OB midterm
Milestones: Month 5
• fingernails • swallows fluid • hearing begins to develop • 0.5 - 1 lb; 8-12"
Doppler works when for FHT
10 - 12 weeks (3 months)
Recommended weight gain during pregnancy - BMI 18.5-24.9 =
25-35 lbs
A hormone which in excess results in Cushing's disease
Cortisol
Paralyse the extensors of the knee
Femoral nerve
Eosinophil granulocytes
Increased in chronic allergic reactions
Physiological atrophy of thymus at puberty
Involution
which immunization is contraindicated with pregnancy
MMR
Major cell that ingests debris within the lung
Macrophage
Site of haematopoiesis
Marrow cavity
The stage of meiosis in which the mature oocyte is stalled prior to fertilisation
Metaphase II of meiosis
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting?
Occiput
The nurse is caring for a client who has an irregular pattern of uterine contraction. As a result, the nurse anticipates a problem with which?
The powers
Structures formed from actin molecules
Thin filaments
A nursing student correctly identifies which of the following as the main reason that hospitals have play rooms for children:
To continue development during hospitalization
The derivative of the mesonephric duct in the male
Vas deferens
A hormone released by the neurohypophysis that regulates body fluid volume
Vasopressin
A property of cells in primary cell culture
Will only grow and proliferate for a limited number of cell cycles
Multigravida
Woman pregnant for 2nd or subsequent time
Primipara
Woman who has carried a pregnancy to viability or term
Multipara
Woman who has given birth to two or more children
A pregnant woman comes to the labor and birth unit in labor. The woman tells the nurse, "Yesterday, I had this burst of energy and cleaned everything in sight, but I don't know why." Which response by the nurse would be most appropriate?
You had a burst of adrenaline, which is common before labor."
The nurse should administer Rho(D) immune globulin to the pregnant woman who is Rho(D)-, after which test?
amniocentesis
anthropoid pelvis
elongated in dimensions more narrow compared to gynecoid pelvis
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?
every 15 minutes
The process that results in the formation of the three 'primary germ layers' is called
gastrulation
A woman is told she has an anthropoid pelvis. This means her pelvis:
is narrow transversely.
The posterior pituitary hormone that stimulates myometrial contractility at parturition
oxytocin
Discomforts of pregnancy leg cramps management
push toe upward while applying pressure on the knee to straighten the leg one quart of milk for calcium or oral calcium supplement exercise
Contributes to the collecting duct of the nephron
ureteric bud
Macrophages
kill and phagocytose bacteria
Thyroid hormone receptors are mainly located in the
nucleus
Lipid mediator hormone present in seminal fluid
Prostaglandin
Neutrophil granulocytes
Diameter about 15µm
Gall bladder contraction is stimulated by
Meals rich in fats
Milestones: Week 8
• brain activity • fetus moves in response to touch • 1" long
treatment for PIH is
methyldopa 250 tid
The nurse determines that it is necessary to implement airborne precautions for children with which infection?
Measles
A molecule that is NOT a component of extracellular matrix
Actin
A statement that is true for melanocytes
Migrate into the epidermis during development
Muscle wasting after nerve injury
Neuropathic
The transmitter used by preganglionic sympathetic neurons
Acetylcholine
Peripheral nerve supplying flexors of the elbow
Musculo-cutaneous nerve
All of the following are physical signs of protein deficiency in pregnancy EXCEPT
Fissures at the corner of the mouth or pale mucous membranes
Active and passive movements of the semi-flexed knee joint include
Flexion, extension and rotation
A woman who is 8 months pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which of the following medications would the nurse anticipate the physician will order?
Amoxicillin
The livers function in fetus
Has a haemopoietic function in the fetus
Structural junction anchoring cells to basement membrane
Hemidesmosomes
The health care provider is reluctant to provide pain medication to a patient delivering a preterm fetus. What should the nurse explain to the patient as the reason for the preterm fetus being more affected by medication?
Inability of the immature liver to metabolize or inactivate drugs
A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is:
Increasing birth weight
A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will:
Instruct the client or her partner to perform light fingertip repetitive abdominal massage.
Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client?
Instruct the client to refrain from emptying her bladder.
The left kidney
Is a retroperitoneal structure
Skin cell type with dendritic immune cell functions
Langerhans cells
Cell type which lays down new bone
Osteoblast
The nurse is instructing on maternal hormones which may impact the onset of labor. Which hormones are included in the discussion? Select all that apply.
Oxytocin Progesterone Prostaglandins
The renal artery supplying the left kidney is a branch of
The descending abdominal aorta
During fetal life, newly oxygenated blood passes first through this vessel
Umbilical vein
Fallopian tube histology
ciliated simple columnar epithelium
false pelvis
flatter upper portion of the bony pelvis -part of the bony passageway
A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?
gravida 4, para 2
most favorable shape for vaginal birth
gynecoid pelvis
The nurse advises a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent?
heartburn
A client has asked that an opioid be kept on standby in case she needs it for pain control. As a precaution, the nurse will also have which of medication readily available to reverse the effects of that opioid?
naloxone Naloxone is an opioid antagonist that can be given to reverse the effects of the central nervous system depression, including respiratory depression, caused by opioids. It is also used to reverse the side effects of neuraxial opioids. Nalbuphine is an opioid. Hydroxyzine is an ataractic. Midazolam is a benzodiazepine. pg 473
The nurse advises a pregnant client to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition?
nausea and vomiting
Which of the following statements regarding weight and pregnancy is correct?
An underweight woman should increase her caloric intake by 500 to 1000 calories a day.
Chadwick's sign
Cervical color changes to Cyanosis See all the CCCCCC's!
A symptom or sign typically associated with hypothyroidism
Cold intolerance
Part of mesoderm from which the nucleus pulposus of each vertebral disc is derived
Notochord
The circulating levels of this hormone are increased by hypoxia or anaemia
Erythropoietin
The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation?
Jugular distention
The neural tube is patterned along the dorsal-ventral axis by
Notochord
A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?
Playing in the woods about a week ago
A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response?
Support the client's decision and call the obstetrician.
The client is being rushed into the labor and delivery unit. At which station would the nurse document the fetus immediately prior to birth?
+4
Gland, tissue or organ from which growth hormone is secreted
Adenohypophysis
A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes?
a. Pelvic inflammatory disease
A young mother delivers twin boys who shared the same placenta. What serious complication are they at risk for? a) TORCH syndrome b) ABO incompatability c) Twin-to-twin transfusion syndrome (TTTS) d) HELLP syndrome
c) Twin-to-twin transfusion syndrome (TTTS) Rationale: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur.
android pelvis
male pelvis
The tissue from which the genital ridge is derived
Intermediate mesoderm
A hormone which stimulates interstitial cells of Leydig to secrete testosterone
Luteinizing hormone (LH)
The left ventricle
Forms the majority of the radiographic left border of the heart
Hegar's sign: what it is, when it happens
softening of the uterus
Why should a woman be cautioned against taking acetylsalicylic acid (aspirin) to relieve pain in labor?
Interference with blood coagulation with increased risk of bleeding in mother or infant
The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?
Dilation of cervix
Which nursing action is applied throughout all stages of labor?
Do not allow the client to lay flat on her back for long periods.
The right atrium
Receives the coronary sinus
Concerning the male reproductive tract
The epididymis is a single, long, coiled tube
The layer of cells that surrounds the oocyte and protects it during ovulation
Corona radiata
In the coronary arterial system
Most capillary blood flow occurs during cardiac diastole
Which of the following form in or supply the 2nd pharyngeal arch?
body of hyoid bone
which immunization is recommended with pregnancy
flu
Which of the following organs does the embryonic endoderm contribute to?
lungs
When discussing rest and sleep with a pregnant woman, the nurse would suggest which position for napping?
on her side with the weight of the uterus on the bed
Which of the following would be appropriate treatment for a woman with mild endometriosis?
oral contraceptives
Tinea cruris (jock itch) is a protozoan infection.
False
The developmental tissue from which the gonadal ridge is derived
Intermediate mesoderm
The major cell type lining the surface of the bronchi
Ciliated columnar epithelial cell
A woman having a cesarean birth will have a low cervical incision. Which of the following would you cite as an advantage?
The skin incision will be just above her pubic hair.
A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?
third stage of labor
Tissue specialised for generation of heat in the newborn
Brown adipose tissue
Which is the innervation of flexors of the fingers?
Median and ulnar nerves
Muscle wall of bladder
Smooth muscle stimulated by acetylcholine
Muscle wall of the bladder
Smooth muscle stimulated by acetylcholine
directional transport of vesicles
Microtubules
recommended weight gain in those with obesity (30 or highte BMI)
11-20
Nerve supplying knee flexors
Sciatic nerve
Intermediate filament protein
Keratin
Corticosteroid clearance from the circulation occurs in the
Liver
A 4-year-old is ordered to bedrest. Which activity would be most appropriate for promoting play?
Providing a basin with water and toys while bathing the child
Neural crest cells are derived from this structure, which is one of the three embryonic germ layers
Ectoderm
A pregnant client with sickle cell anemia is admitted in crisis. Which nursing intervention should the nurse prioritize?
I.V. fluids
A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance?
More consistent regulation of glucose and insulin
A hormone that inhibits insulin release
Somatostatin
Which nursing action is required before a client in labor receives an epidural?
Giving a fluid bolus of 500 ml
The structure in the kidney in which capillaries with fenestrated endothelia are always found in normal individuals
Glomerulus
Acting in the liver in starvation, cortisol stimulates
Gluconeogenesis
The main neurotransmitter used by peripheral sensory neurons
Glutamate
Pituitary hormone when produced in excess may result in acromegaly
Growth hormone (GH)
The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is:
Acyclovir
Contributes to major portion of the urinary bladder
allantois
The principal hormone secreted by the parafollicular C cells
calcitonin
Fundal Height: 8 weeks
• Tennis ball/orange (uterus size) • Hegar's, Goodell's, & Chadwick's sign
The nurse is explaining to a 4-year-old about a CT scan with contrast. Which explanation by the nurse is most appropriate?
"I am going to give you some medicine through the tube in your arm so we can take a picture inside your belly."
A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction?
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."
When the spermatozoon makes contact with the zona pellucida
Acrosomal enzymes are released
Hormone that promotes adrenal cortex steroid secretion and growth
Adenocorticotrophic hormone (ACTH)
A client in labor has received a spinal epidural block. Which nursing intervention should the nurse prioritize after assessing maternal hypotension and changes in the fetal heart rate (FHR)?
Administer supplemental oxygen.
A hormone produced by the outermost zone of the adrenal cortex
Aldosterone
A hormone that acts predominantly through intracellular receptors
Aldosterone
A hormone that stimulates reabsorption of sodium in the kidney
Aldosterone
Which facility policy enhances family-centered care?
Allowing family presence during procedures
The second meiotic division in female oocytes is completed
At fertilisation
A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort?
Avoid consumption of caffeinated drinks.
common complaints in 3rd trimester
Braxton hicks, upper extremity discomfort, edema, heartburn, insomnia
A 17-year-old G2 P0010 patient develops hypertension at 32 weeks and is required to limit her intake of sodium and increase her protein intake. The patient is out of work and does not attend school. Her time is spent primarily at the local shopping mall with friends. The best dietary suggestion that the home visiting nurse can make to this patient is:
Bring water and a lunch from home rather than eating at the food court
The spinal roots supplying small (intrinsic) muscles of the hand
C8, T1
The principal hormone secreted by the parafollicular C cells of the thyroid
Calcitonin
A 28-year-old woman delievers a baby boy. In order to monitor for maternal complications, the nurse should be most alert to what finding?
Changes in BP and Pulse
The nurse cares for a patient 12 hours after delivery of a 3,200 g infant. The nurse notes that the fundus is approximately 1 cm above the umbilicus. It is MOST important for the nurse to take which of the following actions?
Chart the results in the patient's chart
A hormone secreted by the duodenum in response to fatty food in the diet
Cholecystokinin
A woman in her 20s has experienced a miscarriage at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of spontaneous miscarriage in the first trimester is related to which factor?
Chromosomal defects in the fetus
A woman is in active labor. As labor progresses, she bevomes irritable and complains of feeling increasingly uncomfortable. She is 8 cm dilated. Which of these actions should the nurse take FIRST?
Coach the patient in proper breathing and relaxtion techniques.
The main artery supplying derivatives of the foregut
Coeliac
The duct that is joined by the pancreatic duct before entering the intestine
Common bile duct
In the labor and delivery unit, which is the best way to prevent the spread of infection?
Complete hand hygiene
When providing nutritional counseling to a pregnant woman with diabetes, the nurse would urge the client to obtain most of her calories from which source?
Complex carbohydrates
Adrenal cortex cells
Contain prominent smooth endoplasmic reticulum for steroid hormone synthesis
The nurse is caring for a laboring client. The nurse observes that there are early decelerations. The fetal heart rate remains within normal limits with adequate variability. What is the nurse's best action?
Continue to monitor the client and the FHR
The student nurse is learning about normal labor. The teacher reviews the cardinal movements of labor and determines the instruction has been effective when the student correctly states the order of the cardinal movements as follows:
Descent, flexion, internal rotation, extension, external rotation, expulsion.
Cell-cell junctions that are primarily responsible for linking keratinocytes in the prickle cell layer (stratum spinosum) of the epidermis
Desmosomes
A woman who is 42 weeks pregnant comes to the clinic. During the visit, which assessment should be prioritize?
Determining an accurate gestational age
During a prenatal visit, the physician determines that the fetal heart beat is too fast. What drug would the nurse expect the physician to order for the mother to treat the fetal tachycardia?
Digoxin
The ovary
Does not develop properly in Turner's syndrome (XO)
The vessel that will close at birth to prevent blood flow between the aorta and pulmonary circulation
Ductus arteriosus
The vessel which will close at birth to prevent blood flow between the aorta and pulmonary circulation
Ductus arteriosus
Embryonic germ layer from which melanocytes are derived
Ectoderm
A structural junction formed between epithelial cells and the basement membrane
Hemidesmosomes
In the venous drainage of the lower limb
In communicating veins normal flow is from superficial to deep
A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when?
In weeks 28 to 32
The type of epithelium lining the bronchus
Pseudostratified columnar epithelium
A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?
Red, strawberry tongue
28. The nurse knows that a low-birth-weight infant is at greatest risk for developing what?
Respiratory distress syndrome
The phase of the cell cycle in which nuclear DNA replication occurs
S
When the nurse is instructing on disease transmission, which is noted as the smallest infectious agent known?
Virus
A pregnant client has been diagnosed as having a urinary tract infection (UTI). Which of the following instructions regarding control of the infection should the nurse provide the client?
Wear cotton underwear
Vagina histology
stratified squamous epithelium, non-keratinised
A pancreatic hormone whose release is stimulated by raised plasma glucose
Insulin
The germ layer or germ layer derivative that gives rise to the skeletal structures of the limbs
Lateral plate mesoderm
Spermatozoa are first capable of directional swimming when they
Leave the epididymis
A nurse is caring for a family whose child has been admitted to the hospital for orthopedic surgery. Which of the following should the nurse do to promote a positive hospital stay for the child and the family?
Limit diagnostic procedures to only those necessary to minimize the length of the hospital stay
After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections?
Neutrophils
The neurotransmitter receptors on the post-synaptic membrane at the neuromuscular junction
Nicotinic acetylcholine receptors
When caring for a client in the third stage of labor, the nurse notices that the expulsion of the placenta has not occurred within 5 minutes after birth of the infant. What should the nurse do?
Nothing. Normal time for stage three is 5 to 30 minutes.
The membrane-bounded organelle into which proteins can be transported directly from the cytoplasm in their folded form
Nucleus
A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which positions are most effective for pushing to speed up the descent? Select all that apply.
Semi-Fowler's position
A cell type which derives from cells of the neural crest
Sensory neurons
The structure that forms the first incomplete partition between the two atria during heart development
Septum primum
The structure that partially separates the coelomic cavity into superior (thoracic) and inferior (abdominal) portions
Septum transversum
Colon histology
Simple columnar epithelium with goblet cells
Jejunum histology
Simple tall cuboidal epithelium with numerous microvilli
Proximal convoluted tubule of kidney histology
Simple tall cuboidal epithelium with numerous microvilli
The component of the primitive heart tube that forms the smooth walled parts of the atria
Sinus venosus
Medullary collecting ducts
Site of action of vasopressin (ADH)
Muscle wall of the bladder composition and stimulation
Smooth muscle stimulated by acetylcholine
Part of mesoderm from which the limb musculature is derived
Somite
Region giving rise to the vertebral body
Somite
Structure from which the vertebrae are derived
Somite
The germ-line stem cells in the testis
Spermatogonia
A nurse is providing care to an infant who develops roseola during hospitalization. The nurse would institute which infection control precaution?
Standard
Juxtaglomerular apparatus
Stimulated to secrete renin by sympathetic innervation
The nurse cares for a pt receiving mag sulfate IV, and the nurse notes that the pt's deep tendon reflexes are decreased. what action should the nurse take first?
Stop IV
The mammary gland is situated primarily in
Superficial fascia
The artery supplying the ileum
Superior mesenteric
A vein draining into the right atrium
Superior vena cava
The sciatic nerve
Supplies all the muscles below the level of the knee
Muscle/muscle group producing first few degrees of abduction of the shoulder
Supraspinatus
Subcellular location where translation of insulin mRNA is completed
Surface of the rough endoplasmic reticulum
The nurse is transcribing messages from the answering service. Which phone message should the nurse return first?
a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria
Screening Questions for incontinence
• Do you ever leak urine/water when you don't want to? • Do you ever leak urine when you cough, laugh, or exercise? • Do you ever leak urine on the way to the bathroom? • Do you ever use pads, tissue, or cloth in your underwear to catch urine?
Testing at 36-40+ weeks
• Fetal presentation • fundal height will decrease when baby drops • Cervical exam
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placentae and placenta previa. Which statement should the nurse include in the teaching?
"Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placentae is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."
A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?
"The injection is given in the space outside the spinal cord."
A nursing student is learning about fetal presentation. The nursing instructor realizes a need for further instruction when the student makes which of the following statements?
"Transverse lie is the same as when the fetal buttocks present to the birth canal."
A nurse is preparing a 6-year-old boy for an emergency appendectomy. The boy is in a lot of pain and also scared. Which statement would be best to explain this surgery to him?
"We are going to fix the part that hurts down there so that it doesn't hurt anymore."
A woman, who has been in labor for a few hours, is now complaining of being hungry. Which response by the nurse would be best if the client asks for some food to eat?
"You could have some hard candy to suck on."
The health care provider is evaluating a high-risk woman for a continuous internal monitoring. It would be most appropriate to meet which criterion?
"Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again." The cervix must be assessed with a vaginal exam. The frequency of vaginal exams is based on the signs of changes in labor. The client has not demonstrated any changes in her labor pattern; the nurse should provide education on the reason for not checking her. pg 451
S/S of Mastitis r/t Breastfeeding
- unilateral - fever/chills - malaise - local tenderness/pain/lump
Pituitary hormone whose principal control is inhibition by the hypothalamus
. Prolactin
Assessment of a woman in labor reveals that the fetus is in a cephalic presentation and engagement has occurred. The nurse interprets this finding to indicate that the presenting part is at which station?
0
Positive/ Diagnostic S/S of pregnancy
1. fetal heart rate 2. fetal movements 3. fetal sonography
A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.
1. hemolysis 2. elevated liver enzymes 3. low platelet count
The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?
12.0 cm The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.
2nd trimester
14-27 weeks
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is:
5
The number of erythrocytes per litre
5 x 10^12
Which of the following is true regarding problems that commonly affect nutritional health in pregnancy?
50% of women report pyrosis at some point in pregnancy.
The intercostal space in which a normal apex beat is typically located
5th intercostal space
Dilation follows effacement in the primiparous mother. To be fully dilated, the cervix should have a distance of what measurement?
8 to 10 cm Full dilation of the cervix is 8 to 10 cm.
A nursing student correctly identifies an older infant who fixes the eyes on a new caregiver, becomes restless, thrashes arms and legs, and begins to cry as likely experiencing which of the following?
8-month anxiety
Gravida
A pregnancy regardless of duration
A nurse is monitoring a client during the second stage of labor. Which finding in the mother should cause concern for the nurse?
A rise in systolic blood pressure of 30 mm Hg with each contraction
If a woman is in active labor and her membranes ruture and she expresses a concern to the nurse that she is afraid of having a "dry labor" what should the nurse tell the pt?
Amniotic fluid does not function as lubrication for the labor process. It serves to maintain constant body temperature, provides oral fluids, and cushions the fetus
A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?
Assess the client's vital signs. A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps.
Antibody-producing cells
B-cells (lymphocytes)
PIH Pregnancy Induced Hypertension
BP>140/90 or rise in systolic >30 or diastolic over 15mmHg above baseline on at least two occasions with readings six hours apart (occurs about 12% cases)
The nurse is assisting a client who has just undergone an amniocentesis. Blood results indicate the mother has type O blood and the fetus has type AB blood. The nurse should point out the mother and fetus are at an increased risk for which situation related to this procedure?
Baby developing postbirth jaundice
The nurse identifies increased stress in the pediatric client and family prior to an upcoming surgery. Which suggestion is most helpful to decrease the level of stress in parents?
Choosing an ambulatory surgery site.
The structures entering the liver together via the lesser omentum
Common bile duct, hepatic artery, hepatic portal vein
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfuction?
Contractions most forceful in the middle of uterus rather than the fundus
A hormone that acts predominantly through intracellular receptors
Cortisol
Erythrocytes
Diameter 8µm
The location of the cell bodies of peripheral sensory nerves
Dorsal root ganglion
The main hormone that stimulates growth of mammary gland ducts
Estradiol
How often are prenatal visits 28-36 weeks?
Every 2 weeks
When stimulating the fetus via an acoustic vibrator, which action indicates fetal well-being?
Fetal heart rate acceleration occurs
Cell type which secretes collagen
Fibroblast
Cell type which secretes collagen
Fibroblasts
The embryonic structure normally linking left and right sides of the heart, and that closes at birth
Foramen ovale
The nurse is caring for a child diagnosed with Hepatitis B. Which system is most likely to have complications from this diagnosis?
Gastrointestinal
Which type of anesthesia is anticipated when the delivery of the fetus must be done quickly due to an emergency situation?
General
Pica is a symptom of which nutritional deficiency?
Iron deficiency
A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth?
McRoberts maneuver
Cell type which develops from neural crest cells
Melanocytes
A 13 month old who has recurrent illnesses is having difficulty sleeping at night. In considering therapeutic interventions, the pediatric nurse correctly identifies which stage of sleep that allows the body to rest and restore function?
NREM
What OTC meds cannot be taken during pregnancy?
NSAIDS ASA Pepto Bismol
The fetus of a woman in labor is determined to be in a persistent occiput posterior position. Which intervention would the nurse prioritize?
Pain relief measures
A term which best describes the developmental versatility of haematopoietic stem cells
Pluripotent
A maternity nurse is aware that the fetal head is the presenting part in complete extension position. Which type of birth should the maternity nurse anticipate?
Prolonged labor and possible cesarean birth
The phase of meiosis in which homologous chromosomes recombine
Prophase of meiosis 1
A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina?
Put her in bed immediately, call for help, and hold the presenting part of the cord.
A part characterised by an obvious sphincter of thickened smooth muscle
Pyloric canal
Testing at 12-21 week visit
Quad marker screen
The gall bladder receives
Receives bile from the liver via the cystic duct
At the shoulder joint
Rotator cuff muscles are the major stabilisers of the joint
The site of translation for most secreted proteins
Rough endoplasmic reticulum
The first day of the client's last menstrual period was December 1. Based on Naegle's rule, the nurse determines that which date is the estimated date of birth?
September 8
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?
Sudden shortness of breath
A 25-year-old pregnant client has just been diagnosed with hyperemesis gravidarum. Which instruction should the nurse prioritize during a teaching session?
Take your anti-nausea medicine around the clock.
When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful?
The characteristics of labor pain follow a pattern.
The home care nurse visits a 17-year old who delivered a full-term infant 2 weeks ago. Although the client appears mature, the nurse knows the client's age may interfere with positive mothering because of which of the following?
The client is still experiencing the dependency of childhood.
A pregnant woman calls her provider's office to report she thinks she is in labor. The client reports contractions have been fairly strong and at these times: 12:05, 12:10, 12:15, and 12:20. What information is gathered based on this data?
The frequency of the contractions is every 5 minutes. Based on the information, the nurse knows the contractions are regular and every 5 minutes apart. This is the only data gathered based on the information given, but it is very useful to the provider.
The nurse instructs a patient who recently had a modified radical mastectomy.
The nurse states that it is important that the patient exercise her arm postoperatively to prevent lymphedema
In vasa previa, the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.
True
Louder sounds are produced by forcing air more rapidly past the vocal cords
True
Secretion of adrenocorticotrophic hormone (ACTH) is inhibited by plasma glucocorticoids
True
The epiglottis helps prevent the food bolus from entering the trachea during swallowing
True
A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention?
Urine output of 20 mL/hour
Bladder histology
Uroepithelium (transitional epithelium)
A 24-year-old pregnant woman reports excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation, but she finds it messy and unpleasant. What should the nurse advise her to do?
Use sanitary pads. Vaginal discharge increases during pregnancy and is a concern for many women. Encourage the client to keep clean and wear sanitary pads as needed. Douching may be dangerous for the mother. STIs are not indicated simply by discharge. Pregnant women should not decrease fluid intake.
Spontaneous miscarriage occurs in 5% to 10% of all pregnancies. a) False b) True
a) False Rationale: Spontaneous miscarriage occurs in 15% to 30% of all pregnancies and arises from natural causes.
During pregnancy the cardinal rule regarding taking medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?
asthma
A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location?
at the umbilicus
Which of the following nursing diagnoses would be most appropriate for a woman diagnosed with pregnancy-induced hypertension? a) Risk for injury related to fetal distress b) Deficient fluid volume related to vasospasm of arteries c) Imbalanced nutrition related to decreased sodium levels d) Ineffective tissue perfusion related to poor heart contraction
b) Deficient fluid volume related to vasospasm of arteries Rationale: Hypertension of pregnancy is caused by vascular spasm. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume.
Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes?
between 24 and 28 weeks' gestation All women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.
Embryonic ectoderm gives rise to the
brain
A hormone which is principally controlled by adrenocorticotrophin hormone (ACTH)
cortisol
A hormone released by the endocrine pancreas in response to hypoglycemia
glucagon
A hormone secreted by cells in the islets of Langerhans in response to hypoglycaemia
glucagon
Which of the following organs does the embryonic mesoderm contribute to?
gonads, heart, kidneys, lungs
Milestones: Week 6
heart begins beating
A symptom typically associated with thyrotoxicosis
high basal metabolic rate
If constipation is a problem for a woman during pregnancy, which measure would be best to recommend?
increasing fluid intake
Organ in which corticosteroids are cleared from the circulation
liver
By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?
near the bottom of the sternum
A __ hr OGTT is recommended
one
Nerves that directly stimulate secretion of catecholamines from the adrenal medulla
preganglionic sympathetic nerves
The structure largely responsible for separating the thorax and abdomen is
septum transversum
Thin descending part of the loop of Henle histology
simple squamous epithelium
A woman taking estradiol is at risk for developing endometrial cancer.
true
A patient having a cesarean birth will have a low segment incision. What should the nurse explain to the patient as an advantage for this type of incision?
vaginal deliveries can occur with future births
A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?
"I respect your preference whether it is to have medication or not."
When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?
"You have no trouble walking around and using the bathroom after you receive the epidural." Epidural anesthesia impairs mobility; most clients are placed on bed rest after epidural anesthesia is given. Urinary catheterization is frequently required.
A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure?
"You'll need to stay in bed while you're having this procedure."
Lymphocytes
'B' and 'T' cells develop from precursors in bone marrow
Probable/ Objective S/S of pregancy
1. (+) pregnancy test 2. enlarged abd 3. Hegar's sign 4. Chadwick's sign 5. Goodell's sign 6. Ballottement 7. Fetal outline 8. Braxton-hicks
One minute after birth the newborn appears cyanotic. Five minutes after birth the extremities are pink. What should the 1 and 5 minute APGAR scores be?
9 and 10
. Cervical Cancer: general, screening
: third most common gynecological CA in U.S. • 99.7% test positive for HPV. • ___________ cancer screening: • Never before 21 • Every three years 21-30 • Every five years 30+, when combined with HPV testing. • Discontinue at 70.
The nurse is noting a collection of blood under the scalp on a newborn being discharged to home. The nurse is correct to prepare teaching instructions of which topic?
A cephalohematoma
A part in which the lining mucosa is derived from ectoderm
Anal canal
Which statement is true regarding analgesia versus anesthesia?
Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area
The part of the nephron formed from the ureteric bud
Collecting duct
A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?
Dark red, "clumpy" vaginal discharge
Platelets
Derived from megakaryocytes
Which intervention would be least effective in caring for a woman who is in the transition phase of labor?
Encouraging the woman to ambulate
During development of ovarian follicles
FSH stimulates follicle development by an action on granulosa cells
A hepatic vein tributary is a component of each portal triad
False
Muscle group causing flexion of the joint
Hamstring group
The uterine artery is a branch of the
Internal iliac artery
The phase of meiosis in which the mature oocyte is arrested prior to fertilisation
Metaphase of meiosis 2
The embryonic cell or tissue that gives rise to peripheral sensory neurons
Neural crest cells
A 17-year-old is diagnosed with infectious mononucleosis. The nurse should discuss which intervention with the teenager's caregiver to best assure an uncomplicated recovery?
Precautions to avoid secondary infections
The sinu-atrial node is situated in the wall of this heart chamber
Right atrium
The cell type responsible for myelinating peripheral nerve axons
Schwann cell
Secretion of thyroxine (T4) from the thyroid is controlled by
Thyrotrophin-stimulating hormone (TSH)
The nurse instructs a client in the prenatal clinic about nutrition during pregnancy. The nurse determines teaching is successful if the client selects which of the following foods from a menu?
Two eggs and 8 oz of milk.
Discomforts of prregnancy nasal stiffness management
avoid allergen and smoke NS drops (1/4 ns in 1 cup water) steam pot of boiling water
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?
fetal distress related to hypoxia When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement.
What term is used to describe the position of the fetal long axis in relation to the long axis of the mother?
fetal lie
A woman is about to go for her first cesarean delivery and asks the nurse what complications can come from this type of delivery. The nurse correctly identifies which of the following as the number one complication of cesarean delivery?
infection
The principal hormone produced by beta cells in the pancreas
insulin
The pituitary hormone that stimulates mammary gland milk production
prolactin
Bladder histology
uroepithelium (transitional epithelium)
Fundal Height Measurement: 20-36 wks
• Uterus: 1 cm increase weekly • Uterine fundus at the umbilicus • fundal height = gestational age (+ or - 1 cm)
The fetus of a nulliparous woman is in a shoulder presentation. The nurse would prepare the client for which type of birth?
Cesarean
The major cell type within the epiphyseal plate of developing long bones that grows by hypertrophy
Chondrocyte
A 38-year-old client, G4P3, at 10 weeks' gestation with an unplanned pregnancy, has concerns the fetus may have a genetic defect. The nurse should point out which test would be the best current choice to investigate the possibility of a chromosomal abnormality?
Chorionic villus sampling
The nurse is comforting and listening to a young couple who just suffered a miscarriage. When asked why this happened, which reason should the nurse share as a common cause?
Chromosomal abnormality
Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting?
Limiting intake of heavy, greasy foods
A part of the large bowel with complete circumferential layers of longitudinal and circular smooth muscle
Rectum
The motor nerve supply to the muscles controlling the glottis
Recurrent laryngeal branch of the vagus nerve
The main spinal nerve root which innervates skin on the lateral side of the foot and heel
S1
The gene that determines the type of gonad derived from a genital ridge
SRY
Which nursing intervention will help reduce a child's anxiety about hospitalization?
Show the child all equipment to be used, including sounds
Distal convoluted tubule of the kidney histology
Simple cuboidal epithelium
Alveolar epithelium histology
Simple squamous epithelium
Endothelium histology
Simple squamous epithelium
Lining of blood vessels histology
Simple squamous epithelium
Follicular cells of thyroid histology
Simple tall cuboidal epithelium with numerous microvilli
Sympathetic outflow from spinal cord
T1-L2
The nurse is caring for a client at 39 weeks' gestation and whose fetal station is noted as a 0 (zero). The nurse is correct to document which?
The fetus is in the true pelvis and engaged.
A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. For what should the nurse immediately check the patient?
Umbilical cord prolapse
4 Probably signs of pregnancy
Urine and blood tests Chadwick's sign (blue cervix) Goodell's sign ( cervical softening) Hegar's sign (uterine softening)
The nurse is identifying nursing diagnoses for a patient with gestational hypertension. Which diagnosis would be the most appropriate for this patient?
Ineffective tissue perfusion related to vasoconstriction of blood vessels
Cells that mature in the thymus
T-cells (lymphocytes)
The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment?
Uterine atony
A structure that forms the roots and proximal parts of the aorta and pulmonary artery
Truncus arteriosus
What immunizations can be given in pregnancy?
