EXAM 1 ( CH 1,2,3,4,7,8)

Pelvic midplane diameters

transverse midplane normally is the largest plane and has the longest diameter

vaginitis: caused by which micros?

• Bacterial vaginosis • Candidiasis • Trichomoniasis • Strep B = normal flora → infection

what is the most common STI in America? why is it hard to diagnose?

chlamydia nonspecific symptoms expensive to culture

Nursing Diagoses

- Decisional conflict - fear - risk for infection - ineffective sexuality patterns - acute pain - risk for spiritual distress

Chlamydia bacteria

chlamydia trachomatis drug: azithromycin 1 g once orally or doxycicline 10 mg orally for 7 days ( amoxicillin for pregnant and lactating)

cultural competence

"Approach that involves acknowledging, respecting, and appreciating ethnic, cultural, and linguistic diversity."

married parent

"Family structure composed of biologic or adoptive married parents and their children."

Cervical Mucus Ovulation Detection Method

- women recognize and interpret cyclic changed in the amount and consistency of cervical mucus that characterizes her own pattern of changes at time of ovulation - cervical mucus transforms prior to and during ovulation in order to facilitate and promote viability and motility of sperm - intercourse safe without restrictions: beginning fourth day after last day of wet,clear,slippery mucus: indicated ovulation occurred 2-3 days previously

factors of maternal death

- younger than 20 and older than 35 - lack of prenatal care - low educational attainment - unmarried status - non-causasian race

Common Menstrual Disorders

-Amenorrhea -Dysmenorrhea -Premenstrual syndrome (PMS) -menorrhagia metrorhagia -Endometriosis

"X-linked dominant inheritance"

Form of inheritance that mimics autosomal dominant inheritance, except that male-to-male transmission cannot occur unless the father has Klinefelter syndrome due to XY disomy.

studies ranks

1. beneficial forms of care 2. forms of care that are likely to be beneficial 3. form of care with a trade-off between beneficial and adverse effects 4. forms of care with unknown effectiveness 5. forms of care that are unlikely to be beneficial 6. forms of care that are likely to be ineffective of harmful

A client complaining of secondary amenorrhea is seeking care from her gynecologist. Which of the following may have contributed to her problem? 1. Athletic activities. 2. Vaccination history. 3. Pet ownership. 4. History of asthma.

1. If the young woman exercises excessively—for example, as a competi- tive gymnast or runner—her body fat index will be so low she will become amenorrheic.

components of failure to rescue

1. careful surveillance and identification of complications 2. quick action to initiate appropriate intervention and activate a team response

health damaging hazards

1 pathogenic - viruses, bacteria, fungi 2. natural and synthetic chemicals ( natural toxins, insects, plants) 3. radiation ( heat waves, sound waves) 4. food substances ( added components) 5. physical objects ( moving vehicles, machinery, weapons) affect fertility, fetal development, live birth, child's future mental and physical development

During a genetic evaluation, it is discovered that the woman is carrying one autosomal dominant gene for a serious late adult-onset disease, while her partner's history is unremarkable. Based on this information, which of the following family members should be considered high risk and in need of genetic counseling? Select all that apply. 1. The woman's fetus. 2. The woman's sisters. 3. The woman's brothers. 4. The woman's parents. 5. The woman's partner.

1, 2, 3, and 4 are correct. 1. The woman's fetus has a 1 in 2, or 50%, probability of having the gene. 2. The woman's sisters have a 1 in 2, or 50%, probability of having the gene. 3. The woman's brothers have a 1 in 2, or 50%, probability of having the gene. 4. One of the woman's parents definitely has the gene. Since the age of onset can be as late as age 50, the parents' symptoms may not yet have appeared. 5. It is unlikely that the woman's partner has the gene.

Which female anatomical structure protects the labia minora? Clitoris Perineum Mons pubis Labia majora

Labia majora The labia majora are fleshy folds of tissue that protect the fragile tissues of the external female genitalia, including the labia minora

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply) A. Anger at others who have babies B. Feeling of failure because they can't make a baby C. Sexual excitement because they want so desperately to conceive a baby D. Sadness because of the perceived loss of being a parent E. Guilt on the part of one partner because he or she is not able to give the other a baby

1,2,4,5 - Infertility clients often express anger at others who are able to conceive. - Infertility clients often express a feeling of personal failure. - Sadness is another common feeling expressed by infertility clients. - Guilt is commonly expressed by infertility clients.

evaluation for contraception

1- woman's reproductive history - physical examination - current lab tests - woman's knowledge about contraception, reproduction and STI - partner's commitment - religious and cultural factors

how long do HIV tests usually take to get results?

1-3 weeks waiting period = anxious

Healthy people goals

1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.

united nations millennium Development Goals

1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

The nurse is creating a pedigree from a client's family history. Which of the following symbols should the nurse use to represent a female? 1. Circle. 2. Square. 3. Triangle. 4. Diamond.

1. The circle is the symbol used to represent the female

A 54-year-old client calls her health care practitioner complaining of frequency and burning when she urinates. Which of the following factors that occurred within the preceding 3 days likely contributed to this client's problem? 1. She had intercourse with her partner. 2. She returned from a trip abroad. 3. She stopped taking hormone replacement therapy. 4. She started a weight-lifting exercise program.

1. The fact that the client had intercourse in the last 3 days likely led to the symptoms she is reporting, which are symptoms of a urinary tract infection (UTI).

emergency after abortion

1. chills 2. fever more than 38C (100.4F) 3. bleeding greater than 2 saturated pads in 2 hours or heavy bleeding lasting a few days 4. foul smelling vaginal discharge 5. severe abdominal pain, cramping, backache 6. abdominal tenderness ( when pressure applied)

A woman, whose menstrual cycle is 35 days long, states that she often has a slight pain on one side of her lower abdomen on day 21 of her cycle. She wonders whether she has ovarian cancer. Which of the following is the nurse's best response? 1. "Women often feel a slight twinge when ovulation occurs." 2. "You should seek medical attention as soon as possible since ovarian cancer is definitely a possibility." 3. "Ovarian cancer is unlikely because the pain is not a constant pain." 4. "It is more likely that such pain indicates an ovarian cyst because pain is more common with that problem."

1. This statement is true and the discom- fort, at the location of the ovary where ovulation occurs, is called mittelschmerz. Ovulation usually occurs 14 days before the first day of the menses.

It is day 17 of a woman's menstrual cycle. She is complaining of breast tenderness and pain in her lower left quadrant. The woman states that her cycle is usually 31 days long. Which of the following is an appropriate reply by the nurse? 1. "You are probably ovulating." 2. "Your hormone levels should be checked." 3. "You will probably menstruate early." 4. "Your breast changes are a worrisome sign."

1. This statement is true. Breast tender- ness and mittelschmerz often occur at the time of ovulation.

health risk to women

1. age (teen pregnancy, parenthood after 35) 2. social, cultural, economic and genetic factors 3. substance use and abuse (alcohol, tobacco, caffeine, prescription and illicit drugs) 4. nutritional deficiencies 5. lack of exercise 6. stress 7. depression, anxiety and other mental health conditions 8. sleep disorders 9. environmental and workplace hazards 10. sexual practices 11. medical conditions 12. genital mutilation 13. violence against women

team STEPPS phases

1. assess the need 2. plan, train, and implement the TeamSTEPPS initiative 3. sustain the improvements in performance, processes, and outcomes that result from the initiative

most common STI in women

1. bacteria (chlamydia, gonorrhea, syphilis, chancroid, venerium) 2. viruses (HP, herpes simplex type 2, HIV, viral hepatitis types A and B) 3. protozoa ( trichomoniasis) 4 parasites (pediculosis, scabies)

who and when should be screened for gonorrhea?

Screen all women at risk - asymptomatic Pregnant: • Screened first prenatal visit • Infected and not infected with high risks → rescreened at 36 weeks Coinfection common - also test for chlamydia and syphilis

SCOFF questions to ask a patient with an eating disorder

1. do you make yourself SICK because you feel too full? 2. Do you worry about loss of CONTROL over the amount you eat? 3. have you recently lost more than ONE stone ( 6.4 kg) in 3 months? 4. do you think you are too FAT even if other think you are too thin? 5. Does FOOD dominate your life?

barriers to entering the health care system

1. financial issues 2. cultural issues 3. gender issues

menstrual cycle phases

1. follicular phase 2. ovulation 3. luteal phase 4. menstruation

factors affecting contraceptives

1. frequency of intercourse 2. motivation to prevent pregnancy 3. understanding of how to use the method 4. adherence to method 5. provision of short oblong term protection 6. likelihood of pregnancy for the individual women 7. consistent use of method

top 10 leading causes of death in women in the US

1. heart disease 2. malignant neoplasm 3. cardiovasculardisease (stroke) 4. chronic lower respiratory disease 5. alzheimers disease 6. unintentional injury 7. diabetes milletus 8. flu and pneumonia 9. nephritis 10 septicemia

Problems with the US Health Care system

1. is often fragmented and expensive and is inaccessible to many 2. medical errors are a leading cause of death in the US. as a result Medicaid and Medicare refuse to pay for 8 hospital acquired conditions 3. high cost of health care - not all insurances cover nurse practitioners and clinical nurse specialists 4. inability to pay 5. lack of transportation and dependent child care - barriers 6. lack of providers for low income women

When a nurse is teaching a woman about her menstrual cycle, which of the following is the most important change that happens during the follicular phase of the menstrual cycle? 1. Maturation of the graafian follicle. 2. Multiplication of the fimbriae. 3. Secretion of human chorionic gonadotropin. 4. Proliferation of the endometrium.

1.FSH is elevated during the follicular phase and the graafian follicle matures.

signs of potential complications oral contraceptives

ACHES - A= abdominal pain (liver/gallbladder) - C= chest pain or shortness of breath (clot problem in lungs or heart - H= headaches (cardiovascular accident or hypertension - E= eye problems (vascular accident or hypertension) - S= Severe leg pain (thromboembolic process)

what are the AE of metronidazole - used to treat bacterial vaginosis?

AE: numerable • Sharp, unpleasant metallic taste in mouth • Furry tongue • CNS reactions • Urinary tract disturbances

period of critical fetal organ development

17-56 days after fertilization

Hearing testing

18-49 every 10 years after 50 yo every 3 years annually if working with explosives

first US program for prenatal nursing care established

1906

condoms became legal

1918

pap test introduced

1941

Apgar scoring system of neonatal assessment

1953

birth control pill introduced in the US

1960

rubella vaccine available

1968

mammogramm available

1969

abortion legalized

1973

Montgomery tubercles

Sebaceous glands under the skin called Montgomery tubercles that secrete a fatty substance thought to lubricate the nipple

Tail of Spence

Segment of mammary tissue that extends into the axilla.

GeneReviews

collection of expert-authored, peer reviewed sides descriptions presented in a standardized format and focused on clinically relevant and medically actionable information on the diseases, management and genetic counseling

Symptothermal Method

combines BBT and cervical mucus methods with awareness of secondary phase: related signs and symptoms of menstrual cycle

disparities are results of

complex interactions among biologic factors envitronment health behaviors education income

jadelle

2 rod subdermal levonorgestrel implant

Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tests the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? (Select all that apply) A. Women who have menstrual cycles that are up to 30 days long B. Women who experience pain during intercourse C. Women who have had pelvic inflammatory disease D. Women who have excess facial hair E. Women who have menstrual periods that are over 5 days long

2,3,4 - Dyspareunia, or pain during intercourse, may be a symptom of a sexually transmitted infection (STI) or of endometriosis. Both STIs or of endometriosis can adversely affect a woman's fertility. - A woman who has had pelvic inflammatory disease (PID) is much more likely to have blocked fallopian tubes than a woman who has never had PID. - Women who have facial hair (hirsutism) often have polycystic ovarian syndrome (PCOS). PCOS patients frequently have irregular menses, elevated serum cholesterol, and insulin resistance. Women with PCOS are often infertile.

A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? (Select all that apply) A. Chorionic villus sampling B. Endometrial biopsy C. Hysterosalpingogram D. Serum progesterone assay E. Postcoital test

2,3,4,5 - Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. - Hysterosalpingogram is performed after menstruation to detect whether or not the fallopian tubes are patent. - Serum progesterone assay is performed about 1 week following ovulation to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. - Postcoital tests are performed about 1 to 2 days before ovulation to determine whether healthy sperm are able to survive in the cervical mucus.

jarisch-Herxheimer reaction

complication of Penicillin G (used to treat syphilis) acute febrile reaction = headache, myalgia, arthralgia develop within 24 hours of treatment analgesics and antipyretics if reaction in second half of pregnancy --> preterm labor and birth

A woman's temperature has just risen 0.4°F and will remain elevated during the remainder of her cycle. She expects to menstruate in about 2 weeks. Which of the following hormones is responsible for the change? 1. Estrogen. 2. Progesterone. 3. Luteinizing hormone (LH). 4. Follicle-stimulating hormone (FSH).

2. Progesterone elevation occurs after ovulation and spikes at about 5-6 days after ovulation. Progesterone is thermogenic—that is, heat producing. Progesterone is the reason women's temperatures are elevated following ovulation.

intergrate into all health histories

comprehensive sexual assessment

asian american view on newborn

concept of family is important father is head of the household birth of boy preferred may delay naming child some believe colostrum is dirty (vietnamese), so will postpone breastfeeding

obesity of mom

20% of women who give birth and 1/3 (36.2%) of women in US are obese most common maternal risk factors - hypertension associated with pregnancy and diabetes ( associated with obesity) obesity causes - decreased fertility, congenital anomalies, miscarriage, fetal death as well as increased health care services and longer hospital stay

nonoxynol-9 based spermicides

concern for potential cervicovaginal epithelial disruption vaginally applied chemical barriers - dual protection against bacterial STIs and contraceptives do NOT protect against cervical gonorrhea and chlamydia or HIV

human papillomavirus

condylomata acuminate genital warts 40 serotypes that can be transmitted sexually - 5 forms genital wart formtation - 8 have oncogeneic potential types 16 and 18 --> cervical cancer

leading cause of death in neonatal

congenital anomalies other causes - short gestation - lbw - SID - respiratory distress syndrome - effects of maternam complications

herpes simplex fetal effects

congenital infection (rare)

transdermal contraceptive method

contraceptive form that delivers continuous levels of norelgestromin and ethinyl estradiol; a patch is applied to intact skin of the upper outer arm, upper torso, the lower abdomen, or buttocks on the same day once a week for 3 weeks followed by a week without the patch

unifactorial inheritance

controlled by a single gene - autosomal dominant - autosomal recessive - x-linked dominant and recessive

how is syphilis transmitted?

entry in subcutaneous tissue through abrasions that can occur during sexual intercourse • Kissing, biting, oral-genital sex • Transplacental transmission occurs duing pregnancy • Risk related to quantity of spirochetes in maternal bloodstream

what are the three ways to acquire cancer?

environment: UV light, tobacco smoke mutations by chance - chemicals that damage DNA inherit mutations from parents

In analyzing the need for teaching regarding sexual health in a client who is sexually active, which of the following questions is the most important for a nurse to ask? 1. "How old are your children?" 2. "Did you have intercourse last evening?" 3. "With whom do you have intercourse?" 4. "Do you use vaginal lubricant?"

3. This question is the most important for the nurse to ask. The nurse is trying to learn whether or not the client is having intercourse with more than one partner and/or whether the client has intercourse with men, women, or both.

A nurse is discussing sexual arousal during a preadolescent boys' sex education class. Which of the following should the nurse base her reply on when a boy asks, "What exactly happens when my body gets aroused, anyway?" 1. The vas deferens thickens and expands. 2. The sympathetic nerves of the penis are stimulated. 3. The corpora of the penis become engorged. 4. The prepuce of the penis elongates.

3. When arousal occurs, the penile blood vessels become engorged and an erec- tion is achieved.

stay in hospital

usually discharge within 24 hours law passed that mom can stay for at least 48 hours after vaginal birth and 96 after c birth

menopause

35-60yo

A single young-adult woman received instructions from the nurse regarding the use of an oral contraceptive. The woman demonstrates a need for further instruction if she: A. Stops asking her sexual partners to use condoms with spermicide B. States that her menstrual periods should be shorter with less blood loss C. Takes a pill every morning D. Uses a barrier method of birth control if she misses two or more pills

A Oral contraceptive provides no protection from STI

internal organs

vagina uterus uterine tubes ovaries

A woman with an IUD to confirm its placement by checking the IUD string A. After menses ceases B. After intercourse C. Two days after ovulation D. During menstrual bleeding

A Check the string after menses, before intercourse, at ovulation and if expulsion is suspected A missing string or one that becomes longer or shorter should be checked by a healthcare professional

A woman whose blood type is O- (negative) states, "My husband is AB+ (positive)." The mother queries the nurse about what blood type the baby will have. Which of the following blood types should the nurse advise the mother that the baby may have? Select all that apply. 1. "Your baby could be type O+ (positive)." 2. "Your baby could be type O- (negative)." 3. "Your baby could be type AB- (negative)." 4. "Your baby could be type A+ (positive)." 5. "Your baby could be type B- (negative)."

4 and 5 are correct. 1. This response is incorrect. The baby will be either type A or type B. Type O is the recessive. 2. This response is incorrect. The baby will be either type A or type B. Type O is the recessive. 3. This response is incorrect. The offspring cannot be type AB since the mother is type O. 4. The baby could be blood type AO (type A) and, if the father is heterozygous for the Rh factor, the baby could be either Rh+ (positive) or Rh- (negative). 5. The baby could be type BO (type B) and, if the father is heterozygous for the Rh factor, the baby could be either Rh+ (positive) or Rh- (negative).

perimenopause

4 years before

Vaginal secretion pH

4-5; slightly acidic to reduce infection

A nurse teaches a woman who wishes to become pregnant that if she assesses for spinnbarkeit she will be able closely to predict her time of ovulation. Which technique should the client be taught to assess for spinnbarkeit? 1. Take her temperature each morning before rising. 2. Carefully feel her breasts for glandular development. 3. Monitor her nipples for signs of tingling and sensitivity. 4. Assess her vaginal discharge for elasticity and slipperiness.

4. Spinnbarkeit is defined as the "thread" that is created when the vaginal discharge is slippery and elastic at the time of ovulation. The changes are in response to high estrogen levels. The woman inserts her index and middle fingers into her vagina and touches her cervix. After removing her fingers, she separates her fingers and "spins a thread" between her fingers. Whenshe is not in her fertile period, the mucus is thick and gluey.

A woman is menstruating. If hormonal studies were to be done at this time, which of the following hormonal levels would the nurse expect to see? 1. Both estrogen and progesterone are high. 2. Estrogen is high and progesterone is low. 3. Estrogen is low and progesterone is high. 4. Both estrogen and progesterone are low.

4. When the ovum is not fertilized, both estrogen and progesterone levels drop. The hormonal drop is followed by menstruation.

When is the best time for women to perform a breast self-exam?

5-7 days after menstruation stops or when breasts are not tender or swollen

average blood loss

50 ml ( 20-80 ml)

A 36-year-old woman has chosen the Depot medroxyprogesterone acetate as a method of contraception for her lifestyle. Which statement made by the woman indicates a lack of understanding and I need for further instruction by the nurse? A. I will need to receive another injection every four weeks B. I'm going to watch my diet and exercise because weight gain is common C. If I plan to continue with Depo I should have my bone density assessed D. The method will result in a smaller amount of the current cervical mucus

A The injection is repeated every 11 to 13 weeks

For some women the most distressing side effect of progestin only contraception is A. Irregular vaginal bleeding B. Headache C. Nervousness D. Nausea

A Women often complained of the irregular bleeding that occurs with progestin only contraceptive

A Native-American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for bottle feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: Delayed attachment. Embarrassment. Disappointment in the sex of the baby. A belief that babies should not be fed colostrum.

A belief that babies should not be fed colostrum. Delayed attachment is a developmental concern, not a cultural belief. Embarrassment is likely not the cause for a delay in the initiation of breastfeeding and should be explored further by the nurse. The mother may voice her disappointment that the infant is a girl; however, this would rarely cause her to delay breastfeeding and would manifest itself in other ways. Native Americans commonly use cradleboards and avoid handling their newborns often. They also believe that infants should not be fed colostrum.

euploid

A cell with the correct or normal number of chromosomes within it.

Human developmental ecology

A family theory based on the belief that behavior is a function of the interaction of traits and abilities with the environment. Major concepts include ecosystem, niches, adaptive range, and ontoge- netic development.

Family Stress Theory

A family theory concerned with the way families react to stressful events; stress is studied within the internal and external contexts in which the family is living.

Subculture

A group existing within a larger cultural system that retains its own characteristics.

Which case would be considered a sentinel event? A newborn in the ward has signs and symptoms of infection. A newborn with a birth weight of 1500 g died immediately at birth. A newborn has hyperbilirubinemia with a bilirubin level of 45 mg/dl. A newborn is born with congenital anomalies of upper and lower limbs.

A newborn has hyperbilirubinemia with a bilirubin level of 45 mg/dl. A sentinel event is described as an unexpected occurrence involving death or serious physical or psychologic injury, or risk, which signals a need for an immediate investigation and response. Bilirubin levels of more than 45 mg/dl indicate that the newborn has severe jaundice, which needs immediate attention. Delays in treating the child may lead to death. Infection in a newborn needs to be treated, but is not considered a sentinel event. Death of a newborn with birth weight of 1500 g is expected and cannot be referred to as a sentinel event. Congenital anomalies are not a condition that requires immediate investigation and response.

Which of the following actions, if demonstrated by a nursing student, could lead to dismissal from the health program? A student nurse refuses to give her phone number to a client. Nursing students go out for lunch following a clinical rotation to a local restaurant while still in uniform. A nursing student posts pictures of clinical site experiences on her Facebook page. Student nurses share their thoughts about their clinical site experiences on Twitter. Discussing client disease processes in post-conference.

A nursing student posts pictures of clinical site experiences on her Facebook page. Student nurses share their thoughts about their clinical site experiences on Twitter. Images related to clinical experiences should not be posted on a Facebook page. The student who posted images of clinical experiences would be liable for violation of privacy. Sharing of thoughts related to clinical experiences on social media may result in dismissal from a health program if student nurses provide information that result in violation of HIPPA policies. A nursing student should not provide a phone number to a client, because it goes against the ethically prescribed professional client-nurse boundaries. Nursing students going out to lunch following a clinical experience while in uniform would not pose a problem, as long as they maintained their professional demeanor and did not discuss clinical events. Discussing client disease processes in post-conference is part of the learning process, as long as confidentiality is maintained.

vaginal contraceptive reing

flexible device worn in the vagina to deliver continuous levels of etonorgestrel and ethinyl estradiol; the device is worn for 3 weeks, followed by a week without the device

hepatitis A: symptoms

flu-like symptoms • Malaise, fatigue, anorexia, nausea, fever, pruritus, RUQ pain

ovaries

form and expel ova secrete estrogen and progesterone

Which patient may be a carrier for an X-linked recessive trait? A patient whose son is colorblind. A patient whose father was born with cystic fibrosis. A patient whose daughter was born with Turner syndrome. A patient whose brother was born with Trisomy 21 (Down syndrome).

A patient whose son is colorblind. Colorblindness is an X-linked recessive trait that is commonly displayed in males. Because this patient's son expresses the recessive gene, this patient may be a carrier for an X-linked recessive trait.

