OB test

The client has an obstruction between the uterus and fal- lopian tubes. In obtaining a health history, the nurse col- lects information about which possible etiology? 1. Rubella infection prior to adolescence 2. Pelvic inflammatory disease caused by gonorrhea 3. Smoking two packs of cigarettes per day 4. Ingestion of 2 ounces of alcohol daily

2. Pelvic inflammatory disease caused by gonorrhea Rationale: Infectious processes of the reproductive tract such as PID may result in tubal scarring and therefore tubal blockage. Rubella infection in childhood usually results in the development of active immunity to the disease. Smoking and alcohol present health risks to the woman but not related to tubal patency.

nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. 1.Monitor maternal vital signs every 2 hours 2.Notify the physician if respirations are less than 18 per minute. 3.Monitor renal function and cardiac function closely 4.Keep calcium gluconate on hand in case of a magnesium sulfate overdose 5.Monitor deep tendon reflexes hourly 6.Monitor I and O's hourly 7.Notify the physician if urinary output is less than 30 ml per hour.

3, 4, 5, 6, and 7. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2005. Using Nagele's rule, the nurse determines the estimated date of confinement as: 1.July 26, 2006 2.June 12, 2007 3.June 26, 2006 4.July 12, 2007

3. Accurate use of Nagele's rule requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.

A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions? 1."I need to cook meat thoroughly." 2."I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat." 3."I need to drink unpasteurized milk only." 4."I need to avoid contact with materials that are possibly contaminated with cat feces."

3. All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sand boxes, and garden soil.

The client has been diagnosed with Trichomonas vaginitis. The nurse explains during client teaching that this infec- tion can affect fertility by which mechanism? 1. Using glycogen in vaginal secretions, leaving no nutrition for spermatozoa 2. Blocking fallopian tubes, which prohibits spermatozoa from reaching an ovum 3. Decreasing pH of vaginal secretions, thus destroying most spermatozoa 4. Increasing temperature inside the vagina, which decreases sperm motility

3. Decreasing pH of vaginal secretions, thus destroying most spermatozoa Rationale: Vaginal fluid pH is slightly alkaline, as is semen. Spermatozoa cannot survive in an acidic environ- ment. Trichomonas vaginitis increases the acidity of the vaginal and cervical secretions, thus reducing the number of viable sperm.

A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician? 1.Blood pressure reading is at the prenatal baseline 2.Urinary output has increased 3.The client complains of a headache and blurred vision 4.Dependent edema has resolved

3. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.

The client, who is married and has three children, has come to the family planning clinic asking about a birth control method that is most effective and sanctioned by the Roman Catholic Church. What would be the nurse's best recommendation? 1. Billings or cervical assessment method 2. Ovulation testing kit 3. Symptothermal method 4. Basal body temperature (BBT) method

3. Symptothermal method Rationale: The symptothermal method combines cervical mucus and BBT measurements and results in a lower failure rate than either BBT or cervical mucus as a single assessment of the fertile period. This method is com- pletely natural and congruent with beliefs of this religious group. Ovulation testing kits do not give enough warningof ovulation to prevent pregnancy.

A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)? A.Elevated blood pressure B.Negative urinary protein C.Facial edema D.Increased respirations

A and C. The three classic signs of preeclampsia are hypertension, generalized edema, and protenuria. Increased respirations are not a sign of preeclampsia

The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity? A.Calcium gluconate B.Hydralazine (Apresoline) C.Narcan D.RhoGAM

A. Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.

In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must: A.Admister RhoGAM within 72 hours B.Make certain she receives RhoGAM on her first clinic visit C.Not give RhoGAM, since it is not used with the birth of a stillborn D.Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.

A.RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. A pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. A pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. A total of 25 to 35 lbs.