- No live vaccines - No Rubella vaccine - No HPV
treatment for nausea/vomiting
- benadryl, dramamine, compazine, phenergan, reglan, zofran
1st trimester
1-13 weeks
A hormone which is produced by the anterior pituitary gland and is under the inhibitory control of hypothalamic dopamine
Prolactin
A pituitary hormone that can cause infertility when levels are raised
Prolactin
A term which best describes the developmental versatility of embryonic stem cells
Totipotent
The developmental potential of human stem cells derived from a 4-cell stage embryo
Totipotent
Site of packaging of secretory proteins into vesicles
Trans-Golgi Network
Lymphocytes
'B' cells have surface antibodies
The neurotransmitter used by somatic motor neurons
Acetylcholine
Antibody-producing cells of the blood
B cells
Cell type that makes cartilage
Chondrocyte
Which movements are possible at the wrist joint
Flexion, extension, abduction, adduction, circumduction
A hormone secreted by cells in the islets of Langerhans in response to hyperglycaemia
Insulin
Nasal epithelium histology
Pseudostratified columnar epithelium
The duodenum
Regulates gall bladder contraction by an endocrine mechanism
The client and her partner have prepared for a natural birth and bring a picture of a sunset over the ocean with them. The nurse predicts they will be using which techniuqe during labor?
Attention focusing
How can the nurse best counsel a patient with pyrosis?
"Avoid lying down 2 hours after eating."
During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume?
40% Vital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock.
The proportion (%) of leukocytes that are neutrophils
40-70%
A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy?
Client does not have an incompetent cervix.
A 38-year-old woman comes into the obstetrician's office for prenatal care, stating that she is about 12 weeks pregnant with her first child. What questions would the nurse ask this client, considering her age and potential sensitivity to being labeled an "older" primipara?
Be non-judgmental in your history gathering and offer her pregnancy resources to read and explore.
The structure in the kidney on which the hormone vasopressin acts to increase permeability to water
Collecting duct
The client is experiencing back labor and reporting intense pain in the lower back. The nurse should point out which intervention will be the most effective at this point?
Counterpressure against the sacrum
What is MOST important for the nurse to do when administering phototherapy to a newborn with jaundice?
Cover the infan'ts eyes with protective pads during therapy.
Location of the cell bodies of peripheral sensory neurons
Dorsal root ganglion
The nursing instructor is teaching a group of nursing students about the uniqueness of pain involved with the birthing process. The instructor determines the session is successful when the students correctly choose which pain factor to be related to psychosocial influences?
Fear of pain during labor
Cell-cell junctions that permit diffusion of ions between cardiomyocytes
Gap junctions
The process by which three embryonic germ layers are generated
Gastrulation
The structure in the kidney in which podocytes are found
Glomerulus
The sensory component of the gag reflex
Glossopharyngeal nerve
During a difficult labor of an infant in the face presentation, the nurse notes the infant has a large amount of facial edema with bruising and ecchymosis. Which assessment would be the priority for this infant?
Patent airway
The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:
Penicillin
A child is diagnosed with scarlet fever. The nurse is reviewing the child's medical record, expecting which medication to be prescribed for this child?
Penicillin V
The nurse is discussing options to provide relief of labor pain when the client states, "Why can't the health care provider provide a sedative during labor?" Which disadvantages are common with providing a sedative as pain management? Select all that apply.
Sedatives will not provide pain relief. The sedation effect can cross to the fetus. Sedatives are only used in early labor
A patient who is 16 weeks pregnant is passing pieces of body tissue along with blood clots and dark red blood from the vagina. What should the nurse direct the patient to do at this time?
Seek immediate medical attention and bring the expressed vaginal material.
Hormones that are lipid soluble and produced from cholesterol
Steroid hormones
Which of the following medications is the treatment of choice for trichomonas?
a. Metronidazole
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
administration of oxygen by mask The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation. pg 460
A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate?
b. "The hot flashes are a result of the antiestrogenic effects of tamoxifen."
_ 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?
b. "We will order a mammogram and ultrasound to help establish a diagnosis."
A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?
b. Estradiol, 7.5 mcg/24 hr vaginal ring
A fetus is in the LST position. The nurse interprets this as indicating which presenting part?
buttocks The letter "S" indicates the sacrum or buttocks as the presenting part. The fetal head would be noted by the letter "O," indicating occiput. The fetal chin would be noted by the letter "M," indicating mentum. The fetal shoulder would be noted by the letter "A," indicating the acromion process.
The neurohypophysis
comprises nerve endings of hypothalamic neurosecretory neurons
In the labor and delivery unit, which is the best way to prevent the spread of infection?
hand hygiene
What would be the physiologic basis for a placenta previa?
low placental implantation
Proximal convoluted tubule of the kidney nephron histology
simple tall cuboidal with numerous microvilli
When developing a labor plan with the client, which outcome is the priority?
the patient is able to direct their pain control methods
One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it?
Folic acid
Which client statement is anticipated after immediately receiving an intrathecal injection of pain medication?
"I have no pain now."
A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize?
"I sometimes get a bit wheezy."
The foramen that interconnects the atria immediately before birth
Foramen ovale
A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client?
Assess fetal heart sounds.
A pregnant client is being admitted for severe preeclampsia. When assigning room placement, which area would be most appropriate?
At the end of the hallway
The tissue from which the mitral and tricuspid valves are developed
Endocardial cushion tissue
Embryonic germ layer from which the stomach epithelium is derived
Endoderm
During an unfertilised menstrual cycle
Endometrial growth involves hyperplasia and hypertrophy
Cell that typically shares a fused basement membrane with pneumocytes in the alveoli
Endothelial cell
A woman at 37 weeks gestation presents to the labor and delivery area with symptoms of abruptio placentae. Which action should the nurse prioritize?
Ensure large bore IV access is obtained
A nurse is listening to a patient's heart and determines that there is a change since the last normal prenatal visit. The patient has no history of heart disease, so which of the following should the nurse expect has developed?
Functional murmur
Receptors through which ACTH acts to stimulate cortisol synthesis and release
G protein-coupled receptors
The phase when cells exit the mitotic cell cycle prior to terminal differentiation
G0 phase
The type of cartilage found on the articular surface of most synovial joints
Hyaline
production of ribosomes
Nucleolus
The embryonic duct that gives rise to the Fallopian (uterine) tube
Paramesonephric (Müllerian) duct
A hormone which is secreted in response to a fall in plasma calcium
Parathyroid hormone
A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?
Serve the formula at room temperature.
The nurse is concerned that a pregnant patient is experiencing abruptio placentae. What did the nurse assess in this patient?
Sharp fundal pain and discomfort between contractions
A nurse is providing education to a woman at 28 weeks' gestation who has tested positive for gestational diabetes mellitus (GDM). What would be important for the nurse to include in the client teaching?
She is at increased risk for type 2 diabetes mellitus after her baby is born.
A woman whose body mass index (BMI) is 32 has just learned that she is pregnant. Which of the following should the nurse advise her regarding her weight over the course of her entire pregnancy?
She should gain 11 to 20 lb
A female client presents to the emergency department reporting she recently had a positive home pregnancy test but is now suspected of having an ectopic pregnancy. Which assessment should the nures prioritize?
Shoulder pain
The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?
The nurse will administer oxygen.
Danger s/s in 3rd trimester
decrease in fetal mvmt, menstrual-like bleeding, constant, severe contractions
Which finding is most worrisome in a client in her 26th week of pregnancy?
facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension
A hormone that stimulates follicle development and ovulation
follicle stimulating hormone
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?
gestational hypertension
A client in her 38th week of gestation is admitted into the labor and birth unit with painless bleeding from the vagina. The client is diagnosed with placenta previa. When reviewing the client's history, which factor would the nurse identify as a risk factor for placenta previa?
previous cesarean birth A previous cesarean birth is a risk factor for developing placenta previa. This is due to the damage caused to the endometrial tissue. Multiparity, and not a primigravida status, predisposes to placenta previa. Maternal age over 35 years, and not just more than 30 years, is considered another risk factor. Placenta previa is more common among those living in high altitudes not among those living in coastal areas.
what is an abnormal c/o in 1st trimester
vaginal bleeding
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?
"Come to the health facility with any vaginal material passed." This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.
The most common complication of varicella is:
Secondary bacterial infections.
The endometrium
Secretion by endometrial glands is stimulated by progesterone
The hormone that causes the mesonephric (Wolffian) duct to grow and develop
Testosterone
Infants admitted to the hospital need toys in their cribs, such as mobiles, blocks, soft toys, and rattles.
True
The 'muscle pump' aids venous return in the deep veins of the leg
True
The pharynx is mainly lined by a non-keratinised stratified squamous epithelium
True
Vaginal bleeding during pregnancy is always a deviation from the normal.
True
preeclampsia presentaion is noted after the __ week
20th
A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication?
congenital anomalies
Pre-embryonic (ovum stage)
conception - day 14
Which consideration is a priority when caring for a mother with strong contractions 1 minute apart?
fetal heart rate in relation to contractions
Discomforts of pregnancy back ache management
pelvic rocking exercise, rest, avoid fatigue
A nurse is assessing a client's nutritional intake during pregnancy. What is the best method for accomplishing this?
Enacting a 24-hour nutrition recall
A 22-year-old woman is diagnosed with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient's symptoms?
regular exercise
The margins of the inlet to the larynx
Epiglottis and ary-epiglottic folds
A non-dividing cell that after tissue damage can re-enter the cell cycle to regenerate a large portion of the organ in which it normally resides
Hepatocyte
A branch of the coeliac artery
Splenic
A cell involved in bone resorption
Osteoclast
Glucocorticoids are produced from cholesterol
True
A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints?
Ectopic pregnancy
The hormone that in the breast stimulates growth of mammary gland ducts
estradiol
The nurse cares for a pt 24 hrs after deliver, and the pt states that she has been voiding large amounts of urine. What would be the BEST response by the nurse?
Your body is getting rid of the increased fluid
Current research indicates that supplementation with what before pregnancy may reduce the risk of placental abruption?
Folic acid
The left ureter
Originates from the renal pelvis
Secretion of thyroxine (T4) from the thyroid is controlled by
TSH
Embryonic germ layer from which neural crest cells are derived
Ectoderm
Discomforts of pregnancy leukorrhea management
perineal hygiene, flush perineuu with water, samitary pad as needed
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.
4, 1, 1, 1, 1
A 22-year-old female is 25 weeks pregnant. She explains that she is having difficulty getting an adequate amount of protein into her diet because she is a vegetarian. How can the nurse best counsel this patient?
"In addition to getting protein from eating dairy, eat complementary proteins such as beans and rice together, or beans and wheat together."
Which action is a priority when caring for a woman during the fourth stage of labor?
Assessing the uterine fundus
Skin of the sole of the foot histology
Stratified squamous epithelium, keratinised
Between pneumocytes and pulmonary endothelial cells
The basement membranes are fused
How often are prenatal visits >36 weeks
every week or more as necessary
The principal hormone secreted by the zona fasciculata is
Cortisol
During the second stage of labor, a woman is generally:
turning inward to focus on body sensations
A 29-year-old client comes to the clinic because she has not had a menstrual period for two months and thinks she is pregnant. The nurse would assess the client for which of the following?
Nausea and vomiting that fades as the day goes on
The nurse is instructing a primipara who has concerns about the need for a cesearan section due to her sister's obstetrical history. Which statement by the client needs further instruction?
"My sister had a cesarean section with the first and then needs it for all subsequent pregnancies."
An artery which branches from the aortic arch
Left subclavian artery
A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?
"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."
The client may spend the latent phase of the first stage of labor at home unless which occurs?
The client experiences a rupture of membrane
The structure(s) from which secretory vesicles typically bud off prior to fusion with the plasma membrane
Trans-Golgi network
Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal?
a. Pregnancy
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition?
mild preeclampsia
Discomforts of pregnancy varicose veins management
rest with elevation of legs support hose avoid standing elastic bandage before getting up-dont wrap toes start at distal end
A pregnant client is asking about medications, supplements, and vaccines. Which would the nurse indicate as potentially teratogenic?
rubella vaccine
The nurse is caring for a client who has a multifetal pregnancy. What topic should the nurse prioritize during health education?
Signs of preterm labor
A hormone which, when deficient, causes Addison's disease
Cortisol
The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist?
Inability to push
Structures that make contact with the right lobe of the liver include the
Inferior vena cava
A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing?
Inhale slowly through nose and exhale through pursed lips. For slow-paced breathing, the nurse should instruct the woman to inhale slowly through her nose and exhale through pursed lips. In shallow or modified-pace breathing, the woman should inhale and exhale through her mouth at a rate of 4 breaths every 5 seconds. In pattern-paced breathing, the breathing is punctuated every few breaths by a forceful exhalation through pursed lips. Holding the breath for 5 seconds after every three breaths is not recommended in any of the three levels of patterned breathing.
A cell of the blood that gives rise through migration to macrophages
Monocyte
A hormone secreted by Sertoli cells that blocks development of parts of the female reproductive system
Mullerian inhibiting factor
A direct consequence of tricuspid valve incompetence i.e. a failure of the valve to close completely during ventricular contraction
Raised right atrial pressure
The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should:
confirm the consent has been provided
The nurse manager is reviewing all the L & D clients on the unit in order to prepare assignments to the nursing staff. For which clients would augmentation of labor with oxytocin be considered contraindicated or used cautiously? Select all that apply.
44 year old primipara diagnosed with gestational diabetes in active labor for the past 6 hours. 33 year old female who is 32 weeks gestation in labor with twins. A 30 year old multipara woman who has experienced premature rupture of membranes 5 days ago but just now reporting it to provider.
the mechanical skeleton of the cell
Intermediate filaments
The site of initiation of the cardiac conduction impulse
SA node
A primigravida is 1 cm dilated, in early latent labor, and interested in avoiding epidural anesthesia. After asking about which nonpharmacologic options for pain relief she can use at this time, which options should tne nurse point out to the client? Select all that apply.
Simple breathing exercises Effleurage Walking and then using a birthing ball
A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angerily says no and starts crying?
Tell her that the hospital will keep the photos for her in case she changes her mind.
While monitoring the EFM tracing the nurse notes decelerations with each contraction. The nurse knows that for a deceleration to be classified as early it has to meet three criteria. What is one of these criteria?
The nadir of the deceleration coincides with the acme of the contraction.
A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time?
Less than 3 hours
The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding?
Lie
Embryonic origin of the kidney
Intermediate mesoderm
A pregnant client has developed iron-deficiency anemia and has been prescribed 200 mg of elemental iron per day. The nurse should encourage the client to take this medication with which substance?
Orange juice
Which finding would the nurse expect in a neonate who is born with the assistance of a vacuum extractor?
Scalp edema
Which order by the health care provider would the nurse question if given in the active stage of labor?
Secobarbital for relaxation
Structure that can fuse with the plasma membrane to release its contents outside of the cell
Secretory vesicle
The nurse caring for a patient in an acute care setting utilizes a family-centered approach to the patient's care. Which of the following is a good example of this approach?
The nurse asks the parents which activities of daily living they would like to participate in.
A primigravidia client at 38 weeks' gestation calls the clinic and reports, "My baby is lower and it is more difficult to walk." Which response should the nurse prioritize?
"The baby has dropped into the pelvis; your body and baby are getting ready for labor in the next few weeks."
The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth?
"The baby is coming. I'll explain what's happening and guide you."
At her 12-week prenatal visit, the primagravida states, "I haven't felt my baby move yet. What is wrong?" What is the best response to the client?
"The fetus kicks regularly, although the pregnant woman usually cannot feel the movements until approximately 16 to 20 weeks."
A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. Which response from the nurse is the most accurate?
15% to 20%
A client comes to the prenatal clinic for her first visit. THe nursing history reveals that the client's last menstraul period was five months ago, and the client is sure she is pregnant becaue she has been feeling the baby move. Which of the following responses by the nurse is BEST?
Lie down so that I can listen for fetal heart tones with the Doppler
During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume?
40%
A hormone which causes milk ejection from the lactating breast
Oxytocin
Hormone directly responsible for powerful uterine contractions at parturition
Oxytocin
A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management
Administration of 500 mL of IV Ringer's lactate
The aortic arch which forms part of the arch of the aorta
Aortic arch 4
A client in week 38 of her pregnancy arrives at the emergency room reporting a sharp pain between her umbilicus and the iliac crest in her lower right abdomen that is increasing. She reports having experienced intense nausea and vomiting for the past 3 hours. Given these symptoms, the nurse suspects which of the following conditions?
Appendicitis
A pregnant woman has been admitted to the hospital due to severe preeclampsia. Which measure will be important for the nurse to include in the care plan?
Institute and maintain seizure precautions.
The structure that allows most blood in the pulmonary artery to bypass the lungs
Ductus arteriosus
The vessel linking the arch of the aorta and the pulmonary artery during development
Ductus arteriosus
A 3-year-old is admitted to the hospital for pneumonia. Which intervention would be most effective in reducing separation anxiety?
Encouraging rooming-in
A teenage patient active on the high school football team comes to the clinic with a cut on his leg that looks infected. The culture report returns information that leads to a diagnosis of MRSA. What should the nurse use as preventive measures in this case?
Handwashing Contact precautions Gloves
A patient is admitted with a diagnosis of ectopic pregnancy. For what should the nurse anticipate preparing the patient?
Immediate surgery
A pregnant client is admitted to a maternity clinic for birth. Which assessment finding indicates that the client's fetus is in the transverse lie position?
Long axis of fetus is perpendicular to that of client. If the long axis of the fetus is perpendicular to that of the mother, then the client's fetus is in the transverse lie position. If the long axis of the fetus is parallel to that of the mother, the client's fetus is in the longitudinal lie position. The long axis of the fetus being at 45° or 60° to that of the client does not indicate any specific position of the fetus. pg 428
Cause loss of sensation along the medial border of the upper limb
Lower trunk (C8, T1) of the brachial plexus
A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered?
Naloxone
Hormone produced by endocrine glands situated on the posterior aspect of the thyroid
Parathyroid hormone
Para
Past pregnancies that continued to the period of viability
A hormone that has a relaxant effect on uterine smooth muscle during pregnancy
Progesterone
The hormone mainly responsible for the secretory activity of the uterus is
Progesterone
The hormone which stimulates growth of mammary alveoli
Progesterone
The primary hormone secreted by the corpus luteum
Progesterone
A 15-year-old admitted for asthma exacerbation is nearing discharge and is requesting to take a shower. Which nursing intervention is most appropriate?
Provide privacy and needed supplies
A pregnant woman comes to the clinic and reports redness and swelling in her right calf as well as pain, even when resting. The nurse suspects a deep vein thrombosis (DVT). Which of the following does the nurse diagnose as the biggest danger for this patient?
Pulmonary embolism
A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?
Push with contractions and rest between them.
A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs?
Refrain from crossing legs when sitting for long periods.
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon. During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.
A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?
Rho(D) immune globulin administration to Rh-negative women
Distal convoluted tubule of kidney histology
Simple cuboidal epithelium
Gland, tissue or organ from which secretin is secreted
Small intestine
Oesophagus histology
Stratified squamous epithelium, non-keratinised
The nurse identifies from a client's prenatal record that she has a documented gynecoid pelvis. Upon the client entering the labor and delivery department, which nursing action is best?
Take no extra measures; prepare for a standard labor.
A woman complains to the nurse that during the client's menstrual period she gains weight and gets muscle cramps. The nurse should suggest which of the following measures to alleviate the client's symptoms?
Take over-the-counter analgesics, restrict caffeine, exercise moderately
A fetal heart tracing shows early fetal decelerations. the nurse is aware that this indicates which of the following?
The FHR slowing early in the contraction, which is a normal finding
THe nurse prepares a client for a cesarean section. The client asks how the anesthesia is going to affect her baby. Which answer by the nurse is best?
The amount of narcotic given is decreased in a client undergoing cesarean section. Th elower level of narcotic is given to prevent respiratory depression
A nurse is promoting vaccine administration. When instructing on the physiological changes, which statement best explains what occurs in the child when vaccines are administered?
The child develops an active immunity.
A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful?
The client delivers a full-term fetus at 39 weeks' gestation.
The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?
These methods are a technique to prevent the painful stimuli from entering the brain.
A hormone which directly stimulates basal metabolic rate
Triiodothyronine (T3)
A woman in active labor with a history of two previous C-sections is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "Something inside me is ripping/tearing." The RN notes her BP is 80/50, pulse rate is 130 and weak, skin is cool and clammy and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication?
Uterine rupture
Which changes in the female body occur to allow the passage of the fetus down the birth canal? Select all that apply.
Vaginal rugae stretch and smooth out The cervix dilates to 10 cm The cervix softens
A hormone which is directly stimulated by a rise in plasma osmotic pressure
Vasopressin
THe nurse prepares a client for a total abdominal hysterectomy with bilateral salpingo-oophorectomy due to uterine cancer. The nurse observes that the client is client is talking continously and has difficulty maintaining eye contact. Which of the following responses by the nurse is BEST?
What are your concerns about the surgery
There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain?
Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.
You are caring for a young woman who is in her 10th week of gestation. She comes into the clinic complaining of vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? a) Dark red, "clumpy" vaginal discharge b) Painful uterine contractions and nausea c) Bright red painless vaginal bleeding d) Brisk deep tendon reflexes and shoulder pain
a) Dark red, "clumpy" vaginal discharge Rationale: If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.
A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses?
a. Leiomyoma b. Pregnancy c. Ovarian cancer *******All of the above
The expected fetal heart rate response in an active fetus is:
acceleration of at least 15 bpm for 15 seconds. A reassuring active fetal heart rate is a change in baseline by increase of 15 bpm for 15 seconds. This is a positive and reassuring periodic change in fetal heart rates as a response to fetal movement.
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction?
acme The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction pg 453
A woman has been diagnosed as having pregnancy-induced hypertension. Which of the following is the most typical symptom of this? a) Increased perspiration b) Blood pressure elevation c) Weight loss d) Susceptibility to infection
b) Blood pressure elevation Rationale: The symptom of hypertension of pregnancy is blood pressure elevation (140/90 mm Hg).
The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as:
baseline FHR. The baseline FHR averages 110 to 160 beats per minute over a 10-minute period. Fetal bradycardia occurs when the FHR is less than 110 beats per minute for 10 minutes or longer. Short-term variability is the beat-to-beat change in FHR. Baseline variability refers to the normal physiologic variations in the time intervals that elapse between each fetal heartbeat observed along the baseline in the absence of contractions, decelerations, and accelerations.
When assessing a woman with an ectopic pregnancy, which of the following would lead the nurse to suspect that the tube has ruptured? a) Breast tenderness b) Vaginal spotting c) Referred shoulder pain d) Nausea
c) Referred shoulder pain Rationale: Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.
The nurse in the prenatal clinic assesses a client at 31 weeks gestation. The client's BP is 150/96, edema of the face and hands is noted, 3+ protein in the urine, and serum albumin level is 3 gm/dL. Which of the following instructions by the nurse is MOST important?
c) the client should ensure adequate protein
A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to?
c. Chlamydia
Which compound would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?
calcium gluconate
A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer?
d. Her grandmother's history of colon cancer
A nurse is caring for a client who is in labor. For which fetal response should the nurse monitor?
decrease in circulation and perfusion to the fetus 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.
A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth?
decreased alertness Morphine is a commonly used opioid for the management of pain during labor. It is associated with newborn respiratory depression, decreased alertness, inhibited sucking, and a delay in effective feeding. pg 473
When an infant is born by cesarean delivery there is always a risk of complications. What is one of the most common complications to the fetus because of a cesarean delivery?
respiratory distress
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?
diminished reflexes Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.
A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea?
endometriosis
A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?
ensures passage of all the products of conception
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?
every 15 minutes 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. pg 491
A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?
headache following anesthesia 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 nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:
hydatidiform mole.
If a fetus is in an ROA position during labor, the nurse would interpret this to mean the fetus is:
in a longitudinal lie facing the left posterior. ROA (right occiput anterior) means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part.
The nurse is teaching a prenatal class the signs and symptoms of true labor. What is the appropriate response by the class that shows an understanding of true labor contractions?
increase even if I relax and take a shower True labor contractions do not stop; they continue and strengthen, as well as increase in frequency. If the contractions subside while taking a shower or relaxing, then they are not labor contractions. The discomfort over the top of the uterus is normal for full term pregnancy.
A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will:
instruct the client or her partner to perform light fingertip repetitive abdominal massage. The relaxation technique of visualization is used in hypnobirthing or focused meditation. Controlled chest breathing is a technique used in Lamaze breathing. Pressing on trigger points is an acupressure technique. pg 465
Concerning the adenohypophysis
it is controlled by specific releasing factors from the hypothalamus via hypothalamo-hypophysial portal vessels
Concerning the neurohypophysis
it secretes oxytocin, a hormone which causes milk ejection from the lactating breast
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
left lower quadrant. The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant. pg 455
Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with PPROM has completed how many weeks of gestation?
less than 37 weeks Preterm premature rupture of membranes (PPROM) is defined as the rupture of the membranes prior to the onset of labor in a woman who is less than 37 weeks' gestation. PROM (premature rupture of membranes) refers to a woman who is beyond 37 weeks' gestation, has presented with spontaneous rupture of the membranes, and is not in labor.
The physican orders a coloscopy. The nurse explains to the client that the purpose of the colonoscopy is to
magnify the tissue for examination
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition?
mild preeclampsia A woman is said to have gestational hypertension when she develops an elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema. If a seizure from gestational hypertension occurs, a woman has eclampsia, but any status above gestational hypertension and below a point of seizures is preeclampsia. A woman is said to be mildly preeclamptic when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart. A woman has passed from mild to severe preeclampsia when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present. A woman has passed into eclampsia when cerebral edema is so acute a grand-mal seizure (tonic-clonic) or coma has occurred.
A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?
nothing by mouth
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?
pregnancy loss The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for pregnancy loss. Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy
A client with preeclampsia is receiving magnesium sulfate. Which nursing assessment should be ongoing while the medication is being administered?
respiratory rate The level of magnesium in therapeutic range is 4 to 8 mg/dL. If magnesium toxicity occurs, one sign in the client will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The client's hemoglobin and ability to sleep are not factors for ongoing assessments for the client on magnesium sulfate. Urinary output is measured hourly on the preeclamptic client receiving magnesium sulfate, but urine protein is not an ongoing assessment.
A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will move the same amount every day. The nurse also adds that the client may notice an unusual increase or decrease in movement, explaining that this is due to which situation?
response to a need for oxygen A fetus normally moves more or less the same amount every day. If there is an unusual increase or decrease in movement, the client should be examined because such a change suggests that the fetus is responding to a need for oxygen.
During active labor, the nurse observes the patient crying during contractions and not using breathing techniques learned during prenatal classes. Which nursing diagnosis would be appropriate for the patient at this time?
risk for ineffective breathing pattern related to breathing exercises
When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?
slight vaginal bleeding Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os are associated with a threatened abortion. Strong abdominal cramping is associated with an inevitable abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.
Treatment for mild PIH
- Labetalol - nifedipine - weekly OB visits - Kick counts - NST
The nursing student demonstrates an understanding of dystocia with which statement?
"Dystocia is diagnosed after labor has progressed for a time."
Vitamin B12 deficiency is most likely to be found in which patient?
A vegan
Neutrophil granulocytes
Adhere to endothelium at sites of inflammation
Nutritional requirements generally go up during pregnancy. Which nutritional requirement proportionally increases the most during pregnancy?
Iron
A nursing instructor is teaching students about anemia during pregnancy. Which type of anemia does the instructor teach students is most prevalent during pregnancy?
Iron-deficiency anemia
Innervation of knee flexors
Is derived from the sciatic nerve
A group of nursing students are on the L & D unit where there is a woman having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. The preceptor asks the students, "What is the highest priority fetal assessment we [the nursing staff] should focus on at this time?
Look for late decelerations on monitor which is associated with fetal anoxia.
The site of degradation for most endocytosed plasma membrane proteins
Lysosomes
The hormone that causes milk ejection in lactation
Oxytocin
Paralyse the diaphragm
Phrenic nerve
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy?
Potential for greater than usual back pain
When caring for a client requiring a forceps-assisted birth, the nurse would be alert for:
Potential lacerations and bleeding
A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?
Uterine stimulants
There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain?
Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience. Research has shown that women report higher levels of satisfaction with their labor experience when they feel a high degree of control over the experience of pain (Stuebe & Barbieri, 2005). pg 464
A 24-year-old woman presents at the emergency room with abdominal pain, vaginal bleeding, and fatigue. What should the nurse's first action be? a) Monitor the patient for signs of shock. b) Ascertain from the patient if she has been sexually active to rule out pregnancy. c) Prepare for IV blood transfusion. d) Assume a pregnancy and prepare to determine the viability of the fetus.
a) Monitor the patient for signs of shock. Rationale: Anytime a patient presents with hemorrhage, the initial nursing consideration is assessment and evaluation of shock. This is also the case in the pregnant patient. If the mother is in shock the fetus will have lack of oxygen. Monitor the maternal status first. Ascertaining sexual activity to rule out pregnancy or assuming a pregnancy and preparing to determine the viability of the fetus is not the initial nursing consideration for this patient. The scenario does not indicate the need for a blood transfusion.
After a newborn circumcision, the nurse should take which of the following actions?
c) apply petroleum gauze and observe carefully for bleeding
Discomforts of pregnancy frequent urination management
limit fluid intake before bed kegel exercise
The major site of metabolism of thyroxine (T4) to active triiodothyronine (T3)
liver
Nursing Management of Individual After Mastectomy
• Risk for Injury: Bleeding • Risk for Injury: Infection • Acute Pain • Risk for Ineffective Breathing Pattern • Risk for Disturbed Body Image • Risk for Ineffective Coping • Fatigue
A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition?
Corticosteriods
The nurse is caring for a laboring client who has been administered a regional block for pain management. What is the nurse's priority action?
Ensure that emergency equipment is readily available
Embryonic germ layer from which the notochord is derived
Epiblast
Layer within bilaminar germ disc that gives rise to the embryo proper
Epiblast
The femoral nerve supplies
Extensors of the knee
In the anterior pituitary
Growth hormone secretion is inhibited by somatostatin
The embryonic origin of enteric neurons
Neural crest
The embryonic origin of peripheral sensory neurons
Neural crest
A woman who is 31 weeks pregnant presents at the emergency room with bright red vaginal bleeding. She says the onset of the bleeding was sudden and she has no pain. The nurse is most likely to assist the physician or technician with which exam? a) A blood transfusion b) An abdominal ultrasound c) A transvaginal ultrasound d) A digital cervical exam
c) A transvaginal ultrasound Rationale: The use of a transvaginal ultrasound is the diagnostic test of choice; it is 100% accurate in prediction of placenta previa, while abdominal ultrasound is only 95% accurate. A digital cervical exam is contraindicated in this patient and the scenario described does not indicate the need for a blood transfusion.
The embryonic layer from which the urinary system is derived
Mesoderm
The embryonic duct that gives rise to the vas deferens
Mesonephric (Wolffian duct)
The nurse is monitoring a primipara who has been receiving oxytocin and is now in hypertonic labor. If the nurse notes the fetal heart rate has suddenly dropped, which action should the nurse prioritize?
Decrease the oxytocin drip rate
The embryonic duct that gives rise to the vas deferens
Mesonephric (Wolffian) duct
Which of the following contributes only to placental tissue?
Cytotrophoblast
The nurse is analyzing the readout on the EFM and determines the FHR pattern is reassuring based on which recording?
Acceleration of at least 15 bpm for 15 seconds
The transmitter used by peripheral somatic motor neurons
Acetylcholine
Cells of the exocrine pancreas secreting pancreatic enzymes
Acinar cells
A cytoskeletal microfilament protein
Actin
A hormone secreted by Sertoli cells that blocks development of parts of the female reproductive system
Anti-Mullerian hormone (AMH)
Blood cells that give rise by migration to macrophages
Monocytes
Paralyse the diaphragm if damaged
Phrenic nerve
The client in labor at 3 cm dilation and 25% effaced is asking the nurse for analgesia. Which explanation should the nurse provide when explaining why it is too early to administer an analgesic?
This may prolong labor and increase complications
Milestones: Month 9
• full-term 38-40 wks • gains 0.5 lb/week • 19-21"
Which cardinal movement of delivery is the nurse correct to document by station?
Descent
A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority?
Confine the client to bed rest in a darkened room.
A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor?
Upright
Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be the:
Incubation period
Cause wasting of muscles of the thenar eminence of the hand
Median nerve
The nerve which innervates the superficial small muscles of the thenar eminence in the hand
Median nerve
The nerve whose function may be compromised in carpal tunnel syndrome
Median nerve
The cell type synthesising skin pigment
Melanocytes
The germ layer or germ layer derivative that gives rise to enteric neurons
Neural crest
The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?
Urine output of 10 ml over 3 hours
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome?
Congenital anomalies
A child is diagnosed with an enterovirus infection. Which type of infection control precaution would be most important for the nurse to use?
Contact
The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding?
Erratic
A hormone that increases gap junction proteins in uterine smooth muscle cells to ensure contractions are in synchrony in childbirth
Estradiol
A client in her second trimester of pregnancy complains to the nurse of heartburn. Which of the following should the nurse suggest to the client as a preventative measure?
Have small frequent meals
Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated?
Have the client pant and blow through the contraction
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation?
Premature separation of the placenta
A child is diagnosed with group A streptococcal pharyngitis. The nurse would teach the parents to be alert for signs and symptoms of:
Scarlet fever.