Which patient would benefit from prenatal genetic counseling? A patient with sickle cell disease (SCD) A patient who is having difficulty conceiving A patient with history of two multifetal pregnancies A patient with history of miscarriage due to polyploidy

A patient with sickle cell disease (SCD) Sickle cell disease (SCD) is an autosomal recessive trait that can severely impact a patient's life. This patient would benefit from genetic counseling at any point in the perinatal care period.

inversion

A portion of the chromosome is rearranged in reverse order.

mutation

A spontaneous and permanent change in normal gene structure.

Which methods help alleviate the problems associated with access to health care for the maternity client? (Select all that apply.) a. Provide transportation to prenatal visits. b. Provide child care to enable a pregnant woman to keep prenatal visits. c. Increase the number of providers that will care for Medicaid clients. d. Provide low-cost or no-cost health care insurance. e. Provide job training.

A, B, C, D Lack of transportation to prenatal visits, child care, access to skilled obstetric providers, and affordable health insurance are prohibitive factors associated with the lack of prenatal care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

implanon

form of hormonal contraception in which a single flexible rod containing progestin is implanted subdermally, usually into the inner aspect of the upper arm

A man has inherited the gene for familial adenomatous polyposis (FAP), an autosomal dominant disease. He and his wife wish to have a baby. Which of the following would provide the couple with the highest probability of conceiving a healthy child? 1. Amniocentesis. 2. Chorionic villus sampling. 3. Pre-implantation genetic diagnosis. 4. Gamete intrafallopian transfer.

ANS 3 1. Amniocentesis will provide the couple with information regarding the genetics of a fetus in utero. 2. CVS will provide the couple with information regarding the genetics of a fetus in utero. 3. Pre-implantation genetic diagnosis will provide the couple with the highest probability of conceiving a healthy child. 4. GIFT is a type of infertility procedure.

Infertility increases a client's risk of which of the following diseases? A. Diabetes mellitus B. Nystagmus C. Cholecystitis D. Ovarian cancer

D Infertility has been shown to increase a woman's risk of developing ovarian cancer.

A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. Which of the following is an appropriate response by the nurse? 1. It is unlikely that any of these factors is affecting his fertility. 2. Daily alcohol consumption could be causing his infertility problems. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males.

ANS: 3 1. This response is incorrect because exposing the testes to the heat of the sauna can alter the normal morphology of the sperm. 2. Alcohol consumed in excessive amounts can alter spermatogenesis, but one beer per day has not been shown to be a problem. 3. The high temperature of the sauna could alter the number and morphology of the sperm. 4. Chemotherapy has been shown to affect the ability of males to create sperm.

multiphasic pill (biphasic, triphasic)

form of oral contraceptive pill that has varying amounts of progestin and sometimes the amount of estrogen within each cycle

Which pictorial tool can assist the nurse in assessing the aspects of family life related to health care? a. Genogram b. Ecomap c. Life-cycle model d. Human development wheel

ANS: A A genogram depicts the relationships of the family members over generations. An ecomap is a graphic portrayal of the social relationships of the woman and her family. The life-cycle model, in no way, illustrates a family genogram; rather, it focuses on the stages that a person reaches throughout life. The human development wheel describes various stages of growth and development rather than the family members' relationships to each other.

A client's household consists of her husband, his mother, and another child. To which family configuration does this client belong? a. Multigenerational family b. Single-parent family c. Married-blended family d. Nuclear family

ANS: A A multigenerational family includes three or more generations living together. Both parents and a grandparent are living in this extended family. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults. Married-blended families refer to those who are reconstructed after divorce. A nuclear family comprises male and female partners and their children living together as an independent unit.

Which term is an accurate description of the process by which people retain some of their own culture while adopting the practices of the dominant society? a. Acculturation b. Assimilation c. Ethnocentrism d. Cultural relativism

ANS: A Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures.

monophasic pill

form of oral contraceptive pill that provides a fixed dosage of estrogen and progesterone

What is the goal of a long-term treatment plan for an adolescent with an eating disorder? a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring client perception of body image

ANS: D The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a. HSV b. AIDS c. Venereal warts d. Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

Which action would be inappropriate for the nurse to perform before beginning the health history interview? a. Smile and ask the client whether she has any special concerns. b. Speak in a relaxed manner with an even, nonjudgmental tone. c. Make the client comfortable. d. Tell the client her questions are irrelevant.

ANS: D The woman should be assured that all of her questions are relevant and important. Beginning any client interaction with a smile is important and assists in putting the client at ease. If the nurse speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The client's comfort should always be ensured before beginning the interview.

What information should the nurse be aware of regarding telephonic nursing care such as warm lines? a. Were developed as a reaction to impersonal telephonic nursing care b. Were set up to take complaints concerning health maintenance organizations (HMOs) c. Are the second option when 9-1-1 hotlines are busy d. Refer to community service telephone lines designed to provide new parents with encouragement and basic information

ANS: D Warm lines are one aspect of telephonic nursing care specifically designed to provide new parents with encouragement and basic information. Warm lines and similar services sometimes are set up by HMOs to provide new parents with encouragement and basic information. The name, warm lines, may have been suggested by the term hotlines, but these are not emergency numbers but are designed to provide new parents with encouragement and basic information.

colon cancer - predisposing genes

APC tumor suppressor gene mutations in a mismatch repair gene hereditary nonpolyposis colon cancer - mutation in one of many mismatch repair genes - MMR genes = MSH2 and MLH1 often 3+ relatives with colorectal cancer in at least 2 generations and diagnosis before age 50

prevention of HPV

Abstinence, limit sexual partners, prophylactic vaccine Vaccines: Cervarix and Gardasil • Recommened for 11-12 year old • Cervarix: protects against 16 and 18 HPV • Gardasil: protects against 6, 11, 16, 18 • Most effective if given before first sexual contact • Given in three doses over 6 month period

A patient who is breastfeeding has been diagnosed with Gonorrhea. Which treatment plan should be instituted? Amoxicillin 500 mg three times a day for 1 week Benzathine penicillin G 2.4 million units one injection Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection Ceftriaxone 250 mg IM injection

Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection Amoxicillin or ceftriaxone can be part of the treatment plan for gonorrhea but the patient should be treated empirically for chlamydia as well. Dual therapy with amoxicillin and ceftriaxone can be used for treatment of gonorrhea and empirical treatment of chlamydia. Benzathine penicillin is indicated for treatment of syphilis for the lactating patient.

Where is the ovum usually fertilized?

Ampulla

Aneuploidy

An abnormality in chromosome number in which the numeric deviation is not the exact multiple of the haploid set.

How do hormones affect the female reproductive cycle? A decrease in estrogen causes fertilization. An abrupt increase in luteinizing hormone (LH) causes ovulation. Increased progesterone stimulates follicle-stimulating hormone (FSH) secretion. A sudden increase in human chorionic gonadotropin (hCG) causes the corpus luteum to regress.

An abrupt increase in luteinizing hormone (LH) causes ovulation. An abrupt increase in LH is responsible for ovulation during the female reproductive cycle.

Genotype

An individual's collection of genes or entire genetic makeup.

Phenotype

An individual's observable expression of his or her genetic makeup.

The nurse is explaining sentinel events to a group of nursing students. Which events does the nurse include in the list of sentinel events? An infant discharged to the wrong family Maternal death related to the birthing process Leaving a foreign body in a client after surgery Perinatal death related to an infant's congenital condition Neonatal hyperbilirubinemia with a serum bilirubin 18 mg/dl

An infant discharged to the wrong family Maternal death related to the birthing process Leaving a foreign body in a client after surgery Sentinel events are unexpected occurrences that involve death, serious physical or psychologic injury, or risk of serious injury. Such events may also lead to loss of limb or function. These events indicate a need for an immediate investigation and response. Maternal death related to the birthing process is a sentinel event, because death is not an expected occurrence during childbirth. An infant discharged to the wrong family is a serious error and needs immediate response. Leaving a foreign body in a client after surgery is negligence that may lead to serious complications. Perinatal death related to an infant's congenital condition is not a sentinel event, because the death may be due to the congenital anomaly. Neonatal hyperbilirubinemia with a serum bilirubin level of 18 mg/dl does not cause irreparable damage. Thus, it cannot be referred to as a sentinel event. However, a serum bilirubin level of more than 30 mg/dl is a cause for concern.

When providing health education to the client, the nurse understands that an example of the secondary level of prevention is: Approved infant car seats. Breast self-examination (BSE). Immunizations. Support groups for parents of children with Down syndrome.

Breast self-examination (BSE). Infant car seats and immunizations are examples of primary prevention. BSE is an example of secondary prevention, which includes health screening measures for early detection of health problems. Support groups are an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., Down syndrome).

mamogramm

annually after 40 50-74 biannually

"Fornices"

Anterior, posterior, and lateral pockets that surround the cervix.

"Urethra (urinary meatus)"

Bladder opening found between the clitoris and the vagina.

Goals of prenatal care

Define health status of mother and fetus, determine gestational age of the fetus and monitor fetal development, identify the woman at risk for complications and minimize those risks, provide appropriate education and counseling

hepatitis B - symptoms

Disease of the liver → silent infection • Sudden and severe → fatal • arthralgias, arthritis, lassitude, anorexia, nausea, vomiting, headache, fever, and mild abdominal pain • Later the woman may have clay-colored stools, dark urine, increased abdominal pain, and jaundice • Can become chronic HBV carriers

fundus

Dome-shaped top of the uterus.

Layers of the uterine wall

Endometrium Myometrium Peritoneum

genome

Entire set of genetic instructions found in the nucleus of each human cell.

Which hormone increases the vascularity of the breast tissue?

Estrogen

gene testing registry

Free online tool that s used to obtain list of available genetic tests GeneReviews: • Collection of expert-authored, peer reviewed disease descriptions presented in standardized format and focused on clinically relevant and medically actionable information on the diagnosis, management and genetic counseling of individuals and families with specific inherited conditions OMIM: • Online catalog of human genes and genetic disorders

Functions of ovaries

Hormone production (estrogen, progesterone, androgen) and ovulation (release of a mature ovum from the ovary at usually monthly intervals)

"Gonadotropin-releasing hormone (GnRH)"

Hormone secreted by the hypothalamus when ovarian hormones are re- duced to a low level. It stimulates the pituitary gland to secrete two critical hormones.

chlamydia maternal effects

postpartum endometritis, premature rapture of membrane, and preterm birth

native american view on labor

prefers female attendant husband, mother and father may assist birth may be attended by whole family herbs may be used to promote uterine activity birth may occur in squatting position

The viral sexually transmitted infection (STI) that affects most people in the United States today is: Herpes simplex virus type 2 (HSV-2) Human papillomavirus (HPV) Human immunodeficiency virus (HIV) Cytomegalovirus (CMV)

Human papillomavirus (HPV) HPV infection is the most prevalent viral STI seen in ambulatory health care settings.

If used consistently and correctly, which of the barrier methods of contraception has the lowest failure rate? Spermicides Female condoms Male condoms Diaphragms

Male condoms For typical users, the failure rate for male condoms may approach 15%; however, if condoms are used correctly, the failure rate is only 2%. Failure rates are about 29% for spermicides, about 21% for female condoms, and 16% for diaphragms with spermicides.

nipple

Mammary papilla.

Which screening procedure can be used to detect unusual breast growth not large enough to be palpated? Lipid profile Mammography Breast self-examination (BSE) Clinical breast examination (CBE)

Mammography Mammography, the study of breast tissue using very-low-dose radiography, is the primary screening procedure that can detect breast lumps long before they are large enough to be palpated.

Homologous

Matched chromosomes, each having the same number and arrangement of genes.

effectiveness of oral contraceptives influenced negatively by

anticonvulsants - barbiturates, phentoin, carbamazepine, topiramate systemic antifungal - griseofulvin antituberculosis drugs - rifampin antiHIV protease inhibitors - nelfinavir ampenavir

national effort to eliminate disparities and improving delivery system

HRSA Health Disparities Collaboratives National Institute of health - improve health of minorities and provides funding for research and training of minority researchers national institute of nursing research - supportive research that promotes health equity and eliminates health disparities CDC - first periodic health disparities and inequalities report, which includes recent trends and variation in health disparities and iniqualities US Department of health and human services - HHS despairs action plan that provides a vision of a nation free of disparities in health and health care Afdordable care act - addresses disparities in income. aims to make insurance affordable, contain costs, strengthen and improve Medicare and Medicaid, reform insurance market, eliminate duplication of services, prevent medical errors, and saving health care dollars

caffeine risks

anxiety sleep disorder heart dysrhythmias interaction with lithium increase in birth weight may increase risk for miscarriage

"Proliferative phase"

Phase of the menstrual cycle during which the uterine lining grows rapidly and thickens from about the fifth day to the time of ovulation.

phases of sexual response in women/ orgasmic phase

HT BP and RR increase to maximum. involuntary smash occurs. external rectal sphincter contracts strong rhythmic contraction are felt in the clitoris, vagina and uterus. sensations of warmth spread through the pelvic area

phases of sexual response in men/ orgasmic phase

HT BP and RR increase to maximum. involuntary smash occurs. external rectal sphincter contracts testes elevate to maximum level point of inevitability occurs just before ejaculation and an awareness of fluid in the urethra rhythmic contractions occur in the penis ejaculation of semen occurs

Homozygous

Having two copies of the same allele for the same trait.

Heterozygous

Having two different alleles for a given trait.

obesity is a risk factor for

Heart disease, stroke, hypertension, cancer, diabetes gallbladder disease diverticular disease some anemias oral disease constipation osteorthritis gout osteoporosis respiratory dysfunction sleep apnea cholesterol enstrual irregularity hirsutism stress incontinence depression complication of pregnancy increased surgical risk shortened life span

"Unifactorial inheritance"

Phenotypic characteristics controlled by a single gene; it is also known as single-gene inheritance.

Hemophilia

Hemophilia is a rare hereditary bleeding disorder with two forms due to different clotting factor deficiencies. Hemophilia A is a deficiency in Factor VIII, which accounts for 80% of hemophilia cases whereas hemophilia B otherwise known as Christmas disease is a deficiency of clotting factor IX, which accounts for 20% of cases Hemophiliacs form platelet plugs at the bleeding site, but the clotting factor deficiency impairs the formation of stable fibrin clots. Which causes excessive bleeding, which may be mild, moderate, or severe, depending on the degree of factor deficiency The treatment for hemophilia is very costly and involves infusions two to three times a week, but is only available in highly developed areas of the world and can cause bleeding, especially into the joints. Gene therapy is being studied and is in clinical trials that are showing promise, with some showing curative expression with a 98% reduction in infusions

"Multifactorial inheritance"

Phenotypic characteristics resulting from two or more genes on different chromo- somes acting together; it involves a combination of genetic and environmental factors.

birth control pills not to use by people

cardiovascular disease, breast cancer, smoking if older than age 35, high blood pressure, and long term diabetes with vascular disease

scope of maternity and women's health nursing

care of childbearing women and their families through all stages of pregnancy and childbirth and the first 4 weeks after birth

condoms - how to use them safely?

Physical barrier for STI transmission Open conversation about them • Use latex or plastic male condoms - NOT natural skin condoms • Use for every sexual encounter • Use only once each • Current expiration date • Do not damage with sharp objects - teeth, fingernails

What are the main causes of maternal death in the United States?

Hemorrhage Pulmonary embolism Gestational hypertension Maternal mortality is a significant problem in the United States, although the overall number of maternal deaths is small. The three main causes of maternal mortality in the United States today are hemorrhage, pulmonary embolism, and gestational hypertension. Stillbirths and preterm births are not related to maternal mortality.

translocation

results when there is an exchange of chromosomal material between two chromosomes causes: exposure to certain drugs, viruses, radiation often arise for no reason 2 major types of translocation - reciprocal and robertsonian

frenulum

Fold of tissue under the clitoris.

pay attention with adolescents

risky behavior eating disorder depression injury prevention drugs contraceptives

A mother's household consists of her husband, his mother, and another child. She is living in a/an: Extended family. Single-parent family. Married-blended family. Trinuclear family.

Extended family. An extended family includes blood relatives living with the nuclear family. Married-blended refers to families reconstructed after divorce.

Factor V leiden method of inheritance

Factor V Leiden is an autosomal dominant inheritance disorder that can be present on a single, linear chromosome (homozygous) or on both of the chromosomes in a pair (heterozygous) Typically, if one is affected by Factor V Leiden there are multiple generations within their family that have had the disorder Autosomal dominant disorders need one copy of a variant allele for phenotypic expression The presence of one copy of the Factor V Leiden mutation increases a woman's risk of developing venous blood clots by 4- to 8-fold If a woman has inherited two copies of the gene the risk factor for blood clots increases to 75- to 80-fold

Nondisjunction

Failure of chromosomes to separate.

homosexual

Family structure in which gay or lesbian couples may live together with or without children.

Fundus

Fundus Dome-shaped top of the uterus and is the site at which the uterine tubes enter the uterus

alleles

Genes at corresponding loci on homologous chromosomes that code for different forms or variations of the same trait.

Increasing levels of estrogen and progesterone in the 3-4 days before menstruation cause...

Increase in the vascularity of the breasts, induce the growth of the ducts and acini, and promote water retention

"Autosomal recessive inheritance"

Inherited disorder in which both genes of a pair are forms associated with the disorder to be expressed.

A woman reports not being able to stand up straight and says, "I feel like I've shrunk." Which step in the physical assessment should the nurse perform first? Measure the woman's weight. Auscultate the woman's apical pulse. Assess the woman's extremities for edema. Measure the woman's height and compare it to previous visits.

Measure the woman's height and compare it to previous visits. Measuring the woman's height and assessing the curvature of the vertebral column is an effective way to determine if the woman's symptoms are the result of osteoporosis when findings are compared with previous visits.

bacterial vaginosis: diagnosis

Microscopic exam of vaginal secretions Wet Smear tests • Normal saline smear • Positive findings: • Presence of clue cells (vaginal epithelial cells coated with bacteria) Vaginal secretions tested for pH and amine odor • Detect pH of 4.5 or greater • Fishy odor released when KOH added to vaginal secretions on speculum

What contracts to expel milk from the acini?

Myopeithelium

which type of neurofibromatosis do people usually live normal lives?

NF1

two components of HIV testing counseling

Pretest: • Personalized risk assessment • Meaning of positive and negative results • Informed consent • Develop realistic plan for reducing risk and preventing infection Posttest: • Informing women of test results • Reviewing meaning of results • Reinforcing prevention messages

HIV: symptoms

Seroconversion to HIV positivity occurs within 6-12 weeks • Asymptomatic • Viremic flu-like response: • Symptoms include fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash

What is family planning

The conscious decision on when to conceive throughout the reproductive years

"Endometrial cycle"

The cycle that involves cyclic changes in the lining of the uterus.

If a woman is pregnant, it is desirable for her to enter prenatal care within...

The first 12 weeks

Which statement explains the function of the hypothalamus in male sexual maturation? The hypothalamus releases testosterone to increase height. The hypothalamus releases follicle-stimulating hormone (FSH) to start spermatogenesis. The hypothalamus releases luteinizing hormone (LH) to stimulate the Leydig cells. The hypothalamus releases gonadotropin-releasing hormone (GnRH), leading to enlarged testes.

The hypothalamus releases gonadotropin-releasing hormone (GnRH), leading to enlarged testes. The function of the hypothalamus is to release GnRH to initiate puberty and cause male sexual maturation

What is contraception

The intentional prevention of pregnancy during sexual intercourse

transverse diameter

The largest diameter of the pelvic inlet; helps determine the shape of the inlet. located at right angles to the true conjugate

"Menopause"

The last menstrual period dated with certainty once 1 year has passed after menstruation ceases.

population based screening

carrier screening for single gene disorders • CF = cystic fibrosis • Significance of CF mutation is uncertain - many do not display symptoms of CF with mutation • Sickle cell disease • Tay-Sachs disease • Preconceptionally or prenatally

Which statement made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? The nurse encourages the mother and father to make choices whenever possible. The nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth. The nurse believes that he or she is acting in the best interest of the client and commands her on what to do throughout labor. The father is discouraged from accompanying his wife during a cesarean birth.

The nurse encourages the mother and father to make choices whenever possible. With family-centered maternity care it is important to allow for choices for the couple and to include the partner in the care process. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her (unless of course the birth is emergent and guests may be requested to leave). FCMC involves collaboration between the health care team and the client. In a family-centered care model, the partner, or even a grandparent, may be present for a cesarean birth.

Which action taken made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? The nurse encourages the mother and father to make choices whenever possible. The nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth. The nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout labor. The father is discouraged from accompanying his wife during a cesarean birth.

The nurse encourages the mother and father to make choices whenever possible. With family-centered maternity care (FCMC), it is important to allow for choices for the couple and to include the partner in the care process. Also, FCMC involves collaboration between the health care team and the client. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her. In a family-centered care model, the partner or even a grandparent may be present for a cesarean birth (unless of course the birth is an emergency, for which guests may be requested to leave).

mitosis

cell division occurring somatic cells that results in two identical daughter cells containing a diploid number of chromosomes

which cells can be used for a karyotype? which are most commonly used?

cell from any nucleated, replicating body tissue most common = WBCs and fetal cells in amniotic fluid

A nurse who has recently joined the agency has been asked by the primary health care provider (PHP) to prepare an intravenous (IV) access for a client. The nurse is not clear about the steps to be taken for this procedure. What does the nurse do in this situation? The nurse will ask a colleague for help. The nurse will refer to the nursing textbooks. The nurse will refer to the agency procedure book. The nurse will ask the PHP to perform the procedure.

The nurse will refer to the agency procedure book. The standards of care differ from agency to agency. Therefore, if the nurse is uncertain about how to perform a procedure, the nurse should refer to the agency procedure book. The nurse should not rely on a colleague for help while performing basic nursing procedures. The guidelines given in the nursing textbooks may not be in accordance with the agency guidelines. Preparing an IV access is the nurse's role. Therefore, the nurse would not routinely ask the PHP to perform the procedure.

Which statement about female sexual response is not accurate? Women and men are more alike than different in their physiologic responses to sexual arousal and orgasm. Vasocongestion is the congestion of blood vessels. The orgasmic phase is the final state of the sexual response cycle. Facial grimaces and spasms of hands and feet are often part of arousal.

The orgasmic phase is the final state of the sexual response cycle. Men and women are surprisingly alike. Arousal is characterized by increased muscular tension (myotonia). Vasocongestion causes vaginal lubrication and engorgement of the genitals. The final state of the sexual response cycle is the resolution phase after orgasm.

Breasts

The paired mammary glands.

HSV cervictitis

cervix friable, red, ulcerated, necrotic heavy watery to purulent vaginal discharge

false pelvis

The shallow portion above the pelvic brim Supports the abdominal viscera

Genomics

The study of all genes in the human genome together, including their interactions with each other and the environment and the influence of other psychosocial and cultural factors.