B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased: A.Metabolic rates B.Production of estrogen C.Functioning of the Bartholin glands D.Supply of sodium chloride to the cells of the vagina

B. The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.

A pregnant client is making her first Antepartal visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is: A.G4 T3 P2 A1 L4 B.G5 T2 P2 A1 L4 C.G5 T2 P1 A1 L4 D.G4 T3 P1 A1 L4

C. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to: A.Administer magnesium sulfate intravenously B.Assess the blood pressure and fetal heart rate C.Clean and maintain an open airway D.Administer oxygen by face mask

C. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.

An expected cardiopulmonary adaptation experienced by most pregnant women is: A.Tachycardia B.Dyspnea at rest C.Progression of dependent edema D.Shortness of breath on exertion

D. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: A. Review the woman's current dietary intake. B. Teach the woman about the food pyramid. C. Caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. Instruct the woman to limit the intake of fatty foods.

A. Review the woman's current dietary intake. Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. These are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.

1.21. Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following? A.Being affected by Rh incompatibility B.Having Rh positive blood C.Developing a rubella infection D.Developing physiological jaundice

A. Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby's Rh positive blood can enter the maternal circulation, causing the woman's immune system to form antibodies against Rh positive blood. Administration of Rho (D) immune globulin prevents the woman from developing antibodies against Rh

At a prenatal visit at 36 weeks' gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to: A.Lie down until they stop B.Walk around until they subside C.Time contraction for 30 minutes D.Take 10 grains of aspirin for the discomfort

B. Ambulation relieves Braxton Hicks.

The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as: A.Ladin's sign B.Hegar's sign C.Goodell's sign D.Chadwick's sign

D. A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. Iron absorption is inhibited by a diet rich in vitamin C. C. Iron supplements are permissible for children in small doses. D. Constipation is common with iron supplements.

D. Constipation is common with iron supplements. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? A.Conception B.9 weeks' gestation, when the fetal heart is well developed C.32-34 weeks gestation D.maternal and fetal blood are never exchanged

D. Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally.

During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted? 1.80 BPM 2.100 BPM 3.150 BPM 4.180 BPM

.3. The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.

A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to: 1.Dorsiflex the foot while extending the knee when the cramps occur 2.Dorsiflex the foot while flexing the knee when the cramps occur 3.Plantar flex the foot while flexing the knee when the cramps occur 4.Plantar flex the foot while extending the knee when the cramps occur.

1. Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.

. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy. 1.Uterine enlargement 2.Fetal heart rate detected by nonelectric device 3.Outline of the fetus via radiography or ultrasound 4.Chadwick's sign 5.Braxton Hicks contractions 6.Ballottement

1, 4, 5, and 6. The probable signs of pregnancy include uterine enlargement, Hegar's sign (softening and thinning of the uterine segment that occurs at week 6), Goodell's sign (softening of the cervix that occurs at the beginning of the 2nd month), Chadwick's sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at week 6), ballottement (rebounding of the fetus against the examiners fingers of palpation), Braxton Hicks contractions and a positive pregnancy test measuring for hCG. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler) at 10-12 weeks and by nonelectronic device (fetoscope) at 20 weeks gestation, active fetal movements palpable by the examiner, and an outline of the fetus via radiography or ultrasound.

Which statement by a client could indicate a potential problem for a couple planning to use coitus interruptus? 1. "I really don't want to get pregnant right now, so we need a very effective method." 2. "I think I can always pull out before I ejaculate." 3. "We don't have any other sex partners." 4. "We want a contraceptive method that is inexpensive and completely natural."

1. "I really don't want to get pregnant right now, so we need a very effective method." Rationale: Because some semen is released before ejaculation, coitus interruptus has an 18% failure rate and would not be considered a very effective method for a cou- ple wanting to avoid pregnancy. An ability to withdraw before ejaculation is necessary for coitus interruptus to be effective, so the client's statement would be consistent with successful use of this method. Not having other sex partners has no effect on choice of coitus interruptus as a contracep- tive method. Coitus interruptus has no cost and is com- pletely natural.