The nerve responsible for knee flexion and ankle plantar flexion
Sciatic nerve
Part of somite from which the bulk of each vertebra is derived
Sclerotome
After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical?
Amniotomy
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?
"Come to the health facility with any vaginal material passed."
A nursing student is learning tips when caring for children. The instructor informs students that they should not call children "honey." What explanation for avoiding this term is the best reason the nurse would give?
"Honey" can cause children to worry that they have been confused with another child.
A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?
"I should substitute intercourse with nonsexual touch to avoid harming the fetus."
A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse?
"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet."
S/S Gestational HTN
- BP >140/90 - no proteinuria after 20 weeks of gestation
A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
a. Pregnancy test
A patient of normal weight and new to the obstetric clinic asks the nurse how much weight to gain during pregnancy. What is the best response the nurse can give?
10 lbs over the first 20 weeks; 1 lb per week after that
What is the normally accepted fetal heart rate range?
110-160 bpm The standard acceptable fetal heart rate baseline is the range of 110-160 beats per minute. Sustained heart rates above or below the norm are cause for concern.
Recommended weight gain during pregnancy - BMI 25-29.9 =
15-25 lbs
Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely?
164 beats per minute A fetal heart rate of 164 beats per minute (bpm) indicates fetal tachycardia. The normal range of FHR is between 120 and 160 bpm. When the FHR is above 160 bpm, it should be considered as fetal tachycardia. Therefore, a FHR of 164 beats per minute is considered tachycardia.
A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about:
18 to 20 weeks pregnant. There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.
OGTT (oral glucose tolerance test) is positive when (3 hr test)
2 elevated levels of 140 or more
A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse anticipates that medication would be safe and appropriate to use with this client? Select all that apply.
Amoxicillin Ampicillin Cephalosporins
The first time the nurse sees a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?
20 weeks
The nurse is caring for a pregnant woman is determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame?
24 to 28 weeks
A woman is admitted to the L & D unit for prostaglandin insertion along with IV oxytocin induction to begin 12 hours afterward. The nurse, preparing to insert the prostaglandin, questions this order for which of the women on the unit who have a history of which disease? Select all that apply.
24 year old female with a history of asthma, diagnosed at age 9. 30 year old female who developed diabetes at age 5 and currently is in pre-renal failure.
a 1 hr 50g oral glucose challenge test remains the most common lab for GDM, for low risk is done when
24-28 weeks 1 hr 50 g oral glucose challenge test
A pregnant client of normal weight is concerned about excessive weight gain during her pregnancy. She states, "I don't want to get fat!" The nurse should inform her that she can expect to gain how much weight during her pregnancy?
25 to 30 pounds
You are discussing weight gain with a group of pregnant women at the clinic. One woman is very thin and her prepregnancy weight falls below the normal weight range for her height. What is her recommended weight gain during her pregnancy?
28 to 40 pounds
Third trimester
28 wks - term
underweight recommendations for wt. gain (less than 18.5 bim)
28-40
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test?
6%
A nurse is providing care to several pregnant women at different weeks of gestation. The nurse would expect to screen for group B streptococcus infection in the client who is at:
36 weeks' gestation.
Mrs. Carter is admitted to the labor and birth unit. The lab results of her cervical culture for group B streptococcal were positive. What priority intervention will be initiated?
Ampicillin or cefazolin intravenous is given before delivery.
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:
4 weeks.
A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanelle. The client is anxious to know when the posterior fontanelle will close. Which time span is the normal duration for the closure of the posterior fontanelle?
8 to 12 weeks The posterior fontanelle is a triangular-shaped area at the back of the skull. The nurse should inform the client that the posterior fontanelle normally closes by 8 to 12 weeks after birth, and if there is delay the primary health care provider should be notified.
The nurse cares for clients in the prenatal clinic. The nurse identifies which of the following pregnant women as MOST likely to have a problem with Rh incompatibility with her fetus?
An Rh-negative woman who conceived with a Rh-positive man and who has Rh antibodies
The nurse is assessing the external fetal monitor and notes the following: FHR of 175 bpm, decrease in variability, and late decelerations. Which action should the nurse prioritize at this time?
Have the woman change her position.
The clinic nurse teaches a pregestational type 1 diabetic client that constant insulin levels are very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use:
An insulin pump.
A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure?
Amniocentesis
A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management?
Administration of 500 mL of IV Ringer's lactate
A hormone whose main function is to control body fluid by regulating sodium reabsorption in the kidney
Aldosterone
The principal hormone secreted by the zona glomerulosa is
Aldosterone
The phase of mitosis in which chromatids move to opposite poles of the cell
Anaphase
A client has just received combined spinal epidural. Which nursing assessment should be performed first?
Assess vital signs. The most common side effect of spinal and epidural anesthesia is hypotension, which can lead to fetal bradycardia, decelerations, or fetal distress. Although each is important, this nursing assessment should be performed first.
Spiral artery vasoconstriction occurs
At the end of the secretory phase of the uterine cycle
A term which describes skeletal muscle tissue after a long period of denervation
Atrophic
A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?
Headache following anesthesia
A nurse studying high-risk pregnancies correctly identifies which of the following as causes for such a label? (Select all that apply.)
Concurrent disorder Pregnancy-related complication External factor that jeopardizes both the health of the woman and fetus External factor that jeopardizes the health of the woman or the fetus
Why is the first prenatal visit usually the longest prenatal visit?
Baseline data is collected.
Cells in pancreas that produce insulin
Beta cells
common complaints during first trimester
Breast pain, enlargement, & changes in pigmentation, constipation, increased salivation, hemorrhoids
A molecule that is NOT a component of the sarcomere
Collagen
A hormone precursor that is stored extracellularly
Colloid
A spinal nerve root which innervates the diaphragm
C4
The spinal nerve root supplying the lateral (radial) part of the forearm and thumb
C6
The nurse is admitting a woman at 32 weeks' gestation in preterm labor. The nurse should question the order for magnesium sulfate after noting which assessment finding?
Cervical dilation of 5 cm
A woman with a positive history of genital herpes is in active labor. Assessment reveals vesicles in the perineum area, membranes are ruptured, dilated 5 cm, and effaced 70%. The nurse should prepare the client for which type of birth?
Cesarean
Trachea histology
Ciliated pseudostratified columnar epithelium
The renal glomerulus
Contains a fenestrated endothelial barrier for ultrafiltration
The nurse is admitting a client who is in labor who reports her husband and doula will be arriving shortly. Which action should the nurse prioritize in response?
Continue with the admission assessment
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound?
Continuing to monitor maternal and fetal status
The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client?
Continuous labor support
The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication?
Continuous support through the labor process helps decrease the need for pain medication. Continuous labor support involves offering a sustained presence to the laboring woman. A support person can assist and provide aid with acupressure, massage, music therapy, or therapeutic touch. Research has validated the value of continuous labor support versus intermittent support in terms of lower operative deliveries, cesarean births, and request for pain medication. pg 465
A nurse counsels a couple who have had difficulty conceiving a child. The nurse explains infertility is defined as which of the following?
Inability to conceive after at least one year of unprotected intercourse.
The trigone of the bladder is derived from
Incorporation of the distal ends of the mesonephric ducts
Cause wasting of the small muscles of the hand if damaged
Ulnar nerve
The nurse is teaching a prenatal class on the difference between true and false labor contractions. The nurse determines the session is successful when the class correctly chooses which factor as an indication of true labor contraction?
Increase even if relaxing and taking a shower
A structure located in the posterior mediastinum
Descending thoracic aorta
The nurse has just administered morphine 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse prioritize?
Decreased variability
Intercellular junctions that are primarily responsible for linking cells of the epidermal stratum spinosum (spiny cell layer) to each other
Desmosomes
A vessel allowing blood to bypass the lungs in the fetus
Ductus arteriosus
The nursing instructor is preparing a group of nursing students for their clinical phase and is questioning them on the various assessment skills they will need. The instructor determines the session is successful when the students correctly choose which time interval to assess the fetal heart rate of clients who are in the active phase of labor?
Every 15 to 30 minutes
The primary junctions that attach the epidermis to the underlying basement membrane
Hemidesmosomes
The type of tissue growth by which skeletal muscle normally increases in size
Hypertrophic
Growth of tissue in the absence of proliferation
Hypertrophy
Tissue growth by increase in cell size
Hypertrophy
Layer of bilaminar germ disc that will not give rise to definitive embryonic structures
Hypoblast
The partial failure of ovaries to develop in Turner's syndrome
Hypoplasia
The immune system works to destroy pathogens by helping the body get rid of or resist the invasion of foreign materials The blood cells that surround, ingest and neutralize the pathogens are which of the following?
Macrophages
Embryonic origin of peripheral sensory neurons
Neural crest
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?
Palpate the fundus, and check fetal heart rate. The classic signs of abruptio placentae are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.
Structure within epiblast where key invagination movements of gastrulation take place
Primitive streak
A 32-year-old woman presents to the labor and birth 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?
ROA
Peripheral nerve supplying the extensor muscles of the upper limb
Radial nerve
The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?
Ring-like rash on lower leg
The subcellular location where growth hormone mRNA is translated
Rough ER
A hormone that causes the mesonephric duct to grow and develop
Testosterone
The nurse is assisting a client in labor and delivery and notes the placenta is now delivered. Which documentation should the nurse prioritize?
The completion of the third stage of labor
When describing the role of a doula to a group of pregnant women, the nurse would include which information?
The doula primarily focuses on providing continuous labor support
In the arterial supply of the lower limb
The main arterial supply to the head of the femur passes along its neck
A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?
The viral load
The extracellular storage molecule for thyroid hormone precursor in thyroid follicles
Thyroglobulin
What is the drug methylergonovine maleate used for?
Uterine contraction
A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect?
Uterine rupture
The layer surrounding the oocyte immediately after ovulation
Zona pellucida
A client states that "she thinks" her water has broken. Which best provides confirmation of the rupture of membranes?
a positive Nitrazine test
A client is admitted to the labor and birthing suite in early labor. On review of her prenatal history, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have noted?
gynecoid
A woman with an incomplete abortion is to receive misoprostol. The nurse understands that the rationale for administering this drug is to: a) Ensure passage of all the products of conception b) Suppress the immune response to prevent isoimmunization c) Halt the progression of the abortion d) Alleviate strong uterine cramping
a) Ensure passage of all the products of conception Rationale: Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.
A 45-year-old woman is seen because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response?
a. "You are approaching menopause."
_40-year-old woman is seen for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes "occasionally" and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best for this patient?
condom
A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia?
a. Menopause
Platelets derivation
are derived from megakaryocytes
A novice nurse asks to be assigned to the least complex antepartum patient. Which of the following conditions would necessitate the least complex care requirements? a) Pre-ecalmpsia. b) Gestational hypertension. c) Placenta previa. d) Abruptio placenta.
b) Gestational hypertension. Rationale: Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of pre-eclampsia, or pre-existing hypertension. Abruptio placenta (separation of the placenta from the uterine wall), placenta previa (placenta covering the cervical os), and pre-eclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which of the following assessments would be most important prior to administering a new dose? a) Anxiety level b) Patellar reflex c) Blood pressure d) Pulse rate
b) Patellar reflex Rationale: A symptom of magnesium sulfate toxicity is loss of deep tendon reflexes. Assessing for one of these before administration is assurance the drug administration will be safe.
A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?
b. Bacterial vaginosis
Common complaints in 2nd trimester
backache, dyspnea, epistaxis, leukorrhea ^ discharge, ligament pain, muscle cramps, pica, syncope
During a prenatal visit a pregnant client asks the nurse how to tell whether the contractions she is having are true contractions or Braxton Hicks contractions. Which description should the nurse mention as characteristic of true contractions?
begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity True contractions begin irregularly but become regular and predictable; are felt first in the lower back and sweep around to the abdomen in a wave; continue no matter what the woman's level of activity; increase in duration, frequency, and intensity; and achieve cervical dilatation. False (Braxton Hicks) contractions begin and remain irregular; are felt first abdominally and remain confined to the abdomen and groin; often disappear with ambulation or sleep; do not increase in duration, frequency, or intensity; and do not achieve cervical dilatation.
What anatomic area should be examined when assessing Montgomery tubercles?
breasts
Urogenital Displacement (cystocele) Cystocele (prolapsed bladder):
weakening of anterior vaginal wall, with bladder "bulging" or prolapsing into the vagina; can be seen/felt on exam. Risk factors: childbirth, aging, loss of estrogen, hysterectomy
A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present?
cervical dilation of at least 2 cm
A pregnant client at 20 weeks' gestation arrives at the health care facility reporting excessive vaginal bleeding and no fetal movements. Which assessment finding would the nurse anticipate in this situation?
cervical incompetence
When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories?
change in estrogen-to-progesterone ratio One of the theories suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. The number of oxytocin receptors have been noted to increase. Estrogen levels also increase, which in turn increases myometrial sensitivity to oxytocin. Prostaglandin levels also increase, which in turn leads to myometrial contractions.
Which action is a priority when caring for a woman during the fourth stage of labor?
checking the fundus
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?
clean catch urine
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?
diminished reflexes
an RH-negative women with negative rubella titiers should be vaccinated at what time period in pregnancy?
during the postpartum period
A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition?
diabetes Approximately 18% of all women with diabetes will develop hydramnios during their pregnancy. Hydramnios occurs in approximately 3% of all pregnancies and is associated with fetal anomalies of development.
A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor in the client?
dilation of cervix diameter to 10 cm 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 term is the nurse referring to in the explanation?
effacement 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. page 422
A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?
ensures passage of all the products of conception Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.
Most breast cancer cases are in women with a family history of breast cancer.
false
A hormone secreted by anterior pituitary somatotroph cells
growth hormone
A pregnant client has come to the labor and birth suite in labor. The nurse reviews the client's medical record and determines that a vaginal birth is favorable based on which finding related to the client's pelvic shape?
gynecoid Vaginal birth is most favorable with a gynecoid pelvis because the inlet is round and the outlet is roomy. This shape offers the optimal diameters in all three planes of the pelvis. This type of pelvis allows early and complete fetal internal rotation during labor. Although vaginal birth is favorable with an anthropoid pelvis, it is less favorable than a gynecoid pelvis. However, vaginal birth is more favorable with an anthropoid pelvic shape compared with the android or platypelloid shape. page 425
At which time during a woman's labor might the nurse assist with a pudendal block?
just before birth Pudendal block is a local block in the perineal area and is used to numb for birth. Application before labor begins or while it is in the early stages would be counterproductive, as the client would not have proper feeling and would have a harder time pushing. After birth it is pointless; the most painful part is over
Eosinophil leukocytes
kill metazoal parasites
The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding?
lie The nurse is assessing fetal lie, the relationship of the fetal long axis to the maternal long axis. When the fetal long axis is longitudinal to the maternal long axis, the lie is said to longitudinal. Presentation is the portion of the fetus that overlies the maternal pelvic inlet. Attitude is the relationship of the different fetal parts to one another. Position is the relationship of the fetal denominator to the different sides of the maternal pelvis.
The major site of conversion of thyroxine (T4) to triiodothyronine (T3)
liver
A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared?
need for someone to control the situation Prenatal education teaches the woman about the birth experience and increases her sense of control. An increasing body of evidence indicates that the well-prepared woman, with good labor support, is less likely to need analgesia or anesthesia and is unlikely to require cesarean birth.
A patient who had a previous cesarean birth asks the nurse if all future births must occur the same way. Which response should the nurse make to support the 2020 National Health Goals regarding cesarean births?
not if you qualify for a vaginal birth
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting?
occiput With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. The shoulders are the presenting part when the fetus is in a shoulder presentation. The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation. pg 427
A 26-year-old woman tells the clinician that she has endometriosis, because she has frequent pelvic pain. The clinician also should consider which of these differential diagnoses?
ovarian cysts
A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?
patellar reflex
A client for has an Rh-negative blood type. Following the birth of the client's infant, the nurse administers her Rho(D)immune globulin. The purpose of this is to:
prevent maternal D antibody formation. Because Rho(D) immune globulin contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies.
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 finding?
radiating to the front of the abdomen from the back 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.
Which information on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?
recurrent pelvic infections
To prevent tearing of the perineum of a client during birth, a physician performs a mediolateral episiotomy. The nurse recognizes that an advantage of a mediolateral episiotomy over a midline episiotomy is which of the following?
reduce the risk of rectal mucosal tear
Danger s/s in second trimester
regular uterine contractions (6+/hr), unilateral leg/calf pain, sudden gush or consistent leaking of fluid, absence of fetal mvmt for 24+ hrs after quickening, sudden weight gain, facial edema, HA, visual changes, photophobia
When teaching a group of nursing students about the different types of pelvis, the nurse describes which features of a gynecoid pelvis? Select all that apply.
round-shaped inlet dull ischial spines wide pubic arch The features of a gynecoid pelvis are oval-shaped inlet, dull ischial spines, and wide pubic arch. The birth of a baby is easiest in a gynecoid pelvis. Straight sacrum and convergent side walls are seen in an android pelvis
As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus?
rubella Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.
Which finding would the nurse expect in a neonate who is born with the assistance of a vacuum extractor?
scalp edema
A pregnant patient in labor is being encouraged to push with contractions. In which position should the nurse assist to help the patient at this time?
semi fowlers with legs bent against the abdomen
A woman in labor is at risk for abruptio placentae. Which assessment would most likely lead the nurse to suspect that this has happened?
sharp fundal pain and discomfort between contractions
Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation?
shoulder The three main fetal presentations are cephalic or vertex, with the head as the presenting part, breech, with the pelvis as the presenting part, and shoulder, with the scapula as the presenting part. pg 428
Discomforts of pregnancy hemorrhoidsmanagement
sims position several times a day avoid constipation hot sitz bath 15-20 min. avoid bearing down topical anestetics, stool softner, warm soaks
When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?
slight vaginal bleeding
During the first prenatal visit an extensive history is collected from the client. What is one part of this extensive history?
social history
Hegar's sign
softening of the lower uterine segment (cervicouterine junction) or isthmus
An adolescent who is pregnant asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe?
swimming
A woman presents in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission for this woman?
taking her blood pressure and determining whether clonus or edema is present In advanced labor the most important assessments must be completed first. The assessment for signs or symptoms of preeclampsia must be assessed first. The history can be obtained after the birth of the baby or if labor slows down. Plans for the newborn can be figured out later. Blood tests can be run as soon as a sample can be taken from the mother.
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?
the analgesia will limit your pain for a limited period of time
On examination, the nurse determines the client is at 50% effacement. This means:
the cervical canal is 1 cm long. Effacement refers to the length of the cervical canal. At 0%, the cervical canal is 2 cm long; at 50%, 1 cm long; and at 100%, the cervical canal is obliterated.
A nursing student is studying labor and delivery and has learned that the first stage of labor consists of which of the following phases? Select all that apply.
transition active latent
A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor?
transition phase The woman is likely in transitional labor (first stage, transition phase) as evidenced by her increasing anxiety and distress, intense frequent contractions, and cervical dilation of 9 cm. The amount of bloody show indicates remarkable cervical changes. Cervical dilation in the transition phase is 8 to 10 cm. The latent and early phase is the same phase of labor in the first stage and characterized by positive coping, mild contractions, and cervical dilation of 1 to 4 cm. The active phase is characterized by increased anxiety but cervical dilation of 4 to 7 cm.
A hormone which directly stimulates basal metabolic rate
triiodothyronine (T3)
Abnormal Uterine Bleeding (AUB)
• Menorrhagia: excessive or prolonged uterine bleeding at regular intervals (fibroids, uterine polyps, perimenopause). • Metrorrhagia: Uterine bleeding at irregular intervals. (breakthrough bleeding with hormonal contraception, IUD, cervical polyps, infection (uterine, vaginal, cervical), genital tract cancers, physiologic intramenstrual mid-cycle bleeding (30% of women). • Annovulatory bleeding: menarche, menopause, PCOS, thyroid disorders, stress, weight loss. • ALWAYS RULE OUT PREGNANCY
Milestones: 30-40 weeks
• ^ subcutaneous fat & weight
The pituitary hormone that promotes long bone growth before puberty
Growth hormone
The nurse is caring for a patient in an acute care setting. Which of the following is true regarding activities of daily living (ADLs) for this patient?
Greater cooperation can be achieved if ADLs mimic home routines.
The nurse care for a woman in labor. Which method should the nurse use to measure the frequency of uterine contraction?
Timing the contraction from the beginnning of one contraction to the beginning of the next contraction.
Which of the following infections is often contracted by having contact with an infected dog or cat?
Tinea corporis
Nullipara
Woman who has not had any children
Structure derived from dilation of the lower allantois
Bladder
A nurse notes the digital readings of the electronic fetal monitor shows decreased beat-to-beat variability in a client who was just admitted to the unit. The nurse interprets this as indicating which system is mainly being affected in the fetus?
Central nervous system
Location of the cell bodies of somatic motor neurons
Ventral horn of spinal cord
The location of the cell bodies of peripheral somatic motor neurons
Ventral horn of spinal cord
Which nursing intervention offered in labor would probably be the most effective in applying the gate control theory for relief of labor pain?
Massage the woman's back.
The identification band on a infant was removed for performance of a procedure. What is the priority nursing intervention?
Apply a new band after verifying identity using two identifiers
A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement?
"A pregnant woman does not have to worry about contracting new illnesses during pregnancy."
You have just admitted a 32-year-old female in active labor to the delivery suite. During the admission assessment she says, "I am so afraid that my asthma will get out of control during labor and my baby will be harmed." Which response by the nurse would be most appropriate?
"Actually, asthma symptoms tend to diminish during labor."
A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states:
"I may end up with a severe headache from the spinal anesthesia."
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?
"I'll switch to chewing gum instead of using mints."
The nurse is caring for a primipara with PROM who appears extremely anxious and reveals that she is scared her birthing process will be extremely painful because it will be "dry". Which is the best response from the nurse?
"No birth is ever really dry, because amniotic fluid continues to be manufactured."
A woman is documented on the labor and birth board to be 7 cm dilated. Her family wants to know how long she will be in labor. The nurse should provide which information to the family?
"She is in active labor; she is progressing at this point and we will keep you posted." At 7 cm dilated, she is considered in the active phase of labor. There is no science that can predict the length of labor. She is progressing in labor, and it is best not to give the family a specific time frame.
A woman refuses to have an epidural block because she does not want to have a spinal headache after birth. What would be the nurse's best response?
"Spinal headache is not a usual complication of epidural blocks." Because epidural anesthesia does not enter the cerebral spinal fluid space, it is unlikely to cause a "spinal headache."
When collecting data to devise a labor plan for a multiparous woman, which question best allows the nurse to develop individualized strategies?
"Tell me how you handled labor pain in your past deliveries."
A client suffering a miscarriage at 12 weeks' gestations is very upset that the health care provider has ordered a D&C. How should the nurse respond after the client states she didn't have a D&C the time she lost a previous baby at 5 weeks' gestation?
"This procedure is needed to adequately remove all the fetal tissue."
A 33-year-old P2002 is 6 weeks pregnant. She always felt nauseous in the early part of her previous pregnancies, and she is concerned about her dietary intake at the beginning of this pregnancy because she has just begun to feel nauseous. How can the nurse best counsel this patient?
"Try eating fruit in the morning and having small, frequent meals throughout the day as opposed to three large meals."
A pregnant client states, "I am only 6 weeks pregnant, but the morning sickness is awful. When is it going to stop?" What is the best response by the nurse?
"Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends."
A client is 11 weeks pregnant after many years trying to conceive. After arriving home from a normal prenatal visit, she experiences mild cramping and has a gush of bright red vaginal bleeding. She calls the nurse and reports having soaked a pad with fresh blood in fewer than 30 minutes. The uterine cramping is worsening. What is the most appropriate response from the nurse?
"You need to seek immediate attention from the primary care provider."
A pregnant woman who has been taking penicillin prophylactically because she had rheumatic fever as a child tells the nurse that she wants to stop taking it now that she is pregnant. Which of the following is the best response by the nurse?
"You should continue taking this drug, because penicillin is not known to be a fetal teratogen."
A nurse has been assigned to assess a pregnant client for abruptio placenta. For which classic manifestation of this condition should the nurse assess?
"knife-like" abdominal pain with vaginal bleeding
At each Ob appt what are the appropriate findings?
- quickening; fetal movement - fundal height after 17 weeks - FHT after 12 weeks
A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station?
-2 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. pg 431
A woman entering her third trimester of pregnancy asks the nurse how much weight she should gain during this trimester. What is the nurse's best answer?
1 lb/week
The recommended weight gain during the first trimester for a woman who was in the normal weight range prepregnancy is 2 to 4 pounds. After the first trimester, what is the recommended weekly weight gain for a woman who was considered normal weight prepregnancy?
1 pound
Mucus-secreting cells within the bronchi
Goblet cell
142. Components of Quad Screen
1. Alpha-fetoproten (AFP) - protein produced by fetal liver 2. Unconjugated Estriol (UE) - Protein produced by placenta & fetal liver 3. Human chorionic gonadotrophin - hormone produced by placenta 4. Inhibin-A - h. produced by placenta
The nurse is preparing discharge instructions for a pregnant patient experiencing preterm rupture of membranes. What should the nurse include in this teaching? Select all that apply.
1. Avoid douching. 2. Measure oral temperature twice a day.
The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply.
1. maintaining NPO status for the first day or two 2. administering antiemetic agents 3. obtaining baseline blood electrolyte levels 4. monitoring intake and output
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:
7.15 or less. In the hypoxic fetus, the pH will fall below 7.2, which is indicative of fetal distress. pg 464
A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR?
10:30 am
Recommended weight gain during pregnancy - BMI >30 =
11-20 lbs
The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range?
110 to 160 bpm
recommended weight gain in those with elevated BMI (overweight- 25-29.9)
15-25 lb
EDD - Estimated date of delivery by Ultrasound 1st trimester vs. 2nd trimester
1st trimester - accurate with poss. 7 day error 2nd - poss. 10-14 day error
Discomforts of pregnancy headache management
1st trimester is normal 2nd tri-less headache 3rd tri- frontal and visual disturbances may be PIH
The client arrives in the office and reports that her feet and legs swelling. During a client evaluation, the nurse notes that she can elicit a 4-mm skin depression that disappears in 10 to 15 seconds. The nurse correctly documents this finding as:
2+ pitting edema. Pitting edema is recorded using the following relative scale: 1+ is a 2-mm depression that disappears rapidly; 2+ is a 4-mm depression that disappears in 10 to 15 seconds; 3+ is a 6-mm depression that lasts more than one minute; and 4+ is an 8-mm depression that lasts 2 to 3 minutes.
A nurse explains to a pregnant woman the importance of consuming adequate iodine in her diet. Which of the following conditions can a deficiency in iodine lead to?
Goiter
Assessment of pregnant woman reveals that the woman has a BMI of 31. The woman is pregnant with one fetus. The nurse would most likely recommend a total weight gain of no greater than which amount?
20 pounds
Recommended weight gain during pregnancy - BMI <18.5 =
28-40 lbs
A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:
30111.
A nurse is serving as a doula to a client who is now in labor at an alternative birthing center. The client has opted for a water birth, and the nurse is now drawing the water into a large tub. What temperature should the nurse keep the water at?
37 C
How long should the nurse advise the client to leave a diaphragm in place after intercourse?
6 hours
At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1c above which level is concerning for diabetes and warrants further testing?
6.5%
Discomforts of pregnancy fatigue management
8 hr sleep, rest during day avoid standing long time eat well balanced meals
A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanelle. The client is anxious to know when the posterior fontanelle will close. Which time span is the normal duration for the closure of the posterior fontanelle?
8 to 12 weeks
A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?
85 mg/dL
Breast Assessment men and women
>Female • Inspection • Palpation • Lump or mass= begin palpation on unaffected side • Note: location, size, shape, contour, consistency, mobility, pain, tenderness, discharge, number of lumps or masses) >Male • Similar to preadolescent girl • Contains few ducts surrounded by connective tissue • Men also can get breast cancer
The most peripheral layer of living cells in the skin
Granular cell layer of the epidermis (stratum granulosum)
What is a true statement regarding varicella zoster virus infection?
A complication of this infection includes secondary bacterial infections of the skin.
When counseling a Japanese American about nutrition and diet in pregnancy, it would be important to include
A list of foods that contain calcium
Which neonate is at highest risk for developing neonatal herpes following birth?
A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions
The nurse recognizes which person as needing further education?
A nursing assistant who is obtaining vital signs in the playroom
A client states that "she thinks" her water has broken. Which best provides confirmation of the rupture of membranes?
A positive Nitrazine test
The health care provider and nurse are assisting the client in the delivery of the fetus. The mother has been pushing with little effect. As the nurse obtains the instruments to assist with delivery, which method is used for pain relief?
A pudendal block
HELLP syndrome
A variant of gestational hypertension where hematologic conditions coexist with severe preeclampsia and hepatic dysfunction. or Hemolysis Elevated Liver enzymes Low Platelets
A nurse is reviewing the medical records of several women who come to the prenatal clinic for care. The nurse plans to increase the number of teaching sessions on nutrition for the women at risk for poor nutritional status. Which woman would the nurse most likely identify as needing the additional sessions. Select all that apply.
A woman who is 42-years of age A woman whose prepartum weight was less 85% of ideal weight. A woman who shows a weight gain of 2 or more pounds per week.
A nurse is conducting a program at women's health clinic about nutritional needs and women during pregnancy. When discussing dietary intake, which information would the nurse include?
A woman with twins should gain approximately 1 pound a week for a total of 40 to 45 lbs.
The nurse notes that a two-day-old infant shows a tendency to bleed. The nurse understands this is MOST likely caused by what?
Absence of intestinal bacteria needed for the production of Vitamin K
Which assessment findings indicate a distressed fetus? Select all that apply.
Absent accelerations Late deceleration patterns Persistent bradycardia
A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do?
Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.
Failure of renal development in Potter's syndrome
Agenesis
A hormone which stimulates reabsorption of sodium in the kidney
Aldosterone
A young patient has been corrected by nurses numerous times for running in the hallway. Which is the best action to take to modify this behavior?
Allow the child to accompany nurses to obtain a wheelchair.
Cells in pancreas that secrete increased amounts of a hormone in response to low plasma glucose
Alpha cells
A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?
Always wear a three-point seat belt.
The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner?
Ambulate only with assistance from the nurse or caregiver.
A client has just received IV sedation. What must the nurse tell the client to do?
Ambulate only with assistance from the nurse or caregiver. The client may have decreased sensory ability 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. pg 475
Which child will the nurse identify as at greatest risk for developing a urinary tract infection?
An 8-month-old bottle-fed female with HIV
Which statement is true regarding analgesia versus anesthesia?
Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.
The aortic arch which forms the arch of the aorta
Aortic arch 4
The type of growth that increases the diameter of the diaphysis of the long bone during development
Appositional
A client asks the nurse to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be:
April 27.
The labor nurse reports to the nurse on the oncoming shift, "The woman in labor room 2 is handling her pain very well. She smiles whenever I go in to talk to her, and she doesn't complain at all!" What assessment by the oncoming labor nurse would best reveal if the off-going labor nurse's observations were correct?
Asking the woman to describe her pain and rate it on a scale of 0 to 10
During which time is the nurse correct to document the end of the third stage of labor?
At the time of placental delivery
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?
Avoid medications.
A nurse is client teaching with a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority?
Avoidance of infection
The main artery which gives rise to the anastomosis of vessels around the neck of the humerus
Axillary artery
The name of the vessel which lies in close proximity to the cords of the brachial plexus
Axillary artery
A nurse is teaching a group of primigravida woman who are in their first trimester. One of the women asks the nurse about sexual activity during pregnancy. Which information would the nurse most likely incorporate into the response?
Because of pelvic congestion, women may experience increased clitoral sensitivity. Only a few complications of pregnancy such as vaginal bleeding and ruptured membranes limit sexual activity. A partially dilated cervix does not warrant a restriction in sexual activity.
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point?
Bed rest to maintain pregnancy as long as possible
A 13-year-old boy who recently immigrated to the United States from India is found to be infected by a strain of the poliovirus. After initial symptoms of fever, headache, nausea, vomiting and abdominal pain subside, the virus proceeds to his central nervous system. Which of the following would be the best intervention for this client at this point?
Bed rest, analgesia, and application of moist hot packs
Superior mesenteric artery
Blood supply to jejunum, ileum, caecum, appendix, ascending colon and 2/3rd of transverse colon
The vessel giving rise to the right carotid artery
Brachiocephalic artery
The structure in the gastrulated embryo where anterior (rostral) endoderm makes direct contact with anterior ectoderm
Buccopharyngeal membrane
The spinal nerve root responsible for abduction of the shoulder
C5
Which spinal nerve roots supply the small muscles of the hand
C8, T1
Erin, a 19-year-old first-time mother in the second stage of labor who has been given an epidural, reports severe, unrelenting abdominal pain and rates it as 10 on a scale of 0 to 10. What should the nurse do?
Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication.
A nurse is teaching a 32-year-old primigravida woman about nutrition during pregnancy. Which information would the nurse include in the teaching plan? Select all that apply:
Caloric intake should be increased 300 cal/day. Protein intake should be increased by more than 30 g/day. Intake of all minerals, especially iron, should be increased.
A 28-year-old primigravida client presents to the unit in early labor. The record reveals the client is 5 ft (1.5 m) tall, 95 lbs (43 kg), and has gained 25 lbs (11.3 kg) over a normal, uneventful pregnancy. The nurse predicts this client will have which type of pelvis upon assessment?
