OB exam 1

Primary prevention for HPV includes which of the following? a) Teaching about HPV testing in women over age 30 b) Recommending treatment of genital warts c) Administering HPV vaccine d) Educating about the importance of regular Pap smears

Administering HPV vaccine Correct Explanation: Primary prevention is aimed at preventing the disease or condition before it occurs, so giving the HPV vaccine would be a primary prevention activity. Educating about the importance of regular Pap smears, teaching about HPV testing, and recommending treatment of genital warts would be secondary prevention activities.

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations? a) Just below the ensiform cartilage b) Symphysis pubis c) Between the symphysis and umbilicus d) At the umbilicus

At the umbilicus Correct Explanation: At 20 weeks' gestation, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.

An intrauterine device has been inserted into a client as a requested birth control method. Which of the following is an advantage of intrauterine devices (IUDs)? a) Protection against sexually transmitted infections b) Decreased incidence of pelvic inflammatory disease c) Continuous protection without client's active participation d) Decreased incidence of tubal pregnancies

Continuous protection without client's active participation Explanation: IUDs provide continuous protection without the need for the client's active participation. IUDs give no protection against sexually transmitted infections, and may cause an increased incidence of pelvic inflammatory disease and tubal pregnancies.

The nurse is working with a patient in labor. She is happy and cheerful, and states she is "ready to see her baby." What stage or phase of labor would she anticipate the patient to be in right now? a) Latent Phase b) Transition Phase c) Stage Two d) Stage Three

Latent Phase Explanation: The woman in labor undergoes numerous psychological adaptations during labor. During the latent phase, she is often talkative and happy, and yet anxious. During transition, the patient may show fear and anger. During stage two she may remain positive, but the work of labor is very intense. (

The following are nursing measures commonly offered to women in labor. Which nursing intervention probably would be most effective in applying the gate-control theory for relief of labor pain? a) Give the prescribed medication b) Change the woman's position c) Massage the woman's back d) Encourage the woman to rest between contractions

Massage the woman's back Explanation: Gate control is based on the idea of distraction or redirection of the conduction of impulses up the neural pathways. Massage redirects the paths of sensation away from the pain to the other area.

About which childhood communicable disease should the nurse question the male patient who is seeking information about subfertility?

Mumps

A client in her second trimester of pregnancy asks the nurse for information regarding certain oral medications to induce a miscarriage. What information should this client be given about such medications?

They can be taken only in the first trimester.

A young woman comes to the free clinic asking for birth control pills. Which of the following best indicates that another type of contraception would be better for this patient?

history of noncompliance with medications

An 18-year-old pregnant woman asks why she has to have a routine alpha-fetoprotein serum level drawn. You explain that this a) tests the ability of her heart to accommodate the pregnancy. b) measures the fetal liver function. c) is a screening test for placental function. d) may reveal chromosomal abnormalities.

may reveal chromosomal abnormalities. Correct Explanation: An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching? a) "I'll try to drink more fluids to help move things along." b) "I'll switch to chewing gum instead of using mints." c) "I'll increase my time spent on walking each day." d) "I'll stay away from foods like cabbage and brussels sprouts."

"I'll switch to chewing gum instead of using mints." Correct Explanation: Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.

A female client comes to the clinic and asks the nurse what would be the most cost effective method for her to determine her ovulation patterns. What is the best response by the nurse? a) "The testing kit, Fertell, should be purchased, as well as a sperm kit for your male partner." b) "The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months." c) "The least costly method would be a surgical procedure to determine if your fallopian tubes are blocked." d) "The least costly method would be to purchase a commercial kit from the store to assess the upsurge of LH that occurs just after ovulation."

"The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months." Correct Explanation: The least costly way to determine a woman's ovulation pattern is to ask her to record her basal body temperature (BBT) for at least 4 months.

During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." Based upon your knowledge, how should you reply? a) "You have a sexually transmitted disease." b) "You are describing gonorrhea." c) "You may have Chlamydia so we will need to perform a pelvic exam." d) "Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam."

"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam.

Which of the following is true regarding analgesia versus anesthesia? a) Hypotension is the most common side effect when systemic analgesia is used. b) Decreased FHR variability is a common side effect when regional anesthesia is used. c) Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. d) Regional anesthesia should be given with caution close to the time of delivery because it crosses the placenta and can cause respiratory depression in the newborn

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. Explanation: Systemic analgesia should be used with caution near the time of delivery because it can cause respiratory depression, in addition to decreased FHR variability. Hypotension is a common side effect of regional anesthesia.

A friend tells you that she is going to use a home pregnancy test to determine whether she is pregnant. Which of the following precautions would you give her? a) Refrain from eating for 4 hours before testing. b) Wait until after two missed menstrual periods. c) Arrange for prenatal care if the test is positive. d) Use a diluted urine specimen.

Arrange for prenatal care if the test is positive. Correct Explanation: Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? a) Back pain could be a sign of bladder or kidney infection b) Back pain could be a result of improper lifting c) Back pain could be a sign of degenerated discs d) Back pain could be a result of a soft mattress

Back pain could be a sign of bladder or kidney infection Correct Explanation: Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. The other causes of back pain listed do not warrant as much immediate concern as the possibility of a bladder or kidney infection.

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway? a) Perineum b) Uterus c) Cervix d) False pelvis

Cervix Explanation: The cervix and vagina are soft tissues that form the part of the passageway known as the birth canal.

A 25-year-old client wants to know if her baby boy is at risk for Down syndrome, as one of her distant relatives was born with it. Which of the following will the nurse tell the client while counseling her about Down syndrome? a) Instances of Down syndrome in the family increase the risk for the baby. b) Down syndrome occurs only in females, and there is no risk as the baby is male. c) Children with Down syndrome are intellectually normal. d) Children with Down syndrome have 47 chromosomes instead of 46.

Children with Down syndrome have 47 chromosomes instead of 46. Explanation: Down syndrome occurs because of the presence of an extra chromosome in the body. Down syndrome is not genetically inherited. Both males and females are equally at risk for Down syndrome. Most children with Down syndrome have mild to moderate intellectual disability.

During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus how often? a) Every 20 minutes b) Every 10 minutes c) Every 5 minutes d) Every 15 minutes

Every 15 minutes Explanation: During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus every 15 minutes, and then every 30 minutes for the next hour.

A woman complains of constant redness and itching of her palms early in her pregnancy. She fears that she is suffering an allergic reaction and asks the nurse whether this is normal. Which of the following should the nurse mention? a) It is caused by increased estrogen levels and should disappear in time b) It is likely an allergic reaction to a lotion, which should be avoided during pregnancy c) It is a sign of high blood pressure; she should start an anti-hypertensive drug d) It is a sign of fatigue; she should get more rest

Explanation: Palmar erythema, or palmar pruritus, occurs in early pregnancy and is probably caused by increased estrogen levels. Constant redness or itching of the palms can make a woman believe she has developed an allergy. Explain that this type of itching in early pregnancy is normal. She may find lotion to be soothing. As soon as a woman's body adjusts to the increased level of estrogen, the erythema and pruritus disappear. This condition is not a sign of fatigue or high blood pressure.

