Women's Health/Disorders and Childbearing Health Promotion (Level 1)

What is a tubal ligation?

'Tubes tied'

During the discharge conference with a client who has had a hysterectomy the nurse includes instructions for avoiding the thromboembolic phenomena that may occur as a complication. What should these instructions include? Avoid sitting for long periods of time. Limit fluids to less than 2000 mL per day. Have a blood coagulation test every 2 weeks. Continue with hormone replacement therapy.

Avoid sitting for long periods of time. Sitting for long periods leads to pooling of blood in the pelvic area, predisposing the client to thrombus formation. Fluids should be increased to 3000 mL daily to decrease blood viscosity, which can lead to thrombus formation. Blood coagulation tests are not done routinely because clotting elements are not usually disturbed by a hysterectomy. Hormone replacement therapy is not considered unless the client is premenopausal and an oophorectomy has been performed.

A nurse is giving discharge instructions to an anemic postpartum client. The nurse concludes that the client understands the instructions when she states, "The fluid that I should drink with my iron supplement that will enhance its absorption is milk." water." apple juice." orange juice."

orange juice." Iron is best utilized when given in an acidic medium. Orange juice contains ascorbic acid. Milk, water, and apple juice all decrease stomach acidity; they do not enhance iron absorption.

A nurse is counseling a pregnant client who is a vegetarian. What should the nurse plan to do to ensure optimal nutrition during the pregnancy? Refer the client to a dietitian to help plan her daily menu. Encourage the client to join a group that teaches nutrition. Explain that she needs to include meat in her diet at least once a day. Advise the client that it is unhealthy to continue a vegetarian diet during pregnancy.

Refer the client to a dietitian to help plan her daily menu. The dietitian can give the client specific information that would help her plan nutritious meals. Specific foods, such as nuts and soy products, may be substituted for meat or animal-related products. The client may know healthy nutrition; she needs help to adapt the vegetarian diet to meet pregnancy needs. Explaining that she needs to include meat in her diet at least once a day or advising the client that it is unhealthy to continue a vegetarian diet during pregnancy ignores the client's beliefs and lifestyle; a nutritious vegetarian diet is available during pregnancy.

At a routine monthly visit, while assessing a client who is in her 26th week of gestation, the nurse identifies the presence of striae gravidarum. The nurse describes this condition as: Brownish blotches on the face Purplish discoloration of the cervix Reddish streaks on the abdomen and breasts A black line running between the umbilicus and mons veneris

Reddish streaks on the abdomen and breasts Reddish streaks on the abdomen and breasts are striae gravidarum; they occur as a result of stretching of the breast and abdominal skin. Chloasma is brownish blotches on the face. Purplish discoloration of the cervix is Chadwick's sign. A black line running between the umbilicus and mons veneris is the linea nigra.

A woman comes into the clinic and states that she is thinking about becoming pregnant. What can the woman do to improve the health of her baby before she becomes pregnant? Go buy maternity clothes. Start running 3 miles a day. Start taking prenatal vitamins. Buy a crib for the baby to sleep in.

Folic acid is important for the pregnant woman; a lack of folic acid can result in neural tube defects, including spina bifida. The time during fetal development when this occurs is very early in the pregnancy, when the woman may not even realize that she is pregnant. Taking prenatal vitamins with adequate folic acid can greatly reduce this birth defect. Although exercise is good for the pregnant woman and infant, it is not necessary to start running 3 miles a day, especially if this is something the client has never done before. Running may not be healthy for the soon-to-be mother and infant if it is a new activity; however, if this is what the woman normally does, she will be encouraged to continue.

A client is scheduled to have a contraction stress test (CST) to determine fetal well-being. Which type of fetal heart rate (FHR) decelerations constitutes a nonreassuring outcome? Late Early Baseline Variable

Late The fetus with a borderline cardiac reserve will show hypoxia, evidenced by a decreased FHR with minimal stress, making the test positive. Early decelerations, a response to head compression, are benign. "Baseline" is not used to describe the baseline measurement; the baseline rate is determined before the test or early in the test to provide a basis for comparison, not to indicate fetal compromise. Variable decelerations are nonuniform drops in FHR before, during, or after a contraction; these are related to partial, brief cord compression that can be eliminated with a change in the mother's position.

A 28-year-old woman seeks advice about oral contraceptives from the nurse in her company health office. What should the nurse tell her if she is a smoker? Oral contraceptives can cause thrombophlebitis. Oral contraceptives can be used with other methods. Some oral contraceptives can be used without concern. Some oral contraceptives are safe while others are not safe

Oral contraceptives can cause thrombophlebitis. Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis. Using oral contraceptives with other methods of contraception is not necessary if there are no contraindications; oral contraceptives are effective used alone. There is no "safe" oral contraceptive for all women, or one that may be used without concern; any client at risk should be informed of the potential consequences of taking an oral contraceptive.

