Test 3

A client is diagnosed with urinary incontinence. The nurse teaches the client about the condition and ways to manage it. The nurse determines that the teaching was successful based on which client statement? A. "I will limit my daily fluid intake to about 1.5 liters." B. "I can continue to drink coffee, but I must avoid drinking tea." C. "I can use a feminine deodorant spray to help control the odor." D. "I should perform Kegel exercises about once a week

"I will limit my daily fluid intake to about 1.5 liters."

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? A. "I'll try to move my bowels." B. "I'll lie down with my legs raised." C. "I'll drink several glasses of water." D. "I'll sit down to rest for 30 minutes."

"I'll drink several glasses of water." If the woman experiences any signs and symptoms of preterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction.

The nurse is teaching a client with polycystic ovarian syndrome (PCOS) who is receiving oral contraceptives as part of her treatment plan about the drug therapy and how it will help the client. The nurse determines that the teaching was successful when the client states which reason for the drug? A. "It will help regulate my menstrual cycle." B. "It will help me to ovulate." C. "It will help decrease my hair growth." D. "My body will be able to use insulin better."

"It will help regulate my menstrual cycle."

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? A. 11 B. 8 C. 6 D. 3

11 The Bishop score helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success.

A woman is being evaluated for pelvic organ prolapse. A postvoid residual urine specimen is obtained via a catheter. Which residual volume finding would lead the nurse to suspect the need for further testing? A. 50 mL B. 75 mL C. 120 mL D. 95 mL

120 A postvoid residual urine specimen of greater than 100 mL indicates the need for further urodynamic evaluation and testing.

A nurse is reading a journal article about treatment options for fibroids. Which information would the nurse most likely find as a disadvantage associated with uterine artery emobolization? Select all that apply. A. The procedure often causes pain. B. It can negatively affect fertility. C. The procedure is noninvasive. D. The fibroids can regrow after the procedure. E. Radiation and contrast dye are used.

A. The procedure often causes pain. B. It can negatively affect fertility. Radiation and contrast dye are used.

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? A. "It's strange, one minute I'm happy, the next I'm sad." B. "I'm feeling so guilty and worthless lately." C. "I keep hearing voices telling me to take my baby to the river." D. "I just feel so overwhelmed and tired."

I'm feeling so guilty and worthless lately

When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area? A. labia minora B. clitoris C. labia majora D. prepuce

Labia majora

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. A. nifedipine B. dinoprostone C. misoprostol D. indomethacin E. magnesium sulfate

Nifedinipe Indomethacin Mag sulfate Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), terbutaline (Brethine, a beta-adrenergic), indomethacin (Indocin, a prostaglandin synthetase inhibitor), and nifedipine (Procardia, a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

A pregnant client has received dinoprostone. Following administration of this medication, the nurse assesses the client and determines that the client is experiencing an adverse effect of the medication based on which client report? Select all that apply. A. headache B. diarrhea C. tachycardia D. nausea E. hypotension

Tachycardia Nausea Headache Diarrhea

Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition? A. retained placental fragments B. hypertension C. uterine subinvolution D. thrombophlebitis

Thrombophebitis Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition?

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next? A. Apply warm soaks to the area. B. Notify the health care provider. C. Massage the uterine fundus. D. Encourage the client to void.

notify health care provider

A nurse is assessing a postpartum client. Which finding would the cause the nurse the greatest concern? A. perineal pain with swelling along the episiotomy B. leg pain on ambulation with mild ankle edema C. calf pain with dorsiflexion of the foot D. sharp stabbing chest pain with shortness of breath

sharp stabbing chest pain with shortness of breath

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which measures would the nurse most likely include in this teaching plan? Select all that apply. A. checking temperature once a week B. taking the prescribed antibiotic until it is finished C. Handle parinatal pads by edges D. directing peribottle to flow from back to front E. washing hands before and after perineal care

taking the prescribed antibiotic until it is finished washing hands before and after perineal care handle perinatal pads by the edges

A client with advanced breast cancer, who has had both chemotherapy and radiation therapy, is to start endocrine therapy. Which agent would the nurse expect the client to receive? A. trastuzumab B. cortisone C. tamoxifen D. estrogen

tamoxifen The objective of endocrine therapy is to block or counter the effect of estrogen in the pathogenesis of cancer. The best-known agent is tamoxifen. Use of progestins along with estrogens in postmenopausal women increases a woman's risk for breast cancer. In addition, estrogen is considered to play a major role in the development of breast cancer and as such would not be used. Cortisone is a steroid and would not be used.

