Archer Reproductive

You have been chosen to give a presentation about maternal risk factors to your community health class. Which of the following are considered adverse risk factors in women wanting to get pregnant? Select all that apply. A. Women older than 30 years of age or less than 18 years of age B. Substance abuse C. Abuse and violence D. Concurrent medical conditions Submit Answer

Explanation Choices B, C, and D are correct. Substance use during pregnancy puts the fetus at risk for abnormal growth, abruptio placentae, and fetal bradycardia. This is a severe risk factor and should be discussed with women trying to conceive (Choice B). Abuse and violence put both the mother and fetus at risk. There are higher instances of abruptio placentae, preterm birth, and infections from unwanted and forced sex (Choice C). Concurrent medical conditions such as diabetes mellitus and hypertension cause the pregnancy to be considered high risk. Different risks are dependent on the situation, such as macrosomia and hypoglycemia in infants of a diabetic mother. These should be discussed thoroughly for women wishing to become pregnant who live with a severe medical condition (Choice D). Choice A is incorrect. The correct maternal risk factor is women older than 35 years of age or less than 20 years of age. NCSBN Client Need: Topic: Health Promotion and Maintenance, Subtopic: Reproductive, antepartum Last Updated - 01, Nov 2021

A nurse is reviewing discharge instructions for a client nearing discharge after undergoing a dilation and curettage (D&C) procedure for an elective abortion at 14 weeks gestation. As part of the discharge instructions, the nurse instructs the client on complications that would warrant the client to seek medical attention. Which statement, if made by the client, would indicate a need for additional education on this topic? A. "If I have stomach pain, tenderness, and a low-grade fever, I can just take a tablet of acetaminophen, and I will be fine." B. "There will be instances where I will feel a sense of loss." C. "I should anticipate minimal vaginal bleeding for 10 to 14 days." D. "I need to see a doctor if my temperature reaches 100°F or higher." Submit Answer

Explanation Choice A is correct. Abdominal tenderness, pain, and a "low-grade fever" may be indicative of a uterine infection. The client should report this to their health care provider (HCP) immediately. Choice B is incorrect. The client may likely experience intermittent feelings of loss following an elective abortion. This is often a common occurrence following this type of procedure. If the client finds these feelings occurring frequently or becoming difficult to deal with, instruct the client to contact the clinic to arrange a referral with an appropriate mental health provider. Choice C is incorrect. The client should anticipate some vaginal bleeding due to uterine changes and surgical trauma. Bleeding may last from two weeks to a month, with the average duration ranging from 10 to 14 days. Choice D is incorrect. Instruct any client who has undergone an abortion to seek medical attention in the event they develop a temperature of 100°F or higher or foul-smelling vaginal drainage, as the main concern is infection and/or sepsis. Learning Objective Recognize a post-elective abortion client has not retained the appropriate discharge information pertaining to the signs and symptoms associated with potential infections and subsequently reorientate the client on those discharge instructions. Additional Info The nurse's role in caring for women seeking an elective abortion is one of providing physical and emotional support and information. Nurses are responsible for providing information about self-care after an elective abortion, while also providing information about follow-up visits and contraception. Counseling and lending emotional support are nursing responsibilities, although a designated counselor also may perform these services. Last Updated - 25, Aug 202

The nurse is caring for a client who has been prescribed depot medroxyprogesterone acetate. Which of the following statements, if made by the client, requires follow-up? A. "I will need another injection in 8 weeks." B. "I may gain weight while on this medication." C. "I can expect increased vaginal bleeding." D. "I should increase my weight-bearing exercises." Submit Answer

Explanation Choice A is correct. Depot medroxyprogesterone acetate is an injection that provides contraception for 13 weeks. The client should return for another injection at 13-week intervals - not 8 weeks. Choices B, C, and D are incorrect. Weight gain, acne, increased vaginal bleeding, and decreased bone density are common effects associated with this contraception. Additional Info ✓ Depot medroxyprogesterone acetate is an effective contraceptive given intramuscularly or subcutaneously every 13 weeks. ✓ While a client takes depot medroxyprogesterone acetate, calcium and vitamin D supplementation are recommended, coupled with weight-bearing exercises. ✓ Women with a high risk for cardiovascular disease and a stroke should not take depot medroxyprogesterone acetate. This medication may increase the risk for major adverse cardiovascular events (MACE). Last Updated - 18, Jan 2023