Which fetal complications can the nurse prevent by using the Fetal Safety Failure to Rescue Process Tool? Uterine rupture Abruptio placentae Amniotic fluid embolism Uterine hyperstimulation Prolapsed umbilical cord

Uterine hyperstimulation Prolapsed umbilical cord The Fetal Safety Failure to Rescue Process Tool is used to determine and manage fetal and maternal complications in the perinatal period. Uterine hyperstimulation poses a risk to the fetus, and may be prevented by proper monitoring. Prolapsed umbilical cord is also a risk to the fetus, and can be managed if assessed and identified early. Uterine rupture, abruptio placentae, and amniotic fluid embolism are primarily maternal risk factors.

For which maternal complications does the nurse monitor in perinatal patients? Uterine rupture Shoulder dystocia Placental abruption Amniotic fluid embolism Prolapsed umbilical cord

Uterine rupture Placental abruption Amniotic fluid embolism Uterine rupture, placental abruption, and amniotic fluid embolism are life-threatening maternal complications in the prenatal period. Shoulder dystocia and prolapsed umbilical cord are fetal complications that are to be assessed in the perinatal period.

On assessment, the nurse learns that a male toddler born with a congenital heart defect lives with his parents and two young siblings in the Midwest. The mother is pregnant with a fourth child. Which additional information would the nurse need to know to evaluate the risk for the fourth child being born with a heart defect? Socioeconomic status of the family The mother's family history of tobacco use Variations of symptoms due to time or season Sex of family members born with a heart defect Number of close relatives born with a heart defect

Variations of symptoms due to time or season Seasonal variations of symptoms are a factor that may influence the risk of developing a heart defect. The nurse would need this information in order to evaluate the fourth child's risk for developing a heart defect. Correct Sex of family members born with a heart defect Sex of affected family members is a factor that may influence the risk of developing a heart defect, as it can help determine whether the trait is X-linked. The nurse would need this information in order to evaluate the fourth child's risk for developing a heart defect. Correct Number of close relatives born with a heart defect Number of affected relatives is a factor that may influence the risk of developing a heart defect. The nurse would need this information in order to evaluate the fourth child's risk for developing a heart defect.

sex chromosomes

X and Y chromosomes.

which sex chromosome is responsible for sex determination?

Y chromosome absence of Y --> female

Risk-reduction measures

____________________ Precautions used during sexual activity to prevent the transmission of pathogens.

Rubella

____________________________ German or 3-day measles; the virus is transmitted by droplets.

Pelvic inflammatory disease (PID)

_______________________________ Infectious process that most commonly involves the uterine (fallopian) tubes, uterus, and more rarely ovaries and peritoneal surfaces.

menses

day 1 of menstrual cicle

fasting blood sugar

every 3-5 years for all women after 45

preterm infant

infants born before 38 weeks of gestation

oblique diameter

not clinically measured

breasts

not equal is size and shape but no masses, retractions of dumplings

who and how often should women be screened for chlamydia?

screen asymptomatic women at high risk • YEARLY screening for all sexually active adolescents, women between 20-25, and high risk over 25 ALL pregnant women have cervical cultures for chlamydia at first prenatal visit • Screening late in third trimester (36) weeks if previously positive or younger than 25, new sexual partner or multiple partners

thermal shift

term used to refer to the decrease and subsequent increase in temperature associated with ovulation

african american views on postpartum

vaginal bleeding is a sign of sickness tub bath and shampooing prohibited sassafras tea - for healing power eating liver thought to cause heavier vaginal bleeding because of its high blood content

highest birth rate

women between 20-29

what are some possible reactions to a negative HIV test?

• Escalate risk behaviors • Assume negative means bad • Provide education • Ongoing tested if continue risk behaviors or exposed in past 6 months

how do you decrease the chance of mother to child transmission?

• Triple-drug antiretroviral therapy (ART) • Highly active antiretroviral therapy (HAART) • ALL women treated with combination of ART during pregnancy - regardless of CD4 counts Teratogenic risk is UNKNOWN • HIV positive women start drugs - even if in first trimester • Taking drugs prophylactically → start after first trimester

what are high risk practices (UNSAFE)

• Unprotected anal intercourse; unprotected vaginal intercourse • Oral-anal contact • Multiple sexual partners, no HIV or STI testing • Any sex (fisting, rough vaginal or anal intercourse, rape) that causes tissue damage or bleeding • Oral sex on man or woman without a latex or plastic barrier • Sharing sex toys, douche equipment • Sharing needles • Blood contact, including menstrual blood

isthmus

" Also known as the lower uterine segment, it is the short constricted portion that separates the corpus of the uterus from the cervix."

primary prevention

" Level of preventive care that involves promoting healthy lifestyles to decrease the occurrence of illness and enhance general health and quality of life."

"Carrier screening tests"

" Tests used to identify individuals who have a gene mutation for a genetic condi- tion but do not show symptoms of the condition because it is an autosomal recessive condition."

Ethnocentrism

"A belief that one's cultural way of doing things is the right way, supporting the notion that "My group is the best."

family life cycle theory

"A family theory that focuses on the family as it moves through stages and relationships among family members as they progress through transitions."

temperature

- before ovulation: 96-98 degree F - after ovulation: 97-99 degree F - temperature remains on elevated plateau for 2-4 days before menstruation

first trimester

- permissible, state can't interfere - less than 9 weeks of gestation - methods: surgical or medical

trichomoniasis: symptoms

- Asymptomatic o Yellowish greenish, frothy, mucopurulent, opious, malodorous discharge o Inflammation of vulva and vagina o Irritation and pruritus o Dysuria and dyspareunia o Discharge worsens after menstruation o Strawberry spots - vaginal walls and cervix • Tiny petechiae • Bleed on contact

Contraceptive Sponge

- Concave side vs cx - contains N-9 spermicide -protection up to 24 hours - leave in place at least 6 hours after intercourse and no > 24-30 hr (TSS); - Failure rate 12 parous and 24% nulliparous

Hispanic views on pregnancy

-pregnancy desired soon after marriage -late prenatal care -expectant mother influenced by mothers and mothers-in-law -cool air in motion is dangerous during pregnancy - unsatisfied cravings will result in birthmark - milk avoided because might cause large babies and difficult pregnancy - may be opposed to pelvic examination by male examiner - use herbs to treat common complaint of pregnancy - drinking chamomile will ensure effective labor - may wear ribbon around belly in belief that baby will be born healthy

Hispanic views on labor

-use of midwife preferred - may prefer presence of mother not husband - after birth legs of mother brought together to prevent air from entering uterus - loud behavior in labor

coitus interruptus

-withdrawal - involves male partner withdrawing penis from woman's vagina before ejaculates - effectiveness depends on man's ability to withdraw -doesn't prevent against STIs, or HIV

Breast Exam- How?

.Lie down and put a pillow under your right shoulder. Place your right arm behind your head (Fig. 1). 3.Use the finger pads of your three middle fingers on your left hand to feel for lumps or thickening. Your finger pads are the top third of each finger. 4.Press firmly enough to know how your breast feels. If you're not sure how hard to press, ask your health care provider or try to copy the way your health care provider uses the finger pads during a breast examination. Learn what your breast feels like most of the time. A firm ridge in the lower curve of each breast is normal. 5.Move around the breast in a set way. You can choose either circles (Fig. 2, A), vertical lines (Fig. 2, B), or wedges (Fig. 2, C). Do it the same way every time. It will help you to make sure that you've gone over the entire breast area and to remember how your breast feels. 6.Gently compress the nipple between your thumb and forefinger and look for discharge. 7.Now examine your left breast using the finger pads of your right hand. 8.If you find any changes, see your health care provider right away. 9.You may want to check your breasts while standing in front of a mirror right after you do your breast self-examination each month. See if there are any changes in the way your breasts look: dimpling of the skin, changes in the nipple, or redness or swelling. skin, changes in the nipple, or redness or swelling. 10.You may also want to do an extra breast self-examination while you're in the shower. Your soapy hands will glide over the wet skin, making it easy to check how your breasts feel. 11.It is important to check the area between the breast and the underarm and the underarm itself. Also examine the area above the breast to the collarbone and to the shoulder. Can do this in the shower.b

advantages of CE/PCs oral contraceptives

Decreased menstrual blood flow - decreased iron- deficiency anemia - Regulation - menorrhagia, irregular cycles - Decreased PMS and dysmenorrhea and benign breast disease - Improved Acne Protection vs endometrial and - ovarian CA - Protection vs functional ovarian cysts and salpingitis - Decreased risk of ectopic pregnancy

national quality forum serious reputable events pertaining to maternal and child health

1. maternal death or serious injury associated with labor or birth in a low risk pregnancy while being care for in health care setting 2. death of a serious injury of a neonate associated with labor or birth birth in a low risk pregnancy 3. artificial insemination with the wrong donor sperm or wrong egg 4. abduction of a client/resident of any age

technology use in OB

1. monitor mother and fetus 2. definitive tests for hypoxia and acidosis 3. labor monitoring 4. interactions between healthcare providers 5. medical records in electronic forms 6. genetic codes and genetic engineering social media - nurses link with other nurses with similar interests. however client privacy and confidentiality can be violated shift from acute care institutes to ambulatory settings

maternal complications

1. placental abruption 2. postpartum hemorrhage 3. uterine rapture 4. eclampsia 5. amniotic fluid embolism

factors affecting womens health

1. race 2. violence ( battery, rape, etc)

Healthy people objectives on maternity

1. reduce the rate of fetal and infant death 2. reduce the rate of maternal mortality 3. reduce preterm births 4. reduce c births among low risk women

preconception time

1. review family history and provide personalized recommendations based on family history 2. counsel couple about carrier testing options 3. optimal time to refer couples to specialists in high risk pregnancy and genetics

abortus

Embryo or fetus is removed or expelled from uterus at 20 weeks of gestation or less, weighs 500g or less, or measures 25 cm or less.

what is the treatment for HPV?

NO treatment to eradicate • Removal of genital warts • Relief of S/S • Many different treatments During pregnancy: • Imiquimod • Podophyllin • Podofilox • Sinecatechins Removal with cyrotherapy or surgical techniques during pregnancy • Bathing with oatmeal solution and drying with cool hair dryer = relief • Clean and dry • Healthy lifestyle = increase immune system

A woman receiving treatment for gonorrhea may also be treated for which sexually transmitted infection without further testing? Chlamydia Trichomoniasis Herpes genitalis Condylomata acuminata (genital warts)

Chlamydia Gonorrhea and chlamydial infection often coexist, so dual treatment is recommended without additional testing.

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? A. The couple has established a set schedule for their sexual encounters B. The couple has been married for more than eight years C. The couple lives with one set of parents D. The couple has close friends who gave birth to a baby within the past year

A Clients who "schedule" intercourse often complain that their sexual relationship is unsatisfying

An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appropriate for the nurse to make? A. "Scarring surrounds the ends of your tubes, preventing your eggs from being fertilized by your partner's sperm." B. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." C. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." D. "You have a chronic infection of the vaginal tract that makes the secretions hostile to your partner's sperm."

A Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility.

A nurse working in an infertility clinic should include which of the following in her discussions with the couple? A. Adoption as an alternative to infertility treatments B. The legal controversy surrounding intrauterine insemination C. The need to seek marriage counseling before undergoing infertility treatments D. Statistics regarding the number of couple who never learn why they are infertile

A It is important for the couple to be provided with al relevant information. Adoption is a viable alternative to infertility treatments.

A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs? A. The testes are overheated B. The vas deferens is ligated C. The prostate gland is enlarged D. The flagella are segmented

A Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.

A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be contributing to the couple's infertility? A. The client is 36 years old B. The client was 13 years old when she started to menstruate C. The client works as a dental hygienist 3 days a week D. The client jogs 2 miles every day

A The eggs of an older woman (for reproductive purposes considered age 35 years +) age and fertility is reduced.

Which of the following actions, if demonstrated by a nursing student, could lead to dismissal from the health program? Select all that apply. A student nurse offers her phone number to a patient so that they can remain in touch. Nursing students go out for lunch following a clinical rotation to a local restaurant while still in uniform. A nursing student posts pictures of clinical site experiences on her Facebook page. Student nurses share their thoughts about their clinical site experiences on Twitter.

A nursing student posts pictures of clinical site experiences on her Facebook page. Although a nursing student can provide a phone number to a patient so that they remain in touch, the student should be aware of the limits of the relationship while in nursing school. Nursing students going out to lunch following a clinical experience while in uniform would not pose a problem as long as they maintained their professional demeanor and did not discuss clinical events. Posting of images related to clinical experiences on a Facebook page would make the student liable for violation of privacy. Sharing of thoughts related to clinical experiences on social media may result in dismissal from a health program if a student nurse provides information that results in violation of the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule. Student nurses share their thoughts about their clinical site experiences on Twitter.

While completing an assessment of a homeless woman, the nurse should be aware of which of the following ailments this client is at a higher risk to develop? (Select all that apply.) a. Infectious diseases b. Chronic illness c. Anemia d. Hyperthermia e. Substance abuse

A, B, C, E Poor living conditions contribute to higher rates of infectious disease. Many homeless individuals engage in sexual favors, which may expose them to sexually transmitted infections (STIs). Poor nutrition can lead to anemia. Lifestyle factors also contribute to chronic illness. Exposure to cold temperatures and harsh environmental surroundings may lead to hypothermia. Many homeless people turn to alcohol and other substances as coping mechanisms.

A woman must assess her self or signs of ovulation is occurring. Which signs are associated with population? A. Increase in the level LH in her urine 12 to 24 hours before ovulation B. SpinBarkett C. drop in at BBT during the luteal phase of her menstrual cycle D. Softened moist cervix, which opens in rises in the vagina E. Decreased libido

A, B, D BBT rises during the luteal phase and the libido increases

Joyce has chosen the diaphragm as her method of contraception. Which actions indicate that Joyce is using the diaphragm effectively? A. Joyce came to be refitted after Healing was complete following the term vaginal birth of her son B. Joyce apply as a spermicide only to the rim of the diaphragm just before insertion C. Joyce emptied her bladder before inserting the diaphragm and after intercourse D. Joy applies more spermicide for each act of intrrcourse E. Joyce removes the diaphragm within one hour I have intercourse F. Joyce always use a diaphragm during her menstrual period

A,C,D Spermicide should be spread on both services at the diaphragm It should not be removed for at least six hours after intercourse nor should it be used during Mences because of the risk of toxic shock syndrome

A woman is pregnant. During amniocentesis it is discovered that her child has Down syndrome with a mosaic chromosomal configuration. She asks the nurse what that means. What is the nurse's best response? 1. "Instead of two number 21 chromosomes, your child has three." 2. "Your baby's number 21 chromosomes have black and white bands on them." 3. "Some of your baby's number 21 chromosomes are longer than others." 4. "Some of your baby's cells have two number 21 chromosomes and some have three."

ANS 4 1. This is the definition of Down syndrome, but not of Down syndrome with mosaic chromosomal configuration. 2. All chromosomes are banded. 3. The number 21 chromosomes are of normal length in Down syndrome 4. Mosaicism is characterized by the fact that some of the cells of the body have the abnormal number of chromosomes but some of the cells have the normal number. This may happen with rapid disjunction. In Down syndrome, it means that some of the cells have three number 21 chromosomes and some have the normal number of two number 21 chromosomes. Mosaicism is not specific to Down syndrome but can occur with other chromosomal abnormalities.

A woman is informed that she is a carrier for Tay-Sachs disease, an autosomal recessive illness. What is her phenotype? 1. She has one recessive gene and one normal gene. 2. She has two recessive genes. 3. She exhibits all symptoms of the disease. 4. She exhibits no symptoms of the disease.

ANS 4 1. This is the woman's genotype. It is not the woman's phenotype. 2. This is the genotype of a person with Tay-Sachs disease. 3. This is the phenotype of a person with Tay-Sachs disease. 4. This is the woman's phenotype.

A woman asks the nurse, "My nuchal fold scan results were abnormal. What does that mean?" Which of the following comments is appropriate for the nurse to make at this time? 1. "I am sorry to tell you that your baby will be born with a serious deformity." 2. "The results show that your child will have cri du chat syndrome." 3. "The test is done to see if you are high risk for preterm labor." 4. "An abnormal test indicates that your baby may have Down syndrome."

ANS 4 1. This response is inappropriate. The nuchal fold scan is done either late in the first trimester or with the quad second trimester screen. A fetal genetic evaluation (amniocentesis or percutaneous umbilical blood sampling [PUBS]) must be done before a definitive diagnosis can be made. A genetic analysis is the only absolute diagnostic tool. 2. Cri du chat syndrome is a mental retar - dation disease caused by a deletion on chromosome 5. The nuchal fold scan does not screen for chromosomal deletions. It is done to assess for trisomy chromosomal diseases. 3. The first-trimester assessment screens for Down syndrome. It does not screen for preterm labor risk. 4. This statement is true, but the definitive diagnosis can be made only via genetic testing.

To provide culturally competent care to an Asian-American family, which question should the nurse include during the assessment interview? a. "Do you prefer hot or cold beverages?" b. "Do you want some milk to drink?" c. "Do you want music playing while you are in labor?" d. "Do you have a name selected for the baby?"

ANS: A Asian-Americans often prefer warm beverages. Milk is usually excluded from the diet of this population. Asian-American women typically labor in a quiet environment. Delaying naming the child is not uncommon for Asian-American families.

Individual irregularities in the ovarian (menstrual) cycle are most often caused by what? a. Variations in the follicular (preovulatory) phase b. Intact hypothalamic-pituitary feedback mechanism c. Functioning corpus luteum d. Prolonged ischemic phase

ANS: A Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the ovulatory phase and fertilization. During the ischemic phase, the blood supply to the functional endometrium is blocked, and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins.

Which contraceptive method best protects against STIs and the HIV? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. Same protection with all methods

ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV.

Which body part both protects the pelvic structures and accommodates the growing fetus during pregnancy? a. Perineum b. Bony pelvis c. Vaginal vestibule d. Fourchette

ANS: B The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is formed by the labia minor.

In which culture is the father more likely to be expected to participate in the labor and delivery? a. Asian-American b. African-American c. European-American d. Hispanic

ANS: C European-Americans expect the father to take a more active role in the labor and delivery of a newborn than the other cultures.

An infertile man is being treated with Viagra (sildenafil citrate) for erectile dysfunction (ED). Which of the following is a contraindication for this medication? A. Preexisting diagnosis of herpes simplex 2 B. Nitroglycerin ingestion for angina pectoris C. Retinal damage from type I diabetes mellitus D. Complications after resection of the prostate

B It is unsafe to take Viagra while also taking nitroglycerin for angina

Acini

Breast structures that are lined with epithelial cells that secrete colostrum and milk.

Translocation

Chromosomal material is exchanged between two chromosomes.

health desparities

Conditions that disproportionately affect certain racial, ethnic, or other groups.

The nurse understands the importance of a walking survey because this tool: Determines how much exercise expectant mothers have been getting, to help inform client care decisions. Usually takes place on the maternity ward but can be expanded to other areas of the hospital. Is a method of observing the resources and health-related environment of the community. Is performed by government census takers as part of their canvas.

Is a method of observing the resources and health-related environment of the community. A walking survey is a valuable tool that has nothing to do with exercise. It is an observational method conducted by nurses in a community to assess the health environment of the community.

deletion

Loss of chromosomal material and partial monosomy for the chromosome involved.

With regard to the most common bacterial sexually transmitted infections, which statement is not accurate? Chlamydial infections and gonorrhea are more likely to occur in women younger than age 20. Gonorrhea can be transmitted to the newborn by direct contact with gonococcal organisms in the cervix. Syphilis can be transmitted through kissing, biting, or oral-genital sex. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear.

Medications for pelvic inflammatory disease can be discontinued once symptoms disappear. For any infection, the entire prescription must always be taken.

Menstrual blood is a potent source of what?

Menstrual blood is a potent source of what?

Place the phases of the endometrial cycle in order, starting with day 1 of the female reproductive cycle.

Menstrual phase Proliferative phase Secretory phase Ischemic phase

Which statement accurately describes a function of testosterone in male sexual maturation? Release of testosterone causes increased growth of bones. Secretion of testosterone results in thickening of the scrotum. Testosterone targets the pituitary gland to enlarge the testes. Increased testosterone stimulates Leydig cells to deepen the voice.

Release of testosterone causes increased growth of bones. One function of testosterone in male sexual maturation is to cause increased growth of the skeletal system.

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? Disturbed body image Interrupted family processes Anxiety Risk for injury

Interrupted family processes Women commonly experience body image disturbances in the postpartum period, but this development is unrelated to giving birth to a child with Down syndrome. This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. She likely will also have a mix of emotions that may include anxiety, guilt, and denial, but anxiety is not the most essential nursing diagnosis for this family. Risk for injury is not an applicable nursing diagnosis.

Intravaginal Spermacides

Intravaginal Spermacides - Different forms: aerosol foams, tablets, suppositories, creams, films, and gels - needs to make contact with cervix - Insert at least 15 min before coitus and no longer than 1 hour before coitus - Must reapply with each act of intercourse = Typical failure rate 28%

The two most frequently reported maternal medical risk factors are: Hypertension associated with pregnancy and diabetes. Drug use and alcohol abuse. Homelessness and lack of insurance. Behaviors and lifestyles.

Hypertension associated with pregnancy and diabetes. Hypertension and diabetes are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of more health care services and longer hospital stays. Both drug use and alcohol abuse continue to increase in the maternal population; they are associated with low-birth-weight infants, mental retardation, and birth defects. The number of clients who are homeless or lack health care insurance is increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

how do you prevent neonatal HSV transmission?

If visible lesions NOT present at onset of labor → vaginal birth acceptable • Cesarean birth if visible lesions present

"Autosomal dominant inheritance"

Inherited disorder in which only one copy of a variant gene is needed for phenotypic expression.

inborn errors of metabolism

Inherited in an autosomal recessive pattern • Occur when a gene mutation reduces the efficiency of encoded enzymes to a level at which normal metabolism cannot occur • Defective enzyme action interrupts the normal series of chemical reactions from affected point onward • Result → accumulation of damaging product (PKU) or absence of necessary product (lack of melanin in albinism) PKU Tay-Sachs disease sickel cell anemia CF

The two most frequently reported maternal medical risk factors are what? Hypertension associated with pregnancy and diabetes Drug use and alcohol abuse Homelessness and lack of insurance Behaviors and lifestyles

Hypertension associated with pregnancy and diabetes Hypertension and diabetes are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of increased health care services and longer hospital stays. Both drug and alcohol use continue to increase in the maternal population. These are associated with low-birth-weight infants, cognitive impairment, and birth defects. The number of these clients is increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

hepatitis C: treatment

Interferon alfa • Alone • With ribavirin • For 6-12 months NO vaccine No reports of transmission through breastfeeding

Which of the following statements are true with regard to Factor V Leiden? Select all that apply. Factor V Leiden is an autosomal dominant disorder. It increases the likelihood of DVT in an affected patient . It is due to a mutation in factor IV and V genes. A woman who has one copy of the gene should not use oral contraceptives as a birth control method. Factor V Leiden leads to increased susceptibility of activated protein C.

Factor V Leiden is an autosomal dominant disorder. Factor V Leiden is an inherited disorder via autosomal dominant transmission. Presence of this genetic mutation increases the likelihood for blood clots to develop. This genetic mutation is found in Factor V gene only.A patient who tests positive for Factor V Leiden, regardless of whether she is homozygous or heterozygous for the trait, should not use oral contraceptives as a birth control method. The Factor V Leiden mutation leads to activated protein C resistance. It increases the likelihood of DVT in an affected patient. A woman who has one copy of the gene should not use oral contraceptives as a birth control method.

