Exam 3 practice questions

What is the drug of choice for the treatment of gonorrhea? a. Penicillin G b. Tetracycline c. Ceftriaxone d. Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

After giving birth to a stillborn infant, the woman turns to the nurse and says, I just finished painting the baby's room. Do you think that caused my baby to die? What is the nurses most appropriate response? a. That's an old wives tale; lots of women are around paint during pregnancy, and this doesn't happen to them. b. That's not likely. Paint is associated with elevated pediatric lead levels. c. Silence. d. I can understand your need to find an answer to what caused this. What else are you thinking about?

ANS: D The statement I can understand your need to find an answer to what caused this. What else are you thinking about? is very appropriate for the nurse. It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving.

One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea b. Menorrhagia c. Leiomyoma d. Metrorrhagia

ANS: D - Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants.

Varicella Zoster Virus (VZV) (Chicken Pox)

Crosses placenta Typical transmission: droplet/direct contact. 25x more serious in adults! Maternal complications: preterm labor, encephalitis, varicella pneumonia (can be fatal) Treatment: LIVE VACCINE CANNOT BE GIVEN DURING PREGNANCY. Can be given in household w/ pregnant woman, maintain kids' vaccine schedule. VZIG can be given if exposed: passive immunity. Postpartum immunization: avoid conception for 1 month Fetal effects: Congenital varicella syndrome (2nd trimester is greatest risk) → Limb hypoplasia (small) & cutaneous scars

Long-term Grief or Chronic Sorrow

Mourning persists movement through phases seemingly impossible

Trichomoniasis

Parasite transmitted during sex Maternal sx: Pruritis, increased yellow/green frothy discharge, odor, irritation, & petechiae spots on cervix that bleed easily Impact on pregnancy: cause PROM or PTL Treatment: Metronidazole or Tinidazole Retest in 3 months post tx

What is the most likely cause of Secondary Amenorrhea?

Pregnancy

Menorrhagia

Prolonged bleeding >8 days or excessive >80 mL month, occurs at regular intervals

What's used to assess for structural/obstruction factors in males with fertility issues?

Semen Analysis

Explain how abnormalities in the hormonal regulation of the menstrual cycle may lead to amenorrhea or heavy menstrual bleeding.

The HPG Axis interplay results in the development of sex characteristics and regulations ovulation and menstruation. Any alteration may result in Amenorrhea.

Mourning

The process through which integration and assimilation of the reality of loss is accomplished - To accept the reality of the loss - To experience the pain of grief - To adjust to life without the baby - To withdraw emotional energy from grief for this baby and reinvest in other relationships

Zika Virus

Transmission: mosquitoes in high risk areas & sex with someone who traveled Maternal effects: Asymptomatic, fever, rash, arthralgia, conjunctivitis Fetal effects: microcephaly & severe brain defects

What is the focus of treatment for Primary or Secondary amenorrhea? Give 2 treatment options.

Treat the underlying cause: *Give Estrogen, *Modify exercise, *Psychotherapy for anorexia, *Surgery - uterine transplant or repair hymen

Absent Grief

Unresolved grief from a previous loss Will assault individuals at later time

Infant Mortality

death before the age of 1

Maternal Mortality

death of a woman due to any pregnancy related cause up to 1 year postpartum

Adenomyosis

endometrium grows in to the uterine muscle

Documentation should be F.A.C.T.

factual, accurate, complete, & timely

​​Mittelschmerz

pain at ovulation, usually in the RLQ

Leiomyoma

uterine fibroids/ benign growths

Pelvic Relaxation

-weakening of structures that support pelvic organs -uterine prolapse: Bulging at the vaginal introitus, feels pelvic/vaginal pressure that worsens with standing and after sex, dyspareunia -incontinence: Stress incont; Involuntary leaking of urine: laugh, cough, sneeze Prevention: Kegel exercises/Pelvic therapy/biofeedback. -cystocele: Weakening and bulging of the anterior vaginal wall. Patient may have difficulty emptying the bladder. Recurrent UTI, incontinence. -rectocele: Bulging of posterior vaginal wall, feel pressure in vagina, constipation. Present when standing, absent when lying down Treatment: All therapies used to prevent can help manage symp. Pessary Ring, Surgery

The female reproductive organ(s) responsible for cyclic menstruation is/are the: a. Uterus b. Ovaries c. Vaginal vestibule d. Urethra

ANS: A - The uterus is responsible for cyclic menstruation. It also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and production of estrogen; the uterus is responsible for cyclic menstruation.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a. Number of partners b. Level of physical activity c. Prevention of pregnancy d. Protection from STIs e. Past history

ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

Which benefit regarding FAMs makes it an appealing choice for some women? a. Adherence to strict recordkeeping b. Absence of chemicals and hormones c. Decreased involvement and intimacy of partner d. Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict record keeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? a. Anticipatory grief b. Acute distress c. Intense grief d. Reorganization

ANS: B The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, a lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress.

Which STI does not respond well to antibiotic therapy? a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis

ANS: C Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as: a. Amenorrhea b. Dysmenorrhea c. Dyspareunia d. Premenstrual syndrome (PMS)

ANS: B - Dysmenorrhea is pain during or shortly before menstruation.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a. HSV b. AIDS c. Genereal warts d. Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence.

TORCHES stands for ___

Toxoplasmosis Others (hepatitis, HIV, VZV, parvovirus B19, enteroviruses) Rubella Cytomegalovirus (CMV) Herpes simplex virus Syphilis

Which infections cross the placenta?

Toxoplasmosis VZV Neisseria gonorrhoeae CMV HSV Parvovirus B19 (Fifth disease) Syphilis HIV Zika virus

Cytomegalovirus (CMV)

Transmission: contact w/ body fluids (urine, saliva, blood, milk, cervical mucus, semen, feces) Infected mom prior to pregnancy will not result in fetus obtaining virus because becomes latent after primary infection Primary CMV is most dangerous to fetus Maternal Symptoms: mild, febrile illness or unapparent Perinatal Impact: appears normal at birth then suddenly becomes sick → most common cause of congenital infection and hearing loss with latent infection Tx: hand washing, gloves, safer sex, safe blood transfusions, CMVIg passive immunity, vaccination

Pertussis (Whooping Cough)

Transmission: droplets of highly infectious gram neg coccobacillus bacteria: B. pertussis Moms are main source of pertussis in their infants: 93% of infant deaths related to pertussis Tx: Tdap vaccine should be given to moms during pregnancy (27-36 weeks or postpartum) Dads & other household members should also be considered for vaccine

What's the treatment for Gonorrhea?

Ceftriaxone 250 mg once IM Azithromycin 1 gram once by mouth Doxycycline 100 mg twice a day for 7 days by mouth

What is the most common cause of Primary Amenorrhea?

Chromosomal abnormalities (e.g., ovarian insufficiency, Turner's Syndrome)

Identify two medications used to treat Endometriosis and describe how they work.

Combined Oral Contraceptive & Depo - suppress endometrial tissue growth Lupron - (leuprolide acetate) & Nafarelin (Synarel) are GnRH agonists that reduce the production of FSH & LH from the pituitary gland, decreasing the level of estrogen Danazol - suppress FSH and LH

Delayed Grief

Decisions must be made by someone else, especially funeral arrangements.