The nurse is counseling a female client interested in starting contraception. The client tells the nurse a preference for contraception that does not involve pills or any device. Based on the client's preferences, the nurse may recommend which contraceptive product to the primary healthcare provider (PHCP)? A. Depot medroxyprogesterone B. Intrauterine device (IUD) C. Hormonal vaginal ring D. Combined estrogen-progestin pill Submit Answer

Explanation Choice A is correct. Depot medroxyprogesterone acetate is an intramuscular (IM) injection that provides contraception for 13 weeks. Considering that the client prefers no pills or anything invasive, this would be an appropriate recommendation to the PHCP. Choices B, C, and D are incorrect. An IUD and vaginal ring are invasive and would not be recommended for this client based on their stated preference. The combined estrogen-progestin pill is given orally and is not preferred by the client. Additional Info ✓ Several factors play into the appropriate contraception selection for a client. These include her age, current health status, preference for delivery method, and future pregnancy plans. ✓ Depot medroxyprogesterone acetate fits the client's preferences by being non-invasive and administered parenterally, allowing the client the flexibility of not taking a pill daily. ✓ While a client takes depot medroxyprogesterone acetate, calcium and Vitamin D supplementation are recommended, coupled with weight-bearing exercises. ✓ Women with a high risk for cardiovascular disease and a stroke should not take depot medroxyprogesterone acetate. Last Updated - 18, Jan 2023

The nurse is in the screening room of a women's health clinic. The nurse notices a particular woman complaining of back and leg pain, spotting after intercourse with her husband, and vaginal discharge for the past few months. The nurse suspects: A. Cervical cancer B. Endometrial cancer C. Ovarian cancer D. Vaginitis Submit Answer

Explanation Choice A is correct. Signs and symptoms of cervical cancer include back and leg pain, spotting between menstrual periods and after intercourse, vaginal discharge, and lengthening of a menstrual period. A pap smear is needed to assess cellular changes (i.e. check for cancerous and precancerous conditions). Choice B is incorrect. Endometrial cancer manifests as menorrhagia (excessive menstrual bleeding), low abdominal pain, backache, and constipation due to pressure from an enlarging mass. A biopsy is needed to confirm the diagnosis. Choice C is incorrect. Initial signs and symptoms of ovarian cancer include the following: an increasing abdominal girth due to ovarian enlargement, constipation due to rectal pressure from the enlarging mass, anemia, vomiting, and cachexia. Choice D is incorrect. A bacterial infection causes vaginitis. Signs and symptoms include pruritus, burning urination, dysuria, dyspareunia, and a foul-smelling vaginal discharge. Last Updated - 17, Dec 2021

A 28-year-old married woman was just prescribed a pack of oral contraceptive pills. The nurse's initial instruction would be: A. "Once you've taken the pills, you are now safe from pregnancy whenever you have sexual contact." B. "You need to use another form of contraception for the next 7 days as these pills will not take effect during the first week." C. "You should take two pills today and take two pills tomorrow." D. "Expect to have breakthrough bleeding. This is because of the increased estrogen levels in your system brought about by the pills." Submit Answer

Explanation Choice B is correct. Contraceptive pills do not take effect until seven days after they are started. The nurse should instruct the client to use another form of contraception during the initial seven days that she takes the pills. Choice A is incorrect. The patient can still conceive during the first seven days of taking contraceptive pills. Contraceptive pills do not take effect until seven days after they are started. The nurse should instruct the client to use another form of contraception during the initial seven days she takes the pills. Choice C is incorrect. Taking two pills today and another two pills tomorrow is an instruction given by the nurse to the client who forgot to take her pills for two consecutive days. Choice D is incorrect. While this may happen as a side effect of the contraceptive medication, the most important instruction for the nurse to the patient would be to instruct them to use another form of contraception for the first seven days. Last Updated - 15, Feb 2022

Relaxin is a hormone that is released throughout a woman's pregnancy to help prepare her uterine ligaments for the growth of her fetus and uterus. A downside to relaxin is that it may: A. Cause high blood pressure in some women B. Lead to musculoskeletal injury due to loose ligaments C. Make urinating more difficult than normal D. Increase bowel motility Submit Answer

