Maternity Midterm
A female client, who has been newly diagnosed with herpes simplex virus (HSV) ask the nurse how long it will take for the "sores" to go away. How should the nurse respond? "It will take about 2 weeks for the outbreak to fully heal." "Once you start the medication it will take about 1 week." "The pain should go away in a few days once the 'sores' crust over." "The first outbreak takes about 3 weeks to heal with medication."
"It will take about 2 weeks for the outbreak to fully heal." During an initial occurrence vesicles appear on the labia or perineum. These vesicles open, begin to weep, then crust over, dry and then disappear without scar formation. This is the process of viral shedding and takes about 2 weeks to complete. Recurrent episodes of an outbreak take a shorter time for this to occur. Medication used to treat the outbreak is required for a 10-day period. The amount of pain does not determine how long the outbreak will need to heal.
A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? "I will be put under general anesthesia for the procedure." "They will place a catheter in my uterus and use an ultrasound to see what the problem is." "This is just an ultrasound procedure, like they do for a baby." "They will surgically implant the ovum during the procedure."
"They will place a catheter in my uterus and use an ultrasound to see what the problem is." A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.
A nurse is reviewing sperm count results for a couple trying to conceive. Which results would concern the nurse? 10 million per ml of seminal fluid 20 million per ml of seminal fluid 30 million per ml of seminal fluid 40 million per ml of seminal fluid
10 million per ml of seminal fluid The sperm count is the number of sperm in a single ejaculation or in a milliliter of semen. The minimum sperm count considered normal is 20 million per milliliter of seminal fluid, or 50 million per ejaculation.
A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment? Avoid extremes of temperature to the genital area. Use condoms during sex. Increase fluid intake. Avoid alcohol.
Avoid alcohol. The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting. Avoiding extremes of temperature to the genital area is a requirement for clients with genital ulcers, not trichomoniasis. The nurse should instruct the client to avoid sex, regardless of using condoms, until she and her sex partners are cured, that is, when therapy has been completed and both partners are symptom-free. It is not required to increase fluid intake during treatment.
A woman has opted to use medroxyprogesterone injections for birth control. The client receives the first injection today. The nurse instructs the woman to return to the clinic in how many months for the next injection?
The medroxyprogesterone injection is given intramuscularly every 3 months.
A client in her second trimester of pregnancy asks the nurse for information regarding certain oral medications to induce a miscarriage. What information should this client be given about such medications? They are available only in the form of suppositories. They can be taken only in the first trimester. They present a high risk of respiratory failure. They are considered a permanent end to fertility.
They can be taken only in the first trimester. The client is seeking a medical abortion. The nurse should inform the client that such medications are effectively used to terminate a pregnancy only during the first trimester, not the second. The medications are available as a vaginal suppository or in oral form and do not present a high risk of respiratory failure. Sterilization, not abortion, is considered a permanent end to fertility.
A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis? a painless genital ulcer that appeared about 3 weeks after unprotected sex copper-colored macules on the palms and soles that appeared after a brief fever patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas one or more flat, wartlike papules in the genital area that are sensitive to touch
a painless genital ulcer that appeared about 3 weeks after unprotected sex A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.
A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? cervical infection a weight gain of 10 lb (4.5 kg) a vaginal infection six months of nonuse
a weight gain of 10 lb (4.5 kg) A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.
A client prescribed oral contraceptive pills (OCPs) has presented for a routine visit. Which finding upon assessment should the nurse prioritize? abdominal pain small amount of breakthrough bleeding light menstrual flow cramping during menses
abdominal pain The warning signs to report for a client on oral contraceptive pills are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema. Light bleeding, light flow, and cramping are all normal.
A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? burning on urination dry, hacking cough diffuse skin rash painless chancre
burning on urination Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.
A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by: dilating the cervix. acting as a toxin to the trophoblastic tissue. blocking the action of progesterone on the endometrium. causing uterine contractions to expel the uterine contents.
causing uterine contractions to expel the uterine contents. Misoprostol works by causing uterine contractions, which help to expel the uterine contents. It has no effect on cervical dilation. Methotrexate is toxic to the trophoblastic tissue. Mifepristone blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.
