Adaptive Quizzing Women's Health/Disorders and Childbearing Health Promotion

Which client statement leads the nurse to conclude that the client has been experiencing menorrhagia? 1 "It hurts when I have intercourse." 2 "I have a foul-smelling vaginal discharge." 3 "I have bleeding between my menstrual periods." 4 "I have severe bleeding during my menstrual periods."

"I have severe bleeding during my menstrual periods." Menorrhagia is severe bleeding during a menstrual period. Painful intercourse is the definition of dyspareunia. Foul-smelling vaginal discharge is a sign of a vaginal infection. Metrorrhagia is uterine bleeding that occurs at any time other than during the menstrual period.Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal. Topics

The nurse is teaching breast-feeding to a newly delivered client. Which statement by the client indicates the need for further instruction? 1 "I'll try to empty my breasts at each feeding." 2 "I'll alternate between breasts to start feedings." 3 "I need to wash my breasts with soapy water before I breast-feed." 4 "I need to stroke my baby's cheek gently when I'm ready to breast-feed."

"I need to wash my breasts with soapy water before I breast-feed." Soap irritates, cracks, and dries breasts and nipples, making it painful for the mother when the baby sucks; it also increases the risk for mastitis. The client should empty the breasts at each feeding to keep milk flowing. Alternating between breasts to start feedings is a permissible and often-used technique of breast-feeding. Gently stroking the baby's cheek elicits the rooting reflex; the infant's head turns toward and touches the mother's breast.

Which client statement confirms that the client who is being treated for a sexually transmitted infection (STI) has understood the nurse's instruction regarding future sexual contacts? 1 "If I have sex, nothing I do will really prevent me from getting another STI." 2 "If I get another STI, I can take any antibiotic, because I'm not allergic to any of them." 3 "I won't have unprotected sex again, and I'll tell my partners to be tested for STIs." 4 "I have to ask my partners if they have an STI, and if they say no I'll know that I can have sex."

"I won't have unprotected sex again, and I'll tell my partners to be tested for STIs." The most effective strategies for preventing sexually transmitted infections--contracting them or spreading them to sex partners--are the use of condoms and having sex partners tested to determine their status and get treatment if necessary. There are protective measures that can be used to help prevent the transmission of STIs. The emphasis should be on prevention, not treatment; some STIs have no cure. Asking partners whether they have an STI does not always elicit a truthful answer; protection is necessary to help prevent the transmission of STIs.

A pregnant client tells the nurse, "I'm sticking to my diet, and I don't eat anything containing salt." How would the nurse respond? 1 "You're doing fine. Just keep up the good work." 2 "A low-salt diet will protect you from getting swollen feet." 3 "We now encourage pregnant women to increase their salt intake because of changes in the circulation." 4 "Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt."

"Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt." Sodium is important in the diet of a pregnant woman and so she is counseled to continue moderate sodium intake. Blood volume increases during pregnancy; sodium is required to maintain physiological edema in interstitial spaces so blood volume is not depleted. High-sodium processed meats and canned foods with added salt are discouraged in diets for all adults, not just pregnant women. Telling the client that she is doing fine is false reassurance. Salt restriction does not prevent swollen feet, other peripheral edema, or preeclampsia. Increasing salt intake during pregnancy is unnecessary, as there is enough salt in the average diet to meet the increased sodium needs of pregnant women.

A client admitted with a diagnosis of cervical cancer tells the nurse "I haven't had a Papanicolaou (Pap) smear for more than 8 years. I probably wouldn't be in the hospital today if I'd had those tests more often." Which response would the nurse provide? 1 "Please tell me why you waited so long." 2 "You feel as though you've neglected your health." 3 "It's never too late to start taking care of yourself." 4 "Most women hate to have Pap smears done, but they're really important."

"You feel as though you've neglected your health." Stating that the client feels that she's neglected her health indicates recognition of expressed feelings; a nondirective and reflective response encourages verbalization. Asking the client why she waited so long ignores the client's current emotional needs; direct statements often do not elicit feelings and may cut off communication. Stating that it is never too late to start taking care of her health is a judgmental response because it implies that the client has been negligent. Although it is true that most clients hate to have Pap smears, this statement ignores the client's current emotional needs.

Which response would the nurse provide to the client who asks if contraception is needed while she is breast-feeding? 1 "As long as you aren't having periods, you won't need a contraceptive." 2 "It would be best to delay sexual relations until you have your first period." 3 "You should use contraceptives because ovulation may occur at any time without a period." 4 "Breast-feeding suppresses ovulation, so you don't need to worry about pregnancy."

"You should use contraceptives because ovulation may occur at any time without a period." An ovulation occurs in nursing mothers for varying periods of time; breast-feeding is not a reliable method of birth control. Ovulation can occur without menstruation. Periods may not occur for several months; sexual relations need not be delayed until the first period. Lactation may delay both ovulation and menstruation, but the timing of when ovulation returns is variable so the client should not rely on this as a method of contraception.