Explanation Choice B is correct. Relaxin can lead to clumsiness because of increased flexibility and ligament relaxation. This clumsiness increases the risk of musculoskeletal injury. Relaxin may also cause round ligament pain, indigestion, and an increase in the frequency of urination. Choice A, C, and D are incorrect. High blood pressure, difficulty urinating, and increased bowel motility are not associated with relaxin. NCSBN client need Topic: Health Promotion and Maintenance, Ante / Intra / Postpartum Last Updated - 03, Jan 202

The nurse is working in a women's health clinic. Which patient should the nurse see first? A. A 17-year-old complaining of severe cramping in her lower abdomen. B. A 25-year-old primigravida with blurred vision. C. A 50-year-old menopausal client expelling dark red blood clots. D. A 70-year-old client who states her uterus is going to "fall out." Submit Answer

Explanation Choice B is correct. Signs and symptoms of preeclampsia include blurred vision, hypertension, generalized edema, and proteinuria. The client is also a primigravida (first-time pregnant), which predisposes her to preeclampsia. The nurse should prioritize the client to include further assessment and intervention. Choice A is incorrect. The 17-year-old with severe lower abdominal cramping needs to be assessed if she is currently menstruating. It does not, however, take priority over a client with signs of preeclampsia. Choice C is incorrect. Clients who undergo menopause experience expulsion of dark red blood clots. This should not cause concern to the nurse. Choice D is incorrect. This may indicate a possible uterine prolapse, but this is not a life-threatening situation. The client may need a hysterectomy to remove the uterus or use a pessary device. Additional Info Source : Archer Review Last Updated - 10, Nov 2022

The nurse is working at a women's health clinic. A patient comes in suspected of having trichomoniasis. Upon physical examination of the perineal region, the nurse should expect which type of sign? A. White, "cheesy" discharge B. Malodorous, thin, yellow discharge C. Grayish-white, malodorous discharge D. No vaginal discharge Submit Answer

Explanation Choice B is correct. Trichomoniasis patients would yield a malodorous, thin, yellow discharge. Trichomoniasis is caused by a protozoon, Trichomonas vaginalis. Choice A is incorrect. A white, "cheesy" discharge is indicative of moniliasis or candidiasis, which is caused by Candida albicans. Choice C is incorrect. Grayish-white, malodorous discharges would indicate bacterial vaginosis. Choice D is incorrect. Patients with trichomoniasis yield a malodorous, thin, yellow discharge. Last Updated - 31, Jan 2022

A Pap smear is recommended to screen for which of the following conditions? A. Ovarian cancer B. Endometrial cancer C. Cervical cancer D. Vaginal cancer Submit Answer

Explanation Choice C is correct. A Pap smear is an excellent screening tool to detect precancerous or cancerous cells of the cervix. There is a long lag time between the appearance of precancerous cells and the development of invasive cervical cancer. Therefore, early detection of precancerous lesions by PAP smear and addressing them promptly with localized treatments help prevent cervical cancer. Choice A is incorrect. Tests and procedures used to diagnose ovarian cancer include a pelvic exam. During a pelvic exam, the provider performs a bimanual exam while simultaneously pressing on the abdomen to palpate pelvic organs. Imaging and blood tests may also be ordered, but they are not accurate for "screening" purposes. Choice B is incorrect. An endometrial biopsy is done to determine endometrial cancer. Choice D is incorrect. A vaginal biopsy determines the presence of cancerous vaginal tissue cells. Last Updated - 13, Nov 2021

The nurse is talking to a client who is scheduled to undergo a pelvic exam the following week. The nurse would include which instruction to the client? A. The client will undergo local anesthesia during the procedure. B. She should relax by clenching her fists or squeezing her eyes during insertion of the speculum. C. She should avoid douching 24 hours before the examination. D. She should open her mouth wide when the speculum is inserted. Submit Answer

Explanation Choice C is correct. Douching within 24 hours of the pelvic exam kills the flora as well as other cells in the cervix and surrounding areas leading to inaccurate results. Choice A is incorrect. Local anesthesia is not used during a pelvic examination. Choice B is incorrect. The client should avoid clenching her fists and squeezing her eyes to facilitate relaxation. Choice D is incorrect. When the speculum is inserted, the client is encouraged to breathe slowly and deeply, exhaling with her mouth open and lips in an "O" shape. This facilitates the relaxation of the vaginal wall. Last Updated - 15, Feb 2022

The fertility nurse is providing education to a woman hoping to become pregnant. This nurse would be most correct in stating that which of the following hormones is chiefly responsible for the release of an ovum from a woman's ovary? A. Estrogen B. Testosterone C. Luteinizing hormone D. Human chorionic gonadotropin Submit Answer

