Unit 3

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: a. Bradycardia. b. A normal baseline heart rate. c. Tachycardia. d. Hypoxia.

b. A normal baseline heart rate. Rationale: The baseline heart rate is measured over 10 minutes; a normal range is 110 to 160 beats/min. Bradycardia is a fetal heart rate (FHR) below 110 beats/min for 10 minutes or longer. Tachycardia is an FHR over 160 beats/min for 10 minutes or longer. Hypoxia is an inadequate supply of oxygen; no indication of this condition exists with a baseline heart rate in the normal range.

What age does menopause typically begin?

51

The nurse is preparing to examine a client who is experiencing menopause. What information should the nurse obtain when performing a health history? (Select all that apply)

B, C, D Rationale: When performing a health history on a client experiencing menopause, the nurse should obtain information on the client's menstrual history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical exam

Which breathing technique should the nurse instruct the client to use as the head of the fetus is crowning? A. Shallow B. Blowing C. Slow chest D. Modified paced

B. Blowing Blowing forcefully through the mouth controls the strong urge to push and allows for a controlled birth of the head. A shallow breathing pattern does not help control expulsion of the fetus. Slow chest breathing is used during the latent phase of the first stage of labor; it is not helpful in overcoming the urge to push. Modified paced breathing is used during active labor when the cervix is dilated 3 to 7 cm; it is not helpful in overcoming the urge to push.

What can a woman do to decrease the vasomotor effect of menopause? a. Perform aerobic exercise b. Increase the amount of calcium and vitamin D in the diet c. Increase caffeinated beverages d. Dress in layers of cotton clothing

D. Dress in layers of cotton clothing

Which FHR finding would concern the nurse during labor? a. Accelerations with fetal movement b. Early decelerations c. An average FHR of 126 beats/min d. Late deceleration

D. Late deceleration Rationale: Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected.

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the fetus is positioned how? A. Breech B. Transverse C. Occiput anterior D. Occiput posterior

D. Occiput posterior Persistent occiput posterior positioning causes intense back pain, the result of fetal compression of the sacral nerves. The breech position is not associated with back pain. The transverse position is not associated with back pain. Occiput anterior, the most common fetal position, generally does not cause back pain.

Label each as either Normal (reassuring) or abnormal (non-reassuring) 1. Late deceleration 2. Acceleration 3. Sinusoidal variability 4. Early deceleration 5. Decreased variability 6. Moderate variability 7. Variable deceleration

1. Abnormal (Non assuring 2. Normal (reassuring) 3. Abnormal (Non assuring) 4. Normal (reassuring) 5. Abnormal (nonreassuring) 6. Normal (reassuring) 7. Abnormal (nonreassuring)

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement: a. Are reassuring b. Are caused by umbilical cord compression c. Warrant close observation d. Are caused by uteroplacental insufficiency

A. Are reassuring Rationale: Episodic accelerations in the FHR occur during fetal movement and are indications of fetal well-being. Umbilical cord compression results in variable decelerations in the HFR. Accelerations in the FHR are an indication of fetal well-being and do not warrant close observation. Uteroplacental insufficiency results in late decelerations in the FHR.

Most characteristic symptom of menopause? a. Hot flashes b. It varies from woman to woman c. Mood swings d. Vaginal dryness and painful intercourse

B. It varies from woman to woman

A pregnant client has labor pains. However, the nurse finds that the client's cervix is not dilated. Which drug should be administered to the client to promote labor? A. Oxytocin B. Nifedipine C. Dinoprostone D. Methylergonovine

C. Dinoprostone Dinoprostone induces cervical ripening. This action helps in the induction of labor at term. Oxytocin enhances labor when uterine contractions are weak and ineffective. Nifedipine is a calcium channel blocker used to maintain pregnancy during preterm labor. Methylergonovine reduces postpartum hemorrhage.

A client who has just experienced her second spontaneous abortion expresses anger toward the practitioner, the hospital, and the "rotten nursing care." When assessing the situation, the nurse concludes that the client may be using which coping mechanism? A. Denial B. Projection C. Displacement D. Reaction formation

C. Displacement The client's anger about the miscarriage is shifted to the staff and the hospital because she is unable to cope with her loss at this time. The client is neither ignoring nor refusing to recognize reality. The client is not attributing unacceptable or undesirable thoughts or feelings to another; nor is she exhibiting a behavior pattern opposite to what she feels.

The nurse is caring for a client who has had a spontaneous abortion. The client asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by what? A. Physical trauma B. Unresolved stress C. Congenital defects D. Embryonic defects

D. Embryonic defects Approximately 75% of all spontaneous abortions take place between 8 and 12 weeks' gestation and reveal embryonic defects. Though possible, physical trauma rarely causes an abortion. Unresolved stress is rarely associated with spontaneous abortions. Congenital defects are asymptomatic during pregnancy and do not usually cause abortion

You are evaluating the fetal monitoring tracing of your client, who is inactive labor. Suddenly you see the FHR drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures would you take? a. Scream for help b. Insert a Foley catheter c. Start pitocin d. Notify the HCP

D. Notify the HCP Rationale: To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluids, and provide oxygen. If oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary care provider should be notified immediately. If the FHR were to continue in a nonreassuring pattern, a C/S could be warranted, which would then require a foley.

A normal uterine activity pattern in labor is characterized by: a. Contractions every 2 to 5 minutes. b. Contractions lasting about 2 minutes. c. Contractions about 1 minute apart. d. A contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg.

a. Contractions every 2 to 5 minutes. Rationale: Contractions normally occur every 2 to 5 minutes and last less than 90 seconds (intensity 800 mm Hg) with about 30 seconds in between (20 mm Hg or less).

The physician prescribes clomiphene citrate (Clomid) for a woman who has been having difficulty getting pregnant. When teaching the client about this drug's potential side effects, which of the following would the nurse include in the teaching plan? " CHOICES a.) Multiple pregnancies. b.) Increase in spontaneous abortions. c.) Increase in fibrocystic breast disease. d.) Increase in congenital anomalies

a.) Multiple pregnancies.