A 16-year-old high school student comes to a community health center because of the fear of having contracted herpes. The teenager is upset and shares this information with the community health center nurse. Which response would the nurse provide? 1 "Let me get a brief health history now." 2 "Try not to worry until you know whether you have herpes." 3 "You sound worried. Let me make arrangements to have you examined."

"You sound worried. Let me make arrangements to have you examined." Telling the client that she sounds worried and offering to arrange an examination immediately identifies the client's fear as real and offers a service to meet the need for information about the client's physical status. Obtaining the health history ignores the client's concern and focuses on the nurse's need to complete the task of obtaining a history. Telling the client not to worry minimizes the client's concern about having a sexually transmitted infection. Saying that herpes has received too much attention in the media minimizes the client's concern and implies that the client is being unrealistic.

After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. Which response would the nurse give? 1 "Avoid regular use of tampons." 2 "Decrease your intake of prune juice." 3 "Increase your daily fluid consumption." 4 "Cleanse the perineum from back to front."

-Increase daily fluid consumption. Increasing fluid intake flushes the urinary tract of microorganisms. Tampons do not increase the risk of cystitis. Fluids should be increased, not decreased; prune juice promotes acidic urine, which is desirable because it discourages the growth of microorganisms. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis.

Which information regarding risks that may result from an untreated chlamydia infection would the nurse include when providing education for a female client? Select all that apply. One, some, or all responses may be correct. 1 Sterility 2 Ectopic pregnancy 3 Blocked Fallopian tubes 4 Pelvic inflammatory disease 5 Increased likelihood of HIV infection

1. Untreated chlamydia can result in sterility in both women and men 2. increased risk for ectopic pregnancy 3. blocked Fallopian tubes 4. pelvic inflammatory disease 5. five-time greater risk for contracting HIV infection. Sterility Correct2 Ectopic pregnancy Correct3 Blocked Fallopian tubes Correct4 Pelvic inflammatory disease Correct5 Increased likelihood of HIV infection Untreated chlamydia can result in sterility in both women and men, an increased risk for ectopic pregnancy, blocked Fallopian tubes, pelvic inflammatory disease, and a five-time greater risk for contracting HIV infection.

The nurse is teaching a family planning class about ovulation and conception. For which period of time would the nurse inform the class that the ovum is capable of being fertilized after ovulation? 1 1 to 6 hours 2 12 to 18 hours 3 24 to 36 hours 4 48 to 72 hours

24 to 36 hours The ovum is capable of being fertilized for 24 to 36 hours after ovulation. After this time it travels a variable distance between the fallopian tube and uterus and, if not fertilized, disintegrates and is phagocytized by leukocytes. The other time periods listed are not correct.

Which medication is safe to take during pregnancy? Select all that apply. One, some, or all responses may be correct. 1 Metronidazole 2 Aspirin 3 Codeine 4 Acetaminophen 5 Diphenhydramine HCl

Acetaminophen may be taken safely during all stages of pregnancy. Metronidazole should not be used during the first trimester of pregnancy. Salicylates like aspirin, codeine, and antihistamines like diphenhydramine HCl should be avoided throughout pregnancy.

After the client gives birth, her vital signs are temperature 99.3°F (37.4°C); pulse 80 beats per minute, regular and strong; respirations 16 breaths per minute, slow and even; and blood pressure 148/92 mm Hg. Which vital sign would the nurse check more frequently?

Blood pressure This blood pressure is higher than anticipated; therefore intervention may be necessary. A pulse of 80 beats/min is within expected limits. A respiratory rate of 16/min is within expected limits. The temperature of 99.3° F (37.4° C) is slightly high but consistent with the physiology of the birthing process.

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing? 1 Anger 2 Denial 3 Bargaining 4 Acceptance

Denial The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" types of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.

Which suggestion would the nurse make to help the pregnant client who is experiencing morning sickness? 1 Eating 3 small meals a day 2 Increasing dietary calcium intake 3 Eating small amounts more frequently 4 Drinking 2 qt (1.9 L) or more of fluid a day

Eating small amounts more frequently Eating more frequently and in smaller amounts prevents distension of the stomach and subsequent nausea. Dry toast, crackers, and small, frequent meals may alleviate morning sickness. Three small meals a day are not sufficient to meet the nutritional needs of the mother and fetus; caloric intake should increase by 300 to 400 calories a day during pregnancy. Additional calcium intake will not relieve the nausea. Fluids need not be increased, but they should be consumed between meals.

Which information would the nurse provide to the breast-feeding client asking how human milk compares with cow's milk? 1 Lactose content is higher in cow's milk than in human milk. 2 Protein content in human milk is higher than in cow's milk. 3 Fat in human milk is easier to digest and absorb than the fat in cow's milk. 4 Immunological and antiallergenic factors found in human milk are now added to cow's milk.

Fat in human milk is easier to digest and absorb than the fat in cow's milk. Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Also, human milk is not heat treated, as is cow's milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow's milk; however, it is easier for human beings to digest. Human immunological and antiallergenic factors are found only in human milk, not in cow's milk.