Long-Acting Reversible Contraceptive Methods (LARC)

Implant or IUD: Levonorgestrel IUS & Copper IUD (Paragard) Contraindications: Pregnancy, Acute pelvic infection, & Known uterine anomaly Etonogestrel Implant (Nexplanon)

What are the distinguishing characteristics of Premenstrual Dysphoric Disorder?

More severe and debilitating than PMS 5 or more symptoms that persist in most cycles over a year 1 symptom must be Affective - anxiety, depressed mood, Elevated suicide risk

HIV/AIDS

Perinatal HIV crosses placenta during labor & birth and by breastfeeding Transmission: sexual contact, sharing needles, blood transfusions Vertical transmission minimized by: Antiretroviral meds during pregnancy excluding 1st trimester Antiretroviral meds during labor Cesarean section for delivery depending on viral load Infants are given a 6 week course of antiretroviral therapy post birth & no breastfeeding (milk is a blood product) Don't delay infant bathing

With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus b. It is found more often in African-American women than in Caucasian or Asian women c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause d. It is unlikely to affect sexual intercourse or fertility

ANS: C - Symptoms vary among women, ranging from nonexistent to incapacitating.

One purpose of preconception care is to: a. Ensure that pregnancy complications do not occur b. Identify women who should not become pregnant c. Encourage healthy lifestyles for families desiring pregnancy d. Ensure that women know about prenatal care

ANS: C - Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus.

Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PDD) is a milder form of premenstrual syndrome and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of premenstrual syndrome (PMS) have been well established.

ANS: C - PMS may manifest itself with one or more of a hundred or so physical and psychologic symptoms.

_____ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications. a. Alcohol b. Caffeine c. Tobacco d. Chocolate

ANS: C - Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low birth weight.

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus 2 (HSV-2) b. HPV c. HIV d. CMV

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection.

Menstruation is periodic uterine bleeding: a. That occurs every 28 days b. In which the entire uterine lining is shed c. That is regulated by ovarian hormones d. That leads to fertilization

ANS: C - Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle.

Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client? a. Preeclampsia b. IPV c. Diabetes d. Abnormal Pap test

ANS: B The prevalence of IPV during pregnancy is estimated at 6% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions.

Which statements regarding the HPV are accurate? (Select all that apply.) HPV infections: a. are thought to be less common in pregnant women than in women who are not pregnant. b. are thought to be more common in pregnant women than in women who are not pregnant. c. were previously called genital warts. d. were previously called herpes. e. may cause cancer.

ANS: B, C, E HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a. 6 to 10 days b. 2 to 4 weeks c. 6 to 12 weeks d. 6 months

ANS: C

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt? a. Siblings b. Mother c. Father d. Grandparents

ANS: D Survivor guilt is sometimes felt by grandparents because they feel that the death is out of order; they are still alive, while their grandchild has died.

Metrorrhagia

Bleeding at irregular intervals and more frequent than normal intervals

Benign Neoplasms

Fibroids (leiomyomas) Ovarian cysts

Toxoplasmosis

a parasite which is most commonly transmitted from animals to humans by contact with contaminated feces fetal effects are most fatal with exposure in 1st trimester Maternal effects: flu like sx in acute phase Fetal/neonatal effects: hydrocephalus; Spontaneous Abortion, CNS lesions → Hydro-, microcephaly Chronic retinitis, seizures

What is malpractice mostly due to?

failure to communicate

Negilgence

harm caused by an act of omission or commission that violates a standard of care w/o conscious intent

What are TORCHeS?

perinatal acquired, significant cause of fetal/neonatal mortality, contributes to childhood morbidity, timely diagnosis is crucial, vague symptoms for mom → flu-like sx, fever, rash, nausea, HA, fatigue that can lead to sponatenous abortion, CNS lesions, hydrocephalus, seizures, & developmental delay

Oligomenorrhea

scanty or infrequent menstrual flow

What's Perinatal death?

the birth and death of loved ones are two of the most emotional and ambivalent experiences in life

Polymenorrhea

the occurrence of menstrual cycles more frequently than is normal

Grieving

the process of assimilating the changes and meanings.

Hepatitis B Virus (HBV)

virus that causes inflammation of the liver; transmitted through any body fluid, including vaginal secretions, semen, and blood Maternal effects: abdominal pain, jaundice, fever, rash, painful joints, PTL 2x as likely Fetal effects: jaundice Infant Tx: All infants are given HBV birth, 1 month & 6 months Unknown status: vaccinate mom within 12 hrs & obtain maternal labs + status: HBIG (passive immunity) & vaccine

What is the minimum level of practice that a reasonably prudent nurse is expected to provide? a. Standard of care b. Risk management c. Sentinel event d. Failure to rescue

ANS: A Guidelines for standards of care are published by various professional nursing organizations.

The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called: a. Family planning b. Birth control c. Contraception d. Assisted reproductive therapy

ANS: A - Family planning is the process of deciding when and if to have children.

Group B Streptococcus (GBS)

A common bacterium found in the vagina and rectum of healthy women. However, an infant infected with GBS can develop septicemia, pneumonia, or meningitis. LEADING CAUSE OF NEONATAL MORBIDITY & MORTALITY Risk Factors: Delivery at less than 37 weeks of gestation; PROM of 18 hours or longer; Triple 'I"; GBS bacteriuria during the current pregnancy; Temperature greater than 38ºC or 100.4°F, during labor; Sustained intrapartum fetal tachycardia; Prior delivery of an infant with GBS disease; UTI; Postpartum infection Pregnancy Recommendations: All pregnant women are screened between 35 & 37 weeks If positive - IV antibiotic prophylactic (IAP) during labor If urine is pos for GBS bacteriuria during pregnancy, no need to screen - TREAT Previous infant with GBS disease - TREAT GBS unknown - TREAT based on gestation & risk factors Treatment: Penicillin 5 million units IV initial dose, then 2.5 million (3 million) units q 4 hrs until delivery or Ampicillin 2 g initial dose, then 1 gm every 4 hrs until delivery

Neonatal Abstinence Syndrome (NAS)

A group of problems that occur in a newborn who was exposed to addictive illegal or prescription drugs during pregnancy Constellation of behavioral and physiological signs and symptoms that are remarkably similar despite marked differences in the properties of the causative agent. Prenatal opioid substance abuse Postnatal treatment with narcotics Babies of mothers who drink during pregnancy may have a similar condition.

A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (Select all that apply.) a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner b. Asking the client if she is afraid of her partner c. Asking the client if she has been forced to perform sexual acts d. Diagramming the clients current injuries on a body map e. Asking the client what she did wrong to elicit the abuse

A, B, C, D Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as slap, kick, or punch to elicit information is best.

Kegel exercises, or pelvic muscle exercises: a. Were developed to control or reduce incontinent urine loss b. Are the best exercises for a pregnant woman because they are so pleasurable c. Help to manage stress d. Are ineffective without sufficient calcium in the diet

ANS: A

Maternity nurses can enhance communication among health care providers by using the SBAR technique. The acronym SBAR stands for what? a. Situation, background, assessment, recommendation b. Situation, baseline, assessment, recommendation c. Subjective, background, analysis, recommendation d. Subjective, background, analysis, review

ANS: A

When the nurse is alone with a battered client, the client seems extremely anxious and says, It was all my fault. The house was so messy when he got home, and I know he hates that. What is the most suitable response by the nurse? a. No one deserves to be hurt. It's not your fault. How can I help you? b. What else do you do that makes him angry enough to hurt you? c. He will never find out what we talk about. Don't worry. We're here to help you. d. You have to remember that he is frustrated and angry so he takes it out on you.

