Women's health/Disorders & Childbearing

After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate (Clomid) is prescribed. The nurse concludes that the client understands the teaching about the correct time to take the clomiphene when the she states: 1. "I'll start the pills on the fifth day of my cycle." 2. "I'll start the pills on the last day of my period." 3. "I'll start the pills on the third day after my period." 4. "I'll start the pills on the 16th day of my cycle."

1. "I'll start the pills on the fifth day of my cycle." **The objective is to stimulate ovulation near the 14th day of the menstrual cycle, and this is achieved by taking the medication on the fifth through the ninth days; there is an increase in two pituitary gonadotropins luteinizing hormone and follicle-stimulating hormone, with subsequent ovarian stimulation.

On the first postpartum day, a client whose infant is rooming in asks the nurse to return her baby to the nursery and bring the baby to her only at feeding times. How should the nurse respond? 1. "It seems that you've changed your mind about rooming in." 2. "I think you're having difficulty caring for the baby." 3. "All right. I'll inform the other nurses of your decision." 4. "You must be tired. I'll bring the baby back at feeding time."

1. "It seems that you've changed your mind about rooming in."

What instruction should a nurse include when teaching about the correct use of a female condom? 1. "Remove the condom before standing up." 2. "Insert the condom within 1 hour before intercourse." 3. "Have your partner wear a male condom at the same time." 4. "Cleanse the condom with warm water when preparing it for future use."

1. "Remove the condom before standing up." **Removing the condom before standing up keeps the semen in the female condom and prevents the inadvertent contact of semen with vaginal tissues.

A 20-year-old woman is known to be heterozygous for the cystic fibrosis (CF) gene. Her husband's genotype is unknown at present and the couple is expecting their first child. What should the nurse tell the couple about the probability of their baby's having CF? 1. 25% or less 2. 50% or more 3. Extremely common 4. Unknown at this time

1. 25% or less **Males with cystic fibrosis are usually sterile; therefore the father does not have cystic fibrosis, but he could be a carrier. If both parents are heterozygous carriers, the chance of having a child with CF is 25%. When one parent is a heterozygous carrier and the other has two unaffected genes, the chance of having a child who has CF is 0% but the chance of having a child who is a carrier is 50%.

Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. Which symptoms are suggestive of a vaginal infection? (Select all that apply.) 1. Abdominal pain 2. Urinary frequency 3. Rising temperature 4. Decreased pulse rate 5. Decreased blood pressure

1. Abdominal pain 3. Rising temperature

After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect? 1. An incisional nick in the bladder 2. A urinary infection from the catheter 3. Disseminated intravascular coagulopathy 4. Uterine relaxation with increased bleeding

1. An incisional nick in the bladder **During an abdominal hysterectomy the urinary bladder may be nicked accidentally.

A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage the mother to do? (Select all that apply.) 1. Apply cool packs to her breasts to reduce the discomfort 2. Take the analgesic medication prescribed to limit the discomfort 3. Remove the infant from the breast for a few days to rest the nipples 4. Never expose the nipples to air, only wear a tight fitting brassiere 5 . Assume a different position when breastfeeding to adjust the infant's sucking

1. Apply cool packs to her breasts to reduce the discomfort 2. Take the analgesic medication prescribed to limit the discomfort 5 . Assume a different position when breastfeeding to adjust the infant's sucking

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. What intervention is important when the nurse discusses this finding with the client? 1. Asking her whether she has had German measles and when she had the disease 2. Arranging for her to receive the rubella booster vaccine after the birth 3. Planning for her to receive the rubella booster vaccine at her next visit 4. Informing her that the result was expected and that treatment will not be needed

1. Asking her whether she has had German measles and when she had the disease

A woman has made the decision to have breast augmentation surgery, and the procedure is to be performed on an outpatient basis. As part of the preoperative protocol, the nurse provides teaching regarding the discharge instructions. Which instructions apply to this type of surgery? (Select all that apply.) 1. Avoid taking aspirin or NSAIDs (e.g., ibuprofen [Advil]) for pain relief. 2. Sleep with your head and torso elevated for at least 1 week. 3. You may sleep on your back or sides but not on your stomach. 4. Begin slowly raising your arms over your head after the first week. 5 . Take your temperature daily and notify the clinic if it goes above 99.6° F

1. Avoid taking aspirin or NSAIDs (e.g., ibuprofen [Advil]) for pain relief. 2. Sleep with your head and torso elevated for at least 1 week. 5 . Take your temperature daily and notify the clinic if it goes above 99.6° F

A client seeking family planning information asks the nurse during which phase of the menstrual cycle an intrauterine device (IUD) should be inserted. Before responding the nurse recalls that the insertion usually is done: 1. Between the first and fourth days of the cycle 2. Between fifth and 11th days 3. Between the 14th and 16th days 4. Between the 25th and 28th days

1. Between the first and fourth days of the cycle **An IUD should be inserted during menstruation because the cervical os is slightly dilated at this time; also, there is little chance of the woman's being pregnant.