Factor V Leiden

Factor V Leiden or FVL is an autosomal dominant disorder that occurs when there is a mutation in the Factor V gene which can lead to the resistance of the activated protein C This protein is essential for blood clotting. Due to the resistance of this protein FVL increases one's risk for developing pulmonary emboli and deep vein thrombosis Women that use oral contraceptives, are pregnant, or are on hormone replacement therapy during menopause are especially vulnerable to deep vein thrombosis and PE when they have Factor V Leiden it can be accurately detected with genetic testing but a woman with a personal or family history of placenta abruption, stillbirths, venous blood clots, fetal growth restriction, and early and recurrent preeclampsia should be screen for FVL

The perinatal continuum of care begins with: The diagnosis of pregnancy. The interval just before birth. Identification of a pregnant woman as high risk. Family planning and preconception care.

Family planning and preconception care. The continuum of care begins with family planning and preconception care, not at the beginning of pregnancy.

What does the infundibulum have to pull the ovum into the tube?

Fimbriated ends

how do you screen for gonorrhea?

Gold standard: cultures with selective media • Test endocervical, vaginal, or urine specimens • Thayer-Martin cultures recommended to diagnose gonorrhea • NAATs testing: variety of specimens cannot be diagnosed by clinical signs

Match the phase of the ovarian cycle with its primary action.

Ovum matures. Follicular phase Follicle ruptures. Ovulatory phase Cells from follicle persist. Luteal phase

gynecological conditions affecting women

PID endometriosis STI uterine fibroids uterine deformities urinary incontinence

Purpose of the bony pelvis

Protection of the pelvic structures, accommodation of the growing fetus, and anchorage of the pelvic support structures

which cells CANNOT be used for karyotype?

RBCs nerves muscles - must be nucleated, replicating body tissue

SBAR

S: Situation B: Background A: Assessment R: Recommendation technique that gives a specific framework for communication among health care providers. It is an easy-to remember useful, concrete mechanism for communicating important information that requires a clinicin's immediate attention

Which condition in an infant is considered a sentinel event and necessitates neonatal phototherapy? Malaria Urinary problems Severe hyperbilirubinemia Birth weight less than 2500 g

Severe hyperbilirubinemia A sentinel event is a serious or unexpected condition in an infant that warrants prompt intervention. Severe hyperbilirubinemia is a condition in which the child's bilirubin is greater than 30 mg/dl. It indicates an immediate need for neonatal phototherapy. Conditions such as malaria, urinary problems, and birth weight less than 2500 do not warrant phototherapy.

sickle cell disease method of inheritance

Sickle cell disease is an autosomal recessive disorder. "Autosomal recessive inheritance disorders are those in which both genes of a pair are forms associated with the disorder to be expressed Many people who have this disorder pass the gene down to their children but some of their offspring are only carriers of this gene. That being said, sometimes these patients may have a mild flare up. According to Lowdermilk, "for the trait to be expressed, two carriers must each contribute a variant allele to the offspring

What do prostaglandins affect?

Smooth muscle contractility and modulation of hormonal activity

"Cytogenic testing"

Tests that examine chromosomes.

"Biochemical testing"

Tests that examine the protein products of genes.

"Linkage analysis"

Tests that look at markers coinherited with a gene that causes a genetic condition.

"Direct (molecular) testing"

Tests used to directly examine the DNA and RNA that make up a gene.

Which statement describes the purpose of the luteal phase of the female reproductive cycle? The mature ovum is released. Growth of the follicle is promoted. One follicle is matured for ovulation. The endometrium is prepared for the ovum.

The endometrium is prepared for the ovum. During the luteal phase, the corpus luteum secretes estrogen and progesterone to prepare the endometrium for a fertilized ovum.

The head nurse warns the trainee nurse against inappropriate use of social media on the job. Why did the head nurse give this warning to the trainee nurse? The nurse became friends with a client on Facebook. The nurse shared professional information on LinkedIn. The nurse refused to share client information on Facebook. The nurse shared details of the services provided in the hospital on LinkedIn.

The nurse became friends with a client on Facebook. Facebook and LinkedIn are popular social networking sites. The nurse should observe ethically prescribed professional client-nurse boundaries. The nurse should not maintain a personal relationship with the client by being friends with the client on Facebook. Many people can view the information shared on Facebook, and sharing client information on Facebook goes against the ethical principal of client confidentiality. LinkedIn is a professional networking site at which nurses can share their professional information and details of the hospital's services.

Interprofessional Education

Type of educational approach that involves faculty and students from 2 or more health professions who create and foster a learning environment that is collaborativ and will facilitate improvement in patient care

what is the teratogenic risk of ART and HAART?

UNKNOWN • HIV positive women start drugs - even if in first trimester • Taking drugs prophylactically → start after first trimester

group B streptococci maternal effects

UTI chorioamnionitis postpartum endometriosis postpartum sepsis meningitis (rare)

A 38-year-old patient declines prenatal diagnostic testing due to a lack of family history of genetic or chromosomal abnormalities. Which nursing education is appropriate for this patient? The patient's age increases the risk of having a child with an abnormality. Prenatal diagnostic testing is recommended even if no risk factors are present. If no family history of abnormalities is present, prenatal diagnostic testing is not recommended. The patient should receive prenatal diagnostic testing to screen for potential recessive gene abnormalities

The patient's age increases the risk of having a child with an abnormality. Advanced maternal age increases the risk of chromosomal trisomy, such as Trisomy 21 (Down syndrome).

With regard to emergency contraception pills, nurses should be aware that: The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap. The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment. Emergency contraception has no medical contraindications.

The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. A backup method of birth control is also a good idea for beginners. The woman has up to 120 hours after unprotected intercourse to take emergency contraception pills; they do not, however, protect against pregnancy from subsequent unprotected intercourse. These pills are contraindicated during pregnancy and if the woman has undiagnosed abnormal vaginal bleeding.

Trisomy

Union of a normal gamete and a gamete containing an extra chromosome, resulting in a cell with 47 chromosomes.

untreated HPV results in what?

Untreated HPV → resolves spontaneously in young women = immune systems fight off If virus persists → cervical cancer and genital warts • Develop months or years after infected

Parts of the uterus

Upper triangular portion (corpus) and a lower cylindric portion (cervix)

"Corpus"

Upper triangular portion of the uterus.

The device or practice that decreases the risk of conceiving

What is birth control

Toxoplasmosis

______________________________ A protozoal infection associated with the consumption of raw or undercooked meat or exposure to litter used by infected cats.

what is the major AE of ART?

bone marrow suppression

Group B strep fetal effects

preterm birth

female condoms

• Lubricated polyurethane sheath with ring on each end • Inserted into vagina and covering labia • Can block smaller viruses (HIV) - not efficient for STIs CAN block smaller viruses (HIV) CANNOT block STIs

predictive testing

• Which is used to clarify the genetic status of asymptomatic family members. • The two types of predictive testing are presymptomatic and predispositional Presymptomatic Testing: • Mutation analysis for HD, a neurodegenerative disorder • If the gene mutation for HD is present, symptoms of HD are certain to appear if the individual lives long enough Predispositional testing: • Testing for a BRCA1 gene mutation to determine breast cancer susceptibility • Predispositional testing differs from presymptomatic testing in that a positive result (indicating that a BRCA1 mutation is present) does not indicate a 100% risk of developing the condition (breast cancer).

what are the risk factors for PID?

• Young age < 25 years old • Nulliparity • Multiple partners • History of STIs and PID • Intrauterine devices (IUDs) up to 3 weeks after insertion

trisomy 13 = patau syndrome

• central nervous system anomalies, • visual abnormalities, • microcephaly (small head), • absent nasal bridge, • cleft lip and palate, • holoprosencephaly (one large eyelike structure in the center of the face due to fusion of the developing eyes), • capillary hemangiomas, • cardiac defects, • extremity deformities including o polydactyly (extra fingers or toes), • renal abnormalities • Genital abnormalities

CDC recommends treatment for PID if the following criteria are found and no other causes of illness are found

• lower abdominal tenderness, • bilateral adnexal tenderness, • cervical motion tenderness. all sexually active young women and others at risk for STIs

trisomy 18 = Edward syndrome

• small for gestational age or low birth weight; • craniofacial abnormalities including o cleft lip and/or palate, small mouth, o small jaw; • weak cry; • feeding difficulties; • Cardiac malformations; • central nervous system manifestations including hypertonia, seizures, and apnea; • Extremity malformations such as o Small fingernails and toenails, o Clenched fist with index finger overlapping the third finger o Rocker-bottom feet

Importance of Family History

・Completion of the Human Genome Project has resulted in renewed interest in family history ・Single most cost-effective piece of genetic information ・U.S. Department of Health and Human Services has designated Thanksgiving as "National Family History Day" ・A number of family history tools are available online

Essential Competencies for all Nurses

・Constructs pedigree from collected family history using standardized symbols and terminology ・Develops plan of care that incorporates genetic and genomic assessment information ・Recognizes when one's own attitudes and values may affect care provided to clients ・Provides clients with credible, accurate, appropriate, and current genetic and genomic information, resources, services, and/or technologies ・Demonstrates in practice the importance of tailoring genetic information to clients based on ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues ・Assesses the client's knowledge, perceptions, and responses to genetic and genomic information ・Facilitates referrals for specialized services

condoms

- covers penis before genital, oral, or anal - barrier to sperm and STIs (HIV) - polyurethane (more likely to slip) - failure rate: 18%

injectable progestins

- depot medroxyprogesterone (DMPA) - 150 mg intramuscularly in deltoid or glut max. - 21- to 23- guage needle, 2.5 to 4 cm long -given first 5 days of menstrual cycle, administered 11 to 13 weeks - long lasting, required 4 times a year side effects - decreased bone mineral density per one year - weight gain - irregular vaginal spotting - breast changes

Cervical Caps: FemCap (only available one is US)

- fits snuggly around cx - 3 sizes - remains no less than 6 hours and no more than 48hr. leave in place 6 hr after intercourse - Refit same as diaphr.; - Use during menses: TSS - significant failure rates (16% nulliparous and 32% multiparous); different from diaphragm - no need to reapply spermicide during multiple actions of intercourse contraindicated if pap smear is not good, latex or spermicide allergy

Hepatitis C virus (HCV)

______________________________ Viral infection of the liver that is a major bloodborne infection in the United States. It is transmitted parenterally and through intimate contact. There is no vaccine available to provide protection against this infection.

Vagina rugae; Skene; Bartholin

"Fibromuscular collapsible tubular structure that extends from the vulva to the uterus and lies between the bladder and rectum. Its mucosal lining is arranged in transverse folds called ________. ________ and ______ glands secrete mucus that lubricates the vagina."

genetic testing

"Testing that involves the analysis of human DNA, RNA, chromosomes, or proteins to detect abnormalities related to an inherited condition."

family

"The primary unit of socialization and nurturing within a community that preserves and transmits culture."

second trimester abortion

- state regulates procedures if reasonable and related to woman's health - dilation and evaculation

serious adverse effects

- stroke - myocardial infarction - thromboembolism - hypertension - gallbladder disease - liver tumors

Genital herpes simplex virus (HSV)

______________________________ Viral infection that is transmitted sexually and is widespread in the United States. It is characterized by painful, recurrent genital ulcers.

1. Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs); chlamydia; HPV; gonorrhea; HSV-2; syphilis; HIV

_______________________________ Infections or infectious disease syndromes primarily transmitted by close intimate contact. The most common infections of this type in women are , _______________________________, ________________________________, ________________________________, ________________________________, _______________________________ and _______________________________.

Syphilis; chancre; condylomata lata

_______________________________ One of the earliest described STIs. It is caused by Treponema pallidum, a motile spirochete. _______________________________ Primary lesion that appears 5 to 90 days after infection. _______________________________ Broad, painless, pink-gray wartlike infectious lesion that may develop on the vulva, the perineum, or the anus.

-Predictive testing -presymptomatic -predispositional

_______________________________ Tests used to clarify the genetic status of asymptomatic family members. There are two specific types of these tests, namely, _______________________________ tests (gene mutation is present and symptoms are certain to appear if the individual lives long enough) and _______________________________ tests (gene mutation is present but this positive result does not indicate that there is a 100% risk of developing the condition).

A 40-year-old male has elected to have a vasectomy because he no longer wants to worry that a sexual partner will become pregnant. The nurse describes the procedure along with care requirements before and after the procedure. Which statements by the client indicate the need for further instruction? (Circle all that apply.) A. "I am glad I will not need to use a condom. I hate them!" B. "I will use ice packs for a few hours after I get home to reduce swelling and discomfort." C. "I will wear a scrotal support for a few days to reduce discomfort." D. "I will need to wait about 3 weeks before resuming sexual intercourse." E. "I should not expect to see a decrease in the amount of semen I ejaculate."

a d

graphic representations of families

a family genogram (family tree) depicting relationships of family members over at least 3 generations

neurofibromatosis (NF)

a progressive disorder of the NS that causes tumors to form on nerves anywhere in the body half inherited, half spontaneous mutations NF1: neurofibromas NF2: bilateral vestibular schwannomas

Millenium Development Goals (MDGs)

a set of eight goals to be achieved by 2015 that respond to the world's main development challenges and adopted by 189 nations under the auspices of the united nations

Healthy People 2020

a set of science-based 10 year objectives that reflects the nation's agenda for improving health with the ultimate aims to increase the quality and years of healthy life and to eleminate health disparities

contraceptive sponge

a small round polyurethane device that contains spermicide. it fts over the cervix and has a woven polyester loop to facilitate its removal

cervical cap

a soft rubber or latex-free silicone dome with a firm but pliable brim that fits snugly around the base of the cervix close to the junction of the cervix and vaginal fornices.

knowledge of trends in fertility and birth rates can guide nurses in targeting health care resources to those areas and patents in most need of intervention. Which statements accurately reflect current trends in the united states? SATA a. women between ages 20 and 29 years have the highest birth rate b. the nincidence of LBW ( low birth weight) is highest among non hispanic african-maerican women c. the leading cause of neonatal dealth is premature birth d. the infant mortality rate is a common indicator of the adequacy of prenatal care and th ehealth of a nation as a whole e. hispanic women are twice as likely as non-hispanic caucasion women to die as a result of pregnancy

a. women between ages 20 and 29 years have the highest birth rate b. the nincidence of LBW ( low birth weight) is highest among non hispanic african-maerican women d. the infant mortality rate is a common indicator of the adequacy of prenatal care and th ehealth of a nation as a whole

elective abortion

abortion performed at woman's request

therapeutic abortion

abortion performed for reasons of maternal or fetal health or disease

african american views on pregnancy

acceptance of pregnancy depends on economic status status pregnancy thought to be state of wellness which is often the reason for delay in seeking prenatal care beliefs - picture taken during pregnancy will result in stillborn craivings for certain food - chicken, greens, clay, starch, dirt pregnancy viewed by men as their virility

normal vaginal discharge

adequate secretions --> vaginal discharge leucorrhea = clear to cloudy, turn yellow after dying • Slimy, nonirritating, mild/inoffensive odor • Acidic = pH of 4-5 • Contain lactobacilli and epithelial cells Amount differs based on menstrual cycle • Greater amounts at ovulation and just before menses • Increased during pregnancy

disparities in morbidity and mortality rates

african americans native americans hispanic alaska natives asian/pacific islanders compared to caucasians

what are the criteria for diagnosing PID?

all sexually active young women and others at risk for STIs • lower abdominal tenderness, • bilateral adnexal tenderness, • cervical motion tenderness. • an oral temperature of 38.3° C or above, • abnormal cervical or vaginal discharge, • elevated erythrocyte sedimentation rate, elevated C-reactive protein, • laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis

multiphasic pills

alter amount of progestine and amount of estrogen within each cycle

Affordable Care Act

an act passed in 2010 that aims to make insurance affordable, contain costs, strengthen and improve Medicare and Medicaid, and reform the insurance market. Full implementation of this act will occur over the next several years

risk management

an evolving process that is used to identify risks, establish preventive practices, develop reporting mechanisms, and delineate procedures for managing lawsuits

oral cavity examination

annually

Reportable Sentinel Events

any maternal death related to the process of birth any perinatal death unrelated to a congenital condition in an infant having birth weight greater than 2500 gr severe neonatal hyperbillirubinemia (> 30 mg/dl) infant discharged to the wrong family hemolytic transfusion reaction involving major blood group incompatibilities leaving a foreign body in a client after surgery falls that result in death major permanent loss of function as a direct result of fall

TeamSTEPPS

approach developed by the Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality as a teamwork system for health professionals to provide higher quality, safer client care. It provides an evidence base to improve communication and teamwork skills

outcomes of care

approach to care that measures effectiveness of care against nebchmarks or standards. it is a measure of the value of nursing using quality indicators and answers to question : did the client benefit or not benefit from the care provided

hepatitis C: symptoms

asymptomatic flu-like symptoms

clinical manifestations: latent phase of syphilis

asymptomatic • If untreated • Detected by serologic testing • Early latent infection = if acquired in preceding year

BRCA1 and BRCA2 genes are inherited in which pattern?

autosomal dominant 50% chance inheriting mutated gene

NF1 is inherited how?

autosomal dominant inheritance

phenylketonuria

autosomal recessive disorder inborn errors of metabolism deficiency in liver enzymes phenylalanine hydroxylase --> failure to metabolize the amino acid phenylalanine --> metabolites accumulate in blood state-mandated screening for new borns

after teaching a group of pregnant women about the hazards of cigarette smoking during pregnancy, a women answers a question by listing the hazards. Which hazard, if included by the womenin her list, indicates the need for further teaching a. intrauterine growth restriction b. congenital abnormalities c.low birth weight d. premature labor and birth

b. congenital abnormalities

when caring for women, nurse should focus on helping their patients to decrease their risk for the leading cause of death for women, which is a. breast cancer b. heart disease c. cervical cancer d. diabetes millitus

b. heart disease

reciprocal translocation

balanced translocation - exchanged equally unbalanced translocation - extra chromosomal material

least effective contraceptive methods

barrier methods and natural family planing - condoms, diaphragms, cervical caps, spermicides, withdrawal, periodic abstinence during perceived ovulation

Calgary Family Assessment Model

based on the nurse's personal and professional life experiences, beliefs, and relationships with those being interviewed categories include: structural, developmental, functional with several subcategories in them

what are the nonpharmacogical treatments for PID?

bed rest in semi-Fowler position • Comfort measures = analgesics • As few pelvic exams as possible • Recovery phase → restrict activity, adequate rest, proper nutrition • Follow up lab work after treatment = endocervical cultures

history should include

biogrsaphic data reasons for seeking care present health or history of present illness past health family history screening for abuse review of systems functional assessment

alcohol risks

birth defects risk for miscarriage stillbirth preterm birth SID FASD

european american views on labor

birth is a public concern technology dominated birthing process in institutional setting preferred involvement of father is expected physician is a head of team

withdrawal bleeding

bleeding that occurs from 1 to 4 days after the last combined oral contraceptive is taken

ischemic phase

blood supply to the functional endometrium is blocked and necrosis develops functional layer separates from basal layer and menstrual begins again, making it day 1

reproductive tract infection

both STIs and other genital tract infections

Hispanic views on newborn

breastfeeding begins after 3rd day - colostrum - filthy or spoiled or just not enough nourisment - olive oil or castor oil is given to help to pass meconium - male infant not circumcised - female infant's ears are pierced - belly band used to prevent umbilical hernia - religious medal worn by mother during pregnancy, worn by newborn - infant protected from evil eye - various remedies used to treat even eye and depressed fontanel

most anomalies present

by end of 8 weeks

A woman has had a ParaGard T380A IUD inserted. The nurse should recognize that the woman needs further teaching if she says: (Circle all that apply.) A. "This IUD remains effective for 10 years." B. "It is normal to experience an increase in bleeding and cramping within the first year after it has been inserted." C. "My IUD works by releasing progesterone." D. "I should avoid using NSAIDs such as Motrin if I have cramping." E. "I must use risk prevention measures, including condoms, to prevent infections in my uterus."

c d

a nurse manager of a prenatal clinic should recognize that the most significant barrier encountered by pregnant women in accessing health care is a. lack of transportation to the clinic b. child care responsibilities c. inability to pay d. deficient knowledge related to the benefits of prenatal care

c. inability to pay

TSS/ Toxic shock syndrom

can occur during associatio n with diaphragm and cervical cap - sunburn rash diarrhea dizzinesss faintness weakness ST, myalgias, arthralgias, sudden fever and vomiting.

velocardiofacial syndrome

cardiac and craniofacial abnormalities microdeletion - very small piece of the long arm of chromosome 22 is missing

Ligaments supporting uterus

cardinal uterosacral round broad

five STIs required to report

gonorrhea syphilis lymphogranuloma venereum chancroid granuloma inguinale - some states require chlamydia, genital herpes, and genital warts AIDS reported in all states

Joanna Briggs Institute

grades of recommendation for evidence of feasibility, appropriateness, meaningfulness and effectiveness A - strong support that merit application B- moderate support that warrants consideration of application C- no supported

Standards of Practice

guidelines for nursing practice that reflect current knowledge, represent levels of practice agreed on by leaders in the speciality, and can be used for clinical benchmarking

bacterial vaginosis: most common cause

haemophilus vaginitis = gardnerella

areas of common injury after abuse in women

head neck chest abdomen brests upper extremities

community health assessment wheel

health care delivery system ( services, resources, organizational) environment - physical, biologic/chemical, social) people - ( demographics, biologic, social, cultural)

woman's health care

health care that focuses on the physical, psychologic and social needs of women throughout their lives

Evidenced Based Practice

health care that is based on information gained through research and clinical trials

data collection

health departments US census hpspitsld voluntary health agencies

components of preconceptions care

health promotion: general teaching (nutrition, exercise, substance abuse, risk reducing sex practice, family and social needs) risk factor assessment ( chronic diseases, infectious diseases, reproductive history, genetics, medications, personal behavior) interventions ( guidance and teaching)

leading cause of death in women

hearth disease 2. malignant neoplasm

Types of Pelvis: Android

heary shaped or angulated ressembles a male pelvis not favourable for labor and vaginal birth narrow pelvic planes can cause slow descent and midpelvic arrest

hepatitis A: vaccine

hepatitis A: vaccine • Two doses recommended for high risk women • Unknown safety in pregnancy • Pregnant women: • Immune globulin (gamma lobulin) or immune specific lobulin for pregnant women exposed to HAV

prevention of exposed pregnant women to HBV

hepatitis B immune globulin • Begin hep B vaccine series within 14 days of most recent contact = prevent infection • Vaccination during pregnancy = NOT risk to fetus

native american view on postpartum

herbal teas to stop bleeding

BRCA1 and BRCA2 mutations

hereditary breast cancers - autosomal dominant pattern = 50% inheriting mutation carriers = risk for pancreatic, prostate, ovarian, uterine tube cancer

tay-sachs disease: deficiency in which enzyme?

hexosaminidase - lipid storage disease

what is the only definitive test for HPV?