ANS: A

Which statement regarding emergency contraception is correct? a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b. Emergency contraception may be taken right after ovulation. c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d. Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

In evaluating the level of a pregnant woman's risk of having a low-birth-weight (LBW) infant, which factor is the most important for the nurse to consider? a. African-American race b. Cigarette smoking c. Poor nutritional status d. Limited maternal education

ANS: A For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor.

A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are declining. c. Cigarette smoking among pregnant women continues to increase. d. Rates of pregnancy and abortion among teenagers are lower in the United States than in any other industrialized country.

ANS: A LBW infants and preterm births are more likely because of the large number of teenagers in the unmarried group.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a fishy odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a. Bacterial vaginosis b. Candidiasis c. Trichomoniasis d. Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic fishy odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a. Wear gloves. b. Wear mouth, nose, and eye protection. c. Wear a mask. d. Wash the hands after medication administration.

ANS: A Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures.

A client exhibits a thick, white, lumpy, cottage cheeselike discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and are providing care across the perinatal continuum. Which of these priorities has made the most significant progress? a. Reduction of fetal deaths and use of prenatal care b. LBW infants and preterm births c. Elimination of health disparities based on race d. Infant mortality and the prevention of birth defects

ANS: A Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care.

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a. Only one vaccine for the HPV is available. b. The vaccine is given in three doses over a 6-month period. c. The vaccine is recommended for both boys and girls. d. Ideally, the vaccine is administered before the first sexual contact.

ANS: A Two vaccines for HPV are available Cervarix and Gardasiland other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a. Strategies to enhance condom use b. Choice of colors and special features c. Leaving the decision up to the male partner d. Places to carry condoms safely

ANS: A When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner.

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is: a. IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife's ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus. b. A donor embryo will be transferred into your wife's uterus. c. Donor sperm will be used to inseminate your wife. d. Don't worry about the technical stuff; that's what we are here for.

ANS: A - A woman's eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred.

Individual irregularities in the ovarian (menstrual) cycle are most often caused by: a. Variations in the follicular (preovulatory) phase b. An intact hypothalamic-pituitary feedback mechanism c. A functioning corpus luteum d. A prolonged ischemic phase

ANS: A - Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase.

The absence or cessation of menstrual flow is known as: a. Amenorrhea b. Dysmenorrhea c. Menorrhagia d. Metrorrhagia

ANS: A - Amenorrhea is most often the result of pregnancy, although it could be a sign of conditions that require treatment.

Nurses who provide health care for women should recognize that the most commonly reported gynecologic problem for women of any age-group is: a. Dysmenorrhea b. Menorrhagia c. Dyspareunia d. Endometriosis

ANS: A - Dysmenorrhea, or pain during or shortly before menstruation, is one of the most common gynecologic problems in women of all ages.

Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS? a. Respiratory conditions b. Impaired growth c. Central nervous system (CNS) abnormality d. Craniofacial dysmorphologies

ANS: A - Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include organ deformities, genital malformations, and kidney and urinary defects.

A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse: a. Obtain a history of menstrual cycle lengths for the past 6 to 12 months b. Determine the clients weight gain and loss pattern for the previous year c. Examine skin pigmentation and hair texture for hormonal changes d. Explore the clients previous experiences with conception control

ANS: A - The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. Administration of prostaglandins b. Instillation of hypertonic saline into the uterine cavity c. IV administration of Pitocin d. Vacuum aspiration

ANS: A - The most common technique for medical termination of a pregnancy in the second trimester is administration of prostaglandins. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. IV administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.

Although reported in small numbers, toxic shock syndrome can occur with the use of a diaphragm. If a client is interested in this form of conception control, the nurse should teach the woman how to reduce her risk of TSS. The nurse might say: a. You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash. b. You should remove your diaphragm right after intercourse to prevent TSS. c. Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS. d. Make sure you don't leave your diaphragm in for longer than 24 hours, or you may get TSS.

ANS: A - The nurse should instruct the client on proper use and removal of the diaphragm, and include the danger signs of TSS.

A woman presents with a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, the nurse understands that clinical manifestations of PCOS might include all except: a. Anorexia b. Hirsutism c. Irregular menses d. Infertility

ANS: A - These clients often present with obesity rather than anorexia and weight loss. 40% of these women also display glucose intolerance and hyperinsulinemia.

When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse includes the risk of: a. Breast cancer b. Vaginal and urinary tract atrophy c. Osteoporosis d. Arteriosclerosis

ANS: A - Women with a high risk for breast cancer should be counseled against using ERT.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a. Fellatio b. Unprotected anal intercourse c. Multiple sex partners d. Dry kissing e. Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

Which nursing diagnoses would be most applicable for battered women? (Select all that apply.) a. Loss of trust b. Ineffective family coping c. Situational low self-esteem d. Risk for self-directed violence e. Enhanced communication

ANS: A, B, C, D Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for a battered woman would be impaired communication.

Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. These alterations in physiology belong to one of five categories. Choose all that apply. a. Congenital or developmental factors b. Hormonal or ovulatory factors c. Tubal or peritoneal factors d. Uterine factors e. Emotional or psychologic factors

ANS: A, B, C, D - Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors.

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospitals maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a. Intrapartum treatment with antiviral medications b. Cesarean birth c. Postpartum treatment with antiviral medications d. Avoidance of breastfeeding e. Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction and stroke c. Hypotension d. Breast tenderness and fluid retention e. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following? (Select all that apply.) a. Physical b. Sexual c. Emotional d. Psychologic e. Financial

ANS: A, B, D, E Physical, sexual, financial, and psychologic abuse can all be components in a relationship with IPV. Emotional abuse is a form of psychologic abuse.

There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often result in symptom improvement. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes including: a. Regular exercise b. Improved nutrition c. A daily glass of wine d. Smoking cessation e. Oil of evening primrose

ANS: A, B, D, E - Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are accurate modalities that may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the client may need to begin pharmacologic therapy.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a. Toxoplasmosis b. Other infections c. Roseola d. Clostridium e. Herpes simplex

ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama in early 2010. The Act provides some immediate benefits, and other provisions will take place over the next several years. The practicing nurse should have a thorough understanding of how these changes will benefit his or her clients. Which outcomes are the goals of the ACA? (Select all that apply.) a. Insurance affordability b. Improve public health c. Treatment of illness d. Elimination of Medicare and Medicaid e. Cost containment

ANS: A, B, E - The ACA goals are to make insurance more affordable, contain costs, and strengthen Medicare and Medicaid. The Act contains provisions that promote the prevention of illness and improve access to public health. The ultimate goal of the Act is to improve the quality of care for all Americans while reducing waste, fraud, and abuse of the current system.

You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out? Choose all that apply. a. It is highly unlikely that you will become pregnant after the procedure. b. This is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against sexually transmitted infections. d. Sterilization offers no protection against sexually transmitted infections. e. Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D - A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against sexually transmitted infections (STIs). Tubal ligation is not 100% effective. Tubal ligation does not offer any protection against STIs. Typically, the menstrual cycle remains the same after a tubal ligation.