Which behavior indicates to a nurse that a new mother is in the taking-hold phase? 1. Calling the baby by name 2. Talking about the labor and birth 3. Touching the baby with her fingertips 4. Being involved with the infant's need to eat and sleep

1. Calling the baby by name **The mother has moved into the taking-hold phase when she takes control and becomes actively involved with her infant and calls the infant by name

A client has just been told that she has cervical erosion. The nurse would expect to help explain that early treatment of the erosion can help prevent: 1. Cancer of the cervix 2. Pelvic inflammatory disease 3. Unexpected vaginal bleeding 4. Additional cervical erosions

1. Cancer of the cervix **Erosion of the cervix frequently occurs at the columnosquamous junction, the most common site for carcinoma of the cervix.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? (Select all that apply.) 1. Cardiac output increases. 2. Blood pressure decreases. 3 . The heart is displaced upward. 4. The blood plasma volume peaks. 5 . The hematocrit level is lowered

1. Cardiac output increases. 2. Blood pressure decreases. 3 . The heart is displaced upward.

Which risk factors are associated with the future development of osteoporosis in women? (Select all that apply.) 1. Cigarette smoking 2. Moderate exercise 3. Use of street drugs 4. Familial predisposition 5 . Inadequate intake of dietary calcium

1. Cigarette smoking 4. Familial predisposition 5 . Inadequate intake of dietary calcium

A client with a history of endometriosis has abdominal surgery to remove adhesions. What should this client's postoperative plan of care include? 1. Encouraging the client to ambulate in the hallway 2. Elevating the client's legs by gatching the bed 3. Helping the client dangle her legs over the side of the bed 4. Maintaining the client on bedrest until the dressings have been removed

1. Encouraging the client to ambulate in the hallway

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response? (Select all that apply.) 1. Expulsion of the device 2. Occasional dyspareunia 3. Delay of return to fertility 4. Risk for perforation of the uterus 5. Increased number of vaginal infections

1. Expulsion of the device 2. Occasional dyspareunia 4. Risk for perforation of the uterus

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? (Select all that apply.) 1. Focus on and repeat a rhythmic chant. 2. Sit upright for 30 minutes after meals. 3. Take low-sodium antacids after meals. 4. Drink carbonated beverages with meals. 5. Eat small, frequent meals and eat dry crackers in between.

1. Focus on and repeat a rhythmic chant. 5. Eat small, frequent meals and eat dry crackers in between.

A client has a modified radical mastectomy because of a malignant tumor of the breast. What does the nurse plan to teach the client during the early postoperative period? 1. Keep the arm in an elevated position. 2. Observe the incision site for redness and bleeding. 3. Maintain a high Fowler position with the affected arm on a pillow. 4. Perform range-of-motion exercises, including flexion and abduction of the affected arm.

1. Keep the arm in an elevated position.

A client is scheduled to have a contraction stress test (CST) to determine fetal well-being. Which type of fetal heart rate (FHR) decelerations constitutes a nonreassuring outcome? 1. Late 2. Early 3. Baseline 4. Variable

1. Late

A client in preterm labor is to receive a tocolytic medication, and bedrest is prescribed. Which position should the nurse suggest that the client maintain while on bedrest? 1. Lateral 2. Supine 3. Fowler 4. Semi-Fowler

1. Lateral **The lateral position relieves pressure on the vena cava, thereby promoting venous return and increasing placental perfusion.

During discharge teaching a client who just had a hysterectomy states, "After this surgery, I don't expect to be interested in sex anymore." What should the nurse consider before responding? 1. Many women incorrectly equate hysterectomy with loss of libido. 2. Surgically forced menopause usually results in a decreased sex drive. 3. The loss of estrogen that results from this surgery will cause most women to experience a decrease in libido. 4. Body image changes that occur after this surgery prevent many women from resuming sexual activity.

1. Many women incorrectly equate hysterectomy with loss of libido. **The uterus is often erroneously believed necessary for a satisfying sex life.

During a routine prenatal office visit at 26 weeks' gestation, a client states that she is getting fat all over and that she even needed to buy bigger shoes. What is the next nursing action? 1. Obtaining the client's weight and blood pressure 2. Reassuring the client that weight gain is expected 3. Supporting the client's decision to buy comfortable shoes 4. Teaching the client about the importance of limiting fatty foods and sweets

1. Obtaining the client's weight and blood pressure **The client's weight and blood pressure helps the nurse determine whether an unusual weight gain or an increase in blood pressure has occurred; both of these findings are early signs of preeclampsia.