Explanation Choice C is correct. Luteinizing hormone is the hormone chiefly responsible for the release of an ovum from a woman's ovary. Choice A is incorrect. Estrogen is responsible for creating a thick endometrium wall to protect an implanting fertilized egg. Choice B is incorrect. Testosterone is not responsible for releasing an ovum. Choice D is incorrect. Human chorionic gonadotropin is produced by the placenta and is not responsible for the release of an ovum. NCSBN client need Topic: Maintenance and Health Promotion, Ante/Intra/Postpartum Care Last Updated - 13, Feb 2022

Which of the following suspected diagnoses requires immediate referral for a 21-year-old patient with complaints of scrotal pain? A. Epididymitis B. Inguinal hernia C. Testicular torsion D. Hydrocele Submit Answer

Explanation Choice C is correct. Testicular torsion requires immediate surgical intervention to prevent strangulation of the testicle. Choice A is incorrect. Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. The onset of pain is typically over a day or two. The pain may improve with raising the testicle. Choice B is incorrect. An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object. Choice D is incorrect. A hydrocele is a sac filled with fluid that forms around a testicle. They're usually painless and are most common in babies, but they can affect males of any age. NCSBN Client Need Topic: Health Promotion and Maintenance, Subtopic: Scrotum and Testes Abnormalities Last Updated - 16, Feb 2022

A 52-year-old client comes to the clinic and tells the nurse: "I can't believe it! I've been having hot flashes the last few months and thought I was going into menopause, but I guess I'm pregnant!" The client then shows her the positive pregnancy test kit. What is the most appropriate response of the nurse? A. "Wow! That's good news! Let's celebrate!" B. "Really? How can that be? You're too old." C. "That sounds exciting, but we will have to confirm with an ultrasound. People undergoing menopause tend to have a false-positive pregnancy test." D. "Let's do another urine pregnancy test and check if it's still positive." Submit Answer

Explanation Choice C is correct. The nurse acknowledges the patient's emotions and educates the patient regarding the situation. False reassurance is not given and client expectations are set. The client's age and the symptoms she has been experiencing over the last few months indicate that she is likely peri-menopausal or post-menopausal. Pregnancy around such an age is unusual. Some post-menopausal women have elevations in β-hCG that may cause the serum and urine pregnancy tests to be reported as positive; however, such patients are not pregnant. Since false-positive pregnancy tests can occur, an ultrasound would be helpful to confirm. Alternatively, serial serum β-hCG can be performed to see if there is an expected increasing trend with the progression of pregnancy. The absence of such a serial increase indicates a false-positive test. Choice A is incorrect. The nurse is still unsure whether the client is pregnant. Clients undergoing menopause tend to have a false-positive pregnancy test due to high levels of β-hCG. The nurse should not jump to conclusions that may give the client false reassurance. Choice B is incorrect. This response to the client is inappropriate; it conveys a sense of ridicule to the patient and challenges the patient. Choice D is incorrect. A repeat urine pregnancy test is still likely to be positive. The nurse should acknowledge the client's feelings and should tell her that a confirmatory test early in pregnancy is an ultrasound. Alternatively, serial serum β-hCG can be performed to see if there is an expected increasing trend with the progression of pregnancy. The absence of such a serial increase indicates a false-positive test. Last Updated - 03, Feb 2022

A couple in a fertility clinic tell the nurse that they are concerned about transmitting a particular disease to their children. The nurse refers them to genetic counseling. All of the following are the purposes of genetic counseling, except: A. Reassure people who are concerned about their children inheriting a particular disorder as well as provide concrete and accurate information. B. Allow people who are affected by inherited disorders to make informed choices about future reproduction. C. Educate the couple on how to prevent their child from acquiring inherited disorders. D. Educate the couple about inherited disorders and the process of inheritance. Submit Answer

Explanation Choice C is correct. This is an incorrect statement and therefore the correct answer to the question. Genetic counseling aims to let people understand that they have no control over inherited traits. Marriages and relationships can suffer because of this unless they are given adequate support. Choice A is incorrect. This is a correct statement. Genetic counseling results in making individuals feel well or free of guilt, knowing that the disorder they are worried about is not an inherited disorder. Choice B is incorrect. This is a correct statement. Genetic counseling results in individuals acquiring information about having a trait that is responsible for a child's condition. Some people may opt not to have children because of this, but it is essential knowledge for decision-making. Choice D is incorrect. This is a correct statement. Genetic counseling educates people regarding how a particular inherited trait is passed on to the next generation. Last Updated - 03, Feb 2022