Which statement indicates to the nurse that a couple is coping with the stress of infertility treatment? 1. "We are trying to maintain a little romance in our relationship." 2. "My wife was so upset she threw a syringe at me yesterday." 3. "My husband couldn't have an erection when he was sup- posed to." 4. "We have two or glasses of wine each night to help us relax."

1. "We are trying to maintain a little romance in our relationship." Rationale: Maintaining a healthy relationship, such as romance, is important during infertility treatments, which can be very stressful. Emotional outbursts, decreased libido, and regular use of alcohol to relax warrant further investigation as possible signs of excess stress.

A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell's sign. The nurse determines this sign indicates: 1.A softening of the cervix 2.A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus. 3.The presence of hCG in the urine 4.The presence of fetal movement

1. In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell's sign

The nurse working in an infertility clinic explains to an infertile couple that they will likely have which tests ordered? Select all that apply. 1. Semen analysis 2. Papanicolaou smear 3. Colposcopy with endocervical biopsy 4. Sexually transmitted infection testing 5. Hysterosalpingogram

1. Semen analysis 5. Hysterosalpingogram Rationale: The most common causes of infertility are inadequate number or motility of sperm and tubal anomaly or blockage. Semen analysis will provide information on number of and motility of sperm. Hysterosalpingogram will detect uterine or tubal anomalies or blockage. A Papanicolaou smear tests for abnormal cervical cells. Colposcopy and testing for sexually transmit- ted infections will not directly test for causes of infertility.

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: 1.Any bleeding, such as in the gums, petechiae, and purpura. 2.Enlargement of the breasts 3.Periods of fetal movement followed by quiet periods 4.Complaints of feeling hot when the room is cool

1. Severe Preeclampsia can trigger disseminated intravascular coagulation (DIC; remember the Peds lecture?) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? 1."I will maintain strict bedrest throughout the remainder of pregnancy." 2."I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." 3."I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4."I will watch for the evidence of the passage of tissue."

1. Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.

What information would the nurse gather before schedul- ing a client's endometrial biopsy? 1. Usual length of menstrual cycle 2. Blood type and Rh factor 3. Presence of any metal implants 4. Last type of birth control used

1. Usual length of menstrual cycle Rationale: The nurse assesses the first day of the last normal menstrual period and the menstrual cycle length. Endometrial biopsy is performed on day 21-27 of the menstrual cycle to assess endometrial response to progester- one and development of luteal phase endometrium. It is unnecessary to assess for blood type and Rh factor, metal implants, or most recent type of birth control used.

The client is interested in using female condoms and wants to know if there are any disadvantages. What is the nurse's best response? 1. "The female condom provides good protection against preg- nancy but not against sexually transmitted infections (STIs)." 2. "The female condom may be difficult to insert and may be uncomfortable to both partners." 3. "The female condom is very effective; let me arrange to get you a prescription." 4. "The female condom is made of latex and should not be used by those with latex allergies."

2. "The female condom may be difficult to insert and may be uncomfortable to both partners." Rationale: Made of polyurethane, the female condom does not require a prescription but can be difficult to insert, and can cause discomfort. It is effective against both STIs and pregnancy.

A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of: 1.Two umbilical veins and one umbilical artery 2.Two umbilical arteries and one umbilical vein 3.Arteries carrying oxygenated blood to the fetus 4.Veins carrying deoxygenated blood to the fetus

2. Blood pumped by the embryo's heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.

The client couple is planning intracytoplasmic sperm injection, followed by intrauterine embryo transfer. Which statement indicates the nurse's teaching was effective? 1. Whether or not the couple has medical insurance 2. How infertility is affecting their lives 3. Whether the man has seafood allergies 4. Whether the woman works outside the home

2. How infertility is affecting their lives Rationale: The psychological, cultural, and social ramifications of infertility can be extensive. These areas are assessed to determine if the couple needs assistance in coping with infertility and treatment. Payment for infertility workup is an area of concern, but is not the priority of the nurse when interviewing the couple. Seafood allergies of the man are not of concern, although they may be of concern for the woman if having tests that involve dye injection. Working outside the home is not a priority con- cern of the nurse during the interview.