histologic evaluation of a biopsy specimen

contraindications to oral contraceptives

history of thrombotic events cerebrovascular or coronary artery disease breast cancer gallbladder jaundice with prior pill use estrogen dependent tumor pregnancy severe cirrhosis liver tumor lactation less than 6 week postpartum smoking headaches with focal neurologic symptoms surgery with prolonged immobilization hypertension diabetes milletus vascular disease

home predictor kits: urine predictor test

home predictor kits: urine predictor test -sudden surge of luteinizing hormone (LH) that occurs approx. 12-24 hours before ovulation - unlike BBT: not effective by illness, emotions, physical activities

Biological Marker Methods

home predictor test kits - marquette model

hormonal methods

hormonal methods - Combined Estrogen-progestin contraceptives - Combined Estrogen-progestin contaceptions

how do you do a physical inspection for HPV?

how do you do a physical inspection for HPV?

exercise effective to prevent

hypertension arthritis diabetes respiratory disorders osteoporosis improve body image and self-esteem, mood

pregnant women are at risk for____________ if they are morbidly obese

hypertension diabetes gallbladder postterm pregnancy musculoskeletal problems intrauterine growth restrictions intrauterine fetal demise

fetal ultrasound or sonogram - prenatal testing

image technique using high-frequency sound waves to produce images of the fetus inside the uterus

tay sachs disease

inborn errors of metabolism autosomal recessive lipid storage disease deficiency in hexosaminidase normal until age 4-6 months clinical symptoms: apathy and regression in motor and social development - decreased vision - death between 3-4 years NO treatment

infertility tests in men

include transrectal ultrasound (TRUS) to look for abnormalities, such as obstruction. Absence of sperm might be due to missing vas deferens or seminal vesicles. Laboratory tests include semen analysis (determining abnormalities in the number, shape, and motility of sperm). Blood tests to evaluate hormone levels ( free and total testosterone, LH, FHS, PRL, SHBG. Sometimes doctor might advise a biopsy of testicular tissue to identify the problems such as sperm production, abnormal growth, tumors, underdeveloped reproductive organs.

european american view on newborn

increased popularity of breastfeeding breastfeeding ASAP fascilitate bonding with sacred hour after birth

medical abortion

induced early abortion method using one of three drugs namely: methotrexate, misoprostol, or mifepristone

native american view on newborm

infant not fed colostrum use of herbs to increase flow milk use of cradle boards for infant babies not handled often

low birth weight infants

infant whose weight at birth is less than 2500 g (5 lb 8 oz) - multiple births - smoking - non-hispanick black

unsafe sexual practices affect

infectility ectopic pregnancy neonatal morbidity mortality genital cancers AIDS death

microdeletions in Y chromosome

infertility problems

vulvovaginitis

inflammation of vulva and vagina • Vaginal infection • Copious amounts of leucorrhea → tissue maceration • Chemical irritants, allergens, FB → inflammation

what must be obtained before HIV testing?

informed consent sometimes written consent

pelvic examination internal

insert speculum check cervix for color, lesions, bleeding, discharge, masses, protrusion, inflammation - collection of specimens - pap smear - vaginal wall examination ( color, lesions, rugae, fistulas, bulging)

gene therapy

inserting healthy copy of defective gene into somatic cells = any cell except sperm/egg cell

Herpes simplex maternal effects

intrauterine infection (rare)

autosomal abnormalities

involve difference in number or structure of autosome chromosomes. they result from unequal distribution of genetic material during gamete ( egg and sperm) formation

side effects of IUD

irregular bleeding for several months lighter or shorter periods or no periods at all symptoms of premenstrual syndrome espulsion uterine perforation PID ( kind of if you have PID you cannot put it on, but if you put it in, you will get PID, and then you definitely cannot put it in) cysts

Klinefelter Syndrome (KS)

is a sex chromosome abnormality. Our sex chromosomes are normally XX if you are female, and XY if you are male. Males are most commonly affected by Klinefelter syndrome, which is characterized by an extra X chromosome, resulting in "XXY" genes. Males with KS are usually tall with wide arm spans and will have small testes and breasts Males may be infertile or fertile. They are also more likely to suffer learning disabilities, psychosocial problems, low self-esteem, and depression While KS usually happens by chance due to the failure of homologous X chromosomes (Links to an external site.)Links to an external site. to separate at anaphase (which can take place in oogenesis or spermatogenesis), one risk factor found was the age of the female when she gives birth. A maternal age of >40 has a 4-fold increase in the risk of conceiving a Klinefelter fetus as compared to maternal age < 24

maternal mortality rate

is preventable by accessing and using prenatal services leading cause of maternal death in general - hypertensive disorders, infection, hemorrhage leading causes of maternal death in US - cardiovascular disease, infection/sepsis, non cardiovascular diseases

native american view on pregnancy

it is normal natural process late prenatal care avoid heavy lifting hearbal teas encouraged

serious problems in US related to health care of mothers and infants

lack of access to pre-pregnancy and pregnancy-related care for all women lack of reproductive health services for adolescents STDs affect reproduction racial and ethnic diversity is increasing ( including health outcomes)

breasts functions

lactation organs of sexual arousal change in size and dodularity in response to cyclic ovarian changes

breastfeeding

lactational amenorrhea method (LAM) - effective, temporary method of birth control - works best is mother is exclusively breastfeeding, hasn't had menstrual flow and infant is younger then 6 months - frequent feedings of intervals of less than 4 hours during day and no more then 6 at night mechanism: - when infant feeds, prolactin hormone release - inhibits estrogen productions and suppresses ovulation and return of menses

recurrent HSV symptoms

less severe, local lasts 5-7 days vesicles - rapidly to ulcers

pelvic examination external

lithotomy wxplanation external inspection - for sexual maturity, lesions, STI, trauma, scars external palpation - before touch explain, first touch less sensetive area skene glands are checked by milking urethra check for masses and erythema -vaginal orifice - ask to strain to see for any bulging ( rectocele etc) - check perimeum - anus assessed for hemorroids, tumors etc - culture for any STI

lobules

lobes divided into

interstitial deletion

loss of chromosomal material anywhere else in the chromosome

terminal deletion

loss of chromosomal material at the end of a chromosome

Chlamydia fetal effects

low birth weight

X-linked recessive

males are hemizygous - only one X chromosome = carries genes with no alleles on Y chromosome most common in males Fragile X syndrome

lobes

mammary glands are made of

current prenatal testing options

maternal serum screening fetal ultrasound/sonogram invasive procedures noninvasive prenatal testing for fetal aneuploidy

Outcomes-oriented care

measures effectiveness of care against benchmarks or standards

fertility awareness methods. natural family planning, periodic abstinence

mehtods that depend on identifying the beginning and end of the fertile period of the menstrual cycle; they provide contraception by relyin gon avoidance of intercourse during fertile periods.

two-day method

method based on monitoring and recording cervical secretions; each day the woman ask herself, (1) did I note secretions today? and (2) did i note secretions yesterday? if the answer to either is yes, she should avoid coitus or use a backup method of birth control. if the answer to both questions is no, her probability of getting pregnant is very low

calendar rhythm method

method based on the number of days in each cycle, counting from the first day of menses. the fertile period is determined accurately recording the lengths of menstrual cycles for at least 6 months.

basal body temperature (BBT) method

method based on variations in a healthy woman's lowest body temperature taken immediately after waking and before getting out of bed

PKU (Phenylketonuria) method of inheritance

method of inheritance of the disorder Babies born from mother, suffering from non-controlled PKU, might suffer intellectual disability due to exposure to phenylalanine, as well as heart defects or other heart problems, an abnormally small head size, and behavioral problems (Genetics Home Reference). This disorder is inherited in an autosomal recessive pattern (a baby has two copies of the gene that is altered). Each parent carries one copy of the altered gene, and one that is normal, which means that they wouldn't have signs or symptoms of PKU. PKU is caused by mutation in PAH gene, causing low levels of an enzyme (phenylalanine hydroxylase) and prevents phenylalanine from being metabolized. When child inherits only one gene, they are carriers and they don't have PKU. This disorder is mostly noticed in Native Americans and Northern European. And It is rarely seen in Jewish, African, or Japanese populations. This disease has 2 predisposing factors: Both parents are gene carriers Certain ethnic background When child inherits only one gene, they are carriers and they don't have PKU.

symptothermal

method that combines the basal body temperature (BBT) and cervical mucus methods with awareness of secondary cycle phase-related symptoms

coitus interruptus

method that requires the male partner to withdraw his penis from the woman's vagina before he ejaculates

ovulation metnhod

method that requires the woman to recognize and interpret cyclic changes in the amount and consistency of cervical mucus that characterize her own unique pattern of changes.

biologic marker

methods based on detecting the sudden surge of luteinizing hormone (LH) that occurs approximately 12 to 24 hours before ovulation

bacterial vaginosis: treatment

metronidazole = oral AE: numerable • Sharp, unpleasant metallic taste in mouth • Furry tongue • CNS reactions • Urinary tract disturbances

treatment: trichomoniasis

metronidazole or tinidazole • Orally in single dose • Male partner - even though asymptomatic • Otherwise recur

x-linked dominant inheritance

mimics autosomal dominant inheritance male to male transmission canNOT occur - unless father has klinefelter syndrome occurs in males and heterozygous females - females less severely affected than males - more likely transmit affected gene (variant allele) = 50% transmitting Vitamin D resistant rickets Rhett syndrome

syphilis maternal effects

miscarriage preterm labor

Gonorrhea maternal effects

miscarriage preterrm labor premature rapture of membrane amniotic infection syndrome chorioamnionitis postpartum endometriosis postpartum sepsis

TwoDays Methods

monitoring and recording cervical secretion - 2 days without secretions, woman may resume unprotected intercourse - easy to teach, learn and use failure rate 24%

turner syndrome

monosomy X (45,X) missing x chromosome = female • Exhibits juvenile external genitalia with undeveloped ovaries. • She is short and often has webbing of the neck, a low hairline in the back, low-set ears, and lymphedema of her hands and feet. Intelligence may be impaired • Most miscarry spontaneously

NF1 (neurofibromatosis)

most common neurofibromas: benign, soft tumors patches of skin pigmentation = cafe-au-lait spots mild --> normal lives autosomal dominant complete penetrance by 5 years old

primary prevention STI

most effective way of reducing the adverse consequences of STI prevent infection complete abstinence from sexual activities that transmit semen, blood or body fluids mutually monogamous relationship with unaffected partner

most trisomies are maternal meiosis errors

most trisomies are caused by nondisjunction during the first meiotic division first meiotic division involves segregation of homologous or similar chromosomes one pair of chromosomes fails to separate --> one cell contains both chromosomes, the other contains none initiated during fetal development; not complete until undergo ovulation after menarche

asian american view on labour

mother attended by other women father does not actively participate labor in silence c birth not desired but cooperative if needed

european american view on parenting

motherhood is stressful nuclear family valued, women deal with multiple roles early return to pre-pregnancy activities

uterus

muscular pear shaped cavity in which the fetus develops cavity from which menstruation occurs

vagina

muscular tube that extensd from the cervix to the vaginal opening in the perineum known as the birth canal passageways from menstrual blood flow, for penis for intercourse, and for the fetus

fallopian tubes

muscular tubes lying near the ovaries and connected to the uterus tubes that propel the ova from the ovaries to the uterus

asian american view on postpartum

must protect self from yin cold forces for 30 days ambulation limited shower and bathing prohibited warm room diet - warm fluids, vegetarians, korean mother will serve seaweed soup with rice, chinese diet high in hot food, chinese mother avoids fruit and veggies

oncogenes:

mutated forms of proto-oncogenes --> encourage and promote normal growth and development mutate --> carcinogenic oncogenes --> excessive cell multiplication

fetal complications

nonreassuring fetal heart rate and pattern prolapsed umbelical cord shoulder dystocia uterine hyperstimulation

Types of Pelvis: Gynecoid

normal female pelvis transversely rounded or blunt

tumor suppressor genes

normally inhibit cell growth and division cycle = prevent growth of tumors mutations --> ignore inhibitory signals --> higher rate of uncontrolled growth = cancer mutations of tumor protein p53 --> lung, colorectal, breast

HPV fetal effects

not known

infant mortality rate

number of deaths of infants younger than 1 year of age per 1000 live births

neonatal mortality rate

number of deaths of infants younger than 28 days of age per 1000 live births

maternal mortality rate

number of maternal deaths from births and complcations of pregnancy, childbirth, and the puerperium ( the first 42 days after termination of the pregnancy) per 100000 live births

how are chromosomes organized in a karyotype?

numbered largest to smallest = 1-22

aneuploidy

numerical deviation is NOT exact multiple of haploid set - most common chromosomal abnormality Monosomy - 45 Trisomy - 47

bacterial vaginosis: risks

o Multiple partners o Increases susceptibilities to STIs o Associated with preterm labor and birth

autosomal dominant inheritance

o Only one copy of a variant allele is needed for phenotypic expression VERTICAL pattern of inheritance - NO skipping generations

risks for neonatal GBS

o Positive prenatal culture in current pregnancy o Preterm birth of less than 37 weeks o Premature rupture of membranes for duration of 18+ hours o Intrapartum maternal fever higher than 38C o Positive history for early onset neonatal BVS

HPV lesions

o Posterior part of introitus • Buttocks, vulva, vagina, anus and cervix o Small, soft, papillary swellings (2-3 mm in diameter and10-15 mm in height) - singly or clusters o Long duration → cauliflower-like mass o Moist areas (vaginal introitus) → multiple, find finger-like projections o Vaginal lesions = multiple o Cervix = flat-topped papules - magnification needed o Warts = flesh colored or slightly darker on Caucasian women o Painless but may be uncomfortable o Chronic vaginal discharge, pruritus, dyspareunia

decreased risks for GBS

o Screened at 35-37 weeks gestation = rectovaginal culture o IV Abx prophylaxis during labor if test positive • NOT before cesarean birth if labor or rupture of membranes has not occurred

trisomy

o The product of the union of a normal gamete with a gamete containing an extra chromosome o Have 47 chromosomes in most or all their cells o The vast majority of trisomies occurs during oogenesis • The process by which a premeiotic female germ cell divides into a mature egg

bilateral vestibular schwannomas

o Tumors on the eighth cranial nerves, which are hearing and balance nerves o These tumors often cause pressure damage to nearby nerves that may result in the individual with NF2 experiencing headaches, facial pain, and facial numbness.

nutritient deficiencies

obesity eating disorders (bulimia, anorexia, binge eating disorder)

what are some common factors that influence the decision to undergo genetic testing?

obligation to others location and socioeconomic status - ability and access to prenatal screening more available to widespread group of people

vision test

once 20-29 twice 30-39 every 2-4 years 40-64 every 1-2 years after 65

progestin patch

once a week for 3 weeks, one week no patch continuous level of progestin

genes that play role in developing of cancer

oncogeneses tumor supressor genes

Types of Pelvis: Anthropoid

oval shape adequate outlet with a narrow pubic arch

female reproductive organs

ovaries, fallopian tubes, uterus, cervix, vagina

unbalanced translocation

part of chromosome transferred to different chromosome extra chromosomal material - extra of one chromosome but the correct or deficient amount of the other chromosome reciprocal translocation phenotypically and genotypically abnormal?

group B streptococcus

part of normal vaginal flora poor pregnancy outcomes o Neonatal morbidity and mortality = vertical transmission form birth canal of infected mother to infant during birth

factors of infertility in women

pelvic inflammatory disease and blocked fallopian tubes ( due to STD), abnormal levels of hormones, polycystic ovary syndrome, ovary insufficiency, fibroids in uterus, endometriosis, autoimmune disorders, hypothyroidism, eating disorders, celiac disease

male reproductive structures

penis scrotum prostate gland

contraceptive failure rate

percentage of contraceptive users expected to have an unplanned pregnancy during the first year, even when they use a method consistently and correctly

multifactorial inheritance

phenotypic characteristics from two or more genes on different chromosomes acting together combination of genetic and environmental factors Each malformation may range from mild to severe, depending on the number of genes for the defect present or the amount of environmental influence

sleep disorders are correlated with

physical and mental health problems like - depression, pain, fybromyalgia

karyotype

pictorial analysis of number, form, size of individual's chromosomes cells from any nucleated, replicating body tissue (NOT RBCs, nerves or muscles) can be used most commonly tissues are WBCs and fetal cells in amniotic fluid numbered from largest to smallest = 1-22, sex chromosomes X and Y

contraindications IUD

pregnancy ( or suspicion) - abnormalities in uterus - PID - postpartal/postlabour endometriosis in the past 3 months - suspected or known malignancy - genital bleeding of unknown etiology - Mucopurulent cervicitis - Wilson's disease - previous, not removed IUD - possible fibroids - abnormal Pap smear - acute liver disease or liver tumor - multiple sex partners - increased susceptibility to infections (HIV, leukemia etc) - possible breast carcinoma - history of ectopic pregnancy - genital actinomycosis

asian american view on pregnancy

pregnancy - when mother has happiness in her body natural process strong presence for female care provider belif in hot and cold may omit soy sauce to prevent dark skinned baby prefer soup with ginseng root milk excluded because it causes stomach distress inactivity or sleeping late may cause difficult birth

european american view on pregnancy

pregnanyc requires medical attention to ensure health early prenatal care variety childbirth education technology driven emphasis on nutrient involvement of father is valued written sources of info

Gonorrhea fetal effects

preterm birth Intrauterine growth restriction

syphilis fetal effects

preterm birth stillbirth congenital infection Intrauterine growth restriction

emergency contraception before ovulation

prevents ovulation by inhibiting follicular development ineffective if the women is pregnant

pregnancy prevention

primary and secondary maintain healthy pregnancy and preventing illness screening those at risk for potential illness prevention of complications during the perinatal period

tubal reconstruction

procedure used to restore tubal continuity (reanastomosis) after sterilization procedure

Monosomy

product of union between normal gamete and gamete that is missing a chromosome only 45 chromosomes in each of their cells

what is common for both trisomy 18 and trisomy 13?

profound intellectual disabilities poor prognosis - most die before reach first birthday more living longer = 20s and 30s

depo-provera (DMPA, depot medroxyprogesterone acetate)

progesin only IM injection providing contraception for approximately 3 months

Which hormone causes the maturation of mammary gland tissue, specifically the lobules and acinar structures?

progesterone

minipill

progestin only contraceptive pill

secondary prevention of STI

prompt diagnosis and treatment

penetrance

proportion of heterozygotes for a dominant trait who express a trait, even mildly

Evidence-based practice is best described as: gathering evidence of mortality and morbidity in children. meeting physical and psychosocial needs of the family in all areas of practice. using a professional code of ethics as a means for professional self-regulation. providing care based on evidence gained through research and clinical trials

providing care based on evidence gained through research and clinical trials. Evidence-based practice is providing care based on evidence gained through research and clinical trials. Practitioners must use the best available information on which to base their interventions. Gathering evidence of mortality and morbidity of children will assist the nurse in determining areas of concern and potential involvement. It is not possible to meet all needs of the client and family in all areas of practice. The nurse is an advocate for the family. This is part of professional role and licensure.

pt teaching for decreasing the transmission of HSV

pt teaching for decreasing the transmission of HSV • Viral shedding = transmission most likely = refrain from sex until complete healing of lesions • Suppressive therapy decrease risk of transmission • Condoms recommended - do not prevent transmission • Avoid contact with lesions • Assess for herpetic lesions with mirror • Wash hands with soap and water after touching lesion avoid sharing intimate items

induced abortion

purposeful interruption of a pregnancy before 20 weeks of gestation

proliferative phase

rapid growth from 5th say till ovulation endometrial surface is restored this phase depends on estrogen stimulation derived from ovaries follicles

what should infants receive if they were born of an HIV positive mother?

receive oral zidovudine for 6 weeks after birth • Avoid breastfeeding

rectovaginal palpation

rectovaginal septum posterior surface of the uterus region behind cervix and adnexa

self-care after vasectonmy

reduce swelling and relieve discomfort - ice packs - scrotal support - moderate inactivity for 2 days - contraception needed until sperm count on 2 consecutive tests are 0. may take up to one week- to several months until sperm is cleared from ducts

ovulation

release of the mature ovum from the ovary

ovarian hormones

released by anterior pituitary gland follicle stimulating hormone and luteinizing hormone hormoones produce changes in the ovaries and the endometrium

bimanual palpation

requires use of both hands to envelop or capture certain body parts or organs vagina palpated for distensibility, lesions, tenderness cervix is examined for position, shape, consistency, motility, lesions fonix palpated uterus assessfor position, size, shape, consistency, regularity, motility, masses and tenderness

Cochrane Pregnancy and Childbirth Database

result of collaboration that oversees up to date, systematic reviews of randomized controlled trials of health care and disseminates these reviews to provide the most reliable evidence about the effects of care. Care measures are ranked in six categories from beneficial forms of care to those that are ineffective and potentially harmful

deletions

results in loss of chromosomal material and partial monosomy for the chromosomes involved

homologous chromosomes

same number and arrangement of genes same loci = located in same place both code for the same trait - NOT for same specific trait

Healthy People

science based 10 year national objectives for improving health of all americans

prostate gland

secrete a milky alkaline fluid enhances sperm movement and neutralizes acidic vaginal secretions

deletion of long arm of chromosome 18

severe psychomotor delay with multiple organ malformations

who are at highest risk for developing chlamydia?

sexual active ages 15-24 18-20 highest incidence

how is gonorrhea transmitted?

sexual contact - exclusively • Genital to genital contact • Oral to genital • Anal to genital Age biggest risk factor = sexually active teenagers, young adults and blacks • Age 15-24

diaphragm

shallow, dome-shaped latex or silicone device with a flexible rim that covers the cervix resulting in a mechanical barrier to sperm

menstrual phase

shedding of endometrium is initiated by periodic vasoconstriction in the upper layer of endometrium

acculturation

"Changes that occur within one group or among several groups when people from different cultures come into contact with one another and exchange and adopt each other's mannerisms, styles, and practices while retaining some of their own culture."

single parent

"Family category in which there is only one biologic or adoptive parent as head of the household who may or may not be living with other adults; it is becoming an increasingly recognized structure in our society."

multigenerational

"Family structure consisting of three or more generations of relatives (e.g., grandparents, children, and grandchildren)." might create stress because children must care for their parents

Married-blended

"Family structure formed as a result of divorce and consisting of unrelated family members (stepparents, stepchildren, and stepsiblings) who join to create a new household."

no-parent families

"Family structure in which children live independently in foster or kinship care, such as living with a grandparent."

Cohabitating families

"Family structure in which children live with two unmarried biologic or adoptive parents."

nuclear

"Family structure in which male and female partners and their children live as an independent unit, sharing roles, responsibilities, and economic resources."

Walking survey (community walkthrough)

"A community assessment technique that involves observing a community by traveling through it." includes - physical environment, people in the area, stores and services available, social, religious, health services, transportation, education, government, safety, evaluation of the community based on your observations

McGill Model of Nursing

"A family theory that involves a strength-based approach in clinical practice with families as opposed to a deficit approach."

Family Systems Theory

"A family theory that views the family as a whole greater than the sum of its individual members and thus focuses on observing the interaction among family members rather than on studying family members individually."

Health Belief Model

"A family theory with a focus on reducing cultural and environmental barriers that interfere with access to health care. Key elements include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and confidence."

"Culture"

"A unified set of values, attitudes, beliefs, and standards of behavior shared by a group of people and passed down from one generation to the next."

vestibule

"Almond-shaped area enclosed by the labia minora that contains openings to the urethra, Skene glands, vagina, and Bartholin glands."