Which food would the nurse recommend to a pregnant client to most significantly increase the client's intake of folic acid? 1 One egg 2 Slice of bread 3 Half a cup of corn 4 Half a cup of cooked spinach

Half a cup of cooked spinach A half a cup of cooked spinach provides 121 to 139 mcg of folic acid per serving. One egg, a slice of bread, and half a cup of corn each provides only 20 to 30 mcg per serving. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.

Which cause may produce abnormal uterine bleeding? Select all that apply. One, some, or all responses may be correct. 1 Hypothyroidism 2 Failure to ovulate 3 Bleeding disorders 4 Unidentified pregnancy 5 Use of oral contraceptives 6 Benign lesions of the uterus

Hypothyroidism Failure to ovulate Bleeding disorders Unidentified pregnancy Use of oral contraceptives Benign lesions of the uterus Common causes for any type of abnormal uterine bleeding include endocrine disorders like hypothyroidism; failure to ovulate or respond appropriately to ovulation hormones; bleeding disorders; pregnancy complications such as an unidentified pregnancy that is ending in spontaneous abortion; breakthrough bleeding, which may occur in the woman taking oral contraceptives; and lesions of the vagina, cervix, or uterus (benign or malignant).Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which is the reason that the bacterium Escherichia coli would be the probable causative agent in a client with cystitis? 1 It thrives in the kidneys. 2 It is a virulent bacterium. 3 It inhabits the intestinal tract. 4 It competes with fungi for host sites.

It inhabits the intestinal tract. E. coli is commonly found in the bowel and, because of anatomical proximity and possibly careless hygiene after bowel movements, may spread to the urethra. E. coli is not normally found in the kidneys. E. coli is no more virulent than other infective agents, nor does it compete with fungal organisms for host sites. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less-regular intervals, with a scanty flow. Which condition would the nurse suspect to be the likely cause of these changes? 1 Uterine cancer 2 Lack of estrogen 3 Early cervical carcinoma 4 Perimenopause

Perimenopause The adaptations described, along with the client's age, suggest that the client is experiencing perimenopausal symptoms, which are normal in the years preceding cessation of menses. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy? 1 Prolactin 2 Estrogen 3 Progesterone 4 Somatotropin

Produced by the ovaries and placenta, progesterone is a female sex hormone that prepares the endometrium for implantation of the fertilized ovum, maintains pregnancy, and plays a role in the development of the mammary glands. Prolactin is secreted by the anterior lobe of the pituitary gland; it is responsible for initiating and maintaining milk secretion from the mammary glands. Estrogen is a female sex hormone that starts to prepare the endometrium for implantation and promotes development of secondary sex characteristics. Somatotropin is a growth hormone secreted by the anterior pituitary gland.Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

Which type of surgery would be listed on the informed consent for a client with a ruptured ectopic pregnancy being prepared for surgery? 1 Myomectomy 2 Hysterectomy 3 Salpingectomy 4 Oophorectomy

Salpingectomy The ruptured fallopian tube may be removed (salpingectomy) rather than repaired; repair of the tube may result in scarring, predisposing the client to another tubal pregnancy. Myomectomy is a procedure for removing leiomyomas (fibroids) from the uterus. The uterus is uninvolved in a tubal pregnancy and does not need to be removed (hysterectomy). The ovaries should not be removed (oophorectomy), especially if another pregnancy is desired.Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

A pregnant client tells the nurse that she has two toddlers at home and that their father abandoned the family last month and she doesn't know what to do. Which conclusion would the nurse make about the client's emotional state? 1 She is angry that the father has left. 2 She feels overwhelmed by the situation. 3 She is expressing ambivalence about her pregnancy. 4 She is denying the reality of her pregnancy.

She feels overwhelmed by the situation. Because of the difficult home situation, this client is experiencing multiple stressors that could cause difficulty with coping. The client also directly tells the nurse that she doesn't know what to do, suggesting that she is overwhelmed with her situation. There is no information to support the conclusion that the client is angry or that she is ambivalent about the pregnancy. The client is attending the prenatal clinic, which indicates that she is aware of reality and is not in denial.

After giving birth to her third child, a client tearfully says to the nurse, "How much more can I give of myself?" Which principle would the nurse consider in the care of any new mother? 1 It is easier to adjust to the first child than to later ones. 2 Feeling anger and resentment toward a child is pathological. 3 Some parents experience feelings of being overwhelmed by multiple children. 4 Parents usually have inborn feelings of love and acceptance of their children.

Some parents experience feelings of being overwhelmed by multiple children. A parent's feeling of being overwhelmed by multiple children is a normal response. It is vital to help parents realize this as a means of easing feelings of guilt and shame. The first child causes the greatest amount of adjustment in one's life. Anger and resentment toward one's child are expected feelings. Stating that parents usually have inborn feelings of love and acceptance of their children is a false generalization.

Which aspect of the client's life is most important for the nurse to explore when obtaining a health history from a client newly diagnosed with cervical cancer? 1 Sexual history 2 Support system 3 Obstetric history 4 Elimination patterns

Support system During a health crisis, the client will need support from significant others. The sexual history is important in diagnosis and the obstetric history and elimination patterns are important parts of the medical history; however, none are the priority at this time.