Which of the following would be the best recommendation for osteoporosis prevention a. Taking vitamin E b. Cycling every day c. Include more dairy and green leafy vegetables d. Limit caffeine

c. Include more dairy and green leafy vegetables

The nurse caring for a woman in labor understands that prolonged decelerations: a. Are a continuing pattern of benign decelerations that do not require intervention. b. Constitute a baseline change when they last longer than 5 minutes. c. Usually are isolated events that end spontaneously. d. Require the usual fetal monitoring by the nurse.

c. Usually are isolated events that end spontaneously. Rationale: Prolonged decelerations usually are isolated events that end spontaneously. However, in certain combinations with late and/or variable decelerations, they are a danger sign that requires the nurse to notify the physician or midwife immediately. A deceleration that lasts longer than 10 minutes constitutes a baseline change.

The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? A. Hemorrhage B. Dehydration C. Hypertension D. Subinvolution

A. Hemorrhage Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth

A woman has been administered clomiphene as part of a treatment for infertility. What assessments indicate that the drug is working effectively? Select all that apply. A. Increased estrogens B. Increased ovarian stimulation C. Increased luteinizing hormone D. Decreased follicle-stimulating hormone E. Decreased gonadotropin-releasing hormone

A. Increased estrogens B. Increased ovarian stimulation C. Increased luteinizing hormone Clomiphene acts by stimulating the hypothalamus in the treatment for infertility. This drug indirectly increases the levels of estrogens, which causes ovarian stimulation due to the increase in the levels of luteinizing hormone. Stimulation of the hypothalamus by clomiphene indirectly increases the level of follicle-stimulating hormone via the increased production of gonadotropin-releasing hormone from the hypothalamus

A client who has been pregnant for 5 months experiences a spontaneous abortion after an accident. The client tells the nurse that she feels depressed over the loss of her son. She describes how he would have looked and how bright he would have been. What is the client demonstrating? A. Panic level of anxiety B. Typical grief syndrome C. Pathological grief reaction D. Diminished ability to test reality

B. Typical grief syndrome The client is grieving the loss of a fantasized child; talking about it is part of the typical grief reaction. The client is sad, not out of control or immobilized. The client is coping with the loss effectively. The client recognizes the loss, but is lamenting what could have been.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by: a. Narcotics. b. Barbiturates. c. Methamphetamines. d. Tranquilizers.

c. Methamphetamines. Rationale: Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; methamphetamines may cause increased variability.

A primigravida at 34 weeks' gestation tells the nurse that she is beginning to experience some lower back pain. What should the nurse recommend that the client do? Select all that apply. A. Wear low-heeled shoes. B. Wear a maternity girdle during waking hours. C. Sleep flat on her back with her feet elevated. D. Perform pelvic tilt exercises several times a day. E. Take an ibuprofen (Motrin) tablet at the onset of back pain.

A. Wear low-heeled shoes. D. Perform pelvic tilt exercises several times a day. Low-heeled shoes help maintain her center of gravity to counterbalance the gravid uterus. Pelvic tilt exercises help relieve lower backaches, are easily learned, and can be done without any equipment. A maternity girdle is not routinely recommended. Sleeping flat during this stage of pregnancy decreases venous return, impedes respiration, and puts pressure on the vena cava, which can cause uteroplacental insufficiency. Nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin) should be avoided during pregnancy, and the prescription of medications is beyond the scope of nursing practice.

Fetal bradycardia is most common during a. Intraamniotic infection b. Fetal anemia c. Prolonged umbilical cord compression d. Tocolytic treatment using terbutaline

C. Prolonged umbilical cord compression Rationale: Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension. Intraamniotic infection, fetal anemia, and tocolytic treatment using terbutaline would most likely result in fetal tachycardia.

A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine is prescribed. How does this medication relieve pain? A. By producing amnesia B. By acting as a preliminary anesthetic C. By inducing sleep until the time of birth D. By acting on opioid receptors to reduce pai

D. By acting on opioid receptors to reduce pain Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep.

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: a. Hypotension b. Cord compression c. Maternal drug use d. Hypoxemia.

D. Hypoxemia Rationale: Nonreassuring heart rate patterns are associated with fetal hypoxemia. Fetal bradycardia may be associated with maternal hypotension. Fetal variable decelerations are associated with cord compression. Maternal drug use is associated with fetal tachycardia

A laboring client has asked the nurse to help her use a nonpharmacologic strategy for pain management. Name the sensory simulation strategy. A. Gentle massage of the abdomen B. Biofeedback-assisted relaxation techniques C. Application of a heat pack to the lower back D. Selecting a focal point and beginning breathing techniques

D. Selecting a focal point and beginning breathing techniques Use of a focal point and breathing techniques are sensory simulation strategies. Heat and massage are cutaneous stimulation strategies; biofeedback-assisted relaxation is a cognitive strategy.

A woman is considered to be in menopause after she has missed how many menstrual cycles?

12

The nurse providing care for the laboring woman should understand that the late FHR decelerations are the result of: a. Altered cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Meconium fluid

C. Uteroplacental insufficiency

What are the clinical manifestations of menopause? (Select all that apply) a. Vaginal dryness b. Thinning hair c. Headaches d. Hot flashes e. Cold intolerance

a. Vaginal dryness b. Thinning hair c. Headaches d. Hot flashes

The nurse is providing care to a multiparous client in active labor. The client is requesting something for the pain. What is the nurse's priority intervention? A. Examining the client's cervix for dilation and effacement B. Determining the client's options by assessing the prescriptions in the chart C. Asking her whether she prefers an epidural or something in her intravenous line D. Evaluating the fetal monitoring strip to determine the frequency and duration of contractions

A. Examining the client's cervix for dilation and effacement Evaluating the client's cervical dilation and effacement determines her progress in labor and reveals whether it is safe to administer analgesia or anesthesia. Assessment is the initial step of the nursing process. Options for pain management would be determined after dilation has been assessed. The client may be asked about her preferred method of analgesia, but that should be done after her degree of dilation has been determined. The stem of the question indicated that the client is in active labor; information on the fetal monitoring strip regarding contractions will not add to the assessment data.