A physician tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This order would be appropriate for a woman with which condition? a) Genital warts b) Genital herpes c) Gonorrhea d) Syphilis

Gonorrhea Explanation: Gonococcal infections can be completely eliminated by drug therapy. Genital warts aren't curable and are identified by appearance, not culture. Genital herpes isn't curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.

A pregnant woman's husband does not voice concerns at prenatal visits. You would believe he is emotionally involved in the pregnancy by observing which of the following actions? a) He states he definitely wants a girl. b) He states he is concerned about the loss of his free time. c) He has refused to paint the baby's room blue. d) He walks around furniture as if his abdomen is enlarged.

He walks around furniture as if his abdomen is enlarged. Explanation: Men who identify with their wife's pregnancy may act as if their abdomen is enlarging, the same as they may take on nausea of pregnancy.

To deliver her infant, a woman is asked to push with contractions. Which of the following is the most effective and safest pushing technique to teach her? a) Lying on side, arms grasped on abdomen b) Lying supine with legs in lithotomy stirrups c) Head elevated, grasping knees, breathing out d) Squatting while holding her breath

Head elevated, grasping knees, breathing out Correct Explanation: An important point is to be certain the woman does not hold her breath, as this puts pressure on the vena cava, reducing blood return.

Which instruction should be given to a woman newly diagnosed with genital herpes? a) Obtain a Papanicolaou (Pap) test every 3 years. b) Have your partner use a condom when lesions are present. c) Limit stress and emotional upset as much as possible. d) Use a water-soluble lubricant for relief of pruritus.

Limit stress and emotional upset as much as possible. Correct Explanation: Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it isn't known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Pap test is recommended every year

The nurse teaches a pregnant woman about breastfeeding, stating that stimulation of the breast through sucking or touching stimulates the secretion of which hormone? a) Cortisol b) Oxytocin c) Follicle stimulating hormone d) Antidiuretic hormone

Oxytocin Correct Explanation: Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

When assessing fetal heart rate patterns, which of the following would alert the nurse to a possible problem? a) Variable decelerations b) Early decelerations c) Accelerations d) Prolonged decelerations

Prolonged decelerations Correct Explanation: Prolonged decelerations are associated with prolonged cord compression, abruptio placentae, cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.

A pregnant woman comes to the emergency department because she thinks she is in labor. The nurse determines that the client is in true labor when assessment of contractions reveals which of the following? a) Occurring in an irregular pattern b) Radiating to the front of the abdomen from the back c) Lasting about 20 to 30 seconds d) Slowing when the woman changes position

Radiating to the front of the abdomen from the back Correct Explanation: Contractions that begin in the back and then radiate to the front are typical of true labor. Contractions that slow when a woman walks or changes position suggest false labor, as do irregular contractions. Contractions lasting 30 seconds or less commonly suggest Braxton-Hicks contractions and are associated with false labor.

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from? a) Diptheria b) Rubeola c) Small pox d) Rubella

Rubella Correct Explanation: The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue.

A client in her third trimester of pregnancy wishes to use the method of feeding formula to her baby? a) Serve the formula at room temperature. b) Feed the infant every 8 hours. c) Refrigerate any leftover formula. d) Mix one scoop of powder with an ounce of water.

Serve the formula at room temperature. Correct Explanation: The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded.

A woman is concerned that orgasm will be harmful during pregnancy. Which of the following statements is most factual? a) Orgasm during pregnancy is potentially harmful. b) Some women experience orgasm intensely during pregnancy. c) Venous congestion in the pelvis makes orgasm painful. d) Most women do not experience orgasm during pregnancy.

Some women experience orgasm intensely during pregnancy. Correct Explanation: Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.

A patient, 38 weeks gestation, pregnant with her first child calls the clinic and states "my baby is lower and it is more difficult to walk" and ask if she should come to the hospital to be checked. How should the nurse respond? a) "The baby has dropped into the pelvis, your body and baby are getting ready for labor in the next few weeks." b) "This is not normal unless you are in active labor, come to the hospital and be checked." c) "The baby moved down into the pelvis, this means you will be in labor within 24 hours, wait for contractions to come to the hospital." d) "That is something we expect with a second or third baby, because it is your fist, you need to be checked."

The baby has dropped into the pelvis, your body and baby are getting ready for labor in the next few weeks." Correct Explanation: The baby can drop into the pelvis, an event termed lightening, and can happen for up to 2 weeks before the woman goes into labor. This is normal and does not require intervention.

A non-stress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which of the following statements by the patient indicates understanding of the test results? a) There is no evidence of congenital anomalies or deformities b) The fetal heart rate increases with activity and indicates fetal well-being c) The test is non-reactive, which is reassuring d) The results indicate a contraction stress test is needed for evaluation

The fetal heart rate increases with activity and indicates fetal well-being Correct Explanation: A reactive NST for non-stress test is a noninvasive way to monitor fetal well-being. A reactive NST is positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity and indicates fetal well-being.

Many couples attempt to influence the gender of the child they are trying to conceive by using special sexual positions, eating special food, or having intercourse at specific times. None of these are factors in the determination of the gender of the conceptus. What has research shown about gender determination? a) Female gametes can have either X or Y chromosomes b) There is a 50-50 chance of having a male or a female c) Male gametes carry only Y chromosomes d) Female determines the sex of the conceptus

There is a 50-50 chance of having a male or a female Correct Explanation: Sex determination occurs at the time of fertilization based on the inheritance of X or Y chromosomes. Because the spermatozoon can have either an X or a Y chromosome, the male gamete is responsible for fetal sex determination. Research indicates that there is an approximately 50-50 chance of either occurrence.

A post delivery CBC has noted an elevated WBC count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count? a) Occurs in patients who have cesarean birth, from the trauma of surgery b) This is a normal variation due to stress of labor c) Abnormal finding and she needs antibiotics d) Might be a false result, recommend re-testing

This is a normal variation due to stress of labor Correct Explanation: An elevation of WBC up to 30,000mm/3 can be normal variation for any woman after delivery. This is related to the stress on her body from labor and delivery. Antibiotics are not indicated as this is a normal response to intense stress. The increase in WBC is not related to cesarean birth. Retesting would be wasteful as it is known that this is a normal response to any stress.