Ovaries ovulation estrogen progesterone androgen

"Almond-shaped organs located on each side of the uterus. Their two functions are ____ and the production of the hormones _______, _______, and ______."

A woman with genital herpes whose lesions have healed asks the nurse if treatment can be stopped "now that the virus is gone." What nursing education is appropriate for this woman? "If your blood test comes up negative, we can stop treatment." "If you have no symptoms for the next seven days, we can stop treatment." "Antiviral treatment does not cure herpes, it only treats the symptoms and prevents outbreaks." "You should finish the prescribed course of medication so the virus does not become drug-resistant."

"Antiviral treatment does not cure herpes, it only treats the symptoms and prevents outbreaks." There is currently no cure for herpes, and antiviral treatment is focused on reducing symptoms, shedding, and recurrent episodes. This education is appropriate for the woman.

extended

"Family structure that includes the nuclear family and other people related by blood (kin), such as grandparents, aunts, uncles, and cousins." realtives livign in the same household

mons pubis

"Fatty pad that lies over the anterior surface of the symphysis pubis."

what effects woman's ability to seek and receive health care

changing responsibilities and roles socioeconomic status personal lifestyle employment outside of home physical disability inadequate or no health insurance divorce single parenthood sexual orientation

spermicide

chemical that destroys sperm. when inserted into the vagina it acts a a chemical barrier to sperm

invasive procedures - prenatal testing

chorionic villus sampling amniocentesis

QSEN competensies

client centered care teamwork collaboration evidence based practice quality improvement safety informatics

lobules are

clusters of acini

nurse role in promotion family health

collaboration with the family identifying risk factors providing health information to facilitate positive health behaviors

Based on genetic testing of a newborn, a diagnosis of neurofibromatosis is made. The parents ask the nurse if this could happen to future children. Because this is an example of autosomal dominant inheritance, the nurse tells the parents: A. For each pregnancy, there is a 50/50 chance the child will be affected by neurofibromatosis. B. This will not happen again because the neurofibromatosis was caused by the harmful genetic effects of the infection you had during pregnancy. C. For each pregnancy there is a 25% chance the child will be a carrier of the defective gene but unaffected by the disorder. D. Because you already have had an affected child, there is a decreased chance of this happening in future pregnancies.

"Choice A is correct; autosomal dominant inheritance is unrelated to exposure to teratogens; each preg- nancy has the same potential for expression of the disorder; there is no reduction if one child is already affected; if the gene is inherited, the disorder is always expressed." A. For each pregnancy, there is a 50/50 chance the child will be affected by neurofibromatosis.

A woman has been diagnosed with factor V Leiden (FVL). The nurse caring for this woman would be alert for which of the following problems? A. Breast cancer B. Postpartum hemorrhage C. Deep vein thrombosis (DVT) D. Placenta previa

"Choice C is correct; factor V Leiden (FVL) affects the body's clotting mechanism by increasing the woman's risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)." C. Deep vein thrombosis (DVT)

A pregnant woman carries a single gene for cystic fibrosis, an inborn error of metabolism. The father of her baby does not carry this gene. Which of the following is true regarding the genetic pattern of the inborn error of metabo- lism as it applies to this family? A. The pregnant woman has cystic fibrosis herself. B. There is a 50% chance her baby will have the disorder. C. There is a 25% chance her baby will be a carrier. D. There is no chance her baby will be affected by this disorder.

"Choice D is correct; cystic fibrosis, as an inborn error of metabolism, follows an autosomal recessive pat- tern of inheritance; two defective genes (one from each parent) are required for the disorder to be ex- pressed; the woman does not have the disorder and the father does not have the defective gene; therefore none of their children will have the disorder but there will be a 50% chance they will be carriers of the defective gene." D. There is no chance her baby will be affected by this disorder.

A female carries the gene for hemophilia on one of her X chromosomes. Her father does not have hemophilia. Now that she is pregnant she asks the nurse how this might affect her baby. The nurse should tell her: A. A female baby has a 50% chance of also being a carrier. B. A male baby can be a carrier or have hemophilia. C. Female babies are never affected by this disorder. D. Hemophilia is always expressed if a male inherits the defective gene.

"Choice D is correct; there is a 25% chance that fe- males will be carriers; if males inherit the X chromo- some with the defective gene, the disorder will be expressed and they can transmit the gene to female offspring; females are affected if they receive the defective gene from both parents." D. Hemophilia is always expressed if a male inherits the defective gene.

personal space

"Cultural concept that reflects dimensions of personal comfort zones. Actions such as touching, placing the woman in proximity to others, taking away personal possessions, and making decisions for the woman can decrease personal security and heighten anxiety."

A patient with a family history of spina bifida reports reluctance to attempt conception without knowing the risk of having an infant with spina bifida. Which response from the nurse is appropriate? "Development of spina bifida depends on more than just genetic factors." "The only way to screen for spina bifida is through testing after conception." "Spina bifida is not affected by genetics; therefore, the risk cannot be determined." "Genetic counseling can determine your exact risk of having a child with spina bifida."

"Development of spina bifida depends on more than just genetic factors." Spina bifida is caused by genetic factors, as well as by environmental influences, such as inadequate maternal intake of folic acid.

A woman with a history of Toxic Shock Syndrome (TSS) states she wishes to continue using a diaphragm as her primary method of contraception. Which nursing education is appropriate for preventing further TSS infection? Select all that apply. "Remember to douche before inserting the diaphragm." "Do not use the diaphragm during your menstrual period." "Since you have a history of TSS, you should not use spermicide." "Wash your hands thoroughly before inserting the diaphragm." "Make sure to remove the diaphragm within the time frame given to you by the health care provider."

"Do not use the diaphragm during your menstrual period." A diaphragm should never be used during the woman's menstrual period, regardless of toxic shock syndrome history. This instruction is appropriate for the woman. "Wash your hands thoroughly before inserting the diaphragm." The woman should wash her hands thoroughly before inserting the diaphragm in order to help prevent toxic shock syndrome. This education is appropriate for the woman. "Make sure to remove the diaphragm within the time frame given to you by the health care provider." Removing diaphragm within the time frame given by the health care provider is important in preventing toxic shock syndrome. This education is appropriate for the woman.

Which question should the antepartum nurse ask patients when determining the need for genetic counseling? "Have you ever had a miscarriage?" "Have you ever been diagnosed with depression or anxiety?" "Does anyone in your family need to use a wheelchair or a cane?" "Do you have any relatives who have learning problems or are developmentally delayed?"

"Do you have any relatives who have learning problems or are developmentally delayed?" Family history of developmental disabilities is an indicator for genetic counseling, as it can indicate a patient at increased risk for fetal abnormalities.

A woman with bacterial vaginosis reports that douching at home helps relieve some of the symptoms. How should the nurse respond to this woman? "You should not douche unless your symptoms become severe." "Douching is a good way to relieve symptoms of bacterial vaginosis." "You should only douche once per day to avoid excessive drying of the vaginal walls." "Douching is associated with bacterial vaginosis and may have contributed to your infection."

"Douching is associated with bacterial vaginosis and may have contributed to your infection." Douching is associated with bacterial vaginosis infection and may have contributed to the woman's current infection. The woman should be instructed not to douche, even after infection has cleared, in order to prevent reinfection.

The antepartum nurse is caring for a patient who has a 2-year-old child with Down syndrome. The patient declines genetic counseling for her current pregnancy because she states, "there is nothing I can do about it now." Which education is appropriate for this patient regarding the use of genetic counseling? "If genetic counseling is done early in the pregnancy, defects can be prevented." "Genetic counseling is necessary because the risk for Down syndrome increases with each child." "Genetic counseling can help us determine if the abnormality came from you or your partner." "Genetic counseling can help us determine the risk of your second child being born with Down syndrome."

"Genetic counseling can help us determine the risk of your second child being born with Down syndrome." Genetic counseling is used to determine the risk for anomalies in subsequent pregnancies after the first child is born.

vulnerable populations

"Groups within the community that are more likely to experience health status problems and negative health outcomes as a result of a variety of sociocultural, economic, and environmental risk factors."

Which statement concerning personal health history would indicate the need for STI screening? "I cut my outer labia while shaving." "I had a positive pregnancy test yesterday." "I had a red sore on my perineum, but it's gone now." "I just finished antibiotics for a urinary tract infection (UTI)."

"I had a red sore on my perineum, but it's gone now." A single red, painless sore on the genital area is a sign of primary syphilis. When a chancre heals, bacteria enter the bloodstream and spread to all other parts of the body. The woman requires STI testing to determine if the sore was caused by syphilis infection so that the necessary treatment can begin.

The nurse is caring for a patient who has just received genetic counseling and is visibly distressed. The patient tearfully explains to the nurse that the counselor informed her that there was a 50% chance of her child having cystic fibrosis and asks, "What should I do about my pregnancy?" Which response from the nurse is appropriate for this patient? "Did the counselor say if there was anything you could do to lower the chance?" "We can get you information about adoption, if you think you might want to look at it." "A 50% chance isn't very high. There's an equal chance your baby will be perfectly healthy." "I know you're faced with a difficult decision, but I'm here to support the choices you make."

"I know you're faced with a difficult decision, but I'm here to support the choices you make." Genetic counseling is nondirective. The patient's autonomy should be respected, even when the patient does not know what to do. This response is appropriate because it acknowledges the patient's distress but does not make a decision for the patient.

Which patient statement would indicate the need to reschedule a pelvic exam? "I had unprotected sex three days ago." "My last menstrual period ended two weeks ago." "The home pregnancy test I used this morning was positive." "I made sure to douche last night so I would be clean for the exam."

"I made sure to douche last night so I would be clean for the exam." Women are advised not to douche for at least 48 hours before a pelvic exam. Douching can interfere with the normal vaginal environment and potentially mask signs of an infection, so this woman might need to reschedule.

The nurse-midwife is teaching a group of women who are pregnant about Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? "I will see results only if I perform 100 Kegel exercises each day." "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." "I should perform Kegel exercises only in the sitting position." "I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results."

"I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." Guidelines suggest that women perform between 30 and 80 Kegel exercises daily. The correct technique is to hold the contraction for at least 10 seconds and to rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. The exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

A pregnant woman refuses retesting for Human Immunodeficiency Virus (HIV) because the test administered during her last pregnancy was negative. Which is the appropriate nursing education for this woman? "HIV testing is mandatory for all pregnant women." "The test is only necessary if you are having symptoms of a secondary infection." "If the test is positive, we may be able to prevent transmission of the virus to your baby." "Since you do not have a history of injectable drug use, the HIV test is not necessary for your second pregnancy."

"If the test is positive, we may be able to prevent transmission of the virus to your baby." HIV testing is routine for pregnant women so that treatment can be started if necessary, possibly avoiding transmission to the fetus. This is an appropriate response for the woman.

A woman reports anxiety about the pelvic exam and states, "I hate that I won't be able to see what you're doing down there." How should the nurse respond to this woman? "If you are that upset, maybe we should reschedule the exam." "Don't worry. The doctor won't do anything that will hurt you." "You will have to get used to not seeing everything during medical exams." "If you like, I can give you a mirror to hold so you can see what is happening."

"If you like, I can give you a mirror to hold so you can see what is happening." Offering the woman the use of a hand mirror to observe the external genitalia and exam gives the woman direct visual access to the exam and addresses the woman's concern. Therefore, this is an appropriate response for the woman because it addresses the woman's concerns regarding the procedure.

A patient with no family history of genetic abnormalities asks the nurse if there may still be the need for prenatal genetic counseling. Which patient statement indicates that genetic counseling may be necessary? "My partner is 14 years older than me." "I was adopted by my biological mother's sister." "One of my children went deaf in one ear after an ear infection." "My family and I practice a religion that does not allow outside marriage."

"My family and I practice a religion that does not allow outside marriage." Patients who are members of groups that are isolated by geography, religion, or culture are at increased risk for autosomal recessive traits.

Spermicides and Barrier Methods

- contraceptive method and protections against spread of STIs: Human papillomavirus, herpes simplex virus - some male and female protect STIs - male condoms HIV - spermicides: chemical barriers against semen and inhibit ability of sperm to fertilize ovum

PKU (Phenylketonuria)

"In the United States, PKU occurs in 1 in 10,000 to 1 in 15,000 newborn babies. Newborn screening has been used to detect PKU since the 1960's (NHGRI, 2014)". It is inherited disorder, which increases the levels of phenylalanine in the blood (building block of proteins and obtained through diet). If it is not treated it phenylalanine can built up to dangerous levels and cause intellectual disability as well as Seizures, delayed development, behavioral problems, and psychiatric disorders. Infants with normal form of this disorder appear to be normal until they are few months old. Another interesting symptom is musty or mouth like odor from excess of phenylalanine. Children also might have lighter skin and hair color and eczema. Less severe form might not require treatment, just a diet adjustment (Genetics Home Reference). PKU is diagnosed through needle stick (heel stick), which is done shortly after birth. Treatment mostly consists of low protein diet ( low phenylalanine). So, foods to avoid are milk, cheese, ice cream and other dairy products, eggs, fish, meat, and poultry, nuts, beans, foods containing aspartame, beverages sweetened with products like NutraSweet® and Equal® Breastfeeding is particularly contraindicated for mother's with PKU. This is because the toxins created by the mother cross through the breastmilk. high phenylalanine level could also be due to liver dysfunction, premature birth, or biopterin disorder. With this, further analysis would be performed to determine if the infant has the PKU disorder.

The nurse educator is teaching a group of nursing students about infant mortality rate. Which statement by the nursing student indicates effective teaching? "Infant mortality rate is the number of fetal deaths per 1000 live births." "Infant mortality rate is the number of deaths per 1000 live births during the first year of life." "Infant mortality rate is the number of stillbirths and the number of neonatal deaths per 1000 live births." "Infant mortality rate is the number of deaths per 1000 live births occurring at birth or within the first 28 days of life."

"Infant mortality rate is the number of deaths per 1000 live births during the first year of life." The infant mortality rate is defined as the number of deaths during the first year of life per 1000 live births. The number of fetal deaths per 1000 live births is the fetal death rate. The number of deaths per 1000 live births occurring at birth or within the first 28 days of life is the neonatal death rate. The number of stillbirths and the number of neonatal deaths per 1000 live births are called the perinatal mortality rate.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: "Karyotyping will reveal whether the baby's lungs are mature." "Karyotyping will reveal whether your baby will develop normally." "Karyotyping will provide information about the gender of the baby and the number and structure of the baby's chromosomes." "Karyotyping will detect any physical deformities the baby has."

"Karyotyping will provide information about the gender of the baby and the number and structure of the baby's chromosomes." The lecithin/sphingomyelin ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Karyotyping provides genetic information, such as gender and chromosomal structure. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. Deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

Myoepithelium

"Layer of breast tissue below the epithelium that contracts to expel milk from the acini forward toward the nipple."

"Myometrium"

"Layer of the uterus composed of smooth muscles that extend in three different directions."

tertiary prevention

"Level of preventive care that focuses on rehabilitation of an individual who already has a disease back to as optimal a level of health as possible."

secondary prevention

"Level of preventive care that involves early detection of a disease and prompt treatment with the goal of curing the disease or slowing its progression and preventing subsequent disability; popula- tions at risk for certain diseases are targeted."

Squamocolumnar junction; Papanicolaou (Pap)

"Location in the cervix where the squamous and columnar epithelia meet (the transformation zone); it is the most common site for neoplastic changes; cells from this site are scraped for the ________ test."

cervix

"Lower cylindric portion of the uterus composed of fibrous connective tissue and elastic tissue."

A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make? "Male and female sterilization methods are 100% effective." "A vasectomy may have a slight effect on sexual performance." "Tubal ligation can be easily reversed if you change your mind in the future." "Major complications after sterilization are rare."

"Major complications after sterilization are rare." Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5% and for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.

A woman is reluctant to schedule a mammogram due to concerns about exposure to radiation. What is the appropriate nursing education? "You have had many x-rays in the past with no trouble, so you should be fine." "Mammograms use very low doses of x-rays, so the risk is almost nonexistent." "Your breast will be spread out between two plates, so the radiation will not focus on one specific spot." "Since you are already at risk for breast cancer, you should not have a mammogram due to the amount of radiation you would receive."

"Mammograms use very low doses of x-rays, so the risk is almost nonexistent." The risk of mammography is low to nonexistent because of the very-low-dose x-rays used in the procedure. Therefore, this teaching is appropriate for the woman because it addresses the woman's concerns and anxiety regarding the procedure.

"Uterus; cul-de-sac of Douglas"

"Muscular pelvic organ located between the bladder and the rectum and just above the vagina. The _______________________________ is a deep pouch, or recess, posterior to the cervix formed by the posterior ligament."

Genogram

"Term used for the family tree format of depicting relationships of family mem- bers over at least three generations; it provides valuable information about a family and its health."

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: "The lubricant prevents vaginal irritation." "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." "The additional lubrication improves sex." "Nonoxynol-9 improves penile sensitivity."

"Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Answer B is a true statement. Nonoxynol-9 may cause vaginal irritation.It has no effect on the quality of sexual activity or on penile sensitivity.

An obese woman reports having no body-image-related distress and asks if being obese is "really that bad." Which preventive counseling statements are appropriate? Select all that apply. "Obesity puts you at risk for multiple types of cancer." "The only disease you are at significant risk for is diabetes." "Your abnormal menstrual cycle may be related to obesity." "Inactivity related to obesity puts you at greater risk for stroke." "As long as you are comfortable with your body image, there is no reason for you to alter your diet or exercise habits."

"Obesity puts you at risk for multiple types of cancer." Obesity is associated with multiple chronic diseases, including breast, endometrial, and colon cancer. "Your abnormal menstrual cycle may be related to obesity." Gynecologic conditions associated with obesity include abnormal menses and infertility. Correct "Inactivity related to obesity puts you at greater risk for stroke." Inactivity related to obesity is associated with osteoporosis, osteoarthritis, dyslipidemia, stroke, and coronary artery disease.

complication sof IUD

"PAINS" to ensure signs of potential complications are understood. I would explain that PAINS refers to the following: P- period late, abnormal spotting or bleeding; A- abdominal pain, pain with intercourse; I- infection exposure, abnormal vaginal discharge; N - not feeling well, fever, or chills; S - string missing, shorter or longer

"Endocervical canal; internal os; external os"

"Passage that connects the uterine cavity to the vagina. The opening between the uterus and this passage is the _______. The opening between this passage and the vagina is the _______."

A woman is reluctant to perform vulvar self-examinations and asks if they are necessary, since she has no family history of reproductive cancers and is not sexually active. What nursing education is appropriate for this woman? "If you are not sexually active, monthly examinations are not necessary." "If your Pap test is normal, you only need to perform self-examination once every three months." "Performing self-examination now will help you recognize any abnormal changes that may occur in the future." "Because you do not have any family history of reproductive cancers, monthly examinations are not necessary."

"Performing self-examination now will help you recognize any abnormal changes that may occur in the future." Vulvar self-examination should be performed regardless of family history in order for the woman to establish a baseline appearance and detect signs of infection or abnormal growth in the future. Therefore, this teaching is appropriate.

Assimilation

"Process in which one cultural group loses its cultural identity and becomes a part of the dominant culture."

cultural relativism

"Recognizing that people from different cultural backgrounds comprehend the same objects and situations differently and that a culture determines a person's viewpoint."

What does the nurse tell a pregnant client about self-management during maternity care? "Self-management will help decrease health care costs." "You may not need to learn any nursing interventions." "Self-management may result in a poor pregnancy outcome." "You can obtain self-management information on any website."

"Self-management will help decrease health care costs." Pregnancy is primarily health focused and hence more suited to self-management. It also helps to reduce costs because hospitalization is not needed. The client is taught different interventions such as nutrition education, stress management, and parenting education, which the client needs to implement to reduce risks. Self-management does not result in poor pregnancy outcomes if the pregnant client implements health and illness interventions effectively. The nurse does not instruct the client to obtain information from any website, because the information may be inaccurate.

A woman states her partner is being treated for herpes but declines testing because she "feels fine." How should the nurse respond regarding the etiology of herpes and need for testing? "You do not need to be tested unless symptoms develop." "You should get tested now, because if we detect the virus early enough, it may still be curable." "You do not need testing now, but if you stay with your partner, you will definitely get infected." "Since your partner tested positive, you should be tested too, even if you don't have any symptoms."

"Since your partner tested positive, you should be tested too, even if you don't have any symptoms." All partners should be tested and treated simultaneously for any sexually transmitted infection. Herpes infection can be asymptomatic at first. This response is appropriate for the woman.

perineum

"Skin-covered muscular area between the fourchette and the anus that covers the pelvic structures."

clitoris

"Small structure underneath the prepuce composed of erectile tissue with numerous sensory nerve endings; it increases in size during sexual arousal."

The bony pelvis

"Structure that protects the bladder, uterus, and rectum; accommodates the growing fetus during pregnancy; and anchors support structures."

IUD

"T" shaped with two arms open near the fallopian tubes to ensure positioning and adversely affect sperm movement Some advantages include the long-term protection and immediate return to fertility once the device is removed Disadvantages include potential risk for pelvic inflammatory disease, infection, uterine perforation, and unintentional expulsion of the IUD Ideal candidates for the IUD are women who are not pregnant, have no current STI's, have signed the consent form, and are in a mutually monogamous relationship Women should feel for the string weekly for the first four weeks after insertion, and then monthly after that right after menses.

ecomap

"Term used for a graphic portrayal of social relationships of the woman and family, including school, work, religious affiliations, and club memberships."

A woman presenting with genital warts declines treatment because the growths are painless and she is otherwise asymptomatic. What nursing education is appropriate for this woman? "It's your choice whether to receive treatment." "If untreated, the warts will rupture and become painful." "The warts will go away on their own, but it will take longer if they go untreated." "The warts are extremely contagious and can easily transmit the infection to your partner."

"The warts are extremely contagious and can easily transmit the infection to your partner." Genital warts are highly contagious and can easily transmit the virus between partners. Treatment focuses on removing them to prevent further transmission. This education is appropriate for the woman.

"Fourchette"

"Thin, flat tissue formed by the joining of the labia minora; it is underneath the vaginal opening at the midline."

A patient with a 2-year-old child with cystic fibrosis declines genetic counseling during her antepartum visit, stating that the birth defect has "already happened"; therefore, her future children will not be affected. Which is the appropriate nursing education for this patient? "The risk of a child developing cystic fibrosis increases with maternal age." "This infant has an equal risk of developing cystic fibrosis as your first child." "The risk of your infant developing cystic fibrosis is less than your first child, but it is still present." "There is no longer a risk for your infant developing cystic fibrosis, but genetic counseling can help detect other abnormalities."

"This infant has an equal risk of developing cystic fibrosis as your first child." Having one child with a birth defect does not change the risk for developing the same defect in subsequent children. This response clarifies the patient's misconception about genetic factors of cystic fibrosis and is appropriate for the patient.

labia minora

"Two flat reddish folds composed of connective tissue and smooth muscle, which are supplied with extremely sensitive nerve endings."

During bimanual examination, a woman asks the nurse why the examination is performed with both hands at once. What nursing education is appropriate? "Two hands are used to evaluate the size of the uterus." "Two hands are only used to assess postmenopausal women." "Two hands are used to keep the uterus steady during palpation." "It is necessary to place one hand on the abdomen to palpate the cervix."