Fetal well-being during labor is assessed by a. The response of the FHR to uterine contractions b. Maternal pain control c. Accelerations in the FHR d. An FHR above 110 beats/min

A. The response of the FHR to uterine contractions Rationale: Reassuring FHR patterns are characterized by an FHR baseline in the range of 110-160 BPM with no periodic changes, a moderate baseline variability, and accelerations with fetal movement.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that FHR begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: a. Change the womans position b. Discontinue the oxytocin infusion c. Insert an internal monitor d. Document the finding in the clients record

D. Document the finding in the clients record

A woman who is infertile is diagnosed with primary ovarian failure. Which fertility drug regimen may be prescribed to treat infertility? A. Clomiphene B. Menotropins C. Estrogens and progestins D. Choriogonadotropin alfa

C. Estrogens and progestins Exogenous administration of estrogens or progestins is used to treat infertility associated with primary ovarian failure. The administration of clomiphene, menotropins, and choriogonadotropin alfa cannot stimulate the ovaries to increase the levels of estrogens or progestins

Which nursing assessment is important to recognize to determine the causative factors in a client with a history of spontaneous abortions? A. Use of sex hormones B. Use of contraceptive pills C. Presence of heart problems D. History of alcohol consumption

D. History of alcohol consumption Alcohol consumption during pregnancy may cause fetal abnormalities and increase the risk of spontaneous abortions. The presence of heart problems may not cause spontaneous abortions. The use of sex hormones in pregnancy may cause fetal abnormalities. Contraceptive pills may inhibit the ovulation process, but they rarely affect the embryo

A 30-week-pregnant woman reports low backache and abdominal cramps. Which drug may be prescribed if the client is suspected of having preterm labor? A. Methylergonovine B. Mifepristone C. Calcium gluconate D. Magnesium sulfate

D. Magnesium sulfate Low backache and abdominal cramps in a pregnant woman may indicate labor; however, labor pains may not be safe if the gestation is not at full term. Magnesium sulfate may be prescribed to prevent preterm labor. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Mifepristone may cause an elective termination of pregnancy. Calcium gluconate may be prescribed to reverse magnesium toxicity.

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? a. Early decelerations b. Late decelerations c. Variable decelerations d. It is always a good idea to change the womans position.

a. Early decelerations Rationale: Early decelerations (and accelerations) generally do not need any nursing intervention. Late decelerations suggest that the nurse should change the maternal position (lateral); variable decelerations also require a maternal position change (side to side). Although changing positions throughout labor is recommended, it is not required in response to early decelerations.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

b. Uteroplacental exchange may be compromised. Rationale: The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, thus depleting fetal oxygen reserves. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. Oxytocin affects the uterine muscles.

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that: a. They can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with electronic fetal monitoring (EFM) when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to EFM. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor. Rationale: Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if ultrasound is used to help locate the heartbeat. When used as the primary method of fetal assessment, auscultation requires a nurse-to-client ratio of one to one. Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate.

the nurse knows that placing the naked newborn on mom's bare chest and covering both with a blanket/towel does what?

reduces conduction and radiation heat loss enhances newborn temperature control enhances maternal infant interaction

Which hormonal therapies will the nurse suggest for a healthy perimenopausal woman who prefers not to use hormone therapy (HT)? a. Reduce coffee intake b. Exercise several times a weak c. Take black cohosh supplements d. Have a glass of wine in the evening e. Increase intake of dietary soy products

A, B, C, E Rationale: Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising 3-4 times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.

A 52-year-old woman complains of hot flashes, night sweats, irritability, decreased vaginal lubrication, and no menstrual period. Over the past several weeks, the hot flashes and night swears have increased in frequency and she has noticed that she is more irritable. Lab values reveal increased FSH and LH levels. Which intervention should the nurse initiate? (Select all that apply) a. Asking open-ended questions about the client's body image b. instructing the client to avoid OTC vaginal lubricants c. Explaining such physiological manifestations of menopause as hot flashes and night sweats d. Providing information about medications that might be prescribed to help with menopausal symptoms e. Encouraging discussion of how menopausal symptoms are affecting sexual functioning

A, C, D, E Rationale: The client is undergoing menopause. The client with menopause may have problems understanding the natural female aging process, sexual dysfunction, low self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiological manifestations of menopause; providing information about medications that might be prescribed to help with menopausal symptoms; encouraging discussion of how menopausal symptoms are affecting sexual functioning; and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking open-ended questions will further explore the client's thoughts and feelings about body image in a therapeutic manner.

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. A. "Do you have a support system available to help you?" B. "Have you been told about the status of your pregnancy?" C. "Do you know the causes related to spontaneous abortions?" D. "Are you aware of how a healthy lifestyle affects a pregnancy?" E. "What are the characteristics of an impending spontaneous abortion?"

A. "Do you have a support system available to help you?" B. "Have you been told about the status of your pregnancy?" The availability of support persons is important when the client is deciding how to try to maintain the pregnancy. Knowing the status of her pregnancy is helpful to the nurse planning her care. If the status is not known, the nurse can correct any misconceptions and assist the client in focusing on reality while helping ease her anxiety. The causes of spontaneous abortion are not always known; theoretic knowledge of the causes will not help the client maintain her pregnancy. Questions about the interrelationship of lifestyle and a healthy pregnancy may add to the client's anxiety; they are not relevant at this time. Questioning the client's knowledge of an impending spontaneous abortion may add to the client's anxiety; after three abortions the client probably knows what to expect before a spontaneous abortion

The nurse is caring for a couple during their initial visit to a fertility clinic after being unable to conceive for 2 years. Which of the following assessment questions would be appropriate to determine an alternate cause of infertility? A. "Do you use any lubrication during intercourse?" B. "Can both of you reach orgasm at the same time?" C. "What type of birth control did you use in the past?" D. "Are you consistent in the manner in which you have intercourse?