The nurse is caring for a client who is in the taking-in phase of the postpartum period. The area of health teaching that the client will be most responsive to is: 1. Perineal care 2. Infant feeding 3. Infant hygiene 4. Family planning

1. Perineal care

What does the nurse teach a client to do when performing breast self-examination? 1. Squeeze the nipples to examine for discharge 2. Use the right hand to examine the right breast 3. Place a pillow under the shoulder opposite the examined breast to raise it 4. Compress breast tissue to the chest wall with the palm to palpate for lumps

1. Squeeze the nipples to examine for discharge

The nurse is teaching a sex education course to high school students. What should the nurse teach them about why gonorrhea is difficult to control? (Select all that apply.) 1. Symptoms of the disease are vague. 2. Screening blood tests are expensive. 3. The incubation period is relatively short. 4 . Causative organisms have become resistant to treatment. 5 . Diagnostic tests for the causative organism are not yet available.

1. Symptoms of the disease are vague. 3. The incubation period is relatively short. 5 . Diagnostic tests for the causative organism are not yet available.

After an emergency cesarean birth, the client tells the nurse that she was hoping for a "natural" childbirth but is glad that she and her baby are all right." Which postpartum phase of adjustment does this statement most closely typify? 1. Taking-in 2. Letting-go 3. Taking-hold 4. Working-through

1. Taking-in

A nurse caring for a pregnant client and her partner suspects domestic violence. Which observations support this suspicion? (Select all that apply.) 1. The woman has injuries to the breasts and abdomen. 2. The partner refuses to come into the examination room. 3. The partner answers questions that are asked of the woman. 4. The woman has visited the clinic several times in the last month. 5 . The partner is excessively attentive while the health history is being taken.

1. The woman has injuries to the breasts and abdomen. 3. The partner answers questions that are asked of the woman. 4. The woman has visited the clinic several times in the last month.

A client with endometriosis asks the nurse what side effects to expect from leuprolide (Lupron). What should the nurse include in the response? 1. Weight gain 2. Increased libido 3. Frequent urination 4. Heavy menstrual bleeding

1. Weight gain **The nurse should teach the client that the side effects of leuprolide (Lupron) include edema, which causes an increase in weight.

A client has a child with Tay-Sachs disease and wants to become pregnant again. She tells the nurse, "I'm worried it will happen again." How should the nurse respond? 1. "Did you discuss this with your physician?" 2. "Have you considered the option of genetic counseling?" 3. "Can you remember if Tay-Sachs occurred before in your family?" 4. "It is a rare disease that is statistically improbable to happen again."

2. "Have you considered the option of genetic counseling?"

After a mastectomy or a hysterectomy a client may feel incomplete as a woman. What statement should alert the nurse to this feeling in a client who has undergone total hysterectomy? 1. "I can't wait to see all my friends again." 2. "I feel washed out; there isn't much left." 3. "I'm planning to recuperate at my daughter's home." 4. "I can't wait to get home; I so want to see my grandchild."

2. "I feel washed out; there isn't much left."

A nurse is instructing a client to cough and deep-breathe after an emergency cesarean birth. The client says, "Get out of here. Can't you see that I'm in pain?" Which response will be the most effective? 1. "I'm sure you're in pain. I'll come back later." 2. "If you can't cough, try taking six very deep breaths." 3. "Your pain is to be expected, but you must exercise your lungs." 4. "I'll give you something for your pain. We can start the coughing tomorrow."

2. "If you can't cough, try taking six very deep breaths." **Having the client take deep breaths is important because deep breathing promotes full expansion of the alveoli and prevents stasis of pulmonary secretions.

A client who had a child with Tay-Sachs disease is pregnant and is to have an amniocentesis to determine whether the fetus has the disease. The nurse counsels her to plan for the procedure at the optimal time for the procedure at: 1. 6 to 8 weeks' gestation 2. 14 to 16 weeks' gestation 3. 18 to 20 weeks' gestation 4. 22 to 24 weeks' gestation

2. 14 to 16 weeks' gestation **An amniocentesis is done at this time because a therapeutic abortion may be legally and safely performed if desired by the parents.

A 2-day-old infant who weighs 6 lb (2722 g) is fed formula every 4 hours. Newborns need about 73 mL of fluid per pound of body weight each day. In light of this information, approximately how much formula should the infant receive at each feeding? 1. 1 to 2 oz 2. 2 to 3 oz 3. 3 to 4 oz 4. 4 to 5 oz

2. 2 to 3 oz

The school nurse is teaching a group of 16-year-old girls about the female reproductive system. One student asks how long after ovulation it is possible for conception to occur. The most accurate response by the nurse is based on the knowledge that an ovum is no longer viable after: 1. 12 hours 2. 24 hours 3. 48 hours 4. 72 hours

2. 24 hours **The ovum is viable for about 24 hours after ovulation; if not fertilized before this time, it degenerates.

The nurse instructs a pregnant client in the sources of protein that can be used to meet the increased daily requirement during pregnancy. How many grams of protein should the client eat each day? 1. 65 g 2. 60 g 3. 55 g 4. 50 g

2. 60 g **The Food and Nutrition Board of the National Academy of Sciences recommends that a pregnant woman consume 60 g of protein daily to meet the needs of pregnancy. The recommended daily intake of protein for a breastfeeding (lactating) woman is 65 g.