What is the gold standard for HSV diagnosis? culture shave biopsy excisional biopsy punch biopsy
culture The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but they would not be used for HSV.
A group of students is reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which cause of condylomata? herpes virus human papillomavirus Treponema pallidum Haemophilus ducreyi bacillus
human papillomavirus Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.
While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? hematoma laceration uterine inversion uterine atony
laceration Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. Hematoma would present as a localized bluish bulging area just under the skin surface in the perineal area, accompanied by perineal or pelvic pain and difficulty voiding. Uterine inversion would present with the uterine fundus at or through the cervix. Uterine atony would be manifested by a noncontracted uterus.
A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? overstimulation of the ovary resulting in potential multiple births extensive bleeding during menstruation elevation of her blood glucose level hypertension
overstimulation of the ovary resulting in potential multiple births Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use.
A woman comes to the local women's health clinic for an evaluation. The woman is diagnosed with chlamydia. Which action(s) by the nurse would be important? Select all that apply. report the condition to public health authorities teach the woman how to use the intravaginal medication instruct the client to avoid alcohol with treatment explain that there is no cure for the infection discuss the need for treatment for gonorrhea as wel
report the condition to public health authorities discuss the need for treatment for gonorrhea as well Federal law in the United States and Canada recognize chlamydia, gonorrhea, and syphilis as notifiable conditions. This means that federal law mandates health care providers to report new cases of these infections to public health authorities. Chlamydia is treated with antibiotics. Because of the common coinfection of chlamydia and gonorrhea, a combination antibiotic regimen is prescribed frequently. Intravaginal medications are used to treat candidal infections. Alcohol should be avoided during treatment for trichomoniasis. Chlamydia can be cured; however, genital herpes cannot be cured.
A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply. decreased risk of breast cancer shortening of the menstrual period reduction in severe cramping lowered risk of migraine headaches reduction in risk for osteoporosis
shortening of the menstrual period reduction in severe cramping reduction in risk for osteoporosis Oral contraceptives are associated with shortening and regulating the menstrual cycle, reducing severe cramping and bleeding, and reducing the risk for osteoporosis. They are also associated with an increased risk for breast cancer and migraine headaches.
A woman with candidiasis is prescribed fluconazole. When teaching the woman about this medication, which instruction would the nurse include? "Take 1 dose of the drug by mouth." "Insert the suppository into the vagina daily for 1 week." "Apply the cream to the area for 3 days." "Use the applicator to insert the vaginal tablet."
"Take 1 dose of the drug by mouth." Fluconazole, when prescribed, is a 150-mg oral tablet taken as a single dose. Miconazole, clotrimazole, and terconazole are used intravaginally in the form of a cream, tablet, or suppositories for 3 to 7 days.
A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. in vitro fertilization counseling fertility drugs semen analysis ovulation monitoring tubal patency
Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.
A client is diagnosed with chlamydia and gonorrhea and is receiving azithromycin as treatment. In addition to this medication, the nurse anticipates that the client will also be prescribed which drug? miconazole doxycycline ceftriaxone tetracycline
ceftriaxone Individuals with chlamydia usually receive treatment with doxycycline or azithromycin. However, since they also are infected with gonorrhea, ceftriaxone will be commonly added to the regimen. Miconazole is used to treat candidal infections. Tetracycline or erythromycin is used to treat gonococcal ophthalmia neonatorum.
A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client education, what group should the nurse include as at risk for cervical cancer? clients with irregular menstrual cycles clients who have not had babies clients who have genital warts clients with fibrocystic breast disease
clients who have genital warts The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.
Which stage of syphilis occurs when the infected person has no signs or symptoms of syphilis? primary latency secondary tertiary
latency Explanation: Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. S econdary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.
Which finding would alert the nurse to suspect that a client has a yeast infection? changes in skin color vulvar burning and itching lymphadenopathy acidic vaginal secretions
vulvar burning and itching The primary symptom of a yeast infection is burning and itching on the vulva or in the vagina. Acidic vaginal secretions are not the primary symptoms of a yeast infection. Skin changes and lymphadenopathy may occur in the breast and require a follow up for breast exam; however, these are not associated with yeast infections.
