Online Quiz Week 3

A pregnant woman at 10 weeks gestation calls the prenatal clinic to report that she is experiencing vaginal bleeding. What should the nurse's initial response be? a) "Describe your bleeding for me." b) "Go to bed and rest for the remainder of the day and call if bleeding continues." c) "Come to the clinic as soon as possible so you can be examined." d) "You are probably miscarrying. Bring all pads used to the clinic for examination."

a) "Describe your bleeding for me." Rationale: Describe the bleeding is the best option. We would ask her to compare it to a period so that she has a frame of reference with which she is familier. Likely she will be asked to come to the clinic after a conversation, depending on what she says.

A pregnant client comes to the emergency room because of vaginal bleeding. The nurse asks the client to approximate how much bleeding is occurring. The best way to gauge how much bleeding has occurred is to ask the client which of the following? a) Where clots present in the blood you passed? b) Have there been any changes in fetal activity since the bleeding? c) How would you compare the amount of bleeding to your normal menstrual flow? d) Do you feel weaker and less able function at your normal activity level since the bleeding began?

c) How would you compare the amount of bleeding to your normal menstrual flow? Rationale: This frame of reference is one that every woman understands and can communicate. Using the period helps the nurse to figure out if the bleeding is significant. No bleeding is insignificant, but we need to know how much as it helps to diagnose the situation.

A woman who is G2, P0, has a medical diagnosis of Class C diabetes mellitus. She is at 34 weeks' gestation. In the third trimester she asks the nurse how her baby will be delivered. Which of the following is the best response of the nurse? a) "Diabetes is lethal to the fetus, so you will probably have a cesarean delivery to decrease the stress of delivery on the baby" b) "Since the baby's health starts deteriorating early in this disease, you will probably have either a cesarean delivery or have labor induced at about 37 weeks gestation" c) "As long as you are compliant with treatment, your pregnancy will probably be allowed to progress to term with labor occurring naturally" d) "Your pregnancy will be carefully monitored with the best time for delivery chosen on the basis of your status and tests of placental function and fetal maturity"

d) "Your pregnancy will be carefully monitored with the best time for delivery chosen on the basis of your status and tests of placental function and fetal maturity" Rationale: Although cesarean delivery at 37 weeks' gestation used to be common for diabetic mothers, current practice is to try achieving delivery at the optimum time for mother and infant. Stress for the infant is greater during a cesarean section versus a vaginal. Presently, testing is used to determine optimal delivery time without compromising fetal health.

Which of these substances, as a powerful central nervous system stimulant, can lead to miscarriage, preterm labor, premature separation of the placenta, and stillbirth? a) Heroin b) Alcohol c) PCP d) Cocaine

d) Cocaine Rationale: This is a simple knowledge level question, just to test that you understand the dangers of cocaine during pregnancy. It can cause powerful uterine stimulation leading to abruptio placenta, fetal death, and hemorrhage. It is very dangerous.

Which of the following is a viral sexually transmitted infection characterized by a primary infection followed by recurrent episodes? a) Herpes simplex virus 2 (HSV-2) b) c) Human immunodeficiency virus (HIV) d) Cytomegalovirus (CMV)

a) Herpes simplex virus 2 (HSV-2)

Which of the following nursing actions would reduce the possibility of a seizure in a client with severe pregnancy-induced hypertension? a) Keep the side rails padded and up b) Place the client in the room closest to the nurse's station c) Keep the room dimly lit d) Stay with the client at all times

c) Keep the room dimly lit Rationale: Bright lights and loud sounds can stimulate the nervous system of a woman with severe preeclampsia enough to cause a seizure. She should be kept in a dark, quiet room, away from activity and her visitors should be limited and warned to be quiet and not cause her to be upset. Place a sign on the door that all visitors be cleared with the nurse before entering, then keep to a minimum. No children.

The nurse is counseling a 15-year-old who is pregnant for the first time. The nurse does this mainly to help the client prevent which of the more common problems of underage clients: a) Incompetent cervix. b) Spontaneous abortion. c) Preterm birth. d) Placental abnormalities.

c) Preterm birth. Rationale: Preterm delivery is one of the biggest problems of teen mothers. Their bodies are immature and they tend to deliver prematurely.

Which of the following statements regarding chlamydial infections is correct? a) Treatment of choice is oral penicillin. b) Treatment of choice is nystatin or miconazole. c) Clinical manifestations include dysuria and urethral itching in males. d) Clinical manifestations include small, painful vesicles on genital areas.

c) Clinical manifestations include dysuria and urethral itching in males.

