Women's Health/Disorders and Childbearing Health Protection

After a client has a spontaneous abortion at 12 weeks' gestation, the nurse notes that both she and her partner are visibly upset and crying. Which statement would be a therapeutic response? 1. "I'll be here if you want to talk." 2. "Try to relax—it'll speed the healing process." 3. "With any luck you'll get pregnant again soon." 4. "It's best that this happened early rather than having the baby die after it was born."

1. "I'll be here if you want to talk." Rationale: Saying, "I'll be here if you want to talk" gives the client and her partner room to comfort each other while letting them know that the nurse is available; it also gives the couple time and space in which to recognize and accept their feelings of loss. Telling the couple to relax denies their feelings and may cut off communication. Telling the client that she will become pregnant again soon minimizes the couple's grief over this loss and cuts off further communication. Also, an assumption is made that another pregnancy will occur. Telling the client that it is best that the miscarriage happened early rather than having the baby die after it was born is an insensitive statement. Grieving for a loss is not confined to when the loss occurs, either during the pregnancy or after the birth.

On the first postpartum day, a client whose infant is rooming in asks the nurse to return her baby to the nursery and bring the baby to her only at feeding times. Which response would the nurse provide? 1. "It seems that you've changed your mind about rooming in." 2. "I think you're having difficulty caring for the baby." 3. "All right. I'll inform the other nurses of your decision." 4. "You must be tired. I'll bring the baby back at feeding time."

1. "It seems that you've changed your mind about rooming in." Rationale: Stating that it seems that the client has changed her mind opens communication and allows the client to verbalize her thoughts and feelings. Stating that the client is having difficulty caring for the baby is judgmental; there is not enough information for the nurse to make this assumption. Stating the intention of informing the other nurses of the client's decision does not give the client the opportunity to verbalize her feelings and needs. Although the client may be tired, stating as much ignores the client's needs and cuts off communication.

A client has just given birth to an infant with Down syndrome. The mother is crying and asks the nurse what she is supposed to do now. Which response would the nurse give? 1. "Tell me what you know about Down syndrome." 2. "I would just continue to rest and recover from your delivery." 3. "You really need to pull yourself together for your baby." 4. "Should I call in a chaplain or social worker for you?"

1. "Tell me what you know about Down syndrome." Rationale: Asking the client what she knows about Down syndrome is an open-ended question that will facilitate teaching and open dialogue. Telling the client to just recover is not addressing the client's emotional adjustment. Chastising the client for emotional expression will block further dialogue. A chaplain or social worker is not needed at this moment but could potentially be used later.

After 5 years of unprotected intercourse, a childless couple comes to the fertility clinic. The husband tells the nurse that his parents have promised to make a down payment on a house for them if his wife gets pregnant this year. Which response would the nurse provide? 1. "This must be very difficult for you with this added pressure." 2. "Having a child is a decision you should make without your parents' input." 3. "You're lucky. It's nice that your parents are making such a generous offer." 4. "Five years without a pregnancy is a long time. You were right to come to the fertility clinic."

1. "This must be very difficult for you with this added pressure." Rationale: Stating that the situation must be difficult encourages the clients to verbalize their feelings. The clients are not seeking advice concerning their relationship with their parents; the focus should be on them. Stating that 5 years without a pregnancy is a long time is an insensitive statement and cuts off further communication.

When a client who has had a mastectomy sees her incision for the first time, she exclaims, "I look horrible! Will it ever look better?" Which response would the nurse provide? 1. "You seem shocked by the way you look now." 2. "Now that the tumor is gone, the area will heal quickly." 3. "After it heals, others won't even know you had surgery." 4. "You will feel better about it when the swelling subsides."

1. "You seem shocked by the way you look now." Rationale: Reflection of feelings provides an opportunity to express emotions, which may promote eventual acceptance of body image changes. Saying that the area will heal quickly now that the tumor is gone, that others won't know that the client had surgery, or that the client will feel better once the swelling subsides negates the client's feelings and is not an honest or realistic response; false reassurance does not promote trust.

The nurse notes bruises on the pregnant client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm which condition? 1. Domestic abuse 2. Hydatidiform mole 3. Excessive exercise 4. Thrombocytopenic purpura

1. Domestic abuse Rationale: Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.

During which time in pregnancy would the nurse inform the client that the fetus shows a marked increase in size? 1. During the third trimester 2. During the second trimester 3. At the end of the first trimester 4. No difference is observed.

1. During the third trimester Rationale: During the third trimester the fetus is laying down fat deposits and gaining the most weight. Fetal weight gain occurs throughout pregnancy, including the second trimester, but it is most marked in the third trimester. There is little fetal weight gain during the first trimester, when organ development is occurring.

Which instructions would the nurse provide to a client before a Papanicolaou test (Pap test)? Select all that apply. One, some, or all responses may be correct.

1. Empty the bladder just before the test. 2. Avoid scheduling a Pap test to be performed during menses. 3. Avoid sexual intercourse for at least 24 hours before the test. 4 Douche the vagina with soap the evening before the test. 5 Refrain from eating or drinking for 6 hours before the test.

Arrange the series of steps involved for the nurse assisting a primary health care provider with a hysterosalpingography procedure for a client

1. Instructing the client to appear for test during first 14 days of menstrual period 2. Confirming the date of the client's last menstrual period 3. Asking about allergies to iodine dye 4. Placing the client in the lithotomy position 5. Assisting with insertion of speculum to view the cervix 6. Assisting with injecting dye through the cervix. Hysterosalpingogram is used to visualize the cervix, uterus, and fallopian tubes in the clients with uterine problems such as fibroids, tumors, and fistulas. A client with intrauterine fibroids must appear for the examination during the first 14 days of the menstrual cycle, which reduces the chance that the client may be pregnant. Confirm the date of the client's last menstrual period. It is always advisable to ask the client about allergies to iodine dye used in the procedure. Then, place the client in lithotomy position to allow the insertion of a speculum to view the cervix. Iodine dye is then injected through the cervix to fill and highlight the interior of the cervix, uterus, and fallopian tubes.

Which information would be given to a concerned mother who sees her newborn assume the fencing or tonic neck position? 1. It is expected in the healthy newborn. 2. It should disappear around 2 months of age. 3. This is suspicious, and the health care provider will be notified. 4. This may indicate a minor neurological problem and will be monitored.

1. It is expected in the healthy newborn. Rationale: The tonic neck reflex is an expected response in the healthy newborn and disappears within 3 to 4 months. It does not need further intervention. Absence of the fencing reflex may indicate neurological impairment.

Which type of fetal heart rate (FHR) decelerations constitutes a nonreassuring finding on a contraction stress test (CST)? 1. Late 2. Early 3. Baseline 4. Variable

1. Late Rationale: Late decelerations suggest uterine/placental insufficiency, which puts the fetus at risk of hypoxia. Early decelerations, a response to head compression, are benign. "Baseline" is not used to describe a type of deceleration; 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 often be eliminated with a change in the mother's position.

Which information would the nurse include in the explanation of a Papanicolaou (Pap) test to the client in the Family Planning Clinic? 1. The Pap smear screens for cancer of the cervix. 2. Vaginal bleeding like a period is expected after a Pap smear. 3. Colposcopy will be used to visualize the cervix. 4. Scraping the cervix is the most uncomfortable part.

1. The Pap smear screens for cancer of the cervix. Rationale: The Pap smear is a screening test for cancer of the cervix. If results are abnormal, follow-up testing can be done including colposcopy and biopsy for confirmation of findings. Scraping of the cells can cause a few drops of blood to be expelled; vaginal bleeding like a period does not occur. A colposcopy is not part of a routine Pap smear. Insertion of the speculum is usually the most uncomfortable part of the test.

A nurse caring for a pregnant client at 28 weeks' gestation and her partner suspects intimate partner violence. Which assessments support this suspicion? Select all that apply.

1. The woman has injuries to the breasts and abdomen.3. The partner answers questions that are asked of the woman.4. The woman has visited the clinic several times in the last month.

Which technique for nipple cleansing would the nurse recommend to the breast-feeding client? 1. Wash the breasts and nipples with water when bathing. 2. Wipe the nipples with sterile water before each feeding. 3. Swab the nipples with an alcohol sponge after each feeding. 4. Rub the breasts and nipples with soapy water when showering.

1. Wash the breasts and nipples with water when bathing. Rationale: Daily washing of the breasts and nipples with water is sufficient for cleanliness. It is unnecessary to use sterile water; the infant's gastrointestinal tract is not sterile. Alcohol is drying and may cause the nipples to crack. Scrubbing, as well as the use of soap, may irritate and dry the nipples.

A client who has undergone a mastectomy because of breast cancer is now undergoing chemotherapy, which has caused hair loss. The client states, "I feel like I've lost my sense of power." Which response would the nurse give? 1. "Hair does not empower a person." 2. "Losing power seems important to you." 3. "Knowledge is power; I'll give you some pamphlets to read." 4. "Hair loss is common; it will grow back, so you should not worry."

2. "Losing power seems important to you." Rationale: Stating that the loss of power seems important to the client provides an opportunity for the client to discuss her feelings. Stating that hair does not empower a person is confrontational and may cut off further communication. Offering to get the client some pamphlets dismisses the client's concern and does not promote the client's further verbalization of feelings. Stating that hair loss is common and the client should not worry dismisses the client's concerns and cuts off further communication.

A client at 16 weeks' gestation is being treated for Trichomonas vaginalis infection. Which statement best indicates to the nurse that the client has learned measures to prevent a recurrence? 1. "After having sex I'll insert a vaginal suppository." 2. "My partner has to get treated before we have sex again." 3. "I need to urinate immediately after having sexual intercourse." 4. "Douching immediately after sexual intercourse will help protect me."

2. "My partner has to get treated before we have sex again." Rationale: The male partner should be treated to prevent the infection from passing back and forth between him and his sexual partner. Inserting a vaginal suppository after having sex is an ineffective remedy and will not prevent a recurrence. The organism is usually present in the partner's urogenital tract; voiding will not prevent a recurrence. A douche is not recommended either during pregnancy or in the nonpregnant state.

A primipara who was exhausted after a long labor requested time to rest before rooming in with her infant. After awakening and having the infant brought back to her, she asks whether she may undress him. How would the nurse respond? 1. "I'll help you undress the baby." 2. "This is important for you. Of course you can undress your baby." 3. "You should wait a few hours, until your baby's temperature has stabilized." 4. "Let's walk back to the nursery. We'll put the baby in a heated crib so you can undress him."

2. "This is important for you. Of course you can undress your baby." Rationale: One aspect of the attachment or bonding process is the parents' need to touch, hold, and observe their newborn; this is facilitated by encouraging the mother to undress, gaze at, and hold her newborn. If not asked for help, the nurse would honor the mother's request and encourage her to undress, touch, and hold her baby. A healthy naked newborn can withstand the temperature variation in the mother's room especially if placed skin to skin with the mother whose body warmth can help maintain the newborn's temperature.

Which instruction would the nurse give to the pregnant client with anemia? 1. Take an iron and calcium supplement together daily. 2. Drink orange juice with an iron supplement. 3. Include fresh fruit at every meal. 4. Include 4 servings of calcium-rich foods daily.

2. Drink orange juice with an iron supplement. Rationale: The vitamin C in orange juice aids in absorption of iron, which is used to treat anemia. Taking calcium at the same time as iron will reduce absorption of the iron. Fresh fruits are recommended in pregnancy but are not a primary source of iron. Including calcium-rich foods is also recommended, but this does not address anemia.

Which discharge instructions would the nurse include for a woman who has undergone breast-conserving surgery (lumpectomy) for breast cancer? 1. Assuring her that a supportive brassiere is unnecessary 2. Emphasizing the importance of breast self-examination 3. Instructing her to return the next day for removal of the drain 4. Explaining why it is unnecessary to exercise the arm on the unaffected side

2. Emphasizing the importance of breast self-examination Rationale: A client who has cancer of one breast is at risk for the development of cancer in the remaining breast; therefore, breast self-examination is important. Wearing a supportive brassiere limits incisional discomfort. There may or may not be a wound drainage system in place, and the timing of its removal is individualized. With the removal of breast tissue, specific exercises are needed to prevent muscle atrophy and contractures; the right and left arms should be exercised at the same time.

Which client statement confirms that the client who is being treated for a sexually transmitted infection (STI) has understood the nurse's instruction regarding future sexual contacts? 1. "If I have sex, nothing I do will really prevent me from getting another STI." 2. "If I get another STI, I can take any antibiotic, because I'm not allergic to any of them." 3. "I won't have unprotected sex again, and I'll tell my partners to be tested for STIs." 4. "I have to ask my partners if they have an STI, and if they say no I'll know that I can have sex."

3. "I won't have unprotected sex again, and I'll tell my partners to be tested for STIs." Rationale: The most effective strategies for preventing sexually transmitted infections--contracting them or spreading them to sex partners--are the use of condoms and having sex partners tested to determine their status and get treatment if necessary. There are protective measures that can be used to help prevent the transmission of STIs. The emphasis should be on prevention, not treatment; some STIs have no cure. Asking partners whether they have an STI does not always elicit a truthful answer; protection is necessary to help prevent the transmission of STIs.

A client who has just given birth has been given her newborn wrapped in a blanket to hold. The client asks, "Is my baby normal?" Which response would the nurse provide? 1. "The pediatrician will make rounds in the morning and check your baby." 2. "Your baby must be all right; listen to that strong cry." 3. "Let's unwrap your baby so you can see for yourself." 4. "Yes, because your entire pregnancy has been so normal."

3. "Let's unwrap your baby so you can see for yourself." Rationale: Mothers need to explore their infants visually and tactilely to assure themselves that their infants are healthy. Telling her that the pediatrician will make rounds in the morning would cause a prolonged period of worry and not help the client at this moment. A strong cry is not indicative of a healthy newborn. The "normalcy" of the mother's pregnancy is not necessarily correlated with the good health of the newborn.

Which goal would the client with dysmenorrhea seeking treatment want to achieve? 1. Reducing the pad saturation rate 2. Making intercourse less uncomfortable 3. Easing the pain of the client's menstruation 4. Eliminating bleeding between menstrual periods

3. Easing the pain of the client's menstruation Rationale: Dysmenorrhea is painful menstruation; the goal of care is making menstruation less painful. The other options are appropriate for a client who is experiencing excessive menstrual flow (menorrhagia) or dyspareunia (painful intercourse). Bleeding between menstrual periods would require further investigational workup.