A. "Do you use any lubrication during intercourse?" Some lubricants act as a spermicide; they should be avoided, or only a recommended one should be used. A female orgasm is not necessary for conception; simultaneous orgasms is not a relevant question. The type of birth control before the couple began trying to conceive 2 years ago is not relevant at this time; some hormonal contraceptives should be discontinued 6 to 18 months before trying to conceive. Consistency in the manner of intercourse usually is not relevant to conception, although a change in position may be recommended

A client in active labor is considering combined spinal-epidural analgesia. She states that she is concerned about her ability to walk after receiving this type of analgesia. What is the most accurate response by the nurse? A. "This analgesia gives you pain relief without compromising your ability to ambulate." B. "The analgesia will require you to remain in bed, but you'll be able to move from side to side." C. "You may experience slight weakness, but someone will be at your side when you're ambulating." D. "Someone will help you ambulate every couple of hours before you're given another dose of the analgesia."

A. "This analgesia gives you pain relief without compromising your ability to ambulate." Because the spinal nerve receptors are sensitive to opioids, small quantities are needed to produce analgesia; therefore the client's ability to ambulate without assistance is not jeopardized. Bed rest is not required. The analgesia does not cause weakness. The client's ability to ambulate without assistance is not jeopardized. The analgesia lasts for more than 2 hours; there is no need to ambulate before a dose is given.

The nurse caring for a laboring woman should understand that early decelerations are caused by: a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Spontaneous rupture of membranes

A. Altered fetal cerebral blood flow Rationale: Early decelerations are the fetus's response to head compression. Variable decelerations are associated with umbilical cord compression. Late decelerations are associated with uteroplacental insufficiency. Spontaneous rupture of membranes has not bearing on the FHR unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by a. Change in position b. Oxytocin administration c. Regional anesthesia d. Intravenous analgesic

A. Change in position Rationale: Maternal supine hypotension syndrome is caused by weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the womans heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration, regional anesthesia, and IV analgesic may reduce maternal cardiac output.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the FHR for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurses first priority is to: a. Change the womans position b. Notify the care provider c. Assist with amnioinfustion d. Insert a scalp electrode

A. Change the womans position Rationale: Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, the nurse would contrinue with subsequent intrauterine resuscitation measures, including notifying the provider. An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely reveals variable deceleration. A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurses first priority.

A client and her partner are working together to achieve an unmedicated birth. The client's cervix is now dilated to 7 cm, and the presenting part is low in the midpelvis. What should the nurse instruct the partner to do that will alleviate the client's discomfort during contractions? A. Deep-breathe slowly. B. Perform pelvic rocking. C. Use the panting technique. D. Begin patterned, paced breathing.

A. Deep-breathe slowly. Slow, deep breathing expands the spaces between the ribs and raises the abdominal muscles, giving the uterus room to expand and preventing painful pressure of the uterus against the abdominal wall. Pelvic rocking is used to relieve pressure from back labor. Panting is used to halt or delay the expulsion of the infant's head before complete dilation has occurred. Patterned, paced breathing is used during the transition phase of the first stage; the client has not yet reached this phase.

A nurse in the fertility clinic is instructing a client who will be using progesterone gel vaginally in the treatment of luteal phase infertility. When discussing the side effects of progesterone, what should the nurse tell the client to expect? A. Enlarged, tender breasts B. Increased vaginal secretions C. Additional facial and body hair D. Decreased basal body temperature

A. Enlarged, tender breasts The hormonal influence of progesterone during the luteal phase of the menstrual cycle contributes to breast enlargement and tenderness. Vaginal secretions decrease, not increase, with the administration of progesterone. Loss of hair, not additional facial and body hair, is a side effect associated with the administration of progesterone. An increase, not decrease, in basal body temperature is associated with the administration of progesterone.

After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate is prescribed. When will the nurse instruct the client to take clomiphene? A. Fifth day of her cycle B. Last day of her period C. Third day after her period begins D. Sixteenth day of her cycle

A. Fifth day of her cycle The objective is to stimulate ovulation near the fourteenth day of the menstrual cycle, and this is achieved by taking the medication on the fifth through the ninth days; there is an increase in two pituitary gonadotropins, luteinizing hormone and follicle-stimulating hormone, with subsequent ovarian stimulation. On the third day after the cycle there are insufficient hormones for clomiphene to be effective. The sixteenth day of the cycle is also too late for clomiphene to be effective.

A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply. A. Monitor vital signs. B. Encourage the client to track her medications in a journal. C. Recommend the self-administration of oral drugs. D. Recommend the long-term use of indomethacin orally. E. Administer oral drugs to the client when the client wakes up along with six glasses of water

A. Monitor vital signs.B. Encourage the client to track her medications in a journal. C. Recommend the self-administration of oral drugs. The nurse should monitor the client's vital signs to minimize the risk of hypotension. Journal tracking of medication helps to ensure the regular administration of the drug. Self-administration of oral drugs at home should be encouraged, and proper instructions regarding the administration should be provided to ensure rational use of the drug. The nurse should not advise the long-term oral use of indomethacin because it may cause birth defects. The administration of oral drugs upon rising with six glasses of water is the nursing intervention for administration of oral bisphosphonates in the treatment of osteoporosis

Treatment goal for patient/couple with infertility issues. (select all that apply) A. Provide the couple with accurate information about human reproduction, infertility treatments, and prognosis for pregnancy B. Assist in identifying the cause of infertility C. Discuss the use of antidepressants D.Provide emotional supportE. Guide and educate about forms of treatment

A. Provide the couple with accurate information about human reproduction, infertility treatments, and prognosis for pregnancy B. Assist in identifying the cause of infertility D.Provide emotional support E. Guide and educate about forms of treatment

A 50-year old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching? a. The symptoms may decrease after the patient undergoes menopause b. The tumor size is likely to increase throughout the patients lifetime c. Aspirin or acetaminophen may be used to control mild to moderate pain d. The patient will need frequent monitoring to detect any malignant changes

A. The symptoms may decrease after the patient undergoes menopause Rationale: Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the anti-platelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: a. Variable decelerations b. Late decelerations c. Fetal bradycardia d. Fetal tachycardia

A. Variable decelerations Rationale: Amnioinfusion is used during labor either to dilute meconium-stained amniotic fluid or to supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression.