"Two hands are used to evaluate the size of the uterus." Two hands are used during bimanual examination to evaluate the size, motility, consistency, and configuration of the uterus. Therefore, this education is appropriate.

Past orientation

"Type of time orientation of families or people who are more likely to strive to maintain tradition or the status quo and have little motivation for formulating future goals."

present orientation

"Type of time orientation of families or people who may have difficulty adhering to strict schedules and are often described as "living for the moment.""

future orientation

"Type of time orientation that maintains a focus on achieving long-term goals; families or people who practice this time orientation are more likely to return for follow-up visits related to health care and to participate in primary prevention activities."

During a prenatal interview, a client asks the nurse about the benefits of midwifery. Which is the best response by the nurse? "Use of a midwife will help reduce health care costs." "Midwives can provide care and delivery only at hospitals." "Midwifery care is available only to clients who are uninsured." "Use of a midwife will substantially increase health care costs."

"Use of a midwife will help reduce health care costs." By opting for a midwife, the client can participate actively in all decisions related to childbirth, with fewer interventions during labor. Midwives can provide care and delivery at home, in birth centers, and at hospitals. Availability of midwifery services is not related to insurance status. Because fewer interventions are needed, the health care costs related to pregnancy are reduced.

The nurse is caring for a client who has undergone cesarean birth. The client asks the nurse when she can be discharged. What does the nurse reply? "You just have to stay for 1 day after cesarean birth." "You may have heavy bleeding due to early discharge." "We recommend you stay at least 96 hours after a cesarean." "You have to stay in the hospital for 48 hours after cesarean birth."

"We recommend you stay at least 96 hours after a cesarean." Legislation has been enacted to ensure that mothers and babies are permitted to stay in the hospital for at least 96 hours after cesarean birth. There is a need for a follow-up visit to prevent complications. Discharge 1 day after a cesarean birth is not the best practice, because early discharge may lead to health complications in the client. Heavy bleeding may occur due to injury or any other postpartum complications; however, heavy bleeding is not related to an early discharge. By law, the client may stay in the hospital for 48 hours after vaginal birth and may stay as long as 96 hours after a cesarean birth.

What does the nurse tell a pregnant client who asks whether discharge is possible soon after vaginal delivery? "Discharge is possible within an hour after vaginal delivery." "You can stay in the hospital for 48 hours after vaginal delivery." "There are risks of bleeding after birth with early discharge." "Discharge is possible 96 hours after vaginal delivery."

"You can stay in the hospital for 48 hours after vaginal delivery." Legislation has been enacted to ensure that the mothers and babies can stay in the hospital setting for 48 hours after vaginal delivery. There is a need for follow-up and home care after discharge to prevent complications. Discharge is not possible within an hour of vaginal delivery because the client is still weak. Risks such as bleeding after birth may result from injury or other complications but not from early discharge. Clients must wait 96 hours after a cesarean birth, not a vaginal birth, before discharge.

A woman who has completed half of the prescribed course of antibiotics to treat a chlamydial infection reports being completely asymptomatic. What instruction should the nurse give regarding antibiotic treatment? "Since your symptoms are gone, you may stop taking the medication today." "If the symptoms do not come back in the next three days, you may stop treatment." "You must take all of the prescribed medication, even if you no longer have symptoms." "You may stop the medication now, but be sure to resume treatment if your symptoms come back."

"You must take all of the prescribed medication, even if you no longer have symptoms." The entire course of medication must be finished when treating a sexually transmitted infection, even if symptoms subside. This instruction is appropriate for the woman.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: "This probably means you're pregnant." "Don't worry; it's probably nothing." "Have you been sick this month?" "You probably didn't ovulate during this cycle."

"You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). The absence of a temperature decrease most likely is the result of lack of ovulation. Illness would most likely cause an increase in BBT. A comment such as the one in B discredits the client's concerns.

A pregnant patient asks the nurse about the advantage or disadvantage of choosing a midwife as the primary care provider. Which is the best response given by the nurse? "You would not have any pregnancy-related complications." "You can receive midwifery care only if you are insured." "You will be able to actively participate in the childbirth decisions." "Your health care costs may increase substantially due to midwifery care."

"You will be able to actively participate in the childbirth decisions." Midwifery care allows the client to actively participate in childbirth decisions. Midwives give all appropriate information to the client so that the client makes an informed decision. Midwifery care aims at preventing pregnancy complications. However, the nurse cannot assure the client that the client would not have any pregnancy complications. The client's insurance status is unrelated to the availability of midwifery services. Midwives offer fewer interventions during labor. Therefore, the health care costs related to pregnancy are reduced due to midwifery care.

A nurse is teaching an infertile couple about how the sperm travel through the man's body during ejaculation. Please put the following five major structures in order, beginning with the place where spermatogenesis occurs and continuing through the path that the sperm and semen travel until ejaculation. 1. Epididymis. 2. Prostate. 3. Testes. 4. Urethra. 5. Vas deferens

(3,1,5,2,4)

hypothalamic-pituitary cycle

(note when this cycle begins)  When the blood levels of estrogen and progesterone decrease toward the end of the menstrual cycle ↓ this stimulates hypothalamus to secrete GnRH; ↓ which stimulates anterior pituitary secretion of FSH; ↓ which stimulates development of ovarian graafian follicles and their own production of estrogen Now estrogen levels will slowly decrease and the GnRH will trigger the anterior pituitary to release LH. This combination of LH surge and a lower estrogen peak happen about 24 to 36 hours before the ovum is pushed out of the graafian follicle in the ovary. This means the LH surge is on day 12-13 of the 28 day cycle.  If fertilization and implantation do not occur, the corpus luteum becomes non functional, the estrogen and progesterone levels drop, menstruation occurs and the hypothalamus begins again the cycle of stimulating GnRH

diaphram

- 4 types: coil, arc, flat, and wide rim - needs to be fitted - sits behind pubis symphysis Bone and completely covers cervix - poor choice for recurrent UTIs - replace every 2yrs or weight fluctuation > 20%, birth or gyn surg; - remove 6-8 hours post coitus/ intercourse - addit. Spermacide needed for addit. Intercourse; discour. - Use during menses can cause TSS largest size comfortable empty bladder before diaphragm insertion and after intercourse not good choice for: poor vaginal muscle tone women, recurrent UTI, uterine prolapse, large systole, latex allergy

who should be screened for syphilis?

- All women diagnosed with other STI screened for syphilis • All pregnant women screened for syphilis in first prenatal visit

pelvic inflammatory disease

- Involves uterine (fallopian) tubes (salpingitis), uterus (endometritis) and ovaries and peritoneal surfaces Multiple organisms = N. gonorrhoeae, C. trachomatis Ascending spread of micros from vagina and endocervix to upper genital tract • Most often end of just after menses • During the menstrual period several factors facilitate the development of an infection: • the cervical os is slightly open, • the cervical mucus barrier is absent • menstrual blood is an excellent medium for growth

types of spermicides and barrier methods

- Nonoxynol-9 - Intravaginal Spermacides - condoms - vaginal sheath - diaphragm - Cervical caps -contraceptive sponge

Combined Estrogen-progestin contraceptives

- Oral contaceptives (OCPs): 24 hours, extended cycle-12 weeks - Trandermal- 7 days - Vaginal Ring- 3 weeks

emergency contraception

- Plan B: no prescription needed - should be taken within 72 hours - does not protect future pregnancy risks - if no menstruation within 21 days after taking pill, should be evaluated for pregnancy - five methods available in US

mifepristone

- RU 486 - binds to progesterone receptors and blocks action of progesterone which is critical for maintain pregnancy - given up to 7 weeks of last menstrual period

human immunodeficiency virus

- Severe depression of cellular immune system - Seroconversion to HIV positivity occurs within 6-12 weeks

symptoms- based methods

- Two day method - Cervical Mucus Ovulation Detection Method - Basal Body Temperature Method - Symptothermal Method

maternal morbidity include

- acute renal failure - amniotic fluid embolism - cerebrovascular accident - eclampsia - pulmonary embolism - liver failure - obstetrick shock - respiratory failure - septicemia - complications of anesthesia

Calendar based Method

- calendar rhythm method - standard days method - based on number of days in each cycle, counting from first day of menses - fertile period determined after accurately recording lengths of menstrual cycles for at least 6 months - difficult to predict future events beginning of fertile period - substracting 18 days from length of shortest cycle end of fertile period - subtracting 11 days from length of longest cycle (avoid during two calculations) abstaining from beginning to end

methotrexate

- causes abortion by blocking folic acid in fetal cells so they can't divide - given intramuscularly or orally

oral progestins (minipill)

- contains low dose of progestin, must be taken at same time everyday

LARC methods

- contraceptive implants - intrauterine contraception theoretical and typical pregnancy rates the same

feedback mechanism

- follicle- stimulating hormone (FSH) and LH are secreted in response to fluctuating levels of ovarian estrogen and progesterone - regular ingestion of combined oral contraceptive pill suppresses action of Hypothalamus and anterior pituitary - leads to insufficient secretion of FSH and LH - follicles do not mature - ovulation is inhibited

facts

- human ovum can be fertilized no later than 12-24 hours after ovulation - Motile sperm can last approx. 60 hours however ability to fertilize ovum - about 24 - 48 hours - Uses charts, calculations, tools to determine fertile period and then either abstains or uses barrier method

secondary signs and symptoms

- increased libido - midcyle spotting - mittelschmerz-cramplike pain prior to ovulation - pelvic fullness or tenderness - vulvar fullness

disadvantages of IUD

- increased risk of pelvic inflammatory disease (PID) after placement - unintentional expulsion of the device - infection - possible uterine perforation

three phases identified during FAB/NFP

- infertile phase: before ovulation - fertile phase: 5-7 days around middle of cycle, several days before and during ovulation and the day after - infertile phase: after ovulation

laws and regulations

- informed consent necessary - state permit voluntary sterilization of any mature, rational woman without reference to marital and pregnancy status - sterilization of minors or mental incompetent individuals restricted and requires board of eugenicists or court- appointed individuals

transcervical sterilization

- inject occlusion agents into uterine tubes - Essure system: interval sterilization method (not intended for postpartum period) - stimulate woman's scar tissue formation to occlude uterine tubes and prevent conception - use another method until occlusion is proved - like 3 months

tubal occlusion

- laparoscopic approach or minilaparotomy can be used for tubal ligation, tubal electrocoagulation, or application of bands or clips - electrocoagulaton and ligation: permanent - band and clips: possible remove and return of tubal patency

infant mortality rate is associated with

- limited maternal education - young maternal agge - unmarried status - poverty - lack of prenatal care - smoking - poor nutrition - alcohol use - maternal poor health - hypertension

third trimester abortion

- limited or even prohibited by state regulations unless interferes with life or health of pregnant woman

Basal Body Temperature method (BBT)

- lowest body temperature of healthy person: immediately after waking and before getting out of bed - BBT during mesus: 36.2-36.3 for 5-7 days after - prior to ovulation, slight temperature drop (.5 degree C) - after ovulation: temperature increase (.4-.8 degrees)

Mirena and Skyla

- mirena: lasts 5 years - skyla: 3 years - impair sperm motility, thicken cervical mucus, decreasing lining of uterus - have anovulatory effects side effects: irregular bleeding initially

standard days method

- modified form of calendar rhythm method - has fixed number of days of fertility for each cycle, days 8-19 - avoid unprotected intercourse on days 8-19 - unreliable for longer and shorter cycles, use hormonal contraception, breastfeeding, IUDs, recent pregnancy

effective contraceptive methods

- most effective: long-acting reversible contraception (LARC) methods - exogenous hormones (estrogen/ progestins)

implantable progestins

- one or more nonbiodegradable flexible tubes or rods that are inserted under the skin of arm - last for 3 years - prevent some ovulatory cycles, and will thicken cervical mucus - side effect: irregular bleeding

women sterilization

- oviducts (uterine tubes) occluded absolute sterile - - ovaries (oophorectomy) or uterus (hysterectomy) or both - bilateral tubal ligation (BTL) - immediately after childbirth or within 24-48 hours, concomitment with induced abortion or interval procedure

family awareness-based (FAB) Methods (Natural family planning)

- periodic abstinence depends on identifying beginning and end of fertile period of menstrual cycle - Avoiding coitus during fertile periods - determining exact time of ovulation can be difficult

misoprostol

- prostaglandin analog that acts directly on cervix to soften and dilate on uterine muscle to stimulate contractions - vaginal placement follows in 3-7 days

induced abortion

- purposeful interruption of pregnancy before 20 weeks of gestation indications: - preservation of life or health of mother - genetic disorders of fetus - rape or incest - pregnant woman's request elective performed at woman's request therapeutic performed for reasons of maternal or fetal health or disease

tubal reconstruction

- reanastomose sperm ducts can be accomplished 90% of time - rate of success decreases as time since procedure increases

factors to consider when choosing contraseptives

- reliability - relative cost of the method - protection from STI - individual's comfort level - partner's willingless - how many partners - woman's life plan for reproduction

tubal reconstruction

- restoration of tubal continuity and function is feasible except after leparoscopic tubal electrocoagulation

two methods of vasectonmy

- scapal incision (conventional) -puncture

vasectonmy

- sealing, tying or cutting of mans vas deferens so sperm can't travel from testes to penis -permanent method

intrauterine devices (IUD)

- small T-shape device with bendable arms for insertion through cervix - affect sperm motility and irritate the lining of the uterus - long-term protection from pregnancy and immediate return to fertility when removed

male sterilization

- sperm ducts (vas deferens) occluded

Paragard Copper IUD

- spermicide and inflames the endometrium, preventing fertilization - lasts 10 years - Side effects: more bleeding and cramping (NSAIDs)

oral conceptives

- suppresses feedback mechanism - supresses action of hypothalamus and anterior pituitary, leading to insufficient secretion of FSH and LH - Combined Steroids make endometrium inhabitable to implantation - Thickened cervical mucus from progestin inhibits sperm penetration - to maintain adequate hormal levels for contraception and enhance compliance, should be taken at same time everyday

Sterilization

- surgical procedures intended to render a person infertile - occlusion of passageways for ova and sperm

TORCH infections

- toxoplasmosis - other infections = hepatitis - rubella virus - cytomegalovirus - herpes simplex virus group of organisms capable of crossing the placenta flu-like symptoms in mother fetal and neonatal effects are serious

medical abortion

- up to 9 weeks after last menstrual period - methotrexate, misoprostol and mifepristone are drugs used in current regimens to induce

surgical/ aspiration

- vacuum or suction curettage - most common - under local anesthesia - bleeding after is normal complications: excessive vaginal bleeding and infection (endometritis or salpingitis) periods resume 4-6 weeks after procedure

female condom

- vaginal sheath made of nitrile, non-latex synthetic rubber, with flexible rings at both ends - closed end: inserted into vagina and anchored around cervix - open ring: covers labia - typical failure 21%

The nurse is teaching a class on reproduction. When asked about the development of the ova, the nurse would include which of the following? 1. Meiotic divisions begin during puberty. 2. At the end of meiosis, four ova are created. 3. Each ovum contains the diploid number of chromosomes. 4. Like sperm, ova have the ability to propel themselves.

-"meiotic divisions begin during puberty" -rationale: meiosis 1 occurs during puberty

reasons for entering the health care system

-Preconception counseling and care -Pregnancy -Well-woman care -Fertility control and infertility -Menstrual problems -Perimenopause

What are the types of biological contraceptive methods

-abstinence -coitus interruptus -douching -natural family planning / fertility awareness method

What are the types of contraception

-biological methods -mechanical methods -chemical methods -surgical methods

What are the types of natural family planning/fertility awareness method

-calendar method -basal body temperature -cervical mucous

Marquette Model (MM)

-cervical monitoring along with ClearPLan Ease Fertility Monitor: measure urinary metabolites of estrogen and LH

A nurse is explaining to a client about monthly hormonal changes. Starting with day 1 of the menstrual cycle, please place the following four hormones in the chronological order in which they elevate during the menstrual cycle. 1. Follicle-stimulating hormone. 2. Gonadotropin-releasing hormone. 3. Luteinizing hormone. 4. Progesterone.

-gonadotropin releasing hormone -FSH -LH -progesterone -rationale: gonadotropin releasing hormone stimulates the production of FSH and LH. FSH rises first and LH follows. After ovulation, progesterone rises

advantages:

-low to no cost - heightened awareness and understanding of personal fertility - increased self-reliance - absence of chemicals - instant availability - increased involvement and intimacy with partner - religious and cultural traditions

robertsonian translocation

short arms (p) of two different acrocentric chromosomes (chromosomes with very short p arms) break --> leaving sticky ends that then cause the two long arms (q arms) to stick together forms new, large chromosome of two large arms 45 chromosomes usually no symptoms

disparities include

shorter life expectancy higher infant and maternal mortality rate more birth defects more STDs

nexplanon

single rod etonogestrel implant, lasts up to 3 years

intrauterine device (IUD)

small T-shaped device inserted into the uterine cavity. it is loaded with copper or levonoregestrel

A Roman Catholic couple is infertile. Their healthcare practitioner advises them that their best chance of getting pregnant is via in-vitro fertilization with a mixture of the man's sperm and donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? (Select all that apply) A. The man will ejaculate by masturbation into a specially designed condom. B. The woman may become pregnant with donor sperm. C. Fertilization is occurring in the artificial environment of the laboratory. D. More embryos may be created than will be used to inseminate the woman. E. The woman will receive medications to facilitate the ripening of her ova.

1,2,3,4 - Masturbation and the use of a condom, even for the express purpose of creating life, are considered sins in the Catholic tradition. - Procreation with the man's sperm alone is unlikely. The addition of the donor sperm makes this unacceptable in the eyes of the Catholic Church because a woman should become pregnant only by her husband. - According to the precepts of the Catholic Church, fertilization may take place only within the body of the woman. - It is immoral in the Catholic tradition to create more embryos than are needed to conceive.

key components of culturally competent care

1. recognizing that disparity exists between one's culture and that of a client 2. educating and promoting healthy behaviors in a cultural context that has meaning for clients 3. taking abstract knowledge about other cultures and applying it in a practical way, so that the quality of service improves 4. communicating respect for wide range of differences, including client use of nontraditional healing practices 5. recognizing the importance of culturally different communication styles, problem-solving techniques, concepts of space and type 6. anticipating the need to address varying degrees of language ability and literacy

Calgary Family Assessment Model structure

1. structural assessment - determine the members of the family, relationship among family members, and context of the family 2. developmental assessment - describe the life cycle - typical trajectory that most families experience 3. functional assessment - evaluate the way in which individuals behave in relation to each other in instrumental and expressive aspects

communication involves

1. understanding individual's language, including subtle variations in meaning and distinctive dialect 2. appreciating individual differences in interpersonal style 3. accurately interpreting the volume of speech as well as the meanings of touch and gestures

women with special needs

1. women with disabilities 2. abused women 3. adolescents ( 13-19) 4. midlife and older women ( age 50 and older)

maternity nursing

specialty area of nursing practice that focuses on the care of childbearing women and their families through all stages of pregnancy and childbirth, as well as the first 4 weeks after birth

condom

thin, stretchable sheath that covers the penis or is inserted into the vagin

leading cause of preventible death and illness

tobacco use

anorexia nervosa

too heavy even if told they are thin extreme exercise severe diet starvation

factors of infertility in men

erectile dysfunction, imbalance of hormones, enlarged veins around testicles, obstruction on the way of sperm release, mumps, injury to testicles, exposure of testicles to excessive heat, Klinefelter syndrome, problems with the sperm, such as low count, poor motility, clumped or agglutinated sperm and abnormally shaped sperm

breast examination

every 3 years ( 20-29) annualy after 40 annually after 18 if history of breast cancer in family

Pap test

every 3 years (21-65) after total hysterectomy and 3 negative tests women can stop

BP

every visit but at least every 2 yeasr

height and weight

every visit but at least every 2 yeasr

microdeletions

too small to be detected by standard cytogenetic techniques FISH analysis to identify

Progesterone Related Side Effects

excess: increased appetite - vaginal yeast infections - tiredness, depression - oily skin and scalp - hirsuitismi - post pill amenorrhea deficiency: - breast tenderness - late spotting / BTB (deficiency) - Heavy flow/clot (deficiency) - decreased breast size (deficiency)

phases of sexual response in men/ excitement phase

excitement - (heart rate and blood pressure increase, nipple become erect. myotonia begins) erection of the penis begins penis increases in length and diameter scrotal skin becomes congested and thickened testes begin to increase in size and elevate toward the body

phases of sexual response in women/ excitement phase

excitement - (heart rate and blood pressure increase, nipple become erect. myotonia begins) clitoris increases in diameter and swells. external genitals become congested and darken vaginal lubrication occurs upper 2/3 of vagina lengthens and extends cervix and uterus pull upward breast size increase

Which statement regarding the Family Systems Theory is inaccurate? a. Family system is part of a larger suprasystem. b. Family, as a whole, is equal to the sum of the individual members. c. Changes in one family member affect all family members. d. Family is able to create a balance between change and stability.

ANS: B A family, as a whole, is greater than the sum of its individual members. The other statements are accurate and can be attributed to the Family Systems Theory.

sexual response

excitement, plateau, orgasm, resolution sexual stimulation -> increase in circulation to circumvaginal blood vessels, causing engorgement and distention of genitals arousal characterized my myotonia ( increased muscular tension), resolution in voluntary and involuntary rhythmic contractions

family roles

expectations and behaviors associated with a member's position in the larger family system (social class and cultural norms affect it as well)

A client asks the nurse about the gamete intrafallopian transfer (GIFT) procedure. Which of the following responses would be appropriate for the nurse to make? A. Fertilization takes place in the woman's body B. Zygotes are placed in the fallopian tubes C. Donor sperm are placed in a medium with donor eggs D. A surrogate carries the infertile woman's fetus

A This statement is true. Although the gametes are placed in the fallopian tubes artificially, fertilization does occur within the woman's body.

An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? A. Ferning capacity B. Basal body temperature C. Colposcopy D. Hysterotomy

A When a woman's cervical mucus is estrogen rich, it is slippery and elastic (thread-like), and when assessed under a microscope, the practitioner will observe "ferning" - that is, an image that looks like a fern. The woman is not in her fertile period, the mucus is thick and gluey.

The provider has ordered a genetic testing to assess whether the patient's fetus is at risk for sickle cell disease. The patient is asymptomatic but relates a positive family history. On the basis of this information, the nurse realizes that the provider has ordered: Predictive testing. A carrier screening test. Presymptomatic testing. Predispositional testing.

A carrier screening test. Carrier screening test would help identify whether the mother had the genetic mutation, thereby increasing the risk for transmission to the fetus. Predictive testing is used to determine genetic status of an asymptomatic family member. Presymptomatic testing would indicate the presence of a specific genetic mutation that is associated with a clinical presentation that would occur over the course of time. Because sickle cell disease is an autosomal recessive transmission and the patient is asymptomatic, such testing would not be indicated. Predispositional testing would also not be indicated because sickle cell disease is an autosomal recessive disease; if the patient is asymptomatic and a genetic mutation is found, it would exist only in a carrier state.