The nurse cares for a client newly diagnosed with Trichomonas vaginalis. The nurse plans to take which appropriate action? A. Start a 24-hour urine collection B. Initiate contact precautions C. Obtain a prescription for metronidazole D. Contact the local health department Submit Answer

Explanation Choice C is correct. Trichomoniasis is a protozoan infection primarily spread through sexual contact. The treatment for this infection is metronidazole because of its antibiotic and antiprotozoal properties. This effective treatment may be prescribed in a single dose or over several days. Choices A, B, and D are incorrect. A 24-hour urine collection is not necessary to diagnose or verify the diagnosis of Trichomoniasis. This infection is primarily diagnosed by swabbing the vagina and viewing it under wet-mount microscopy. Contact precautions are not used for this infection because the primary mode of transmission is through sexual contact. This infection is not reported to public health services, unlike other sexually transmitted infections (syphilis, gonorrhea, chlamydia). Additional Info ✓ Trichomonas vaginalis causes Trichomoniasis. ✓ Trichomonas vaginalis is a protozoan parasite primarily spread via sexual contact. ✓ This infection is only found in humans and may cause symptoms in females such as thin, malodorous vaginal discharge that is yellow/green. ✓ Other manifestations include pelvic pain and dyspareunia ✓ Males are commonly asymptomatic. However, they may have symptoms such as urethritis with purulent discharge. ✓ Treatment of this infection is a prescription of metronidazole which may be given in a single dose. Last Updated - 22, Jan 2023

Which of the following would be an appropriate question to ask when taking a patient's menstrual history? A. How many sexual partners have you had? B. Do you have a history of any type of cancer in your family? C. Do you ever skip periods? D. Do you use condoms during intercourse? Submit Answer

Explanation Choice C is correct. When obtaining a menstrual history, the nurse should ask for information only related to the menstrual function. This includes information about the last menstrual period (LMP, date of the first day of bleeding), cycle length, and frequency (e.g. 4/28, 4 days of bleeding every 28 days), the heaviness of bleeding (number of tampons used per day), history of intermenstrual bleeding, history of postcoital bleeding (PCB), age of menarche/menopause, and presence or absence of postmenopausal bleeding. Choices A and D are incorrect. These questions are a part of the sexual history, not menstrual history. Questions related to sex or sexually transmitted infections are asked later in the history-taking after the nurse has established a trusting relationship with the patient. Choice B is incorrect. History of cancer in relatives is part of the family history. NCSBN Client Need: Topic: Health Promotion and Maintenance, Subtopic: Reproductive Last Updated - 23, Jan 2022

The nurse is giving discharge instructions to a client recently diagnosed with vaginitis. Which of the following instructions should the nurse include? A. Use oral contraceptives during sexual intercourse. B. Practice regular douching. C. Abstain from eating yogurt. D. Wear loose-fitting clothing and cotton underwear. Submit Answer

Explanation Choice D is correct. Clients are encouraged to wear loose-fitting clothing and cotton underwear, avoid tight pants and thongs, and avoid using tampons to facilitate ventilation and improve circulation. Choices A, B, and C are incorrect. The client should use a condom during sexual intercourse to prevent her partner from acquiring the infection. Oral contraceptives do not provide a barrier that prevents disease. Clients are advised not to practice regular douching unless prescribed by the healthcare provider. Clients are advised to include yogurt or supplements containing Lactobacillus acidophilus in their diet to maintain vaginal flora. Additional Info Vaginitis is a broad term to describe inflammation of the vagina. This may be because of a pathogen such as bacteria or fungus. General education to provide to the client is to avoid douching and wear loose, cotton underwear. The client should also be reinforced on properly wiping after the bathroom. Finally, the client should be educated on completing any course of antibiotics or antifungals if the vaginitis is caused by a specific pathogen. Last Updated - 27, Dec 2022

Which assessment question would be most appropriate for a patient who is experiencing dyspareunia? A. "Do you take anti-hypertensive medication?" B. "Do you currently have a new partner?" C. "Have you been diagnosed with a neurological disorder?" D. "Do you use antihistamines?" Submit Answer