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What three assessments does the nurse anticipate will be performed for this couple? (Select all that apply.) a) Fertility drugs b) Semen analysis c) Tubal patency d) Ovulation monitoring e) In vitro fertilization counseling

Tubal patency • Semen analysis • Ovulation monitoring

If the monitor pattern of uteroplacental insufficiency were present, which of the following would you do first? a) Ask her to pant with the next contraction. b) Turn her or ask her to turn to her side. c) Administer oxygen at 3 to 4 L by nasal cannula. d) Help the woman to sit up in a semi-Fowler's position.

Turn her or ask her to turn to her side. Correct Explanation: The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression.

A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do? a) Douche and wash frequently with mild soap and warm, not hot, water b) Decrease her fluid intake c) Use sanitary pads d) See her primary care provider to be tested for STIs

Use sanitary pads Explanation: Vaginal discharge increases during pregnancy and is a concern for many women. Encourage the patient to keep clean and wear sanitary pads as needed. Douching may be dangerous for the mother. STI's are not indicated simply by discharge. Pregnant women should not decrease fluid intake.

A pregnant client complains of an increase in a thick, whitish vaginal discharge. Which of the following information should a nurse provide to this client? a) Use local antifungal agents regularly. b) Refrain from any sexual activity. c) Consult physician for fungal infection. d) Such discharge is normal during pregnancy.

uch discharge is normal during pregnancy. Explanation: During pregnancy, the vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

At 40 weeks gestation, a woman in for her prenatal visits states to the nurse "I am tired of being pregnant". What is the appropriate response by the nurse? a) "That is a very normal feeling, especially at this point in pregnancy." b) "Are you getting enough rest? If you don't take time for rest, that is why you might be tired." c) "Most woman would have asked to be induced by this point, is that what you want?" d) "Do you need to speak with someone about your feelings?"

"That is a very normal feeling, especially at this point in pregnancy." Correct Explanation: During the third trimester, the patient is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities and be ready to have her baby in her arms rather than in her uterus. This is not an abnormal statement and the provider should not overreact. Deciding to induce is something that should be done in consultation with the physician, and only when it failing to do so would have a negative impact on the mother or baby.

A client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse? a) "The safest medication to take for your headaches during your pregnancy would be Ibuprofen." b) "Wait until you reach your third trimester. You can take something to relieve headaches then." c) "The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." d) "You don't want to harm the baby by taking medications now, do you?"

"The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." Correct Explanation: The medication that is approved for treatment of headaches is acetaminophen (Tylenol).

A man is interested in artificial insemination if he is proven to be infertile. He asks you if this procedure would be appropriate for him and his sexual partner. Which of the following statements would be your best response? a) "Artificial insemination is useful only if your sexual partner has an allergy to your sperm, not if you are infertile." b) "You need to consider donor-therapeutic insemination if you are found to be infertile." c) "The chance of twins is increased with artificial insemination." d) "You and your sexual partner should consider embryo transfer first, because it is safer."

"You need to consider donor-therapeutic insemination if you are found to be infertile." Explanation: Donor-therapeutic insemination involves the donation of sperm from another fertile male; it is used when the primary sexual partner is infertile.

A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as: a) -2 b) +4 c) 0 d) +2

-2 Correct Explanation: When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2. A 0 station indicates that the fetal presenting part is at the level of the ischial spines. Positive stations indicate that the presenting part is below the level of the ischial spines.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? a) 1.5 lb b) 1 lb c) 2 lb d) 2/3 lb

1 lb Correct Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb per week. Overweight women should gain about 2/3 lb per week.

A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that a sperm count of which of the following would suggest infertility? a) 75 million/mL b) 100 million /mL c) 50 million/mL d) 18 million/mL

18 million/mL Correct Explanation: A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately: a) 85 beats per minute b) 100 beats per minute c) 95 beats per minute d) 90 beats per minute

85 beats per minute Correct Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

Now that you are familiar with the risk factors for osteoporosis, to which of these patients would you be most eager to suggest a bone mineral density test? a) A 25-year-old Asian woman, 5 feet and 7 inches tall, 129 pounds, with two children b) A 55-year-old Caucasian woman who smokes and whose 80-year-old mother has osteoporosis c) An African American woman, 5 feet and 4 inches tall, 172 pounds, with an inactive lifestyle d) A woman with a vitamin D deficiencyA 55-year-old Caucasian woman who smokes and whose 80-year-old mother has osteoporosis

A 55-year-old Caucasian woman who smokes and whose 80-year-old mother has osteoporosis Correct Explanation: Older women and those who smoke are at more risk for osteoporosis. This client should be referred to bone scan or density testing. Vitamin D levels, body weight, and race are not factors heavily weighted in osteoporosis.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Assuming that all of the following methods of birth control are acceptable to her, which of the following would be the best recommendation? a) An ovulation suppressant b) A diaphragm and spermicide c) A spermicidal suppository d) The rhythm (calendar) method

A diaphragm and spermicide Explanation: Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated. (

A 28-year-old client in her first trimester of pregnancy complains of conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which of the following maternal emotional responses is the client experiencing? a) Acceptance b) Introversion c) Mood swings d) Ambivalence

Ambivalence Correct Explanation: The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester. The client is not experiencing introversion, acceptance, or mood swings. Introversion, or focusing on oneself, is common during the early part of pregnancy. The woman may withdraw and become increasingly preoccupied with herself and her fetus. Acceptance is the common maternal emotional response during the second trimester. As the pregnancy progresses, the physical changes of the growing fetus, along with an enlarging abdomen and fetal movement, bring reality and validity to the pregnancy. Although mood swings are common during pregnancy, this client is not experiencing mood swings.

Jennifer has just received IV sedation. What must the nurse tell Jennifer to do? a) Ambulate within 15 minutes to prevent spinal headache b) Ambulate only with assistance from the nurse or caregiver c) Remain in bed for at least 30 minutes d) Sit on the edge of the bed with her feet dangling before ambulating

Ambulate only with assistance from the nurse or caregiver Explanation: The patient may have decrease sensory from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.

A 24 year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

An azole antifungal agent Explanation: The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

During a routine antepartal visit, a pregnant woman reports a white thick vaginal discharge. Which of the following would the nurse do next? a) Tell the woman that this is entirely normal. b) Ask the woman if she is having any itching or irritation. c) Check the discharge for evidence of ruptured membranes. d) Advise the woman about the need to culture the discharge.

Ask the woman if she is having any itching or irritation. Explanation: Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's complaint is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? a) Three finger-breadths above the umbilicus b) At the level near the bottom of the sternum c) At the level of the symphysis pubis d) At the level of the umbilicus

At the level of the umbilicus Correct Explanation: By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks', it nears the bottom of the sternum.