The mother of an infant in the neonatal intensive care unit expresses concern about her infant. Which nursing intervention best facilitates mother-infant bonding? 1. Asking the mother to change her baby's diaper 2. Assuring the mother that her baby is receiving excellent care 3. Encouraging the mother to touch her baby whenever possible 4. Keeping the mother informed about the care the nursing staff is giving her baby

3. Encouraging the mother to touch her baby whenever possible Rationale: Touching the infant is the most effective way of promoting mother-infant bonding, especially if the infant is too ill to be held. Mother-infant boding is a gradual process; it is inappropriate at this time to expect the mother to care for her infant by changing diapers. Assuring the mother that her baby is receiving excellent care does not help promote bonding. Although keeping the mother informed about the care her baby is receiving is important, it does not foster bonding.

Before an amniocentesis, both parents express anxiety about the fetus's safety during the test. Which nursing intervention would promote the parents' ability to cope? 1. Initiating a parent-primary health care provider conference 2. Reassuring them that the procedure is safe 3. Explaining the procedure, step by step 4. Arranging for the father to be present during the test

3. Explaining the procedure, step by step Rationale: Giving the parents information about what to expect during the procedure will help allay their fears and encourage their cooperation. The nurse would be able to provide information and interpretation of procedures for clients; a delay in answering questions may increase a client's concerns. The primary health care provider would need to obtain informed consent including potential risks of the procedure. Amniocentesis is a low-risk procedure; however, some complications may occur. If the father is uninformed, viewing the procedure may increase his anxiety, even though his presence may be comforting to the mother. The presence of the father may be a beneficial intervention, but the explanation of the procedure would come first.

Which is the reason that the bacterium Escherichia coli would be the probable causative agent in a client with cystitis? 1. It thrives in the kidneys. 2. It is a virulent bacterium. 3. It inhabits the intestinal tract. 4. It competes with fungi for host sites.

3. It inhabits the intestinal tract. Rationale: E. coli is commonly found in the bowel and, because of anatomical proximity and possibly careless hygiene after bowel movements, may spread to the urethra. E. coli is not normally found in the kidneys. E. coli is no more virulent than other infective agents, nor does it compete with fungal organisms for host sites.

A female client is scheduled for a hysterectomy. While discussing the preoperative preparations, the nurse determines that the client's understanding of the surgery is inadequate. Which nursing intervention would be performed? 1. Describing the proposed surgery to the client 2. Proceeding with the preoperative plan 3. Notifying the surgeon that the client needs more information 4. Explaining gently to the client that she should have asked more questions

3. Notifying the surgeon that the client needs more information Rationale: The surgeon should be notified that the client needs more information. Legally, the person performing the surgery is responsible for informing the client adequately; the nurse may clarify information, provide information about the nursing care that will be provided, witness the client's signature, and cosign the consent form. The nurse would not proceed with the preoperative plan until there is assurance that the client understands the surgery to be done. Explaining gently that she should have asked more questions places blame on the client; it is the responsibility of the surgeon to impart the vital information required for consent.

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy? 1. Prolactin 2. Estrogen 3. Progesterone 4. Somatotropin

3. Progesterone Rationale: Produced by the ovaries and placenta, progesterone is a female sex hormone that prepares the endometrium for implantation of the fertilized ovum, maintains pregnancy, and plays a role in the development of the mammary glands. Prolactin is secreted by the anterior lobe of the pituitary gland; it is responsible for initiating and maintaining milk secretion from the mammary glands. Estrogen is a female sex hormone that starts to prepare the endometrium for implantation and promotes development of secondary sex characteristics. Somatotropin is a growth hormone secreted by the anterior pituitary gland.

A female client who is undergoing infertility testing is taught how to examine her cervical mucus. After listening to the instructions, the client says, "That sounds gross. I don't think I can do it." Which conclusion would the nurse make from this statement? 1. The client is unduly fastidious. 2. The client feels that having a baby is not that important. 3. The client may be uncomfortable with performing manual examination of the genitals. 4. The client is afraid that she is the cause of the infertility.

3. The client may be uncomfortable with performing manual examination of the genitals. Rationale: Some women find it emotionally stressful to handle their genitals and discharges. The nurse would need to question the client further to determine if this is the case. The nurse does not have data to support whether the client is unduly fastidious. The nurse would not pass judgment on whether or not the client desires having a baby. Although many women in this situation feel that they are the cause of infertility, this has no bearing on either the nurse's instruction or the client's response.

Which response would the nurse provide to the mother questioning why her teenage daughter was foolish and became pregnant despite several discussions with the mother about birth control? 1. "Apparently your daughter wasn't listening to you." 2. "You should have made sure that her boyfriend understood birth control too." 3. "Teenagers often fail to use birth control because they forget to discuss it with their sexual partners." 4. "Although teenagers can intellectually discuss birth control, they often don't believe that they will become pregnant."

4. "Although teenagers can intellectually discuss birth control, they often don't believe that they will become pregnant." Rationale: Teenagers are capable of cognitively understanding the risks of unprotected sex, but often believe themselves invulnerable, which leads to risk-taking behaviors. Stating that the daughter was not listening to the mother does not help the mother understand her daughter's behavior and may precipitate increased hostility toward the daughter. Stating that the mother should have made sure that the daughter's boyfriend understood birth control could precipitate feelings of guilt and does not assist the mother in understanding her daughter's behavior. Sexual activity may be impulsive and not conducive to discussion; also, adolescents, who are developing their sense of sexuality, may feel too insecure to raise this discussion.

A pregnant client tells the nurse, "I'm sticking to my diet, and I don't eat anything containing salt." How would the nurse respond? 1. "You're doing fine. Just keep up the good work." 2. "A low-salt diet will protect you from getting swollen feet." 3. "We now encourage pregnant women to increase their salt intake because of changes in the circulation." 4. "Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt."

4. "Salt is necessary in your diet. Use a little when you're cooking, but avoid processed meats and canned foods with salt." Rationale: Sodium is important in the diet of a pregnant woman and so she is counseled to continue moderate sodium intake. Blood volume increases during pregnancy; sodium is required to maintain physiological edema in interstitial spaces so blood volume is not depleted. High-sodium processed meats and canned foods with added salt are discouraged in diets for all adults, not just pregnant women. Telling the client that she is doing fine is false reassurance. Salt restriction does not prevent swollen feet, other peripheral edema, or preeclampsia. Increasing salt intake during pregnancy is unnecessary, as there is enough salt in the average diet to meet the increased sodium needs of pregnant women.

After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. Which response would the nurse give? 1. "It's best to wait until a few months after surgery because you may not have any symptoms." 2. "Hormone replacement therapy has been associated with increased risk of breast cancer, so it would not be recommended." 3. "You have to wait until symptoms are severe; otherwise the hormones will have no effect." 4. "There are pros and cons to hormone replacement therapy. I will let your primary health care provider know you would like to discuss this."

4. "There are pros and cons to hormone replacement therapy. I will let your primary health care provider know you would like to discuss this." Rationale: The use of hormone replacement therapy (HRT) can have benefit to a client who has undergone an oophorectomy. It can prevent menopausal symptoms such as hot flashes and vaginal dryness. It can also increase bone strength. The risks of HRT include an increased risk of breast cancer. The decision to use HRT would involve review of the client's age, medical conditions, and symptoms. The health care provider and client would engage in shared decision-making regarding initiation of HRT. If a client is going to begin HRT, the timing of initiation might depend on the reason it is being used. Stating the HRT will have no effect unless the symptoms are severe is not a true statement.

A 45-year-old client is scheduled to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. Which response would the nurse give? 1. "You're right, but there are medicines you can take that will ease the symptoms." 2. "Sometimes that happens in women of your age, but you don't need to worry about it right now." 3. "You should probably talk to your surgeon, because I am not allowed to discuss this with you." 4. "Women may experience symptoms of menopause if their ovaries are removed with their uterus."

4. "Women may experience symptoms of menopause if their ovaries are removed with their uterus." Rationale: A hysterectomy involves only removal of the uterus. The ovaries, which secrete estrogen and progesterone, are not removed. Menopause will not be precipitated but will occur naturally. Surgical menopause is precipitated by the removal of the ovaries, not the uterus. It would be incorrect to state that there are medicines to help with menopause because menopause would not be caused by the surgery the client will have. When the ovaries are removed, an older woman might have less severe symptoms than a younger woman; however, in this instance the ovaries are not removed. Telling the client that she needs to talk to her surgeon does not answer the question. The nurse should serve as a resource.

Which response would the nurse provide to a client who has been diagnosed with genital herpes at her annual examination and asks how the health care provider knew that she had herpes? 1. "There's a sore in your vagina." 2. "There's a rash near your vagina." 3. "You have a typical discharge from your vagina." 4. "You have blisters on the skin around your vagina."

4. "You have blisters on the skin around your vagina." Rationale: Herpes genitalis is characterized by a cluster of vesicles (blisters) on the vulva, perineum, vagina, cervix, and/or perianal area. A single sore in the vagina would not be typical of herpes. A rash near the vagina or a discharge from the vagina do not suggest herpes.

An adolescent woman who has become sexually active asks the nurse, "What's the most effective way to prevent a pregnancy?" Which method of preventing pregnancy should the nurse tell her is most effective? 1. Birth control pills 2. Spermicidal foam 3. Condoms 4. An intrauterine device

4. An intrauterine device Rationale: According to the U.S. Centers for Disease Control and Prevention, having an intrauterine device inserted provides a 99% effective means of preventing pregnancy. The oral contraception pill is theoretically 99% effective (91% effective with typical use). Condoms are 98% effective with perfect use (85% effective with typical use), and this barrier can reduce (but not eliminate) the risk of sexually transmitted infections. Spermicidal foam is 82% effective with perfect use and 72% effective with typical use. The birth control pill, foam, and condoms all require the user of the method to consistently use the method perfectly for the highest effectiveness. The intrauterine device, once placed, requires no attention for it to be highly effective. Although refraining from sexual intercourse is the most effective form of birth control (100% effective), this client has come to the nurse for advice about how to prevent pregnancy while being sexually active.

Which information is essential for the nurse to explain to the client who has scheduled a vasectomy? 1. Recanalization of the vas deferens is impossible. 2. Unprotected coitus is safe within 1 week to 10 days. 3. Some impotency is to be expected for several weeks after the procedure. 4. At least 15 ejaculations to clear the tract of sperm must occur before the semen is checked.

4. At least 15 ejaculations to clear the tract of sperm must occur before the semen is checked. Rationale: Some spermatozoa will remain viable in the vas deferens for a period of time after a vasectomy; at least 15 ejaculations are needed to clear the tract of sperm. There has been some success in reversing vasectomies, so recanalization is sometimes possible. Precautions must be taken to prevent fertilization until absence of sperm in the semen has been verified, so unprotected coitis is not reliably safe within 1 week to 10 days. The procedure does not affect sexual function, so impotency is not expected.

Which recommendation for the premenstrual period would the nurse provide to the client who complains of tender breasts before her menstrual period? 1. Take salt tablets daily. 2. Increase protein intake. 3. Eliminate daily exercise. 4. Decrease caffeine intake.

4. Decrease caffeine intake. Rationale: The client is exhibiting a symptom of premenstrual syndrome (PMS); eliminating food and beverages containing caffeine can limit breast swelling. Salt intake should be reduced premenstrually to limit the development of edema. Increased protein intake is unnecessary if the client is eating a nutritious diet. Exercise should be increased before the menstrual period to help ease the symptoms of PMS.

Which food would the nurse recommend to a pregnant client to most significantly increase the client's intake of folic acid? 1. One egg 2. Slice of bread 3. Half a cup of corn 4. Half a cup of cooked spinach

4. Half a cup of cooked spinach Rationale: A half a cup of cooked spinach provides 121 to 139 mcg of folic acid per serving. One egg, a slice of bread, and half a cup of corn each provides only 20 to 30 mcg per serving.

Which information would the nurse include as part of the teaching plan for an anxious client about to have her first routine Papanicolaou (Pap) smear? 1. Past statistics on the incidence of cervical cancer 2. Description of the early symptoms of cervical cancer 3. Explanation of why there is a small risk for cervical cancer 4. Information on how a Pap smear screens for precancerous and cancerous cells of the cervix

4. Information on how a Pap smear screens for precancerous and cancerous cells of the cervix Rationale: Providing verbal information about what a Pap smear is used for decreases fear and fosters further communication. Current, not past statistics on the incidence of cervical cancer should be used. Cervical cancer is asymptomatic in the early stages. Explanation of why there is a small risk for cervical cancer offers false reassurance.

The nurse in the women's health clinic is counseling clients about oral contraception. Which information is accurate about the estrogen component of the oral contraceptive? 1. It causes ovulation. 2. Lactation is stimulated. 3. It prompts secretion of oxytocin. 4. It inhibits secretion of follicle-stimulating hormone (FSH).

4. It inhibits secretion of follicle-stimulating hormone (FSH). Rationale: The estrogen component of oral contraceptives inhibits anterior pituitary secretion of FSH; this effect appears to be mediated by the hypothalamus and its releasing factors. Luteinizing hormone, not estrogen, causes ovulation. Lactogenic hormone (prolactin) stimulates lactation. Putting the infant to the breast prompts the release of oxytocin, which is secreted by the posterior pituitary gland, resulting in the let-down reflex.

Which postprocedural instruction would the nurse to give the client after a first trimester abortion by suction and curettage? 1. Avoid showering for 2 days. 2. Postpone tampon use for 1 or 2 days. 3. Wait 3 weeks before engaging in sexual intercourse. 4. Report any bleeding that requires a pad change every 2 hours.

4. Report any bleeding that requires a pad change every 2 hours. Rationale: Excessive bleeding should be reported because it is an indication that all of the byproducts of conception have not been evacuated. The client may shower daily. Tampons should be avoided for at least 3 days, although some protocols stress avoidance of tampons for 3 weeks. Depending on the protocol, sexual intercourse should be avoided for at least 1 week and up to 2 weeks.

A client who recently gave birth is transferred to the postpartum unit by the nurse. Which nursing action would the nurse perform to prevent a charge of client abandonment? 1. Assess the client's condition. 2. Document the client's condition and the transfer. 3. Orient the client to the room and explain unit routines. 4. Report the client's condition to the responsible staff member assuming her care.