A client who has a complete bicornuate uterus with two vaginas is considering getting pregnant. The nurse would include in discussions with the client which associated concerns? Select all that apply. 1. Inability to ever achieve pregnancy 2. Increased risk for preterm labor 3. Need for artificial insemination to conceive 4. Need for cesarean delivery 5. Risk for multiple pregnancy loss

2. Increased risk for preterm labor 5. Risk for multiple pregnancy loss Rationale: A complete bicornuate uterus is two complete and separate unicornuate uteri. Because the uteri are long and narrow (instead of pear-shaped), the maximum uterine volume is often less than that of a normally shaped uterus. Risks of bicornuate uterus include multiple preg- nancy losses, preterm labor, and breech presentation. Becoming pregnant is not an issue; carrying the pregnancy to term is the problem.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the nurse that she doesn't have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as: 1.G = 3, T = 2, P = 0, A = 0, L =1 2.G = 2, T = 0, P = 1, A = 0, L =1 3.G = 1, T = 1. P = 1, A = 0, L = 1 4.G = 2, T = 0, P = 0, A = 0, L = 1

2. Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies. T is term births, the number born at term (38-41 weeks). P is preterm births, the number born before 38 weeks gestation. A is abortions or miscarriages (included in gravida if before 20 weeks gestation; included in parity if past 20 weeks gestation). L is live births, the number of live births or living children. Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.

The client is unable to become pregnant after she has had one full-term pregnancy. The nurse should develop a plan of care for which health problem? 1. Primary infertility 2. Secondary infertility 3. Unexplained infertility 4. Combined factor infertility

2. Secondary infertility Rationale: Secondary infertility is the term for couples that have had one pregnancy but are unable to conceive again. Primary infertility describes the inability to conceive even once. Unexplained and combined factor infertility are not terms used when discussing fertility.

A nurse is performing an assessment of a primapira who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing? 1.Consistent increase in fundal height 2.Fetal heart rate of 180 BPM 3.Braxton hicks contractions 4.Quickening

2. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.

The client couple is planning intracytoplasmic sperm injection, followed by intrauterine embryo transfer. Which statement indicates the nurse's teaching was effective? 1. "His sperm swim too fast for me to become pregnant." 2. "My eggs have thick walls and don't let his sperm in." 3. "Any extra embryos can be frozen for implantation later." 4. "We will have to wait several weeks to see if any eggs get fertilized."

3. "Any extra embryos can be frozen for implantation later." Rationale: In vitro fertilization usually creates multiple embryos, of which up to four are implanted. Cryopreservation of excess embryos is common, and they can be implanted at a later date. Slow sperm motility could adversely affect fertilization. The thickness of the wall of the egg does not impede sperm penetration. It does not take several weeks to determine whether eggs are fertilized with intracytoplasmic sperm injection.

Which statement by a client being treated for infertility indicates the need for additional teaching? 1. "I should come back for a postcoital test 1-2 days before I expect to ovulate." 2. "I should schedule my hysterosalpingogram for the week after ovulation." 3. "We should abstain for 14 days prior to coming back for the sperm penetration test." 4. "I should schedule my endometrial biopsy for the last week of my menstrual cycle."

3. "We should abstain for 14 days prior to coming back for the sperm penetration test." Rationale: The sperm penetration test, which tests for the ability of sperm to penetrate an egg, should be performed after 2-7 days of abstinence. Having a post-coital test before ovulation is not useful. A hypersalpingogram would be scheduled in the proliferative phase before ovulation to avoid early pregnancy or secretory changes in endometrium after ovulation, which could obstruct dye passage. Endometrial biopsy should not be scheduled earlier than 10 to 12 days after ovulation to accurately detect effects of progesterone and endometrial sensitivity.