Although a client in labor is prepared and plans to participate in the labor and birth process, she states that she is in severe discomfort. The nurse administers the prescribed butorphanol (Stadol). Which phase of labor is the safest time for the nurse to administer this medication? 1. Early phase 2. Active phase 3. Transition phase 4. Expulsion phase

2. Active phase **Respiratory depression of the newborn will not occur if the medication is given during the active phase; it should not be given when birth is expected to occur within 2 hours.

A female client came to the clinic with suspected primary syphilis. What sign of primary syphilis does the nurse expect the client to exhibit? 1. Flat wartlike plaques around the vagina and anus 2. An indurated painless nodule on the vulva that is draining 3. Glistening patches in the mouth covered with a yellow exudate 4. A maculopapular rash on the palms of the hands and soles of the feet

2. An indurated painless nodule on the vulva that is draining **This is the description of a chancre, which is the initial sign of syphilis.

During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because of the presence of a white curdlike vaginal discharge. What other assessment supports a fungal vaginal infection? 1. A foul odor 2. An itchy perineum 3. An ischemic cervix 4. A forgotten tampon

2. An itchy perineum

A husband sits in the waiting room while his wife is getting her infertility prescription refilled by the clinic pharmacist. As the nurse sits down beside him, he blurts, "It's like there are three of us in bed—my wife, me, and the doctor." What feeling is reflected by this statement? 1. Guilt 2. Anger 3. Depression 4. Unworthiness

2. Anger

A client's temperature is 100.4° F 12 hours after a spontaneous vaginal birth. What does the nurse suspect is the cause of the increased temperature? 1. Mastitis 2. Dehydration 3. Puerperal infection 4. Urinary tract infection

2. Dehydration

A resident practitioner in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a low-lying placenta who is in early labor. What is the priority nursing action? 1. Preparing an intravenous piggyback of oxytocin (Pitocin) 2. Explaining why a vaginal examination should not be performed 3. Obtaining an internal monitor to be applied during the examination 4. Having equipment ready for a fetal scalp pH after the examination

2. Explaining why a vaginal examination should not be performed

A pregnant client who is scheduled for a nonstress test (NST) asks a nurse how the test can show that "my baby is all right." The nurse explains that it is a way of evaluating the condition of the fetus by comparing the fetal heart rate (FHR) with: 1. Fetal gestational age 2. Fetal physical activity 3. Maternal blood pressure 4. Maternal uterine contractions

2. Fetal physical activity

The clinic nurse is providing home care instructions for a client with pelvic inflammatory disease. What resting position should be recommended by the nurse? 1. Sims 2. Fowler 3. Supine with knees flexed 4. Lithotomy with head elevated

2. Fowler **The Fowler position facilitates localization of the infection by pooling exudate in the lower pelvis.

During the fourth stage of labor, the assessment of a primipara who has had a vaginal birth reveals a moderate to large amount of lochia rubra, a firm fundus that is at the umbilicus and deviated to the right, and pain that she rates as a 3 on a scale of 1 to 10. What is the priority nursing action? 1. Massaging the fundus 2. Helping the client void 3. Increasing the rate of the oxytocin infusion 4. Administering the prescribed pain medication

2. Helping the client void **A fundus that is deviated to the right during the fourth stage of labor commonly is caused by a distended bladder ; if the bladder remains distended, involution will be inhibited, resulting in a boggy uterus that is prone to hemorrhage.

A nurse is caring for a client who is receiving internal radiation for cancer of the cervix. For which adverse reactions to the radiotherapy should the client be monitored? (Select all that apply.) 1. Nausea 2. Hemorrhage 3. Restlessness 4. Vaginal discharge 5. Increased temperature

2. Hemorrhage 5. Increased temperature

A pregnant client with an infection tells the nurse that she has taken tetracycline (Tetracyn) for infections on other occasions and prefers to take it now. The nurse tells the client that tetracycline is avoided in the treatment of infections in pregnant women because it: 1. Affects breastfeeding adversely 2. Influences the fetus's teeth buds 3. Causes fetal allergies to the medication 4. Increases the fetus's tolerance to the medication

2. Influences the fetus's teeth buds

A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecological history. What condition does the client have that causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy? 1. Prolapsed uterus 2. Large uterine fibroids 3. Mild dysplasia of the cervical os 4. Urinary incontinence when coughing

2. Large uterine fibroids **Attempting to remove a uterus with large uterine fibroids vaginally can cause trauma, resulting in hemorrhage.