Cannot be determined
The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?
Caput succedaneum
The cell type that grows by hypertrophy at the epiphyseal plate
Chondrocyte
The structures passing through the porta hepatis are the
Common hepatic duct, hepatic artery, hepatic portal vein
A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients?
Contact precautions
The time in the cell cycle where cleavage of the cytoplasm occurs
Cytokinesis
The primary constituents of sarcomeres
Cytoskeletal proteins
A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes?
Degree of blood glucose control achieved during the pregnancy
When assessing cervical effacement of a client in labor, the nurse assesses which characteristic?
Degree of thinning
A toddler who is vomiting and has diarrhea is seen in the clinic. The child's mother states that these symptoms started in the last 6 to 8 hours. Which of the following would the nurse expect from these symptoms?
Dehydration
Embryo: days and whats happening, vulneralabilities
Day 15 - 8 wks Rapid cell division, sensitive to teratogens
A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize?
Decrease activity and rest more often.
A woman in labor has received a pudendal block. The nurse would assess the woman for which condition?
Decrease in maternal blood pressure
A pregnant client in her first trimester visits the health care facility for regular checkups. The nurse instructs the client to increase her dietary intake of folic acid based on the understanding that folic acid is important for which action?
Decreasing incidence of birth defects
A nurse assesses a primigravida client in the eighth week of gestation. The client reports nausea and vomiting in the mornings. The client tells the nurse, "I'm not able to keep liquids down and I'm eating like a bird." The client also expresses concerns about hormonal changes and how the pregnancy will affect her physical appearance. Which client problem should the nurse assess first?
Deficient fluid volume
A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this?
Delay breakfast until midmorning. The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.
A woman in her 20s explains to the nurse that she would like to eat more healthy foods during her pregnancy but complains about the high cost of food. She confides that she just makes minimum wage at her job and that things are tight for her financially. What would be the most appropriate intervention for the nurse to make?
Discuss the WIC program with the client.
The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?
Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.
The gall bladder
Drains via the cystic duct which joins the common hepatic duct
The gall bladder drains...
Drains via the cystic duct which joins the common hepatic duct
The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply.
Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible.
A vessel linking the pulmonary artery and dorsal aorta in the fetus
Ductus arteriosus
A vessel allowing umbilical blood to bypass the liver in the fetus
Ductus venosus
The event that occurs at birth or shortly afterwards to reverse the state which allows blood to bypass the liver in the fetus
Ductus venosus closes
The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding?
Duration
At which time in a client's labor process would the nurse encourage effleurage?
During the early labor phase
The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize?
Dyspnea, crackles, and irregular weak pulse
A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?
Eat dry crackers or toast before rising.
The nurse monitors a client at 30 weeks gestation, and the client states that she has periodic heartburn. It is MOST important for the nurse to make which of the following recommendations?
Eat frequent and small meals.
A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?
Eat small meals frequently rather than large meals.
Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply.
Ensure immunization status is current. Use appropriate personal protective equipment. Provide information about disease transmission. Educate the child and family about infection control.
A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which instruction should the nurse give this client?
Eat small, frequent meals throughout the day. The nurse should instruct the client with hyperemesis gravidarum to eat small, frequent meals throughout the day to minimize nausea and vomiting. The nurse should also instruct the client to avoid lying down or reclining for at least 2 hours after eating and to increase the intake of carbonated beverages. The nurse should instruct the client to try foods that settle the stomach such as dry crackers, toast, or soda.
The embryonic layer from which the neural tube is derived
Ectoderm
A nurse is conducting a program for a group of women in a community health about the importance of prenatal care. Which information would the nurse include when describing its purpose? Select all that apply.
Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Identify women at risk for complications. The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.
A client in week 38 of her pregnancy has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client?
External cephalic version
A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?
Fetopelvic disproportion
A client contacts the nurse and describes some soft and movable masses she felt in her breasts that become enlarged during menstruation. The nurse should be aware that the client is most likely describing what?
Fibrocystic disease of the breast
How should the nurse expect the fundus to be when palpating after the third stage of labor?
Firm and globular
The hormone that acts on Sertoli cells to initiate and maintain spermatogenesis
Follicle stimulating hormone
A pregnant client arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks gestation. How will the nurse document her "G" and "L" for her records?
G3 L2
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?
G3 P0020
A client presents to the office for her obstetric history. She tells the nurse she has 4 children living at home. One child was born at 34 weeks, another child at 37 weeks, two were born consecutively at 38 and 39 weeks, and one was aborted. Record the client's obstetric record using the GTPAL format.
G5, T2, P2, A1, L4
A client in labor receiving epidural anesthesia develops hypotension. Which of the following would the nurse do first?
Give an intravenous bolus of fluid
The nasal cavity
Has a prominent submucous venous plexus to warm the air
A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor?
Have been shown to be effective and safe in recent short term studies.
The obstetrician is examining a woman who is in early labor to determine the positioning of the fetus. The nurse knows that which of the following fetal attitudes would be the most advantageous for birth?
Head flexed forward so much that the chin touches the sternum
A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?
Health-seeking behaviors related to ways to relieve discomforts of pregnancy
THe nurse should place the HIGHEST priority on monitoring a woman after a cesarean section for what?
Hemorrhage and shock-- observe for pt airway and observe incisional dressing from bleeding and amount of lochia
A nursing student learning about childhood infectious diseases correctly identifies which of the following as the disease related to chickenpox, which tends to occur in older children or young adults?
Herpes zoster
A physiological change typically associated with thyrotoxicosis
High basal metabolic rate
A symptom typically associated with thyrotoxicosis
High basal metabolic rate
The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply.
Hyperactive deep tendon reflexes Nondependent edema Blood pressure above 160/110 mm Hg
Which changes in pregnancy would the nurse identify as a contributing factor for arterial thrombosis, especially for the woman with atrial fibrillation
Hypercoagulable state
A young woman in her first trimester confesses to the nurse when questioned that she is probably not consuming enough calories. The nurse should explain to this client that deficient nutrition can hinder the baby's growth, which at this point in her pregnancy is primarily via an increase in the number of cells formed. This type of growth is known as which of the following?
Hyperplasia
Combined growth and proliferation of a non-diseased tissue
Hyperplasia
The type of tissue growth by which the liver normally increases in size
Hyperplastic
Put the following stages of infectious disease in correct order:
Incubation period Prodromal period Illness Convalescent period
The adenohypophysis
Is controlled by specific releasing factors from the hypothalamus via hypothalamo-hypophysial portal vessels
A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and alert the RN or health care provider?
Initial BP 100/70 mm Hg; current BP 140/90 mm Hg
A multigravida is admitted to the hospital in active labor. The client's and the fetus's condition have been good since admission. The client calls out to the nurse, "the baby is coming!" What is the first action of the nurse?
Inspect the perineum. The nurse needs to determine if birth is imminent and be prepared for birth. Once the nurse assesses the coming labor, the heart sounds, contraction rate, and contacting the primary care provider can all be done, if there is time.
A pregnant woman has been admitted to the hospital due to severe preeclampsia. Which measure will be important for the nurse to include in the care plan?
Institute and maintain seizure precautions. The woman with severe preeclampsia should be maintained on complete bed rest in a dark and quiet room to avoid stimulation. The client is at risk for seizures; therefore, institution and maintenance of seizure precautions should be in place.
When teaching the pregnant patient about self-medicating for pain during labor, why did the nurse instruct the patient to avoid taking acetylsalicylic acid (aspirin)?
Interference with blood coagulation with increased risk of bleeding in mother or infant
Part of mesoderm from which the kidneys are formed
Intermediate mesoderm
Part of the mesoderm from which the kidneys are formed
Intermediate mesoderm
The kidney develops from
Intermediate mesoderm
The region of mesoderm from which the gonadal ridge is derived
Intermediate mesoderm
The tissue from which the gonadal ridge is derived
Intermediate mesoderm
The main artery supplying the uterus
Internal iliac
The sensory innervation of the vestibule of the larynx
Internal laryngeal branch of the vagus nerve
The juxtaglomerular apparatus
Is located between the vascular pole of the renal glomerulus and the distal convoluted tubule
The uterus
Is normally anteverted and anteflexed over the bladder
The mitral valve
Is situated between the left atrium and the left ventricle
Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide?
Lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels
When discussing the advantages and disadvantages of spinal anesthesia with a client in labor, which of the following would the nurse include as a disadvantage?
Lack of sensation of urge to push
Uterine Growths: treatment
Leiomyomas (fibroids) Tx • Oral contraceptives, IUDs • Iron supplements, NSAIDs • Surgical: hysteroscopic resection, myomectomy, hysterectomy
Uterine Growths:
Leiomyomas (fibroids) s/s • Abdominal fullness, gas, or constipation • Bleeding between periods • Increase in urinary frequency • Heavy menstrual bleeding (menorrhagia) • Menstrual periods (last longer than normal) • Pelvic cramping or pain with periods • Sensation of fullness or pressure in lower • abdomen • Pain during intercourse
A nurse places an external fetal monitor on a woman in labor. Which instruction would be best to give her?
Lie on her side so she is comfortable. The best position for all women during labor is on their side.
The ligament which forms from the obliterated fetal shunt through the liver
Ligamentum venosum
A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply.
Limit consumption of food before bedtime. Sleep in a semi-Fowler's position. Avoid overeating.
Gut diverticula undergo branching morphogenesis to form the
Liver, pancreas and lungs
In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following?
Low birth weight
A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Low-grade fever Macular rash Papular rash Vesicle formation Crusting
A foregut derived part in which portal-systemic anastomotic veins are located in the submucosa
Lower part of the oesophagus
A glycoprotein hormone which acts on Leydig cells to stimulate testosterone synthesis and release
Luteinizing hormone
Testosterone acts by negative feedback to inhibit the release of this hormone
Luteinizing hormone
The hormone that stimulates testosterone production by Leydig cells
Luteinizing hormone
A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.
Lyme disease Rocky Mountain spotted fever
The site(s) of degradation for most endocytosed plasma membrane proteins
Lysosomes
Which of the following cell types other than pneumocytes are commonly found in the walls of alveoli?
Macrophages
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?
Massage the woman's back. 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.
A client in labor has been given an epidural anesthetic. Which nursing assessment finding is most important immediately following the administration of epidural anesthesia?
Maternal blood pressure decreases from 130/70 to 98/50 mm Hg.
Concerning spermatogenesis
Maturation of spermatids to spermatozoa requires the presence of testosterone
The embryonic layer from which cardiac muscle is derived
Mesoderm
The structure from which each ureteric bud sprouts off
Mesonephric duct
The stage of mitosis when chromosomes align at the midline of the cell
Metaphase (Mitosis)
A hormone secreted by Sertoli cells that blocks development of parts of the female reproductive system
Mullerian inhibiting factor (MIF)
Peripheral nerve supplying flexors of the elbow
Musculocutaneous nerve
A 25-week-gestation client presents with a blood pressure of 152/99, pulse 78, no edema, and urine negative for protein. What would the nurse do next?
Notify the health care provider
Part of the mesoderm from which the central portion of the intervertebral disc is formed
Notochord
entry of cytoplasmic transcription factors to the nucleus
Nuclear pore
The organelle(s) whose membrane breaks down in the early stages of mitosis
Nuclei
The site where ribosomal subunits are assembled
Nucleolus
The nurse is discussing medications to be given to a child who has been diagnosed with candidiasis. Which of the following medications would most likely be prescribed for the child?
Nystatin
The nurse cares for a patient after a breast biopsy. After the procedure, it is MOST important for the nurse to take which of the following actions?
Observe for bleeding.
A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation?
Observe the client for signs of petechiae and premature separation of the placenta
The nurse is caring for an Rh-negative nonimmunized client at 14 weeks' gestation. What information would the nurse provide to the client?
Obtain Rho(D) immune globulin at 28 weeks' gestation. The current recommendation is that every Rh-negative nonimmunized woman receives Rho(D) immune globulin at 28 weeks' gestation and again within 72 hours after giving birth. Consuming a well-balanced nutritional diet and avoiding sexual activity until after 28 weeks will not help to prevent complications of blood incompatibility. Transvaginal ultrasound helps to validate the position of the placenta and will not help to prevent complications of blood incompatibility.
A client is in active labor. As one of the nursing diagnoses is "Risk for trauma to the woman or fetus related to intrapartum complications or a full bladder," what would be appropriate for the nurse to do in order to achieve the goal of "no complications due to a full bladder"?
Palpate the area above the symphysis pubis every two hours. Another source of trauma that can interfere with the progress of labor is a full bladder. Every two hours the nurse should palpate the area just above the symphysis pubis feeling for a rounded area of distention, which indicates the bladder is full. pg 481
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?
Palpate the fundus, and check fetal heart rate.
The embryonic duct that gives rise to the Fallopian (uterine) tube
Paramesonephric (Mullerian) duct
The structure formed from mesoderm that produces the Fallopian tubes and uterus
Paramesonephric (Mullerian) duct
A hormone which stimulates reabsorption of calcium in the kidney
Parathyroid hormone
The nurse observes a staff member palpate uterine contractions. The nurse determines the staff member is using the correct technique if the following is observed?
Place one hand on the abdomen over the fundus and, with the fingertips, press gently.
The nurse understands the need to be aware of the potential of bleeding disorders in her pregnant clients. Which disorder should she be aware of that occurs in the second trimester?
Placenta previa
Structures through which oxygen is absorbed into the fetus
Placental villi
Are derived from megakaryocytes
Platelets
A pregnant patient is developing HELLP syndrome. During labor, which order should the nurse question?
Prepare for epidural anesthesia.
After 12 hours of active labor, a multipara patient at 39 weeks' gestation is only dilated 6 centimeters. Which of the following is a consideration for the nurse?
Reassess the fetal presentation and position.
A 33-year-old client has been progressing slowly through an unusually long labor. The nurse assesses the fetal scalp pH and determines it is 7.26. How should the nurse explain this result to the client when asked what it means?
Reassuring; it is associated with normal acid-base balance.
The nurse observes four newborns. Which of the following characteristics, if noted by the nurse, are MOST common in preterm infant?
Red, wrinkled skin, lanugo, and hypotonic muscles.
A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV?
Respiratory rate
A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client?
Restricted sodium intake
A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client?
Risk for fetal infection related to early rupture of membranes
The site(s) of translation for most secreted proteins
Rough endoplasmic reticulum
Testing at 16-20 weeks
Routine OB U/S
A 24-year-old client is brought to the emergency department complaining of severe abodminal pain, vaginal bleeding, and fatigue. The nurse notes on assessment cool, clammy skin, confusion, and vital signs: HR 130, RR 28, and BP 98/60 mm Hg. Which action should the nurse prioritize?
Rule out shock.
Which assessment finding in a client reporting uterine contractions would be most consistent as an indicator of approaching labor?
Rupture of amniotic membranes
The time in the cell cycle where DNA replication takes place
S-phase
An important store of intracellular calcium used during muscle contraction
Sarcoplasmic reticulum
The septum in the primitive atrium which normally fuses completely with the atrioventricular endocardial cushion tissue
Septum primum
A nurse precepting a student in labor and delivery informs the student that the incidence of venous thromboembolic disease increases during pregnancy. What does the nurse tell the student contributes to this increased risk? (Select all that apply.)
Stasis of blood in lower extremities Hypercoagulability
A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which guideline should the nurse give her?
Stop and walk every few hours.
Class of drugs used in the treatment of type II diabetes
Sulphonylureas
The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which assessment would lead the nurse to suspect cat-scratch disease?
Swollen lymph nodes
The tissue that invades the maternal endometrium
Syncytiotrophoblast
Classification of the knee joint
Synovial hinge joint
Structures that conduct changes in cell surface membrane potential to the interior of the muscle fibre
T tubules
The major structures that conduct excitatory stimuli to the sarcomeres
T-tubules
The spinal nerve root giving the major supply to the small muscles of the hand
T1
Hormone that stimulates thyroid gland secretions and growth
TSH
The hormone that is secreted by the anterior pituitary gland in response to hypothalamic releasing factor TRH
TSH
A client with hyperemesis gravidarum is on a clear liquid diet. Which foods would be appropriate for the nurse to serve? Select all that apply:
Tea and gelatin Ginger ale and apple juice Cranberry juice and chicken broth
A 5-year-old girl was brought to the emergency room following a car wreck in which she sustained a head injury. She has been thoroughly assessed, including having a skull x-ray, which showed no signs of fracture. The child is conscious and demonstrates no signs of neurologic injury. Which of the following actions should the nurse anticipate performing next?
Teaching the parents of the child how to evaluate consciousness and assess for signs of intracranial pressure for the next 24 hours at home
A preschooler is hospitalized with asthma. His mother needs to leave to go home and check on her other children. It is close to dinner time and she plans on returning first thing in the morning. What should she tell her son before leaving to help in the transition?
Tell him she will be back after he wakes up tomorrow.
A client is 20 weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client?
The client has pink vaginal discharge and pelvic pressure.
Labor can be indicated by which occurrence?
The client reports back pain, and the cervix is effacing and dilating. True labor is indicated when the cervix is changing. Contractions occur for weeks before true labor, and may occur close together. Contractions may also occur for a long time before true labor begins. pg 424
A nurse is caring for a female client in labor who has chosen hydrotherapy as her pain management for labor. As the nurse prepares the client for this treatment, which procedure is recommended as the most appropriate consideration?
The client should be in active labor. Most recommendations for hydrotherapy, or water therapy, include active labor. If the client is not in active labor, the contractions could slow because of relaxation of muscles. There is no time limit for water therapy; it is provided for comfort. The water temperature should not be higher than the maternal body temperature, and water therapy can be used with intact or ruptured membranes.
Which statement describes why hypertonic contractions tend to become very painful?
The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells.
The nurse instructs a woman about how to prevent conception using the basal body temperature (BBT) method.
The nurse explains that during ovulation, a woman's basal body temperature rises slightly
The school nurse attends a soccer game at the local high school. The nurse notes a pregnant woman has grabbed her throat, indicates that she is choking, and is unable to speak. Which of the following actions, if taken by the nurse, is BEST?
The nurse stands behind the woman and performs chest thrusts.
A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative, although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years before. She felt fine afterward, so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take?
The nurse will perform all normal procedures and follow-up tasks because the Rh status of the client and the child are not a concern at this time. If the woman is Rh negative and her partner is Rh negative, the fetus will also be Rh negative, and the woman will not require treatment with Rho(D) immune globulin. Therefore, the remaining options are incorrect.
A woman arrives at the hospital in labor. THe midwife states that the client is 4 cm dilated and 60% effaced. The nurse explains to the client this means which of the following?
The opening of the cervix is 4 cm wide and the cervical canal is 60% shorter than normal.
Structures formed from regularly arranged bundles of myosin molecules
Thick filaments
The major component of the extracellular material in the thyroid gland
Thyroglobulin
The development potential of embryonic stem cells
Totipotent
packaging of secretory proteins into vesicles
Trans-Golgi network
Urogenital Displacement & Prolapse (uterine or vaginal prolapse Tx
Treatment • Kegel exercises • Knee chest position • Tampons • Pessary • Estrogen • Surgical: abdominal or vaginal hysterectomy
A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?
Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding.
If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first?
Turn her or ask her to turn to her side. The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression. pg 463
A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?
Twin-to-twin transfusion syndrome (TTTS)
On the second day postpartum following a cesarean birth, at which of the following locations would you expect to palpate the woman's fundus?
Two fingers below the umbilicus
The cell type covering most of the surface of the alveolus
Type 1 pneumocyte
The left coronary artery
Typically supplies most of the interventricular septum
Parents of a child who has been diagnosed with tinea capitis ask how the child got the infection. Which of the following would the nurse explain as the most likely cause?
Using a friend's comb
A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem?
Uterine contractions are weak and ineffective.
A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication?
Uterine rupture
Which method does the nurse use to determine fetal presentation, position and attitude?
Utilize Leopold maneuvers
The nurse is caring for a client who prefers resting on her back during the labor process. To facilitate client wishes, which nursing action is required?
Utilize a wedge under one hip
The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize?
Vaginal bleeding
You are doing client education with an obese woman who is trying to get pregnant. She confides in you that she is on a diet and trying to lose weight. Which of the following would you teach her?
Weight reduction should not be undertaken during pregnancy.
Fibrocystic Disease Tx
Well-fitted bra: Not too tight, no underwire Dietary: • Decrease/ eliminate caffeine • Decrease estrogen • Diet changes: decrease sodium & sugar; low fat Medical: • Analgesics - acetaminophen & NSAIDS • Diuretics - mild • Hormonal therapy - progesterone; androgen; anti-estrogen Surgical - rare
If a pt pregnant with her second child comes in and asks an acceptable amount of exercised for her what is the MOST important response by the nurse?
What is your usual type of exercise?
At what time is the laboring client encouraged to push?
When the cervix is fully dilated
A nurse is assisting a client who is in the first stage of labor. Which principle should the nurse keep in mind to help make this client's labor and birth as natural as possible?
Women should be able to move about freely throughout labor. Six major concepts that make labor and birth as natural as possible are as follows: 1) labor should begin on its own, not be artificially induced; 2) women should be able to move about freely throughout labor, not be confined to bed; 3) women should receive continuous support from a caring other during labor; 4) no interventions such as intravenous fluid should be used routinely; 5) women should be allowed to assume a nonsupine position such as upright and side-lying for birth; and 6) mother and baby should be housed together after the birth, with unlimited opportunity for breastfeeding.
On the evening before a modified radical mastectomy, a 29-year-old patient tells the nurse she is afraid that her husband will not find her sexually attractive if her breast is removed. Which of the following responses by the nurse is BEST?
You're worried about how he'll react to the changes in your body.
The layer directly surrounding the oocyte immediately after ovulation
Zona pellucida
The nurse is transcribing messages from the answering service. Which phone message should the nurse return first?
a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria The nurse should call the at-risk 35-year-old client first. She is 21 weeks and has symptoms (blurred vision) of preeclampsia. She also had an increase of protein in her urine (2+) and a 15% increase in her BP. The nurse will need more information to determine if the 38-week client may be in the early stages of labor, and if the 31-week client with flank pain has a kidney infection. The client with malaise and rhinitis will need to talk to the nurse last to find out what over-the-counter medication she is able to take.
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom is the priority concern for the nurse?
a dipstick value of 2+ for protein The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in the majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since there is no indication what the baseline blood pressure was
Apgar scale
a standard measurement system that looks for a variety of indications of good health in newborns 0=absent 2=perfect Activity Pulse Grimace Appearance Resp.
A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse? a) "I can understand your need to find an answer to what caused this. Let's talk about this further." b) "It is hard to know why a woman bleeds during early pregnancy." c) "Your spontaneous bleeding is not work-related." d) "Something was wrong with the fetus."
a) "I can understand your need to find an answer to what caused this. Let's talk about this further." Rationale: Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.
A client experiences a threatened abortion. She is concerned about losing the pregnancy and asks what activity level she should maintain. What is the most appropriate response from the nurse? a) "Restrict your physical activity to moderate bedrest." b) "There is no research evidence that I can recommend to you." c) "Carry on with the activity you engaged in before this happened." d) "Strict bedrest is necessary so as not to jeopardize this pregnancy."
a) "Restrict your physical activity to moderate bedrest." Rationale: With a threatened abortion, moderate bedrest and supportive care are recommended. Regular physical activity may increase the chances of miscarriage. Strict bedrest is not necessary. Activity restrictions are part of standard medical management.
A nurse is caring for a client who just experienced a miscarriage in her first trimester. When asked by the client why this happened, which is the best response from the nurse?
abnormal fetal development
The principal hormone produced by adrenal chromaffin cells
adrenaline
A student observing in labor and delivery watches a physician introduce a hard plastic instrument with a hook on the end into the vagina during a digital examination. The physician proceeds to guide the hook to snag a hole into the membranes. This process causes the body to release prostaglandins, which induces labor and is known as which of the following?
artificial rupture of membranes
A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that:
as long as she receives RhoGAM, there is no limit.
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission?
assessing fetal heart tones by use of an external monitor
The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority?
assessing the amount and color of the bleeding
It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time?
at 28 weeks' gestation and again within 72 hours after birth
A client in her first trimester has just experienced a miscarriage. The nurse knows that which of the following is the most likely cause of the miscarriage? a) Lack of sufficient progesterone produced by the corpus luteum b) Abnormal fetal development c) Rejection of the embryo through an immune response d) Implantation abnormality
b) Abnormal fetal development Rationale: The most frequent cause of miscarriage in the first trimester of pregnancy is abnormal fetal development, due either to a teratogenic factor or to a chromosomal aberration. In other miscarriages, immunologic factors may be present or rejection of the embryo through an immune response may occur. Another common cause of early miscarriage involves implantation abnormalities. Miscarriage may also occur if the corpus luteum on the ovary fails to produce enough progesterone to maintain the decidua basalis.
What makes the diagnosis of gestational hypertension different from the diagnosis of preeclampsia? a) Ketonuria b) Proteinuria c) Severity of hypertension d) The hypertension of gestation disappears after delivery. The hypertension of preeclampsia does not.
b) Proteinuria Rationale: Gestational hypertension is the current term used to describe elevated blood pressure (greater than or equal to 140/90 mm/Hg) that develops for the first time during pregnancy without the presence of protein in the urine.
The nurse cares for a 6lb, 7oz baby girl delivered two hours ago. The nurse knows which of the following occurrence initiates the changes that take place in the newborn circulatory system after birth?
b) the infant begins pulmonary ventilation
Select the statement by the pregnant woman that indicates the need for more teaching about preeclampsia. a) "I will count my baby's movements twice a day." b) "If I have a slight headache I'll take Tylenol and call if unrelieved." c) "If I have changes in my vision, I will lie down and rest." d) "I will weigh myself every morning after voiding before breakfast."
c) "If I have changes in my vision, I will lie down and rest." Rationale: Changes in the visual field may indicate the patient has moved from preeclampsia to severe preeclampisa and is at risk for developing a seizure due to changes in cerebral blood flow. The patient would require immediate assessment and intervention. Options B, C, and D would not indicate that more teaching about preeclampsia is indicated.
Which of the following changes in B/P assessment findings during the second trimester indicate the highest risk for preeclampsia. a) Initial BP 120/80, current BP 130/88. b) Initial BP 110/60, current BP 112/86. c) Initial BP 100/70, current BP 140/90. d) Initial BP 140/85, current BP 130/80.
c) Initial BP 100/70, current BP 140/90. Rationale: A rise in blood pressure to above 140/90 is a concern the patient may be developing preeclampsia. The B/Ps noted in options A, C, and D are not indicative of developing preeclampsia, so these are incorrect responses.
Signal or hormone that directly stimulates cells of the anterior pituitary gland to secrete adrenocorticotrophic hormone, ACTH
corticotrophin releasing hormone (CRH)
The principal hormone secreted by the zona fasciculata
cortisol
A woman is being admitted to your hospital unit for severe preeclampsia. When deciding on where to place her, which of the following areas would be most appropriate? a) Near the elevator so she can be transported quickly b) Near the nurse's station so she can be observed closely c) By the nursery so she can maintain hope she will have a child d) In the back hallway where there is a quiet, private room
d) In the back hallway where there is a quiet, private room Rationale: A sudden noise can trigger a seizure in a severely preeclamptic woman. Room placement, therefore, should not be near noise, such as the nursery, the elevator, or nurse's station.
Discomforts of pregnancy N&V management
eat dry toast before rising, small frequent meals
effleurage may help her manage the pain. This indicates that the nurse will
instruct the client or her partner to perform light fingertip repetitive abdominal massage.
A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly?
lower quadrant of the maternal abdomen In a cephalic presentation, the FHR is best heard in the lower quadrant of the maternal abdomen. In a breech presentation, it is heard at or above the level of the maternal umbilicus.
To assess the frequency of a woman's labor contractions, the nurse would time:
the beginning of one contraction to the beginning of the next. Measuring from the beginning of one contraction to the next marks the time between contractions. pg 453
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?
use of IUD for contraception
Routine prenatal visits
• Wt & BP • Quickening & fetal movement • Urine - blood, ketones, protein, glucose • Fundal height (after 17 wks) • Fetal heart tones (after 12 wks) • parental concerns and education
Uterine Cancer information
• ____________ CA is most common gynecological cancer in U.S., \ • Adenocarcinoma of the endometrium is most common form of uterine CA in U.S. • Type I: 80% of tumors (risk factors: diabetes, HTN, obesity, nulliparity, unopposed estrogen tx) • Type II: 10-20% of tumors, more aggressive, poorer prognosis (Risk factors: ethnicity, parity, breast CA hx) • Major symptom is abnormal uterine bleeding • Bleeding is evaluated depending on age: never normal to have any postmenopausal bleeding or spotting
precautions for all vaccines
• anaphylaxis • moderate to severe illness • live vaccines not used on immunocompromised No live for pregnant women
Initial Prenatal visit
• confirm pregnancy • history: social, medical, etc. • Physical Exam • Labs
Milestones: Month 3
• hear heartbeat c doppler (10-12 wks) • respiratory mvmnts • moves extremities • sucks thumb • 4" long
Milestones: Month 7
• lecithin forming on alveolar surfaces • lungs take practice breaths • can perceive light • senses are functional • brown fat formed • 3 lb; 15"
Milestones: Month 8
• lungs may be immature until 34-35 wks • 5 lb; 18"
Milestones: Month 4
• placenta fully formed • movement (quickening) • 5 oz./ 6-7"
A pediatric nurse observes signs of separation anxiety and suggests rooming- in. The goal of rooming-in is to prevent which?
Separation anxiety for both pediatric client and caregiver
Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?
Difficulty breathing
A woman comes to the clinic for an exam and says that she is considering trying to become pregnant in the next few months. What would the nurse encourage the client to begin taking now?
Folic acid
A hormone that acts on liver via cAMP to promote both glycogenolysis and gluconeogenesis
Glucagon
Hormone class used therapeutically for immunosupression actions
Glucocorticoid
qA full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication?
Naloxone
Parturition
Prostaglandins can be used to stimulate the onset of parturition
The nurse teaches prenatal classes in the antepartum clinic. Which of the following statements, if made by a client to the nurse, indicates that further teaching is necessary?
I may feel hot flashes and chills (indicates infection)
The nurse instructs a prenatal client about warning signs of pregnancy. The nurse determines teaching is sucessful if the client states which of the following?
I should contact the physican if I notice swelling in my face and fingers
Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in:
Latent phase of the first stage.
Part of the mesoderm from which the limb skeleton is derived
Lateral plate mesoderm
The heart chamber into which most foetal blood passes after entering the right atrium
Left atrium
A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best?
Left lateral recumbent
The nurse performs a home care visit on a mother who delivered a baby three days ago. The client expresses alarm when she hears that her baby has lost 8 oz. What response by the nurse is most appropriate?
That is a normal weight loss. Sometimes babies lose as much as 10% of their birth weight
A pregnant client with cystic fibrosis (CF) comes to the office for a prenatal visit. She asks the nurse for information on breast-feeding. The best response by the nurse is:
"Breast-feeding is not a good idea. Because your breast milk is high in sodium due to CF, there is a risk of the infant receiving too much sodium."
A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states:
"Breathing patterns are distraction techniques taught to decrease pain in labor." Breathing techniques are largely distraction techniques taught in birth classes and are well documented to decrease pain in labor. pg 471
What would be most important to include in the teaching plan for parents of a child with pinworm?
"Make sure the child washes his hands after using the bathroom."
A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best?
"Your statistical risk of another tubal pregnancy is increased." If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.
A nurse has been assigned to assess a pregnant client for abruptio placenta. For which classic manifestation of this condition should the nurse assess?
"knife-like" abdominal pain with vaginal bleeding The classic manifestations of abruption placenta are painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement. Painless bright red vaginal bleeding is the clinical manifestation of placenta previa. Generalized vasospasm is the clinical manifestation of preeclampsia and not of abruptio placenta.
What are the recommended office visits for a low-risk client throughout the pregnancy?
- < 28 wks = every 4 weeks - 28-36 wks = every 2 wks - > 36 weeks = every week
How to screen for gestational DM
- Fasting - 1 hr; 50 g - 3 hr if indicated; 100 g
Sexuality: Physiological --Physical changes: --Aging: Common issues: --Comorbidities:
--Physical changes: breast, genitalia, skin, hair. Menarche, menstruation, fertility/ovulation/conception, contraception, pregnancy, perimenopause (35-50). --Aging: hormones, vaginal changes, menopause. Common issues: decreased desire, vaginal dryness, lack of partner, difficulty with orgasm. Menopause: average 51, range 44-55, premature: 40. --Comorbidities: REMEMBER these can affect sexual function! • Diabetes • Stroke/ hypertension • MI --Surgical Intervention/ Trauma/ Pelvic Injury --Medications --Incontinence
During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used
-4 station -2 station 0 station +2 station +4 station Progressive fetal descent (-5 to +4) is the expected norm during labor, moving downward from the negative stations to zero station to the positive stations in a timely manner. pg 452
The nurse is monitoring a client who is recovering from general anesthesia after an emergent cesarean delivery. Which assessment findings will lead the nurse to predict the client is now developing malignant hyperthermia? Select all that apply.
-Muscle rigidity -Tachycardia and irregular heart rhythms -Decreased oxygen saturation and cyanosis
A 10-year-old child will require daily shots for a new diagnosis of diabetes. Which equipment should be included when planning for therapeutic play?