4. Report the client's condition to the responsible staff member assuming her care. Rationale: Because the nurse is responsible for the client's care until another nurse assumes that responsibility, the nurse would report directly to the client's primary nurse. Safe handoffs of clients at the time of transfer are an essential element of client safety. Making an assessment of the client's condition is not enough. Although documentation is important, it is insufficient. Orienting the client to the room and explaining unit routines is insufficient. Although the nurse would carry out these activities, the safe handoff of client care is the essential action at this time.

The nurse is teaching a group of new mothers regarding the benefits of breast-feeding. Which factor would have a significant effect on the success of breast-feeding? 1. Age of the woman at the time of delivery 2. Distribution of erectile tissue in the nipples 3. Amount of milk products consumed during pregnancy 4. Viewpoint of the woman's family toward breast-feeding

4. Viewpoint of the woman's family toward breast-feeding Rationale: If the woman perceives that significant others in her life hold a negative view of breast-feeding, she may be tense, and the let-down reflex may not occur; a positive attitude on the part of significant others toward breast-feeding promotes relaxation and the let-down reflex. If the significant persons in her life do not support breast-feeding, she will have little encouragement to breast-feed and to get through the challenges that breast-feeding may present. The age of the woman at the time of the birth and distribution of erectile tissue in the nipples have no influence on lactation. Intake of milk or milk products during pregnancy has little influence on lactation.

Which instruction would the nurse provide to the client who has been diagnosed with a urinary tract infection? 1. Void every 2 hours. 2. Record fluid intake and urinary output. 3. Pour warm water over the vulva after voiding. 4.Urinate after intercourse.

4.Urinate after intercourse. Rationale: During sexual intercourse, bacteria from the perineum, vagina, and anus can move near the urethra because of the anatomic proximity of these organs. Voiding promptly after intercourse can help decrease the ascent of bacteria up the urethra to the bladder. Voiding every 2 hours is unnecessary, but the client should be encouraged to void when the urge occurs. Intake and output need not be measured. Pouring warm water over the vulva after voiding is unnecessary for cystitis; it may be used as a part of perineal care for other problems.

Which traits would be expected when a client is in the reorganization phase of rape-trauma syndrome? Select all that apply. One, some, or all responses may be correct. 1. Eating disorders 2. Blaming self for the incident 3. Fear of being alone or in a crowd 4. Not being able to stop talking about it 5. Fleeing the job or home or making other radical changes 6. Having a calm demeanor and seeming to act as if nothing happened

ANS: 1, 3 Rationale: A client in the reorganization phase of rape-trauma syndrome might develop an eating disorder or express fear of being alone or in a crowd. In the acute period of disorganization, clients may blame themselves for the incident. A client might not be able to stop talking about the event during the outward adjustment phase of rape-trauma syndrome. Victims sometimes flee their job or home or make other radical changes during the acute phase of disorganization. At other times, a victim will have a calm demeanor and seem to act as if nothing happened during the disorganization phase of rape-trauma syndrome.

Which health screening and immunization recommendations are appropriate for a 48-year-old client? Select all that apply. One, some, or all responses may be correct. 1. Pelvic examination annually 2. Blood cholesterol annually over the age of 45 3. Blood pressure at every visit but at least every 2 years 4. Blood lipids every 5 years if blood cholesterol is within normal limits 5. Papanicolaou (Pap) and human papillomavirus (HPV) testing unnecessary if three tests are negative after the age of 40 6. Measles, mumps, and rubella immunization once if born after 1956 with no evidence of immunity

ANS: 1, 3, 4, 6 A 48-year old female will need a pelvic examination annually, a blood pressure check at every visit (at least every 2 years), blood lipid measurement every 5 years if blood cholesterol is within normal limits, and the measles, mumps, and rubella immunization once if born after 1956 with no evidence of immunity. Blood cholesterol needs to be done only every 5 years or more often if a client has abnormal levels or risk factors for coronary artery disease. Pap and HPV testing should be done every 5 years between the ages of 30 and 65.

Which foods would the nurse encourage the client to ingest to meet the increased need for vitamin A during pregnancy? Select all that apply. One, some, or all responses may be correct. 1. Carrots 2. Citrus fruits 3. Fat-free milk 4. Cantaloupes 5. Extra egg whites

ANS: 1, 4 Rationale: Carrots provide the precursor pigment carotene, which the body converts to vitamin A. Cantaloupes also contain large amounts of carotene, which the body converts to vitamin A. Citrus fruits contain only a very small amount of vitamin A precursor. Fat-free milk contains only about half the needed vitamin A precursor. Egg whites contain no vitamin A precursor.

which suggestion would the nurse share to help relieve the discomfort when an adolescent female presents with menstrual cramps?

Mittelschmerz is one-sided, lower abdominal pain associated with ovulation. German for "middle pain," mittelschmerz occurs midway through a menstrual cycle — about 14 days before your next menstrual period.

The nurse is obtaining a health history from a client with endometriosis. What consequences can occur as a result of this disorder? Select all that apply. 1Menopause 2Metrorrhagia 3Impaired fertility 4Bowel strictures 5Voiding difficulties

2 3 4 5 Metrorrhagia is bleeding between periods

Which statement indicates that a client understands the ways HIV is transmitted? Select all that apply.

"I can contract HIV by participating in oral sex." "HIV is contracted by using contaminated needles." "Babies can contract HIV because of contact with maternal blood during birth."

What instructions should the nurse give to an adolescent to prevent sexually transmitted infections? Select all that apply.

-"Remember to use condoms properly."- "Make sure you are up-to-date with your vaccinations." "Have sexual contact only if you and your partner are monogamous. "The safe use of condoms helps to avoid contact with body fluids and helps prevent sexually transmitted infections. Getting updated with vaccinations helps prevent vaccine-preventable sexually transmitted infections. Monogamous partners have a low risk of contracting sexually transmitted infections. Abstaining from sexual activity is not a practical approach. Regular screening for sexually transmitted infections helps to detect a disease at an early stage, but does not prevent contraction of the disease.

The primigravida would be taught by the nurse to anticipate quickening in which week of pregnancy? 1. 24th week 2. 20th week 3. 16th week 4. 12th week

2. 20th week Rationale: Most primigravidas feel movement by the 20th week of gestation. The 24th week is very late for the pregnant woman to feel initial movement; lack of movement by the 24th week should be investigated. Multiparas may feel movement by the 16th week; however, most primigravidas feel movement between 18 and 20 weeks. Twelve weeks is too early for movement to be felt.

A client who has participated in caring for her infant in the neonatal intensive care unit for several days in preparation for the infant's discharge comes to the unit on the last hospital day with an alcohol odor on her breath and slurred speech. Which action would the nurse take at this juncture? 1. Speak with the mother about her condition and assess her willingness to participate in an alternate discharge plan. 2. Request that the mother wait in the hospital lobby and call the primary health care provider to cancel the discharge order. 3. Speak to the mother about her condition and have her see a social worker about the infant's discharge to a foster home. 4. Continue with the discharge procedure and alert the home health nurse that the mother needs an immediate follow-up visit.

1. Speak with the mother about her condition and assess her willingness to participate in an alternate discharge plan. Rationale: Confrontation regarding the active substance abuse and the mother's diminished ability to care for the infant safely at this time is necessary to help the mother obtain help and to protect the infant. Decisions should not be made without input from the mother. Planning a foster home placement is not warranted until full evaluation is completed. Continuing with the discharge procedure and alerting the home health nurse that the mother needs an immediate follow-up visit is unsafe; the mother may not be capable of caring for the infant.

A pregnant client tells the nurse that she is a strict vegan. Which foods would the nurse encourage the client to eat that includes all of the essential amino acids? 1. Macaroni and cheese 2. Whole-grain cereals and nuts 3. Scrambled eggs and buttermilk 4. Brown rice and whole wheat bread

2. Whole-grain cereals and nuts Rationale: Whole-grain cereals and nuts provide a complete protein for vegans because they do not eat foods from animal sources, which contain all of the essential amino acids. Macaroni and cheese provides a complete protein and is acceptable to ovo-lacto-vegetarians, who eat milk, eggs, and cheese, but is not acceptable to vegans. Eggs are a complete protein, but are not acceptable to vegans, only to ovo-lacto-vegetarians, who eat milk, eggs, and cheese. Brown rice and whole wheat bread are both unrefined grains, but together they do not provide a complete protein.

A client who menstruates regularly every 30 days asks the nurse on what day she is most likely to ovulate. The client's menses started January 1. Which day in January would the nurse tell her that ovulation should occur? 1.) 7 2.) 16 3.) 24 4.) 29

2.) 16 Rationale: 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. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.

The school nurse would teach the students that the ovum is no longer viable at which time interval after ovulation? 1. 12 hours 2. 24 hours 3. 48 hours 4. 72 hours

24 hours Rationale: After ovulation, the egg lives for 12 to 24 hours and must be fertilized during that time if a woman is to become pregnant. The ovum is viable for about 24 hours after ovulation; if not fertilized before this time, it degenerates. For this reason, 12 hours, 48 hours, and 72 hours are all incorrect answers.

Which food selection by the client with osteoporosis indicates that the nurse's dietary instruction was effective? 1. Red meat 2. Coffee 3. Turnip greens 4. Wheat bran

3. Turnip greens Rationale: Turnip greens are high in calcium and vitamins. Adequate calcium intake is essential for the client with osteoporosis. Consumption of significant amounts of red meat with its high protein and iron content may reduce absorption of calcium. Excess caffeine intake is also associated with reduced absorption of calcium. Wheat bran has high levels of phytates, which prevent absorption of calcium.

The day after a client has a cesarean birth, the indwelling catheter is removed. Which finding would indicate that urinary function has returned? 1. The client has 90 mL of residual urine after voiding. 2. The client's daily urinary output is at least 1500 mL. 3. The client's urinalysis indicates that no bacteria are present. 4. The client voids 300 mL of urine within 4 hours of catheter removal.

4. The client voids 300 mL of urine within 4 hours of catheter removal. Rationale: Voiding 300 mL of urine within 4 hours of catheter removal indicates that urinary sphincter tone has not been affected by the catheter and that urine retention with overflow has not occurred. A residual volume of 90 mL after voiding indicates retention; the client urinates but does not completely empty the bladder. Although the total daily amount of urine indicates adequacy of kidney function, it does not reflect sphincter control or the possibility of retention. The absence of bacteria indicates the absence of infection; however, it does not reflect the return of urinary function.

For which conditions is obesity a known risk factor? Select all that apply. One, some, or all responses may be correct. 1. Gout 2. Atrial fibrillation 3. Multiple myeloma 4. Gallbladder disease 5. Diverticular disease 6. Inflammatory bowel disease

ANS: 1, 4, 5 Rationale: Gout, gallbladder disease, and diverticular disease are affirmatively linked with obesity. Obesity is not a known risk factor for atrial fibrillation, multiple myeloma, or inflammatory bowel disease.

Which is correct regarding the safety of caffeinated beverages during pregnancy? Select all that apply. One, some, or all responses may be correct. 1. High intake causes congenital disabilities. 2. One 12-ounce cup of coffee per day is probably fine. 3. High consumption is often related to a decrease in birth weight. 4. Pregnant women should try to abstain from caffeine completely. 5. Caffeine does not increase the risk for miscarriage, regardless of the amount consumed. 6. There is no effect of caffeine on the fetus in the third trimester.

ANS: 2, 3 Rationale: One 12-ounce cup of coffee per day is probably fine. A high intake of caffeine is often related to a decrease in birth weight. It does not cause congenital disabilities. All pregnant women do not need to abstain from caffeine completely; this is an individual choice. High intakes of caffeine during pregnancy might increase the risk of miscarriage. It is not true that a woman need not worry about caffeine intake once she has entered the third trimester; the recommendation remains no more than one 12-ounce cup daily.

Which time of the month would the nurse teach premenopausal women to perform breast self-examination? 1. When ovulation occurs 2. The first day of every month 3. The day that the menses begins 4. About a week after menses ends

About a week after menses ends A week after the end of menses, breast engorgement has abated, limiting lumps that may occur because of fluid accumulation. Breast engorgement begins before ovulation and does not subside until several days after menses ends; engorgement interferes with accurate palpation. Inaccurate assessment may result when examinations are performed at different times of the menstrual cycle because accurate comparisons may not be made from month to month.

which intervention would the nurse classify as the highest priority for a client experiencing symptoms of premensural syndrome?

Adequate rest

What is the most commonly reported sexually transmitted infection (STI)?

Chlamydial infections are the most commonly reported sexually transmitted infection.

What causes condylomata acuminate?

Condylomata acuminate are genital warts which are caused by the human papillomavirus (HPV). Genital warts are not caused by chlamydia, gonorrhea, or herpes simplex.

which organ produces sex steroid hormones in female reproductive organ?

Estrogens—estrone (E1), estradiol (E2), and estriol (E3)—are the predominant female sex hormones, produced primarily in developing follicles in the ovaries.

Which hormone is crucial for ovulation and complete maturation of the ovarian follicles?

Luteinizing hormone

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? 1. 7 2. 16 3. 24 4. 29

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. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.

which statement is an accurate description of dysmenorrhea?

Pain with menses.

Signs and symptoms of Chlamydial.

Painful urination, increased urinary frequency, and postcoital bleeding are characteristics of a chlamydial infection. Patients with a chlamydia infection have a friable cervix, with yellow or green mucopurulent cervical discharge. Therefore, the nurse concludes that the patient has chlamydia.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. Fluid overload Intermittent diarrhea Pale mucous membranes Difficulty emptying the bladder High hemoglobin and hematocrit levels

Pale mucous membranes. Difficulty emptying the bladder. Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.