A client with cervical cancer is to undergo a course of internal radiation. The client returns to her lead-lined room on the oncology unit with an indwelling urinary catheter and a vaginal applicator in place. Once the practitioner has loaded the applicator with the radiation source, the nurse's plan of care should include: 1. Changing linens several times a day 2. Leaving the urinary catheter undisturbed 3. Cleansing the perineal area with a mild antiseptic twice daily 4. Removing equipment from the room immediately after it is used

2. Leaving the urinary catheter undisturbed

A client starting her second trimester asks a nurse in the prenatal clinic whether she can safely take an over-the-counter (OTC) medicine now that she is past the first 3 months of pregnancy. The nurse explains why she should consult with her health care provider before taking any oral medications. What physiological alteration associated with pregnancy may change the client's response to medication? 1. Decreased glomerular filtration rate 2. Longer gastrointestinal emptying time 3. Increased secretion of hydrochloric acid 4. Development of fetal-placental circulation

2. Longer gastrointestinal emptying time **Gastrointestinal motility is reduced during pregnancy because of the high level of placental progesterone and displacement of the stomach superiorly and the intestines laterally and posteriorly; absorption of some drugs, vitamins, and minerals may be increased because of their slow passage through the gastrointestinal tract.

A nurse teaches a pregnant woman about the need to increase her intake of complete proteins. Which foods identified by the client indicate that the teaching is effective? (Select all that apply.) 1. Nuts 2. Milk 3. Eggs 4. Bread 5. Beans 6. Cheese

2. Milk 3. Eggs 6. Cheese

Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching has been understood? (Select all that apply.) 1. Tailor sitting 2. Pelvic rocking 3. Forward tilting 4. Sacral pressure 5. Kegel exercises

2. Pelvic rocking 3. Forward tilting 4. Sacral pressure

A nurse is teaching a breastfeeding client about medications that are safe and unsafe for her to take. Which medication is contraindicated? 1. Heparin (Hep-Lock) 2. Propylthiouracil (PTU) 3. Gentamicin (Garamycin) 4. Diphenhydramine (Benadryl)

2. Propylthiouracil (PTU) **The concentration of propylthiouracil (PTU) excreted in breast milk is three to 12 times higher than its level in maternal serum; this may cause agranulocytosis or goiter in the infant.

A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including that the client will understand with regard to active immunity? 1. Protein antigens are formed in the blood to fight invading antibodies. 2. Protein substances are formed by the body to destroy or neutralize antigens. 3. Blood antigens are aided by phagocytes in defending the body against pathogens. 4. Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens.

2. Protein substances are formed by the body to destroy or neutralize antigens.

A nurse is obtaining a health history from a client with newly diagnosed cervical cancer. What aspect of the client's life is most important for the nurse to explore at this time? 1. Sexual history 2. Support system 3. Obstetrical history 4. Elimination patterns

2. Support system

A nurse instructs a client who is taking oral contraceptives to increase her intake of dietary supplements. Which supplement should be increased? 1. Calcium 2. Vitamin C 3. Vitamin E 4. Potassium

2. Vitamin C **Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required.

A nurse on the postpartum unit discusses breast care with a client who is formula feeding her newborn. Which statement indicates to the nurse that more teaching is needed? 1. "The discomfort will be better after a couple of days." 2. "I need to ask my husband to bring me my new bra." 3. "Applying heat to my breasts will help ease the discomfort." 4. "Pain medication will help with the pain from engorgement."

3. "Applying heat to my breasts will help ease the discomfort."

A nurse is teaching a postpartum client the characteristics of lochia and any deviations that should be reported immediately. What client statement indicates that the teaching was effective? 1. "If I pass any clots, I'll notify the clinic." 2. "I'll call the clinic if my lochia changes from red to pink." 3. "I'll notify the clinic if my lochia starts to smell bad." 4. "If my vaginal discharge continues for three weeks, I'll call the clinic."

3. "I'll notify the clinic if my lochia starts to smell bad." **Lochia has a characteristic menstrual musky or fleshy smell. A foul-smelling discharge, along with fever and uterine tenderness, suggests an infection.

Which statements by a client with hyperemesis gravidarum would confirm that the client needs further teaching? (Select all that apply.) 1. "I'll start drinking protein shakes." 2. "I'll start drinking plenty of fluids." 3. "I'll start limiting my carbohydrates." 4. "I'll lie down for at least 2 hours after I eat." 5. "I'll be sure to schedule rest periods throughout the day so I won't get tired."

3. "I'll start limiting my carbohydrates." 4. "I'll lie down for at least 2 hours after I eat."

A 63-year-old woman with the diagnosis of estrogen-receptor positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen (Nolvadex) is prescribed. The client asks the nurse how long she will have to take the medication. The nurse responds: 1. "You'll have to take it for the rest of your life." 2. "You'll need to take it for 10 days, like an antibiotic." 3. "You'll need to take it for 5 years, after which it will be discontinued." 4. "You'll need to take it for several months, until the bone pain subsides."

3. "You'll need to take it for 5 years, after which it will be discontinued."