Which statements indicate to the nurse that a male client understands how to correctly apply a condom? Select all that apply. 1. "I need to put it on before the penis is erect." 2. "I should unroll the condom, then place it on the penis." 3. "When putting on the condom, I need to leave some space at the tip to collect the sperm." 4. "I can use oil-based lubricants if needed." 5. "I can use a water-based lubricant if needed."

3. "When putting on the condom, I need to leave some space at the tip to collect the sperm." 5. "I can use a water-based lubricant if needed." Rationale: The male condom is placed when the penis is erect, then rolled down. Leaving space at the end of the condom to collect semen can prevent breakage or spill- age after ejaculation. Water-based lubricants can be used to provide additional comfort, if needed. Oil-based lubricants are contraindicated.

Which client being seen in the outpatient clinic would be the best candidate for insertion of an intrauterine device (IUD)? 1. A client who is married, has one child, and wants to get preg- nant in about 6 months 2. A client who is unmarried, has no children, and has numerous sexual partners 3. A client who is married, has two children, and does not want more children for at least 3 years 4. A client who is unmarried, has one child, and has a history of pelvic inflammatory disease (PID)

3. A client who is married, has two children, and does not want more children for at least 3 years Rationale: An IUD is a long-term method of contraception usually recommended for women who have been pregnant and are in a monogamous relationship so that they are at a low risk for sexually transmitted infection. The clients in the incorrect options have one or more factors that should guide them to select a different contraceptive method.

In planning care for the infertile client, the nurse should take which actions? Select all that apply. 1. Encourage client to seek additional formal education. 2. Restrict the amount of information given so as not to over- whelm client. 3. Facilitate client's self-esteem through use of careful wording and avoiding blame. 4. Aid client in finding a relaxing vacation spot to improve the chances of conception. 5. Explain that fertility testing process is lengthy and results will not be instantaneous.

3. Facilitate client's self-esteem through use of careful wording and avoiding blame. 5. Explain that fertility testing process is lengthy and results will not be instantaneous. Rationale: Self-esteem can be threatened by the inability to conceive a child. Care must be taken to avoid placing blame on the person whose body is not functioning as expected. Fertility testing takes a long time and there- fore results are not instantaneous. The amount of formal education does not affect fertility or treatments for infertility. Information should be given when appropriate and not limited or withheld. The need to take a relaxing vacation to conceive is a potentially expensive myth.

A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term? 1."It is the irregular, painless contractions that occur throughout pregnancy." 2."It is the soft blowing sound that can be heard when the uterus is auscultated." 3."It is the fetal movement that is felt by the mother." 4."It is the thinning of the lower uterine segment."

3. Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar's sign.

Which client statement indicates that teaching about cervical mucus changes as an indicator of ovulation has been understood? 1. "If my cervical mucus is yellowish and thick, I am probably fertile." 2. "The thin, clear mucus will block sperm from getting to my cervix." 3. "If my cervical mucus is thick and white, I will need to avoid intercourse or use a backup method of contraception." 4. "If my cervical mucus is thin and stretchable, I am probably fertile."

4. "If my cervical mucus is thin and stretchable, I am probably fertile." Rationale: Thin and clear cervical mucus indicates a rising level of estrogen and impending ovulation. Stretchability of the cervical mucus, or spinnbarkeit, is indicative of the fertile period and promotes motility of the sperm. Thick cervical mucus occurs during the infertile period when sexual intercourse is unlikely to result in preg- nancy.

The nurse is teaching a class in the community on com- mon myths regarding fertility and infertility. Which state- ment made by a class participant indicates teaching has been successful? 1. "If my husband works out everyday, he won't be able to make a baby." 2. "If we have intercourse standing up, we won't be able to conceive." 3. "If we have intercourse on the even days after ovulation, we will conceive a girl." 4. "If my husband sits in the hot tub every night, his sperm count will decrease."