Explanation Choice D is correct. Factors contributing to dyspareunia include diabetes, hormonal imbalances, vaginal, cervical, or rectal disorders, antihistamine, alcohol, tranquilizer, or illicit drug use, and cosmetic or chemical irritants to the genitals. Dyspareunia is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or more profound in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Choice A is incorrect. Anti-hypertensive medications are not associated with the occurrence of dyspareunia. Choice B is incorrect. Dyspareunia occurs due to medical or psychological causes, not because of the change in partners. Choice C is incorrect. Neurological disorders are not associated with dyspareunia. NCSBN Client Need Topic: Psychosocial Integrity, Subtopic: Female Primary Sexual Dysfunctions Last Updated - 15, Feb 2022

The nurse is teaching individuals at a local health fair about female contraception options. Which information should the nurse include? A. "Intrauterine devices (IUDs) may be safely continued during pregnancy." B. "Contraceptive rings may be rinsed with rubbing alcohol if they are expelled." C. "Combined estrogen-progestin contraception may lower your blood pressure." D. "Hormonal implants that are placed subdermally need to be removed after 3 years." Submit Answer

Explanation Choice D is correct. Hormonal implants may be placed subdermally and should be removed, and if the client elects, replaced after three years. Three years is the approved duration for this device. Choices A, B, and C are incorrect. IUDs may cause serious maternal and fetal consequences, including maternal infection, miscarriage, and placental abruption. If the client is pregnant, the IUD most likely needs to be discontinued. Contraceptive rings that are expelled or inadvertently removed may be reinserted as long as they are rinsed with cool water and within two to three hours. Combined estrogen-progestin contraception may adversely cause hypertension. NCLEX Category: Pharmacological and Parenteral Therapies Activity Statement: Adverse Effects/Contraindications/Side Effects/Interactions Question type: Analysis Additional Info The etonogestrel contraceptive implant is advantageous because it allows the client to attain effective contraception without having to take daily medication. The insertion site is typically on the upper arm overlying the triceps muscle. This contraceptive device's most common adverse effects include headache, weight gain, acne, and breast tenderness. This device is approved to stay in place for three years and may be inserted in an outpatient setting. Last Updated - 23, May 2022

A client who is 28 weeks pregnant is admitted to the gynecology ward for labor induction due to fetal demise. Which of the following substances will be used for the effacement of the client's cervix? A. Normal saline solution B. Oxytocin IV C. Amniotomy D. Laminaria Submit Answer

Explanation Choice D is correct. Laminaria is a cone-shaped substance made from sterile, dried seaweed. For second-trimester abortions, cervical dilation with the removal of the fetus and placenta is generally performed. To begin this process, dilation is initiated with the insertion of laminaria into the cervix 12 to 24 hours before the procedure into the cervical canal to absorb the cervical secretion. Additionally, laminaria expands and aids in the effacement and dilatation of the cervix. Choice A is incorrect. Normal saline is not effective for use for the purpose of effacement of a client's cervix for induction of labor due to fetal demise. Choice B is incorrect. Oxytocin induces uterine contractions but is not utilized for the effacement of the client's cervix. Choice C is incorrect. An amniotomy is the intentional rupture of the amniotic sac by an obstetrical provider performed during labor to aid in the descent of the fetal head. However, in fetal demise, it does not help in effacing the cervix. Learning Objective Identify laminaria as the substance utilized for the effacement of a client's cervix for labor induction in a client in the 28th week of pregnancy experiencing fetal demise. Additional Info The technique used to terminate pregnancy depends on the length of gestation. Abortion techniques based on medications may be options within seven weeks of the woman's last menstrual period. Surgical abortion techniques are needed if the woman has been pregnant for more than seven weeks or if her medical abortion failed and she still desires pregnancy termination. Through 12 weeks of gestation, vacuum aspiration with curettage is the method of choice. Medical methods exist for abortion in the second trimester, but these involve labor. Last Updated - 15, Feb 2022

The nurse is caring for a client recently diagnosed with ovarian cancer. Which of the following statements, if made by the client, would indicate ineffective coping? A. "I joined a local community support group." B. "I am unsure of my overall prognosis." C. "The radiation I receive has made intercourse difficult." D. "I find myself sleeping more and eating less." Submit Answer