The patient is G1 P0, in the second stage of labor and is at 2+ station and in anticipation of delivery within the hour. Her epidural did not work and she is begging for Demerol. Which is the most appropriate action by the nurse? a) Give the Demerol because she needs pain relief now b) At the nurses' station call the anesthetist to retry the epidural c) Call the doctor and obtain a reduced dose of Demerol d) Encourage her through the contractions and explain not giving the Demerol

At this point, any medication would be contraindicated as it would pass to the fetus and may cause respiratory depression. The nurse will have to work with the mother through the contractions and pushing. The patient has progressed too far to retry the epidural medication. No Demerol should be given due to the risk to the fetus.

Which of the following instructions should the nurse give to a client with genital herpes to help control the infection? a) Apply imiquimod cream b) Avoid sexual contact until sores heal c) Apply antibacterial medication d) Avoid people with upper respiratory infections

Avoid sexual contact until sores heal Explanation: The nurse should instruct the client to avoid sexual contact until sores heal completely and new skin forms. Application of antibacterial medication is suggested for wounds in case of lymphedema. Clients with HIV are advised to avoid people with upper respiratory infections. Application of imiquimod cream is suggested for clients infected with human papilloma virus.

Yvonne, a 27-year-old client, is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell Yvonne about the potential effects of smoking in pregnancy? a) "Babies of women who smoke tend to weigh significantly less than other infants." b) "Smoking during pregnancy places your baby at an increased risk of mental retardation." c) "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." d) "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

Babies of women who smoke tend to weigh significantly less than other infants." Correct Explanation: Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, mental retardation, or nicotine dependence.

Which of the following would alert the nurse that the client is in the transition phase of labor? a) Beginning urge to bear down b) Enthusiasm in the client c) Decrease in the bloody show d) Reduction of rectal pressure

Beginning urge to bear down Correct Explanation: Starting of the urge to bear down is a feature associated with the transition phase of labor. The transition phase is the last phase of the first stage of labor. In this phase the process of cervical dilatation is completed. During this phase the client experiences an increase in rectal pressure, an increase in the bloody show and an urge to bear down. The contractions are stronger and hence the client feels irritable, restless and nauseous. The client feels enthusiastic during the latent phase and not the transition phase.

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor? a) Braxton Hicks contractions get closer together with activity b) Braxton Hicks contractions cause "ripening" of the cervix. c) Braxton Hicks contractions usually decrease in intensity with walking d) Braxton Hicks contractions do not last long enough to be true labor

Braxton Hicks contractions usually decrease in intensity with walking Correct Explanation: Braxton Hicks contractions occur more frequently and are more noticeable as pregnancy approaches term. These irregular, practice contractions usually decrease in intensity with walking and position changes.

Some women are lactose intolerant. Lactose intolerance occurs more frequently in individuals of African, Hispanic, Native American, Ashkenazic Jewish, and Asian descent. What is the major concern for a lactose intolerant woman who is pregnant? a) Vitamin D deficiency b) Calcium deficiency c) Dangerous symptom of abdominal cramping d) Nausea and vominting

Calcium deficiency Explanation: Calcium deficiency is a major concern for the pregnant woman who is lactose intolerant. There are several ways to address this concern. Some lactose-intolerant individuals are able to tolerate cooked forms of milk, such as pudding or custard. Cultured or fermented dairy products, such as buttermilk, yogurt, and some cheeses may also be tolerated. A chewable lactase tablet may be taken with milk. Lactase-treated milk is available in most supermarkets and may be helpful. Other options are to drink calcium-enriched orange juice or soy milk or to take a calcium supplement. If the woman is infrequently exposed to sunlight, she will need a vitamin D supplement

A petite, 5-foot tall, 95-pound woman who is 28 years old is about to deliver her first child and would like to have a vaginal delivery. She has two sisters, both of whom have given birth vaginally. She has gained 25 pounds during a normal, uneventful pregnancy. What type of pelvis would a nurse expect this woman to have upon assessment of the patient? a) Gynecoid b) Platypelloid c) Cannot be determined d) Android

Cannot be determined Explanation: Pelvis shape cannot be determined by the information included in the statement. Early in the pregnancy, particularly if a woman has never delivered a baby vaginally, the practitioner may take pelvic measurements to estimate the size of the true pelvis. This helps to determine if the size is adequate for vaginal delivery. However, these measurements do not consistently predict which women will have difficulty delivering vaginally, so most practitioners allow the woman to labor and attempt a vaginal birth

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a) Clients infected with the human papillomavirus (HPV) b) Clients with a long history of hormonal contraceptive use c) Clients with a pregnancy before age 20 d) Clients with a history of recurrent candidiasis

Clients infected with the human papillomavirus (HPV) Correct Explanation: HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.

A client with a family history of cervical cancer is to undergo a Pap test. During the client education, what group should the nurse include as at risk for cervical cancer? a) Clients with fibrocystic breast disease b) Clients who have not had babies c) Clients who have genital warts d) Clients with irregular menstrual cycles

Clients who have genital warts Correct Explanation: The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer

While assessing a client's breast during the third trimester, which of the following would the nurse expect to find? a) Breasts becoming soft b) Pain in the nipple area c) Pink colored nipples d) Colostrum from the nipples

Colostrum from the nipples Explanation: During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.

Your patient wants to discuss birth control options. She is a 36-year-old woman who is in a long-term, monogamous relationship. She runs 2 miles a day but also smokes a pack of cigarettes a day. Which birth control method would you discourage her from using? a) Combination oral contraceptives b) Coitus interruptus c) Condoms d) Spermicides

Combination oral contraceptives Explanation: Oral contraceptives are contraindicated for women who smoke, they would be at a higher risk for blood clots. Condoms, coitus interruptus, and spermicidals can be used at no risk.

An adolescent who is pregnant asks you which of the following sports would be safe for her to learn during pregnancy. Which of the following activities would you suggest as safe? a) Skiing b) Jogging c) Bicycling d) Swimming

Correct response: Swimming Explanation: Sports that require balance (bicycling, skiing) become difficult during pregnancy. Jogging can be difficult because of lax knee cartilage.

A nurse is caring for a client in labor who is delivering. Which of the following fetal responses should the nurse monitor for in the client's fetus? a) Decrease in circulation and perfusion to the fetus b) Increase in fetal breathing movements c) Increase in fetal oxygen pressure d) Decrease in arterial carbon dioxide pressure

Decrease in circulation and perfusion to the fetus Explanation: When monitoring fetal responses in a client experiencing labor, the nurse should monitor for a decrease in circulation and perfusion to the fetus secondary to uterine contractions. The nurse should monitor for an increase, not a decrease, in arterial carbon dioxide pressure. The nurse should also monitor for a decrease, not an increase, in fetal breathing movements throughout labor. The nurse should monitor for a decrease in fetal oxygen pressure with a decrease in the partial pressure of oxygen.