The nurse is conducting a class for postpartum women about mood disorders. The nurse describes a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse determines that the women understood the description when they identify the condition as postpartum: A. bipolar disorder. B. depression. C. psychosis. D. blues.

blues

A nurse is assessing a pregnant woman who has come to the clinic. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply. A. constipation B. four to five contractions in 1 hour C. malodorous vaginal discharge D. dysuria E. dull low backache

dysuria Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and intestinal cramping with or without diarrhea.

A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis? A. transvaginal ultrasound B. endometrial biopsy C. pap smear D. colposcopy

endometrial biopsy

After presenting an in-service presentation on measures to prevent postpartum hemorrhage, the nurse determines that the teaching was successful when the group identifies which measure to prevent postpartum hemorrhage due to retained placental fragments? A. inspecting the placenta after delivery for intactness B. applying pressure to the umbilical cord to remove the placenta C. administering broad-spectrum antibiotics D. manually removing the placenta at delivery

inspecting the placenta after delivery for intactness After birth, a thorough inspection of the placenta is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which finding? A. bruising on arms and legs B. moderate lochia serosa C. fever D. nonpalpable fundus

moderate lochia serosa

A postpartum client is prescribed medication therapy as part of the treatment plan for postpartum hemorrhage. Which medication would the nurse least expect to administer in this situation? A. carboprost B. methylergonovine C. nifedipine D. oxytocin

nifedipine

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching? A. "I guess the nurses will be getting me up and out of bed rather quickly." B. "I'm going to have to wait a few days before I can start breast-feeding." C. "I'll probably have a tube in my bladder for about 24 hours or so." D. "Holding a pillow against my incision will help me when I cough."

"I'm going to have to wait a few days before I can start breast-feeding." Typically, breast-feeding is initiated early as soon as possible after birth to promote bonding. The woman may need to use alternate positioning techniques to reduce incisional discomfort. Splinting with pillows helps to reduce the discomfort associated with coughing. Early ambulation is encouraged to prevent respiratory and cardiovascular problems and promote peristalsis. An indwelling urinary catheter is typically inserted to drain the bladder. It usually remains in place for approximately 24 hours.

Which statement best indicates that a client has taken self-care measures to reduce her risk for cervical cancer? A. "I've thrown out all my bubble baths and just use soap and water now." B. "I've really cut down on the amount of caffeine I drink every day." C. "My partner always uses a condom when we have sexual intercourse." D. "Every time I have sexual intercourse, I douche.

"My partner always uses a condom when we have sexual intercourse." Unprotected sexual intercourse is a risk factor for cervical cancer. Use of barrier methods of contraception such as condoms is a key measure for reducing the risk for cervical cancer. Cessation of smoking and drinking alcohol, not caffeine, also are effective measures for risk reduction. Eliminating irritants such as bubble baths is a general measure to reduce perineal irritation and urinary tract infections. Douching has no effect on risk reduction for cervical cancer.

A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply. A. "Stop what you are doing and rest." B. "Drink 2 or 3 glasses of water." C. "Lie down on your back." D. "Walk around the house for the next half hour." E. "Try emptying your bladder."

"Stop what you are doing and rest." "Drink 2 or 3 glasses of water." "Try emptying your bladder."

A nurse is conducting an in-service program for a group of labor and birth unit nurses about cesarean birth. The group demonstrates understanding of the information when they identify which condition as an appropriate indication? Select all that apply. A. prolonged labor B. placenta previa C. previous cesarean birth D. fetal distress E. active genital herpes infection

Active genital herpes infection Placenta previa Previous cesarean birth Fetal distress The leading indications for cesarean birth are previous cesarean birth, breech presentation, dystocia, and fetal distress. Examples of specific indications include active genital herpes, fetal macrosomia, fetopelvic disproportion, prolapsed umbilical cord, placental abnormality (placenta previa or abruptio placentae), previous classic uterine incision or scar, gestational hypertension, diabetes, positive HIV status, and dystocia. Fetal indications include malpresentation (nonvertex presentation), congenital anomalies (fetal neural tube defects, hydrocephalus, abdominal wall defects), and fetal distress.