Explanation Choice D is correct. The client states that she is sleeping more and eating less, which are two depressive symptoms that signify ineffective coping and warrant follow-up. Choices A, B, and C are incorrect. Joining a local community support group would signify effective coping as the client is engaging in prosocial behavior. The client being unsure of their overall prognosis would indicate a knowledge deficit - not ineffective coping. Radiation to the pelvic area may make intercourse difficult. This is a common side effect associated with radiation and does not indicate that the client is engaging in ineffective coping. NCLEX Category: Psychosocial Integrity Activity Statement: Coping mechanisms Question type: Analysis Additional Info Ineffective coping needs to be addressed by the nurse at every client encounter. Depressive symptoms such as decreased appetite, avolition, suicidal ideations, sleep changes, and lack of interest are suggestive of ineffective coping and need to be addressed. Last Updated - 27, Apr 2022

Which statement should the nurse use during client education regarding a vasectomy as a permanent method of contraception? A. If you change your mind in the future, it's simple to reverse the procedure. B. You will need to return for an annual follow-up visit and sperm count. C. If you have a history of cardiac disease. we won't be able to do the vasectomy. D. You'll need to use another type of birth control until your sperm count is zero. Submit Answer

Explanation Choice D is correct. The second method of birth control is necessary until the sperm count is zero. A vasectomy is a form of male birth control that cuts the supply of sperm to your semen. It's done by cutting and sealing the tubes that carry sperm. Vasectomy has a low risk of problems and can usually be performed in an outpatient setting under local anesthesia. Although vasectomy reversals are possible, vasectomy should be considered a permanent form of male birth control. Vasectomy offers no protection from sexually transmitted infections. Vasectomy is a safe and effective birth control choice for men who are sure they don't want to father a child in the future. Vasectomy is nearly 100 percent effective in preventing pregnancy. Vasectomy is an outpatient surgery with a low risk of complications or side effects. The cost of a vasectomy is far less than the price of female sterilization (tubal ligation) or the long-term value of birth control medications for women. Choice A is incorrect. Although reversal is possible, it is often difficult, requiring microsurgery. Also, results may be unsuccessful. Choice B is incorrect. Once the sperm count is zero, there is no need for follow-up exams. Choice C is incorrect. There is no correlation between having a vasectomy and cardiac disease. NCSBN Client Need Topic: Health Promotion and Maintenance, Subtopic: Altered Sexual Function Last Updated - 31, Jan 2022

What position will the nurse assist the female patient into for a comfortable genital examination? A. Semi-fowler's B. Supine with the knees bent C. Prone with the knees bent D. Semi-lithotomy Submit Answer

Explanation Choice D is correct. The semi-lithotomy position allows the patient to maintain eye contact with the practitioner and communicate while the procedure is being performed. It also allows adequate visualization of the female genitalia. Choice A is incorrect. Semi-Fowler's position is a semi-upright position and does not allow visualization of the female genitalia. Choice B is incorrect. A supine position with bent knees can be used; however, it is not the most comfortable position for the patient during a genital examination. Choice C is incorrect. The prone position with bent knees is not a comfortable position for genital examination. NCSBN Client Need Topic: Health Promotion and Maintenance, Subtopic: Female Genitalia and Rectal Assessment Last Updated - 15, Feb 2022

The nurse is educating the client regarding oral contraceptives. All of the following statements by the nurse are true, except: A. "Oral contraceptives are drugs containing combined doses of estrogen and progesterone that stop ovulation." B. "Oral contraceptives increase your risk for thrombophlebitis and hypertension." C. "They are almost 99% effective when taken consistently." D. "They prevent sperm from entering the cervical os." Submit Answer

Explanation Choice D is correct. This nurse's statement is incorrect, therefore the correct answer to the question. Oral contraceptives work by stopping the process of ovulation, preventing implantation, and inhibiting sperm travel. Prevention of sperm from entering the cervical os is the mechanism of action of barrier contraceptive methods (example: Diaphragm). Choice A is incorrect. This nurse's statement is correct. Oral contraceptives contain fixed or altered estrogen and progesterone doses that inhibit the hypothalamus from producing hormones needed for ovulation. Choice B is incorrect. This nurse's statement is correct. Oral contraceptives increase platelets and clotting factors that increase the woman's risk for thrombophlebitis. Choice C is incorrect. This nurse's statement is correct. Oral contraceptives, when taken consistently, are about 99.7% effective. Generally, the efficacy rate is about 92 to 95%, but the efficacy rate approaches 99.7% if taken perfectly. The nurse needs to emphasize that oral contraceptive intake should not be based on the timing of sexual intercourse. Meaning, to ensure utmost efficacy, the client should take them every day at the same time of day, regardless of whether she will have sex. Last Updated - 02, Feb 2022