The parent of an infant with Down syndrome asks the cause. Before responding, the nurse recalls that the genetic factor of Down syndrome results from which finding? a. An intrauterine infection b. An X-linked genetic disorder c. Extra chromosomal material d. An autosomal recessive gene

c. Extra chromosomal material

which factors contribute to development of osteoporosis in female clients?

cigarette smoking familial predisposition inadequate intake of dietary calcium

A healthy couple whose child has cystic fibrosis (CF) is concerned about having another child with the disease. Knowing that this disorder has an autosomal-recessive mode of inheritance, how would the nurse respond?a. 'There is a 50% chance that this baby will also be affected.!'b. 'If this baby is male, there is a 50% chance of his being affected.!'c. 'If this baby is female, there is no chance of her being affected, but she will be a carrier.'d. 'There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier.'

d. 'There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier

The nurse anticipates that a child born with a missing chromosome is most likely to have which condition? a. Cretinism b. Phenylketonuria c. Down syndrome d. Turner syndrome

d. Turner syndrome

Which medication is safe to take during pregnancy? Select all that apply. One, some, or all responses may be correct. 1. Metronidazole 2. Aspirin 3. Codeine 4. Acetaminophen 5. Diphenhydramine HCl

4. Acetaminophen

WHO defines health

A state of complete physical, mental, and social well-being

Which is the priority nursing intervention for a client with placenta previa who is having vaginal bleeding at this time? 1. Maintaining bed rest 2. Planning for an ultrasound test 3. Preparing for a nonstress test 4. Administering oxygen by way of a mask

1. Maintaining bed rest Rationale: Gravitational pull on an already stressed placenta may cause further bleeding; bed rest limits this pressure and may prolong the pregnancy. If the client is bleeding, bed rest would be advised. If she were asymptomatic, just pelvic rest would usually be recommended. Planning for an ultrasound test or a nonstress test provides for fetal assessment; it will not delay the birth. Unless the fetal heart rate is decelerating, oxygen supplementation is not necessary.

Which information is important to obtain during the nursing assessment of a female who is taking oral contraceptives? Select all that apply.

1.History of vascular or thromboembolic disorder. 2.Drug interactions leading to a decreased effect of oral contraceptives. 3.Prescription of a medication that may have its therapeutic effects decreased if taken with oral contraceptives

The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. Which finding would indicate that the therapy is helping? 1. Mobility increases. 2. Fewer muscle spasms occur. 3. The heartbeat is more regular. 4. There are fewer bruises than before therapy.

1. Mobility increases. This regimen limits bone demineralization and reduces bone pain, thereby promoting increased mobility and activity. The occurrence of fewer muscle spasms is unrelated to osteoporosis; it would be an expected outcome if the client were receiving calcium for hypocalcemia. A more regular heartbeat is unrelated to osteoporosis or its therapy. The occurrence of fewer bruises than before therapy is unrelated to osteoporosis; it would be expected if the client were receiving vitamin C for capillary fragility.

Which important intervention would be included in the nursing care provided immediately after a sexual assault? 1. Obtaining the assault history from the client 2. Reporting the assault to the police before the client is examined 3. Having the client void a clean-catch urine specimen 4. Testing the client's urine for seminal alkaline phosphatase

1. Obtaining the assault history from the client Rationale: Obtaining the assault history from the client provides a basis for assessing trauma; in a client of childbearing age it also is necessary to assess the risk for pregnancy. Examination may precede reporting; the decision to report is mandated by law. Urination may wash away spermatic or bloody evidence. A test for seminal acid phosphate, not seminal alkaline phosphatase, is performed.

The client at 8 weeks' gestation requests information from the nurse regarding abortion. Which action would be the nurse's responsibility? 1. To share her own thoughts on abortion with the client 2. To provide the client with correct, unbiased information 3. To ask why the client wants information about abortion 4. To notify the primary health care provider because this is beyond the scope of nursing practice

2. To provide the client with correct, unbiased information Rationale: Nurses who counsel clients regarding abortion should know what services are available and the various methods that are used to induce abortion. Nurses who cannot control their negative feelings regarding abortion should not counsel women who are thinking of undergoing the procedure. Nursing practice necessitates knowledge of research results; statements must be based on fact, not personal feelings or beliefs. Counseling of the client would include giving information and assessing her knowledge of the procedure, risks, benefits, and alternatives. As part of this discussion, the reasons for the request of information would be included. The nurse can provide this information to the client and need not defer to the primary health care provider.

Which question would help the nurse determine the pregnant client's estimated date of delivery? 1. "Did you do a home pregnancy test?" 2. "How old were you when your menses began?" 3. "Are your menstrual periods regular?" 4. "Were you using condoms before you became pregnant?"

3. "Are your menstrual periods regular?" Rationale: Determining an accurate estimated date of delivery requires synthesizing data from the client. Asking if the menstrual periods are regular allows the nurse to know if Naegele's rule can be appropriately used to determine the estimated delivery date for this client. If her menstrual periods are regular and occur roughly every 28 days, Naegele's rule would be used. If, however, her menses are irregular, use of this method for determining the estimated delivery date would not be accurate. Knowing whether she did a home pregnancy test, or her age at menarche do not help determine the estimated delivery date. The use of condoms before pregnancy does not affect the method of determining the estimated delivery date.

What drugs are used to induce abortion in an adolescent? Select all that apply. 1Leuprolide 2Zidovudine 3Misoprostol 4Mifepristone 5Methotrexate

345Misoprostol is a prostaglandin analog that acts directly on the cervix, stimulating contractions. Mifepristone acts by binding to progesterone receptors and blocking the action of progesterone, which is necessary for maintaining a pregnancy. Methotrexate is a cytotoxic drug that can cause early abortion by blocking folic acid in fetal cells. Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist used to treat endometriosis. Zidovudine is an antiviral drug used in a pregnant woman in the prenatal and the perinatal periods to prevent the transmission of human immunodeficiency virus to the fetus.

Which treatment strategies would benefit a client diagnosed with chlamydia? Select all that apply. 1 Penicillin G 2 Ceftriaxone 3 Clotrimazole 4 Doxycycline 5 Azithromycin

4 Doxycycline 5 Azithromycin. Doxycycline and azithromycin are used to treat chlamydia. Penicillin G is used to treat syphilis. Ceftriaxone is used to treat gonorrhea. Clotrimazole is used to treat candidiasis. is used to treat candidiasis.

A 13-year-old adolescent whose menses began 2 years ago complains of lower abdominal pain that began 3 months ago midway between periods. How would the nurse respond to the adolescent? 1. "It requires a pelvic examination." 2. "This usually occurs when menses first begin." 3. "It usually disappears when there is regular ovulation." 4."This is a common occurrence known as mittelschmerz."

4."This is a common occurrence known as mittelschmerz." Rationale: Mittelschmerz is pain that sometimes occurs at the time of ovulation when the ovum erupts from the follicle. The pain is mild, cyclic, and characteristic of mittelschmerz; it does not require pelvic examination. The pain usually begins when there is regular ovulation. When menses first begins the girl is anovulatory and does not experience the pain known as mittelschmerz.

After interacting with a client, a nurse finds that a 23-year-old client has never undergone a Papanicolaou (Pap) test. What should the nurse suggest to the client?

A. Schedule a Pap test immediately B. Schedule a Pap test during menses C. Schedule a Pap test every five years D. Schedule a Pap test and human papillomavirus test

Which medication would the nurse question if prescribed for a pregnant client? Select all that apply. One, some, or all responses may be correct. 1. Warfarin 2. Phenytoin 3. Isotretinoin 4. Clavulanate 5. Methotrexate

ANS: 1, 2, 3, 4, 5 Rationale: Some medications are not safe to take during pregnancy because of the adverse effects to the fetus and/or newborn. Warfarin, phenytoin, isotretinoin, clavulanate, and methotrexate are not safe during pregnancy.

Which statements are true regarding health risks to adolescent females? Select all that apply. One, some, or all responses may be correct. 1. Papanicolaou (Pap) testing should start at age 21. 2. Women should have Papanicolaou (Pap) tests when they become sexually active. 3. A sexually active teen who does not use contraception has a 50% chance of pregnancy within 1 year. 4. Pregnant teenagers don't often know to avoid teratogens or have prenatal care and instruction or follow-up care. 5. Adolescents enter the health care system due to the human papillomavirus vaccine.

ANS: 1, 4, 5 Rationale: Current guidelines call for Pap tests starting at age 21, although this recommendation is not without some controversy. Old recommendations were for Pap screening at age 18 or when the woman became sexually active. Many teenagers do not have the maturity to avoid teratogens or have prenatal care and instruction or follow-up care. A sexually active teen who does not use birth control has a 90% chance of becoming pregnant within a year. Many women enter the health care delivery system for a Pap test or for contraception, although some don't enter until a specific need arises; the availability of the human papillomavirus vaccine has created another reason for young women to enter the health care system, however.

A nurse performs a nonstress test on a pregnant client. The nurse determines that the results are nonreactive if which of the following findings is noted on the electronic monitoring recording strip?

Absence of accelerations after fetal movement

which diagnosis would the nurse suspect when an enlarged uterus and nodular masses are palpated on examination of a client with abnormal uterine bleeding, pelvic pressure during urination, and painful intercourse?

Leiomyomas Ovarian Cysts can cause constipation, anorexia, increased abdominal girth, and peripheral edema; a mass on an enlarged ovary would be felt during the pelvic exam. Endometriosis causes nodular bumps on the adnexa, but a definitive diagnosis requires laparoscopy and biopsy. Pelvic inflammatory disease does not cause any urinary symptoms.

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes?

Perimenopause

Which term is used to describe premenstrual syndrome (PMS) associated with severe mood changes? Menarche Depression Perimenopause Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD)

The couple in the fertility clinic has learned that one of them carries a gene for a serious condition and that the other parent does not carry the gene. They have been told that there is a 50% chance that their child will have this condition. Which pattern of genetic inheritance is this? a. X-linked recessive b. Autosomal recessive c. Autosomal dominant d. Chromosomal trisomy

c. Autosomal dominant. examples-Huntington's disease, Marfan syndrome Examples of autosomal recessive disorders include cystic fibrosis, sickle cell anemia, and Tay-Sachs disease. Examples of x-linked recessive: hemophilia, Fabry disease

Which comment from an adolescent after a sex education class alerts the nurse to have a private discussion with the student? 1. "I can't get pregnant if I have sex during my period." 2. "The pill may prevent me from getting pregnant, but I can still get a sexually transmitted infection (STI)." 3. "I won't get pregnant if I swim in a pool where a boy has just masturbated." 4. "A condom won't always protect me from getting pregnant, but it can help protect me from getting an STI."

1. "I can't get pregnant if I have sex during my period." Rationale: Although unusual, conception can occur during menstrual periods. The birth control pill prevents ovulation and conception; however, the pill does not protect from exposure to a sexually transmitted microorganism. Sperm cannot survive in a large body of water. Condoms provide the lowest risk of contracting an STI, but there is still a risk of pregnancy with their use because they are not 100% effective.

Which information would the nurse include in his or her teaching for a class on breast health? 1. Breast awareness will help a client know if there are changes in her breasts. 2. Body weight makes no difference in the incidence of breast cancer. 3. A specific method of breast self-examination should be performed every month. 4.Alcohol intake has no effect on the incidence of breast cancer.

1. Breast awareness will help a client know if there are changes in her breasts. Rationale: Breast awareness is now promoted to women as a way of becoming familiar with their breasts to be able to recognize changes that would prompt women to seek medical care. Obesity does increase the risk of breast cancer. The American Cancer Society and other organizations no longer promote a specific method of monthly breast self-examination because this activity was found to lead to increased testing and false positive findings without reduction in breast cancer deaths. Alcohol intake is a risk factor for breast cancer.

The mammography results for a 37-year-old client with a breast mass are inconclusive. The client is undergoing further diagnostic tests to determine whether the mass is malignant. Which information would the nurse take into consideration before planning health teaching for this client? 1. Squamous cell carcinomas are neoplasms arising from glandular tissues. 2. Results of a biopsy are necessary before a specific form of therapy is selected. 3. Mammograms should be repeated to confirm the presence of malignancies. 4. Waiting for several weeks before receiving confirmation of cancer is helpful to the client.

2. Results of a biopsy are necessary before a specific form of therapy is selected. Rationale: The therapy selected depends on whether there is a malignancy and, if so, the type of cancer cells, the extent of nodal involvement, and the presence and extent of metastasis. Adenocarcinomas, not squamous cell carcinomas, arise from glandular tissue; squamous cell carcinomas arise from epithelial tissue. Repeating a mammogram would only delay diagnosis. Only a biopsy will confirm the diagnosis of a malignancy. Waiting several weeks for a diagnosis is not advisable; an extended waiting period increases the client's stress and anxiety.

The primary health care provider of a woman who had a mastectomy has arranged for a mastectomy peer support visit. What is the purpose of the referral? 1. To teach arm exercises 2. To prevent social isolation 3. To meet her physical needs 4. To view her surgical incision

2. To prevent social isolation Rationale: A mastectomy peer support visit helps the client meet her need to remain within her social milieu and informs her about available community resources. Teaching arm exercises, meeting the client's physical needs, and viewing her surgical incision are all responsibilities of health care professionals.

A pregnant client whose first child has Down syndrome is about to undergo amniocentesis. The client tells the nurse that she does not know what she will do if this fetus has the same diagnosis and asks if the nurse thinks that abortion is the same as killing. Which response would the nurse give? 1. "Some people think that that's what an abortion is." 2. "No, I don't think so, but it's your decision to make." 3. "I really can't answer that question. Are you ambivalent about abortion?" 4. "I don't want to answer that question at this time. How do you feel about it?"

3. "I really can't answer that question. Are you ambivalent about abortion?" Rationale: The nurse's statement "I really can't answer that question. Are you ambivalent about abortion?" acknowledges that she is unable to answer the question; however, it is open-ended, allowing the client to communicate and reflect more on her own belief system. Stating that some people think that an abortion constitutes killing is judgmental and does not give the client the opportunity to express her feelings. The nurse would not give an opinion on a moral question for a client, because this creates a barrier to the client's own reflection and communication. Declining to answer the question leaves the burden of the decision to the client without offering assistance or the opportunity for further communication.

A client is being initiated on bisphosphonates. Which advice will the nurse provide? 1. "Take it on an empty stomach." 2. "This medication should be taken at night before bed." 3. "These medications should be taken with food or milk." 4. "Lie down for a bit after taking the medication."

1. "Take it on an empty stomach." Rationale: Bisphosphonates should be taken on an empty stomach in the morning because food and some minerals reduce absorption. The client should remain upright for 30 minutes after taking the medication.

A client is crying after undergoing dilation and curettage after an early miscarriage (spontaneous abortion). Which response would the nurse give? 1. "This must be a very difficult experience for you to deal with." 2. "You'll have other children to take the place of the child you lost." 3. "Of course you're sad now, but at least you know you can get pregnant." 4. "I know how you feel, but when a woman miscarries, it's usually for the best."