Which neonatal disorder does folic acid prevent?

A folic acid supplement (0.4 mg/day) greatly reduces the incidence of fetal neural tube defects.

What is a tocolytic effect?

Tocolytics (also called anti-contraction medications or labor represents) are medications used to suppress premature labor (from the Greek tokos, childbirth, and lytic, capable of dissolving). They are given when delivery would result in premature birth.

A pregnant client with iron-deficiency anemia is prescribed iron supplements daily. To help the client increase iron absorption, the nurse should suggest that the client eat foods high in:

Vitamin C Vitamin C aids the absorption of iron.

During an assessment interview the nurse concludes that the client has been experiencing menorrhagia. What client statement led to this conclusion? "It hurts when I have intercourse." "I have a foul-smelling vaginal discharge." "I have bleeding between my menstrual periods." "I have severe bleeding during my menstrual periods."

"I have severe bleeding during my menstrual periods." Menorrhagia is severe bleeding during a menstrual period. Painful intercourse is the definition of dyspareunia. Foul-smelling vaginal discharge is a sign of a vaginal infection. Metrorrhagia is uterine bleeding that occurs at any time other than during the menstrual period.

A client who is breastfeeding is being discharged. The client tells the nurse that she is worried because her neighbor's breasts "dried up" when she got home and she had to discontinue breastfeeding. How should the nurse reply? "Once lactation is established, the milk supply rarely dries up." "You have little to worry about because you already have a good milk supply." "That can happen with the excitement of going home, but putting the baby to the breast more often should get lactation going again." "That happens a lot, so we'll give you a bottle of formula to take home so the baby won't go hungry until your milk supply returns."

"That can happen with the excitement of going home, but putting the baby to the breast more often should get lactation going again." Often the emotional excitement of going home will diminish lactation or the let-down reflex for a brief period. When the mother is aware that this may happen and knows how to cope, the problem is apt to be a minor one and easily overcome. Stating that this rarely happens once lactation is established constitutes false reassurance. Many factors (stresses) inhibit lactation, and the client should be aware of this. Stating that the client has little to worry about because she already has a good milk supply also constitutes false reassurance. The milk supply may diminish or stop under stress. Giving the client a bottle of formula is contraindicated; lack of breast stimulation during formula feeding could diminish lactation.

A pregnant client tells the nurse in the prenatal clinic that although she and her husband do not have the disease, she has a 1-year-old daughter with sickle cell anemia. She asks the nurse, "Will this baby also have sickle cell anemia?" How should the nurse respond? "The chance that another child will have sickle cell anemia is 25%." "Only one child in a family is affected, so the others probably will be all right." "The most likely conclusion is that your children will have sickle cell anemia." "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."

"The chance that another child will have sickle cell anemia is 25%." According to the Mendelian laws of inheritance, the sickle cell gene is recessive. If neither parent has the disease, both of them have the sickle cell trait; there is therefore a 25% chance that a child will have sickle cell anemia, a 50% chance that a child will have the sickle cell trait, and a 25% chance that a child will be unaffected. Saying that only one child in a family is affected and that the others probably will be all right is too vague. Stating that the children will have sickle cell anemia is not an accurate answer. The client should be told the probability of a child's inheriting the disease, but 50% is too high.

A couple at the prenatal clinic for a first visit tells the nurse that their 2-year-old child has just been found to have cystic fibrosis. They state there is no family history of this disorder. They ask the nurse about the chances of their having another child with cystic fibrosis. Knowing that this disorder has an autosomal recessive mode of inheritance, how should the nurse respond? "There is a 50% chance that this baby will also be affected." "If this baby is male, there is a 50% chance of his being affected." "If this baby is female, there is no chance of her being affected, but she will be a carrier." "There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier."

"There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier." According to Mendelian law, because both parents are carriers this baby has a 50% chance of being a carrier, a 25% chance of having the disease, and a 25% chance of being unaffected. Because this is an autosomal recessive gene and not X-linked, there is no difference in prevalence between male and female genetic distribution. Regardless of sex, the infant will have the same risk of being a carrier or noncarrier or having the expressive trait for cystic fibrosis.

A client at 37 weeks' gestation gives birth to a healthy boy. While inspecting her newborn in the birthing room, the client becomes concerned and asks, "What's this sticky white stuff all over him?" How should the nurse respond? "It's a secretion from the baby's fat cells called milia." "This is vernix. It helps protect the baby while he's in the uterus." "Your baby was born several weeks early, so we expect to see this." "It's nothing to be concerned about. Most newborns are covered with it."