The nurse is caring for a client in the first stage of labor. Which position is the least desirable for the client if she is experiencing lower back pain? A. Sitting B. Supine C. Knee-chest D. Left side-lying

B. Supine Low back pain is aggravated when the client is in the supine position because of increased pressure from the fetus as the head rotates. A sitting position relieves back pain. The knee-chest position is an alternate position that a client may choose to use when laboring. The left side-lying position relieves back pain.

The nurse providing care for the laboring woman realizes that variable FHR decelerations care caused by: a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Fetal hypoxemia

B. Umbilical cord compression Rationale: Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia continues.

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patients most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration (Select all that apply)? a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the babys neck e. Maternal supine hypotension

C, E Rationale: Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the umbilical cord is around the babys neck, arm, leg, or other body part or when there is a short cord, a knot in the cord, or a prolapsed cord.

At 12 weeks' gestation a client with a history of several spontaneous abortions says to the nurse, "Every day I wonder whether I'll be able to have this baby." How should the nurse respond? A. "I can understand why you're worried; however, you'll have other chances in the future to get pregnant." B. "You're getting the best of care. Please tell me about the problems with your previous pregnancies." C. "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." D. "Your pregnancy has lasted past the time when most early spontaneous abortions occur. I think you'll be able to continue the pregnancy."

C. "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." Affirming the validity of the client's concerns acknowledges her fearful feelings. It also permits further communication. Assuring the client that she will have other chances to get pregnant in the future does not acknowledge the client's feelings; it also instills fear by implying that the current pregnancy may not go to term, even though there is no evidence to indicate this. Asking the client to talk about the problems with her prior pregnancies does not acknowledge her feelings of fear and changes the focus of the conversation. Telling the client that she should be able to continue the pregnancy is false assurance and does not address the client's feelings

The partner of a primigravida who has been in active labor for about 6 hours asks the nurse, "How much longer will this take? She's having a lot of back pain, and she's so uncomfortable." How should the nurse respond? A. "It shouldn't be much longer now." B. "Take a short break while I take over." C. "Let me show you how to apply back pressure." D. "Everything is progressing nicely, just as expected."

C. "Let me show you how to apply back pressure." Rationale: Counterpressure against the sacrum during contractions affords some relief from the discomfort of back pain. It is difficult to predict the duration of labor for any client. Telling the coach to leave is not a response to the situation; the coach should be included in providing comfort to the client. Telling the client that everything is progressing nicely is false reassurance; the data do not indicate that labor is progressing as expected.

Which statement by a client being treated for infertility indicates the need for additional teaching? A. "I should come back for a postcoital test 1-2 days before I expect to ovulate." B. "I should schedule my hysterosalpingogram for the week after ovulation." C. "We should abstain for 14 days prior to coming back for the sperm penetration test." D. "I should schedule my endometrial biopsy for the last week of my menstrual cycle."

C. "We should abstain for 14 days prior to coming back for the sperm penetration test." The sperm penetration test, which tests for the ability of sperm to penetrate an egg, should be performed after 2-7 days of abstinence.Having a post-coital test before ovulation is not useful.A hypersalpingogram would be scheduled in the proliferative phase before ovulation to avoid early pregnancy or secretory changes in endometrium after ovulation, which could obstruct dyepassage.Endometrial biopsy should not be scheduled earlier than 10 to 12 days after ovulation to accurately detect effects of progesterone and endometrial sensitivity.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? A. G4 T3 P2 A1 L4 B. G5 T2 P2 A1 L4 C. G5 T2 P1 A1 L4 D. G4 T3 P1 A1 L4

C. G5 T2 P1 A1 L4 The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 A1 L4 indicates that there were five pregnancies; two term births; twins counted as one, not two, preterm births; one abortion; and four living children. G4 T3 P1 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one preterm birth; one abortion; and four living children

A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT. b. Increased incidence of colon cancer in women taking HT requires more frequent colonoscopy. c. HT decreases osteoporosis risk and increases the risk of CVD and breast cancer d. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe

C. HT decreases osteoporosis risk and increases the risk of CVD and breast cancer Rationale: Data from the Womens Health Initiative indicate an increases risk for CVD and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

A client at 22 weeks' gestation asks the nurse how to prevent back pain as her pregnancy progresses. What does the nurse suggest that she wear? A. Maternity girdle B. Support stockings C. Low-heeled shoes D. Loose-fitting clothing

C. Low-heeled shoes Low-heeled supportive shoes help maintain the body's center of gravity over the hips, limiting arching of the back that compensates for the increased weight in the abdominal area. Maternity girdles are no longer recommended. Support stockings may be helpful for a woman with varicose veins or ankle edema; however, wearing them does not prevent back pain. Loose-fitting clothing is more comfortable, but has no effect on back pain.

A 49-year old woman tells the nurse that she is postmenopausal but has occasional spotting. Which initial response by the nurse is most appropriate? a. A frequent cause of spotting is endometrial cancer b. How long has it been since your last menstrual period? c. Breakthrough bleeding is not unusual in women your age d. Are you using prescription hormone replacement therapy?

D. Are you using prescription hormone replacement therapy? Rationale: In postmenopausal women, a common cause of spotting is HT. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patients symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

A nurse is teaching a childbirth preparation class. Which information regarding discomfort during labor should the nurse be certain to include in her teaching? A. Labor should be mostly pain free and uneventful. B. Breathing techniques will be taught to prevent the need for medication. C. Medication is given to women who experience painful labor contractions. D. Comfort measures are available when the discomfort of contractions becomes excessive.

D. Comfort measures are available when the discomfort of contractions becomes excessive. Classes in preparation for parenthood should help couples develop realistic expectations of the labor process, including associated discomfort and ways of dealing with it. Stating that labor should be mostly pain free and uneventful is false reassurance; contractions are uncomfortable, and there is no guarantee that the birthing process will be uneventful. Breathing techniques may not be enough for some women to limit the discomfort of contractions. The focus should not be on pain; comfort measures should be attempted first before medication is used.