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including: a) Increased risk of placenta abruptio b) Increased risk of spontaneous abortion c) Decreased birth weight in neonates d) Increased risk of stillbirth

Decreased birth weight in neonates Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including: a) Increased risk of stillbirth b) Increased risk of spontaneous abortion c) Decreased birth weight in neonates d) Increased risk of placenta abruptio

Decreased birth weight in neonates Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine

A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which of the following marks the termination of the first stage of labor in the client? a) Dilation of cervix diameter to 10 cm b) Rupturing of fetal membranes c) Diffuse abdominal cramping d) Start of regular contractions

Dilation of cervix diameter to 10 cm Correct Explanation: The first stage of labor terminates with the dilation of the cervix diameter to 10 cm. Diffused abdominal cramping and rupturing of the fetal membrane occurs during the first stage of labor. Regular contractions occur at the beginning of the latent phase of the first stage; they do not mark the end of the first stage of labor.

A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which of the following marks the termination of the first stage of labor in the client? a) Rupturing of fetal membranes b) Diffuse abdominal cramping c) Start of regular contractions d) Dilation of cervix diameter to 10 cm

Dilation of cervix diameter to 10 cm Explanation: The first stage of labor terminates with the dilation of the cervix diameter to 10 cm. Diffused abdominal cramping and rupturing of the fetal membrane occurs during the first stage of labor. Regular contractions occur at the beginning of the latent phase of the first stage; they do not mark the end of the first stage of labor.

When teaching a group of nursing students about the stages of labor, the nurse explains that softening, thinning, and shortening of the cervical canal occur during the first stage of labor. Which of the following terms is the nurse referring to in the explanation? a) Crowning b) Effacement c) Molding d) Dilatation

Effacement Explanation: The nurse is explaining about effacement, which involves softening, thinning, and shortening of the cervical canal. Dilatation refers to widening of the cervical os from a few millimeters in size to approximately 10 cm wide. Crowning refers to a point in the maternal vagina from where the fetal head cannot recede back after the contractions have passed. Molding is a process in which there is overriding and movement of the bones of the cranial vault, so as to adapt to the maternal pelvis

The nurse is assessing a couple who has come to the health care facility because they have been unable to conceive a child. When assessing the woman, which factor would the nurse identify as increasing the woman's risk for infertility? a) Dysmenorrhea b) Endometriosis c) Patent fallopian tubes d) Age of 25 years

Endometriosis Correct Explanation: Risk factors for infertility include endometriosis, age older than 27 years, tubal blockages, weight variations, hormonal imbalances, fibroids, reduced oocyte quality, chromosomal abnormalities, congenital anomalies of the cervix and uterus, immune system disorders, chronic illnesses, sexually transmitted infections, history of PID, smoking and alcohol consumption, multiple miscarriages, and psychological stress. Dysmenorrhea is not an associated risk factor.

A fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which of the following instructions should the nurse give to the client? (Select all that apply.) a) Walking is an excellent exercise option during pregnancy b) Avoid exercises that involve movements of large muscle groups rhythmically c) Avoid taking up a new sport, such as cycling, during pregnancy d) Include warm-up and cool-down exercises e) Avoid sports that involve body contact f) Exercise three times weekly for 30 consecutive minutes

Exercise three times weekly for 30 consecutive minutes • Include warm-up and cool-down exercises • Avoid sports that involve body contact • Avoid taking up a new sport, such as cycling, during pregnancy • Walking is an excellent exercise option during pregnancy Explanation: As a rule, average, well-nourished women should exercise during pregnancy about 3 times weekly for 30 consecutive minutes. Their exercise program should consist of 5 minutes of warm-up exercises, an active "stimulus" phase of 20 minutes, and then 5 minutes of cool-down exercises. Movements that exercise large muscle groups rhythmically, such as walking, are best but the type of activity chosen should depend on their interests. She should avoid sports that involve body contact, taking up a new sport, and jogging, all of which would put her at greater risk for injury

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also complains of increased pigmentation on her breasts and genitalia. When educating the client, which of the following would the nurse identify as the condition experienced by the client? a) Vascular spiders b) Striae gravidarum c) Linea nigra d) Facial melasma (cholasma)

Facial melasma (cholasma) Correct Explanation: The skin and complexion of pregnant women undergo hyperpigmentation, primarily as a result of estrogen, progesterone, and melanocyte stimulating hormone levels. The increased pigmentation that occurs on the breasts and genitalia also develops on the face to form the "mask of pregnancy," or facial melasma (cholasma). This is a blotchy, brownish pigment that covers the forehead and cheeks in dark-haired women. The symptoms experienced by the client do not indicate linea nigra, striae gravidarum, or vascular spiders. The skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area. Striae gravidarum, or stretch marks, are irregular reddish streaks that appear on the abdomen, breasts, and buttocks in about 50% of pregnant women after month 5 of gestation. Vascular spiders appear as small, spider-like blood vessels in the skin and are usually found above the waist and on the neck, thorax, face, and arms

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history? a) G2 P0020 b) G3 P0021 c) G2 P1020 d) G3 P0020

G3 P0020 Correct Explanation: Gravida (G) is the total number of pregnancies she has had, including the present one. Therefore she is G3 and not G2. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today. She has no living children; therefore, it is 0 and not 1.

As part of her first prenatal visit, you are taking a pregnant woman's obstetric history. She has an 18-month-old daughter who was delivered 2 days after her estimated date of delivery and a 3-year-old son who was born at 35 weeks' gestation. Before her son was born, she lost two pregnancies: one at 12 weeks and the other at 21 weeks. Using the GTPAL method, how would you record this history? a) G5 T2 P2 A1 L1 b) G4 T1 P2 A2 L2 c) G4 T1 P1 A2 L2 d) G5 T1 P2 A1 L2

G5 T1 P2 A1 L2 Correct Explanation: 5 pregnancies, 1 between 38-42 weeks, 2 between 20-37 weeks, 1 abortion at 12 weeks, 2 current living, 1 still in uterus

A client in active labor is given spinal anesthesia. Which of the following would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? a) Increased frequency of micturition b) Excessive contractions of the uterus c) Headache following anesthesia d) Passage of the drug to the fetus

Headache following anesthesia Correct Explanation: The nurse should inform the client and her family about the possibility of headache after spinal anesthesia. The drug is retained in the mother's body and not passed to the fetus. There may be uterine atony, and not excessive uterine contractions, following spinal anesthesia. Spinal anesthesia may lead to bladder atony, and not an increased frequency of micturition.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? a) Herpes virus b) Treponema pallidum c) Human papilloma virus d) Haemophilus ducreyi bacillus

Human papilloma virus Explanation: Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which of the following should the nurse include in the teaching plan? Select all that apply. a) Avoid keeping legs elevated while lying down. b) Increase exercise and physical activity. c) Use heating pads or take warm baths. d) Increase water consumption. e) Increase intake of salty foods.