"This is vernix. It helps protect the baby while he's in the uterus." A factual response will allay the mother's concern. Vernix caseosa is a cheesy white substance that covers the fetus and confers protection from the amniotic fluid while the fetus is in utero. Most of it disappears by 40 weeks' gestation. Milia are white pinpoint dots (sebaceous glands) on the newborn's nose, chin, and forehead that disappear within a few weeks. The nurse should explain only what vernix is; referring to the infant as preterm may unnecessarily alarm the mother. Stating that the substance is nothing to be concerned about does not answer the mother's question, and vernix is not abundant on neonates born at term.

A client visiting the prenatal clinic for the first time tells the nurse that she has heard conflicting stories about sex during pregnancy and asks about continuing sexual activity. How should the nurse respond? "You should discontinue intercourse after the second trimester." "This information can be given only by your obstetrician or nurse-midwife." "With an uncomplicated pregnancy, there are no limitations on sexual activity." "Sexual activity should be avoided during the first and last six weeks of pregnancy."

"With an uncomplicated pregnancy, there are no limitations on sexual activity." Although there are no limitations on sexual activity, as the pregnancy progresses the client and her partner may need some guidance in altering positions to make sexual activity more comfortable. Intercourse may be continued throughout the entire pregnancy if there are no complications. Information on sex may be given by a professional nurse; it is not necessary to refer this client to another care provider. Avoiding sexual activity during the first and last six weeks of pregnancy is unnecessary if the cervical plug is still in place and the membranes are intact.

A client undergoing presurgical testing before a total abdominal hysterectomy says to the nurse, "After I have this surgery I know my husband will never come near me again." The nurse's best initial response is: "You're underestimating his love for you." "You're wondering about the effect on your sexual relations." "You're worried that the surgery will change how others see you." "You're concerned about how your husband will respond to your surgery."

"You're concerned about how your husband will respond to your surgery." Stating that the client is concerned about how her husband will respond to her surgery is an open-ended response that encourages further discussion without focusing on an area that the nurse, not the client, feels is the problem. Accusing the client of underestimating her husband's love denies the client's feeling and may cause feelings of guilt for questioning the partner's love. Wondering about the effect on sexual relations is too specific; the nurse does not have enough information to come to this conclusion. Worrying that the surgery will change how others see the client shifts the focus from the client's voiced concerns; the client specifically referred to her husband, not others.

A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January? 7 16 24 29

16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory.

A client at 33 weeks' gestation is experiencing regular contractions. Her cervix is dilated 4 cm. The lung tissue of her fetus is immature. What medication does the nurse expect to be prescribed? Alcohol infusion Ritodrine (Yutopar) Betamethasone (Celestone) Magnesium sulfate infusion

Betamethasone (Celestone) Betamethasone (Celestone) is a corticosteroid that is administered to facilitate fetal lung maturity when a preterm birth is inevitable. Alcohol is not used to arrest labor because it is damaging to the fetus. Ritodrine (Yutopar) is a tocolytic medications used to arrest preterm labor. At 4 cm of dilation, it is too late to stop the progression of labor. Magnesium sulfate has a tocolytic effect. It is too late to institute this therapy.

Six weeks after discharge a client returns to the clinic for her postpartum checkup. While at the clinic, the client seeks advice on preventing toxic shock syndrome. She states that she uses tampons. What should the nurse instruct the client to do? Change the tampon about every 4 hours. Use sanitary napkins rather than tampons. Douche just before inserting each tampon. Replace the tampon at least two times a day.

Change the tampon about every 4 hours. Tampons should be changed frequently because Staphylococcus aureus, which causes toxic shock syndrome (TSS), multiplies and produces more toxin in the presence of the bloody fluid on tampons. Although sanitary napkins may be preferable to tampons in preventing TSS, the client's wishes should be respected; the client should be taught to reduce the risk of TSS by changing tampons frequently. Douching, unless especially prescribed, is no longer recommended because it alters the flora of the vaginal vault. Twice a day is too infrequent for tampon changes; the organism responsible for TSS thrives in the presence of bloody fluid on tampons that are not changed frequently.

The nurse is teaching a prenatal class to expectant mothers in their first trimester of pregnancy. In addition to discussing the need for 0.6 mg/day of folic acid replacement, which dietary choice that is high in folic acid should the nurse recommend? One egg Slice of bread Half cup of corn Half cup of cooked spinach

Half cup of cooked spinach A half cup of cooked spinach provides 100 mcg of folic acid per serving. One egg, a slice of bread, and half a cup of corn each provides only 20 mcg per serving.