An insulin syringe, an alcohol pad and fluid filled vial
Chadwick's sign
An objective change or probable sign of pregnancy, is a blue-purple discoloration of the cervix caused by increased vascularization of the uterus during pregnancy.
The phase of mitosis in which chromatids are pulled apart by the mitotic spindle
Anaphase
The phase of mitosis in which chromatids are separated by the mitotic spindle
Anaphase
Cells of the outer zone of the adrenal cortex are stimulated to secrete aldosterone by
Angiotensin II
A nurse is caring for a young client with pneumonia who has slight nausea and does not feel like eating. The client is sipping on fluids. The child's mother says that she is worried and wants the nurse to make the child eat. What is the best nursing action?
Encourage but do not force the child to eat.
How does a woman who feels in control of the situation during labor influence her pain?
Feelings of control are inversely related to the client's report of pain. Studies reveal that women who feel in control of their situation are apt to report less pain than those who feel they have no control. pg 475
Meconium-stained amniotic fluid should alert the nurse to the possibility of what?
Fetal distress and perinatal asphyxia
Positive signs of pregnancy
Fetal heart rate Fetal movements Fetal sonography
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize?
Fetal heart tones
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist in delivery?
Abnormal position of the fetal head
A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave?
Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications.
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?
Acupressure
A cell type that stores large quantities of triacylglycerols
Adipocyte
A nurse assesses a client in labor and suspects hypotonic uterine dysfunction. Which intervention would the nurse expect to include in the plan of care for this client?
Administering oxytocin
A nurse is meeting the family of a child scheduled for surgery at a reception area. Which of the following approaches should the nurse take while admitting the child to the hospital?
Admit the family as a single entity
Cells of the zona fasciculata are stimulated to secrete cortisol by
Adrenocorticotrophic hormone (ACTH)
A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result?
An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.
The hormone secreted by Sertoli cells that blocks development of parts of the female reproductive system
Anti-Mullerian hormone (AMH)
A pregnant woman with a history of mitral stenosis is to be prescribed medication as treatment. Which of the following medication classes would the nurse expect the patient to begin taking?
Anticoagulant
A woman's obstetrician prescribes vitamin K supplements for a client who is on antiepileptic medications beginning at 36 weeks' gestation. The mother asks the nurse why she is taking this medication. The nurse's best response would be:
Antiepileptic therapy can lead to vitamin K-deficient hemorrhage of the newborn.
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?
Anxiety can slow down labor and decrease oxygen to the fetus.
The arterial supply to the testis and epididymis arises as a direct branch of the
Aorta
The aortic arch, part of which forms the ductus arteriosus
Aortic arch 6
Programmed cell death
Apoptosis
What should the nurse suggest a pt who complains of sensitive and sore breasts in her fifth month of pregnancy?
Apply cold compresses and wear a well-fitting, supportive bra
Composed of actin monomers
Microfilaments
The neurohypophysis
Comprises nerve endings of hypothalamic neurosecretory neurons
A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?
Conduct an interview in a private room to obtain her health history.
Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her?
Continue taking iron supplements but increase fluids and high-fiber foods; exercise more.
A client in her third trimester of pregnancy arrives at a health care facility with a report 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. What should the nurse do next?
Continue to monitor the client. 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. The nurse would continue to monitor the client as this is a normal progression of pregnancy.
Which nursing intervention would be most appropriate for a 9-year-old hospitalized for shoulder dislocation?
Developing a collaborative plan for activities
A hormone important for maturation of the fetal lungs before parturition
Cortisol
A hormone which is principally controlled by adrenocorticotrophin hormone (ACTH)
Cortisol
A hormone which, when in excess, causes Cushing's syndrome
Cortisol
The hormone secreted in excess in Cushing's disease that may cause infertility
Cortisol
A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method?
Counterirritation stimulation blocks pain from traveling to the spinal cord
The nurse is working with a client approaching her due date. Arrange the sequence of typical labor pain that the client may experience from onset to birth of the fetus. Use all options.
Cramping in the lower abdomen Pain noted in the lower back, buttocks and thighs Intense contractions resulting in fetal movement Burning in the perineum
Which nursing diagnosis would be most appropriate for a woman diagnosed with gestational hypertension?
Deficient fluid volume related to vasospasm of arteries Gestational hypertension is caused by vascular spasm. This leads to increased blood pressure and edema. Extensive edema leads to a deficiency of fluid volume.
A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize?
Depressed deep tendons reflexes
A structure within the somite that produces large numbers of mesodermal cells that ultimately underlie the epidermis
Dermatome
The basement membrane surrounding each muscle fibre
Endomysium
At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with?
Hospitalization, tocolytic, and corticosteroids
Hormone produced in pregnancy that is made by the developing embryo after conception
Human chorionic gonadotrophin
The nursing instructor is pointing out the various complcations which can occur during pregnancy in women with diabetes mellitus. The instructor determines the session is successful after the students correctly choose which complication that can occur if the diabetes is not kept under control?
Hydramnios
Gland, tissue or organ that acts as the primary regulator of prolactin production in the adenohypophysis
Hypothalamus
The nurse is caring for a client with an ectopic pregnancy. Which symptom is a sign that the tube has ruptured?
Hypovolemic shock
The medial collateral ligament
Is attached to the medial meniscus
Hydrated molecule reducing friction at joints
Proteoglycans
Muscle group causing extension of the joint
Quadriceps group
The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema?
Redness of the skin produced by congestion of the capillaries
Forms a delicate fibre meshwork holding tissue elements together
Reticulin
Structure responsible for generating a segmental arrangement of peripheral nerves during development
Somite
A client has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help the client relax?
The client's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus. Anxiety out of control can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and have a negative impact on the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural. It is premature to be stern with the client. While it is preferable that she save her energy, it is not damaging to her or to the fetus if she does not sleep. pg464
A nonstress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which statement by the client indicates understanding of the test results?
The fetal heart rate increases with activity and indicates fetal well-being.
The pain of labor is influenced by many factors. What is one of these factors?
The woman is prepared for labor and birth.
An anatomical structure that derives from sclerotome tissue
Vertebra
Anatomical structure that develops from sclerotome tissue
Vertebra
• Ten days after delivery a client is diagnosed with mastitis. Which of the following would the nurse practitioner expect to find on physical examination?
b) Tender, hard, and reddened breast with increased temperature over the affected area.
A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause?
b. "How long have you been underweight?"
The three primary germ layers are
ectoderm, endoderm and mesoderm
A woman at 10 weeks gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?
fundal height measurement of 18 cm
what is abnormal complatin of the 3rd trimester of pregnancy
headache with blurred vision
HELLP syndrome stands for
hepatic dysfunction H-hemolysis EL-elevated liver enzymes LP-low platelet count
Place the following stages of labor in order from what occurs first to last. All options must be used.
latent stage active stage transition stage second stage third stage
The zone of polarizing activity is responsible for
patterning the limb along the cranio-caudal (anterior-posterior) axis
The thyroid gland
produces calcitonin in parafollicular cells
A symptom typically associated with hypothyroidism
slow pulse rate
Discomforts of pregnancy heartburn or pyrosis management
small meals, bend at knees
Goodell's sign
softening of the cervix
The extracellular storage molecule for thyroid hormone precursor in thyroid follicles
thyroglobulin
Exam & Labs for initial prenatal visit
• Pelvic exam & pap smear • blood type & antibody screen • Rubella & Hep B titer • GC, syphillis, HIV, Hep. C & gonorrhea/chlamydia screen • CBC • U/S • UDS
Discomforts of pregnancy breast tenderness management
wash with water only, no soap wear supportive maternity brassiere
Urinary Incontinence
• Range of treatments and procedures • Common surgical procedures include urethral sling, bladder sling, vaginal tape, collagen implants, retropubic suspension. • Most common is mid-urethral sling. • Know pre-op and post-op care: pain management, rest 6-8 weeks post-op, avoid heavy lifting, urinary catheterization • PREVENTION! No straining with urination/defecation, Kegel's, proper second stage management, healthy weight
Testing at 28-34 weeks
• RhoGAM • STI testing if indicated • newborn feeding discussion • administer Tdap
Sexuality: Psychosocial
• Roles , relationships, orientation, gender identity • Self-concept/ Cultural images and influence • Values/ cultural background • Coping & stress tolerance
The hormone that stimulates secretion by endometrial glands
progesterone
A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?
"I can understand your need to find an answer to what caused this. Let's talk about this further."
A woman's primary care provider has told her he wants to use an episiotomy for birth. She asks the nurse what the purpose of this is. Which answer would be best?
"It relieves pressure on the fetal head." An episiotomy widens the vaginal opening, decreasing pressure on the fetal head. pg 483
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?
"The analgesia will reduce the sensation of pain for a limited period of time."
During pregnancy the placenta produces oestrogens from which secretion of the fetal adrenal
Dihydroepiandrosterone
A hormone that stimulates the differentiation and growth of the male external gentialia
Dihydrotestosterone (DHT)
The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is:
1 cm above the ischial spines. Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and referred to as a minus or plus, depending on its location above or below the ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spine, it is recorded as plus stations. Therefore this fetus is 1 cm above the ischial spines. pg 431
A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?
a. Pregnancy test
A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?
Fats are essential during pregnancy, and vegetable oils are a good source.
A 3-year-old admitted to the hospital for pneumonia starts wetting the bed. The parents are visibly upset. Which action by the nurse is most appropriate?
Give reassurance that regression can happen when children are sick
A hormone produced by pancreatic alpha cells
Glucagon
A hormone secreted by cells in the islets of Langerhans, which stimulates glycogenolysis and gluconeogenesis in the liver
Glucagon
A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom?
Moderately strong contractions every 4 minutes, lasting about 1 minute
The skull is the most important factor in relation to the labor and birth processes. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible?
Molding
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?
Monitor the client's vital signs and bleeding.
The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?
Prepare the client for a cesarean birth.
A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client?
Administer IV NS with vitamins and electrolytes. The first choice for fluid replacement is generally NS with vitamins and electrolytes added. If the client does not improve after several days of bed rest, "gut rest," IV fluids, and antiemetics, then total parenteral nutrition or percutaneous endoscopic gastrostomy tube feeding is instituted to prevent malnutrition.
A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which prescription is the nurse most likely to receive regarding the therapy for such a client?
Administer cryoprecipitate and platelets.
The nurse is assessing a laboring client and notes: 5 cm dilated, 80% effaced, zero station, contractions every 2 to 3 minutes, lasting 50 seconds, becoming increasingly uncomfortable, and apprehensive but appropriate and focused on breathing and relaxation. The nurse determines which nursing diagnosis is most appropriate for this client?
Acute pain related to uterine contractions
The structure that acts as an organiser of laterality during embryogenesis is
Primitive node
The corpus luteum produces mainly
Progesterone
The stomach
Is derived from the foregut
The hormone which stimulates milk ejection
Oxytocin
Paralyse the extensors of the wrist and fingers if damaged
Radial nerve
The nurse is working with a client 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 client to be in right now?
latent phase 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 client may show fear and anger. During stage two she may remain positive, but the work of labor is very intense.
complaints that need follow up in first trimester
localized pain/redness to breast, fever, flu-like symptoms, masses, dimples, bloody discharge, changes in skin texture, or changes in breast or nipple size, shape, symmetry
A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion?
strong abdominal cramping Strong abdominal cramping is associated with an inevitable spontaneous abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.
Fundal Height Measurements: 16 weeks
• Uterus: 1/2 way b/t symphysis pubis & umbilicus • Quickening first noted; earlier with subsequent pregnancies; (18-20 weeks with first pregnancy)
Fundal Height: 10 weeks
• Uterus: baseball • FHT via doppler b/t 10-12 weeks
A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client?
observation for bleeding
Fundal height measurement: Term
• Uterus: fundal height drops r/t fetal head engagement • Vertex position in 95% of pregnancies by 36 weeks
A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?
push with contractions and rest between them
The nurse notes that the client has a moderate amount of bleeding after birth. Which instruction is anticipated to control bleeding?
put the newborn on the breast to suck
In he delivery room, the nurse places drops in the newborn's eyes. The nurse explains to the mother the drops
protect against infections that could lead to blindness
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?
deep tendons reflexes 2+
Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?
difficulty breathing
A woman with severe preeclampsia is receiving magnesium sulfate. The woman's serum magnesium level is 9.0 mEq/L. Which finding would the nurse most likely note?
diminished reflexes
Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?
episodes of double vision
During the health assessment of a pregnant client who is 30 years old, the nurse discusses preventive breast care. Which recommendation would the nurse include?
"A breast examination by a health care provider can help detect if there are any structural problems that may affect breastfeeding." Breast self-examination is no longer thought to yield enough reliable information to be continued as a monthly self-care routine, but women should be alerted to normal breast changes during pregnancy and about the responsibility to begin having mammograms when they reach 40-45 years of age. Clinical breast examination in women of average risk has not been shown to be effective in average risk women at any age. However, it may be helpful in identifying any anatomical issues with breastfeeding that may occur Confirm whether a woman has had a human papillomavirus (HPV) vaccine as many women are not yet aware the vaccine has the potential to not only prevent HPV infections but also prevent cervical cancer; it is not associated with breast cancer, however.
A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response?
"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Because of the risk of choriocarcinoma, the woman receives extensive treatment. Therapy includes baseline chest X-ray to detect lung metastasis physical exam including pelvic exam. Serum B-hCG levels weekly until negative results are obtained three consecutive times, then monthly for 6 to 12 months. The woman is cautioned to avoid pregnancy during this time because the increasing B-hCG levels associated with pregnancy would cause confusion as to whether cancer had developed. If after a year B-hCG seruim titers are within normal levels, a normal pregnancy can be achieved.
The nurse is assessing a pregnant client who has a long history of asthma. She states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response?
"Actually, having uncontrolled asthma is much riskier for your baby than the medication."
A woman who has had a cesarean birth asks you if she will always need to have cesarean births in the future. Which of the following would be your best response?
"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."
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 the client about the potential effects of smoking in pregnancy?
"Babies of women who smoke tend to weigh significantly less than other infants."
A client who has been in prolonged labor reports extreme back pain. She asks why her back hurts so much. What would be the best response by the nurse?
"Different fetal positions can cause prolonged labor and back pain."
Which is the best question the nurse can ask a woman who is leaving the hospital after experiencing a complete spontaneous abortion?
"Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" When a woman has a spontaneous abortion one important consideration is the emotional needs of the woman once she is home. She may not want to talk about the loss for a period of time, but the nurse needs to determine her support system for the future. Asking the woman if she is "going to try again" is an inappropriate question for the nurse to ask and diminishes the experience of having a spontaneous abortion. Giving the woman statistical information on spontaneous abortions is not appropriate when this client needs support and caring concern. Offering to give the client resources to aid in smoking cessation is not addressed in the scenario, so this is an inappropriate response.
A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states:
"Effleurage is light abdominal massage used to displace pain."
A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states:
"Effleurage is light abdominal massage used to displace pain." Effleurage is a light abdominal massage used to keep the laboring woman's focus on the massage instead of the pain of labor. pg 470
In light of the high incidence of some illnesses in women, which question is most important to include in a review of systems for a pregnant woman?
"Have you had any urinary tract infections?" Urinary tract infections occur at a greater incidence in pregnant women than in others because stasis of urine occurs because of pressure on the ureters; the trace of glucose often present in urine helps bacteria grow.
A nurse is assessing a pregnant woman in her last trimester. Which question would be most appropriate to use to gather information about weight gain and fluid retention?
"How swollen do your ankles appear before you go to bed?
A pregnant client is diagnosed with syphilis. Which interviewing question would demonstrate respect for the client and therapeutic communication?
"I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."
A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?
"I can understand your need to find an answer to what caused this. Let's talk about this further." Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.
Which statement by the pregnant woman shows an understanding that she should avoid teratogens in the first trimester?
"I have to call my doctor to switch me from lithium to another drug for my bipolar disorder. It is very important for women to avoid teratogens during the first-trimester period (weeks 2 to 8 after conception) because all major fetal organs are formed. Lithium, tetracycline, alcohol, and exposure to radiation all are considered teratogens. The only statement that reflects an understanding is Option D.
After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?
"I need to eat foods high in fiber."
A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?
"I respect your preference whether it is to have medication or not." Individualizing care to meet women's specific needs is a nursing responsibility. pg 464
The nurse is caring for a 10-year-old child dying of leukemia. The mother requests that the nurse allow her to bathe the child. The child has multiple IV lines, electrodes, oxygen tubing, and an NG tube. Which of the following is the best response by the nurse?
"I think that would be a great idea. Would you like some help with all the tubes?"
A nurse is talking to a newly pregnant woman who had a mitral valve replacement in the past. Which statement by the client reveals an understanding about the preexisting condition?
"I understand that my fetus and I both are at risk for complications."
A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching?
"I wear knee-highs rather than pantyhose."
After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful?
"I will be sure to avoid getting pregnant for at least 1 year."
Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate?
"I'm sorry you lost your baby."
Which statement by a pregnant client indicates the need for more teaching about preeclampsia?
"If I have changes in my vision, I will lie down and rest." Changes in the visual field may indicate the client has moved from preeclampsia to severe preeclampisa and is at risk for developing a seizure due to changes in cerebral blood flow. The client would require immediate assessment and intervention. The other options would not indicate that more teaching about preeclampsia is indicated.
A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?
"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.
A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give?
"It distracts your brain from the sensations of pain."
A pregnant client at 32 weeks' gestation calls the clinic and informs the nurse that she thinks her membranes are leaking. She states that some clear fluid has run down her leg. What is the best response by the nurse?
"It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid." The practitioner will perform a speculum examination, looking for pooling of amniotic fluid, and then test the fluid with nitrazine paper, which turns blue in the presence of amniotic fluid. Preterm premature rupture of membranes occurs when the rupture of the amniotic sac before the onset of labor happens in a woman who is less than 37 weeks' gestation.
The nurse is caring for a client in the transition phase of the labor process. Which client statement requires nursing action?
"My lips and fingers are tingling."
A woman who has just been admitted in labor indicates that her husband is parking the car and her doula is on her way. The nurse's best response would be:
"OK, let me ask you some personal questions before she arrives." Doulas are birth coaches who provide one-on-one support in labor and throughout birth. A nurse would want to ask the client any personal questions before the doula arrives because the primary purpose of the doula is to be a continuous presence. A doula does not take the place of a nurse.
Opioids are often used in labor for pharmacologic pain management. A client in the transition phase of labor is requesting fentanyl for pain. How should the nurse respond to her request?
"Pain medication given now might cause the baby to have slow respirations and is not recommended; let's try to focus and breathe." Once the woman has entered into the transition phase of labor, she is considered to be imminent for birth. Any opioid medication might pass to the fetus and is not recommended due to the effects of respiratory compromise. The nurse will need to encourage nonpharmacologic methods at this point and should not consult the provider. The nurse should also remain supportive of the mother.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placenta and placenta previa. Which statement should the nurse include in the teaching?
"Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless bright red bleeding in the third trimester. Abruptio placenta is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor.
The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents?
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?
"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."
A nurse is interviewing a primigravida woman about nutrition during pregnancy. During the interview, the woman asks the nurse about consuming caffeine. Which information would the nurse include when teaching the woman about caffeine intake during pregnancy? Select all that apply.
"Pregnant women should not consume more than 300 mg of caffeine a day. An 8 oz cup of coffee has approximately 120 mg of caffeine." "Although it includes significantly smaller amounts, chocolate also contains caffeine."
A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?
"Purse-string sutures are placed in the cervix to prevent it from dilating."
A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?
"Purse-string sutures are placed in the cervix to prevent it from dilating." The cerclage, or purse string suture is inserted into the cervix to prevent preterm cervical dilatation and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.
Nursing students are learning about the body's response to infection. Which of the following statements made by a student indicates an understanding of the job of pus in an infection?
"Pus indicates that phagocytosis is occurring."
A 16-year-old client gave birth to a 12 weeks' gestation fetus last week. The client has come to the office for follow-up and while waiting in an examination room notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology?
"Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." Abortion is a medical term for any interruption of a pregnancy before a fetus is viable, but it is better to speak of these early pregnancy losses as spontaneous abortions to avoid confusion with intentional terminations of pregnancies. The other responses are correct, but they do not provide the client with the most complete and reassuring answer.
A 6-year-old boy is scheduled to have surgery to repair a congenital defect in his heart in about a week. The parents tell the nurse that they are nervous about telling him about the surgery in advance because they fear that he will just worry about it. On the other hand, they also feel that they should prepare him mentally for the surgery. Which of the following should the nurse recommend to the parents?
"Tell him about the surgery about 6 days ahead of time so that he knows what to expect; at his age that would be best."
A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?
"The injection is given in the space outside the spinal cord." An epidural block, as the name implies, does not enter the spinal cord but only the epidural space outside the cord.pg 474
The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out zero station refers to which sign?
"The presenting part is at the true pelvis and is engaged."
A client is having a routine prenatal visit and asks the nurse what the birth education teacher meant when she used the term zero station. What is the best response by the nurse?
"The presenting part is at the true pelvis and is engaged." Zero station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus.
A woman at 41 weeks' gestation is progressing well in labor; however, the nurse notes the amniotic fluid is greenish in color. When questioned by the client for the reason for this, which explanation should the nurse provide?
"This is meconium-stained fluid from the baby."
A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best?
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions?
"We need to make sure that he washes his hands frequently."
A 43-year-old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is an appropriate first response?
"Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself."
The nurse is preparing a 4-year-old patient for surgery. According to hospital policy, the surgical site must be marked prior to entering the operating room. The patient shies away from the nurse when approached with a black marker. Which is the best approach for the nurse to take?
"Would you like your mother or me to draw a smiley face on your arm?"
A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding her progress?
"You are still 2 cm dilated, but the cervix is thinning out nicely." Women are anxious to have frequent reports during labor, to reassure them everything is progressing well. If giving a progress report, the nurse should remember most women are aware of the word dilatation but not effacement. Therefore, just saying, "no further dilatation" is a depressing report. "You're not dilated a lot more, but a lot of thinning is happening, and that's just as important" is the same report given in a positive manner.
When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?
"You have no trouble walking around and using the bathroom after you receive the epidural."
A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse?
"You should wait until after you give birth to obtain the cat for your daughter."
The nurse is caring for a 12-year-old patient with neuroblastoma. The nurse enters the room to hang a new bag of IV fluid. The mom looks up and states she feels helpless and there is nothing she can do for her child. Which of the following is the best response for the nurse to make?
"Your presence here is very important to your child. Is there some part of his daily care that you would like to do yourself?"
A nurse is caring for a pregnant client with eclamptic seizure. Which is a characteristic of eclampsia?
Coma occurs after seizure. The nurse should know that coma usually follows an eclamptic seizure. Muscle rigidity occurs after facial twitching. Respirations do not become rapid during the seizure; they cease. Coma usually follows the seizure activity, with respiration resuming.
The branches of the descending aorta formed by its bifurcation
Common iliac
Prevent the foot from being everted
Common peroneal nerve
A glycoprotein hormone that acts on Sertoli cells to initiate and maintain spermatogenesis
FSH
The major mechanism of action of thyroid hormones is via
Intracellular receptors that directly control gene transcription
The broad ligament of the uterus
Is a fold of peritoneum which extends laterally from the body of the uterus and hangs down over the uterine tubes
Presumptive/Subjective S/S of pregnancy
1) Amenorrhea 2) n/v 3) excessive fatigue 4) urinary frequency 5) Breast changes 6) Quickening 7) ^ pigmentation of skin & abd striae
The jejunum
Is attached to the posterior abdominal wall by a mesentery
Concerning the anatomy and vasculature of the adult testis
Is attached to the posterior wall of the scrotal sac
Innervation of knee extensors
Is derived from L 2, 3, 4 spinal nerves
In the endocrine pancreas
Islets of Langerhans are mostly located in the body of the pancreas
To give birth to her infant, a woman is asked to push with contractions. Which pushing technique is the most effective and safest?
head elevated, grasping knees, breathing out 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.
Concerning the thyroid gland
it produces and stores thyroglobulin extracellularly
There are advantages and disadvantages to any kind of method used to control pain during labor and birth. What is an advantage of opioid administration?
It has the ability to be administered by the nurse Opioids are most frequently given by the intravenous (IV) route because this route provides fast onset and more consistent drug levels than do the subcutaneous or intramuscular routes.
Assessment of Female Reproductive System
Menstrual history • Menarche, menopause, duration, flow Sexual history • STI, pelvic infections, Pap smear, HPV vaccine Contraception (PRN) Obstetrical history (GPTAL) PMHx (GYN) • Surgical: D&C, C-section, tubal ligation, cystocele/ rectocele repair, TAH-BSO, surgical abortion
The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?
Meperidine
A child is diagnosed with giardiasis. The physician prescribes medication to treat the infection. Which of the following would the nurse anticipate being prescribed?
Metronidazole
Human embryos inherit the DNA in this organelle almost exclusively from their mother
Mitochondria
The valve between the left atrium and left ventricle
Mitral valve
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?
Assess amount of cervical dilation. If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation. Hydration status is monitored as part of the physical examination. A urine specimen is obtained for urinalysis to obtain a baseline. Vital signs are monitored frequently throughout the maternal assessment. pg 451
The nurse identifies a nursing diagnosis of risk for injury related to possible effects of oxytocin therapy. Which action would the nurse perform to ensure a positive outcome for the client?
Assess contractions by using external monitor.
The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering?
Assess fetal heart rate.
A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient?
Assess fetal heart sounds with an external monitor.
A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?
Assess for labor progression
A delivery room nurse notes that after the provider attempts to remove the placenta, a ball of tissue appears in the woman's vagina accompanied by massive amount of gushing blood. Immediately the woman's vital signs reveal: BP 70/48, pulse rate 150, mucous membranes are pale. Which interventions should be the priority for the delivery room nurse? Select all that apply.
Apply oxygen mask at 10 L/min. Discontinue the IV oxytocin infusion.
Extensors of the knee joint
Are located in the anterior compartment of the thigh
Biliary canaliculi
Are situated between adjacent hepatocytes
The structure in the kidney through which most water is reabsorbed
Ascending loop of Henle
Which initial interview technique would be least effective in gathering information from a suspected abuse victim?
Ask the client to strip down and show you where she has been hurt.
The nurse should initially implement which intervention when a nulliparous woman telephones the hospital to report that she is in labor?
Ask the woman to describe why she believes that she is in labor. The nurse needs further information to assist in determining if the woman is in true or false labor. She will need to ask the client questions to seek further assessment and triage information. Having her wait until membranes rupture may be dangerous, as she may give birth before reaching the hospital. She should continue fluid intake until it is determined whether or not she is in labor. She may be in false labor, and more information should be obtained before she is brought to the hospital. pg 424
When interviewing a pregnant woman, how can the nurse best assess the patient's dietary intake?
Ask the woman to recall what she ate in the last 24 hours.
A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?
Assess for labor progression. Performing breathing exercises, ambulating, changing position, and emptying the bladder all can help the client experience a reduction in pain. However, the best first step is to assess the client for labor progress before assisting her otherwise. Bearing down can be a sign that the client is 10 cm dilated. pg 451
The registered nurse has identified that the client's labor progress has slowed. Which nursing intervention, done by the practical nurse, is completed first?
Assess if the bladder is distended
A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?
Assess the client's vital signs.
A client has just received combined spinal epidural. Which nursing assessment should be performed first?
Assess vital signs
A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?
Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask
A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?
Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.
A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels light-headed and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?
Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask. In a pregnant woman, hypotension is best managed in the left lateral or semi-Fowler's position owing to risk of supine hypotension in the supine position and in Trendelenburg's position. The sitting position could exacerbate hypotension. Naloxone is administered for respiratory depression. When the mother experiences a change in vital signs, this may affect the fetal heart rate.
Cell type which contain vasoactive substances including histamine
Basophils
Cell type which contains vasoactive substances including histamine
Basophils
Which nursing intervention is appropriate when preparing a woman for an amniocentesis?
Be certain she knows that there are risks of complication, such as premature labor, from amniocentesis.
The nurse is completing an admission assessment on a patient in an acute care setting. Which of the following approaches is the most effective for the nurse?
Be certain the parents are present during the admission assessment.
Which statement is true regarding sexual activity and pregnancy?
Because of pelvic congestion, women may experience increased clitoral sensitivity.
Which documentation in the health record is most correct for the third stage of labor?
Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta
The endocrine pancreas
Beta cells contain secretory granules which are released by exocytosis in response to raised plasma glucose
A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident?
Black cohosh
The one event that does NOT normally occur at birth or shortly afterwards
Blood begins to flow from the left side of the heart to the right side
A client states, "I think my water broke! I felt this gush of fluid between my legs." The nurse tests the fluid with a nitrazine swab and confirms membrane rupture if the swab turns:
Blue
A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse?
Both parents have to carry the trait.
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?
Braxton Hicks contractions usually decrease in intensity with walking. 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. pg 423
A cell that links to its neighbours by structures called intercalated discs
Cardiomyocyte
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?
Cervix
During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam?
Chadwick's sign During the speculum examination, the practitioner obtains a Papanicolaou test or Pap smear and notes signs of pregnancy, such as Chadwick's sign.
A nurse is monitoring the FHR of a client in labor using an electronic fetal monitor. The reading shows a late deceleration. Which intervention should the nurse implement?
Change maternal position to an upright or side lying position. To intervene with late decelerations, the nurse should change maternal position to an upright or side lying posture. Late deceleration in the fetus indicates insufficient uteroplacental perfusion. Changing the maternal position improves the maternal venous return. In upright position, the uterine activity becomes more efficient. Attempts should be made to increase the uteroplacental perfusion and fetal circulation. Administering oxytocin and encouraging Valsalva maneuver (extended breath holding) may augment the uteroplacental insufficiency. In late deceleration, the nurse should administer oxygen through nasal cannula and discontinue administration of oxytocin. Placing the client in the lithotomy position contributes to poor placental circulation pg 463
The laboring client is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention?
Change the position of the client. Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression. If this does not work, apply oxygen while using the call light to alert others. If this continues, her fluid status needs to be assessed before increasing her IV rate. pg 460
The nurse is caring for a pt immediately after a normal vaginal delivery, what action should the nurse take FIRST?
Check lochial flow- must directly check for hemorrhage, inspection is the first step of physical assessment!
The nurse is caring for a 2-year-old boy who has been admitted to the hospital. Which of the following should she do to ensure a safe environment for this child?
Check that side rails of the boy's crib are in good repair and raised
The nurse is assessing a woman in active labor. She notes a small mass above the symphysis pubis, rounded, distended, and nontender. What intervention should the nurse take next?
Check the chart for the last void. The most probable explanation of the mass is the bladder, which is full. The nurse should determine the last void by the client and offer to assist the client to void or prepare to catheterize the client to empty the bladder. This can be taken care of by the nurse. The client would not likely know if the mass was always present or not, given its location. If it were the uterus, it would be tender to the touch. pg 486
The Nurse instructs a pregnant woman with gestational diabetes about her diet. The nurse determines that teaching is effective if the client selects what dessert?
Cheese and fresh fruit (contains appropriate nutrients for calories ingested)
A woman at 32 weeks' gestation just experienced rupture of her membranes. She asks the nurse what could cause this to happen and the nurse's explanation would include which risk factors? Select all that apply.
Cigarette smoking Multifetal pregnancies Amniocentesis
A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class?
Class III
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
Clear to straw-colored fluid
The nurse is preparing a birthing care plan for a pregnant client. Which factor should the nurse prioritize to achieve adequate pain relief during the birthing process?
Client priorities and preferences are incorporated into the plan.
The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?
Pain originates from the cervix and lower uterine segment.
Part of the small intestinal tract into which pancreatic enzymes are first released
Descending (2nd) part of the duodenum
A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first?
Determine if the client is in true or false labor. When a nurse first comes in contact with a pregnant client, it is important to first ascertain whether the woman is in true or false labor. Information regarding the number of pregnancies or history of drug allergy is not important criteria for admitting the client. The healthcare provider should be notified once the nurse knows the client's current status. pg 478
A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia?
Diabetes
A nursing instructor is teaching students about childhood infectious diseases. Which of the following would the instructor identify as the cause of warts in children?
Papilloma virus
The client is in the second stage of labor and is at 2+ station and in anticipation of birth within the hour. Her epidural did not work, and she is begging for meperidine. Which is the most appropriate action by the nurse?
Encourage her through the contractions, and explain why she is not receiving the meperidine. 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 client has progressed too far to retry the epidural medication. No meperidine should be given due to the risk to the fetus.
A young woman recently gave birth to a healthy 7 lb, 6 oz (3,304 g) baby girl. There were no complications during the birth, and the mother appears to be well. Which of the following should the nurse do to assess this client's psychological state after the pregnancy?
Encourage the client to talk about her birthing experience with the nurse and others.
The nurse cares for a patient in labor. The patient suddenly shouts, "I have to push! I have to push!" The nurse determines that the patient is 8 cm dilated. Which of the following actions should the nurse take first?
Encourage the patient to pant with pursed lips.
The nurse working on a pediatric floor understands the importance of promoting growth and development in all hospitalized patients. Which of the following activities would be an example of encouraging initiative in preschoolers?