A client is scheduled for a vacuum aspiration abortion to terminate an unwanted pregnancy. What information should the nurse's teaching plan include? 1. It is a lengthy procedure but will cause no pain. 2. Both she and the father must sign the consent form. 3. A temperature of 100.4° F (38° C) or higher should be reported immediately. 4. She will experience a heavy menstrual flow for 1 to 2 weeks after the procedure.

3. A temperature of 100.4° F (38° C) or higher should be reported immediately.

A primigravida tells the nurse that she has morning sickness. What suggestion should the nurse make to help relieve the nausea? 1. Eating three small meals a day 2. Increasing dietary calcium intake 3. Avoiding long periods without food 4. Drinking 2 quarts or more of fluid a day

3. Avoiding long periods without food **Fasting results in hypoglycemia, which can cause nausea; in addition, the developing fetus should not be deprived of nutrients for any length of time.

A primigravida at term is admitted to the birthing room in active labor. Later, when the client is dilated 8 cm, she tells the nurse that she has the urge to push. The nurse instructs her to pant-blow at this time because pushing can cause which of the following? 1. Prolapse the cord 2. Rupture the uterus 3. Cervical edema 4. Lead to a precipitous birth

3. Cervical edema

An estrogen-progestin oral contraceptive is prescribed for a client. Which adverse effects should the nurse teach the client to report to the health care provider? (Select all that apply.) 1. Lethargy 2 .Dizziness 3. Chest pain 4. Constipation 5. Breast soreness 6. Calf tenderness

3. Chest pain 5. Breast soreness 6. Calf tenderness

A pregnant client at 30 weeks' gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy her cervix continues to dilate, and it is determined that a preterm birth is inevitable. Which medication does the nurse expect the health care provider to prescribe? 1. Norgestrel 2. Aminophylline 3. Dexamethasone 4. Magnesium sulfate

3. Dexamethasone **Dexamethasone is a glucocorticoid that stimulates the production of fetal lung surfactants, which are needed for fetal lung maturity; administration is started 48 hours before the expected birth.

A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse suspect the client is experiencing? 1. Dehydration 2. Choriocarcinoma 3. Hydatidiform mole 4. Threatened abortion

3. Hydatidiform mole

A client comes to the fertility clinic for hysterosalpingography using radiopaque contrast material to determine whether her fallopian tubes are patent. When preparing for the test, the nurse explains to the client that she: 1. Will receive a local anesthetic and the pain will lessen 2. Will have to rest in bed for 8 hours after the test is completed 3. May have some persistent shoulder pain for 14 hours after the test 4. May become nauseated during the test, but the nausea will subside

3. May have some persistent shoulder pain for 14 hours after the test

What is the focus of the nurse's anticipatory guidance during the first trimester of pregnancy? 1. Birthing process 2. Signs of complications 3. Physical changes of pregnancy 4. Role transition into parenthood

3. Physical changes of pregnancy

e nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day? 1. Dark red 2. Deep brown 3. Pinkish brown 4. Yellowish white

3. Pinkish brown

A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it: 1. Prevents chorioamnionitis 2. Increases uteroplacental exchange 3. Promotes neonatal pulmonary maturity 4. Is used to treat fetal respiratory distress syndrome

3. Promotes neonatal pulmonary maturity

A nurse is evaluating a client's understanding regarding postoperative concerns after mastectomy. Which development near and around the incision noted by the client should be reported to her practitioner? 1. Persistent itching 2. Decreased sensation 3. Swelling with erythema 4. Irregular-appearing ski

3. Swelling with erythema **Swelling and erythema are signs of infection and should be reported to the health care provider. Itching is a sign of healing that is expected.

A nurse is teaching a childbirth preparation class about the discomfort of labor. What is the greatest influence on the perception of pain for a woman in labor? 1. Parity of the client 2. Duration of the labor 3. Tension of the client 4. Difficulty of the labor

3. Tension of the client

A client who is taking an oral contraceptive calls the nurse with concerns about side effects of the medication. Which adverse effect of this medication should alert the nurse to inform the client to immediately stop the contraceptive and contact the health care provider? (Select all that apply.) 1 . Nausea 2 . Weight loss 3. Visual disturbances 4. Persistent headaches 5. Decreased blood pressure

3. Visual disturbances 4. Persistent headaches

A nurse at a women's health clinic confirms that client teaching regarding the use of an oral contraceptive is understood when the client states, "I: 1. Can stop the pill and try to get pregnant right away" 2. May miss two periods and not worry about being pregnant" 3. Will put a baby's picture on my bathroom mirror so I'll see it every morning" 4. Am so glad we won't have to use condoms even if I miss just one pill during the month"

3. Will put a baby's picture on my bathroom mirror so I'll see it every morning" **Putting a baby's picture on the bathroom mirror serves as a reminder that the oral contraceptive must be taken every day.

A 35-year-old client is scheduled for a vaginal hysterectomy. She asks the nurse about the changes she should expect after surgery. How should the nurse respond? 1. "You will stop ovulating." 2. "Surgical menopause will happen immediately." 3. "Sexual intercourse will be uncomfortable when you resume it." 4. "A hysterectomy doesn't affect the chronological age when menopause usually occurs."