Ten minutes after administering nalbuphine via intravenous piggyback to a primigravida in active labor, the nurse notes a fetal heart rate of 132 with minimal variability. The client states that the pain is more tolerable and she is able to use her breathing techniques more effectively. Contractions continue every 2 to 3 minutes and are of 60 seconds' duration. What is the nurse's next action? A. Reposition the client on the left side to increase placental perfusion. B. Administer oxygen via mask to minimize apparent fetal compromise. C. Have an opioid antagonist available to be administered to the infant at the time of birth. D. Document the findings, including the stable fetal heart rate variability after administering the opioid infusion.

D. Document the findings, including the stable fetal heart rate variability after administering the opioid infusion. A common side effect of an opioid analgesic is decreased fetal heart rate variability. Because the fetal heart rate and the length and duration of the contractions remain stable and the analgesic appears to be effective, the only nursing action is to document the findings. Repositioning the client is not necessary because the data do not indicate decreased placental perfusion. It is not necessary to administer oxygen because the data do not indicate fetal compromise. Naloxone, an opioid antagonist, may need to be administered to the newborn, but the present data do not indicate that this is necessary.

The most common cause of decreased variability in the FHR that lasts 30 minutes or less a. Altered cerebral blood flow b. Fetal hypoxemia c. Umbilical cord compression d. Fetal sleep cycles

D. Fetal sleep cycles Rationale: A temporary decrease in variability can occur when the fetus is in a sleep cycle. These sleep states do not usually last longer than 30 minutes. Altered fetal cerebral blood flow would result in early decelerations in the FHR.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering? A. Estrogen B. Progesterone C. Human growth hormone D. Human chorionic gonadotropin

D. Human chorionic gonadotropin Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

A pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension? A. Lithium B. Miglitol C. Calcium gluconate D. Magnesium sulfate

D. Magnesium sulfate Magnesium sulfate can be prescribed for pregnancy-induced hypertension. Lithium is used to treat body water retention. Miglitol is used to decrease blood sugar levels. Calcium gluconate is used to relieve magnesium toxicity associated with magnesium sulfate.

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: a. Over the uterine fundus. b. On the fetal scalp. c. Inside the uterus. d. Over the mothers lower abdomen

a. Over the uterine fundus. Rationale: The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use.

The nurse is interviewing Melinda Britt during her annual gynecologic exam. Which statement by Melinda would cause you to believe she is experiencing perimenopause? a. "I am so cold lately." b. "I feel that my appetite is really increasing." c. "I have problems with constipation.: d. "I often experience sweating at night."

d. "I often experience sweating at night." Rationale: Sweating at night is a manifestation during perimenopause. Cold intolerance, increase appetite, and constipation are not symptoms associated with perimenopause.

A client who underwent treatment for infertility gave birth to triplets. She often complained of breast pain during the infertility treatment. Which drug may have been administered to the client for infertility treatment? A. Estradiol B. Haloperidol C. Clomiphene D. Promethazine

C. Clomiphene Clomiphene is an ovarian stimulant that may cause multiple pregnancies. Breast pain is an adverse effect of clomiphene. Estradiol helps to reduce postmenopausal hot flashes. Haloperidol and promethazine are contraindicated while using clomiphene.

A multipara is admitted to the birthing room in active labor. Her temperature is 98° F (36.7° C), pulse 70 beats/min, respirations 18 breaths/min, and blood pressure 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? A. Naloxone (Narcan) B. Lorazepam (Ativan) C. Meperidine (Demerol) D. Promethazine (Phenergan)

C. Meperidine (Demerol) **Meperidine (Demerol) is an opioid that can cause respiratory depression in the neonate if administered less than 4 hours before birth.

Perinatal nurses are legally responsible for: a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. b. Greeting the client on arrival, assessing her, and starting an intravenous line. c. Applying the external fetal monitor and notifying the care provider. d. Making sure that the woman is comfortable

a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. Rationale: Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. Greeting the client, assessing her, and starting an IV; applying the external fetal monitor and notifying the care provider; and making sure the woman is comfortable may be activities that a nurse performs, but they are not activities for which the nurse is legally responsible.

Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix dilated to 4 cm c. External monitors in current use d. Fetus with a known heart defect

a. Unruptured membranes Rationale: In order to apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. The external monitor can be discontinued after the internal ones are applied. A compromised fetus should be monitored with the most accurate monitoring devices

A just delivered newborn is dried immediately by the nurse in the delivery area. The nurse thoroughly dries the newborn to prevent heat loss by which mechanism? 1. Radiation 3. Convection 4. Conduction 5. Evaporation

5. Evaporation

A patient has come to the healthcare clinic complaining of pain in his left arm after an injury. Which describes the characteristics of nociceptive pain? Select all that apply. A. Nociceptive pain may be localized to the area of injury B. Nociceptive pain develops after an injury to the central nervous system C. Nociceptive pain is categorized as being either somatic or visceral pain D. Nociceptive pain is typically causes an increase in sympathetic activiety E. Nociceptive pain can be referred pain

A, C, E Rationale: Nociceptive pain describes a type of pain that occurs when there is damage to body tissue. A patient may experience this type of pain with a physical injury, such as a fracture or laceration. It is further categorized as being somatic or visceral pain and it can be referred from its original location and felt in another area of the body.

Which drug does the nurse anticipate to be prescribed to a client seeking treatment for infertility? A. Clomiphene B. Misoprostol C. Dinoprostone D. Methylergonovine

A. Clomiphene Clomiphene causes the maturation of ovarian follicles, which leads to ovulation. This drug is used to promote fertility. Misoprostol and dinoprostone are prostaglandins that cause uterine muscle contractions. Methylergonovine is an ergot alkaloid used to reduce postpartum uterine hemorrhage.