1. "This must be a very difficult experience for you to deal with." Rationale: Saying that this must be a difficult experience acknowledges the validity of the client's grief and provides the client an opportunity to talk if she wishes. Other children cannot and should not be substituted for a lost fetus. Getting pregnant is not the issue; this statement belittles the lost fetus. The nurse cannot know how the client feels. Stating that a miscarriage is for the best is patronizing and diminishes the significance of the lost fetus.

At her first prenatal visit, the client informs the nurse that her last menstrual period started on June 10. Which is her expected date of birth (EDB), according to Naegele's rule? 1. March 3 2. March 10 3. March 17 4. March 24

3. March 17 Rationale: The EDB is March 17 of the following year. Using Naegele's rule, subtract 3 months from the first day of the last menstrual period and add 7 days. March 3 and March 10 are too early. March 24 is too late.

Which disease is in the top five leading causes of death in American women? 1. Alzheimer 2. Diabetes mellitus 3. Unintentional injury 4. Influenza and pneumonia

1. Alzheimer Rationale: Alzheimer disease is the fifth leading cause of death among American women. Diabetes mellitus is the seventh, unintentional injury is the sixth, and influenza and pneumonia are the eighth.

Which discharge instruction would the nurse give the client to decrease the risk of thromboembolic events after an abdominal hysterectomy? 1. Avoid sitting for long periods of time. 2. Limit fluids to less than 2000 mL per day. 3. Have a blood coagulation test every 2 weeks. 4. Continue with hormone replacement therapy.

1. Avoid sitting for long periods of time. Rationale: Sitting for long periods leads to pooling of blood in the pelvic area, predisposing the client to thrombus formation. Fluids should be increased to about 2000 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 also been performed. The estrogen component in hormone replacement therapy can increase the risk of clots.

Which instruction would the nurse provide to the client who uses tampons for her menstrual period and is seeking advice on prevention of toxic shock syndrome (TSS)? 1. Change the tampon about every 4 hours. 2. Use sanitary napkins rather than tampons. 3. Douche just before inserting each tampon. 4. Replace the tampon at least twice a day.

1. Change the tampon about every 4 hours. Rationale: Tampons should be changed frequently (at least every 4 hours) because Staphylococcus aureus, which causes 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 is not 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.

Which advice would the nurse provide to the primigravida wanting to diet during pregnancy because of concerns about regaining her figure after delivery? 1. Inadequate food intake can result in a low-birth-weight infant. 2. Dieting is recommended to decrease the risk of stillbirth. 3. Dieting is recommended to make the birthing process easier. 4. Inadequate food intake may result in gestational diabetes mellitus.

1. Inadequate food intake can result in a low-birth-weight infant. Rationale: The recommended weight gain is at least 25 lb (11.3 kg) for a client with a normal body mass index before pregnancy. Inadequate food and nutrient intake during pregnancy can increase the risk for an underweight newborn. The cause of stillbirth is usually not known; however, dieting during pregnancy is not recommended. Inadequate food intake would not make the birthing process easier nor is it a risk factor for gestational diabetes mellitus.

When assessing a newly admitted primigravida in active labor, the nurse hears the fetal heartbeat loudest in the upper left quadrant. Which fetal position would the nurse suspect? 1. Left sacral anterior 2. Left mentum anterior 3. Left occipital posterior 4. Left occipital transverse

1. Left sacral anterior Rationale: If the heart is heard in the upper left quadrant, the fetus is often lying in a breech presentation with the body more towards the left side, such as a left sacral anterior position. Fetal heart tones are heard best in the lower quadrants of the abdomen in cephalic presentations. This fetus is not positioned in the mentum anterior, occipital posterior, or occipital transverse positions, all of which are variations of a cephalic presentation.

Which statement is an accurate description of dysmenorrhea? 1. Pain with menses 2. Endometrial hyperplasia 3. Bleeding between menses 4. Heavy bleeding with menses

1. Pain with menses Rationale: Dysmenorrhea is defined as pain with menses. Endometrial hyperplasia results from anovulation and persistent estrogen stimulation. Bleeding between menses is metrorrhagia. Heavy bleeding with menses is menorrhagia.

Which action would the nurse plan to ensure optimal nutrition during the pregnancy for the client who maintains a vegetarian diet? 1. Refer the client to a dietitian to help plan her daily menu. 2. Encourage the client to join a group that teaches nutrition. 3. Explain that she needs to include meat in her diet at least once a day. 4. Advise the client that it is unhealthy to continue a vegetarian diet during pregnancy.

1. Refer the client to a dietitian to help plan her daily menu. Rationale: 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.

Offspring of men of advanced paternal age are at an increased risk for which condition? 1. Schizophrenia 2. Cystic fibrosis 3. Sickle cell anemia 4. Tay-Sachs disease

1. Schizophrenia Rationale: Advanced paternal age increases the risks of some autosomal dominant disorders, autism spectrum disorder, and schizophrenia. Cystic fibrosis, sickle cell anemia, and Tay-Sachs disease are recessive diseases, and the risk of these diseases does not increase because of advanced paternal age.

Which intervention would the nurse recommend to relieve symptoms of a yeast infection? 1. Using a sitz bath 2. Sleeping in tight leggings 3. Sitting in a warm bubble bath 4. Using tampons if she is on her period.

1. Using a sitz bath Rationale: A sitz bath with or without colloidal oatmeal can be very soothing to irritated skin. It is better to sleep without underwear if possible; tight leggings can worsen symptoms. Use of bath salts or bubble bath is not recommended because it can irritate the already swollen skin. If a woman has her period, treatment should continue, and she should avoid using tampons because they can absorb the vaginal medication that may have been prescribed.

A client who is pregnant with twins is scheduled for a cesarean birth. Which information would the nurse give the client? 1. "We'll give you an enema before the surgery." 2. "We'll be encouraging you to ambulate early after surgery." 3. "You'll be discharged from the hospital in a week." 4. "You should take sponge baths until the incision is healed."

2. "We'll be encouraging you to ambulate early after surgery." Rationale: Early postoperative ambulation helps prevent such postpartum complications as thrombophlebitis and constipation. An enema is not necessary. Clients who have had uncomplicated cesarean births are generally discharged by the third postpartum day. Clients are permitted to shower after 48 hours or even sooner.

How many milligrams of calcium would the nurse instruct the 30-year-old client to consume during pregnancy? 1. 1500 mg 2. 1000 mg 3. 2500 mg 4. 2000 mg

2. 1000 mg Rationale: The adult pregnant client should consume 1000 mg of calcium daily. The nurse would explore her diet to identify good sources of calcium and recommend a calcium supplement if the client cannot obtain the recommended amount of calcium from her diet. 1500 mg, 2500 mg, and 2000 mg are all more than the recommended intake.

How much additional daily protein intake is required by the lactating client? 1. 10 g 2. 25 g 3. 30 g 4. 45 g

2. 25 g Rationale: 25 g is the necessary amount of increased daily protein intake recommended for lactating women. 10 g of added protein will not meet the needs of the lactating client. 30 and 45 g are all more than the additional recommended amount, although most women in developed countries exceed this requirement.

Which client care activity may the nurse safely delegate to an unlicensed health care worker? 1. Assessing a client's mastectomy incision for signs of inflammation 2. Assisting a client who is recovering from an abdominal hysterectomy to the bathroom 3. Providing information about side effects to a client receiving chemotherapy for breast cancer 4. Evaluating the effectiveness of an antiemetic that was administered to a client to relieve nausea

2. Assisting a client who is recovering from an abdominal hysterectomy to the bathroom Rationale: An unlicensed health care worker is taught how to safely ambulate clients; this activity does not require extensive nursing knowledge or expert clinical judgment. Assessment, teaching, and evaluation of client responses to care all require clinical judgment and a license to practice nursing.

A client with an opioid addiction has been taking 40 mg/day of methadone. She is now in the prenatal clinic and is 3 months' pregnant. Which plan of care would the prenatal nurse anticipate? 1. Withdraw the methadone slowly over the next several weeks. 2. Continue the prescribed methadone to prevent withdrawal symptoms. 3. Temporarily discontinue the methadone to improve maternal and neonatal outcome. 4. Leave the methadone maintenance program during the pregnancy and reenter it after the birth.

2. Continue the prescribed methadone to prevent withdrawal symptoms. Rationale: Methadone and buprenorphine are the recommended treatment options for pregnant women with opioid addiction. Although the medications cross the placenta, they are considered safer for the fetus and newborn than the acute opioid detoxification that would result if the medications were not administered. Withdrawing the medications slowly over the next several weeks is not recommended. Detoxification from methadone or buprenorphine takes longer than several weeks. Discontinuing methadone or buprenorphine treatment can lead to withdrawal problems and put the client at risk for a return to opioid abuse. If the medications are discontinued during the pregnancy, both client and fetus will be at risk.

A pregnant client tells the nurse that her husband is a chain smoker. Which information would the nurse's teaching include? 1. Secondhand smoke is related to an increased blood level of alpha-fetoprotein. 2. Continued exposure to secondhand smoke is related to fetal growth restriction. 3. If the mother does not smoke, the fetus will not be affected by secondhand smoke. 4. If the mother is not in the same room where there is smoking, the fetus is not affected.

2. Continued exposure to secondhand smoke is related to fetal growth restriction. Rationale: Exposure to secondhand smoke decreases the oxygen-carrying capacity of Po2, thereby depriving the fetus of nutrients and oxygen, which results in intrauterine growth restriction. An increased blood level of alpha-fetoprotein is not related to secondhand smoke. Both mother and fetus are affected by secondhand smoke. The fetus is affected by secondhand smoke because the environment is contaminated with the end products of burning tobacco.

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

2. Denial Rationale: The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" types of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.

Which nutrient would help the client at 6 weeks' gestation reduce the risk for neural tube defects in her baby? 1. Niacin 2. Folic acid 3. Vitamin A 4. Vitamin B12

2. Folic acid Rationale: Women who take 0.4 mg/day of folic acid during the 4 weeks before pregnancy and during the first trimester reduce the risk of having an infant with a neural tube defect. Vitamins A and B12 and niacin should be included in a balanced diet but do not have the effect on neural tube development that folic acid has.

The clinic nurse is providing home care instructions for a client with pelvic inflammatory disease. Which optimal resting position would the nurse recommend? 1. Sims 2. Fowler 3. Supine with knees flexed 4. Lithotomy with head elevated

2. Fowler Rationale: The Fowler position facilitates localization of the infection by pooling exudate and promoting drainage in the lower pelvis. The Sims position and supine position with knees flexed do not use gravity to promote pooling of exudate in the lower pelvis. The lithotomy position with head elevated does not use gravity to promote pelvic drainage despite an elevated head.

A 15-year-old client tells a school nurse, "I have this awful pain during my periods—it never stops." Which would the nurse encourage her to do? 1. Continue daily activities. 2. Have a medical evaluation. 3. Eat a nutritious diet containing iron. 4. Practice relaxation of abdominal muscles.

2. Have a medical evaluation. Rationale: Dysmenorrhea may affect an adolescent's school attendance and cause her to withdraw from activities. Medical evaluation and treatment can offer solutions to allow the client to continue her normal life. Although diversion by continuing daily activities is a means of altering pain perception, the presence of pain requires investigation of possible causes. Although a nutritious diet is beneficial, iron does not prevent the pain of dysmenorrhea. Voluntary relaxation of the abdominal muscles does not result in cessation of dysmenorrhea.

A hysterectomy is scheduled for a client with endometrial cancer. Before the surgery proceeds, which intervention would the nurse prepare the client to expect? 1. Nasogastric tube 2. Indwelling urinary catheter 3. Vaginal packing for 10 days 4. Jackson-Pratt drain in the abdominal incision

2. Indwelling urinary catheter Rationale: A catheter decompresses the bladder and limits trauma to the surgical site; it eliminates the need for repeated straight catheterizations after surgery. The gastrointestinal tract does not need to be decompressed for this type of surgery. Packing is usually not necessary; if it is used after a hysterectomy, 10 days is an excessively long time. Drains are usually not necessary after a hysterectomy.

Which action would the nurse immediately perform 30 minutes after birth on a postpartum client who has excessive lochia (bleeding) and a relaxed uterus? 1. Check vital signs. 2. Massage the uterus. 3. Notify the practitioner. 4. Elevate the foot of the bed.

2. Massage the uterus. Rationale: Massaging the uterus will induce uterine contraction and cause expulsion of clots; frequent massage should be continued to keep the uterus firm and inhibit bleeding. Pulse and blood pressure should be monitored but may not change significantly unless large amounts of blood are lost. If bleeding continues after the fundus is massaged, the health care practitioner should be notified. Placing the client in the Trendelenburg position is appropriate if the client is in shock, but the data do not indicate shock.

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of which possible complication related to a prolonged pregnancy? 1. Polyhydramnios 2. Placental insufficiency 3. Postpartum infection 4. Subclinical gestational diabetes

2. Placental insufficiency Rationale: Placental function peaks at 37 weeks and declines slowly thereafter; therefore, continuation of the pregnancy past term (42 weeks) places the fetus at risk because of placental insufficiency. Oligohydramnios (decreased amniotic fluid volume), not polyhydramnios (increased amniotic fluid volume), may occur in postterm gestations. A prolonged pregnancy does not present a risk for a postpartum infection. A prolonged pregnancy is unrelated to gestational diabetes.

Which term would the nurse use to describe the first fetal movements that a pregnant client feels? 1. Lightening 2. Quickening 3. Engagement 4. Ballottement

2. Quickening Rationale: The word quickening originates from the Middle English word quik, which means "alive." Lightening is the descent of the fetus into the birth canal toward the end of pregnancy. Engagement occurs when the presenting part is at the level of the ischial spines. Ballottement refers to the technique that causes the fetus to rebound in the amniotic fluid after pressure has been exerted against the fetus.

After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. Which response would the nurse give? 1. "Avoid regular use of tampons." 2. "Decrease your intake of prune juice." 3. "Increase your daily fluid consumption." 4. "Cleanse the perineum from back to front."

3. "Increase your daily fluid consumption." Rationale: Increasing fluid intake flushes the urinary tract of microorganisms. Use of tampons does not increase the risk of cystitis. Fluid consumption should be increased, not decreased. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis.