4. "A hysterectomy doesn't affect the chronological age when menopause usually occurs."

A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have exploratory surgery. How should the nurse respond? 1. "What has the physician told you?" 2. "I don't know the answer to that question." 3. "I'm not allowed to give you that information." 4. "Have you talked to your wife about your concerns?"

4. "Have you talked to your wife about your concerns?" **The correct response protects the wife's confidentiality while fostering open communication between the couple.

A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond? 1. "It covers the entrance to the cervical os." 2. "The openings to the fallopian tubes are blocked." 3. "The sperm are kept from reaching the vagina." 4. "It produces a spermicidal intrauterine environment."

4. "It produces a spermicidal intrauterine environment."

A pregnant client has a positive group B Streptoccus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan? 1. "Go straight to the outpatient area of the maternity unit for a nonstress test." 2. "You'll need to schedule visits twice a week with your health care provider until you deliver." 3. "Your baby will have to spend at least 3 days in the neonatal intensive care unit because of this infection." 4. "This information will be in your prenatal record, but please remind your labor and delivery nurse of this finding."

4. "This information will be in your prenatal record, but please remind your labor and delivery nurse of this finding."

On a return visit to the fertility clinic a couple requests fertility drugs because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. What should the nurse explain to the couple? 1. A laparoscopy will be scheduled. 2. An endometrial biopsy will be required. 3. A fertility medication will be prescribed. 4. An examination of semen will be needed

4. An examination of semen will be needed **Because the client has an ovulatory cyclic pattern, the infertility may be a result of a seminal factor; the partner's semen should be examined before more extensive studies or treatments are begun.

A primigravida complains of morning sickness. What should the nurse plan to teach her? 1. Increasing her fluid intake 2. Eat three small meals a day 3. Increase the calcium in her diet 4. Avoid long periods without food

4. Avoid long periods without food

A client who is visiting the family planning clinic is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of: 1. Cervicitis 2. Ovarian cysts 3. Fibrocystic disease 4. Breakthrough bleeding

4. Breakthrough bleeding

A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely? 1. Respiratory 2. Reproductive 3. Integumentary 4. Cardiovascular

4. Cardiovascular **Syphilis is primarily a vascular disease; aortitis, valvular insufficiency, and aortic aneurysms are the most prevalent problems in tertiary syphilis.

The day after a client has a cesarean birth, the indwelling catheter is removed. The nurse concludes that urinary function has returned when the: 1. Client has 90 mL of residual urine after voiding 2. Client's daily urinary output is at least 1500 mL 3. Client's urinalysis indicates that no bacteria are present 4. Client voids 300 mL of urine within 4 hours of catheter removal

4. Client voids 300 mL of urine within 4 hours of catheter removal **Voiding 300 mL of urine within 4 hours of catheter removal indicates that urinary sphincter tone has not been affected by the catheter and that urine retention with overflow has not occurred.

What is the safest and most reliable birth control method for the nurse to recommend to a client with type 1 diabetes? 1. Vaginal sponge 2. Oral contraceptive 3. Rhythm method with a condom 4. Diaphragm with a spermicidal gel

4. Diaphragm with a spermicidal gel

A client's nipples become sore and tender as a result of her newborn's vigorous suckling. What should the nurse recommend that the mother do to alleviate the soreness? (Select all that apply.) 1. Apply ice packs before each feeding. 2. Formula feed the baby for a few days. 3. Take the prescribed analgesic medication. 4. Expose the nipples to air several times a day. 5. Apply hydrogel pads to the nipples after each feeding.

4. Expose the nipples to air several times a day. 5. Apply hydrogel pads to the nipples after each feeding. **Exposure of the nipples to air dries the nipples by way of evaporation; exposure also tends to harden the nipples, making them less tender. Hydrogel pads create a moist environment conducive to healing.

During a class for prepared childbirth, the nurse teacher discusses the importance of the spurt of energy that occurs before labor. Why is it important to conserve this energy? 1. Fatigue may increase the progesterone level. 2. Extra energy decreases the intensity of contractions. 3. Extra energy is needed to push during the first stage 4. Fatigue may influence pain medication requirements.

4. Fatigue may influence pain medication requirements.

A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn? 1. Reproductive history 2. Adequacy of prenatal care 3. Health habits and social class 4. Gestational age and birthweight

4. Gestational age and birthweight

A 31-year-old client is seeking contraceptive information. Before responding to the client's questions about contraceptives, the nurse obtains a health history. What factor in the client's history indicates to the nurse that oral contraceptives are contraindicated? 1. Older than 30 years 2. Current hypothyroidism 3. Two multiple pregnancies 4. History of borderline hypertension

4. History of borderline hypertension **Oral contraceptives may cause or exacerbate hypertension; borderline hypertension places the client at risk for a brain attack.

