OB Exam 1

A couple is planning for the birth of their first child and is discussing the difference between a physician and a midwife. Which information presented by the couple does the nurse validate as being true?

physicians provide care for both low and high-risk patients.

Genomic medicine is an emerging medical discipline that involves using genomic information about an individual as part of the individual's clinical care. Which example does the nurse associate with genomic medicine?

screening of neonates for inherited, treatable genetic diseases

The nurse is counseling a patient regarding pregnancy. The patient lost her first two pregnancies in the second trimester of gestation for undetermined reasons. Which initial advice does the nurse provide for the patient?

seek genetic studies

The nurse works in a urologist's office. A male patient is scheduled for routine fertility testing. For which test does the nurse refrain from making preparation?

sexual functioning

A female carries one positive genetic marker for Huntington's disease. Her partner does not have any markers for the disease. For which reason is it so important for this family to identify persons with the genetic marker?

symptoms do not manifest until 30 to 50 years of age.

An infertile couple learns that the female is unable to produce viable eggs. The male partner suggests the use of a surrogate as a means of having a child. The female states, "I don't want your baby with another woman!" The nurse us aware of which psychosocial issue with this couple?

the female is experiencing self-esteem issues.

The nurse is counseling a patient who shares the intention to become pregnant. Which finding during the collection of health information will the nurse feel the least concern to address?

the patient lives in a recently renovated house.

The nurse is counseling a couple in the third trimester of pregnancy and recommends the couple attend childbirth education classes. For which reason is the nurse least likely to recommend the classes?

the techniques will enable a medication-free delivery.

The nurse is providing care for a patient at 30 weeks gestation. Which topic related to patient concern or discomfort is most important for the nurse to address?

dizziness when lying supine.

The nurse is assessing a 70-year-old female patient in the family practice clinic. The patient state that she has been experiencing sudden heavy vaginal bleeding the past 3 months. What is the expected diagnostic procedure for this patient?

endometrial biopsy

The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis?

"I realize that this is not a cure for the issue, but I want to have more children within the next year."

A mother has a child who is 4 years of age, and she is expecting another child. The mother expresses concern to the nurse about how the older sibling will receive the newborn. Which intervention shared by the mother does the nurse discourage?

"I think that I will just bring the new baby home as a surprise."

The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure?

"I understand that there will be some light vaginal bleeding for several days."

The nurse is providing care to the 24-year-old patient in the OB/GYN clinic. The patient states that she thinks she may be pregnant because she has missed three menstrual cycles. The patient says, "This couldn't be happening at a worse time. I have been training heavily for a triathlon in 4 months." Which response by the nurse is most appropriate?

"Secondary amenorrhea, or no menses for 3 months, is not always a sign of pregnancy; it may be due to your heavy athletic activity."

A patient who is pregnant shares details of being in a physically and psychologically abusive relationship with her baby's father. Which statement by the nurse is indicative of AWHONN's standing regarding intimate partner violence?

"let's explore ways to protect you and stop the abuse you have been enduring."

A patient in the second trimester of pregnancy seems distressed. With encouragement, the patient states, "I have been totally avoiding physical contact with my husband to avoid prompting any sexual activity." Which statement by the nurse is the best response?

"nonsexual expressions of affection are important for both of you."

The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? SATA

-menopausal women with an intact uterus who receive hormonal therapy -women who have undergone treatment for breast cancer -women with a long-standing history polycystic ovarian syndrome

The nurse is counseling a female patient diagnosed with anovulation as a cause of infertility. Which information does the nurse provide to the patient? SATA

-methods for dietary planning -instructions for clomiphene citrate

The nurse is assessing a 25-year-old female patient when the patient becomes tearful. The patient states that she has thin milky discharge from her nipples and two small masses on her left breast. She has lost over 40 pounds in the past year due to intensive exercises and finds that she needs to wear a sports bra during her sessions. The patient states that she is afraid that she will become the first member of her family to have breast cancer. Besides a negative mammogram, what other symptoms would correlate with this being a benign finding? SATA

-milky discharge from nipples -painful masses -multiple masses

A patient at 37 weeks gestation arrives at the labor and delivery unit and reports a rupture of her membranes. Which factor causes the nurse to anticipate the HCP will prescribe a medical method of labor induction?

the fetus is viable and the barrier for a sterile uterine environment is breached.