A 25-year-old single woman comes to the gynecologists office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, What is that? Can you get rid of it? Which is the best response for the nurse to provide? a. It's just a little lump on your cervix. We can just freeze it off. b. HPV stands for human papillomavirus. It is a sexually transmitted infection that may lead to cervical cancer. c. HPV is a type of early human immunodeficiency virus. You will die from this. d. You probably caught this from your current boyfriend. He should get tested for this.

ANS: B

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions.

ANS: B

The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: a. Perineum b. Bony pelvis c. Vaginal vestibule d. Fourchette

ANS: B

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a. Oral antiviral therapy b. Bed rest in a semi-Fowler position c. Antibiotic regimen continued until symptoms subside d. Frequent pelvic examination to monitor the healing progress

ANS: B

Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)? a. Socially isolated b. Assertive personality c. Struggling with depression d. Dependent partner in a relationship

ANS: B Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.

Parents have asked the nurse about organ donation after that infants death. Which information regarding organ donation is important for the nurse to understand? a. Federal law requires the medical staff to ask the parents about organ donation and then to contact their states organ procurement organization (OPO) to handle the procedure if the parents agree. b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience. c. Most common donation is the infants kidneys. d. Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term.

ANS: B Evidence indicates that organ donation can promote healing among the surviving family members. The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request. The most common donation is the cornea. For cornea donation, the infant must have been born alive at 36 weeks of gestation or later.

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? a. The parents say that they feel no pain. b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings. c. The parents have abandoned those moments of bittersweet grief. d. The parents questions have progressed from Why? to Why us?

ANS: B Many couples have conflicting feelings about sexuality and future pregnancies. A little pain is always present, certainly beyond the first year when recovery begins to peak. Bittersweet grief describes the brief grief response that occurs with reminders of a loss, such as anniversary dates. Most couples never abandon these reminders. Recovery is ongoing.

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their sons prognosis. When the father sees his son, he says, He looks just fine to me. I cant understand what all this is about. What is the most appropriate response or reaction by the nurse at this time? a. Didn't the physician tell you about your sons problems? b. This must be a difficult time for you. Tell me how you're doing. c. Quietly stand beside the infants father. d. You'll have to face up to the fact that he is going to die sooner or later.

ANS: B The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings during the initial steps in the grieving process. This father is in a phase of acute distress and is reaching out to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through a sharing and verbalization of their feelings of grief. Telling the father that his son is going to die sooner or later is dispassionate and an inappropriate statement on the part of the nurse.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a. HIV screening b. HIV antibody testing c. Cluster of differentiation 4 (CD4) counts d. Cluster of differentiation 8 (CD8) counts

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself.

During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding? a. Guilt, particularly in the mother b. Numbness or lack of response c. Bitterness or irritability d. Fear and anxiety, especially about getting pregnant again

ANS: B The second phase of grieving encompasses a wide range of intense emotions, including guilt, anger, bitterness, fear, and anxiety. What the nurse would hope not to see is numbness or unresponsiveness, which indicates that the parents are still in denial or shock.

During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. Which information is most appropriate for the nurse to share with this client? a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. b. She will receive fewer interventions during the birth process. c. She should be aware that midwives are not certified. d. Her delivery can take place only at home or in a birth center.

ANS: B This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process.

Concerning the use and abuse of legal drugs or substances, nurses should be aware that: a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health b. Women ages 21 to 34 have the highest rates of specific alcohol-related problems c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed

ANS: B - Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes.

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a. Miconazole ointment b. Topical podofilox 0.5% solution or gel c. Two doses of penicillin administered intramuscularly (IM) d. Metronidazole by mouth

ANS: B - Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athletes foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.

ANS: B - Barrier methods, such as condoms, best protect against STIs and HIV.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurses most appropriate response would be: a. This is a highly effective method, but it has some side effects. b. Your current medications will reduce the effectiveness of the pill. c. The pill will reduce the effectiveness of your seizure medication. d. This is a good choice for a woman of your age and personal history.

ANS: B - Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants.

An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurses most appropriate response is: a. The IUD does not interfere with sex. b. The risk of pelvic inflammatory disease will be higher for you. c. The IUD will protect you from sexually transmitted infections. d. Pregnancy rates are high with the IUDs.

ANS: B - Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV). Because this woman has multiple sex partners, she is at higher risk of developing an STI. The IUD does not protect against infection, as does a barrier method.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is: a. They're not very effective, and its very likely you'll get pregnant. b. They can be effective for many couples, but they require motivation. c. These methods have a few advantages and several health risks. d. You would be much safer going on the pill and not having to worry.

ANS: B - FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals.

With regard to the assessment of female, male, and couple infertility, nurses should be aware that: a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis b. The investigation takes several months and can be very costly c. The woman is assessed first; if she is not the problem, the male partner is analyzed d. Semen analysis is for men; the postcoital test is for women

ANS: B - Fertility assessment and diagnosis take time, money, and commitment from the couple.

In helping a client manage premenstrual syndrome (PMS), the nurse should: a. Recommend a diet with more body-building and energy food, such as red meat and sugar b. Suggest herbal therapies, as well as yoga and massage c. Tell the client to push for medications from the physician as soon as symptoms occur so as to lessen their severity d. Discourage the use of diuretics

ANS: B - Herbal therapies, yoga, and massage have been reported to have a beneficial effect on PMS.

While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the clients recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days.

ANS: B - Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount.

Certain fatty acids classified as hormones that are found in many body tissues and have roles in many reproductive functions are known as: a. Gonadotropin-releasing hormone (GnRH) b. Prostaglandins (PGs) c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH)

ANS: B - PGs affect smooth muscle contraction and changes in the cervix.

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? a. Pelvic floor support devices b. Bladder training and pelvic muscle exercises c. Surgery d. Medications

ANS: B - Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women.

With regard to the use of intrauterine devices (IUDs), nurses should be aware that: a. Return to fertility can take several weeks after the device is removed b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse c. IUDs offer the same protection against sexually transmitted infections as the diaphragm d. Consent forms are not needed for IUD insertion

ANS: B - The woman has up to 5 days to insert the IUD after unprotected sex.

When assessing a woman for menopausal discomforts, the nurse would expect the woman to describe the most frequently reported discomfort, which would be: a. Headaches b. Hot flashes c. Mood swings d. Vaginal dryness with dyspareunia

ANS: B - Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman.

Which statements indicate that the nurse is practicing appropriate family-centered care techniques? (Select all that apply.) a. The nurse commands the pregnant woman to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the clients sister, who is a nurse, that she cannot be in the room during the delivery.

ANS: B, C - Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care.

What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman? (Select all that apply.) a. Report the incident to legal authorities. b. Provide resources for domestic violence shelters. c. Call a client advocate who can assist in the clients decision about what actions to take. d. Accurately and concisely document the incident (or findings) in the clients record. e. Reassure and support the client.

ANS: B, C, D, E Domestic violence is considered a crime in all states; however, mandatory reporting remains controversial. Nurses must become knowledgeable on the laws that apply in the state in which they practice. Caring for a client who may be a victim of domestic abuse is an ideal opportunity to provide the woman with information for safe houses or support groups for herself and her children. The nurse may assist in reaching out to a client advocate, which often occurs when potential legal action is taken or if the woman is seeking shelter. Documentation must be accurate and timely to be useful to the client later in court if she chooses to press charges. The primary functions for the nurse are to reassure the client and to provide her with emotional support.