How is pain classified (select all that apply) A. Duration B. Characteristics C. Etiology D. Source/location

A. Duration ( acute or chronic) C. Etiology (nociceptive or neuropathic) D.Source/location (somatic or visceral)

A 56-year-old woman is concerned about having a moderate amount of vaginal bleeding after 4 years of menopause. The nurse will anticipate teaching the patient about a. Endometrial biopsy b. Endometrial ablation c. Uterine balloon therapy d. Dilation and curettage

A. Endometrial biopsy Rationale: A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

Which blood test can help confirm if a woman is beginning menopause? a. FSH b. Testosterone c. Progesterone d. Cholesterol

A. FSH

The nurse is providing education to a client who has been diagnosed with menopause. Which health promotion intervention should the nurse discuss with the client? (Select all that apply) a. Wearing tight clothing b. Eating a balanced diet that includes fruits, vegetables, and high-fiber foods c. Doing Kegel exercises d. Avoiding alcohol and cigarette use e. Participating in yoga classes

B, C, D, E Rationale: Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Keeping the bedroom cool will help control and provide comfort during night sweats. Caffeine intake should be decreased during perimenopause because it can trigger hot flashes. Sexual intercourse does not have to be avoided, but lubricants may be used to decrease discomfort from vaginal dryness.

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. These categories include (Select all that apply): a. Reassuring. b. Category I. c. Category II. d. Nonreassuring. e. Category III.

B, C, E Rationale: The three tiered system of FHR tracings include Category I, II, and III. Category I is a normal tracing requiring no action. Category II FHR tracings are indeterminate. This category includes tracings that do not meet Category I or III criteria. Category III tracings are abnormal and require immediate intervention.

Women taking estrogen replacement therapy need how much calcium a day? a. 500 mg b. 1000 mg c. 1250 mg d. 1500 mg

B. 1000 mg

Which medication is indicated for evacuation in case of a miscarriage? A. Clomiphene B. Dinoprostone C. Magnesium sulfate D. Methylergonovine

B. Dinoprostone Dinoprostone is a prostaglandin E 2 abortifacient and cervical ripening drug, which is indicated for uterine evacuation in cases of miscarriage. Clomiphene is indicated for female infertility in some clients. Magnesium sulfate is used to treat pregnancy-induced hypertension. Methylergonovine is used to treat postpartum uterine atony and hemorrhage.

Which assessment finding in a woman who recently started taking hormone therapy (HT) is most important for the nurse to report to the health care provider? a. Breast tenderness b. Left calf swelling c. Weight gain of 3 lb d. Intermittent spotting

B. Left calf swelling Rationale: Unilateral calf swelling may indicate deep vein thrombosis caused by changes in coagulation associated with HT and would indicate that the HT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HT and do not indicate a need for a change in therapy.

Hysterosalpingography (HSG) is performed to determine whether a client has a tubal obstruction. The nurse explains to the client that infertility caused by a defect in the tube is most often related to what? A. A tubal injury B. Past infection C. A fibroid tumor D. A congenital anomaly

B. Past infection Rationale: Past pelvic infections may result in tubal occlusions, most of which are caused by postinfection adhesions. Although tubal injury is possible, tubal infections are more common. Fibroid tumor is a benign tumor of the uterus and does not affect the tube. Tubal congenital anomalies are rare; uterine anomalies are more common.

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. a. Call the provider, reposition the mother, and perform a vaginal examination. b. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. c. Administer oxygen to the mother, increase IV fluid, and notify the care provider. d. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

B. Reposition the mother, increase IV fluids, and provide oxygen via face mask Rationale: The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The second priority is to increase blood volume by increasing IV fluid. The third priority is to optimize oxygenation of the circulatory volume by providing oxygen via face masks.

The client is unable to become pregnant after she has had one full-term pregnancy. The nurse should develop a plan of care for which health problem? A. Primary infertility B. Secondary infertility C. Unexplained infertility D. Combined factor infertility

B. Secondary infertility Rationale: Secondary infertility is the term for couples that have had one pregnancy but are unable to conceive again. Primary infertility describes the inabilityto conceive even once. Unexplained and combined factorinfertility are not terms used when discussing fertility.

A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort? A. Positioning her on the left side B. Using effleurage on her abdomen C. Applying pressure against her sacrum D. Placing her in the semi-Fowler position

C. Applying pressure against her sacrum Counterpressure over the sacral area helps relieve the pain caused by the pressure of the fetal head in the posterior position. Although helpful for placental perfusion, positioning the client on her left side is not the best action for reducing pain caused by the pressure of the fetal head in the posterior position. Massaging the abdomen with the fingertips (effleurage) does not relieve the painful pressure in the lower back. The semi-Fowler position causes additional discomfort because the sacrum is inaccessible and counterpressure cannot be applied to the sacral area.

The nurse caring for a woman in labor should understand that maternal hypotension can result in a. Early decelerations b. Fetal dysrhythmias c. Uteroplacental insufficiency d. Spontaneous rupture of membranes

C. Uteroplacental insufficiency Rationale: Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia.

A 47-year old woman asks whether she is going into menopause if she has not had a menstrual period for 3 months. The best response by the nurse is which of the following? a. Have you thought about using hormone replacement therapy? b. Most women feel a little depressed about entering menopause c. What was your menstrual pattern before your period stopped? d. Since you are in your mid-40s, it is likely that you are menopausal.

C. What was your menstrual pattern before your periods stopped? Rationale: The initial response by the nurse should be to assess the patients baseline menstrual pattern. Although many women do enter menopause in the mid40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although HT may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.

A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered? A. Nifedipine B. Indomethacin C. Betamethasone D. Magnesium sulfate

D. Magnesium sulfate Magnesium sulfate is used to prevent preterm labor in pregnant women with hypertension. To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug. Nifedipine is a calcium channel blocker that inhibits myometrial activity by blocking the calcium influx. Indomethacin is a nonsteroidal antiinflammatory agent used along with sucralfate to protect the stomach. Betamethasone is a corticosteroid used when preterm labor is not maintained by other treatments and delivery is proceeding.

In assisting with the two factors that have an effect on fetal status (i.e., pushing and positioning), nurses should: a. Encourage the womans cooperation in avoiding the supine position. b. Advise the woman to avoid the semi-Fowler position. c. Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d. Instruct the woman to open her mouth and close her glottis, letting air escape after the push.

a. Encourage the womans cooperation in avoiding the supine position. Rationale: The woman should maintain a side-lying position. The semi-Fowler position is the recommended side-lying position with a lateral tilt to the uterus. The Valsalva maneuver, which encourages the woman to hold her breath and tighten her abdominal muscles, should be avoided. Both the mouth and glottis should be open, letting air escape during the push.