Which statement by the female client with a diagnosis of gonorrhea indicates she has understood the teaching by the nurse on how to avoid future infection? 1. "I'll douche after each time I have sex." 2. "Having sex is a thing of the past for me." 3. "My partner has to use a condom all the time." 4. "I'll be using a spermicidal cream from now on."

3. "My partner has to use a condom all the time." Rationale: Although not 100% effective, a condom is the best protection against gonorrhea in a sexually active person. Douching has no proven protective effect against sexually transmitted infections; excessive douching can alter the natural environment of the vagina and may even promote an ascending infection. Although abstaining from sex is the best way to prevent a sexually transmitted infection, it is not the most realistic response for a sexually active person. Once people become sexually active, they usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy.

A 16-year-old high school student comes to a community health center because of the fear of having contracted herpes. The teenager is upset and shares this information with the community health center nurse. Which response would the nurse provide? 1. "Let me get a brief health history now." 2. "Try not to worry until you know whether you have herpes." 3. "You sound worried. Let me make arrangements to have you examined." 4. "Herpes has received too much attention in the media; let's be realistic."

3. "You sound worried. Let me make arrangements to have you examined." Rationale: Telling the client that she sounds worried and offering to arrange an examination immediately identifies the client's fear as real and offers a service to meet the need for information about the client's physical status. Obtaining the health history ignores the client's concern and focuses on the nurse's need to complete the task of obtaining a history. Telling the client not to worry minimizes the client's concern about having a sexually transmitted infection. Saying that herpes has received too much attention in the media minimizes the client's concern and implies that the client is being unrealistic.

A client is scheduled for a laparoscopic bilateral tubal ligation. Which information would the nurse include in preoperative teaching? 1. "Menstruation will stop after the surgery." 2. "You'll need to use birth control until your follow-up visit." 3. "You will be admitted as an outpatient for same-day surgery." 4. "You can have the operation reversed if you decide to have more children."

3. "You will be admitted as an outpatient for same-day surgery." Rationale: A laparoscopic tubal ligation takes about 20 minutes to perform. The client is admitted as an outpatient and goes home the same day after she recovers from the anesthesia. Menstruation will continue because there is no trauma to the ovaries or the endocrine glands involved with reproduction. Sterility is immediate, so there will be no need to use birth control; a waiting period is not required as it is with a vasectomy. Microsurgery to reverse the procedure is not guaranteed or easily accomplished.

Which time during the menstrual cycle would the nurse stress as the optimal time to achieve pregnancy? 1. Midway between periods 2. Immediately after a period ends 3. 14 days before the next period is expected 4. 14 days after the beginning of the last period

3. 14 days before the next period is expected Rationale: Ovulation occurs 14 days before the onset of menses. Midway between cycles is appropriate only if the client has a regular 28-day cycle. Immediately after the end of the period means that ovulation occurs on approximately day 5 of the menstrual cycle, which is not factual. Variations in the cycle occur in the preovulation period; it is not as accurate as counting 14 days before the next expected menses.

The nurse is teaching a family planning class about ovulation and conception. For which period of time would the nurse inform the class that the ovum is capable of being fertilized after ovulation? 1. 1 to 6 hours 2. 12 to 18 hours 3. 24 to 36 hours 4. 48 to 72 hours

3. 24 to 36 hours Rationale: The ovum is capable of being fertilized for 24 to 36 hours after ovulation. After this time it travels a variable distance between the fallopian tube and uterus and, if not fertilized, disintegrates and is phagocytized by leukocytes. The other time periods listed are not correct.

Which information would the nurse's teaching plan include for a client scheduled for an elective vacuum aspiration abortion in the first trimester of pregnancy? 1. It is a lengthy procedure; however, it will cause little to no pain. 2. Both the client and the father must sign the consent form. 3. A temperature of 100.4°F (38°C) or higher should be reported immediately. 4. The client will experience a heavy menstrual flow for 1 to 2 weeks after the procedure.

3. A temperature of 100.4°F (38°C) or higher should be reported immediately. Rationale: Increased temperature may be indicative of an infection; if infection is present, immediate treatment would be indicated. The procedure is a short one, but there is some pain or discomfort. The father is not required to sign the consent form. A light menstrual flow is expected for several days after the procedure.

Which information about genital herpes would the nurse teach the students in the high school sex education class? 1. A healthy lifestyle will prevent exacerbations. 2. Once the infection is effectively treated, exacerbations are rare. 3. Although exacerbations occur, they are not as severe as the initial episode. 4. The most effective way to prevent exacerbations is to abstain from sexual activity.

3. Although exacerbations occur, they are not as severe as the initial episode. Rationale: The initial infection is both local and systemic; exacerbations are milder and localized. Although optimum health habits may limit exacerbations, they will not prevent them. Adequate treatment of the primary outbreak will not limit the number of exacerbations. Exacerbations can be precipitated by physical and emotional stress, not by sexual activity.

A client who has had a cesarean birth has been having difficulty breast-feeding for 2 days and now asks the nurse to bring her a bottle of formula. Which would be the nurse's initial action? 1. Obtaining the requested formula 2. Administering the prescribed pain medication 3. Assessing the client's breast-feeding technique 4. Notifying the health care practitioner of the client's request to switch feeding methods

3. Assessing the client's breast-feeding technique Rationale: The nurse would assess the client to determine why the client is having difficulty breast-feeding. She may be uncomfortable or in need of assistance with her breast-feeding technique. The nurse would also explore the client's feelings about breast-feeding. Immediately providing the formula without assessing the situation does not meet the client's needs at this time. Pain may be a factor in the client's frustration with breast-feeding; however, this should be determined through the assessment process. Notifying the health care practitioner of the client's request to switch feeding methods is premature. It is the nurse's responsibility to assess the situation and arrive at a solution in collaboration with the client.

Which nursing action would the nurse perform to enhance the beginning of the mother-infant relationship? 1. Suggesting that the mother choose breast-feeding instead of formula-feeding 2. Advising the mother to engage in rooming-in with the newborn at the bedside 3. Encouraging the mother to help out with simple aspects of her newborn's care 4. Observing the mother-infant interaction unobtrusively to evaluate the relationship

3. Encouraging the mother to help out with simple aspects of her newborn's care Rationale: Holding, touching, and interacting with the newborn while providing basic care promotes attachment. The nurse's infant feeding preference should not be forced upon the mother. Although rooming-in helps promote attachment, not all women have the physical or emotional ability to provide 24-hour care to the newborn so early in the postpartum period. Early observation is not adequate; full evaluation of the relationship can be achieved only by allowing the mother ample time to interact with her baby.

Where would the fundal height be located in a pregnant client at 16 weeks' gestation? 1. Above the umbilicus 2. At the level of the umbilicus 3. Half the distance to the umbilicus 4. Slightly above the symphysis pubis

3. Half the distance to the umbilicus Rationale: Considering the growth of the fetus, the expected height of the fundus at 16 weeks' gestation is half the distance to the umbilicus. The height of the fundus in centimeters is approximately the same as the number of weeks of gestation if the woman's bladder is empty at the time of measurement. Above the umbilicus is where the fundus should be palpated after 24 weeks' gestation until term. At the level of the umbilicus is where the fundus should be palpated at 22 to 24 weeks' gestation. Between 12 and 14 weeks' gestation, the uterus outgrows the pelvic cavity and can be palpated just above the symphysis pubis.

The nurse teaches a pregnant client regarding the necessity for a folic acid supplement. Folic acid taken in the first trimester of pregnancy helps reduce the risk for which neonatal disorder? 1. Phenylketonuria 2. Down syndrome 3. Neural tube defects 4. Erythroblastosis fetalis

3. Neural tube defects Rationale: A folic acid supplement (0.4 mg/day) greatly reduces the incidence of fetal neural tube defects. Phenylketonuria is a genetic disorder that cannot be prevented by the action of folic acid. Down syndrome is a genetic disorder that also cannot be prevented by the action of folic acid. Erythroblastosis fetalis is related to the Rh factor and is not prevented by the action of folic acid.

Which date would be calculated as the expected date of birth (EDB) for a pregnant client who states her last menstrual period began on January 11 and that she also had light spotting on February 7? 1. October 4 2. October 11 3. October 18 4. October 27

3. October 18 Rationale: The EDB is October 18. Use Naegele's rule to calculate the EDB: Add 7 days to the date of the last menstrual period (January 11 + 7 days = January 18); then subtract 3 months (January 18 minus 3 months = October 18). Spotting can occur in the first trimester of pregnancy but is not used for calculation of the estimated date of birth. October 27 is too late. October 4 and October 11 are too early.

Which description explains striae gravidarum encountered in a client in her 26th week of gestation? 1. Brownish blotches on the face 2. Purplish discoloration of the cervix 3. Reddish streaks on the abdomen and breasts 4. A black line running between the umbilicus and mons veneris

3. Reddish streaks on the abdomen and breasts Rationale: Reddish streaks on the abdomen and breasts are striae gravidarum; they occur as a result of stretching of the breast and abdominal skin. These are known as "stretch marks." Chloasma refers to the condition in which brownish blotches develop on the face. Purplish discoloration of the cervix is the Chadwick sign. A black line running between the umbilicus and mons veneris is the linea nigra.

Which type of surgery would be listed on the informed consent for a client with a ruptured ectopic pregnancy being prepared for surgery? 1. Myomectomy 2. Hysterectomy 3. Salpingectomy 4. Oophorectomy

3. Salpingectomy Rationale: The ruptured fallopian tube may be removed (salpingectomy) rather than repaired; repair of the tube may result in scarring, predisposing the client to another tubal pregnancy. Myomectomy is a procedure for removing leiomyomas (fibroids) from the uterus. The uterus is uninvolved in a tubal pregnancy and does not need to be removed (hysterectomy). The ovaries should not be removed (oophorectomy), especially if another pregnancy is desired.

The nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priority during assessment? 1. The family's feelings about the attack 2. The client's feelings of social isolation 3. The client's ability to cope with the situation 4. Disturbance in the client's thought processes

3. The client's ability to cope with the situation Rationale: The situation is so traumatic that the individual may be unable to use past coping behaviors to comprehend what has occurred. Assessing emotions that occur in response to news of the attack will occur later. The client should be the focus of care at this time, not the family. Social isolation is not an immediate concern. Coping skills, not thought processes, are challenged at this time.

A client is to undergo a tuberculin test as part of her prenatal workup. Before administering the test, which information about the client would the nurse obtain? 1. Whether she has had a previous tuberculin test 2. Whether the client is prone to respiratory diseases 3. Whether the result of an earlier tuberculin test was positive 4. Whether the client's family has a history of tuberculosis

3. Whether the result of an earlier tuberculin test was positive Rationale: A tuberculin test should not be administered to a client with a previous positive result on a tuberculin test because a severe reaction may occur at the test site in a previously sensitized individual. It is more important to know whether the test result was positive than whether a test was performed. Being prone to respiratory diseases is not a contraindication to having a tuberculin test unless the client is infected with tuberculosis. Although a family history may have involved exposure of the client to tuberculosis, the client may not have had a positive tuberculin test result; also, many years may have elapsed since the exposure.

A woman who was discharged recently from the hospital after undergoing a hysterectomy calls the clinic and states that she has tenderness, redness, and swelling in her right calf. Which priority action would the nurse instruct the client to take? 1. "Stay in bed for at least 3 days." 2. "Keep the legs elevated while sitting." 3. "Apply a warm compress to the affected calf twice a day." 4. "Go to the emergency department immediately."

4. "Go to the emergency department immediately." Rationale: The client's description of her problem is indicative of thrombophlebitis; this is a medical emergency because it may precipitate a pulmonary embolism. The client must be assessed by a primary health care provider. Intravenous anticoagulants will probably be necessary. Although bed rest may be prescribed eventually, a delay in pharmacological treatment may jeopardize the client's status. Elevation of the legs may be prescribed eventually, after the thrombophlebitis is resolved. Although warm compresses are commonly prescribed, a delay in pharmacological treatment may jeopardize the client's status.

Which client statement leads the nurse to conclude that the client has been experiencing menorrhagia? 1. "It hurts when I have intercourse." 2. "I have a foul-smelling vaginal discharge." 3. "I have bleeding between my menstrual periods." 4. "I have severe bleeding during my menstrual periods."

4. "I have severe bleeding during my menstrual periods." Rationale: 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 seeking advice regarding contraception asks the nurse to explain how an intrauterine device (IUD) prevents pregnancy. How would the nurse respond? 1. "It covers the entrance to the cervical os." 2. "The openings to the fallopian tubes are blocked." 3. "The sperm are kept from reaching the vagina." 4. "It produces a spermicidal intrauterine environment."

4. "It produces a spermicidal intrauterine environment." Rationale: IUDs produce a spermicidal intrauterine environment. A copper IUD inflames the endometrium, damaging or killing sperm and preventing fertilization and/or implantation. A levonorgestrel-releasing IUD damages sperm and causes the endometrium to atrophy, thus preventing fertilization and/implantation. A diaphragm blocks the cervical os. The IUD does not act by blocking the openings to the fallopian tubes. Preventing sperm from reaching the vagina is the function of a condom.

The nurse is reviewing the breast self-examination procedure with a client. Which comment by the client would the nurse consider significant for follow-up? 1. "My breasts feel engorged when I'm having a period." 2. "My breasts feel lumpy right before my period starts." 3. "My left breast has always been a little bigger than my right one." 4. "My right breast feels thicker and seems bigger than the left one."

4. "My right breast feels thicker and seems bigger than the left one." Rationale: Together, lack of symmetry and palpation of a thickening are abnormal findings. Engorgement is an expected response to menstrual hormones. Premenstrual engorgement may cause the breasts to feel lumpy. Having one breast larger than the other is a common deviation that is within acceptable limits.

Which statement accurately describes the current advice regarding breast self-examination (BSE)? 1. BSEs clearly decrease mortality. 2. BSEs prevent unnecessary testing. 3. BSEs should be done immediately before menstruation. 4. BSE should be taught to all women.

4. BSE should be taught to all women. Rationale: It is true that the American Cancer Society and breastcancer.org continue to recommend self-examinations. BSEs do not clearly decrease mortality. Rather than save women from unnecessary testing, they tend to result in unnecessary procedures, including biopsies. It's best to do self-examinations when breasts are not tender or swollen as they often are right before or after menstruation.