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a. Sterilization should be performed under general anesthesia. b. Pain, bleeding, and infection are possible complications. c. Pregnancy may still be possible. d. Vasectomy may affect potency. e. Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

Which condition is the most life-threatening virus to the fetus and neonate? a. Hepatitis A virus (HAV) b. Herpes simplex virus (HSV) c. Hepatitis B virus (HBV) d. Cytomegalovirus (CMV)

ANS: C

Which statement most accurately describes complicated grief? a. Occurs when, in multiple births, one child dies and the other or others live b. Is a state during which the parents are ambivalent, as with an abortion c. Is an extremely intense grief reaction that persists for a long time d. Is felt by the family of adolescent mothers who lose their babies

ANS: C

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? a. Photographs of injuries b. Clear and legible written documentation c. Summary of information (e.g., The client is a battered woman.) d. Accurate description of the clients demeanor

ANS: C A statement such as, The client is a battered woman lacks the supporting factual information and will render the report inadmissible.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a. Gonorrhea b. Syphilis c. Chlamydia d. Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions.

Nurses who provide care to victims of IPV should be keenly aware of what? a. Relationship violence usually consists of a single episode that the couple can put behind them. b. Violence often declines or ends with pregnancy. c. Financial coercion is considered part of IPV. d. Battered women are generally poorly educated and come from a deprived social background.

ANS: C Economic coercion may accompany physical assault and psychologic attacks.

Which options for saying good-bye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? a. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born. b. Would you like a picture taken of your baby after birth? c. When your baby is born, would you like to see and hold her? d. What funeral home do you want notified after the baby is born?

ANS: C Mothers and fathers may find it helpful to see their infant after delivery. The parents wishes should be respected. Interventions and support from the nursing and medical staff after a prenatal loss are extremely important in the healing of the parents. The initial intervention should be directly related to the parents wishes concerning seeing or holding their dead infant.

A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence? a. Inexperienced maternity nurse was assigned to care for the client. b. Client was past her due date by 3 days. c. Standard of care was not met. d. Client refused electronic fetal monitoring.

ANS: C Not meeting the standard of care is a legitimate factor for a case of negligence. An inexperienced maternity nurse would need to display competency before being assigned to care for clients on his or her own.

When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful? a. Using the words lost or gone rather than dead or died b. Making sure the family understands that naming the baby is important c. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby d. Setting a firm time for ending the visit with the baby so that the parents know when to let go

ANS: C Presenting the baby as nicely as possible stimulates the parents senses and provides pleasant memories of their baby. Baby lotion or powder can be applied, and the baby should be wrapped in a soft blanket, clothed, and have a cap placed on his or her head. Nurses must use the words dead and died to assist the bereaved in accepting the reality.

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurses role at this time? a. To take over as much as possible to relieve the pressure b. To encourage the grandparents to take over c. To ensure that the parents, themselves, approve the final decisions d. To leave them alone to work things out

ANS: C The nurse is always the clients advocate. Nurses can offer support and guidance and yet leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions. For the nurse to be able to present options regarding burial and autopsy, among other issues, in a sensitive and respectful manner is essential. The nurse should assist the parents in any way possible; however, taking over all arrangements is not the nurses role. Grandparents are often called on to help make the difficult decisions regarding funeral arrangements or the disposition of the body because they have more life experiences with taking care of these painful, yet required arrangements. Some well-meaning relatives may try to take over all decision-making responsibilities. The nurse must remember that the parents, themselves, should approve all of the final decisions. During this time of acute distress, the nurse should be present to provide quiet support, answer questions, obtain information, and act as a client advocate.

Intervention for the sexual abuse survivor is often not attempted by maternity and women's health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman's care? a. Initiating a referral to an expert counselor b. Setting limits on what the client discloses c. Listening and encouraging therapeutic communication skills d. Acknowledging the nurses discomfort to the client as an expression of empathy

ANS: C The survivor needs support on many different levels, and a women's health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions.

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who: a. Want menstrual regularity and predictability b. Have a history of thrombotic problems or breast cancer c. Have difficulty remembering to take oral contraceptives daily d. Are homeless or mobile and rarely receive health care

ANS: C - Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year.

When evaluating a client whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress b. Excessive exercise c. Pregnancy d. Eating disorders

ANS: C - Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy.

A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. The nurses initial response should be to: a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled b. Reassure the woman that using vaginal cream is not a problem for the examination c. Ask the woman to describe the symptoms that indicate to her she has a vaginal infection d. Ask the woman to reschedule the appointment for the examination

ANS: C - An important element of the history and physical examination is the clients description of any symptoms she may be experiencing.

As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old client for her first adult physical examination and Pap test, the nurse is aware of excessive shyness. The young woman states that she will not remove her bra because, There is something wrong with my breasts; one is way bigger. What is the best response by the nurse in this situation? a. Please reschedule your appointment until you are more prepared. b. It is okay; the provider will not do a breast examination. c. I will explain normal growth and breast development to you. d. That is unfortunate; this must be very stressful for you.

ANS: C - During adolescence one breast may grow more quickly than the other. Full development of the breasts is not achieved until after the end of the first pregnancy and period of lactation. The client should be reassured regarding this aspect of growth and development.

The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, I have special undergarments that I do not remove for religious reasons. The most appropriate response from the nurse would be: a. You cant have an examination without removing all your clothes. b. I'll ask the doctor to modify the examination. c. Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably. d. What? Ive never heard of such a thing! That sounds different and strange.

ANS: C - Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the woman's religious practices.

A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, she should be advised to: a. Avoid sexual contact for at least 10 days after starting the pill b. Use condoms and foam for the first few weeks as backup c. Use another method of contraception for 1 week after starting the pill d. Begin sexual relations once vaginal bleeding has ended

ANS: C - If contraceptives are to be started within 3 weeks after an abortion, another method of contraception should be used throughout the first week to avoid the risk of pregnancy.

When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except: a. Anatomic abnormalities b. Type 1 diabetes mellitus c. Lack of exercise d. Hysterectomy

ANS: C - Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea.

Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are: a. Ovaries b. Breast milk c. Menstrual blood d. The vagina

ANS: C - Menstrual blood is a potent source of prostaglandins.

Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen b. Oral contraceptive pills (OCPs) c. Nonsteroidal antiinflammatory drugs (NSAIDs) d. Aspirin

ANS: C - NSAIDs have the strongest research results for pain relief. Often if one NSAID is not effective, another one will provide relief. Approximately 80% of women find relief from these prostaglandin inhibitors.

A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this client, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy b. Fibroids increase in size during the perimenopausal period c. Menorrhagia is a common finding d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus

ANS: C - The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large myomas.

A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by: a. Limiting sexual contact for one cycle after starting the pill b. Using condoms and foam instead of the pill for as long as she takes an antibiotic c. Taking one pill at the same time every day d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle

ANS: C - To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day.

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her fertile time. She asks the nurse about emergency contraception. The nurse would tell her that: a. It is too late; she needed to begin treatment within 24 hours after intercourse b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting d. The most effective approach is to use a progestin-only preparation

ANS: C - To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose.

A 20-year-old client calls the clinic to report that she has found a lump in her breast. The nurses best response is: a. Don't worry about it. Im sure its nothing. b. Wear a tight bra, and it should shrink. c. Many women have benign lumps and bumps in their breasts. However, to make sure its benign you should come in for an examination by your physician. d. Check it again in 1 month and call me back if its still there.

ANS: C - Try to ease the clients fear but provide a time for a thorough evaluation of the lump, because it may indicate abnormal changes in the breast.