The nurse is discussing genetically linked diseases with a couple planning a pregnancy. The female states, "I am concerned because there is a history of sickle-cell disease in my family." Which information from the nurse is correct?

the male partner needs genetic testing

the nurse works in an infertility clinic and is interviewing a male patient whose partner has been unable to conceive. Which finding obtained during a health history will cause the nurse greatest concern?

the patient had a vasectomy reversed.

The nurse at a prenatal clinic is aware of the important tasks that each expectant mother will need to address. When an expectant mother states, "I will give up everything I have to make sure this baby is safe and well-cared for," which task if the mother addressing?

Stating a willingness to give of oneself

A patient arrives for her fourth moth prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit?

breast changes.

The nurse is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection and now reports a milky discharge, the health care provider prescribed metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient?

the patient has bacterial vaginosis due to recent disruption of normal vaginal flora.

a female is patient is concerned about an inability to become pregnant after trying for 1 year. Which information collected during a health history causes the nurse the greatest amount of concern about possible infertility?

the patient has hot flashed and mood swings

The nurse is providing care for a patient in the third trimester of pregnancy. Which topic of patient education is most likely to be needed during this time?

management for commonly experienced discomforts.

The nurse is assessing the 19-year-old female patient in the women's health clinic. She reports that for the past several months, she has had lower abdominal pain, elimination issues, and mood swings, and her acne is worse the week before menstruation. The health care provider has prescribed oral contraceptives. The patient asks the nurse for the reason for the prescription. Which response by the nurse is appropriate?

"the hormones in the oral contraceptives can maintain estrogen-progesterone hormones to alleviate discomfort."

The nurse is educating a 24-year-old female patient who was newly diagnosed with polycystic ovary syndrome. The patient was prescribed an antidiabetic medication. Which medication effects should the nurse educate the patient about? SATA

-a change in her integumentary system -low blood sugar until her hormones stabilize -a decrease in abdominal obesity and weight

The nurse works in a prenatal clinic that serves a multicultural population. The nurse is culturally aware, and so, which behaviors by a patient are expected due to common restrictive beliefs? SATA

-a pregnant woman denies sexual intercourse during her third trimester. -a pregnant woman refuses to watch a televised eclipse of the moon.

The nurse is providing postoperative care to a patient who underwent a total abdominal hysterectomy 12 hours ago. Which of the following are appropriate nursing interventions? SATA

-assist the patient with ambulation -monitor intake and output and characteristics of urine -initiate antiembolism therapy as ordered

A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which recommendations does the nurse make to alleviate the problem? SATA

-avoid eating 3 hours prior to bedtime -avoid consuming spicy, fatty, or fried food

A patient is experiencing pregnancy complications. Which factors will affect the client's ability to manage this situation? SATA

-current health status -perceived threat to self or fetus -previously used coping skills -existence of a support network -implemented nursing interventions

The nurse is providing care in a school clinic established for the care of adolescent mothers. When assessing a patient who is 11 years of age and pregnant, which deduction regarding the patient's psychosocial development will the nurse recognize?

the adolescent is self-centered and oriented toward the present.

The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? SATA

-elevated hCG levels in blood and urine -brownish pigmentation on the face -bluish-purple coloration of vagina and cervix

A pregnant patient tells the nurse that her spouse has been diagnosed with Couvade syndrome. Which manifestations does the nurse suspect the spouse is experiencing? SATA

-nausea from unidentifiable causes -significant recent weight gain -unexplainable abdominal pains

The nurse is encouraging cultural sensitivity among the nonmedical personnel in a prenatal clinic. Which type of family does the nurse identify as including children? SATA

-nuclear family -extended family -blended family

The nurse is providing dietary teaching to a patient in the first trimester of pregnancy who is overweight. Which daily dietary suggestions does the nurse make? SATA

-one cup of 100% juice and 3/4 cup of dried fruit -one cup of milk, 1 cup of yogurt, and 1.5 oz of cheese

The nurse is preparing a prenatal plan of care for a patient who is in the first trimester of pregnancy. Which long-range goals does the nurse include in the plan of care? SATA

-perform an ongoing assessment of risk status -build rapport with the childbearing family -make referral to specific resources as needed -implement a risk-appropriate intervention

A couple informs the nurse they have decided to make arrangements for a home birth. Which criteria will the nurse share with the couple regarding a safe home birth? SATA

-the pregnant woman must be in good health with a normal pregnancy -adequate medical supplies and resuscitation equipment is available.