A nurse is teaching a client how to perform Kegel exercises. Which directives would the nurse include? Select all that apply. A. "Squeeze your rectal muscles as if you are trying to avoid passing flatus." B. "Contract and relax your pubococcygeal muscles rapidly 10 times." C. "Do these exercises at least 5 times every hour." D. "Try bearing down for about 10 seconds for no more than 5 times." E. "Tighten your pubococcygeal muscles for a count of 10."

B. "Squeeze your rectal muscles as if you are trying to avoid passing flatus." E. "Contract and relax your pubococcygeal muscles rapidly 10 times." Rationale: To perform Kegel exercises, the nurse would tell the client to squeeze the muscles in her rectum as if she is trying to prevent passing flatus. Then the nurse would tell the client to stop and start urinary flow to help identify the pubococcygeus muscle. Once this is accomplished, the nurse would tell the client to tighten the pubococcygeus muscle for a count of 3, and then relax it. Next the nurse would tell the woman to contract and relax the pubococcygeus muscle rapidly 10 times and try to bring up the entire pelvic floor and bear down 10 times. Finally, the nurse would tell the client to repeat these exercises at least 5 times daily.

Assessment of a woman in labor who is experiencing hypertonic uterine dysfunction would reveal contractions that are: A. erratic. B. poor in quality. C. brief. D. well coordinated.

Erratic Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality and lack sufficient intensity to dilate and efface the cervix. Contractions of precipitous labor occur rapidly such that labor is completed in less than 3 hours.

When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate? A. one who has a history of a contracted pelvis B. one who had a previous cesarean birth via a low transverse incision C. one who has a vertical incision from a previous cesarean birth D. one who has undergone a previous myomectomy

One who had a previous cesarean birth via a low transverse incision VBAC is an appropriate choice for women who have had a previous cesarean birth with a lower abdominal transverse incision. It is contraindicated in women who have a prior classic uterine incision (vertical), prior transfundal surgery, such as myomectomy, or a contracted pelvis.

The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which intervention would the nurse identify as the priority? A. position changes B. oxytocin administration C. immediate cesarean birth D. pain relief measures

Pain relief measures Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse most likely include as the most common? A. macrosomia B. breech presentation C. multifetal pregnancy D. persistent occiput posterior position

Persistent occiput posterior position Common problems involving the passenger include occiput posterior position, breech presentation, multifetal pregnancy, excessive size (macrosomia. as it relates to cephalopelvic disproportion (CPD), and structural anomalies. Of these, persistent occiput posterior is the most common malposition, occurring in about 15% of laboring women.

The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? A. shortened B. posterior position C. closed D. firm

Shortened explanation: A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? A. uterine resting tone of 14 mm Hg B. urine output of 20 mL/hour C. contractions every 2 minutes, lasting 45 seconds D. fetal heart rate of 150 beats/minute

Urine output of 20/hr Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minutes. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which effect? A. blurred vision B. uterine hyperstimulation C. headache D. hypotension

Uterine hyperstimulation A major adverse effect of the obstetric use of Cytotec is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with magnesium sulfate.

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? A. "When I put on a new pad, I'll start at the back and go forward." B. "If I have chills or my discharge has a strange odor, I'll call my doctor." C. "I'll point the spray of the peri-bottle so it the water flows front to back." D. "I need to call my doctor if my temperature goes above 100.4° F (38° C)."

When I put on a new pad, I'll start at the back and go forward.

A breast biopsy indicates the presence of malignant cells, and the client is scheduled for a mastectomy. When preparing the client's preoperative plan of care, which area would the nurse most likely address as the priority? A. urinary elimination B. fluid balance C. activity D. body image

body image

A woman who is 42 weeks pregnant comes to the clinic. During the visit, which assessment would be most important for the nurse to perform? A. checking for spontaneous rupture of membranes B. determining an accurate gestational age C. measuring the height of the fundus D. asking her about the occurrence of contractions

determining an accurate gestational age

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately? A. urine output of 45 mL/hour B. diminished deep tendon reflexes C. alert level of consciousness D. respiratory rate of 16 breaths per minute

diminished deep tendon reflexes