An increase in which factor causes urinary frequency in the first trimester of pregnancy? 1. Estrogen level 2. Extracellular fluid volume 3. Kidney glomerular filtration 4. Bladder pressure from the enlarged uterus

4. Bladder pressure from the enlarged uterus Rationale: The anatomical position of the uterus in the pelvis is directly above the urinary bladder; as the uterus enlarges, it exerts pressure on the bladder. After the first trimester, the uterus rises into the abdominal cavity and urinary frequency lessens until late pregnancy, when the descent of the presenting part of the fetus exerts pressure on the bladder and the client would again experience urinary frequency. Estrogen causes fluid retention, not frequency. An increase in extracellular volume does not occur until the second trimester. An increased glomerular filtration rate does not cause urinary frequency.

After the client gives birth, her vital signs are temperature 99.3°F (37.4°C); pulse 80 beats per minute, regular and strong; respirations 16 breaths per minute, slow and even; and blood pressure 148/92 mm Hg. Which vital sign would the nurse check more frequently? 1. Pulse 2. Respirations 3. Temperature 4. Blood pressure

4. Blood pressure Rationale: This blood pressure is elevated. An elevated blood pressure can be indicative of preeclampsia, which can occur in the postpartum period. Careful evaluation would be needed. A pulse of 80 beats per minute is within expected limits. A respiratory rate of 16 breaths per minute is within expected limits. The temperature of 99.3°F (37.4°C) is slightly high but consistent with the physiology of the birthing process.

While admitting a client who is in labor to the birthing unit, the nurse asks the client about her marital status. The client refuses to answer and becomes very agitated, telling the nurse to leave. How would the nurse respond? 1. By questioning the family about the client's marital status 2. By trying to obtain this information to complete the client's history 3. By referring the client to the social service department for counseling 4. By asking questions that are restricted to the client's present situation

4. By asking questions that are restricted to the client's present situation Rationale: The nurse has inadvertently invaded the client's privacy. Although marital status remains on many admission forms, the client's marital status has no bearing on the needs of the client at this time. The nurse would focus on asking questions appropriate for assessment of a client in labor. Questioning the family about the client's marital status or trying to obtain this information to complete the client's history also constitutes an invasion of privacy. There is no indication that the client requires a counseling referral. If the client continues to be upset by the nurse's presence, another nurse would be assigned to care for her.

Which intervention would the nurse recommend when a client reports moodiness and anxiety a few days before her period? 1. Begin ginseng supplementation. 2. Increase foods that are rich in soy. 3. Consult a mental health therapist. 4. Exercise three to four times a week in the luteal phase.

4. Exercise three to four times a week in the luteal phase. Rationale: Regular aerobic exercise, especially in the luteal phase of the menstrual cycle has been found to be very effective for premenstrual syndrome (PMS) and other menstrual symptoms. Ginseng supplementation is not an intervention known to be helpful for PMS. Increasing intake of soy-based foods is recommended for women in menopause to decrease menopausal symptoms. Referral to a mental health therapist generally is not necessary for someone with PMS symptoms.

The nurse is caring for four postpartum clients, each with a different medical condition. Which condition will result in the primary health care provider advising the new mother not to breast-feed? 1. Mastitis 2. Inverted nipples 3. Herpes genitalis 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Breast-feeding by a mother infected with HIV is contraindicated, because breast milk can transmit the virus to the infant. A mother with mastitis would be counseled to continue breast-feeding during treatment for mastitis. Breast-feeding is not contraindicated in a client with inverted nipples. If the infant cannot latch, a breast shield can provide mild suction to help evert the nipples. Breast-feeding is not contraindicated in a client with genital herpes. The newborn may contract the infection during a vaginal birth but not from breast milk.

Which definition would the nurse use to explain osteoporosis? 1. It is avascular necrosis. 2. It is caused by pathological fractures. 3. It is hyperlasia of osteoblasts. 4. It involves a decrease in bone substance.

4. It involves a decrease in bone substance. Rationale: Osteoporosis involves a defect in the bone matrix formation that weakens bones, making them unable to withstand usual functional stresses. Avascular necrosis is the death of bone tissue that results from reduced circulation to bone. Pathological fractures can result from osteoporosis. Hyperplasia of osteoblasts is not related to osteoporosis. This occurs during bone healing.

Which information about nausea and vomiting in the first trimester would the nurse provide to the pregnant client? 1. It is always present during early pregnancy. 2. It will disappear when lightening occurs. 3. It is a common response to an unwanted pregnancy. 4. It may be related to an increased human chorionic gonadotropin level.

4. It may be related to an increased human chorionic gonadotropin level. Rationale: An increased level of human chorionic gonadotropin, or hCG, may cause nausea and vomiting, but the exact reason is unknown. Some pregnant women do not experience nausea and vomiting. Lightening occurs at the end of the third trimester; nausea and vomiting usually cease at the end of the first trimester. Nausea and vomiting are unrelated to whether a pregnancy is desired or unwanted.

Which action would the nurse plan to take with a postpartum client with a negative rubella titer? 1. Checking for allergies to penicillin 2. Alerting the pediatrician 3. Assuring the client that she has active immunity 4. Obtaining a prescription for immunization at discharge

4. Obtaining a prescription for immunization at discharge Rationale: A negative rubella titer indicates no immunity. Immunizations can be given safely during the immediate postpartum period but are teratogenic when given during pregnancy. Penicillin allergy is not a contraindication to the vaccine. The mother's negative rubella titer does not affect the infant. A client with a negative titer has no immunity to rubella.

Which dietary instruction would the nurse provide to the pregnant client who is a strict vegan? 1. Eat at least 40 g/day of protein. 2. Drink at least 1 qt/day of milk. 3. Take an iron supplement every day. 4. Plan to eat from specific groups of vegetable proteins each day.

4. Plan to eat from specific groups of vegetable proteins each day. Rationale: A variety of incomplete proteins (vegetable proteins) can be combined to provide all of the essential amino acids. The pregnant client should eat at least 71 g/day of protein. Vegans do not drink milk. An iron supplement would not necessarily be indicated based on the information provided in the question. If the client were determined to be anemic, an iron supplement and high-iron foods would be needed.

Which sexually transmitted infection is caused by protozoa? 1. Scabies 2. Chancroid 3. Pediculosis 4. Trichomoniasis

4. Trichomoniasis Rationale: Trichomoniasis is caused by protozoa. A parasite causes scabies. Bacteria cause chancroid. A parasite also causes pediculosis.

Which information regarding risks that may result from an untreated chlamydia infection would the nurse include when providing education for a female client? Select all that apply. One, some, or all responses may be correct. 1. Sterility 2. Ectopic pregnancy 3. Blocked Fallopian tubes 4. Pelvic inflammatory disease 5. Increased likelihood of HIV infection

ANS: 1, 2, 3, 4, 5 Rationale: Untreated chlamydia can result in sterility in both women and men, an increased risk for ectopic pregnancy, blocked Fallopian tubes, pelvic inflammatory disease, and a five-time greater risk for contracting HIV infection.

Which cause may produce abnormal uterine bleeding? Select all that apply. One, some, or all responses may be correct. 1. Hypothyroidism 2. Failure to ovulate 3. Bleeding disorders 4. Unidentified pregnancy 5. Use of oral contraceptives 6. Benign lesions of the uterus

ANS: 1, 2, 3, 4, 5, 6 Common causes for any type of abnormal uterine bleeding include endocrine disorders like hypothyroidism; failure to ovulate or respond appropriately to ovulation hormones; bleeding disorders; pregnancy complications such as an unidentified pregnancy that is ending in spontaneous abortion; breakthrough bleeding, which may occur in the woman taking oral contraceptives; and lesions of the vagina, cervix, or uterus (benign or malignant).

Which statements accurately describe alcohol consumption by women in America? Select all that apply. One, some, or all responses may be correct. 1. Women between the ages of 35 and 49 have the highest rates of chronic alcoholism. 2. A 2020 national health objective is to have 98.3% of pregnant women abstain from alcohol use. 3. If a woman stops drinking by day 50 of pregnancy, the infant will usually be unaffected. 4. Women between the ages of 21 and 34 have the highest rates of specific alcohol-related problems. 5. Women who are problem drinkers are often depressed, have more motor vehicle injuries, and have a higher incidence of attempted suicide.

ANS: 1, 2, 4, 5 Rationale: Women between the ages of 35 and 49 have the highest rates of chronic alcoholism, and women between the ages of 21 and 34 have the highest rates of specific alcohol-related problems. Women who are problem drinkers are often depressed, have more motor vehicle injuries, and have a higher incidence of attempted suicide. A 2020 national health objective is to have 98.3% of pregnant women abstain from alcohol use, because prenatal alcohol exposure increases the chance of birth defects up to fourfold. Severe facial deformities can occur at day 20 of conception, before many women even know that they are pregnant.

Which exercises would the nurse teach the client that she may have perform on the first postoperative day after cesarean section? Select all that apply. One, some, or all responses may be correct. 1. Leg bends 2. Foot circles 3. Pelvic rocking 4. Shoulder circles 5. Deep breathing 6. Kegels

ANS: 1, 2, 4, 5, 6 Rationale: Leg bends promote circulation in the lower extremities and help alleviate gas pains. Foot circles promote circulation in the lower extremities. Shoulder circles relieve neck stiffness and tension that may be present in the postpartum period. Deep breathing helps keep lungs expanded during postoperative recovery. Beginning kegels exercises as soon as the urinary catheter is removed on the first postoperative day helps strengthen pelvic musculature that may have been strained during pregnancy. Pelvic rocking on the first postoperative day could be painful and might traumatize the wound site. It would not be recommended.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply

Answer Pale mucous membranes, Difficulty emptying the bladder Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.

Which symptom indicates pelvic inflammatory disease? Select all that apply. 1. Fever 2. Elevated erythrocyte sedimentation rate (ESR) 3. Chronic pelvic pain 4. Irregular vaginal bleeding 5. Abnormal vaginal discharge 6. Bilateral adnexal tenderness

ANS: 1, 2, 3, 4, 5, 6 Rationale: Fever, elevated ESR and C-reactive protein, chronic pelvic pain, irregular vaginal bleeding, abnormal vaginal discharge, and bilateral adnexal tenderness are all symptoms of pelvic inflammatory disease, an infection of the upper reproductive tract.

Which response would the nurse give to the older female client diagnosed with a cystocele who is reluctant to have surgical repair of the condition? 1. "You should have the surgery done, although it is not harmful to avoid surgery." 2. "Depending on the degree of the cystocele, there may be other options." 3. "You are risking bowel obstruction if you do not do the surgery." 4. "You are risking kidney failure if you do not do the surgery."

2. "Depending on the degree of the cystocele, there may be other options." Rationale: A cystocele is a herniation of the bladder through the vaginal wall resulting from weakened pelvic structures. A cystocele is designated as grade 1, 2, or 3 depending on the severity of the prolapse. With mild cystocele, the client may benefit from Kegel exercises, and even with moderate cystocele, a pessary device may be used in a client wishing to avoid surgery. With severe cystocele (grade 3), surgery may be the best option. At this stage, the herniated bladder does not empty effectively, and urinary stasis, chronic infection, and renal damage may result. It would be incorrect to tell the client to have the surgery while stating that there is no harm in avoiding the surgery. Bowel obstruction is a complication of a rectocele, not a cystocele. It would not be correct to tell the client she is risking kidney failure until the degree of cystocele is determined.

Which instruction would the nurse include in the postoperative teaching for a client who has undergone laparoscopic surgery for a benign ovarian tumor? 1. "Resume usual activities after 12 hours." 2. "Expect shoulder pain for 12 to 24 hours." 3. "Douche with povidone-iodine twice a day." 4. "Report vaginal spotting that occurs during the first 3 days after the surgery."

2. "Expect shoulder pain for 12 to 24 hours." Rationale: Postoperative teaching should include instructing the client to expect shoulder pain, caused by the insufflated carbon dioxide, which presses on the diaphragm for 12 to 24 hours. This occurs more frequently when the client's head is elevated too soon after surgery. Usual activities should not be resumed until 2 to 3 days after surgery; the client should undertake no heavy lifting or strenuous exercise for 4 to 7 days. There is no need to douche with povidone-iodine after the surgery. Vaginal spotting may occur but is benign. Frank bleeding should be reported.

A client gives birth to a healthy girl. Her husband expresses delight but appears anxious and tends to avoid physical contact with his newborn. Later he says to the nurse, "My wife seems so wrapped up in the baby—I hope she has time for me." Which response would the nurse provide? 1. "Your parents may be able to help you and your spouse." 2. "You feel that you'll have to fend for yourself. Tell me more about your concerns." 3. "Your concern about future adjustments in your life is valid." 4. "You'll both be so busy that you won't even miss her attention."

2. "You feel that you'll have to fend for yourself. Tell me more about your concerns." Rationale: Stating that the father feels that he'll have to fend for himself identifies the husband's concern and invites the husband to further explore his feelings. There is not enough information for the nurse to offer a specific suggestion for help. Stating that the husband's concern about future adjustments in his life is valid is a value judgment. Also, it does not invite exploration of feelings. Stating that they will both be so busy that the father won't even miss his wife's attention may compound the anxiety; also, it does not permit the exploration of feelings.

A client at the fertility clinic is being treated for hypertension and obesity and has lost 8 lb (3.6 kg) in the past month, and her blood pressure has decreased to 154/98 mmHg. She states she is using self-control strategies to achieve these improvements. Which would be a therapeutic response by the nurse? 1. Explaining to the client that her current program needs revision to improve results 2. Acknowledging the client's achievement while encouraging continuation of her current program 3. Emphasizing to the client the importance of exercise in addition to reduced sodium and caloric intake 4. Recommending that the client ask her health care practitioner about a prescription for an antihypertensive or a diuretic

2. Acknowledging the client's achievement while encouraging continuation of her current program Rationale: Acknowledging the client's achievement while encouraging continuation of her current program recognizes achievement and reinforces the client's behavior. Explaining to the client that her current program needs revision to improve results focuses on the negative rather than the positive; small gains should be reinforced. Emphasizing to the client the importance of exercising in addition to reducing sodium and caloric intake implies that the client is not doing enough; the focus should be on the positive, and the gains should be reinforced. The client may need an antihypertensive medication because her blood pressure is still elevated, and that would require discussion and consultation with her health care provider, but focusing on that rather than on her successes would not be a therapeutic response.