A nurse working in a prenatal clinic for pregnant teenagers is aware that these young women are at increased risk for complications during childbearing. Which of the following best describes obstetrical hazards experienced by pregnant adolescents? a) They have an increased mortality rate and an increased incidence of anemia, vaginitis, urinary tract infections, and pregnancy-induced hypertension. b) They have decreased cognitive development, have little emotional support available, and display childlike behaviors, which may cause conflict. c) They usually experience economic and social handicaps leading to an unsafe physical environment. d) They usually have low self-esteem; therefore, they have a decreased ability to establish meaningful relationahips.

a) They have an increased mortality rate and an increased incidence of anemia, vaginitis, urinary tract infections, and pregnancy-induced hypertension. Rationale: The adolescent is prone to many complications during pregnancy. This can be attributed to lack of early prenatal care as well as to poor nutrition. The other options generally do not apply particularly to the general adolescent population and even if they can lead to increased problems of many natures do not necessarily cause hazardous physical problems.

In assessing a pregestational diabetic woman's knowledge of changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states: a) "I will increase my insulin dosage by 5 units each month during the first trimester." b) "Insulin dosage will likely need to be increased during the second and third trimesters." c) "Episodes of hypoglycemia are more likely to occur during the first 3 months." d) "Insulin needs after I give birth will be lower than my pregnancy levels because I am going to breastfeed."

a) "I will increase my insulin dosage by 5 units each month during the first trimester." Rationale: Insulin requirements are not predictable. The dosages will have to be determined through response to blood sugars and will be on a sliding scale until she is regulated on longer acting insulins. This scenario may have to be repeated many times. Insulin dependent diabetics are very individual in their needs and ability to be regulated.

A client states that she is afraid that, because she has gestational diabetes, she will be diabetic the rest of her life. The nurse explains which of the following? a) Gestational diabetes usually disappears after pregnancy. b) Taking insulin the rest of her life has no long term effects on her general state health c) There are no life long complications to gestational diabetes. d) Gestational diabetes can be controlled with an adequate diet for the rest of her life.

a) Gestational diabetes usually disappears after pregnancy.

The nurse receives a phone call from a client who received no prenatal care and states she is 36 weeks gestation. She complains of vaginal bleeding that started suddenly without any specific precipitating events and admits that she is not in pain. You advise her to come to the hospital immediately because you are concerned that she may have which of the following? a) Placenta previa. b) Placenta accreta. c) Abruptio placenta. d) Ectopic pregnancy.

a) Placenta previa.

Which of the following would most likely indicate potential problems for a pregnant client with a history of heart disease? a) Reduced activity tolerance b) Polyhydramnios c) Frequent urinary tract infection d) Frequent heartburn

a) Reduced activity tolerance Rationale: Reduced activity tolerance is differentiated from the normal fatigue of pregnancy; it may be an early sign of congestive heart failure, a condition to which the cardiac client is highly predisposed. Reduced activity tolerance is differentiated from the normal fatigue of pregnancy; it may be an early sign of congestive heart failure, a condition to which the cardiac client is highly predisposed.

A diabetic client has an ultrasound at 38 weeks, which demonstrates macrosomia and an estimated fetal weight of 4300 grams. The nurse explains that she is at increased risk for which of the following? a) Shoulder dystocia b) Prolapsed cord c) Placenta previa d) Postpartum depression

a) Shoulder dystocia Rationale: Macrosomic infants get big all over. Wide shoulders put her at risk for an infant with large wide shoulders getting stuck trying to deliver vaginally....shoulder dystocia.

A woman is her third trimester contracts Toxoplasmosis. She is very concerned about the effects on the fetus. Which of the following statements by the nurse best explains what the woman can expect? "You have contracted the illness late in your pregnancy and: b) usually that means the infant will have sever Neurologic problems." c) you are likely to have a more difficult labor but the infant will be fine." d) about 65% of the infants will have blindness and deafness problems."

a) almost 90% of the time the baby will not have any problems. Rationale: "Toxoplasmosis contracted in the last trimester will not exert as severe effects from fetal infection as it would if contracted early in pregnancy, but the fetus could be born with infection from toxoplasmosis. Many don't show signs of infection at this stage. This infection can vary in expression of severity. Contracted early, the fetus can die. If this infection is suspected, the mother should be treated. She should be taught early to avoid raw red meat, unpasteurized goats milk, or caring for cat litter. She should avoid contact with any place the cat may have defecated.