A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? 1. Dizziness 2. Breathlessness 3. Abdominal cramps 4. Increased alertness

4. Increased alertness **Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious.

At a client's first prenatal visit, the healthcare provider performs a pelvic examination, stating that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. The best response is "This is expected; it: 1. Helps confirm your pregnancy" 2. Is not unusual, even in women who are not pregnant" 3. Occurs because the blood is trapped by the pregnant uterus" 4. Is caused by increased blood flow to the uterus during pregnancy"

4. Is caused by increased blood flow to the uterus during pregnancy" **Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick's sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected.

What nursing action best promotes parent-infant attachment behaviors? 1. Restricting visitors on the postpartum unit 2. Supporting rooming-in with parent-infant care 3. Encouraging the mother to choose breastfeeding 4. Keeping the new family together immediately after the birth

4. Keeping the new family together immediately after the birth

What factor identified by the nurse in a client's history places the client at increased risk for breast cancer? 1. Early menopause 2. Low-income background 3. Delayed onset of menarche 4. Late beginning of childbearing

4. Late beginning of childbearing

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1. Obesity 2. High-fat diet 3. Hypertension 4. Late-onset menarche

4. Late-onset menarche

What antidote to the side effects of terbutaline (Brethine) should a nurse have available? 1. Levodopa (l-Dopa) 2. Furosemide (Lasix) 3. Ritodrine (Yutopar) 4. Propranolol (Inderal)

4. Propranolol (Inderal) **Propranolol (Inderal) is a beta-blocking agent that reverses the uterine inhibitory responses and cardiovascular effects of terbutaline (Brethine).

A nurse is providing dietary counseling to a client at 14 weeks' gestation. The client is a recent immigrant from Asia, and the nurse explores the foods that the client usually eats. Which foods should the nurse counsel the client to avoid during pregnancy? (Select all that apply.) 1. Yogurt 2. Oily fish 3. Apricots 4. Raw shellfish 5. Herbal supplements 6. Soft-scrambled eggs

4. Raw shellfish 5. Herbal supplements 6. Soft-scrambled eggs

A client who recently gave birth is transferred to the postpartum unit by the nurse. What must the nurse do first to avoid a charge of abandonment? 1. Assess the client's condition 2. Document the client's condition and the transfer 3. Orient the client to the room and explain unit routines 4. Report the client's condition to the responsible staff member

4. Report the client's condition to the responsible staff member **Because the nurse is responsible for the client's care until another nurse assumes that responsibility, the nurse should report directly to the client's primary nurse.

Before the administration of Rho(D) immune globulin (RhoGAM) the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs test result must a pregnant woman have to receive RhoGAM after giving birth? 1. Rh-positive and Coombs positive 2. Rh-negative and Coombs positive 3. Rh-positive and Coombs negative 4. Rh-negative and Coombs negative

4. Rh-negative and Coombs negative **Rho(D) immune globulin (RhoGAM) is given to an Rh-negative mother after birth if the infant is Rh positive and the Coombs test reveals that the mother was not previously sensitized (negative).

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do? 1. Ask her partner to withdraw before ejaculating 2. Make certain their relationship is monogamous 3. Insist that her partner use a condom when having sex 4. Seek counseling about various contraceptive methods

4. Seek counseling about various contraceptive methods

A nurse is planning care with a client for the recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included among the changes that the client should expect after surgery? 1. Depression 2. Weight gain 3. Urine retention 4. Surgical menopause

4. Surgical menopause

A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program? 1. The need to increase high-quality protein and decreasing fats 2. The need to increase carbohydrates to meet energy demands and prevent ketosis 3. The need to eat a low-calorie diet that maintains the current insulin coverage and helps prevent hyperglycemia 4. The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

4. The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

When discussing dietary needs during pregnancy, a client tells the nurse that milk causes her to be constipated at times. What should the nurse teach the client? 1. Substitute a variety of cheeses for the milk. 2. Replace fat-free or low fat milk for whole milk. 3. Increase intake of prenatal supplements and omit the milk. 4. Treat constipation when it occurs and continue drinking milk.

4. Treat constipation when it occurs and continue drinking milk.

A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which adverse side effect alerts the nurse to notify the health care provider? 1. Respiratory rate of 18 breaths/min 2. 2+ patellar reflex response 3. Magnesium blood level of 5 mEq/L 4. Urine output of less than 100 mL in 4 hours

4. Urine output of less than 100 mL in 4 hours

In childbirth classes the nurse is teaching paced breathing techniques for use during labor. In which order should the breathing techniques be used as labor progresses? 1. Slow, deep breaths 2. Pant-blow breathing 3. Modified-paced breathing 4. Slow, exhalation pushing 5. Cleansing breaths

5. Cleansing breaths 1. Slow, deep breaths 3. Modified-paced breathing 2. Pant-blow breathing 4. Slow, exhalation pushing