A patient who is pregnant does not remember the last date of her menstrual period. In which manner does the nurse expect the estimated date of delivery to be determined for this patient?

having an ultrasound examination.

the nurse is counseling a female patient who has unsuccessfully attempted to become pregnant through a variety of methods and treatments for infertility. Which psychosocial manifestation is the nurse most likely to recognize?

difficulty accepting pregnancy if it does occur.

A female patient with a history of infertility is scheduled to have a hysterosalpingogram. Which findings can be detected with this procedure? SATA

-tubal occlusions -uterine fibroids -bicornate uterus

The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? SATA

-urine testing with a dipstick -presence of dependent edema -antibody screening for Rh2 patient

A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? SATA

-waddling gait -low back pain -increased risk of falls

An infertile couple voices concern to the nurse about assisted reproductive technologies. The nurse agrees that ART has created numerous dilemmas. Which potential questions does the nurse discuss with the couple? SATA

-which partner has ownership of the embryos? -should a child be told about donors or surrogates? -are there parental rights for sperm donors? -what happens to any surplus embryos?

A make patient is diagnosed with low sperm count as the cause of infertility. Which intervention will the nurse recommend to improve the patient's sperm count? SATA

-yoga or relaxation techniques -surgical repair of an inguinal hernia -consultation to change hypertension drugs

A patient who has just received confirmation that she is pregnant is distressed because she has a seizure disorder that she manages with carbamazepine. Which is the nurse's greatest concern?

Carbamazepine is teratogenic and causes neural and facial defects.

A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history?

G6, T1, P4, A2, L5

A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period date as April 14th. Using Naegele's rule, the nurse will set the estimated date of delivery as what date?

January 21st

The nurse works in a prenatal clinic and interacts with multiple patients from various socioeconomic backgrounds. Which patient does the nurse assess most carefully for a mental health issue?

a military veteran who was deployed twice.

The nurse is collecting health information from a patient who is early in the first trimester of pregnancy. Which topic is most important for the nurse to discuss with the patient after learning that the patient works for a commercial cleaning company?

risk related to exposure to environmental toxins

The nurse is teaching a class about embryonic and fetal development to couples in the early stage of pregnancy. For which reason does the nurse emphasize the first 8 weeks of gestation?

all organ systems are developing during this period.

The nurse is providing care for a patient who is 42 years old of age and in the first trimester of her pregnancy. For which possible complication will the nurse closely monitor the patient and fetus?

alterations in fetal chromosomal studies

The nurse is assessing a 64-year-old female patient. The patient states that she is able to reduce the risk of urinary tract infections by drinking a quart of cranberry juice a day. Which health condition, if present in this patient, contraindicates the use of cranberry juice?

atrial fibrillation, managed with warfarin

The telephone triage nurse receives a call from a patient who is 5 days postoperative total abdominal hysterectomy. The patient states that her pain is not relieved with the medications and that she has noticed blood in her urine. The nurse instructs the patient to report immediately to the emergency department. What does the nurse suspect as the surgical complication?

possible injury to the ureters or bladder

The nurse is assessing a 16-year-old sexually active patient in the family practice clinic. The patient's symptoms include breakthrough vaginal bleeding, abdominal pain, nausea, and fever. The health care provider obtains cultures of the cervical epithelial cells during a Pap smear and orders doxycycline 100mg orally twice a day for 7 days for her and her partner. The nurse understands that this prescription is consistent with the treatment of which medical diagnosis?

chlamydia

The nurse is counseling a couple who just learned their 16-week fetus tested positive for a serious genetic disorder. Which action by the nurse is inappropriate upon learning that the couple plan to continue the pregnancy?

determine whether termination is still a consideration

The nurse is preparing a teaching plan for a polycystic ovary syndrome support group. One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What is the reasoning for this rationale?

diet and exercise will promote weight loss, which will decrease hyperandrogenemia.

A 32-year-old female patient arrives to the emergency department with heavy uterine bleeding. The nurse finds that the patient had a positive pregnancy test 1 month prior to the visit. What is the potential medical management for this patient's issue?

dilation and curettage

A patient expresses a desire to become pregnant for a second child. The nurse notes that the patient's first child was born with a serious neural tube defect and died of complications at 18 months of age. Which recommendation does the nurse make to this client?

folic acid 4mg/day orally for 1 month prior to conception through first trimester of pregnancy

A patient at 13 weeks gestation asks the nurse how her baby is nourished during pregnancy. Which information does the nurse use to explain the process to the mother?

glucose, amino acids, and oxygen pass through the placenta from mother to baby.