A 15-year-old client delivers a 5-pound daughter after a difficult labor. Since delivery she has been trying to decide whether or not to keep her baby and asks the nurse what she should do. Which of the following statements made by the nurse is most appropriate? a) "Adoption is really the best solution to your situation." b) "It must be difficult to be in this position." c) "Was this pregnancy planned or unplanned." d) "What would your parents like you to do."

b) "It must be difficult to be in this position." Rationale: This therapeutic communication fosters open expression of feelings. The nurse can only offer alternatives. The ultimate decision lies with the client.

The physician tells a woman that she has had "a missed abortion". The woman asks the nurse to explain what this means. Which response is most appropriate? a) "It's another name for miscarriage." b) "The baby is no longer alive and growing, but your body hasn't expelled it yet." c) "The baby is deformed, resulting in abortion." d) "There was no pregnancy, your body just responded as if there was."

b) "The baby is no longer alive and growing, but your body hasn't expelled it yet." Rationale: This is the definition of a missed abortion. Findings in a missed abortion include spotting and a uterus that is smaller than expected for the length of pregnancy. If spontaneous evacuation of the fetus does not occur soon, a suction evacuation or D&C will be done to remove the products of conception.

A woman has been admitted to the hospital for severe hyperemesis gravidarum. Which of the following interventions would be needed to prevent complications of severe hyperemesis? a) Avoid giving very cold or iced liquids or using straws b) Administer intravenous fluids with potassium chloride added c) Have the client rest in bed with her head and knees elevated d) Prepare her for an ultrasound to rule out molar pregnancy

b) Administer intravenous fluids with potassium chloride added Rationale: This client's greatest need is for fluids and electrolytes. An IV is imperative.

The nurse administers maganesium sulfate to a woman who is hospitalized with severe pregnancy induced hypertension (PIH). Six hours after administration, DTR's are nonexistant and her respiratory rate is 8 breaths/minute. Which of the following medications would she anticipate the HCP will order? a) Sodium bicarbonate b) Calcium gluconate c) Epinephrine (Adrenalin) d) Narcan

b) Calcium gluconate Rationale: Calcium gluconate should be kept at the bedside of all client's receiving magnesium for PIH. These clients are at risk for toxicity because their kidney's many times are functioning at a decreased level and they cannot clear the drug.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often which of the following? a) Orthopnea b) Decreasing energy level c) Moist, frequent cough and frothy sputum d) Crackles (rales) at based of lungs upon auscultation

b) Decreasing energy level Rationale: The first thing that is noted in cardiovascular decompensation is decreasing energy or fatigue. The pregnant woman might not think anything about that, if she doesn't know that it is the very first sign.

A woman with severe preeclampsia is being treated with an IV infusion of Magnesium Sulfate. This treatment will be evaluated as successful if which of the following is present? a) Blood pressure is reduced to her prepregnant baseline. b) Seizures do not occur. c) Deep tendon reflexes become hypotonic. d) Diuresis reduces fluid retention.

b) Seizures do not occur. Rationale: This is the primary reason for administration of magnesium sulfate to preeclamptic women. Prevent seizures.

To facilitate delivery of a client with cardiac problems, the client will be told to expect the plan of care to include which of the following? a) The use of Pitocin induction. b) Use of forceps to assist delivery. c) A scheduled cesarean section. d) No special arrangements, let nature proceed.

b) Use of forceps to assist delivery. Rationale: Clients with cardiac problems are usually delivered vaginally if possible. It is less traumatic cariovascularly than a cesarean. They will be given an epidural early and not allowed to push, so likely they will labor down and forceps will be used at the end.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). Which of the following should the nurse recommend? a) Prophylactic antibiotics b)Condom use c)Any type of contraception method d)Withdrawal method of contraception

b)Condom use

A pregnant woman with preeclampsia is to be induced. Prior to initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings and notes a platelet count of 90,000, an elevated AST level, and a falling hematocrit. The nurse would notify the physician because of concern for which problem? a) Eclampsia b) HELLP syndrome c) Disseminated intravascular coagulation (DIC) d) Idiopathic thrombocytopenia

b)HELLP syndrome Rationale: HELLP syndrome is highly suspected if the platelets fall below 100,000. Other signs would be epigastric pain, high liver enzyme values, and perhaps S&S of preeclampsia.

After a cerclage procedure is done for incompetent cervical os, it will be especially important for the client to receive discharge instructions from the nurse regarding: a) Abstinence from intercourse until after the suture is removed. b)Recognition of the signs and symptoms of labor c) Avoidance of infection d) Monitoring of fetal activity

b)Recognition of the signs and symptoms of labor Rationale: A woman with a suture in place for incompetent cervix must be especially aware of the signs and symptoms of labor. When labor begins, the physician will remove the suture to avoid possible complications.

