancy, labor, and childbirth? The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States and Canada, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client's concerns and block further therapeutic communication. Also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety.

A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which of the following responses would be most helpful?

1. Using a spermicide with the condom offers added protection against pregnancy. The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensibility. However, some users do report an increased sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.

A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions should the nurse include about the use of condoms as a method for family planning?

2. Take her temperature at the same time every morning before getting out of bed. The basal body temperature method requires that the client take her temperature each morning before getting out of bed, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5℉ (0.28 C). At the time of ovulation, the temperature rises 0.4 F to 0.8 F (0.22 C to 0.44 C) because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the menstrual cycle. The client should Keep a diary of about 6 months of menstrual cycles to calculate "safe" days. There is no mucus for the first 3 or 4 days after menses, and then thick, sticky mucus begins to appear. As estrogen íncreases, the mucus changes to clear, slippery, and stretchy. This condition, termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid a pregnancy.

A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body tempature method for family planning. The nurse should instruct the client to do which of the following?

1. I can wait 3 to 4 days after intercourse to start taking these to prevent pregnancy. Plan B is a series of contraceptive pills similar in composition to birth control pills that have been used for the past 30 years. Plan B is the brand name for levonorgestrel 0.75 mg. Pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later. Males can purchase this contraceptive as long as they are over 18 years of age. Common side effects include nausea, breast tenderness, vertigo, and stomach pain.

A client has obtained Plan B (levonorgestrel 0.75 mg, 2 tablets) 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 of the following responses?

3. IVF involves bypassing the blocked or absent fallopian tubes. The client's understanding of the is demonstrated by the statement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The primary health care provider removes the ova by laparo-scope- or ultrasound-guidad transvaginal retrieval and mixes them with prepared sperm from the woman's partner or a donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen, is given to enhance the implantation process. Gamete intrafallopian transfer (GIFT) and tubal embryo transfer have a higher pregnancy rate than IVF. However, these procedures cannot be used for clients who have blocked o absent fallopian tubes because the fertilized ova are placed into the fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF, fertilization of the ova by the sperm occurs outside the client's body. In GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman's body.

A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure?

4. Describe each of the potential causes and possible treatment modalities. By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may hel them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because theds time to adjust to the diagnosis of indtility, a crisis for most couples. Although the may be in a hurry for definitive therapy, a thorou assessment of both partners is necessary before a treatment plan can be initiated. The success rate fo achieving a pregnancy depends on both the caus and the effectiveness of the treatment, and in som s it may be only as high as 30%. The couple may desire information about alternatives to treatment, but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy ma result in a pregnancy, the couple should have time to consider their options. After a thorough evalua- tion, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.

A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines that an appropriate outcome for the couple would be to accomplish which of the following by the end of this visit?