4. "If my husband sits in the hot tub every night, his sperm count will decrease." Rationale: Hot tubs, saunas, and tight underwear can raise the temperature of the testes too high for efficient sper-matogenesis and lead to decreased sperm numbers and motility. Exercise by the male partner does not affect fertility. A standing position does not prevent conception. Sex of a fetus is not affected by whether intercourse occurs on an odd or even day.

A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement? 1.Auscultating for fetal heart sounds 2.Palpating the abdomen for fetal movement 3.Assessing the cervix for thinning 4.Initiating a gentle upward tap on the cervix

4. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.

The women's health clinic nurse determines that which clients would be appropriate candidates for use of emer- gency postcoital contraception? Select all that apply. 1. Had unprotected intercourse 4 days ago 2. Took her oral contraceptive 7 hours late 3. Removed her cervical cap 40 hours after intercourse 4. Had her last Depo-Provera injection 4 months ago 5. Had been sexually assaulted the previous day

4. Had her last Depo-Provera injection 4 months ago 5. Had been sexually assaulted the previous day Rationale: Emergency contraception must be initiated within 72 hours of unprotected intercourse, sexual assault, or method failure. Oral contraceptives may be taken up to 12 hours late and cervical caps may be left in up to 48 hours without compromising safety. Depo-Provera is given every 80-90 days, after which a repeat dose is needed or emergency contraceptive protection is indicated.

The nurse is concerned that which viral infection, if experienced by an adult male, may cause infertility? 1. Varicella zoster 2. Rubella 3. Influenza 4. Mumps

4. Mumps Rationale: Mumps in adult males can cause permanent blockage of the vas deferens, contributing to or resulting in infertility. Varicella, rubella, and influenza do not have this effect.

A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: 1.Avoid wearing a bra 2.Wash the nipples and areola area daily with soap, and massage the breasts with lotion. 3.Wear tight-fitting blouses or dresses to provide support 4.Wash the breasts with warm water and keep them dry

4. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort (especially on test days, even if you're not pregnant. Yo.).

The chief function of progesterone is the: A.Development of the female reproductive system B.Stimulation of the follicles for ovulation to occur C.Preparation of the uterus to receive a fertilized egg D.Establishment of secondary male sex characteristics

C. Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.

Clients with gestational diabetes are usually managed by which of the following therapies? A.Diet B.NPH insulin (long-acting) C.Oral hypoglycemic drugs D.Oral hypoglycemic drugs and insulin

A. Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn't usually needed for blood glucose control for GDM.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs

A. Dried beans B. Seeds C. Peanut butter E. Eggs All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.

A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that: A.FSH and LH are released from the anterior pituitary gland. B.FSH and LH are secreted by the corpus luteum of the ovary C.FSH and LH are secreted by the adrenal glands D.FSH and LH stimulate the formation of milk during pregnancy.

A. FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.

With regard to protein in the diet of pregnant women, nurses should be aware that: A. Many protein-rich foods are also good sources of calcium, iron, and b vitamins. B. Many women need to increase their protein intake during pregnancy. C. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. High-protein supplements can be used without risk by women on macrobiotic diets

A. Many protein-rich foods are also good sources of calcium, iron, and b vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

A pregnant woman's last menstrual period began on April 8, 2005, and ended on April 13. Using Nägele's rule her estimated date of birth would be: A.January 15, 2006 B.January 20, 2006 C.July 1, 2006 D.November 5, 2005

A. Nägele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule, is used with April 8, 2005, the estimated date of birth is January 15, 2006.