Increase water consumption. • Use heating pads or take warm baths. • Increase exercise and physical activity. Explanation: When instructing a client with dysmenorrhea on how to manage her symptoms, the nurse should ask her to increase water consumption, use heating pads or take warm baths, and increase exercise and physical activity. Water consumption serves as a natural diuretic, heating pads or warm baths help increase comfort, and exercise increases endorphins and suppresses prostaglandin release. The nurse should also tell the client to limit salty foods to prevent fluid retention during menstruation and to keep legs elevated while lying down, because this helps increase comfort.

A pregnant client has opted for hydrotherapy for pain management during labor. Which of the following should the nurse consider when assisting the client during the birthing process? a) Ensure that the water temperature exceeds body temperature. b) Do not allow the client to stay in the bath for long. c) Allow the client into the water only if her membranes have rupture d) Initiate the technique only when the client is in active labor.

Initiate the technique only when the client is in active labor. Explanation: The recommendation for initiating hydrotherapy is that women be in active labor (>5 cm dilated) to prevent the slowing of labor contractions secondary to muscular relaxation. Women are encouraged to stay in the bath or shower as long as they feel they are comfortable. The water temperature should not exceed body temperature. The woman's membranes can be intact or ruptured.

A pregnant client has been diagnosed with gonorrhea. Which of the following nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby? a) Instill a prophylactic agent in the eyes of the newborn. b) Perform a cesarean operation to prevent infection. c) Administer cephalosporins to mother during pregnancy. d) Administer an antiretroviral syrup to the newborn.

Instill a prophylactic agent in the eyes of the newborn. Correct Explanation: To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean operation will not prevent gonococcal ophthalmia neonatorum in the newborn. An antiretroviral syrup is administered to the newborn only if the mother is human immunodeficiency virus-positive and will not help prevent gonococcal ophthalmia neonatorum in the baby.

A client in her third trimester of pregnancy arrives at a health care facility complaining of cramping and low back pain; she also notes that she is urinating more frequently and that her breathing has become easier the past few days. Physical examination conducted by the nurse indicates that the client has edema of the lower extremities, along with an increase in vaginal discharge. The nurse knows that the client is experiencing which of the following conditions? a) Nesting b) Lightening c) Bloody show d) Braxton Hicks contractions

Lightening Explanation: The nurse knows that the client is experiencing lightening. Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis, and may occur 2 weeks or more before labor. The uterus lowers and moves into a more anterior position. The client may report increased respiratory capacity, decreased dyspnea, increased pelvic pressure, cramping, and low back pain. She may also note edema of the lower extremities as a result of the increased stasis of blood pooling, an increase in vaginal discharge, and more frequent urination. Some women report a sudden increase in energy before labor. This is sometimes referred to as nesting. Bloody show is a pink-tinged secretion that occurs when a small amount of blood released by cervical capillaries mixes with mucus. Braxton Hicks contractions are typically felt as a tightening or pulling sensation of the top of the uterus.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? a) Azithromycin b) Valacyclovir c) Metronidazole d) Penicillin

Metronidazole Correct Explanation: The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole

Which of the following is the most effective treatment for trichominiasis? a) Penicillin G benzathine b) Azithromycin (Zithromax) c) Doxycycline (Adoxa) d) Metronidazole (Flagyl)

Metronidazole (Flagyl) Correct Explanation: The most effective treatment for trichomoniasis is metronidazole and tinidazole. Penicillin G benzathine is used for syphilis. Doxycycline and Azithromycin are used in the treatment of Chlamydia.

During her 12 week prenatal check-up, the patient informs you on interview she has developed bumps on the dark part of her nipples. She wants to know what these bumps are. What is the appropriate answer? a) Might be sign of cancer, need to speak with provider b) Normal bumps of pregnancy, they do nothing c) Striae, stretching of the breast tissue d) Montgomery's tubercles, secrete lubricant for the nipples

Montgomery's tubercles, secrete lubricant for the nipples Explanation: All woman have Montgomery's tubercles, they become more prominent during pregnancy and help to prepare the nipples for breastfeeding. The bumps are not specific to pregnancy, and are not a sign of cancer. They are not the result of stretching.

A woman in her 15th week of pregnancy is about to undergo amniocentesis. Which of the following nursing interventions should be made first? a) Have the patient void b) Observe the fetal heart rate monitor c) Place the patient in supine position d) Obtain a signed consent form

Obtain a signed consent form Explanation: Nursing responsibilities for assessment procedures include seeing a signed consent form has been obtained as needed (necessary if the procedure poses any risk to the mother or fetus that would not otherwise be present, as is the case with amniocentesis). All of the answers are nursing interventions that should be made before or during amniocentesis, but having the patient sign a consent form should be completed before the others.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which of the following is the recommended schedule for prenatal care? a) Once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth. b) Once every 4 weeks for the first 36 weeks, then weekly until the birth. c) Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth. d) Once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth.

Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth. Explanation: The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A woman is aware that she is the carrier of a sex-linked recessive disease (hemophilia A); her husband is free of the disease. What frequency of this disease could she expect to see in her children? a) All female children will be carriers like she is. b) One-half of her male children will inherit the disease. c) One-half of her female children will inherit the disease. d) All male children will inherit it.

One-half of her male children will inherit the disease. Explanation: With X-linked inheritance, no female children will demonstrate the disease; 50% of the male children will demonstrate the disease.

A 24 year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis? a) Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy b) Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease c) Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection d) Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease Correct Explanation: The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? a) Pain from the dilation or stretching of the cervix b) Distention of the vagina and perineum c) Hypoxia of the contracting uterine muscles d) Pressure on the lower back, buttocks, and thighs

Pain from the dilation or stretching of the cervix Explanation: In the first stage of labor, the primary source of pain is the dilation of the cervix. Hypoxia of the contracting uterine muscles, distension of the vagina and perineum, and pressure on the lower back, buttocks, and thighs may occur in the first stage but are more significantly associated with the second stage of labor.

Amniotic fluid is produced throughout the pregnancy by the fetal membranes. Amniotic fluid has four major functions. What is one of these functions? a) Medium in which to test organ maturity b) Physical protection c) Restriction of movement d) Provide fluid to keep the fetus hydrated

Physical protection Correct Explanation: Amniotic fluid serves four main functions for the fetus: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth.

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which of the following would be a probable sign of pregnancy? a) Amenorrhea b) Nausea and vomiting c) Positive home pregnancy test d) Fatigue

Positive home pregnancy test Explanation: A positive home pregnancy test is confirmed by hCG in the urine. This is considered a probable sign of pregnancy. Fatigue, amenorrhea, and vomiting can all have other causes.