The nurse is discussing menopause with a 40-year-old client. During this discussion, the nurse identified which factor that determines when perimenopause may occur? a. Genetics b. Age of menarche c. Being sexually acitve d. Alcohol use

a. Genetics Rationale: The age of perimenopause is genetically programmed and unrelated to the age of menarche. Cigarette smoking and living at high altitudes can lead to earlier menopause. Alcohol use and being sexually active does not influence perimenopause.

When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that: a. The examiners hand should be placed over the fundus before, during, and after contractions. b. The frequency and duration of contractions is measured in seconds for consistency. c. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. d. The resting tone between contractions is described as either placid or turbulent.

a. The examiners hand should be placed over the fundus before, during, and after contractions. Rationale: The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

What correctly matches the type of deceleration with its likely cause? a. Early decelerationumbilical cord compression b. Late decelerationuteroplacental inefficiency c. Variable decelerationhead compression d. Prolonged decelerationcause unknown

b. Late decelerationuteroplacental inefficiency Rationale: Late deceleration is caused by uteroplacental inefficiency. Early deceleration is caused by head compression. Variable deceleration is caused by umbilical cord compression. Prolonged deceleration has a variety of either benign or critical causes.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. Your best response is: a. Dont worry about that machine; thats my job. b. The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor. c. The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are. d. Your doctor will explain all of that later.

b. The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor. Rationale: The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor educates the partner about fetal monitoring and provides support and information to alleviate his fears. Dont worry about that machine; thats my job discredits the partners feelings and does not provide the teaching he is requesting. The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are provides inaccurate information and does not address the partners concerns about the fetal heart rate. The EFM graphs the frequency and duration of the contractions, not the intensity. Nurses should take every opportunity to provide client and family teaching, especially when information is requested.

Which medication is used off-label to reduce the occurrence of hot flashes associated with menopause? a. Raloxifene (Evista) b. Venlafaxine (Effexor) c. Levothyroxine (Synthroid) d. Triphenylethylene (Tamoxifen)

b. Venlafaxine (Effexor)

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR): a. Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors. b. Every 20 minutes in the second stage, regardless of whether risk factors are present. c. Before and after ambulation and rupture of membranes. d. More often in a womans first pregnancy.

c. Before and after ambulation and rupture of membranes. Rationale: The FHR should be auscultated before and after administration of medications and induction of anesthesia. In the active phase of the first stage of labor, the FHR should be auscultated every 30 minutes if no risk factors are involved; with risk factors it should be auscultated every 15 minutes. In the second stage of labor the FHR should be auscultated every 15 minutes if no risk factors are involved; with risk factors it should be auscultated every 5 minutes. The fetus of a first-time mother is automatically at greater risk.

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should: a. Notify the womans primary health care provider immediately. b. Prepare to administer an oxytocic to stimulate uterine activity. c. Document the findings because they reflect the expected contraction pattern for the active phase of labor. d. Prepare the woman for the onset of the second stage of labor.

c. Document the findings because they reflect the expected contraction pattern for the active phase of labor. Rationale: The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta. In addition, the nurse would document these findings in the clients medical record. This labor pattern indicates that the client is in the active phase of the first stage of labor. Nothing indicates a need to notify the primary care provider at this time. Oxytocin augmentation is not needed for this labor pattern; this contraction pattern indicates adequate active labor. Her contractions eventually will become stronger, last longer, and come closer together during the transition phase of the first stage of labor. The transition phase precedes the second stage of labor, or delivery of the fetus.

What is an advantage of external electronic fetal monitoring? a. The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate. b. The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d. Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.

c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. Rationale: The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor, particularly when the membranes are intact. Short-term changes cannot be measured with this technology. The tocotransducer cannot measure and record the intensity of UCs. The transducer must be repositioned when the woman or fetus changes position.

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both a. Can be used when membranes are intact. b. Measure the frequency, duration, and intensity of uterine contractions. c. May need to rely on the woman to indicate when uterine activity (UA) is occurring. d. Can be used during the antepartum and intrapartum periods

d. Can be used during the antepartum and intrapartum periods Rationale: External monitoring can be used in both periods; internal monitoring can be used only in the intrapartum period. For internal monitoring the membranes must have ruptured, and the cervix must be sufficiently dilated. Internal monitoring measures the intensity of contractions; external monitoring cannot do this. With external monitoring, the woman may need to alert the nurse that UA is occurring; internal monitoring does not require this.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by: a. Maintaining normal maternal temperature. b. Preventing normal maternal hypoglycemia. c. Increasing the oxygen-carrying capacity of the maternal blood. d. Expanding maternal blood volume.

d. Expanding maternal blood volume. Rationale: Filling the mothers vascular system makes more blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most intravenous fluids for laboring women are isotonic and do not provide extra glucose. Oxygen-carrying capacity is increased by adding more red blood cells.

A nurse may be called on to stimulate the fetal scalp: a. As part of fetal scalp blood sampling. b. In response to tocolysis. c. In preparation for fetal oxygen saturation monitoring. d. To elicit an acceleration in the fetal heart rate (FHR)

d. To elicit an acceleration in the fetal heart rate (FHR) Rationale: The scalp can be stimulated using digital pressure during a vaginal examination. Fetal scalp blood sampling involves swabbing the scalp with disinfectant before a sample is collected. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR. Tocolysis is relaxation of the uterus. Fetal oxygen saturation monitoring involves the insertion of a sensor

A 34-year-old client presents to the family practice clinic with complaints of not having a menstrual period in the past 14 months. What data should the nurse obtain when performing a physical examination on the client? a. Drug and alcohol use b. Sexual history c. Menstrual history d. Weight and height

d. Weight and height Rationale: When performing a physical exam on a perimenopausal client, the nurse needs to obtain the client's weight and height. The client's sexual and menstrual history and use of alcohol and drugs are data obtained when performing the health history.