Encouraging them to color in a medication schedule
The embryonic layer from which the stomach epithelium is derived
Endoderm
The germ layer or germ layer derivative that gives rise to the epithelial inner lining of the gut
Endoderm
The germ layer or germ layer derivative that gives rise to the epithelial lining of the gut
Endoderm
During an unfertilised menstrual cycle
Endometrial growth involves both hyperplasia and hypertrophy
Glomerulus
Endothelial basement membrane covered with podocyte foot processes
The site where spermatozoa mature and gain the ability to swim forwards
Epididymis
The hormone mainly responsible for the proliferative phase of the uterine cycle
Estradiol
How often are prenatal visits until 28 wks?
Every 4 weeks
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?
Excessive vomiting
A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?
Exercise
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 instructions should the nurse give to the client? Select all that apply.
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.
Epithelium of the bladder
Expanding epithelium with luminal membrane rich in glycoproteins
Epithelium of bladder
Expanding epithelium with multiple vesicles below a luminal membrane rich in glycoproteins
The nurse assesses that the fetus of a woman is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment?
Experience of additional back pain
The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called?
External version
A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority?
FHR When membranes rupture, the priority focus should be on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. Prolonged rupture can lead to an infection. Assessing the fetal position and maternal comfort are important but should not be the primary focus.
Tissue that gives rise to the somites
Paraxial mesoderm
The nursing instructor is illustrating the various positions the fetus may utilize during the passage through the vaginal canal at birth. The instructor determines the session is successful when the students correctly identify the ROA position, indicating which presentation by the fetus?
Facing the right anterior pelvic quadrant
Blood normally flows from deep to superficial in the communicating veins
False
Insulin is the hormone that protects the body from hypoglycaemia
False
Kupffer cells are liver-specific stem cells
False
Lymph from the ovary drains primarily to internal iliac nodes
False
Sensory deprivation occurs when children receive more stimulation than they can tolerate or process.
False
The arterial supply of the trachea comes from the pulmonary circulation
False
The epithelium of the trachea is stratified squamous
False
The femoral vein lies lateral to the femoral artery as it passes beneath the inguinal ligament
False
The inferior constrictor muscle of the pharynx is attached to the mandible
False
The nurse should encourage a pregnant client who is taking short-acting insulin for her diabetes to avoid eating after self-administering the insulin.
False
The trachea bifurcates at the level of the 10th thoracic vertebra
False
The trachea has complete rings of cartilage strengthening its walls
False
Thyroxine (T4) is stored in dense-cored granules in thyroid follicular cells
False
Tri-iodothyronine (T3) acts primarily via G-protein coupled plasma membrane receptors
False
A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?
Fats are essential during pregnancy, and vegetable oils are a good source. Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.
A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication?
Fetal malnutrition
The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned?
Fetal position
The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next?
Fetal status
A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The mother informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The physician diagnoses the child with erythema infectiosum. The nurse tells the mother that this is also known as:
Fifth disease
Which vitamin is essential for the mother to consume daily to help prevent birth anomalies such as neural tube defects in a developing fetus?
Folic acid
The pulmonary trunk
Passes upward anterior to the ascending aorta
Eosinophil granulocytes
Form less than 5% of all leukocytes
Platelets
Form plugs at breaks in blood vessel wall
Concerning the development of the male reproductive system
Formation of the vas deferens requires the presence of testosterone
A structure normally located within the interatrial septum in the adult heart
Fossa ovalis
Activation of directional motility in spermatozoa requires
Fructose from the vas deferens
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?
Further testing will be required to confirm any diagnosis. Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.
A client has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history?
G3, P2
A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart?
G5 P3114
A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How does the nurse record her obstetric history on the chart using the GTPAL format?
G5 T2 P1 A1 L3 One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for preterm, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation. "L" is for living, the number of children delivered who are alive at the time of history collection.
A nurse is caring for a pregnant client whose fetus has been diagnosed with macrosomia. When reviewing the client's history, which information would the nurse expect to find?
Gestational diabetes
A woman who is obese comes to the clinic because she thinks that she is pregnant. The pregnancy is confirmed. The nurse is developing a teaching plan for this woman about pregnancy and challenges associated with it related to obesity. The nurse would most likely plan to address which condition as being an increased risk?
Gestational diabetes Large for gestational age (LGA) infant Difficult vaginal delivery
A nurse caring for a hospitalized 3 week old finds the infant's name band on the floor. Which is the nurse's best action?
Get two more name bands and place one on the infant's arm and the other on the infant's leg.
The nurse caring for children with fungal infections most often administers which of the following medications?
Griseofulvin
The nurse notices that the 6-year-old sibling of a hospitalized child has a runny nose and is coughing. What action should be taken by the nurse?
Perform a screening for communicable diseases
A patient who has been in labor for 20 hours is being prepared for an emergent cesarean birth. Which action will help ensure the patient's fluid status during the procedure?
IV fluid therapy
In providing culturally competent care to a laboring woman, which is a priority?
Identify how the client expresses labor pain
In providing culturally competent care to a laboring woman, which is a priority?
Identify how the client expresses labor pain.
A part in which Peyer's patches are a prominent feature of the wall
Ileum
A nuse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply.
Individualized assessment Counseling Teaching Nurses contribute to the success of prenatal care through individualized assessment, counseling, and educating. Assistance with social coordination and authoritarian decision making are not associated with successful prenatal care.
A 25 year old primigravida dx with type 1 diabetes mellitus reviews insulin regimen with the nurse. The nurse reinforces the importance of regular prenatal care and explains changes in insulin requirements will include what?
Insulin requirements will INCREASE during pregnancy and DECREASE after delivery.
The period of the mitotic cell cycle that includes all stages except mitosis
Interphase
A tissue that is maintained by continuous division of stem cells
Intestinal epithelium
Cortisol stimulates protein catabolism via actions at
Intracellular receptors that control gene transcription
A pregnant client is admitted to a maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which to be an advantage of adopting a kneeling position during labor?
It helps to rotate fetus in a posterior position. The advantage of adopting a kneeling position during labor is that it helps to rotate the fetus in a posterior position. Facilitating vaginal examinations, facilitating external belt adjustment, and helping the woman in labor to save energy are advantages of the back-lying maternal position.
Why is a Papanicolaou smear done at the first prenatal visit?
It identifies abnormal cervical cells.
A woman calls the obstetrician's office to inquire how long she needs to wait to get pregnant following a seizure she had last week. The nurse would tell her to wait how long?
It is recommended that she wait 6 months after seizures are under control before getting pregnant.
A patient recovering from an uneventful vaginal delivery is prescribed Rho(D) immune globulin (RhIG). What should the nurse explain to the patient regarding the purpose of this medication?
It prevents maternal D antibody formation.
The nurse is preparing to assist with a pudendal block. The nurse predicts the client is at which point in the labor process?
Just before birth
The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?
Keep the suction equipment readily available. The nurse should institute and maintain seizure precautions such as padding the side rails and having oxygen, suction equipment, and call light readily available to protect the client from injury. The nurse should provide a quiet, darkened room to stabilize the client. The nurse should maintain the client on complete bed rest in the left lateral lying position and not in a supine position. Keeping the head of the bed slightly elevated will not help maintain seizure precautions.
Specialised intermediate filament found cross-linked in the cornified cell layer
Keratin
An anatomical structure that derives from intermediate mesoderm
Kidney
Gland, tissue or organ that is directly affected by aldosterone
Kidney
Gland, tissue or organ that is directly affected by vasopressin (ADH)
Kidney
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?
Knee-chest
The appearance of which hallmark clinical manifestation occurs in measles?
Koplik spots
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
Left lower quadrant
The chamber that forms most of the left radiographic margin of the heart
Left ventricle
A nurse is assisting a client in active labor whose diabetes has been poorly controlled. Which assessment of the neonate should be prioritize after its birth?
Macrosomia
The nurse is preparing information for a client who has just been diagnosed with gestational diabetes. Which instruction should the nurse prioritize in this information?
Maintain a daily blood glucose log
The nurse is caring for a 6-month-old patient who has been hospitalized since birth. Which of the following nursing interventions is the most beneficial to this patient's psychosocial health?
Maintain consistent caregivers to promote trust and attachment.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?
Maintain tolerable intensity of exercise.
A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office?
Make a follow-up appointment.
A tumour which grows by invasion and metastasis
Malignant
A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize?
Maternal hypotension and fetal bradycardia
While discussing labor with a client and her partner, the nurse is asked what the best position is for giving birth to the baby. The nurse provides them with information that indicates research has shown which position as the best?
Maternal positioning during labor has only recently been the subject of well-controlled research. Scientific evidence has shown that nonmoving, back-lying positions during labor are not healthy. Women should be encouraged to assume any position of comfort for them pg 434
Concerning spermatogenesis - stimulatory hormones
Maturation of spermatids to spermatozoa requires the presence of testosterone
Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia?
McRoberts maneuver
The nurse is admitting a client in early labor and notes: FHR 120 bpm, blood pressure 126/84 mm Hg, temperature 98.8oF, contractions every 4 to 5 minutes lasting 30 seconds, and greenish-color fluid in the vaginal vault. Which finding should the nurse prioritize?
Meconium in the fluid
Which of the following would be a danger signal of labor for a woman in labor?
Meconium-stained amniotic fluid
The nerve supplying the major part of the palmar surface of the hand and fingers
Median nerve
Part of the interventricular septum commonly involved in a ventricular septal defect
Membraneous part of septum
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?
Monitor the client's vital signs and bleeding. A nurse should closely monitor the client's vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture. Beta-hCG level is monitored to diagnose an ectopic pregnancy or impending abortion. Monitoring the mass with transvaginal ultrasound and determining the size of the mass are done for diagnosing an ectopic pregnancy. Monitoring the FHR does not help to identify hypovolemic shock.
A woman has been in labor for the past 8 hours and she has progressed to the second stage of labor. However, after 2 hours with no further descent the provider diagnoses an "arrested descent." The woman asks, "Why is this happening." Which response by the nurse is the best answer to this question?
More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal.
A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition?
Mumps
A 7-year-old with an earache comes to the clinic. The child's mother reports that 1 day ago her child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis to be for this child?
Mumps
A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease?
Mumps
Muscle/muscle group producing flexion of the elbow
Muscles in the anterior compartment of the arm
The nerve innervating muscles in the anterior compartment of the arm
Musculo-cutaneous nerve
At the elbow joint, the principal flexor muscles are supplied by
Musculocutaneous nerve
The nurse intructs a group of expectant mothers about the advantages of breastfeeding. The nurse should intervene if an expectant mother makes which of the following statements?
My baby will grow faster and sleep more with breast milk.
A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication?
Naloxone
A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next?
Neck
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks?
Neonatal depression is possible. General anesthesia is not used frequently in obstetrics because of the risks involved. The pregnant woman is at higher risk for aspiration. It requires more skill to intubate a pregnant woman because of physiologic changes in the trachea and thorax. In addition, general anesthetic agents cross the placenta and can result in the birth of a severely depressed neonate who requires full resuscitation. pg 476
The germ layer or germ layer derivative that gives rise to melanocytes of the skin
Neural crest
Tissue that gives rise to enteric ganglia
Neural crest
Women who are obese in pregnancy are at higher risk for developing all of the following EXCEPT
Neural tube defects
The cell type which is increased in number in acute bacterial infection
Neutrophils
A nurse is trying to maintain the healthy nutritional intake of a 7-year-old girl who has been admitted to the hospital for surgery. Which of the following should the nurse do encourage proper fluid intake in this child?
Offer the child popsicles
A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time?
Offer to take pictures and footprints of the infant once it is delivered.
The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement?
Orange juice
A multinucleate cell that can resorb extracellular matrix to remodel the tissue in which it resides
Osteoclast
The nutritional needs of an adolescent pregnant patient are unique because
Owing to typical food choices, an adolescent is often lacking calcium, iron, and folic acid in the diet
A nurse is educating a group of nursing students about the etiology of labor. Which of the following should the nurse explain as the hormone produced by the posterior pituitary?
Oxytocin
The nerve(s) innervating the diaphragm
Phrenic nerves
A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?
Physiological anemia
The atrio-ventricular bundle (of His)
Pierces the fibrous skeleton which separates the atria from the ventricles
The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss?
Placental abruption
A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client?
Placental dysfunction
A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply.
Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines. Let the physician know if you become short of breath or have a nighttime cough.
The developmental potential of intestinal stem cells
Pluripotent
When going through the transition phase of labor, women often feel out of control. What do women in the transition phase of labor need the most?
Positive reinforcement
A nursing instructor is teaching students about high-risk pregnancies. Some circumstances that may cause a pregnancy to be labeled as high-risk include which of the following? (Select all that apply.)
Poverty Lack of support people Genetic inheritance Past history of pregnancy complications
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?
Practicing effleurage on the abdomen
Secretion of catecholamines from the adrenal medulla is stimulated by
Preganglionic sympathetic nerves
A nurse is conducting a class for a group of pregnant women about nutritional needs during pregnancy. Which statement would the nurse include when describing a woman's mineral needs in pregnancy?
Pregnant women should drink fluoridated water.
A 24-year-old primigravida has been laboring longer than 24 hours. She has entered the second stage of labor, and the baby is at +2 station. The fetal heart rate has been 90 bpm for the last 2 minutes. The physician applies a Kiwi vacuum; after 3 attempts (pop-offs), the baby is not delivered, and the fetal heart rate is still 90 bpm. What should the nurse do next? Choose the best answer.
Prepare for an emergency cesarean delivery
The nurse is admitting a client in labor. The care provider determines that the fetus is in a transverse lie and not responsive to Leopold maneuvers. What intervention should the nurse provide for the client?
Prepare the client for a cesarean birth.
The nurse is assessing a multipara woman who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifiying the RN and primary care provider, which action should the LPN prioritize?
Prepare to assist with external version
A 17-year-old primigravida with type 1 diabetes is at 37 weeks gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next?
Preparing for amniocentesis and fetal lung maturity assessment
The parents of a preterm infant visit the infant in the newborn nursery. They see their infant resting comfortably in the isolette and express concern about disturbing the baby. What would be the best response by the nurse?
Preterm infants need to develop a sense of trust and security and holding the infant promotes this.
The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?
Preventing spread of infection
During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factor would the nurse identify as increasing the woman's risk? Select all that apply.
Previous history of spontaneous abortion Maternal obesity with body mass index more than 35
A Structure within the epiblast where key invagination movements of gastrulation take place
Primitive streak
A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dL?
Provide the client some milk to drink.
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this?
Pulmonary edema
The seminal vesicles
Produce nutrients for the spermatozoa
The thyroid gland
Produces mainly the metabolically inactive hormone thyroxine (T4)
A hormone that promotes development of breast alveoli and milk production
Prolactin
The main hormone which stimulates synthesis of milk
Prolactin
The only hormone produced by the adenohypophysis whose control is principally through inhibition by the hypothalamus
Prolactin
During male reproductive development, testosterone
Promotes development of the mesonephric (Wolffian) duct system into genital ducts including the vas deferens
The stage when chromatids 'cross-over' during meiosis
Prophase I of meiosis
The phase of meiosis when homologous chromosomes combine
Prophase of meiosis 1
The phase of meiosis when homologous chromosomes recombine
Prophase of meiosis 1
Phospholipid-derived hormone present in seminal fluid
Prostaglandin
Hormones that act locally, are lipid-soluble and produced enzymatically from membrane lipids
Prostaglandins
A client the nurse cares for in labor asks what causes labor to begin. Which statement is a possible explanation?
Prostaglandins may be the causative factor of labor. The cause of labor is unknown, but prostaglandin release is theoretically one of the possible causes for onset of labor. It is unknown whether progesterone, estrogen, or calcium have any effect on labor.
A young hospitalized patient whose parents have just left for a few hours begins to cry uncontrollably, thrashes about, and will not allow the nurse to provide comfort. This patient is exhibiting which stage of separation anxiety?
Protest
A nurse is caring for an infant who has been admitted the hospital for surgery. Which of the following interventions should the nurse implement to ensure the continued growth and development of the infant during his stay?
Provide a singular room for the child and family in the neonatal intensive care unit
A school-aged child is scheduled for surgery. Which of the following would be most helpful to reduce stress and anxiety?
Provide a tour of the surgery unit and allow the child to see hear and feel equipment that will be used during his stay
A woman in labor at the hospital has just received an epidural block. Which intervention is a priority before and during epidural placement?
Provide adequate IV fluids to maintain her blood pressure. The client 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 primary care provider as to when to administer medication. Bradycardia is not a common side effect of epidural medication. pg 474
When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one?
Provide knowledge and skills to actively participate in birth and parenting.
The nurse cares for a client dx with cervical cancer. the nurse notes that the client appears to have a poor appetite. What intervention by the nurse would be best?
Provide small, frequent feedings
A nurse is assigned the task of educating a pregnant client about birth. Which nursing interventions should the nurse perform as a part of prenatal education for the client to ensure a positive birth experience? Select all that apply.
Provide the client clear information on procedures involved. Encourage the client to have a sense of mastery and self-control. Encourage the client to have a positive reaction to pregnancy. To ensure a positive birth experience for the client, the nurse should provide the client clear information on procedures involved, encourage the client to have a sense of mastery and self-control, and encourage the client to have a positive reaction to pregnancy. Instructing the client to spend some time alone is not an appropriate intervention; instead, the nurse should instruct the client to obtain positive support and avoid being alone. The client does not need to change the home environment; this does not ensure a positive birth experience.
A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?
Push with contractions and rest between them. Make sure the woman pushes with contractions and rests between them. Holding the breath during a contraction could cause a Valsalva maneuver or temporarily impede blood return to her heart because of increased intrathoracic pressure, which could then also interfere with blood supply to the uterus. It is important for women to understand they should not bear down with their abdominal muscles to push until the cervix is fully dilated, which is 10 cm, not 8 cm. Panting limits the ability to push and is to be encouraged only when it is desirable to delay labor, such as when a nuchal cord is present.
A 23-year-old client who's 27 weeks pregnant arrives at her physician's office with complaints of fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. Which condition would the nurse most likely suspect?
Pyelonephritis
Muscle group causing extension of the knee joint
Quadriceps group
A 32-year-old woman presents to the labor and birth 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?
ROA The nurse should document the fetal position in the clinical record using abbreviations. 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. page 431
The nerve innervating muscles in the posterior compartment of the forearm
Radial nerve
The nerve supplying the major part of the dorsal surface of the hand and fingers
Radial nerve
A pregnant woman comes to the emergency department stating she thinks she is in labor. Which assessment finding concerning the pain will the nurse interpret as confirmation that this client is in true labor?
Radiates from the back to the front
A nurse is completing a dressing change on a 5-month-old in a crib in the procedure room. The wrap needed to complete the care is just outside of arm's reach. What action should the nurse take?
Raise the side rail, then gather the needed supply
The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2020 related to women in labor?
Reduce the rate of cesarean births among low-risk births. Healthy People 2020 has two goals related to cesarean births in the United States. They are to reduce the rate of cesarean births among low-risk women and reduce the rate of cesarean births among women who have had a prior cesarean birth. Immunizations and genetic counseling are not associated with women in labor.
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 1, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity?
Reflexes
A nurse is teaching a group of pregnant women who are in their first trimester about nutrition during pregnancy. When describing the caloric needs, which information would the nurse incorporate into the teaching plan? Select all that apply.
Regardless of weight or BMI, a woman should never consume less than 1500 calories a day. Recommended total caloric intake in pregnancy is 2500 or 3000 calories a day. It is better to obtain calories from complex carbohydrates (cereals and grains) than from simple carbohydrates (sugars and fruits). The best approach in evaluating a woman's caloric intake is to evaluate the weight that she is gaining.
What information should be included in the teaching plan for a child with varicella?
Remind the child not to scratch the lesions.
A client, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs the nurse of frequent low back pain and ankle edema by the end of the day. What interventions should the nurse suggest to relieve these discomforts?
Rest when possible with feet elevated at or above the heart.
When teaching a group of nursing students about uterine contractions, which of the following would the instructor include as a typical feature?
Retracting of the lower segment The nurse should identify retraction of the lower segment of the uterus as a feature of typical uterine contractions. As labor progresses the uterine contractions become stronger. The upper segment of the uterus contracts more actively than the lower segment. The lower segment retracts, pulling up the cervix. The upper segment thickens with time and the lower segment thins.
A nurse is working as part of a community group focusing efforts on preventing isoimmunization during pregnancy at the local women's health clinic. Which measure would the group encourage?
Rho(D) immune globulin administration to Rh-negative women Rh incompatibility can be prevented with the use of Rho(D) immune globulin. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios not isoimmunization. Cerclage is a treatment for cervical insufficiency.
A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?
Rho(D) immune globulin administration to Rh-negative women Rh incompatibility can be prevented with the use of Rho(D) immune globulin. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios, not isoimmunization. Cerclage is a treatment for cervical insufficiency.
A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin?
STIs Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.
A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102° F (38.9° C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?
Scarlet fever
A cell type which derives from the neural crest
Schwann cells
A patient comes to the birthing suite and informs the nurse that "the baby is coming" and "I feel like I have to have a bowel movement." It is likely that the woman is which of the following stages of labor?
Second stage
The nurse is correct to identify which psychological factor that often causes sleep deprivation while the client is in an acute care setting?
Separation anxiety
The structure that forms a first incomplete barrier between the left and right atria
Septum primum
A patient is concerned about the mercury levels in fish and asks the nurse which fish are safe to eat. The best response is
Shrimp, canned tuna, pollack, and catfish
Which physical characteristic of the neonate is typically present in the neonate of a primigravid mother?
Significant head molding
The type of epithelium found lining the jejunum
Simple columnar epithelium with numerous microvilli
Post-Mastectomy Breast Reconstruction
Simplest Method: implants inserted into skin pocket created by surgeon; tissue expanders may be used to expand skin prior to implant TRAM (transverse rectus abdominis muscle) Flap: • "tummy tuck" • -abdominal muscle & fat tunneled under abdominal skin to mastectomy site Latissimus Dorsi Muscle Flap: • use large muscle under scapula; tunneled under axilla & rotated over mastectomy site • *Indication: inadequate skin is available at mastectomy site.
Tissue which is responsible for generating the segmental pattern of peripheral nerves
Somites
Concerning reproductive function
Spermatozoa motility requires fructose from the seminal vesicles
Prevent the arm being lifted above the head if damaged
Spinal accessory nerve
Cause anaesthesia of the anterior abdominal wall and lower limbs if damaged
Spinal cord at T6 level
Forms in the truncus arteriosus separating the future aorta and pulmonary artery
Spiral septum
The nurse is monitoring a pregnant patient who is receiving intravenous magnesium sulfate for eclampsia. During the last assessment, the nurse was unable to elicit a patellar reflex. What should the nurse do?
Stop the current infusion.
A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate?
Stop the infusion immediately.
The type of epithelium found in the oesophagus
Stratified squamous epithelium, non-keratinised
Surgical Management of Breast Disease Therapeutic Management
Surgery • Lumpectomy • Mastectomy • Breast conservation, limited lymph node removal Preoperative teaching • Basic preop info • Wound care • Arm & hand care Postop Care • Assessment • Intervention • Teaching
Tx of cervical cancer
Surgical • Radical hysterectomy • (TAH-BSO) • Vaginal hysterectomy • (VH) • *Most common reason for hysterectomy is fibroids. Hormonal Therapy
The nurse admits a patient to the postpartum unit two hours after vaginal delivery. Three hours after admission the nurse ambulates the patient to the bathroom, and the patient states there is a sudden gush of bleeding from her vagina. The nurse understands that the increase in amount of bleeding is due to which of the following?
THe lochla pooled in the patient's vagina when she was lying in bed.
The nurse is caring for a woman at 32 weeks gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?
Tachycardia
An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate?
Take the child to a private room and interview her regarding her sexual history and partners.
A woman with active tuberculosis in her sixth month of pregnancy is taking ethambutol hydrochloride. Which assessment would be most important for the nurse to complete for this woman?
Test for color recognition using Snellen eye chart
When needed, total parenteral nutrition (TPN) is often administered at home to reduce health care costs. When teaching a patient how to safely administer TPN, the home care nurse emphasizes
Testing blood glucose every 6 hours
The hormone that causes the mesonephric duct to grow and develop
Testosterone
The hormone that is produced by Leydig cells in response to luteinizing hormone
Testosterone
What should the nurse inform a 32-year-old multipara of average prenatal height and weight that has gained 14 lbs by her fifth month of pregnancy of?
That her weight gain is appropriate and she should continue on her present diet. 1st trimester- 2-4 lbs; second trimester- 12-14 lbs; third trimester- 8-12 lbs
A pt is admitted to the hospital and is scheduled to have a modified radical mastectomy. The pt asks the nurse about the surgical procedure. What would the nurse tell the pt?
The breast, axillary nodes, and superior apical nodes a removed, but the muscles are preserved
A pregnant client wants to know why the labor of a first-time-pregnant woman usually lasts longer than that of a woman who has already given birth once and is pregnant a second time. What explanation should the nurse offer the client?
The cervix takes around 12 to 16 hours to dilate during first pregnancy. The labor of a first-time-pregnant woman lasts longer because during the first pregnancy the cervix takes between 12 and 16 hours to dilate completely. The intensity of the Braxton Hicks contractions stays the same during the first and second pregnancies. Spontaneous rupture of membranes may occur before the onset of labor during each birth, not only during the first birth. page 440
A client is 20 weeks pregnant. At a prenatal visit, the nurse begins the prenatal assessment. Which finding would necessitate calling the primary care provider to assess the client?
The client has pink vaginal discharge and pelvic pressure. Cervical dilatation usually occurs painlessly, and often the first symptom is pink vaginal discharge or increased pelvic pressure, which then is followed by rupture of membranes and discharge of the amniotic fluid. The other answers are nonthreatening signs and symptoms.
When developing a labor plan with the client, which outcome is the priority?
The client will direct her pain management techniques.
Which client outcome during active and transitional labor is best?
The client will practice breathing techniques during contractions.
Which of the following would be the physiologic basis for a placenta previa? a) A loose placental implantation b) A placenta with multiple lobes c) Low placental implantation d) A uterus with a midseptum
c) Low placental implantation Rationale: The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus.
A hormone whose precursor is produced in the thyroid, but which is primarily produced in other tissues
Triiodothyronine (T3)
Bile that enters the bile canaliculi is carried back to the portal triads
True
The Space of Disse separates the sinusoidal surface of hepatocytes from the sinusoidal vessel
True
The great saphenous vein lies superficial to the fascia lata of the thigh
True
A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a C-section is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement?
The parents are beginning to demonstrate positive grieving behaviors.
A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply.
The partner answers questions for the pregnant client. The partner is overly protective of the pregnant client. Poor weight gain during the pregnancy and low birth weight infant
The hepatic veins leave the liver to join the inferior vena cava
True
The nasal cavity has a prominent submucous venous plexus
True
The small saphenous vein drains into the popliteal vein
True
The trachea lies immediately in front of the oesophagus in the superior mediastinum
True
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 role do Braxton Hicks contractions play in aiding labor?
These contractions help in softening and ripening the cervix. 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.
A postbirth complete blood count (CBC) has noted an elevated white blood cell (WBC) count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count?
This is a normal variation due to the stress of labor. An elevation of WBC up to 30,000mm/3 can be normal variation for any woman after birth. This is related to the stress on her body from labor and birth. 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.
The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?
This is a technique to prevent the painful stimuli from entering the brain. Gate control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. pg 465
The laboring client 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. What is the appropriate rationale for this practice?
This may prolong labor and increase complications. Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The client should be offered nonpharmacologic options at this point until she is in active labor. pg 471
The nurse prepares a client for an abdominal hysterectomy. The client asks why she has to have a Foley Catheter. What would be an appropriate response from the nurse?
This will allow you to heal by keeping your bladder decompressed (an expanded bladder may interfere with wound healing by pressing on the wound; catheter is usually removed when the client begins ambulating)
The nursing instructor is teaching the students the basics of the labor and delivery process. The instructor determines the session is successful when the students correctly choose which action will best help to prevent infections in their clients?
Thoroughly wash the hands before and after client contact.
Pituitary hormone that directly controls thyroid function
Thyroid stimulating hormone (TSH)
The main secreted product of the thyroid which is activated by enzymes in other tissues
Thyroxine (T4)
Structure regulating the degree of paracellular (between cells) permeability
Tight junctions
A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating:
Transition phase of the first stage of labor
The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder?
Trichomoniasis
The structure that prevents blood from leaking back into the right atrium during systole
Tricuspid valve
The vessel carrying newly oxygenated blood in the foetus
Umbilical vein
The vessel carrying newly oxygenated blood to the foetus
Umbilical vein
Which nursing intervention stimulates therapeutic play in a hospitalized child?
Uninterrupted role playing of a surgical procedure
Which procedure is contraindicated in an antepartum client with bright red, painless bleeding?
Vaginal examination
Which changes in the female body occur to allow the passage of the fetus down the birth canal? Select all that apply.
Vaginal rugae stretch and smooth out The cervix dilates to 10 cm The cervix softens
The blood vessels descending and ascending parallel to the tubules of the Loop of Henle in the kidney medulla
Vasa recta
A hormone which affects body fluid osmolarity by regulating water reabsorption in the kidney collecting ducts
Vasopressin
A hormone which affects body fluid volume and osmolarity by regulating water re-absorption in the kidney
Vasopressin (ADH)
After teaching nursing students about childhood exanthems, the instructor determines that the teaching was successful when the students identify what as the primary cause?
Viruses
Megadoses of which vitamin can cause congenital anomalies?
Vitamin A
A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?
Wear support hose.
Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.
Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite.
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:
decreased birth weight in neonates.
A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?
a. Ceftriaxone
A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?
a. Fluconazole
A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?
a. Human papillomavirus (HPV)
A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?
a. Transvaginal ultrasound
A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. The most accurate response from the registered nurse is which of the following? a) 11% to 20% b) 21% to 30% c) 5% to 10% d) 31% to 40%
a) 11% to 20% Rationale: During the first trimester, 10% to 20% of all clinically recognized pregnancies end in miscarriage.
A primipara at 36 weeks gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which of the following signs or symptoms is the priority concern for the nurse? a) A dipstick value of 2+ for protein. b) Weight gain of 1.2 lb during the past 1 week. c) A systolic blood pressure increase of 10 mm hg. d) Pedal edema.
a) A dipstick value of 2+ for protein. Rationale: The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in the majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since we have no idea what the baseline blood pressure was.
A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which of the following orders is the nurse most likely to receive regarding the therapy for such a client? a) Administer cryoprecipitate and platelets b) Give each unit of blood to raise the hematocrit by 3 g/dL c) Administer a ratio of 1 unit of blood to 4 units of frozen plasma d) Aim at keeping the client's hematocrit above 20%
a) Administer cryoprecipitate and platelets. Rationale: In a pregnant client with DIC, the nurse may be ordered to administer cryoprecipitate and platelets. Whole blood does not contain clotting factors. Therefore a ratio of 4 units of blood to 1 unit of fresh frozen plasma, and not 1 unit of blood to 4 units of frozen plasma, should be considered. The nurse should aim at maintaining the client's hematocrit above 30% and not just 20%. The nurse should expect one unit of blood to increase the hematocrit by 1.5 g/dL, and not 3g/dL.
A patient is admitted at 22 weeks gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this patient at this point? a) Bed rest to maintain pregnancy as long as possible b) Deliver vaginally c) Notification of social support for loss of pregnancy d) Education on causes of cervical insufficiency for the future
a) Bed rest to maintain pregnancy as long as possible Rationale: At 22 weeks gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. You would not want to deliver this fetus vaginally at this stage of gestation. It is not your responsibility to notify the patient's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.
A client reports to her obstetrician complaining of a significant amount of bright red, painless vaginal bleeding. A sonogram reveals that her placenta has implanted low in the uterus and is partially covering the cervical os. Which of the following immediate care measures should the nurse initiate? (Select all that apply.) a) Determine from the client the time the bleeding began and about how much blood has been lost b) Attach external monitoring equipment to record fetal heart sounds c) Continue to assess blood pressure every 5 to 15 minutes d) Perform a pelvic examination e) Place the woman on bed rest in a side-lying position f) Obtain baseline vital signs
a) Determine from the client the time the bleeding began and about how much blood has been lost b) Attach external monitoring equipment to record fetal heart sounds c) Continue to assess blood pressure every 5 to 15 minutes e) Place the woman on bed rest in a side-lying position f) Obtain baseline vital signs Rationale: With the exception of performing a pelvic examination, all of the answers are appropriate immediate care measures for the client with placenta previa. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, possibly fatal to both mother and child.
A client in her 20th week of gestation develops HELLP syndrome. Which of the following should the nurse consider as features of HELLP syndrome? Select all that apply. a) Elevated liver enzymes b) Leukocytosis c) Low platelet count d) Hemolysis e) Hyperthermia
a) Elevated liver enzymes c) Low platelet count d) Hemolysis Rationale: The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?
acupressure
Which of the following would the nurse most likely include when planning the care for a woman requiring hospitalization for hyperemesis gravidarum? Select all that apply. a) Maintaining NPO status for the first day or two b) Administering antiemetic agents c) Preparing the woman for insertion of a feeding tube d) Obtaining baseline blood electrolyte levels e) Monitoring intake and output
a) Maintaining NPO status for the first day or two b) Administering antiemetic agents d) Obtaining baseline blood electrolyte levels e) Monitoring intake and output Rationale: When hospitalization is necessary, oral food and fluids are withheld to allow the gut to rest. Antiemetic agents are ordered to help control nausea and vomiting. The woman is likely to be dehydrated, so the nurse would obtain baseline blood electrolyte levels and administer intravenous fluid and electrolyte replacement therapy as indicated. Once the nausea and vomiting subside, oral food and fluids are gradually reintroduced. Total parenteral nutrition or a feeding tube is used to prevent malnutrition only if the client does not improve with these interventions.