The nurse is teaching a client scheduled for a vaginal and cervical colposcopy with biopsy. Which of the following information should the nurse include? A. You should not eat or drink eight hours prior to this test. B. You will need to have someone drive you home after this test. C. A metallic taste is common once you get the contrast dye. D. Vaginal intercourse may be painful after the procedure. Submit Answer

Explanation Choice D is correct. Vaginal intercourse following a vaginal colposcopy with a biopsy is not advised 48-hours after the procedure. Intercourse may be painful and increase post-procedure bleeding. Choices A, B, and C are incorrect. The client does not need to be NPO (nothing by mouth) prior to this procedure. This procedure also does not involve contrast dye or require that the client not drive after the procedure considering sedation is not utilized. NCLEX Category: Reduction of Risk Potential Activity Statement: Diagnostic Procedures Question type: Analysis Additional Info A colposcopy is a diagnostic procedure that may be utilized to detect an array of gynecological conditions, including herpes simplex virus, human papillomavirus, cervical cancer, and any other abnormal tissue in the vagina, cervix, and vulva. This outpatient procedure requires the client to provide consent, and the client should be instructed that after the procedure, a small amount of bleeding is normal if biopsies were obtained. Last Updated - 28, Apr 2022

The nurse working in the gynecology clinic talks to the client who is concerned because she missed taking her contraceptive pill for four days. The most appropriate instruction of the nurse is: A. "Take one pill now and continue taking the pills on your regular schedule tomorrow." B. "Take two pills now and continue taking two pills for the rest of your regular schedule." C. "Take two pills now and two pills tomorrow. Continue with your usual schedule the following day." D. "Here's a new set of pills. Start taking the new pills this Sunday and throw away your old one, and use the second form of contraception for the next 7 days after starting your new pack." Submit Answer

Explanation Choice D is correct. When a client misses three or more oral contraceptive pills in a row, she should throw out the rest of the pack and start a new pack of pills the following Sunday. The nurse needs to inform her to use additional methods of contraception ( barrier methods, condoms) until seven days after starting a new pack of pills. Choice A is incorrect. Taking a contraceptive pill right away and continuing with the usual schedule is an instruction given to the clients who missed only one day of taking their pill. Choice B is incorrect. Taking two pills right away and two pills for the rest of the cycle is not indicated. Such a practice increases estrogen levels, placing the client at high risk of venous thromboembolism and arterial thrombotic events ( myocardial infarction, stroke). Choice C is incorrect. Taking two pills as soon as they remember, two capsules the following day, and continuing with one pill for the rest of the cycle is an instruction indicated for women who missed two consecutive contraceptive pills. Last Updated - 18, Feb 2022

The nurse counsels a client about a newly inserted copper intrauterine device (IUD) for contraception. It would require follow-up if the client states which of the following? Select all that apply. A. "This device may raise my risk for breast cancer." B. "I may continue to have bleeding and cramping." C. "I should perform weight-bearing exercises." D. "I will need my device replaced after 15 years." E. "This device may raise my risk for a stroke." Submit Answer

Explanation Choices A, C, D, and E are correct. The copper intrauterine device is non-hormonal; therefore, it does not raise the risk of breast cancer. Unlike depot medroxyprogesterone, the IUD does not cause bone demineralization, so weight-bearing exercises are not a relevant teaching point for this type of contraception (where they would be for depot medroxyprogesterone). An increase in cardiovascular disease is not associated with the copper IUD as it is non-hormonal. The IUD is to be replaced every ten years (US FDA approved duration) - not fifteen. Choice B is incorrect. The most common adverse effect of the copper IUD is increased bleeding and cramping within the first six months after application. This may cause the client to discontinue the device. Additional Info The copper IUD is an effective contraceptive method that does not involve the use of hormones. This is an attractive feature because it does not raise the risk of cancers, thromboembolism, or cardiovascular disease. The IUD has a high degree of client satisfaction and is one of the most effective methods of contraception. The client should be educated that menstrual cycles with the copper IUD may be heavier and cause more cramping. This device may also be utilized for emergency contraception. Last Updated - 29, Nov 2022