A pregnant patient and her spouse live in the same home as the spouse's family who is not supportive of the pregnancy. The patient feels the family is ruining the happiness about the pregnancy. Which is the most important determination for the nurse to make?

if threatened or actual abuse from household members occur toward the patient.

A couple announces to their parents that the couple is pregnant. One expectant grandmother says, "Grandchildren will call me by my first name. I am not ready to be a grandmother." Which feelings are being expressed by the grandmother?

the pregnancy presents undeniable evidence the grandmother is growing older.

The nurse notes that a patient in the third trimester of pregnancy feels unable to "mother" her unborn child. Which information about the patient helps the nurse identify the sources of the patient's ambivalence? SATA

-the patient is estranged from her mother. -the patient expresses a loss of independence. -the patient expresses disgust about body changes.

The nurse is assessing a 42-year-old patient who presents to the gynecology office with complaints of pelvic pressure, backaches, menorrhagia, and urinary frequency. The health care provider has diagnosed the patient with leiomyoma of the uterus. What are the treatment options for this condition? SATA

-routine pelvic examinations to assess rate of disease process -myomectomy for women who desire pregnancy -hysterectomy for women who do not desire pregnancy

The nurse works in a prenatal clinic located in a multicultural city. It is important for the nurse to recognize which cultural beliefs as prescriptive? SATA

-the mother will aid the baby's circulation by remaining active during pregnancy. -the satisfaction of pregnancy cravings will prevent birthmarks on the baby. -A safety pin attached to an undergarment will prevent fetal facial deformities.

A patient in the first trimester of pregnancy states, "I don't understand how a term baby can be accommodated by my uterus." Which information by the nurse specifically addresses the patient's comment?

the uterus size increases in size 20 times over a nonpregnant uterus.

a pregnant patient is at the prenatal clinic for a routine visit at 30 weeks gestation. The nurse monitors the patient for indications of physiological demands by the fetus on the patient. Which finding causes the nurse concern?

Hgb of 9.5 g/dL and Hct of 30%

A patient arrives at a maternal health client and tells the nurse she has missed a period and thinks she is pregnant. Which information shared with the nurse is presumptive sign of pregnancy?

breast enlargement, tenderness, and tingling.

The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment?

this condition is often associated with use of oral contraceptives and may subside upon discontinuation.

The nurse is providing care to a 35-year-old female patient who complains of low back pain, pain with defecation, pelvic pressure, and premenstrual spotting. The health care provider has prescribed the hormonal therapy Lupron for this condition. What is the goal of this prescription?

to suppress menstruation and further growth of the tissue.

The nurse at a family practice clinic is providing care to a 47-year-old obese patient. The patient states that she realizes that she has put on extra weight but is reluctant to go to any exercise classes. She states that she often has to cross her legs when she sneezes and cannot do any exercises with her legs crossed. The health care provider has prescribed tolterodine (Detrol). What is the rationale for this medication?

tolterodine is used to treat overactive bladders and to decrease urinary frequency, urgency, and urge incontinence.

The labor and delivery nursing staff is conducting research to determine the benefits of childbirth education. Which finding does evidence-based practice support?

women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery.

the more prepared a pregnant woman feels for the birth of her baby will lower her anxiety and fear. The behavior is referred to as

nesting behavior

The nurse is assessing a 72-year-old female patient in the women's health clinic. The mildly obese patient's history includes 7 vaginal births, 2 of which necessitated forceps deliveries, type 2 diabetes, and hypertension. The patient states that she has become incontinent of urine, has a history of frequent urinary tract infections, and has a sense of fullness "down there." What would be an appropriate nursing intervention to help the patient with her symptoms?

instruct the patient to stop urinating midstream at least twice a day.

The nurse is providing prenatal care for a patient who is pregnant with a second child. Which understanding about complexity of a second pregnancy does the nurse use to assist the patient with the acceptance of this pregnancy?

offer strategies for working out a new relationship with the first child

A patient at 34 weeks gestation is undergoing ultrasound. The nurse notes that the amniotic fluid is estimated at between 500 and 600 mL. Which deduction does the nurse make from this finding?

oligohydramnios is present.