A pregnant client is admitted with vaginal bleeding. The nurse performs a nitrazine test to confirm that the membranes have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5 and 6. What does this indicate? a) Presence of amniotic fluid b) Presence of excess blood c) Membranes have ruptured d) Presence of vaginal fluid

Presence of vaginal fluid Explanation: The nitrazine tape shows a pH between 5 and 6, which indicates an acidic environment with the presence of vaginal fluid and less blood. If the membranes had ruptured, amniotic fluid was present, or there was excess blood, the nitrazine test tape would have indicated an alkaline environment.

The hormone responsible for the initiation of lactation is what? a) Estrogen b) Progesterone c) Prolactin d) Oxytocin

Prolactin Correct Explanation: Prolactin is the hormone responsible for the initiation of lactation, the production of breastmilk. Oxytocin is responsible for the let down of milk and contraction, estrogen and progesterone are responsible for uterine and pregnancy maintenance.

At each prenatal visit, a patient provides a urine sample to the health care provider. What is this urine sample tested for at each visit? a) Protein and glucose b) Glucose and white blood cells c) White blood cells and albumin d) Protein and albumin

Protein and glucose Correct Explanation: Typically, the nurse weighs the patient, records her blood pressure, assesses her urine for protein and glucose, and identifies any problems or concerns. A patient's urine is not tested for white blood cells or albumin.

A woman in labor at the hospital has just received an epidural block. Which intervention is priority before and during epidural placement? a) Increase oral fluids every hour to prevent dehydration b) Provide adequate IV fluids to maintain her blood pressure c) Monitor temperature every four hours and give Tylenol if 100.4 d) Monitor the maternal apical pulse for Bradycardia

Provide adequate IV fluids to maintain her blood pressure Explanation: The patient will need to have a bolus of IV fluids prior to and then maintained during the epidural to be prepared in the event of the hypotensive episodes that may accompany epidural placement. The hypotensive event is transitory, and increasing oral hydration is unnecessary and may lead to nausea later. Monitor the mother's body temperature, but wait for instructions from the doctor as to when to administer medication. Bradycardia is not a common side effect of epidural medication

A 32-year-old woman presents to the labor-and-delivery suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus? a) ROP b) LOA c) ROA d) LOP

ROA Correct Explanation: Document the fetal position in the clinical record using abbreviations (Box 8-1). The first letter describes the side of the maternal pelvis toward which the presenting part is facing ("R" for right and "L" for left). The second letter or abbreviation indicates the reference point ("O" for occiput, "Fr" for frontum, etc.). The last part of the designation specifies whether the presenting part is facing the anterior (A) or the posterior (P) portion of the pelvis, or whether it is in a transverse (T) position.

A client in her 10th week of gestation arrives at the maternity clinic complaining of morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which of the following factors corresponds to the morning sickness period during pregnancy? a) Increase in red blood cell (RBC) production b) Reduced stomach acidity c) Elevation of human placental lactogen (hPL) d) Elevation of human chorionic gonadotropin (hCG) e) Increase in estrogen level

Reduced stomach acidity • Elevation of human chorionic gonadotropin (hCG) • Increase in estrogen level Explanation: hCG levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization. This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Reduced stomach acidity and high levels of circulating estrogens are also believed to cause morning sickness. Elevation of hPL and RBC production do not cause morning sickness. hPL increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism. The increase in RBCs is necessary to transport the additional oxygen required during pregnancy.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client complains of varicosities of the legs. Which of the following instructions should the nurse provide to help the client alleviate varicosities of the legs? a) Refrain from crossing legs when sitting for long periods. b) Refrain from wearing any kind of stockings. c) Apply heating pads on the extremities. d) Avoid sitting in one position for long.

Refrain from crossing legs when sitting for long periods. Explanation: To help the client alleviate varicosities of the legs, the nurse should instruct the client to refrain from crossing her legs when sitting for long periods. The nurse should instruct the client to avoid standing, not sitting, in one position for long periods of time. The nurse should instruct the client to wear support stockings to promote better circulation, though the client should stay away from constrictive stockings and socks. Applying heating pads on the extremities is not reported to alleviate varicosities of the legs

A patient, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs you of frequent low back pain and ankle edema by the end of the day. What interventions should you suggest to relieve these discomforts? a) Rest when possible with feet elevated at or above the heart. b) Lie on right side with feet elevated and a heating pad on her back. c) Sit semi-fowlers with feet below for breaks at work. d) Soak feet every night and perform pelvic rocks.

Rest when possible with feet elevated at or above the heart. Correct Explanation: Rest in the recumbent position helps alleviate stress on the back and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-fowlers is not enough to alleviate the edema

A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. Which of the following is a risk factor associated with male infertility? a) Sperm density about 20 million/mL b) No or few sperm cells produced c) 2 to 5 mL of semen ejaculated d) Morphology of sperm within normal limits

Sperm analysis is one of the easiest tests to complete Correct Explanation: Because sperm analysis is noninvasive, it is one of the easiest tests (and therefore cost-effective) to complete. There is no bias in male vs. female with regard to being the cause of infertility.

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her? a) Stop and walk every few hours b) Sit in the back seat with feet elevated c) Limit trips away from home, great than 200 miles d) Travel no more than 120 miles daily

Stop and walk every few hours Correct Explanation: Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant woman who sit for extended periods of time. Limiting mileage, sitting in the back with feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which of the following is the role of Braxton Hicks contractions in aiding labor? a) These contractions help in softening and ripening the cervix. b) These contractions increase the release of prostaglandins. c) These contractions make maternal breathing easier. d) These contractions increase oxytocin sensitivity.

These contractions help in softening and ripening the cervix. Correct Explanation: Braxton Hicks contractions assist in labor by ripening and softening the cervix and moving the cervix from a posterior position to an anterior position. Prostaglandin levels increase late in pregnancy secondary to elevated estrogen levels; this is not due to the occurrence of Braxton Hicks contractions. Braxton Hicks contractions do not help in bringing about oxytocin sensitivity. Occurrence of lightening, not Braxton Hicks contractions, makes maternal breathing easier.

The laboring patient who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice. a) This can lead to maternal hypertension. b) This may prolong labor and increase complications. c) The effects would wear off before delivery. d) This would cause fetal depression in utero.

This may prolong labor and increase complications. Explanation: Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The patient should be offered nonpharmacologic options at this point until she is in active labor.

A client in her third trimester complains to the nurse of shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem? a) Use extra pillows b) Avoid overeating c) Avoid spicy food d) Lie on a firmer mattress

Use extra pillows Correct Explanation: The nurse should instruct the client to use extra pillows at night to keep her more upright. The nurse can instruct the client to use a firmer mattress if the client is experiencing backache. The nurse can ask the client to avoid overeating and ingesting spicy food in case the client is experiencing heartburn.