During the initial antepartal appointment, which of the follwoing nursing actions would most encourage a pregnant teenager in developing a positive response to her new, changing physical status? a)Discuss the client's rights and explain informed consent b) Provide a description of the scope of available services c) Spend time with the young woman and listen to her concerns d) Reassure the young woman that many teenagers experience a temporary uneasiness at this time.

c) Spend time with the young woman and listen to her concerns Rationale: It is most important for the nurse initially to establish rapport with the client by demonstrating a concerned and accepting attitude.

A 15 year old client, makes her first prenatal clinic visit at 32 weeks gestation. This is her first pregnancy. Prior to beginning the assessment, the nurse knows that the most useful data for identifying this client's maturational status can best be determined by which of the following? a) Determining this client's chronological age. b) By observing this client's physiological development. c) Talking to this client directly. d) Classifying this client's sexual behavior based on Erickson's stages.

c) Talking to this client directly Rationale: The best way to interview a teen client is to be very direct, try to get her alone, and treat her like an adult. Teens will be likely to talk to you more if they are alone. They tend to behave more like an adult if their friends are not present also. It is best to use a non-judgemental approach.

A pregnant client states that she enjoys a glass of wine with dinner. What information should the nurse convey to this client? a) Fetal effects are associated with 5 to 6 drinks per day. b) The period of organogenesis is the most critical time for effects to the fetus. c) There is no documented amount of alcohol that is safe during pregnancy. d) Fetal effects are associated with two drinks per day.

c) There is no documented amount of alcohol that is safe during pregnancy.

A woman presents to the emergency room complaining of spotting and mild cramping. Initial nursing history is significant for a last menstrual period of 6 weeks ago. On sterile speculum examination, the primary care provider finds the cervix closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of abortion? a) Incomplete b) Inevitable c) Threatened d) Septic

c) Threatened Rationale: Threatened abortion is where there is bleeding and some cramping, but no cervical change.

A client has preeclampsia. Her husband asks the nurse how Magnesium Sulfate works. The most accurate reply by the nurse is: a) "This drug is an antihypertensive drug and lowers your wife's blood pressure." b) "Magnesium sulfate is a sedative and will help your wife sleep." c) "The drug is a metal salt and gives your wife needed electrolytes." d) "This drug is a smooth-muscle relaxant that reduces nervous system irritability."

d) "This drug is a smooth-muscle relaxant that reduces nervous system irritability." Rationale: Magnesium is a smooth muscle relaxant and helps to prevent seizure activity by reducing CNS irritability.

A woman arrives at the clinic seeking confirmation of her pregnancy. The following information is obtained. She is 24 years old. Her body mass index (BMI) is 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure is 108/70, her pulse is 72, and her respirations are 16. Family history is positive for diabetes mellitus and cancer; her sister recently gave birth to a baby with a neural tube defect. Which characteristics place the woman in a high-risk category? a) Blood pressure, age, BMI b) Drug/alcohol use, age, family history c) Family history, blood pressure, BMI d) Family history, BMI, drug/alcohol abuse

d) Family history, BMI, drug/alcohol abuse Rationale: When answering a question like this, you must determine which parts answer the question. Some answers may have parts that you really like, and perhaps better answers than the one selected as the answer, but some part will be wrong. In this case, blood pressure and age are not pieces that would put her in danger.

Which of the following statements is true about gonorrhea? a) It is caused by Treponema pallidum. b) Treatment is by multidose administration of penicillin. c) Treatment is by topical applications to lesions. d) Treatment of all sexual contacts is an essential part of treatment.

d) Treatment of all sexual contacts is an essential part of treatment.

A pregnant woman at 28 weeks gestation has been diagnosed with gestational diabetes. The nurse will teach the client: a) that oral hypoglycemic agents can be used if the woman is afraid to give herself insulin injections. b) that dietary modifications and insulin are both required for adequate treatment. c) that her glucose levels will be monitored by testing urine four times a day and at bedtime. d) that dietary management involves distributing nutrient requirements over 3 meals and 2 or 3 snacks.

d) that dietary management involves distributing nutrient requirements over 3 meals and 2 or 3 snacks. Rationale: The only correct answer is option 4. Her dietary management will be distributed equally throughout the day and late evening for best control. Sometime oral agents are used for control, but not necessarily, and not in the place of insulin if it is required. Dietary control alone may be all that is needed for gestational diabetes...that will have to be determined by glucose testing, and trial and error. Testing in this day and age is done with FSBS's, not urine.