Which statement is the most appropriate for the nurse to make when caring for bereaved parents? a. This happened for the best. b. You have an angel in heaven. c. I know how you feel. d. What can I do for you?

ANS: D Acknowledging the loss and being open to listening is the best action that the nurse can do.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments.

ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a. Positive prenatal culture b. Preterm birth at 37 weeks or less of gestation c. Maternal temperature of 38 C or higher d. Premature rupture of membranes (PROM) 24 hours or longer before the birth

ANS: D PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a. Fever, headache, and malaise b. Widespread rash c. Identified by serologic testing d. Appearance of a chancre 2 months after infection

ANS: D Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information? a. Autopsies are usually covered by insurance. b. Autopsies must be performed within a few hours after the infants death. c. In the current litigious society, more autopsies are performed than in the past. d. Some religions prohibit autopsy.

ANS: D Some religions prohibit autopsies or limit the choice to the times when it may help prevent further loss.

Which statement is the most complete and accurate description of medical abortions? a. They are performed only for maternal health. b. They can be achieved through surgical procedures or with drugs. c. They are mostly performed in the second trimester. d. They can be either elective or therapeutic.

ANS: D - Abortions can be either elective (the woman's choice) or therapeutic (for reasons of maternal or fetal health).

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant? a. Refers to the two live infants as twins b. Asks about the dead triplets current status c. Brings in play clothes for all three infants d. Refers to the dead infant in the past tense

ANS: D - Accepting that the infant is dead (in the past tense of the word) demonstrates an acceptance of the reality and that the family has begun to grieve. Parents of multiples are challenged with the task of parenting and grieving at the same time.

As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: D - Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods, such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

ANS: D - Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia.

In their role of implementing a plan of care for infertile couples, nurses should: a. Be comfortable with their own sexuality and nonjudgmental about others to effectively counsel their clients b. Know about such nonmedical remedies as diet, exercise, and stress management c. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid d. Do all of these plus be knowledgeable about potential drug and surgical remedies

ANS: D - Nurses should also be cognizant that a number of surgical procedures can be used for problems related to female infertility.

With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women b. It is more common in leaner women who exercise strenuously c. Symptoms can begin at any point in the ovulatory cycle d. Pain usually occurs in the suprapubic area or lower abdomen

ANS: D - Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs.

While evaluating a client for osteoporosis, the nurse should be aware of what risk factor? a. African-American race b. Low protein intake c. Obesity d. Cigarette smoking

ANS: D - Smoking is associated with earlier and greater bone loss and decreased estrogen production.

A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurses most appropriate response is: a. No spermicide is used with the cervical cap, so its less messy. b. The diaphragm can be left in place longer after intercourse. c. Repeated intercourse with the diaphragm is more convenient. d. The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later

ANS: D - The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse.

Hormonal problems in males and females that disrupt fertility

Example problems with adrenal gland dysfunction, high levels of prolactin (milk production—lactational amenorrhea), thyroid disease, insulin resistance/hyperglycemia, etc.

The stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH) is part of the: a. Menstrual cycle b. Endometrial cycle c. Ovarian cycle d. Hypothalamic-pituitary cycle

ANS: D - The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that occur simultaneously in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.

With regard to the noncontraceptive medical effects of combination oral contraceptives (COCs), nurses should be aware that: a. COCs can cause toxic shock syndrome if the prescription is wrong b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week c. COCs increase the risk of endometrial and ovarian cancer d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements

ANS: D - The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

The two primary functions of the ovary are: a. Normal female development and sex hormone release b. Ovulation and internal pelvic support c. Sexual response and ovulation d. Ovulation and hormone production

ANS: D - The two functions of the ovaries are ovulation and hormone production.

Any episode of vaginal bleeding that occurs at a time other than during menses is referred to as _______________.

ANS: Metrorrhagia Rationale: Defined as intermenstrual bleeding, this is also commonly referred to as breakthrough bleeding or mittlestaining. This can be a normal part of a womans menstrual cycle if it occurs regularly or it may be an indication of an underlying disease process that requires further investigation.

Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?

ANS: T Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.

Obesity is associated with infertility as well as poorer outcomes for assisted reproductive technologies. Is this statement true or false?

ANS: T - Women who are overweight or obese have a reduced chance of pregnancy following in vitro fertilization (IVF) and a significantly greater risk of spontaneous abortion following infertility treatment. Infertility treatment may be deferred until the body mass index (BMI) is less than 30 kg/m2, with no other risk factors.

Describe the adoption triad and how emotional issues impact the individuals in the adoption triad

Adoption Triad: birth child, birth parents, & adoptive parent(s) Seven common emotional issues for birth parents, adoptive parents and birth children include Loss, Rejection, Guilt and Shame, Grief, Identity, Intimacy, & Control Intimacy: birth child may have difficulty building relationships, birth parents may having issues with having sex because they made a baby and no longer have parental rights, and adoptive parents may have difficulty with sex because they can't make/have children

Identify 3 Affective and 3 Somatic symptoms of PMS.

Affective: Mood swings, irritability, depression, poor concentration, sleep disturbance, social withdrawal, suicide ideation Somatic: abdominal bloating, extreme fatigue, headache, breast tenderness, weight gain, swelling of extremities

Identify 5 menstrual disorders and define them.

Amenorrhea - absence of menses Dysmenorrhea - painful menses Premenstrual Disorder - presence of emotional and/or physical symptoms and behavioral changes that occur during the luteal phase of the menstrual cycle and cease within 4 days after the onset of menses. Endometriosis - endometrial tissue growth out side of the uterus Abnormal Uterine Bleeding - any uterine bleeding that is irregular in amount, duration or timing

Polycystic ovary syndrome (PCOS)

An endocrine disorder where multiple follicular cysts form on the ovaries leading to an endocrine imbalance: - Increased estrogen & LH: High estrogen (being released from all these growing eggs) is converted to androgens & testosterone - The brain is reading that there's a lot of estrogen in the body so the feedback loop releases LH in preparation for ovulation. Excess estrogen can cause heart disease, high blood, and high blood sugar! - Decreased FSH because the body is already producing a lot of eggs so the pituitary isn't stimulated to release it - Decreased progesterone because the immature eggs are never maturing and shedding the corpus luteum - Hyperglycemia and insulin resistance/impaired glucose tolerance is possibly linked to the high level of estrogen (it raises the blood sugar) - Symptoms: *irregular Menses (oligo). *obesity (especially around the waist). *hirsutism = male pattern hair, acne, oily skin. Management: *Weight loss - helps to regulate menses, reduce androgen levels, lower lipid levels, metabolize glucose levels Pharmacological treatments: *Combination Oral Contraceptives - to limit hirsutism and acne and decrease testosterone/LH & clomid if fertility is desired to induce ovulation

Emergency Contraceptive Methods

Copper Intrauterine Contraceptive (Cu IUC): Insert within 5 days following unprotected intercourse (UPI) Ulipristal Acetate (UPA): Ella Levonorgestrel (LNG EC): Plan B, Next Choice

Lutein/Corpus Luteal Cyst

Corpus luteum fails to regress Develops after ovulation → May delay menstruation More likely to cause pain 2° torsion/blood accumulation

What medication is given when fertility is desired?