A pregnant client has been admitted with complaints of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which of the following? a) Molar pregnancy b) Abruption of placenta c) Placenta previa d) Ectopic pregnancy
a) Molar pregnancy Rationale: The client is most likely experiencing molar pregnancy. In molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Abruption of placenta is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa the placental attachment is at the lower uterine segment.
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? a) Pregnancy loss. b) Preterm labor. c) Premature birth. d) Hypertension.
a) Pregnancy loss. Rationale: The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for pregnancy loss. Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which of the following is the biggest concern regarding this client? a) Preterm rupture of membranes followed by preterm birth b) Hemorrhaging c) Development of gestational trophoblastic disease d) Development of eclampsia
a) Preterm rupture of membranes followed by preterm birth Rationale: Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are not as big of concerns as preterm birth, in this situation.
A patient is admitted to labor and delivery for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a) Prevent maternal seizures b) Reverse edema c) Decrease blood pressure d) Decrease protein in urine
a) Prevent maternal seizures Rationale: The primary therapy goal for any preeclamptic patient is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as its primary goal a decrease in blood pressure, a decrease in protein in the urine, nor the reversal of edema.
The following hourly assessments are obtained by the nurse on a patient with preeclampsia receiving Magnesium Sulfate: 97.3, P88, R10, blood pressure 148/110. What other priority physical assessment by the nurse should be implemented to assess for potential toxicity? a) Reflexes b) Magnesium sulfate level c) Lung sounds d) Oxygen saturation
a) Reflexes Rationale: Reflex assessment is part of the standard assessment for patients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened? a) Sharp fundal pain and discomfort between contractions. b) Painless vaginal bleeding and a fall in blood pressure. c) An increased blood pressure and oliguria. d) Pain in a lower quadrant and increased pulse rate.
a) Sharp fundal pain and discomfort between contractions. Rationale: An abruptio placentae refers to premature separation of the placenta from the uterus. As the placenta loosens, it causes sharp pain. Labor begins with a continuing nagging sensation. Painless vaginal bleeding and a fall in blood pressure are indicative of placenta previa. Pain in a lower quadrant and increased pulse rate are indicative of an ectopic pregnancy. Hypertension and oliguria are indicative of preeclampsia.
Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What are the signs and symptoms of a ruptured fallopian tube? a) Shoulder pain b) Unilateral abdominal pain c) Rectal pain d) Bilateral abdominal pain
a) Shoulder pain Rationale: Rarely, a woman may present with late signs, such as shoulder pain or hypovolemic shock. These signs are associated with tubal rupture, which occurs when the pregnancy expands beyond the tube's ability to stretch.
Vaginal bleeding during pregnancy is always a deviation from the normal. a) True b) False
a) True Rationale: Vaginal bleeding during pregnancy is always a deviation from the normal, is always potentially serious, may occur at any point during pregnancy, and is always frightening. It must always be carefully investigated because it can impair both the outcome of the pregnancy and the woman's life or health.
When assessing a woman for infertility, which of the following tests should be done first?
a. Analysis of partner's sperm
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?
acupressure Acupressure is the application of pressure or massage at designated susceptible body points. A common point used for a woman in labor is Co4, which is located between the first finger and thumb on the back of the hand. Women may report their contractions feel lighter when a support person holds and squeezes their hand because the support person is accidentally triggering this point. Acupuncture involves insertion of needles into the same body points. Effleurage, the technique of gentle abdominal massage often taught with Lamaze in preparation for birth classes is a classic example of therapeutic touch. Biofeedback is based on the belief people have control and can regulate internal events such as heart rate and pain responses. pg 465
The principal hormone secreted by the zona glomerulosa
aldosterone
A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure?
allowing the woman time to be alone Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor page 435
The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?
alpha-fetoprotein analysis Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The Doppler flow study evaluates the blood flow, and amniocentesis evaluates the contents of the amniotic fluid looking for chromosomal defects.
A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?
amniotic fluid volume
Signal or hormone that directly stimulates cells of the outer zone of the adrenal cortex to secrete aldosterone
angiotensin II
When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used?
anterior surface of the sacral prominence and the anterior surface of the symphysis pubis The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet.
A nursing instructor is teaching students about the labor and delivery process and recognizes a need for further teaching when overhearing a student make which statement?
anxiety can speed up the labor process
The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority?
assessing the amount and color of the bleeding When the woman arrives and is admitted, assessing her vital signs, the amount and color of the bleeding, and current pain rating on a scale of 1 to 10 are the priorities. Assessing the signs of shock, monitoring uterine contractility, and determining the amount of funneling are not priority assessments when a pregnant woman complaining of vaginal bleeding is admitted to the hospital.
A nurse at the health care facility assesses a client in the 20th week of gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?
at the level of the umbilicus
The nurse is assessing a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location?
at the level of the umbilicus After birth, the fundus is located midline between the umbilicus and symphysis pubis but then slowly rises to the level of the umbilicus during the first hour after birth. Then the uterus contracts, approximately 1 cm (or fingerbreadth) each day after birth.
A woman of 16 weeks' gestation telephones you because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which of the following would you instruct the woman to do? a) "Come to the health care facility if uterine contractions begin." b) "Come to the health facility with any vaginal material passed." c) "Maintain bed rest and count the number of perineal pads used." d) "Continue normal activity, but take your pulse every hour."
b) "Come to the health facility with any vaginal material passed." Rationale: This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.
A client is 11 weeks pregnant after many years trying to conceive. After arriving home from a normal prenatal visit, she experiences mild cramping and has a gush of bright red vaginal bleeding. She calls the nurse and reports having soaked a pad with fresh blood in fewer than 30 minutes. The uterine cramping is worsening. What is the most appropriate response from the nurse? a) "This is nothing to worry about. Many women bleed during pregnancy." b) "You need to seek immediate attention from the primary care provider." c) "I am sorry. There is nothing you can do, because you are likely miscarrying." d) "Lie down and call your health care provider tomorrow if symptoms continue."
b) "You need to seek immediate attention from the primary care provider." Rationale: Pregnancy loss during the early weeks of pregnancy may seem like a heavy menstrual period. A primary care provider should assess blood loss of this amount with or without uterine cramping as soon as possible.
A postpartum mother has the following lab data recorded: RH negative and rubella titer is positive. What is the appropriate nursing intervention? a) Assess the rubella of the baby b) Administer RhoGam within 72 hours. c) Administer rubella vaccine before discharge. d) Assess the RH of the baby.
b) Administer RhoGam within 72 hours. Rationale: The rubella is a virus and the mother has a positive titer indicating she is immune, this is important data for prenatal care and only has a bearing if the patient were negative. The RH is negative for the mother and the infant status is unknown, to protect future pregnancies the mother should be given RhoGam. It would not be appropriate to administer the rubella vaccine, assess the rubella titer of the baby, or assess the Rh status of the baby.
When providing counseling on early pregnancy loss, the nurse should include what as the most common cause for spontaneous abortion? a) Maternal smoking b) Chromosomal defect c) Lack of prenatal care d) The age of the mother
b) Chromosomal defect Rationale: The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal defect. There is nothing that can be done and the mother should feel no fault. The nurse needs to educate the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware of the client's risk of perinatal complications including which of the following? a) Maternal hypotension b) Congenital anomalies c) Post-term birth d) Fetal non-immune hydrops
b) Congenital anomalies Rationale: Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal non-immune hydrops occurs in the infection of pregnant clients with parvovirus. Post-term birth, maternal hypotension and fetal non-immune hydrops are not seen as complications of multiple pregnancy.
A client visits a health care facility with complaints of amenorrhea for 10 weeks, fatigue, and breast tenderness. Which of the following additional signs and symptoms suggest the presence of molar pregnancy? Select all that apply. a) Whitish discharge from the vagina b) Elevated hCG levels c) Hyperemesis gravidarum d) Dyspareunia e) Absence of fetal heart sound
b) Elevated hCG levels c) Hyperemesis gravidarum e) Absence of fetal heart sound Rationale: The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection, and not in molar pregnancy. In molar pregnancy a brownish vaginal bleeding is seen.
• Which of the following may reduce the risk of neural tube defects when taken before conception?
b) Folic acid.
To which of the following patients being discharged for home must the nurse stress that it is absolutely critical the patient return for monthly follow-up visits? A woman who: a) Has experienced a complete spontaneous abortion b) Has experienced a molar pregnancy c) Has experienced an ectopic pregnancy d) Is Rh negative
b) Has experienced a molar pregnancy Rationale: Molar pregnancies can indicate the possibility of developing malignancy. The woman will need close observation and follow-up for the year following the diagnosis. Follow-up visits after an ectopic pregnancy or a complete spontaneous abortion are typically scheduled at six weeks, not monthly. A woman who is Rh negative does not need a follow-up visit because of her Rh status.
A pregnant client with severe pre-eclampsia has developed the HELLP syndrome. In addition to the observations necessary for pre-eclampsia, what other nursing intervention is critical for this patient? a) Administration of a tocolytic, if prescribed b) Observation for bleeding c) Monitoring for infection d) Maintaining a patent airway
b) Observation for bleeding Rationale: Because of the low platelet count associated with this condition, women with the HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for pre-eclampsia. Maintaining a patent airway is a critical intervention needed for a patient with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which of the following is the biggest concern regarding this client? a) Development of gestational trophoblastic disease b) Preterm rupture of membranes followed by preterm birth c) Development of eclampsia d) Hemorrhaging
b) Preterm rupture of membranes followed by preterm birth Rationale: Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are not as big of concerns as preterm birth, in this situation.
A client in her 38th week of gestation is admitted into the labor and birth unit with painless bleeding from the vagina. The client is diagnosed with placenta previa. When reviewing the client's history, which of the following would the nurse identify as a risk factor for placenta previa? a) Maternal age more than 30 years b) Previous cesarean birth c) Primigravida status d) Living in coastal areas
b) Previous cesarean birth Rationale: A previous cesarean birth is a risk factor for developing placenta previa. This is due to the damage caused to the endometrial tissue. Multiparity, and not a primigravida status, predisposes to placenta previa. Maternal age over 35 years, and not just more than 30 years, is considered another risk factor. Placenta previa is more common among those living in high altitudes, and not among those living in coastal areas.
A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. Which of the following are features of an acute increase in blood pressure? Select all that apply. a) Auditory hallucinations b) Proteinuria c) Hypereflexia d) Blurring of vision e) Hyperglycemia
b) Proteinuria c) Hypereflexia d) Blurring of vision Rationale: Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multi-organ system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal BP.
You are caring for a patient with preeclampsia. You know that you need to auscultate this patient's lung sounds every two hours. Why would you do this? a) Pulmonary emboli b) Pulmonary edema c) Pulmonary atelectasis d) Pulmonary hypertension
b) Pulmonary edema Rationale: In the hospital, monitor blood pressure at least every four hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every two hours. Adventitious sounds may indicate, developing pulmonary edema.
A patient with preeclampsia is receiving magnesium sulfate. Which of the following nursing assessments should be ongoing while the medication is being administered? a) Hemoglobin. b) Respiratory rate. c) Urine protein. d) Ability to sleep.
b) Respiratory rate. Rationale: The level of magnesium in therapeutic range is 4 to 8 mg/dL. If magnesium toxicity occurs, one sign in the patient will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The patient's hemoglobin and ability to sleep are not factors for on-going assessments for the patient on magnesium sulfate. Urinary output is measured hourly on the preeclamptic patient receiving magnesium sulfate, but urine protein is not an ongoing assessment.
A pregnant woman at 12 weeks' gestation calls you because she has begun minimal fresh vaginal spotting. She is distressed because her physician says she is not going to do anything for her but "wait and see." Which of the following would you suggest? a) Suggest she take an over-the-counter tocolytic just to feel secure. b) Tell her that medication to prolong a 12-week pregnancy usually is not advised. c) Advise her to ask for a second physician opinion. d) Explain that her doctor meant for her to maintain strict bed rest by "wait and see."
b) Tell her that medication to prolong a 12-week pregnancy usually is not advised. Rationale: Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended.
A pregnant woman at 12 weeks' gestation calls you because she has begun minimal fresh vaginal spotting. She is distressed because her physician says she is not going to do anything for her but "wait and see." Which of the following would you suggest? a) Suggest she take an over-the-counter tocolytic just to feel secure. b) Tell her that medication to prolong a 12-week pregnancy usually is not advised. c) Explain that her doctor meant for her to maintain strict bed rest by "wait and see." d) Advise her to ask for a second physician opinion.
b) Tell her that medication to prolong a 12-week pregnancy usually is not advised. Rationale: Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended.
A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years previously. She felt fine afterward so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take? a) If an antibody screen is positive, the nurse will administer RhoGam to the patient. b) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time. c) The nurse will arrange for an amniocentesis to assess hemolytic disease in the fetus. d) If an antibody screen is negative, the nurse will administer RhoGam to the patient.
b) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the patient and the child are not a concern at this time. Rationale: If the woman is Rh negative and her partner is Rh negative the fetus will also be Rh negative and the woman will not require treatment with RhoGam. Therefore options A, B, and C are incorrect.
A young woman presents at the emergency department with complaints of lower abdominal cramping and spotting at 12 weeks' gestation. The physician performs a pelvic examination and finds that the cervix is closed. What does the physician suspect is the cause of the cramps and spotting? a) Cervical insufficiency b) Threatened abortion c) Habitual abortion d) Ectopic pregnancy
b) Threatened abortion Rationale: Spontaneous abortion occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.
A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her RhIG (D immune globulin). The purpose of this is to a) promote maternal D antibody formation. b) prevent maternal D antibody formation. c) stimulate maternal D immune antigens. d) prevent fetal Rh blood formation.
b) prevent maternal D antibody formation. Rationale: Because RhIG contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies.
After teaching a pregnant client who is in her last weeks of pregnancy about the signs and symptoms of approaching labor, which signs or symptoms if identified by the client would indicate effective teaching? Select all that apply.
backache bloody show lightening The signs of approaching labor include lightening, bloody show, and backache. Lightening is the falling forward of the pregnant uterus due to settlement of the fetal head into the maternal pelvis. Backache associated with pelvic cramping pain, which is regular and increases in the intensity, is suggestive of impending labor. Bloody show is the expulsion of the cervical mucus plug tinged with blood, and occurs due to cervical effacement and dilatation. Weight loss and diarrhea are other signs of impending labor. Weight gain and constipation are not signs of impending labor.
A client is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this client at this point?
bed rest to maintain pregnancy as long as possible At 22 weeks' gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. The nurse would not want this fetus to be born vaginally at this stage of gestation. It is not the nurse's responsibility to notify the client's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies
A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information?
biophysical profile A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detected via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.
The nurse is caring for a woman who is 28 weeks pregnant and has been hospitalized with moderate bleeding which seems to be stabilizing; she is asleep on her side. While checking the fetal monitor tape the nurse notices that the baseline has gradually increased with late decelerations. What is the first action the nurse will take? a) Reposition the mother in a semirecumbent position on her back. b) Notify the physician. c) Administer oxygen to the mother. d) Decrease the rate of IV fluids.
c) Administer oxygen to the mother. Rationale: The fetus is showing signs of fetal distress. The immediate treatment is using oxygen, putting the patient in a side lying position, and increasing IV fluids. The interventions are to improve fetal circulation. Therefore options B, C, and D are incorrect answers.
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would be the priority for this woman on admission? a) Performing a vaginal examination to assess the extent of bleeding b) Helping the woman remain ambulatory to reduce bleeding c) Assessing fetal heart tones by use of an external monitor d) Assessing uterine contractions by an internal pressure gauge
c) Assessing fetal heart tones by use of an external monitor Rationale: Not disrupting the placenta is a prime responsibility. An internal monitor, a vaginal examination, and remaining ambulatory could all do this and thus are contraindicated.
Which of the following would the nurse interpret as indicating that a pregnant client with gestational hypertension has developed severe preeclampsia? a) Proteinuria of 300 mg/24 hours b) Blood pressure of 150/100 mm Hg c) Blurred vision d) Mild facial edema
c) Blurred vision Rationale: Visual symptoms such as blurred vision and blind spots suggest severe preeclampsia. Severe preeclampsia is characterized by a blood pressure of 160/110 mm Hg. Mild facial edema or hand edema occurs with mild preeclampsia. Proteinuria in severe preeclampsia is greater than 500 mg/24 hours.
A client has been admitted to the hospital with a diagnosis of severe pre-eclampsia. Which of the following is the priority nursing? a) Check for vaginal bleeding every 15 minutes b) Keep the client on her side so that secretions can drain from her mouth c) Confine the client to bed rest in a darkened room d) Administer oxygen by face mask
c) Confine the client to bed rest in a darkened room Rationale: With severe pre-eclampsia, most women are hospitalized so that bed rest can be enforced and a woman can be observed more closely than she can be on home care. Darken the room if possible because a bright light can also trigger seizures. The other interventions listed pertain to a client who has experienced a seizure and has thus progressed to eclampsia.
When administering magnesium sulfate to a woman with severe preeclampsia, which finding would alert the nurse to the development of magnesium toxicity? a) Seizures b) Elevated liver enzymes c) Diminished reflexes d) Serum magnesium level of 6.5 mEq/L
c) Diminished reflexes Rationale: Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.
A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, which of the following would the nurse expect to find? a) Bright red vaginal bleeding b) Fetal heart rate within normal range c) Firm, rigid uterus on palpation d) Absence of pain
c) Firm, rigid uterus on palpation Rationale: The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.
A woman is admitted with a diagnosis of ectopic pregnancy. For which of the following would you anticipate beginning preparation? a) Bed rest for the next 4 weeks. b) Intravenous administration of a tocolytic. c) Immediate surgery. d) Internal uterine monitoring.
c) Immediate surgery. Rationale: Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or repair the tube if rupture has already occurred. Bed rest will not correct the problem of an ectopic pregnancy. Administering a tocolytic is not indicated, nor is internal uterine monitoring. This makes options A, B, and D incorrect
Which of the following would the nurse include in the plan of care for a woman with premature rupture of membranes if her fetus's lungs are mature? a) Administration of corticosteroids b) Observation for signs of infection c) Labor induction d) Reduction in physical activity level
c) Labor induction Rationale: With premature rupture of membranes in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.
Which of the following would the nurse prepare to administer if ordered as treatment for an unruptured ectopic pregnancy? a) Promethazine b) Oxytocin c) Methotrexate d) Ondansetron
c) Methotrexate Rationale: Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
A woman is 9 weeks gestation and admitted to the obstetrical unit for hyperemesis gravidarum. The highest priority intervention the nurse should anticipate is which of the following? a) Administration of antiemetics b) IV rehydration c) NPO for 24 hours d) Bed rest with bathroom privileges
c) NPO for 24 hours Rationale: The initial intervention to have priority is to stop all food and fluids by mouth until the vomiting has stopped. The next steps will depend on the severity of the hyperemesis gravidarum. Use of medications should be based on the severity of the hyperemesis gravidarum and only under orders as most medications are pregnancy category C. IV rehydration may be ordered by the physician.
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. Which of the following would be the most likely cause of these symptoms? a) Possible fetal death or injury. b) Placenta previa obstructing the cervix. c) Premature separation of the placenta. d) Preterm labor that was undiagnosed.
c) Premature separation of the placenta. Rationale: Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding. Placenta previa usually produces painless bleeding; Preterm labor contractions are more often described as cramping. Possible fetal death or injury does not present with sharp fundal pain. It is usually painless.
Which measure would be most effective in preventing isoimmunization during pregnancy? a) Cerclage b) Blood typing of mothers with type A or B blood c) RhoGAM administration to Rh-negative women d) Amniocentesis
c) RhoGAM administration to Rh-negative women Rationale: Rh incompatibility can be prevented with the use of RhoGAM. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios, not isoimmunization. Cerclage is a treatment for cervical insufficiency.
A 45-year-old pregnant woman with type O blood has had an amniocentesis to rule out Down syndrome. The fetus has type AB blood. What can the nurse warn the patient is a likely outcome if some fetal blood mixed with maternal blood during the procedure? a) The baby will develop hemolytic anemia. b) Preterm delivery c) The baby will have postdelivery jaundice. d) Placental abruption
c) The baby will have postdelivery jaundice. Rationale: The infant and mother have ABO incompatibility. The result is a development of antibodies and breaking down of the blood resulting in jaundice in the infant after delivery. The mixing of some fetal blood with maternal blood during the amniocentesis would not cause placental abruption or preterm delivery. Hemolytic anemia is caused by Rh incompatibility, not ABO incompatibility.
A woman in week 16 of her pregnancy calls her physician's office to report that she has experienced abdominal cramping, cervical dilation, vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction? a) To determine the stage of development of the fetus b) To determine whether infection is present c) To determine whether gestational trophoblastic disease is present d) To determine whether the fetus is viable
c) To determine whether gestational trophoblastic disease is present Rationale: Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. Abnormal trophoblast cells must be identified because they are associated with choriocarcinoma, a rapidly metastasizing malignancy. This is why it is important for any woman who begins to miscarry at home to bring any clots or tissue passed to the hospital with her. The presence of clear fluid-filled cysts changes the diagnosis from a simple miscarriage to gestational trophoblastic disease. The client is not instructed to bring in passed tissue to determine whether infection is present or the fetus is viable or to determine the stage of development of the fetus.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which of the following is a known risk factor for ectopic pregnancy? a) High number of pregnancies b) Multiple gestation pregnancy c) Use of IUD for contraception d) Use of oral contraceptives
c) Use of IUD for contraception Rationale: Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the patient to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
A petite, 5-foot tall, 95-pound woman who is 28 years old is about to give birth to her first child and would like to have a vaginal birth. 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 client?
cannot be determined Pelvis shape cannot be determined by the information included in the statement. Early in the pregnancy, particularly if a woman has never given birth to 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 birth. However, these measurements do not consistently predict which women will have difficulty giving birth vaginally, so most practitioners allow the woman to labor and attempt a vaginal birth.
A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds which can prolong labor. Which compounds is the nurse referring to in the explanation?
catecholamines Fear and anxiety cause the release of catecholamines, such as norepinephrine and epinephrine, which stimulate the adrenergic receptors of the myometrium. This in turn interferes with effective uterine contractions and results in prolonged labor. Estrogen promotes the release of prostaglandins and oxytocin. Relaxin is a hormone that is involved in producing backache by acting on the pelvic joints. Prostaglandins, oxytocin, and relaxin are not produced due to fear or anxiety in clients during labor.
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?
cervix The cervix and vagina are soft tissues that form the part of the passageway known as the birth canal.
When providing counseling on early pregnancy loss, the nurse should discuss which factor as the most common cause for spontaneous abortion?
chromosomal abnormality The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done, and the mother should feel no fault. The nurse needs to educate the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
Patterned breathing techniques used in labor provide which benefits? Select all that apply.
conscious relaxation -pain relief without special tools -distraction
A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor?
contractions beginning in the back and sweeping forward across the abdomen
A woman is experiencing back labor and reports intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain?
counter pressure against the sacrum Counter pressure against the sacrum is a way to provide support and comfort for a women having intense back labor. Effleurage is ineffective for true back labor, as is conscious relaxation. Breathing will not diminish the pain of back labor. pg 483
Which of the following is the best question the nurse can ask a woman who is leaving the hospital after experiencing a complete spontaneous abortion? a) "Did you know that 75 percent of women who are trying to get pregnant experience spontaneous abortions like you have?" b) "Are you going to try again?" c) "May I give you some resources that you can use to try to stop smoking?" d) "Do you have someone to talk to or may I give you the names and numbers for some possible grief counselors?"
d) "Do you have someone to talk to or may I give you the names and numbers for some possible grief counselors?" Rationale: When a woman has a spontaneous abortion one important consideration is the emotional needs of the woman once she is home. She may not want to talk about the loss for a period of time, but the nurse needs to determine her support system for the future. Asking the woman if she is "going to try again" is an inappropriate question for the nurse to ask, and diminishes the experience of having a spontaneous abortion. Giving the woman statistical information on spontaneous abortions is not appropriate when this patient needs support and caring concern. Offering to give the patient resources to aid in smoking cessation is not addressed in the scenario so this is an inappropriate response.
Rhogam (Rh immune globulin) will be ordered for an RH - mother undergoing which of the following tests? a) Biophysical profile b) Contraction test c) Non-stress test d) Amniocentesis
d) Amniocentesis Rationale: Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a non-stress test, and biophysical profile are not invasive, so there would be no indication for Rhogam to be administered.
A pregnant client in her 22nd week of gestation arrives at the healthcare facility with complaints of excessive vaginal bleeding and absence of fetal movements. She is diagnosed as having second trimester fetal loss. Which of the following would the nurse anticipate as the cause of second trimester fetal loss? a) Ectopic pregnancy b) Congenital malformations c) Placenta previa d) Cervical incompetence
d) Cervical incompetence Rationale: The nurse should identify cervical incompetence as the cause for second trimester fetal loss. Cervical incompetence is a condition where there is painless cervical dilatation and results in second trimester fetal loss or can progress to preterm premature rupture of membranes. Ectopic pregnancy, congenital malformations and placenta previa are not involved in causing second trimester fetal loss. Ectopic pregnancy usually leads to first trimester fetal loss. Placenta previa is a condition in which there is implantation of the placenta to the lower uterine segment. Congenital malformations result in first trimester fetal loss.
A nurse is caring for a client in her fourth stage of labor. Which assessments would indicate normal physiologic changes occurring during the fourth stage of labor? Select all that apply.
decreased intra-abdominal pressure well-contracted uterus in the midline mild uterine cramping and shivering The normal physiologic changes for which a nurse should assess during the fourth stage of labor are a well-contracted uterus in the midline of the abdomen, mild cramping pain and generalized shivering, and decreased intra-abdominal pressure. Hemodynamic changes are due to normal blood loss during birth, causing moderate tachycardia and a slight fall in the blood pressure during the fourth stage of labor. A fall in the pulse rate and increased blood pressure are not normal findings occurring during the fourth stage of labor. page 444
A 28-year-old woman presents in the emergency room with severe abdominal pain. She has not had a normal period for 2 months but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the physician as a possible cause of the patient's abdominal pain? a) Healthy pregnancy b) Placenta previa c) Molar pregnancy d) Ectopic pregnancy
d) Ectopic pregnancy Rationale: Ectopic pregnancy can present with severe unilateral abdominal pain. Given the history of the client , the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the patient were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation with complaints of painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning.
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which of the following conditions? a) Eclampsia b) Severe pre-eclampsia c) Gestational hypertension d) Mild pre-eclampsia
d) Mild pre-eclampsia Rationale: A woman is said to have gestational hypertension when she develops an elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema. If a seizure from gestational hypertension occurs, a woman has eclampsia, but any status above gestational hypertension and below a point of seizures is pre-eclampsia. A woman is said to be mildly pre-eclamptic when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart. A woman has passed from mild to severe pre-eclampsia when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present. A woman has passed into eclampsia when cerebral edema is so acute a grand-mal seizure (tonic-clonic) or coma has occurred.
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? a) Obtain a voided urine specimen and determine blood type. b) Measure fundal height. c) Check deep tendon reflexes. d) Palpate the fundus and check fetal heart rate.
d) Palpate the fundus and check fetal heart rate. Rationale: The classic signs of abruption placentea are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.
A woman develops HELLP syndrome. During labor, which of the following orders would you question? a) Assess her blood pressure every 15 minutes. b) Assess the urine output every hour. c) Urge her to lie on her left side during labor. d) Prepare her for epidural anesthesia.
d) Prepare her for epidural anesthesia. Rationale: A consequence of the HELLP syndrome is poor blood coagulation. Epidural anesthesia is not recommended when blood coagulation is in doubt.
When assessing a pregnant woman with vaginal bleeding, which finding would lead the nurse to suspect an inevitable abortion? a) No passage of fetal tissue b) Slight vaginal bleeding c) Closed cervical os d) Strong abdominal cramping
d) Strong abdominal cramping Rationale: Strong abdominal cramping is associated with an inevitable abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.
In returning to the hospital floor after a weekend off, the nurse takes over care of a pregnant patient who is resting in a darkened room. The patient is receiving betamethasone and magnesium sulfate. What could the nurse deduce from those findings? a) The patient is suffering from eclampsia and the care team is attempting to prevent stroke and induce labor. b) The patient is suffering from mild preeclampsia and the care team is attempting to stabilize her and the baby before discharging her to home. c) The patient is suffering from hypertension and the care team is trying to lower her blood pressure so that she may return home until the baby is full term. d) The patient is suffering from severe preeclampsia and the care team is attempting to prevent advancement of the disorder to eclampsia; they are attempting to help the baby's lungs mature quickly so that they can deliver as soon as possible.
d) The patient is suffering from severe preeclampsia and the care team is attempting to prevent advancement of the disorder to eclampsia; they are attempting to help the baby's lungs mature quickly so that they can deliver as soon as possible. Rationale: The administration of magnesium sulfate is to relax the skeletal muscles and raise the threshold for a seizure. The administration of the betamethasone is to try and hasten the maturity of the fetus' lungs for delivery. This woman is in advanced preeclampsia and must be monitored for progression to eclampsia. The scenario described does not indicate a patient with hypertension who may be discharged home once the condition is under control. A woman in eclampsia would either be seizing or comatose, not resting in a quiet room. Symptoms of mild preeclampsia are limited to slightly elevated blood pressure and small amounts of protein in the urine. Betamethasone may be indicated at this time.
The nurse through assessment can best differentiate between placenta previa and abruptio placentae by which of the following signs and or symptoms. a) Bleeding amount and consistency. b) Low back pain. c) Shape of the abdomen. d) Uterine tone and contractions of the uterus.
d) Uterine tone and contractions of the uterus. Rationale: With placenta previa the bleeding is often bright red and painless, with abruptio placentae the bleeding is usually dark and painful. The uterus is firm and hard and painful with the abruption; the uterus is often soft and lacks tone with the previa. The contractions of the uterus, low back pain, or the shape of the abdomen do not help to distinguish between placenta previa and abruption placentae.
A woman who is Rh negative asks you how many children she will be able to have before Rh incompatibility causes them to die in utero. Your best response would be that a) she will have to ask her physician. b) no more than three children is recommended. c) only her next child will be affected. d) as long as she receives RhIG, there is no limit.
d) as long as she receives RhIG, there is no limit. Rationale: Because RhIG supplies passive antibodies, it prevents the woman from forming antibodies. Without antibodies that could affect the fetus, the woman could have as many children as she wants.
A woman with severe preeclampsia is receiving magnesium sulfate. The woman serum magnesium level is 9.0mEq/L. Which finding would the nurse most likely note?
diminished reflexes Diminished or absent reflexes occur when a client develops magnesium toxicity, serum levels greater than 8.0 mEq/L. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.
Some women contract with other women to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who is contracted?
doula The woman may contract with a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.
A 28-year-old woman presents in the emergency department with severe abdominal pain. She has not had a normal period for 2 months, but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the primary care provider as a possible cause of the client's abdominal pain?
ectopic pregnancy Ectopic pregnancy can present with severe unilateral abdominal pain. Given the history of the client and the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the client were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation reporting painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning.
A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using?
effleurage Effleurage is a form of touch that involves light circular fingertip movements on the abdomen and is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation. pg 470
A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:
effleurage. Effleurage is a light, stroking, superficial touch of the abdomen in rhythm with breathing during contractions. Acupressure involves the application of a finger or massage at a trigger point to reduce the pain sensation. Patterned breathing involves controlled breathing techniques to reduce pain through a stimulus-response conditioning. Therapeutic touch involves light or firm touch to the energy field of the body using the hands to redirect the energy fields that lead to pain. pg 470
A pregnant woman is being evaluated for HELLP. The nurse reviews the client's diagnostic test results. Which result would the nurse interpret as helping to confirm this diagnosis?
elevated LDH HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome is a variant of the preeclampsia/eclampsia syndrome. The diagnosis is based on laboratory test results, including: low hematocrit, elevated LDH, elevated AST, elevated ALT, elevated BUN, elevated bilirubin level, elevated uric acid and creatinine levels, and low platelet count. White blood cell counts are not used to evaluate for HELLP.
A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP?
elevated lipoproteins The acronym HELLP represents hemolysis, elevated liver enzymes, and low platelets. This syndrome is a variant of preeclampsia/eclampsia syndrome that occurs in 10% to 20% of clients whose diseases are labeled as severe.