When speaking with the nurse, the husband of a couple who wants to start a family says, "Well, I guess we're going to have to jump into bed 3 or 4 times a day, every day, until it works." Which response would the nurse provide? 1. Telling them to continue intercourse as usual until conception occurs 2. Instructing them in the optimal frequency and timing of intercourse to promote conception 3. Discouraging this because sperm production decreases with frequent sexual intercourse 4. Agreeing that the frequency of intercourse must increase but twice daily is sufficient to promote conception

2. Instructing them in the optimal frequency and timing of intercourse to promote conception Rationale: Instructing the couple to have intercourse 3 to 4 times a week (the optimal frequency) will increase the chance of conception and will correct the client's misconceptions in a nonthreatening manner. Telling the couple to continue intercourse as usual until conception occurs is too vague; specific instructions should be given in a nonthreatening manner. To openly discourage the partner without providing instruction may be harmful to the relationship between the couple themselves or the couple and the nurse. Twice-daily intercourse is too frequent because it does not allow enough time between ejaculations for adequate spermatogenesis.

A pregnant client tells the nurse that she has two toddlers at home and that their father abandoned the family last month and she doesn't know what to do. Which conclusion would the nurse make about the client's emotional state? 1. She is angry that the father has left. 2. She feels overwhelmed by the situation. 3. She is expressing ambivalence about her pregnancy. 4. She is denying the reality of her pregnancy.

2. She feels overwhelmed by the situation. Rationale: Because of the difficult home situation, this client is experiencing multiple stressors that could cause difficulty with coping. The client also directly tells the nurse that she doesn't know what to do, suggesting that she is overwhelmed with her situation. There is no information to support the conclusion that the client is angry or that she is ambivalent about the pregnancy. The client is attending the prenatal clinic, which indicates that she is aware of reality and is not in denial.

A client who is at 28 weeks' gestation and in active labor is crying. She says, "I just know that this baby is going to die. What's the use of doing all this to save it?" Which explanation would interpret the client's statements? 1. She is depressed and needs firm, positive support during labor. 2. She is experiencing anticipatory grief and withdrawing from bonding. 3. She is in need of sedation to help her cope with the impending birth. 4. She is demonstrating difficulty dealing with the birth by using the word "it."

2. She is experiencing anticipatory grief and withdrawing from bonding. Rationale: Anticipatory grief is expected with a potential loss; expression of feelings should be encouraged. The loss may not be a literal loss or death of the baby, but the loss of an anticipated full-term healthy baby who would go home from the hospital with her. She may be grieving this, and not ready to bond with the new reality of a fragile preterm baby. Gentle, not firm, support is required to help the client cope with potential grieving; maintaining a positive attitude may serve to provide false reassurance. Sedation would delay the client's adaptation to the possible loss; it is more desirable to allow the client to give voice to her feelings and work through the anticipatory grieving process. The use of the word "it" is not relevant; this refers to the fetus and is an expression of the grieving process.

After giving birth to her third child, a client tearfully says to the nurse, "How much more can I give of myself?" Which principle would the nurse consider in the care of any new mother? 1. It is easier to adjust to the first child than to later ones. 2. Feeling anger and resentment toward a child is pathological. 3. Some parents experience feelings of being overwhelmed by multiple children. 4. Parents usually have inborn feelings of love and acceptance of their children.

3. Some parents experience feelings of being overwhelmed by multiple children. Rationale: A parent's feeling of being overwhelmed by multiple children is a normal response. It is vital to help parents realize this as a means of easing feelings of guilt and shame. The first child causes the greatest amount of adjustment in one's life. Anger and resentment toward one's child are expected feelings. Stating that parents usually have inborn feelings of love and acceptance of their children is a false generalization.

Which plan of care would the nurse encourage for the parents who have had an at-risk infant who is in the neonatal intensive care unit? 1. The parents should be encouraged to visit their newborn within a day of birth. 2. The mother should not see the infant until she has completed the necessary grief work. 3. The mother should be reunited with her infant as soon as possible to enhance adjustment. 4. The nurse would wait until the parents ask to see their newborn before suggesting a visit.

3. The mother should be reunited with her infant as soon as possible to enhance adjustment. Rationale: The mother should be reunited with her newborn at the first opportunity after she is emotionally prepared. There is no magic about the first 24 hours; some mothers are too ill or both parents may be too frightened to see their baby that soon. Grief work will go on for an extended period and has no relationship to when the infant is seen. Some parents may be too frightened to ask to see their baby; the nurse can prepare the parents and then suggest a visit.

Which exercise would the nurse teach the pregnant client to increase the tone of the muscles of the pelvic floor? 1. Pelvic tilt 2. Half sit-ups 3. Pelvic rocking 4. Kegel exercises

4. Kegel exercises Rationale: Kegel exercises increase the tone of pelvic floor muscles and prepare the area for the second stage of labor. Pelvic tilting alleviates backache and strengthens the abdominal muscles, not the muscles of the pelvic floor. Half sit-ups strengthen the abdominal musculature, not the muscles of the pelvic floor. Pelvic rocking alleviates backache and strengthens abdominal muscles, not the muscles of the pelvic floor.

Which assessment finding would the nurse question for a client who is considering oral contraceptives? Select all that apply. 1. Blood clots 2. Heart disease 3. Breast cancer 4. Impaired liver function 5. Undiagnosed vaginal bleeding 6. Smoking more than 15 cigarettes per day

ANS: 1, 2, 3, 4, 5, 6 Rationale: Women with the following disorders should not take oral contraceptives or should use them with caution: thromboembolic disorders like blood clots, cerebrovascular accident, or heart disease; estrogen-dependent cancer or breast cancer; impaired liver function; confirmed or possible pregnancy; undiagnosed vaginal bleeding; a smoking pattern of more than 15 cigarettes per day for women older than 35 years (the pill is safe for women older than 35 years if they do not smoke). However, smoking increases the chance of experiencing complications in all age groups.

Which action would the nurse include in the plan of care for a client who is being treated for a sexually transmitted infection and reports fever and irregular bleeding? Select all that apply. One, some, or all responses may be correct. 1. The use of analgesics 2. Abdominal palpation 3. Complete blood count 4. Culture of the cervical canal 5. Administration of antibiotics as prescribed 6. Teaching about negative effects of douching

ANS: 1, 2, 3, 4, 5, 6 Sexually transmitted infection is a common cause of pelvic inflammatory disease (PID). Symptoms include fever, chronic pelvic pain, abnormal vaginal discharge, nausea and anorexia, and irregular vaginal bleeding. Analgesics may be needed to provide for patient comfort. Palpation of the abdomen and pelvic organs may reveal tenderness. A complete blood count may reveal elevated leukocytes and sedimentation rate. Cultures of the cervical canal are done to identify the infecting organism, which most commonly is Neisseria gonorrhoeae or Chlamydia trachomatis. Urinalysis is usually done to identify infection of the urinary tract. Antimicrobials are begun promptly to treat the infection. Douching results in changes in the vaginal flora and predisposes the woman to the development of PID, bacterial vaginosis, and ectopic pregnancy.

A client who is to undergo dilation and curettage and conization of the cervix for cancer appears tense and anxious. Which approach would the nurse use to support the client emotionally? 1. Explaining that these procedures are considered minor surgery 2. Asking whether something is troubling the client and whether she'd like to talk about it 3. Stating that the procedures are routine and asking what the client is really worried about 4. Explaining that everyone is fearful before the surgery even though there is little reason to worry

2. Asking whether something is troubling the client and whether she'd like to talk about it Rationale: Asking whether the client wants to talk about what may be troubling her acknowledges that the client is anxious and, by means of indirect questioning, helps facilitate communication. Saying that these procedures are considered minor surgery denies the client's feelings. The client has not indicated that she is worried, and she may be unaware of or unable to verbalize the actual cause of the emotions. Saying that there is little reason to worry is false reassurance and cuts off communication.

A client presents to the clinic with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy? 1. Her menses is a week late. 2. Her urine immunoassay test is positive. 3. She reports that she has urinary frequency. 4. She complains that she has nausea every morning.

2. Her urine immunoassay test is positive. Rationale: A positive result on a urine pregnancy test is a probable sign of pregnancy because the test, based on the presence of human chorionic gonadotropin (hCG) in the urine, is close to 99% accurate in detecting pregnancy when done 1 week after missed menses. Menses a week late is a presumptive sign of pregnancy; there are many other causes of amenorrhea. Urinary frequency is a presumptive sign of pregnancy; there are other causes of frequency, such as urinary tract infection. Nausea each morning, which may occur during the first trimester because of the secretion of hCG, is a presumptive sign of pregnancy; there are many causes of nausea other than the hormones secreted during early pregnancy.

The nurse plans to delegate some of the tasks for the discharge of a postpartum client to an unlicensed health care worker. Which activity must be performed by the nurse? 1. Taking the neonate's picture 2. Calling to arrange the client's postpartum appointment 3. Comparing the identification bands of mother and infant 4. Preparing the discharge packets and disturbing them to the parents

3. Comparing the identification bands of mother and infant Rationale: It is the nurse's professional responsibility to compare the mother's and infant's identification bands one last time before discharge. This ensures that the correct infant is discharged with the mother. Taking the neonate's picture, arranging the client's postpartum appointment, and preparing the discharge packets and distributing them to parents are all within the role of the nursing assistant and may be delegated safely.

Which information would the nurse provide to the breast-feeding client asking how human milk compares with cow's milk? 1. Lactose content is higher in cow's milk than in human milk. 2. Protein content in human milk is higher than in cow's milk. 3. Fat in human milk is easier to digest and absorb than the fat in cow's milk. 4. Immunological and antiallergenic factors found in human milk are now added to cow's milk.

3. Fat in human milk is easier to digest and absorb than the fat in cow's milk. Rationale: Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Also, human milk is not heat treated, as is cow's milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow's milk; however, it is easier for human beings to digest. Human immunological and antiallergenic factors are found only in human milk, not in cow's milk.

Which action involving client needs would the nurse delegate to an unlicensed health care worker? 1. Assessing a newly admitted client's contraction pattern 2. Discussing pain management options with a laboring client 3. Providing ice chips to a primigravida in early labor per the primary health care provider's prescription 4. Obtaining a sterile urine specimen for a suspected urinary tract infection

3. Providing ice chips to a primigravida in early labor per the primary health care provider's prescription Rationale: Providing ice chips to a primigravida in early labor per the primary health care provider's prescription does not require clinical knowledge or judgment for safe, effective care. Assessment, discussion of alternative actions, and the use of sterile techniques during an invasive procedure all require clinical knowledge and judgment beyond the scope of practice of an unlicensed health care provider.

The nurse teaches a postpartum client how to care for her episiotomy at home. Which statement indicates to the nurse that the client understands the priority instruction? 1. "I should discontinue the anti-inflammatories once I'm home." 2. "I mustn't climb up or down stairs for at least 3 days after discharge." 3. "I should discontinue the sitz baths after 3 days." 4. "I need to continue perineal care after I go to the bathroom until everything is healed."

4. "I need to continue perineal care after I go to the bathroom until everything is healed." Rationale: Prevention of infection—in this case, perineal care—is the priority. Anti-inflammatory medication such as ibuprofen may be continued. Stair climbing may cause some discomfort but is not detrimental to healing. It is not necessary to stop sitz baths as long as they provide comfort.

After a speculum examination in the first trimester of pregnancy, the nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. Which explanation of this sign would the nurse provide? 1. "It helps confirm your pregnancy." 2. "It is not unusual, even in women who are not pregnant." 3. "It occurs because the blood is trapped by the pregnant uterus." 4. "It is caused by increased blood flow to the uterus during pregnancy."

4. "It is caused by increased blood flow to the uterus during pregnancy." Rationale: Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected. Stating that the Chadwick sign helps confirm pregnancy answers part of the question, but fails to explain why it occurs. The Chadwick sign is a probable sign of pregnancy; it is not seen in nonpregnant women. There is no free blood circulating in the uterus during pregnancy.

On the third postpartum day after an unexpected cesarean birth, the nurse finds the client crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" Which information would the nurse consider when responding? 1. The client's feelings will pass after she has bonded with her infant. 2. The client is probably suffering from postpartum depression and needs special care. 3. A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. 4. A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

4. A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. Rationale: The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. Her self-concept may be negatively affected by these factors. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.

Which signs or symptoms would the nurse expect the client admitted for repair of a cystocele and rectocele to report? 1. White vaginal discharge and itching 2. Sporadic bleeding and abdominal pain 3. Increased temperature and intractable diarrhea 4. Stress incontinence and low abdominal pressure

4. Stress incontinence and low abdominal pressure As the uterus drops, the vaginal wall relaxes. When the bladder herniates into the vagina (cystocele) and the rectal wall herniates into the vagina (rectocele), the individual feels pressure or pain in the lower back and/or pelvis. When there is an increase in intraabdominal pressure in the presence of a cystocele, incontinence results. A white vaginal discharge (leukorrhea) and vaginal itching (pruritus) do not indicate cystocele and rectocele; they are common with a vaginal infection. Sporadic bleeding is not expected with cystocele and rectocele. Increased temperature and intractable diarrhea are not expected with cystocele and rectocele; a fever would indicate an infection; constipation, not diarrhea, is more likely to occur.

The nutrition interview of an adolescent client at 10 weeks' gestation indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Which reason indicates why this diet is inadequate? 1. The caloric content will result in too great a weight gain. 2. The ingredients in soft drinks and candy can be teratogenic during early pregnancy. 3. The salt in this diet will contribute to the development of gestational hypertension. 4. The nutritional composition of the diet places herself and the fetus at risk.

4. The nutritional composition of the diet places herself and the fetus at risk. Rationale: The primary problem with the diet is that it does not reflect a healthy balance of foods and nutrients, especially protein; adequate nutrition is necessary for the birth of a healthy full-term infant whose weight is appropriate for gestational age. The adolescent client herself needs a well-balanced diet to meet her own nutritional requirements. The caloric content of these foods may not be high if small amounts are consumed; in addition, this client's weight gain may not be reflective of an adequate weight gain in the developing fetus. No data are available to support the assertion that the ingredients of candy and soft drinks are teratogenic. Unrestricted salt intake does not contribute to the development of gestational hypertension.