CLOMID (50 mg PO) is given to infertile women to induce ovulation

Fibroids (leiomyomas, myomas)

Common benign uterine tumors influenced by the presence of estrogen Sx: Menorrhagia is the most common symptom Tx: Hormonal/Pharm Therapy: COC/IUD: Depo, GnRH agonist, mifepristone. Myomectomy. Ablation - destruction of the endometrial lining. Hysterectomy- leading indication for hysterectomy

What is the most likely cause of Primary Dysmenorrhea?

Excessive production of Prostaglandin F2 Alpha which increase the forces of uterine contractions which results in decreased blood flow to the uterus, ischemia and pain.

Assessment and labs for Amenorrhea

Galactorrhea - Ask if they're having a milky discharge from nipples? Labs: hCG, FSH, TSH (thyroid stimulating hormone), & prolactin (high levels stops you from having a period)

Inhibited Grief

Grief is kept Inward and private Outward expressions not acceptable.

Complicated Grief

Grief work halts, parents have an emotional incapacity to continue to accomplish grief work - Persistent thoughts of self-destruction - Failure to provide for basic needs of survival - Persistent mourning or long-term depression - Abuse of controlling substances - Occurrence or recurrence of mental illness - Lack of balance of life - Interpersonal relationship problems

bacterial vaginosis

Disruption of normal vaginal flora causes inflammation or infection Maternal sx: increased vaginal discharge (thin white) & fishy odor Impact on pregnancy: may cause PROM or intrapartum/postpartum infections Treatments: Flagyl or Clindamycin avoid EtOH with meds

What's the treatment for Chlamydia?

Doxycycline 100 mg by mouth B.I.D. for 7 days Azithromycin 1 gram by mouth once

Identify 3 manifestations of endometriosis.

Dysmenorrhea, pelvic pain, dyspareunia, bowel upset, bowel pain, infertility, ovarian mass, dysuria, menorrhagia, metomenorrhagia, dysuria

What is premenstrual syndrome?

Emotional symptoms, physical symptoms or behavioral changes that occur during the onset of the luteal phase of the menstrual cycle and cease within 4 days after the onset of menses.

What is Endometriosis and what is the gold standard for diagnosis?

Endometrial tissue growth outside of the uterus Laparoscopic surgery is the gold standard for dx

List 4 causes of Secondary Dysmenorrhea and define them.

Endometriosis endometrial tissue attaches to adjacent organs (e.g., fallopian tubes). Adenomyosis - endometrium grows in to the uterine muscle Leiomyoma - uterine fibroids/ benign growths Pelvic Inflammatory Disease - infection of the pelvic organs

Violence against women remains a major health care problem in the United States, affecting millions of women annually. Fortunately, during pregnancy violence often stops entirely or diminishes. Is this true or false?

False - Pregnancy is often when violence either begins or escalates. Maternity and women's health nurses, by the nature of their practice are in a unique position to provide sensitive care to women in abusive relationships, engage in prevention, and influence health care and public policy.

Follicular ovarian cyst

Fluid in a non-dominant follicle is not reabsorbed Asymptomatic or one-sided pain for 24 hours if it ruptures Usually regress on its own

Identify 3 important components of the H&P for PMS/PMDD?

History: family, psycho-social, gyn, medical, substance use Physical exam: general Labs: CBC, TSH Symptom Diary - recorded by patient or parent/partner COPE - Calendar of Premenstrual Experiences

What is the HPG Axis and how might a HPG Axis alteration result in amenorrhea?

Hypothalamic-Pituitary-Gonadotropin Axis The HPG Axis interplay results in the development of sex characteristics and regulates ovulation and menstruation. Any alteration may result in Amenorrhea.

What's used to assess for structural/obstruction factors in females with fertility issues?

Hysterosalpingogram: radiopaque dye to look at uterus and patency of tubes Sonohysterography: saline injected to look inside uterus for lesions & contour

What's the difference between IUI and IVF?

IUI: Sperm collected is placed in the uterus using a thin catheter that passes through the cervix. Higher risk of twins than IVF. Good option for same sex females and couples with a mild sperm factor. IVF: Subcutaneous FSH and LH injections for ~2 wks to help increase the number of follicles, however, we DON'T want to ovulate so we have to make sure the FSH isn't too high! The goal is to get the largest number of mature follicles.

What's primary infertility?

Inability to conceive after 1 yr of unprotected reg sex

What's secondary infertility?

Inability to conceive in a previously fertile couple

What's the role of nurses in transracial adoption?

Inform the parents of the need to commit to the soccer/baseball/dance league or class that has the most families of color involved, even if it's a longer drive and not the one most of my white friends frequent with their kids. Talk about race and racism often, with adults and with my children. Seriously consider moving, to diversify all of our lives. Get over their own discomfort at being in an unfamiliar cultural environment and do it anyway, to pave the way for your child(ren). Volunteer on the school's diversity committee, taking a leadership role in a scholarship program for children of color. Walk into a hair salon and admit that you still don't know how to maintain your child's hair.

Ethinyl Estradiol (EE) = Estrogen

Inhibits FSH production & decreases follicle development Improves cycle control by stabilizing the endometrium

Progestin

Inhibits ovulation by suppressing the LH surge Thickens cervical mucus Slows tubal motility Thins endometrium

How can you be reasonably certain that a patient is not pregnant?

Is < 7 days after LMP No sexual intercourse since LMP Correctly & consistently using reliable contraceptive method Within 4 weeks postpartum Fully/nearly fully breastfeeding (>85% of feeds), amenorrheic, < 6 months postpartum

How does birth control work?

It either contains progestin only or progestin and estrogen. FSH & LH are required to trigger ovulation, artificially blocking them suppresses ovulation. Easier to add to a biological system than to remove: P&E suppresses the release of FSH & LH.

What is the definition of Primary Amenorrhea? Identify both possible criteria.

Lack of secondary sex characteristics by age 13 or Lack of onset of menarche by age 15.

Identify 2 types of surgical treatments for Endometriosis.

Laser vaporization Excision Electrocautery Oophorectomy Hysterectomy

Syphilis

Maternal effects: 1° Syphilis: Painless cancer within the vagina, mouth or rectum-heals in 3 to 6 weeks. 2° Syphilis: Rash-trunk, palms, soles of feet, alopecia, arthralgia, fever, sore throat, swollen LN. Latent Syphilis: No s/s up to five years. 3° Syphilis: Neurosyphilis. SAB (spontaneous abortion), IUFD, & PTL Fetal effects: Congenital (in-utero) syphilis: Fever, irritability, saddle nose, Hutchinson's teeth Treatment: Benzathine penicillin G for mom & Neonate: Aqueous crystalline penicillin OR Procaine penicillin G

Give two examples of Abnormal Uterine Bleeding.

Menorrhagia Metrorrhagia Menometrorrhgia Intermenstrual bleeding Oligomenorrhea Polymenorrhea

Define Menorrhagia or Heavy Menstrual Bleeding and identify 2 blood tests that would be part of the work-up.

Menstrual bleeding is heavy when it is heavy to the woman. HCG, CBC, TSH,

The standard of care for women who are dependent on heroin or other narcotics is ____________________ maintenance treatment (MMT).

Methadone - MMT should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the human immunodeficiency virus (HIV) rate.

Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for clients. Which factor is the most concerning pitfall for nurses using this technology? a. Violation of client privacy and confidentiality b. Institutions and colleagues who may be cast in an unfavorable light c. Unintended negative consequences for using social media d. Lack of institutional policy governing online contact

NS: A The most significant pitfall for nurses using this technology is the violation of client privacy and confidentiality.