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?
elevated liver enzymes
Which intervention would be least effective in caring for a woman who is in the transition phase of labor?
encouraging the woman to ambulate Although ambulating is beneficial during early and possibly even active labor, the strong and frequent contractions experienced and the urge to bear down may make ambulating quite difficult. During transition, women should continue to breathe with contractions and focus on one contraction at a time. Providing one-to-one support at this time helps the woman cope with the events of this phase, as well as help her maintain a sense of control over the situation. pg 481
he nurse is assisting a client in labor and delivery and notes the placenta is now delivered. Which documentation should the nurse prioritize?
end of the 3rd stage of labor
In the gastrointestinal tract
endocrine cells in the gut epithelium sense the contents of the lumen and secrete hormones in response
Concerning the gastrointestinal system
endocrine cells scattered in the gut epithelium sense the contents of the lumen and secrete hormones in response
A client in the first stage of labor is admitted to a health care center. The nurse caring for the client instructs her to rock on a birth ball. The nurse informs her that this causes the release of certain natural substances, which reduces the pain. To which substance is the nurse referring?
endorphins The nurse is referring to the release of endorphins, which are natural analgesic substances released by the movement of the client on the birth ball. The nurse should encourage the client to rock or sit on the birth ball. This causes the release of endorphins. The client's movement on the birth ball does not produce prostaglandins, progesterone, or relaxin. Prostaglandins are local hormones that bring about smooth muscle contractions in the uterus. Progesterone is a hormone involved in maintaining pregnancy. Relaxin is a hormone that causes backache during pregnancy by acting on the pelvic joints. pg 468
Place the cardinal movements of labor in the order in which they occur from first to last. All options must be used.
engagement, then descent flexion internal rotation extension external rotation expulsion p 431
A new mother calls the clinic on her fourth day after delivery and reports difficulty urinating and defecating because of the perineal pain. What does the nurse suspect is causing these problems
episiotomy
The nurse is caring for a client who is considered low-risk and in active labor. During the second stage, the nurse would evaluate the client's FHR at which frequency?
every 15 minutes It is recommended that the FHR be assessed during the second stage of labor every 15 minutes for the low-risk woman and every 5 minutes for the high-risk woman and during the pushing stage.
Leah is 28 weeks pregnant. To prepare her for discomforts that occur during the final trimester of pregnancy, what would the nurse teach her about?
experiencing increased shortness of breath and dyspnea before lightening
The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use?
external electronic fetal monitoring Analysis of the FHR using external electronic fetal monitoring is one of the primary evaluation tools used to determine fetal oxygen status indirectly. Fetal pulse oximetry measures fetal oxygen saturation directly and in real time. It is used with electronic fetal monitoring as an adjunct method of assessment when the FHR pattern is abnormal or inconclusive. Fetal scalp blood is obtained to measure the pH. The fetal position can be determined through ultrasonography or abdominal palpation but is not indicative of fetal oxygenation. pg 455
Oral contraceptive pills can cause endometrial cancer.
false, OBC
When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy?
famotidine Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Isotretinoin and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.
As a woman enters the second stage of labor, which would the nurse expect to assess?
feelings of being frightened by the change in contractions The nature of contractions changes so drastically to an urge to push that this can be frightening. pg 487
A pregnant client in her 32nd week of gestation has been admitted to a health care center reporting decreased fetal movement. What should the nurse determine first before placing the fetoscope on the woman's abdomen, so as to auscultate the fetal heart sounds?
fetal back The nurse assessing the client should first determine the fetal back before placing the fetoscope on the client's abdomen. The fetal back is determined first because it is through the back that the heart signals are best transmitted. During labor, the fetal heart rate should be assessed to check for any variations indicating distress. Fetal heart rate is auscultated by placing a fetoscope on the client's abdomen in the area of the fetal back. Determining the fetal head, shoulders, and the buttocks would be of no help in localizing the heart sounds. pg 453
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?
fetal distress related to hypoxia
If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?
fetal heart rate declining late with contractions and remaining depressed
A nursing student correctly identifies which of the following as the most important predictor of fetal maturity:
fetal lung maturity
During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur?
fetal tachycardia Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tub use.
A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor?
first, active Because the cervix is dilating (5 cm) and has fully effaced (100%), the woman appears to be in active labor, which is characterized by cervical dilation of 4 to 7 cm. Regular uterine contractions are effective in facilitating fetal descent through the pelvis because the presenting part is well applied on the cervix and at -1 station. Second stage of labor begins when the cervix is 10 cm dilated. The first latent phase is characterized by the onset of regular contractions and cervical dilation of 0 to 4 cm. Third stage of labor is from birth of the infant to completed delivery of the placenta.
During a spontaneous vaginal birth several things need to occur to the fetus in sequence. As the fetus encounters resistance, what is its usual reaction?
flexion
A nurse is teaching a group of nursing students about the mechanism of labor when the fetus is in a cephalic presentation. Given in random order are a series of events that take place in a cascade to end with the birth of the baby. Arrange the series of events in the most likely sequence they occur. All options must be used.
flexion internal rotation extension restitution external rotation The sequence of normal mechanism of labor involves flexion, internal rotation, extension, restitution, and external rotation. Following descent, the baby's head encounters resistance and flexes so that the chin touches the chest. During internal rotation, the occiput is rotated 45° anteriorly so as to lie beneath the symphysis pubis. The baby's neck is twisted in internal rotation. Following internal rotation, the delivery of the head is by extension. Once the head is born by extension, there is external rotation, in which it turns 45° more so that the shoulders lie anterior posteriorly. pg 431
A new OB/GYN care provider has just finished evaluating her one hundredth client. In reviewing the documentation from all clients thus far, which types of pelvis would the nurse assume the care provider has seen the most and the least?
gynecoid and platypelloid, respectively The gynecoid is the typical female pelvis shape; platypelloid pelvis is the least common type of pelvis in women. Women with anthropoid pelvic shapes are able to give birth normally one third of the time and are somewhat rare. An android pelvis is similar to a male pelvis and is seen in 16% of nonwhite women.
The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as:
frequency. Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. The peak or acme of a contraction is the highest intensity of a contraction.
A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client?
general anesthesia General anesthesia is administered in emergency cesarean births. Local anesthetic is injected into the superficial perineal nerves to numb the perineal area generally before an episiotomy. Although an epidural block is used in cesarean births, it is contraindicated in clients with spinal injury. Regional anesthesia is contraindicated in cesarean births.
A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause?
gestational hypertension
A client has come to the office for a prenatal visit during her 22nd week of gestation. On examination, it is noted that her blood pressure has increased to 138/90 mm Hg. Her urine is negative for proteinuria. The nurse recognizes which factor as the potential cause?
gestational hypertension Gestational hypertension is characterized by hypertension without proteinuria after 20 weeks of gestation resolving by 12 weeks postpartum. It is defined as systolic blood pressure of greater than 140 mm Hg and/or diastolic of greater than 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation, in women known to be normotensive prior to this time and prior to pregnancy. HELLP is an acronym that refers to hemolysis, elevated liver enzymes, and low platelets. Preeclampsia may result if hypertension is not controlled or advances to a more severe state.
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?
gestational hypertension Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of preeclampsia, or preexisting hypertension. Abruptio placenta (separation of the placenta from the uterine wall), placenta previa (placenta covering the cervical os), and preeclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.
The nurse is assessing a client at 12 weeks' gestation at a routine prenatal visit who reports something doesn't feel right. Which assessment findings should the nurse prioritize?
gestational hypertension, hyperemesis gravidarum, absence of FHR
A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect?
gestational trophoblastic disease
A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?
gestational trophoblastic disease
A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?
gestational trophoblastic disease The client is most likely experiencing gestational trophoblastic disease or a molar pregnancy. In gestational trophoblastic disease or molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Abruption of placenta is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa the placental attachment is at the lower uterine segment.
The third stage of labor is considered to be expulsion of the placenta. This stage can last anywhere from five to 20 minutes. What is a sign that the placenta is separating from the wall of the uterus?
globular shape to the fundus Signs that indicate the placenta is separating from the uterine wall include a gush of blood, lengthening of the umbilical cord, and a globular shape to the fundus.
A client is being admitted to labor and birth. When admitting an obstetric client in early labor, the first intervention by the nurse is:
good rapport is established with the client and significant other. On admission the client and her family need to establish a rapport with their caregiver. If the client is stable and there is no immediate need, rapport should be established over actions that can be taken care of later.
A client has been admitted with abruptio placentae. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae?
grade 2 The classifications for abruptio placentae are: grade 1 (mild) - minimal bleeding (less than 500 mL), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 mL), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 mL), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4
Which type of pelvis has a roomy, round inlet and is most favorable for vaginal birth?
gynecoid The gynecoid pelvis considered the true female pelvis. Its room, round inlet makes it favorable for vaginal birth.
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply.
headache with visual changes in the third trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.
A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.
hemolysis elevated liver enzymes low platelet count
A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.
hemolysis elevated liver enzymes low platelet count The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome
Often associated with a failure in the ascent of the kidneys
horse-shoe kidney
A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:
hydatidiform mole. Gestational trophoblastic disease comprises a spectrum of neoplastic disorders that originate in the placenta. The two most common types are hydatidiform mole (partial or complete) and choriocarcinoma. Ectopic pregnancy, placenta accreta, and hydramnios fall into different categories of potential pregnancy complications.
A woman is admitted with a diagnosis of ectopic pregnancy. For which action would the nurse anticipate beginning preparation?
immediate surgery Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or repair the tube if rupture has already occurred. Bed rest will not correct the problem of an ectopic pregnancy. Administering a tocolytic is not indicated, nor is internal uterine monitoring.
A woman is admitted with a diagnosis of ectopic pregnancy. For which procedure should the nurse prepare?
immediate surgery Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or to repair the tube if rupture has occurred already.
The nurse is assisting a client through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist?
inability to push If she is not able to push, her epidural dose may be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so the nurse should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.
A nurse is caring for a pregnant client with rhythmic uterine contractions. Which feature should the nurse identify as associated with true labor?
increase in frequency of the contractions The nurse should identify that there is an increase in the duration of the contractions associated with true labor. In true labor, the duration, frequency, and intensity of uterine contractions increase. Position change does not reduce the uterine contractions. In false labor, the uterine contractions often disappear with ambulation and sleep. Also, there is no increase in frequency, duration, or intensity of the contractions, and the cervix fails to dilate any further. page 423
A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply.
increase in heart rate increase in blood pressure increase in respiratory rate 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. page 439
A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility?
increased risk of infection After the amniotic sac has ruptured, the barrier to infection is gone, and an ascending infection is possible. In addition, there is a danger of cord prolapse. The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.
The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal?
increased white blood cell count The nurse should identify increased white blood cell count as the hematological change occurring in a client during labor. The increase in the white blood cell count can be attributed to physical and emotional stress during labor. During labor there could be a decrease, and not increase, in the blood coagulation time. There is an increased, and not a decreased, plasma fibrinogen level during labor. Blood glucose levels are decreased during labor.
It was once thought that an episiotomy made the birth less painful and heal faster than a spontaneous laceration of the perineum. Research has not shown these assumptions to be true. What is another finding in the research on episiotomies?
increases the risk of blood loss after delivery
The definitive kidney is derived from
intermediate mesoderm
Receptors through which cortisol directly stimulates protein catabolism
intracellular receptors that directly control gene transcription
A woman is told she has an anthropoid pelvis. This means her pelvis:
is narrow transversely. A gynecoid pelvis is the best shape for birth. An anthropoid pelvis is usually narrow. A "male" pelvis is termed an "android pelvis."
Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide?
lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. This anoxia can cause pain in the same way blockage of the cardiac arteries causes the pain of a heart attack. Endorphins are naturally occurring opiate-like substances that reduce pain, not cause it. Distraction and mechanical irritation of nerve fibers are also methods of reducing pain, not causes of pain.
The nurse is working with a client 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 client to be in right now?
latent phase 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 client may show fear and anger. During stage two she may remain positive, but the work of labor is very intense
A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding?
less anxiety Promethazine is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety. It may also be used to increase sedation. It does not affect the progress of labor. Benzodiazepines are used to calm a woman who is out of control, allowing her to relax enough to participate effectively during labor.
What would be the physiologic basis for a placenta previa?
low placental implantation The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus.
A nurse is reviewing the medical record of a pregnant client diagnosed with placenta previa. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which type of placenta previa?
low-lying Placenta previa is generally classified according to the degree of coverage or proximity to the internal os, as follows: total placenta previa - the internal cervical os is completely covered by the placenta; partial placenta previa - the internal os is partially covered by the placenta; marginal placenta previa - the placenta is at the margin or edge of the internal os; low-lying placenta previa - the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it.
A hormone which directly stimulates progesterone secretion by the corpus luteum
luteinizing hormone
The hormone that stimulates progesterone secretion by the corpus luteum
luteinizing hormone
A nurse is caring for a client who has just received an epidural. Which side effect is the most common in epidural anesthesia?
maternal hypotension, which can lead to fetal bradycardia Epidural anesthesia conveys the risk of hypotension, especially if the client has not received an adequate amount of fluid before the procedure is performed. A sudden drop in maternal blood pressure can cause uterine hypoperfusion, which may result in fetal bradycardia. pg 474
Contributes to the efferent ducts in the male gonad
mesonephros
Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?
methotrexate
After an examination, a client has been determined to have an unruptured ectopic pregnancy. Which medication would the nurse anticipate being prescribed?
methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
The skull is the most important factor in relation to the labor and birth process. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible?
molding The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull thereby reducing the diameter of the head.
A client received IV meperidine for pain. An hour later a full-term neonate is born with respiratory depression. The nurse anticipates the neonate will require administration of which medication?
naloxone Naloxone is the drug used for reversal of opioids' adverse effects. If a narcotic is given too close to birth, the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered (respiratory depression, sleepiness) in the fetus for 2 to 3 hours after birth. Indomethacin is an analgesic and NSAID; ampicillin is an antibiotic; and epinephrine is a vasopressor. pg 471
A 37-year-old woman in the final weeks of her first pregnancy visits the health care provider's office for a scheduled check-up. What might a nurse note as a sign of labor in speaking with the woman prior to the examination?
nesting Nesting is the activity or burst of energy women often experience prior to the onset of labor. The client could express this in her words or by what her activities had been at home. Dilation, effacement, and cervical ripening are all observable by the provider on exam.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?
preterm rupture of membranes followed by preterm birth Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are not as big of concerns as preterm birth, in this situation.
A 24-year-old client presents in labor. The nurse notes there is an order to administer RhoGAM after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out?
prevent maternal D antibody formation.
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?
pain from the dilation or stretching of the cervix 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.
A client in labor has been admitted to the labor and birth suite. The nurse assessing her notes that the fetus is in a cephalic presentation. Which description should the nurse identify by the term presentation?
part of the fetal body entering the maternal pelvis first The term presentation is the part of the fetal body that is entering the maternal pelvis first. Relationship of the presenting part to the sides of the maternal pelvis is called the position. Attitude is the term that describes the relation of the different fetal body parts to one another. Relation of the fetal presenting part to maternal ischial spine is termed the station.
After pelvic measurements, a patient who is 20 weeks' pregnant is informed that the diagonal conjugate diameter is narrow. For which component of labor should the nurse plan care to address this?
passageway
The five "Ps" of labor are:
passageway, passenger, position, powers, psych. The five "Ps" are passageway (birth canal), passenger (fetus and placenta), position (maternal), powers (contractions), and psych (maternal psychological response).
When educating a group of nursing students about the different types of pelvis, the nurse describes one type as being flat, having a wider transverse diameter than anterior-posterior diameter, with ischial spines that are wide apart, and a short sacrum. The students are correct when they identify this description with which type?
platypelloid Platypelloid pelvis is a flat pelvis with a wider transverse diameter than anterior-posterior diameter, ischial spines are wide apart, and the sacrum is short. In a gynecoid pelvis, the inlet is oval, the pubic arch is wide, it has dull ischial spines, and the sacrum has no anterior or posterior inclinations. In an android pelvis, the inlet is heart shaped, the ischial spines are prominent, and the sacrum is straight. In an anthropoid pelvis, the anterior-posterior diameter is longer than the transverse diameter, ischial spine is somewhat prominent, and the sacrum is inclined posteriorly.
A nurse is educating a group of nursing students about the molding of the fetal skull during the birth process. What would the nurse include as the usual cause of molding?
poorly ossified cranial vault Molding is an adaptive process in which there is overriding and movement of the bones of the cranial vault to adapt to the maternal pelvis. The poorly ossified bones of the cranial vault, along with loosely attached membranous attachments, allow for the process of molding in the fetal skull. The bones of the face and the base of the skull are completely ossified and united. Hence they cannot allow for movement or overriding. The membranous attachments are loosely bound to the cranial vault and not tightly, which allows for molding of the fetal skull.
A client has presented in the early phase of labor. She is experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage?
practicing effleurage on the abdomen In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with gate theory. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor. pg 465
The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which area because of the woman's increased risk?
preeclampsia
What is the most common cause of secondary amenorrhea?
pregnancy
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?
pregnancy loss
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. What would be the most likely cause of these symptoms?
premature separation of the placenta
A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. What is the most likely cause of these symptoms?
premature separation of the placenta Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding. Placenta previa usually produces painless bleeding. Preterm labor contractions are more often described as cramping. Possible fetal death or injury does not present with sharp fundal pain. It is usually painless.
A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?
preterm rupture of membranes followed by preterm birth
A pregnant client has an Rh-negative blood type. Following the birth of the client's infant, the nurse administers her Rho(D) immune globulin. The purpose of this is to:
prevent maternal D antibody formation.
A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. What are features of an acute increase in blood pressure? Select all that apply.
proteinuria hypereflexia blurring of vision Eclampsia is usually preceded by an acute increase in blood pressure as well as worsening signs of multi-organ system failure seen as increasing liver enzymes, proteinuria, and symptoms such as blurred vision and hyperreflexia. Hyperglycemia and auditory hallucinations are not seen with an acute increase in maternal blood pressure.
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every two hours. Why would the nurse do this?
pulmonary edema In the hospital, monitor blood pressure at least every four hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every two hours. Adventitious sounds may indicate developing pulmonary edema.
When assessing a woman with an ectopic pregnancy, the nurse would suspect that the tube has ruptured based on which finding?
referred shoulder pain Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.
A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic?
relaxin As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth.
The practical nursing is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the practical nurse do first?
reposition the woman
A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client?
respiratory depression Respiratory depression is a complication of epidural anesthesia and should be closely monitored in laboring clients. A failed block, accidental intrathecal block, and a postdural headache are all side effects of a spinal epidural block.
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
respiratory rate The nurse must monitor for respiratory depression. Monitoring the client's respiratory rate will be the best indicator of respiratory depression. pg 474
Discomforts of pregnancy vulvar varicosities management
rest with pillow under hips modify knee chest position
A pregnant client is admitted to a maternity clinic after experiencing contractions. The assigned nurse observes that the client experiences pauses between contractions. The nurse knows that which event marks the importance of the pauses between contractions during labor?
restoration of blood flow to uterus and placenta The pauses between contractions during labor are important because they allow the restoration of blood flow to the uterus and the placenta. Shortening of the upper uterine segment, reduction in length of the cervical canal, and effacement and dilation of the cervix are other processes that occur during uterine contractions. pg 433
Which assessment finding in a client reporting uterine contractions would be most consistent as an indicator of approaching labor?
rupture of amniotic membranes The nurse should identify the rupture of amniotic membranes as the best indicator of approaching labor. In labor the client experiences increased vaginal secretions, increased duration of contractions, and also loss of mucous plug.
Which assessment finding in a client reporting uterine contractions would be most consistent as an indicator of approaching labor?
rupture of membranes
eclampsia is
seizures with severe preeclampsia or PIH+pre-eclampsia+seizures
Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?
soft systolic murmur A soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.
One of the theories about the onset of labor is the prostaglandin theory. While not being conclusively proven that the action of prostaglandins initiate labor, it is known that prostaglandins do play a role in labor. What is an action of prostaglandins?
softens cervix The prostaglandin theory is another theory of labor initiation. Prostaglandins influence labor in several ways, which include softening the cervix and stimulating the uterus to contract. However, evidence supporting the theory that prostaglandins are the agents that trigger labor to begin is inconclusive.
Danger s/s in first trimester
spotting/bleeding, cramping, painful urination, severe vomiting/diarrhea, fever > 100.4, sever low abd pain, dizziness
Fetus: weeks and velnerabilities
still vulnerable to CNS teratogens 9 weeks to term
A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion?
strong abdominal cramping
A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, the nurse would expect which finding?
sudden dark, vaginal bleeding The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.
While waiting for the placenta to deliver during the third stage of labor the nurse must assess the new mother's vital signs every 15 minutes. What sign would indicate impending shock?
tachycardia and a falling blood pressure Monitor the woman's vital signs at least every 15 minutes during the third stage of labor. Tachycardia and a falling blood pressure are signs of impending shock; the nurse should immediately report these signs. pg 491
Concerning the endocrine pancreas
the beta cells contain secretory granules which are released by exocytosis in response to raised plasma glucose
A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating:
the buttocks are presenting first with both legs extended up toward the face. In a frank breech position, the buttocks present first with both legs extended up toward the face. The full or complete breech occurs when the fetus sits crossed-legged above the cervix. In a footling or incomplete breech one or both legs are presenting.
A woman's perception of pain can differ according to all of the following except:
the presentation, lie, and attitude of the fetus. Fetal position can influence a client's perception of pain. Fetal attitude does not influence a client's perception of pain.
The OGTT (oral Glucose Tolerance test or GTT test diagnose is done at 3 hours when
the results are 130-140
In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?
the use of OTC drugs with teratogens Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.
A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?
third Stage three begins with the birth of the baby and ends with delivery of the placenta.
The principal hormone secreted by the thyroid follicular cells is
thyroxine (T4)
A client in the third stage of labor has experienced placental separation and expulsion. Why is it necessary for a nurse to massage the woman's uterus briefly until it is firm?
to constrict the uterine blood vessels The nurse must massage the client's uterus briefly after placental expulsion to constrict the uterine blood vessels and minimize the possibility of hemorrhage. Massaging the client's uterus will not lessen the chances of conducting an episiotomy. In addition, an episiotomy, if required, is conducted in the second stage of labor not the third. The client's uterus may appear boggy only in the fourth stage of labor not in the third stage. Ensuring that all sections of the placenta are present and that no piece is left attached to the uterine wall is confirmed through a placental examination after expulsion.
A woman in week 16 of her pregnancy calls her primary care provider's office to report that she has experienced abdominal cramping, cervical dilation, vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction?
to determine whether gestational trophoblastic disease is present Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. Abnormal trophoblast cells must be identified because they are associated with choriocarcinoma, a rapidly metastasizing malignancy. This is why it is important for any woman who begins to miscarry at home to bring any clots or tissue passed to the hospital with her. The presence of clear fluid-filled cysts changes the diagnosis from a simple miscarriage to gestational trophoblastic disease. The client is not instructed to bring in passed tissue to determine whether infection is present or the fetus is viable or to determine the stage of development of the fetus.
A pregnant client has come to a health care provider for her first prenatal visit. The nurse needs to document useful information about the past health history. What are goals of the nurse in the history-taking process? Select all that apply.
to prepare a plan of care that suits the client's lifestyle to develop a trusting relationship with the client to prepare a plan of care for the pregnancy
A woman is in the second stage of labor and is crowning. Which diameter of the fetal skull that is smallest should align with the anteroposterior diameter of the mother's pelvis, which is the narrowest diameter at the pelvic inlet?
transverse (biparietal) The anteroposterior diameter of the pelvis, a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet, so the best presentation for birth is when the fetus presents a transverse (biparietal) diameter (the narrowest fetal head diameter, at 9.25 cm) to this. The other diameters of the fetal skull that are listed are all larger.
Immediately following an epidural block, a woman's blood pressure suddenly falls to 90/50. The nurse's first action would be to:
turn her on her left side or raise her legs
During the second stage of labor, a woman is generally:
turning inward to concentrate on body sensations. Second-stage contractions are so unusual that most women are unable to think of things other than what is happening inside their body. pg 441
A nurse is assessing a client diagnosed with mild preeclampsia. The nurse suspects that the client has developed severe preeclampsia based on which finding?
urine output of less than 400 mL/24 hours Severe preeclampsia may develop suddenly and bring with it high blood pressure of more than 160/110 mm Hg, proteinuria of more than 5 g in 24 hours, oliguria of less than 400 mL in 24 hours, cerebral and visual symptoms, and rapid weight gain. Mild facial edema or hand edema occurs with mild preeclampsia. Proteinuria in severe preeclampsia is greater than 500 mg/24 hours.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?
use of IUD for contraception Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
The nurse is monitoring a client's uterine contractions. Which factors should the nurse assess to monitor uterine contraction? Select all that apply.
uterine resting tone frequency of contractions intensity of contractions The nurse should assess the frequency of contractions, intensity of contractions, and uterine resting tone to monitor uterine contractions. Monitoring changes in temperature and blood pressure is part of the general physical examination and does not help to monitor uterine contraction.
While caring for a woman in labor, the nurse notes that the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is:
uteroplacental insufficiency. Late decelerations are associated with uteroplacental insufficiency. They typically indicate decreased blood flow to the uterus during the contractions. Maternal hypotension and fatigue would not be observed on the fetal heart monitor. Cord compression would be marked by fetal tachycardia.
A cesarean delivery is a major surgery and carries with it many risks for complications. The most common complication is infection. At what site is the infection likely to occur?
uterus
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
vaginal bleeding
A hormone which affects body fluid volume and osmolarity by regulating water re-absorption in the kidney
vasopressin (ADH)
platypelloid pelvis
very narrow and wide -most unfavorable -difficult vaginal delivery
Normal complaints during each trimester
vulvar varicosities, increased pigmentation, mild corneal edema/thickening, edematous gums; increased gingivitis, dyspnea, hand/pedal edema, hemorrhoids, exaggerated heart osunds/systolic murmurs, diminished bowel sounds, pelvic congestion/swelling of labia, prominent rugation of vagina, sciatica, lordosis, mildly enlarged thyroid
The nurse has been monitoring the progression of labor for a primipara. At which time is the nurse most correct to prepare for delivery?
when the fetus begins to crown
The nurse is caring for a woman who has had a baby by cesarean birth. Which of the following would be the most important assessment to make?
whether her abdomen is soft or not
Primigravida
woman pregnant for the 1st time
Testing at 24-28 weeks
• 1 hour glucose • Rh neg-type & screen • preterm labor assessment
Uterine Cancer #1 type
• Adenocarcinoma of the endometrium is most common form of _______________CA in U.S.
Diseases that Affect Women's Sexuality
• Breast disorders • Menstrual disorders • Abnormal uterine bleeding • Menopause • Pelvic inflammatory disease • Uterine disorders • Ovarian disorders • Vaginal and vulvar disorders • Eating disorders/ Body dysmorphic disorder
Polycystic Ovarian Syndrome (PCOS)
• Classic symptoms include irregular or infrequent menses, increased body hair or scalp hair loss (male pattern balding), weight gain, acne, difficulty getting pregnant • Most common in overweight and obese women • Exact cause unknown, but believed to be combination of increased LH levels and increased androgens • Also linked to increased insulin levels • Treatment options include hormonal birth control (OCP's): first-line tx. Metformin is also used. • Health promotion: a weight loss of only 5-10% of body mass can reduce symptoms and help restore normal menstruation and fertility.
Urogenital Displacement (rectocele) Common Symptoms
• Few • May protrude outside vagina when woman stands • Sensation of "bearing down" • Sensation pelvic organs are falling out Treatment • Mild symptoms: high-fiber diet, adequate fluid intake, stool softeners • Surgical repair: posterior repair (colporrhaphy) - vaginal approach with shortening of pelvic muscles
Testing at 34-36 weeks
• GBS (group beta strep) • review s/s of labor • Review labor plan
Sexual History Assessment
• Gender identity and orientation • Current/past partners • Last sexual activity • Types of sexual activity: oral, anal, genital, sex objects • Desire, arousal, orgasm: need for knowledge of the female sexual response • Pain, bleeding, s/s of infection • Force, coercion, abuse • Discuss the menstrual cycle, and peak of sex drive mid-cycle: desire, cervical positioning, viscosity of vaginal discharge • Menstruation: 21-35 d. cycle (28), 2-6 d. duration (4), 20-80 ml (30-35)
Urogenital Displacement (cystocele) Common Symptoms
• Generally asymptomatic • Bearing down sensation OR • "something in my vagina" • Urinary frequency, retention, incontinence • Recurrent UTIs Treatment • Vaginal pessary • Surgical: anterior repair (colphorrhaphy): surgical shortening of pelvis muscles to support bladder. May require a tissue graft. Hysterectomy is done when co-morbidity of prolapsed uterus exists.
Breast Cancer
• Most commonly diagnosed cancer in U.S. Second leading cancer-cause of death in U.S. women. • Leading cause of death for women 40-49. • Majority of women newly diagnosed in U.S. with breast cancer have no evidence of metastatic disease. • Most newly diagnosed breast cancers are classified as either Early Stage (Stage I or II) or Locally Advanced (tumor > 5cm, axillary lymph node involvement, extension into chest wall, or inflammatory breast cancer • STAGING (TNM) system establishes the basis for treatment options, along with receptor positivity (estrogen ER), progesterone (PR), human epidermal growth factor 2 (HER2). • BCT (Breast-conserving therapy) is treatment of choice for eligible women and evidence-based to have same or better outcomes as mastectomy, but is not an option for all women (large tumors, prior history, persistently positive margins, pregnancy).
Fibrocystic Disease
• Most frequently occurring benign breast disease • Most prevalent in women 35-50 yo; incidence estimated @ 50-80% of women • Usual mass location: upper, outer quadrants of breast • Risk factors: premenstrual symptoms, nulliparity, long menstrual history, family hx, diet, stress • Chocolate, fat, caffeine can make these changes worse. Often associated with tenderness or pain, during the second phase of the menstrual cycle. Evaluate for changing masses, breast discharge, breast symmetry.
Women's Health Screenings
• Pap tests: Every three years, women ages 21-65, or every five years for women ages 30-65 with HPV testing. NO HPV testing for women under 30. NO screening for women under 21 or over 65. NO screening for women who have had a hysterectomy for reasons other than cancer. • Mammograms: Begin screening age 50, every two years for women 50-74, stop at 75.
PID Clinical Manifestations:
• Pelvic pain, deep dyspareunia, abnormal cervical discharge, uterus motion, adnexal tenderness General causes: STIs • Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobes Common Treatments • Mild/ Moderate: broad spectrum antibiotics for 2wks. • Severe: hospitalization, pregnancy Nursing Management • Pain management • Perineal care • Semi-fowler's position
Clinical Manifestations of Fibrocystic Disease
• Premenstrual exacerbation • Subsides post-menstrually • Breast tenderness/ pain • Mass is round, well-defined, free mobilty • Always compare the two breasts, checking for tenderness, pain, fixity of the mass.
Urogenital Displacement & Prolapse (uterine or vaginal prolapse) Common Symptoms
• Pulling and dragging sensations; pressure • Dyspareunia (painful intercourse) • Protrusions from vagina • Fatigue • Low back pain; pain after intercourse • or prolonged standing • Urinary retention or incontinence • Critical to assess women of all ages for s/s of pelvic fullness, bloating, GI disturbances—also think GU cancers in differential diagnosis.
Cervical Cancer • Risk factors • Health promotion: • Usually asymptomatic
• Risk factors include early onset of sexual activity, high-risk sexual partner, history of STI, immunosupression (HIV), multiple sex partners • Health promotion: incidence lower in male partners who are circumcised • Usually asymptomatic in early stages: NEED FOR SCREENING. Later stages: irregular bleeding, post-coital bleeding
Urinary Incontinence Risk Factors
• Risk factors include ethnicity, parity, obesity, hx of hysterectomy, hx of major depression, and age. • Only 45% of women with weekly UI sought help • Evidence-based: screen all women for UI • Risk factors include ethnicity, parity, obesity, hx of hysterectomy, hx of major depression, and age. • Only 45% of women with weekly UI sought help • Evidence-based: screen all women for UI:
Discussion of Nursing Management of Individual After Hysterectomy
• Risk for Injury: Bleeding • Risk for Injury: Infection • Acute Pain • Risk for Ineffective Breathing Pattern • Risk for Disturbed Body Image • Risk for Ineffective Coping • Fatigue
Ovarian Cancer: NP role and dx
• Role of the nurse is to be aware that ovarian CA can present with these symptoms in women of all ages • Dx: imaging studies to • determine if adnexal mass exists, then surgery • 22,000 new cases/14,000 deaths per year • No decrease in mortality in past 40 years due to difficulty in screening and diagnosing • Only 15% diagnosed in ealry stages
Women's Health Screenings
• STI's: Screen all women 24 and younger for gonorrhea and chlamydia, and older women at risk. Screen all pregnant women for both. All women, ages 18-64, should be screened at least once in their lifetime for HIV. All women 50 and older should be screened at least once for hepatitis C. • BRCA 1 and 2: Screen all women with a history of breast, ovarian, uterine cancers (offer screening) • No routine screening for ovarian cancer (same for prostate cancer)
Ovarian cancer: general • Acute symptoms • Risk factors • Protective:
• Second most common gynecologic CA in U.S., and most common cause of gynecological death in U.S. • Symptoms can present as either acute or sub-acute: GI discomfort, adnexal mass, pelvic or abdominal pain, urinary urgency or frequency • Acute symptoms can include pleural effusion, bowel obstruction • Risk factors: increased hormone exposure family hx, more menstrual cycles, increased age • Protective: pregnancy, breastfeeding, oral contraceptive use, tubal ligation.
Goodell's Sign
• Softening of the cervix that occurs at the beginning of the second month of gestation • This is considered a probable sign of pregnancy
Fundal Height Measurement: 12 weeks
• Uterus: softball • Rising above the symphysis pubis, palpable at this time
Milestones: Month 6
• skin is red, wrinkled, lanugo • responds to light and sound • viable
Milestones: Week 16
• sucking response begins • sex identifiable