A woman comes to the clinic reporting intense pruritus and a thick curd-like vaginal discharge. On examination, white plaques are observed on the vaginal wall. The nurse suspects which condition? trichomoniasis bacterial vaginosis vulvovaginal candidiasis chlamydia
vulvovaginal candidiasis Pruritus accompanied by a thick curd-like vaginal discharge and white plaques on the vaginal wall are characteristic of vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow or green or gray frothy or bubbly discharge. Bacterial vaginosis is characterized by a thin white homogeneous vaginal discharge. Chlamydia is usually manifested by a mucopurulent vaginal discharge.
A client is seen in the clinic requesting an emergency postcoital contraception pill levonorgestrel (Plan B). The client states that she had unprotected sex 3 ½ days ago. What is the most appropriate response by the nurse? "The pill will cause you to begin menstruating within a day." "Unfortunately you are past the time frame to take that prescription." "You should contact the local abortion clinic to set up an appointment." "You will need to also be treated with antibiotics for an STI."
Unfortunately you are past the time frame to take that prescription." Levonorgestrel can be taken anytime within 72 hours (3 days) of unprotected sexual activity. There is a newer form of the pill, ulipristal acetate, that can be taken as late as 120 hours after unprotected intercourse, but this medication does require a prescription.
The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method? coitus interruptus method cervical mucus ovulation method basal body temperature method symptothermal method
coitus interruptus method Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method. Coitus interruptus or withdrawal is not considered a fertility awareness based method.
An Rh positive client vaginally gives birth to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection? length of labor maternal Rh status method of birth size of the neonate
length of labor A prolonged length of labor places the mother at increased risk for developing an infection. The average size of the neonate, vaginal birth, and Rh status of the client do not place the mother at increased risk.
Which instruction should be given to a woman newly diagnosed with genital herpes? Obtain a Papanicolaou test every 3 years. Have your partner use a condom when lesions are present. Use a water-soluble lubricant for relief of pruritus. Limit stress and emotional upset as much as possible.
limit stress and emotional upset as much as possible. Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it is not known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Papanicolaou test is recommended every year.
When using the contraceptive patch, a client should understand that it: should be applied to the breasts, hips, or back. should be covered when swimming in a pool because of chlorine's effect on the adhesive. is immediately effective after application. should be applied to the abdomen, buttocks, or back.
should be applied to the abdomen, buttocks, or back. The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.
A school health nurse is providing education to a group of adolescents regarding the proper procedure for male condom use. The nurse knows the teaching has been effective when which statement is made by a student? "Ensure your condom is always available, so store condoms in your wallet." "It is important to put the condom on just before the penis is erect." "Use only petroleum-based lubricants, such as body lotion or massage oil." "Withdraw the penis erect, holding the condom firmly against the penis."
"Withdraw the penis erect, holding the condom firmly against the penis." The teaching guidelines for proper condom use include: ensure the condom has been stored in a cool, dry place away from direct sunlight. Do not store condoms in wallet; put the condom on before any genital contact; put the condom on when penis is erect; ensure adequate lubrication during intercourse. If external lubricants are used, use only water-based lubricants. Oil-based or petroleum-based lubricants, such as body lotion or massage oil, can weaken latex condoms. Withdraw while penis is still erect, and hold condom firmly against base of penis. Remove carefully to ensure no semen spills out.
A pregnant client has been prescribed a quinolone medication to treat gonorrhea. What is most important for the nurse to do before administering the medication? notify the health care provider ask the client about allergies teach the client about the medication instruct the client to retest after treatment
notify the health care provider Although quinolone drugs are very effective in the treatment of gonorrhea, their effect on the fetus has not been totally proven. It has been believed quinolones cause fetal malformations, especially if taken in the first trimester. Therefore, it is advised quinolones not be taken in pregnancy. When the nurse receives this prescription the health care provider must be notified. There may be a reason for the medication unknown to the nurse or there could simply be a mistake in realizing the client is pregnant. The health care worker should prescribe knowing all the facts and weigh risks versus benefits. Allergies, teaching and retesting instructions should all be done, but alerting the health care provider would be the first action.