Identify 5 treatments for HMB (Heavy Menstrual Bleeding)

NSAIDS, Iron, COCs, Depo, LNG - IUD, D&C Ablation, Hysterectomy

List three different treatment options for Primary Dysmenorrhea?

NSAIDs - reduce prostaglandin production OCs/COCs/Depo and NG-IUD - prevents ovulation and reduces or eliminates menstruation Exercise - reduces pelvic congestion and ischemia TENs - gate control Relaxation/massage - increases endorphins

Malpractice

Negligence committed by a professional which causes harm to an individual from failure to practice with the prudence and skill of such a professional

Identify 3 complimentary therapies for Endometriosis and describe how they work.

Nutrition - low fat decreases fat stores and estrogen Exercise - endorphins and pelvic conditioning Yoga - stress relief and relaxation Acupuncture - pain control Pelvic floor PT - strengthening and relaxation of pelvic muscles Chinese herbal medicine - symptom relief

Anticipatory Grief

Occurs in presence of a perceived life threatening diagnosis or pregnancy is threatened.

Tuberculosis

Perinatal Impact: Fetus can be exposed through amniotic fluid, umbilical cord Newborn can acquire postnatal infection from mom Signs for infant: Failure to thrive, Lethargy, Respiratory distress, Fever, Hepatosplenomegaly, & Enlarged lymph nodes Maternal treatment: Rifampin, INH, ethambutol. Streptomycin contraindicated Neonatal treatment: INH (isoniazid) up to twelve months Can breastfeed if disease not active Mother with active (infectious) TB: Separated from infant with resistant TB/noncompliance until baby undergone appropriate prophylaxis

Identify two 2 pharmacological and two complimentary therapies for Premenstrual Syndrome/Premenstrual Dysphoric Disorder

Pharm: SSRI's (Sarafem, Zoloft and Paxil), COC/Depo, (Yasmin FDA approved for PMDD) Spironolactone Complimentary: Aerobic Exercise, Vit E, Vit B, Evening primrose oil, meditation, yoga, light therapy, chiropractic, hypnosis

Identify 3 possible etiologies for Abnormal Uterine Bleeding.

Polyps Adenomyosis (endometrial tissue grows into the uterine muscle) Leiomyoma (fibroids) Malignant or benign lesions (cervicitis,endometrial cancer) Coagulopathy - platelet function, VWF, ITP Ovulatory dysfunction Endometrial causes Iatrogenic - drug induced (Dilantin, copper IUD...) Not yet classified (**Important to note - any bleeding in a post menopausal (1 year without menses) woman is abnormal and endometrial cancer must be ruled out

Compare the etiologies of Primary and Secondary Dysmenorrhea.

Primary Dysmenorrhea is an excessive production of Prostaglandins (no pathology) versus Secondary which is associated with pelvic pathology.

Menometrorrhagia

Prolonged or excessive uterine bleeding at irregular intervals and more frequent than normal intervals

Candida Albicans (yeast infection)

Rarely transmitted sexually, usually the result of weakened immune system, hormonal changes, BC, tx with abx, steroids, DM, vaginal intercourse, douching, blood or semen Maternal sx: Pruritus & irritation, & thick/clumpy white discharge Treatment: OTC Miconazole, Clortrimazole, & Terconazole. Prescription: Fluconazole

What's the difference between reactive approach vs. proactive approach

Reactive approach: responds to near misses or adverse outcomes, change in policy or protocol, staff re-education, or disciplinary action. Ex: change in policy/protocol for example handoff procedures, staff re-education, disciplinary action ​​Proactive approach: ongoing prospective program to minimize risk of patient harm. Ex: SBAR, clinical drills, simulation

Short Acting Reversible Contraceptive Methods

Ring: Flexible ring w/ ethinyl estradiol & Etonogestrel (progesterone) Patch: Ethinyl Estradiol & Progestin Progestin Only Pill: Mini PILL (Norethindrone) Combined Contraceptive Pills (Monophasic, Multiphasic, extended cycle) → can have progesterone only but not estrogen only because it's proliferative and cancerous Depo Provera Injection (progestin ?) - BLACK BOX WARNING: decreases peak bone mass & inc risk for osteoporotic fracture later in life if given during adolescence or early adulthood

Parvovirus (5th Disease)

Spreads through respiratory transmission Maternal sx: Distinctive rash rosy red cheeks & arthritic symptoms. Fetal effects: Hydrops - a large accumulation of fluid in organ systems and mom's immune system can cause a destruction of the baby's RBCs

What is Dysfunctional Uterine Bleeding and what is the most likely etiology?

Subset of AUB - abnormal bleeding in the absence of organic pathology. Palm-Coien ruled out. Anovulation (when the ovaries do not release a oocyte & so ovulation does not occur) and sustained high levels of estrogen

What's the cycle of abuse and the response of the victim?

TENSION BUILDING - Abuser: yells, nitpicks, withholds affection, threatens, destroys things, engages her to argue - Victim: attempts to calm, tries to reason/satisfy, agrees, avoidance, nurtures ACUTE EXPLOSION - Abuser: verbally and physically abuses, prevents her from calling the police or leaving, stalks, harasses & abuses children, throws objects/uses weapons - Victim: Protects self in any way, tries to reason & calm, fights back, leaves, may/may not call the police HONEY MOON - Abuser: apologizes, promises it won't happen again, tries to justify the behavior, cries, threatens suicide, promises to get help - Victim: sets up counseling for him, drops legal proceedings, forgives, returns home, & happy/relieved

Rubella

Transmission: droplet or direct contact w/ infected materials Maternal symptoms: rash, fever, or malaise Vaccine if not pregnant/postpartum if non-immune → delay conception 1 month Vaccinate children because there's no cure Perinatal Impact: most dangerous in 1st trimester → 33% end in spontaneous abortion Fetal effects → Rubella Syndrome: hearing impairment, developmental delay, cataracts, cardiac defects, IUGR, microcephaly, & viral shedding with open lesions

Bereavement

The entire dynamic process precipitated by loss. Phases: denial, anger, bargaining, depression, & acceptance

Herpes simplex virus

Transmission: crosses placenta, ROM (virus ascends), & during birth (direct contact) Maternal effects: 1° Outbreak: painful, blistering, herpetic lesions that cover perineum. Recurrent: less pain & less lesions → Primary infection is most dangerous to infant! Fetal effects: skin, eyes, and mouth herpes (SEM), Disseminated (DIS) Liver, seizures, & encephalitis NO CURE Initial treatment: Acyclovir 400mg po TID x 7-10 days. Recurrent treatment: 400mg 2x/day until sx subside.

WITHDRAWAL in infants

W Wakefulness I Irritability T Tremulousness, Temperature Variation, Tachypnea H Hyperactivity and High-pitched or continuous cry D Diarrhea, Diaphoresis, Disorganized such R Rub marks, restless sleeping, respiratory difficulty A Apneic attacks W Weight loss or failure to gain weight A Alkalosis (respiratory) LLacrimation (runny eye syndrome)

Neonatal Mortality

death within the first 28 days of life

"Chocolate cyst" of ovary

endometriosis tissue Treatment for cysts: R/O Pregnancy & Surgery to confirm

What is dysmenorrhea?

painful menstruation