The pituitary hormone that stimulates the secretion of milk from the mammary glands is: A.Prolactin B.Oxytocin C.Estrogen D.Progesterone

A. Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to contract and causes the "let down" reflex

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A. Several glasses of fluid If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. E. Normal weight women should gain 11.5 to 16 kg. Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for: A.Acute hemolytic disease B.Respiratory distress syndrome C.Protein metabolic deficiency D.Physiologic hyperbilirubinemia

A. When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC's.

After the first four months of pregnancy, the chief source of estrogen and progesterone is the: A.Placenta B.Adrenal cortex C.Corpus luteum D.Anterior hypophysis

A. When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.

A 26-year old multigravida is 14 weeks' pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect: A.Kidney defects B.Cardiac defects C.Neural tube defects D.Urinary tract defects

C. The alpha-fetoprotein test detects neural tube defects and Down syndrome.

The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is: A.A decrease in WBC's B.In increase in hematocrit C.An increase in blood volume D.A decrease in sedimentation rate

C. The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. Critical iron and folic acid levels must be maintained. D. Lactating women can go back to their prepregnant calorie intake

B. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. Drink warm fluids with each of her meals. B. Eat a high-protein snack before going to bed. C. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. Schedule three meals and one midafternoon snack a day.

B. Eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman experiencing nausea and vomiting should: A. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. Eat small, frequent meals (every 2 to 3 hours). C. Increase her intake of high-fat foods to keep the stomach full and coated. D. Limit fluid intake throughout the day.

B. Eat small, frequent meals (every 2 to 3 hours). A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A 21-year old client, 6 weeks' pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions? A.Bowel perforation B.Electrolyte imbalance C.Miscarriage D.Pregnancy induced hypertension (PIH)

B. Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.

Gravida refers to which of the following descriptions? A.A serious pregnancy B.Number of times a female has been pregnant C.Number of children a female has delivered D.Number of term pregnancies a female has had.

B. Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.

The developing cells are called a fetus from the: A.Time the fetal heart is heard B.Eighth week to the time of birth C.Implantation of the fertilized ovum D.End of the send week to the onset of labor

B. In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. Spina bifida. B. Intrauterine growth restriction. C. Diabetes mellitus. D. Down syndrome.

B. Intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the: A.Oxytocin is too high B.Blood level of LH is too high C.Progesterone level is high D.Endometrial wall is sloughed off.

B. It is the surge of LH secretion in midcycle that is responsible for ovulation.

The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can: A.Unduly prolong labor B.Cause decreased placental perfusion C.Lead to transient episodes of hypotension D.Interfere with free movement of the coccyx

B. This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.

Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include: A.A decrease of 200 calories a day B.An increase of 300 calories a day C.An increase of 500 calories a day D.A maintenance of her present caloric intake per day

B. This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education? A."I need to stay on the diabetic diet." B."I will perform glucose monitoring at home." C."I need to avoid exercise because of the negative effects of insulin production." D."I need to be aware of any infections and report signs of infection immediately to my health care provider."

C. Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.

A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: A.Ankle clonus in noted B.The blood pressure decreases C.Seizures do not occur D.Scotoma's are present

C. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperrelexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.

Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy? A.Mastitis B.Metabolic alkalosis C.Physiologic anemia D.Respiratory acidosis

C. Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron and folate Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

A primagravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A.Urinary output of 20 ml since the previous assessment B.Deep tendon reflexes of 2+ C.Respiratory rate of 10 BPM D.Fetal heart rate of 120 BPM

C. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.

A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: A.Assess the woman's blood pressure and pulse B.Have the woman breathe into a paper bag C.Raise the woman's legs D.Turn the woman on her side.

D. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment? A.Presence of deep tendon reflexes B.Serum magnesium level of 6 mEq/L C.Proteinuria of +3 D.Respirations of 10 per minute

D. Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.

Which of the following symptoms occurs with a hydatidiform mole? A.Heavy, bright red bleeding every 21 days B.Fetal cardiac motion after 6 weeks gestation C.Benign tumors found in the smooth muscle of the uterus D."snowstorm" pattern on ultrasound with no fetus or gestational sac

D. The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.

Which of the following terms applies to the tiny, blanced, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy? A.Epulis B.Linea nigra C.Striae gravidarum D.Telangiectasias

D. The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D. The woman's weight gain is appropriate for this stage of pregnancy. Although this is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. C. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. This is an accurate statement. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.