A nurse is caring for a client who has just delivered a baby. Which of the following information should the nurse give the client regarding hepatitis B vaccination for the baby? a) Vaccine is required only if mother is identified as high-risk for hepatitis B. b) Vaccine may not be safe for underweight or premature babies. c) Vaccine consists of a series of three injections given within 6 months. d) Vaccine is administered only after the infant is at least 6 months old.

Vaccine consists of a series of three injections given within 6 months. Correct Explanation: The hepatitis B vaccine consists of a series of three injections given within 6 months. The vaccine is safe and well tolerated by most babies, including those who are underweight or premature. Vaccines are given after birth in most hospitals, not 6 months later. All babies are vaccinated, not just those whose mothers are identified as at high risk for hepatitis.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which of the following danger signs of pregnancy needing immediate attention by the physician. a) Vaginal bleeding b) Lower abdominal and shoulder pain c) Painful urination d) Severe, persistent vomiting

Vaginal bleeding Explanation: In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the physician. Generally, painful urination, severe/ persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy

A nurse is assessing a client diagnosed with bacterial vaginosis. Which of the following is a symptom of bacterial vaginosis? a) Warts in the vulva and labia b) Cottage cheese-like discharge c) Intense itching of the vulva d) Vaginal odor smelling of fish

Vaginal odor smelling of fish Correct Explanation: Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white. Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.

The pain of labor is influenced by many factors. What is one of these factors? a) Woman has a high threshold for pain b) Woman has lots of visitors during labor c) Woman's preparation for labor and delivery d) Woman has a high tolerance for pain

Woman's preparation for labor and delivery Explanation: The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared.

You are the nurse in a primary care clinic and your patient has come to see the physician because she is getting married and wants to have a prenuptial gynecologic examination. After the exam the nurse asks about the woman's plan to have a family. The woman responds, "why do I have to plan for a family?" What would be your best response?

Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births.

Girls with Turner Syndrome will usually exhibit a) chorealike movements b) painful joints c) short stature d) progressive dementia

short stature Correct Explanation: Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer's disease.

A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which of the following interventions should the nurse perform? Select all that apply. a) Reduce intravenous (IV) fluid rate. b) Assess client for underlying causes. c) Administer oxygen by mask. d) Turn the client on her left side. e) Ignore questions from the client.

• Administer oxygen by mask. • Assess client for underlying causes. • Turn the client on her left side. Correct Explanation: The nurse should turn the client on her left side to increase placental perfusion, administer oxygen by mask to increase fetal oxygenation, and assess the client for any underlying contributing causes. The client's questions should not be ignored; instead, the client should be reassured that interventions are to effect FHR pattern change. A reduced IV rate would decrease intravascular volume, affecting the FHR further.

A 19-year-old female client has been diagnosed with pelvic inflammatory disease (PID) due to untreated gonorrhea. Which of the following instructions should the nurse offer when caring for the client? Select all that apply. a) Increase fluid intake. b) Limit the number of sex partners. c) Avoid douching vaginal area. d) Use an intrauterine device (IUD). e) Complete the antibiotic therapy.

• Avoid douching vaginal area. • Complete the antibiotic therapy. • Limit the number of sex partners. Explanation: The nurse should instruct the client with pelvic inflammatory disease to avoid douching, limit the number of sex partners, and complete the antibiotic therapy. Use of an intrauterine device is one of the risk factors associated with PID and should be avoided. Increasing fluid intake does not help alleviate the client's condition.

A client complaining of genital ulcers has been diagnosed with syphilis. Which of the following nursing interventions should the nurse implement when caring for the client? Select all that apply. a) Instruct the client to wear nonconstricting, comfortable clothes. b) Instruct the client to abstain from sex during the latency period. c) Suggest the client apply ice packs to the genital area for comfort. d) Instruct the client to wash her hands with soap and water after touching lesions. e) Have the client urinate in water if urination is painful.

• Have the client urinate in water if urination is painful. • Instruct the client to wash her hands with soap and water after touching lesions. • Instruct the client to wear nonconstricting, comfortable clothes. Explanation: The nurse should instruct the client to wear nonconstricting clothes and to wash her hands with soap and water after touching lesions to avoid autoinoculation. If urination is painful because of the ulcers, instruct the client to urinate in water but to avoid extremes of temperature such as ice packs or hot pads to the genital area. The client should abstain from intercourse during the prodromal period and when lesions are present. The ulcer disappears during the latency period.

Choice Multiple question - Select all answer choices that apply. A nurse is caring for a pregnant client who is in labor. Which of the following maternal physiologic responses should the nurse monitor for in the client as the client progresses through childbirth? Select all that apply. a) Increase in heart rate b) Increase in gastric emptying and pH c) Increase in blood pressure d) Slight decrease in body temperature e) Increase in respiratory rate

• Increase in respiratory rate • Increase in heart rate • Increase in blood pressure Correct Explanation: When caring for a client in labor, the nurse should monitor for an increase in the heart rate by 10 to 20 bpm, an increase in blood pressure by as much as 35 mm Hg, and an increase in respiratory rate. During labor, the nurse should monitor for a slight elevation in body temperature as a result of an increase in muscle activity. The nurse should also monitor for decreased gastric emptying and gastric pH, which increases the risk of vomiting with aspiration

A pregnant client requires administration of an epidural block for management of pain during labor. Which of the following conditions should the nurse check for in the client before administering the epidural block? Select all that apply. a) Coagulation defects b) Varicose veins c) Hypovolemia d) Skin rashes or bruises e) Spinal abnormality

• Spinal abnormality • Hypovolemia • Coagulation defects Correct Explanation: The nurse should check for any abnormality of the spine, hypovolemia, or coagulation defects in the client. An epidural is contraindicated in women with these conditions. Varicose veins and skin rashes or bruises are not contraindications for an epidural block. They are contraindications for massage used for pain relief during labor.

A nurse is counseling a 17-year-old girl on the importance of contraception. The girl states that she is not really concerned about getting pregnant; she says that she will deal with it if and when it happens. Which of the following points should the nurse emphasize with the patient regarding the risks of unintended pregnancies? (Select all that apply.) a) The woman is less likely to seek prenatal care b) The woman is more likely to have a baby with birth defects c) The woman is more likely to require public assistance d) The woman is less likely to breastfeed e) The woman is less likely to protect her fetus from harmful substances f) The woman is less likely to complete high school or college

• The woman is less likely to seek prenatal care • The woman is less likely to breastfeed • The woman is less likely to protect her fetus from harmful substances • The woman is less likely to complete high school or college • The woman is more likely to require public assistance Explanation: It is important for the health of children that as many pregnancies as possible be intended as when a pregnancy is unintended or mistimed, both short-term and long-term consequences can result. Among the many consequences are all of the answers listed above, except for increased likelihood of having a baby with birth defects, which is not mentioned in the chapter