The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future, but not within the next few years. What action/s should the nurse suggest the women take to protect their fertility for the future? (Select all that apply) A. Use condoms during intercourse B. Refrain from smoking cigarettes C. Maintain an appropriate weight for height D. Exercise in moderation E. Refrain from drinking carbonated beverages

A. Use condoms during intercourse B. Refrain from smoking cigarettes C. Maintain an appropriate weight for height D. Exercise in moderation

common characteristics of down syndrome

ALL some level of intellectual disability • Oblique palpebral fissures or an upward slant to the eyes • Epicanthal folds or small skinfolds on the inner corners of the eyes • Small, white, crescent-shaped spots on the irises called Brushfield spots • A flat facial profile that usually includes a somewhat depressed nasal bridge and a small nose • Enlargement of the tongue in relationship to size of the mouth • Small ears, which may be abnormally shaped or abnormally rotated • Short, broad hands with a fifth finger that has one flexion crease instead of two • A single deep crease across the center of the palm, often referred to as a simian crease • Excessive space between the large and second toes • Hyperflexibility, an excessive ability to extend the joints • Muscle hypotonia or low muscle tone

A client has just had an amniocentesis to determine whether her baby has an inheritable genetic disease. Which of the following interventions is highest priority at this time? 1. Assess the fetal heart rate. 2. Check the client's temperature. 3. Acknowledge the client's anxiety about the possible findings. 4. Answer questions regarding the genetic abnormality.

ANS 1 1. Assessing the fetal heart rate is the highest priority since, although rare, the fetus may have been injured during the procedure. 2. Taking the client's temperature is not the most important action to take at this time. 3. Psychosocial issues are always significant, but they must take a back seat to physiological assessments. 4. It is important to answer all questions posed by clients but, again, these should be answered only after physiological interventions are completed.

A 10-week gravid states that her sister's son has been diagnosed with an X-linked recessive disease, Duchenne muscular dystrophy. She questions the nurse about the disease. Which of the following responses is appropriate for the nurse to make? 1. "Because Duchenne muscular dystrophy is inherited through the woman, it is advisable for you to see a genetic counselor." 2. "Duchenne muscular dystrophy usually occurs as a spontaneous mutation. It is very unlikely that your fetus is affected." 3. "Your child could acquire Duchenne muscular dystrophy only if both you and your husband carried the gene. You need to check your husband's family history." 4. "If you were to have an amniocentesis and it were to be positive for Duchenne muscular dystrophy, I could recommend you to an excellent abortion counselor."

ANS 1 1. Because Duchenne muscular dystrophy is X-linked, if her sister is a carrier, she too may be a carrier. She should see a genetic counselor. 2. It is unlikely that Duchenne muscular dystrophy developed as a spontaneous mutation. 3. Duchenne muscular dystrophy is X-linked, so the father's genetics will not affect the outcome. 4. This response is inappropriate. The decision to abort a child with a disease is up to the parents. Each set of parents must be allowed to make the decision for themselves. Their decision is likely to be based on many things, including their ability to care for a mentally retarded child and the knowledge that their child is affected by a genetic disease. The nurse cannot make the assumption that the parents will decide to abort an affected child.

A woman is a carrier for hemophilia A, an X-linked recessive illness. Her husband has a normal genotype. The nurse can advise the couple that the probability that their daughter will have the disease is: 1. 0% probability. 2. 25% probability. 3. 50% probability. 4. 75% probability.

ANS 1 1. The probability of the couple having a daughter with hemophilia A is 0%. 2. The probability of the couple having a daughter with hemophilia A is 0%. 3. The probability of the couple having a daughter with hemophilia A is 0%. 4. The probability of the couple having a daughter with hemophilia A is 0%.

Which statement by a gravid client who is a carrier for Duchenne muscular dystrophy, an X-linked recessive disease, indicates that she understands the implications of her status? 1. "If I have a girl, she will be healthy." 2. "None of my children will be at risk of the disease." 3. "If I have a boy, he will be a carrier." 4. "I am going to abort my fetus because it will be affected."

ANS 1 1. This response is correct. As can be seen on the Punnett square, female children of carriers may carry the disease but do not express the disease. 2. This response is incorrect. Male children are at risk of the disease. 3. This response is incorrect. Only females are carriers of X-linked diseases. 4. This response is incorrect. When reviewing X-linked recessive inheritance, the test taker must discuss the male and female probabilities independently. If the fetus is a female, she will be healthy—either with two normal genes or as a carrier. The probability of the males being affected, however, is 50/50—either healthy with two normal genes or with disease because of the normal Y mated with an affected "x." Accordingly, as can be seen in the square below, the probability of a male being affected is 50%.

A woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his or her response on which of the following? 1. The woman's pedigree may exhibit a mitochondrial inheritance pattern. 2. The majority of miscarriages are caused by genetic defects. 3. A woman's chromosomal pattern determines her fertility. 4. There is a genetic marker that detects the presence of an incompetent cervix.

ANS 2 1. The pedigree should be analyzed for any and all abnormal inheritance patterns. 2. This is true. The incidence of miscarriage is very high, about 1 out of every 5 pregnancies, and the majority of miscarriages are related to a genetic defect. 3. A woman's fertility is determined by many factors. 4. This statement is not true. There is no genetic marker for incompetent cervix.

At her first prenatal visit, a woman relates that her maternal aunt has cystic fibrosis (CF), an autosomal recessive illness. Which of the following comments is appropriate for the nurse to make at this time? 1. "We can check to see whether or not you are a carrier for cystic fibrosis." 2. "It is unnecessary for you to worry since your aunt is not a direct relation." 3. "You should have an amniocentesis to see whether or not your child has the disease." 4. "Please ask your mother whether she has ever had any symptoms of cystic fibrosis."

ANS 1 1. It is possible that this woman is a carrier for cystic fibrosis. A genetic evaluation can be done to determine that possibility. 2. The affected gene could have been transmitted to both the woman's mother and to the aunt. 3. Only if both this woman and her partner are carriers is there a possibility of their child having CF. And even if that were the case, the probability of the fetus having the disease would be 1 in 4, or 25%, because CF is an autosomal recessive disease. 4. This response is inappropriate. The mother could be a carrier of the CF gene (carriers are symptom free) so the client should be tested.

A pregnant woman and her husband are both heterozygous for achondroplastic dwarfism, an autosomal dominant disease. The nurse advises the couple that their unborn child has which of the following probabilities of being of normal stature? 1. 25% probability. 2. 50% probability. 3. 75% probability. 4. 100% probability.

ANS 1 1. The child has a 25% probability of being of normal stature. 2. The child has a 25% probability of being of normal stature. 3. The child has a 25% probability of being of normal stature. 4. The child has a 25% probability of being of normal stature. After doing a Punnett square

Once oogenesis is complete, the resultant gamete cell contains how many chromosomes? 1. 23. 2. 46. 3. 47. 4. 92.

ANS 1 1. The haploid number of chromosomes is 23, the normal number of chromosomes in the gamete—in this case, in the ovum. 2. The diploid number of chromosomes is 46, the normal number of chromosomes in the somatic cells of human beings. 3. Aneuploidy is characterized by a chromosomal number that is not equal to a multiple of the haploid number—that is, the number of chromosomes in the cell is NOT equal to 23, 46, 69, 92, and so on. Trisomy 21 (47 chromosomes) is an example of an aneuploid number, as is a chromosome number of 48 or 49. 4. Polyploidy is characterized by a chromosomal number that is equal to twice, three times, four times, and so on, of the diploid number—that is, the number of chromosomes in the cell is equal to 92 (2 × 46), 138 (3 × 46), and so on.

A genetic counselor's report states, "The genetic nomenclature for this fetus is 46, XX." How should the nurse who reads this report interpret the cytogenetic results? 1. The baby is female with a normal number of chromosomes. 2. The baby is hermaphroditic male with female chromosomes. 3. The baby is male with an undisclosed genetic anomaly. 4. There is insufficient information to answer this question.

ANS 1 1. This response is correct. The normal number of chromosomes is present— 46—and the child is a female—XX. 2. This response is incorrect. Hermaphrodites exhibit both male and female organs and characteristics. Hermaphroditism may be caused by a number of things, including an environmental insult or a genetic mutation. 3. This response is incorrect. An example of a male with a genetic defect is 46,XY,16p13.3. The child is a male—XY—and the defect, as indicated in the nomenclature, is on the p arm of the 16th chromosome at location 13.3. 4. There is sufficient information to answer this question.

A client is being interviewed prior to becoming pregnant. She states that she has a disease that is transmitted by mitochondrial inheritance. Which of the following statements is consistent with the client's disease? 1. 100% of her children will be affected. 2. Only her female children will be affected. 3. Each fetus will have a 50% probability of being affected. 4. A fetus will be affected only if it inherits a similar gene from its father.

ANS 1 1. This statement is accurate. All of the woman's children will be affected. 2. This statement is incorrect. All of the woman's children will be affected. 3. This statement is incorrect. All of the woman's children will be affected. 4. This statement is incorrect. All of the woman's children will be affected.

A 25-year-old woman, G0 P0000, enters the infertility clinic stating that she has just learned she is positive for the BRCA1 and the BRCA2 genes. She asks the nurse what her options are for getting pregnant and breastfeeding her baby. The nurse should base her reply on which of the following? 1. Fertility of women who carry the BRCA1 and BRCA2 genes is similar to that of unaffected women. 2. Women with these genes should be advised not to have children because the children could inherit the defective genes. 3. Women with these genes should have their ovaries removed as soon as possible to prevent ovarian cancer. 4. Lactation is contraindicated for women who carry the BRCA1 and BRCA 2 genes.

ANS 1 1. This statement is true. Female clients who are BRCA1 or BRCA2 positive have similar fertility rates to those who are BRCA1 or BRCA2 negative. 2. This statement is incorrect. Nurses provide information. It is inappropriate for nurses to counsel clients whether or not to have children based on the client's genotype. 3. The decision to have an oophorectomy is the client's. The nurse's role is to provide the client with information regarding the genetic profile. 4. Lactation is not contraindicated for these women.

What is the rationale for testing all neonates for maple syrup urine disease (MSUD) when only 1 in 100,000-300,000 children will be born with the disease? 1. To encourage the parents to have genetic testing done. 2. To prevent neurological disease in affected children. 3. To reduce the amount of money insurance companies must pay for sick MSUD children. 4. To persuade pharmaceutical companies to develop medications to treat children with MSUD.

ANS 2 1. Although the parents should seek genetic counseling before getting pregnant in the future, this is not the rationale for newborn testing. 2. This is the rationale for newborn testing for maple syrup urine disease. It is done to prevent neurological disease in affected children. 3. This is a benefit of many of the newborn tests, but it is not the primary rationale. The cost-benefit ratio (in terms of money) does not always support newborn testing. In very rare diseases like MSUD, the cost of testing is often higher than the cost of care for any affected children. 4. This is not a rationale for newborn testing

Which of the following is an attainable short-term goal for an 8-week gravid client who has a family history of cystic fibrosis? 1. Have a sweat chloride test done. 2. Seek out genetic counseling. 3. Undergo chorionic villus sampling. 4. Be seen by a pulmonologist.

ANS 2 1. This goal is inappropriate. The client has a family history of cystic fibrosis. She does not have the disease. 2. This goal is appropriate. Since the client has a family history of the disease, she should seek genetic counseling. 3. This goal is inappropriate. It is unnecessary to have CVS unless both the mother and the father are found to be carriers of cystic fibrosis. 4. This goal is inappropriate. The client has a family history of cystic fibrosis. She does not have the disease.

A client's amniocentesis results were reported as 46, XY. Her obstetrician informed her at the time that everything "looks good." Shortly after birth the baby is diagnosed with cerebral palsy. Which of the following responses will explain this result? 1. It is likely that the client received the wrong amniocentesis results. 2. Cerebral palsy is not a genetic disease. 3. The genes that cause cerebral palsy have not yet been discovered. 4. The genetics lab failed to test for cerebral palsy.

ANS 2 1. This information is unsupported by the scenario. Cerebral palsy is not a genetic defect and is not detected through amniocentesis. 2. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period. 3. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period. 4. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period.

A woman asks the obstetrician's nurse about cord blood banking. Which of the following responses by the nurse would be best? 1. "I think it would be best to ask the doctor to tell you about that." 2. "The cord blood is frozen in case your baby develops a serious illness in the future." 3. "The doctors could transfuse anyone who gets into a bad accident with the blood." 4. "Cord blood banking is very expensive and the blood is rarely ever used."

ANS 2 1. This response is inappropriate. The client has asked the nurse for information regarding cord blood banking. 2. This statement is correct. The baby's umbilical cord blood is kept by a cord blood bank to be used if and when the baby should develop a serious illness like leukemia. 3. The blood is not used in the same way that general blood donations are used. It is used to treat catastrophic illnesses. 4. This response is true, but it does not provide the client with the information she needs to make an informed decision.

A woman, who has undergone amniocentesis, has been notified that her baby is XX with a 14/21 robertsonian chromosomal translocation. The nurse helps the woman to understand which of the following? 1. The baby will have a number of serious genetic defects. 2. It is likely that the baby will be unable to have children when she grows up. 3. Chromosomal translocations are common and rarely problematic. 4. An abortion will probably be the best decision under the circumstances.

ANS 2 1. This response is incorrect. The child will likely be a normal-appearing female. 2. Because there is a translocation in the child's chromosomal pattern, the child's gametes will likely contain an abnormal amount of genetic material and the child will be infertile. 3. Translocations are usually not problematic for the first generation, but they can lead to significant defects and/or infertility in the next generation. 4. The client must decide for herself whether or not to abort the fetus.

A 3-month-old baby has been diagnosed with cystic fibrosis (CF). The mother says, "How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!" What must the nurse understand about this situation? 1. Cystic fibrosis cannot be diagnosed by amniocentesis. 2. The baby may have an uncommon genetic variant of the disease. 3. It is possible that the laboratory technician made an error. 4. Instead of obtaining fetal cells the doctor probably harvested maternal cells.

ANS 2 1. This statement is not accurate. Cystic fibrosis can be detected via amniocentesis. 2. This response is likely. The genetic tests that are performed check only for the most common genetic variants of many diseases, including CF. If the baby were positive for an uncommon variant, it would be missed. 3. It is unlikely that the lab tech made a mistake. 4. Although it is possible, it is unlikely that maternal cells were harvested rather than fetal cells.

The nurse discusses the results of a 3-generation pedigree with the proband who has breast cancer. Which of the following information must the nurse consider? 1. The proband should have a complete genetic analysis done. 2. The proband is the first member of the family to be diagnosed. 3. The proband's first degree relatives should be included in the discussion. 4. The proband's sisters will likely develop breast cancer during their lives.

ANS 2 1. Until the pedigree is fully analyzed, the need for a complete genetic analysis is uncertain. 2. This statement is true. The proband is the first individual in any family to be identified with a disorder. 3. This is not correct. Genetic information is confidential. Only if the proband agrees can others be included in the discussion. Plus, the proband's relatives may or may not be interested in discussing their potential of acquiring a genetic disease. 4. It is virtually impossible to determine if and when someone will develop breast cancer even if a genetic screen has been performed.

A client, G4 P4004, states that her husband has just been diagnosed with polycystic kidney disease (PKD), an autosomal dominant disease. The husband is heterozygous for PKD, while the client has no PKD genes. The client states, "I have not had our children tested because they have such a slim chance of inheriting the disease. We intend to wait until they are teenagers to do the testing." The nurse should base her reply on which of the following? 1. Because affected individuals rarely exhibit symptoms before age 60, the children should be allowed to wait until they are adults to be tested. 2. The woman may be exhibiting signs of denial since each of the couple's children has a 50/50 chance of developing the disease. 3. Because the majority of the renal cysts that develop in affected individuals are harmless, it is completely unnecessary to have the children tested. 4. The woman's husband should be seen by a genetic specialist since he is the person who is carrying the affected gene.

ANS 2 1. Symptoms usually appear in affected individuals in their 30s or 40s, but the symptoms can appear as early as childhood. 2. This response is correct. As can be seen by the Punnett square results, the children have a 50/50 chance of developing PKD. Since the capital A connotes the dominant gene, the child needs only one affected gene to exhibit the disease. 3. This statement is untrue. PKD can be a very serious illness. Some patients with the disease will require dialysis and/or kidney transplants. 4. This statement is inappropriate. The husband's genotype is already known.

Most children born into families look similar but are not exactly the same. The children appear different because homologous chromosomes exchange genetic material at which of the following? 1. Centromere. 2. Chiasma. 3. Chromatid. 4. Codon.

ANS 2 1. The centromere is the site where sister chromatids attach during cell division. 2. A chiasma is the site where crossing over between nonsister chromatids takes place. At this site, genetic material is swapped between the chromatids. 3. A chromatid is one strand of a duplicated chromosome. Sister chromatids are attached at the chromosome's centromere. 4. A codon is a triad of messenger RNA that encodes for a specific amino acid in a protein.

A woman is seeking genetic counseling during her pregnancy. She has a strong family history of diabetes mellitus. She wishes to have an amniocentesis to determine whether she is carrying a baby who will "develop diabetes." Which of the following replies would be most appropriate for the nurse to make? 1. "Doctors don't do amniocenteses to detect diabetes." 2. "Diabetes cannot be diagnosed by looking at the genes." 3. "Although diabetes does have a genetic component, diet and exercise also determine whether or not someone is diabetic." 4. "Even if the baby doesn't carry the genes for diabetes, the baby could still develop the disease."

ANS 3 1. Although this response is accurate, it is an inappropriate response for the nurse to make. 2. Although this response is accurate, it is an inappropriate response for the nurse to make. 3. This response is accurate. Diabetes is one of the many diseases that has both a genetic and an environmental component. 4. Although this response is accurate, it is an inappropriate response for the nurse to make.

Which of the following client responses indicates that the nurse's teaching about care following chorionic villus sampling (CVS) has been successful? 1. If the baby stops moving, the woman should immediately go to the hospital. 2. The woman should take oral terbutaline every 2 hours for the next day. 3. If the woman starts to bleed or to contract, she should call her physician. 4. The woman should stay on complete bed rest for the next 48 hours.

ANS 3 1. CVS is performed well before mothers feel quickening. 2. Tocolytics, such as terbutaline, are not routinely administered following CVS. 3. The mother should notify the doctor if she begins to bleed or contract. 4. It is unnecessary for the mother to stay on complete bed rest following a CVS.

A woman has been advised that the reason she has had a number of spontaneous abortions is because she has an inheritable mutation. Which of the following situations is consistent with this statement? 1. A client developed skin cancer after being exposed to the sun. 2. A client developed colon cancer from an inherited dominant gene. 3. A reciprocal translocation was reported on a client's genetic analysis. 4. A client's left arm failed to develop when she was a fetus.

ANS 3 1. The DNA in the client's skin cells did mutate, but the mutation will not affect the client's fertility because the woman's ovaries were not affected. 2. The inherited gene affects a client's risk of contracting colon cancer. It will not affect fertility. 3. A reciprocal translocation can result in infertility. 4. Failure of one arm to develop in utero is related to an environmental insult rather than a genetic insult.

A woman asks a nurse about presymptomatic genetic testing for Huntington's disease. The nurse should base her response on which of the following? 1. There is no genetic marker for Huntington's disease. 2. Presymptomatic testing cannot predict whether or not the gene will be expressed. 3. If the woman is positive for the gene for Huntington's, she will develop the disease later in life. 4. If the woman is negative for the gene, her children should be tested to see whether or not they are carriers.

ANS 3 1. There is a genetic marker for Huntington's disease. 2. In the case of Huntington's disease, if a person has the gene and lives long enough, there is virtually a 100% probability he or she will develop the disease. The gene has a high degree of expressivity, or, in other words, people who carry the gene will develop the disease. 3. This answer is correct, if a person has the gene and lives long enough, virtually 100% of the time the disease will develop and progress. 4. There is no carrier state when a disease is transmitted via a dominant inheritance pattern, as is Huntington's disease.

The nurse is counseling a pregnant couple who are both carriers for phenylketonuria (PKU), an autosomal recessive disease. Which of the following comments by the nurse is appropriate? 1. "I wish I could give you good news, but because this is your first pregnancy, your child will definitely have PKU." 2. "Congratulations, you must feel relieved that the odds of having a sick child are so small." 3. "There is a 2 out of 4 chance that your child will be a carrier like both of you." 4. "There is a 2 out of 4 chance that your child will have PKU."

ANS 3 1. This response is inappropriate. Each and every pregnancy carries the same probability of being affected. 2. This response is inappropriate. It is impossible for a nurse to know how a couple will respond to the probability that their fetus will be affected. 3. This response is accurate. 4. This response is inaccurate. There is a 1 out of 4 chance that the baby will inherit both recessive genes and have the disease.

A woman who is a carrier for sickle cell anemia is advised that if her baby has two recessive genes, the penetrance of the disease is 100%, but the expressivity is variable. Which of the following explanations will clarify this communication for the mother? All babies with 2 recessive sickle cell genes will: 1. Develop painful vaso-occlusive crises during their first year of life. 2. Exhibit at least some signs of the disease while in the neonatal nursery. 3. Show some symptoms of the disease but the severity of the symptoms will be individual. 4. Be diagnosed with sickle cell trait but will be healthy and disease-free throughout their lives.

ANS 3 1. This response is incorrect. No one can make such a prediction. 2. Neonates virtually never exhibit signs of sickle cell because fetal hemoglobin does not sickle. 3. This response is correct. Babies with two recessive sickle cell genes will show some symptoms of the disease but the severity of the symptoms will be individual. 4. This response is incorrect. Virtually all children with sickle cell anemia will exhibit some symptoms during their lives.

The genetic counselor informs a couple that they have a 25% probability of getting pregnant with a child with a severe genetic disease. The couple asks the nurse exactly what that means. Which of the following responses by the nurse is appropriate? 1. Their first child will have the genetic disease. 2. If they have four children, one of the children will have the disease. 3. Their fourth child will have the genetic disease. 4. Whenever they get pregnant, the fetus may have the disease.

ANS 4 1. Each pregnancy has its own probability so it is impossible to predict which, if any, child will or will not have the disease. 2. Each pregnancy has its own probability so it is possible for all or none of the children to have the disease. 3. Each pregnancy has its own probability so it is impossible to predict which, if any, child will or will not have the disease. 4. This is true. Every time the woman gets pregnant there is a possibility (25% chance) that she is carrying a child with the disease.

A couple inquires about the inheritance of Huntington's disease (HD) because the prospective father's mother is dying of the illness. There is no history of the disease in his partner's family. The man has never been tested for HD. Which of the following responses by the nurse is appropriate? 1. "Because HD is an autosomal dominant disease, each and every one of your children will have a 1 in 4 chance of having the disease." 2. "Because only one of you has a family history of HD, the probability of any of your children having the disease is less than 10%." 3. "Because HD is such a devastating disease, if there is any chance of passing the gene along, it would be advisable for you to adopt." 4. "Because neither of you has been tested for HD, the most information I can give you is that each and every one of your children may have the disease."

ANS 4 1. If the prospective father possesses the gene, the probability of their children inheriting the gene is 1 in 2, or 50%. As the man has not been tested, it is impossible to determine the probabilities. 2. This statement is completely false. 3. It is improper for the nurse to recommend that the clients not have children. It is the couple's choice whether or not to get pregnant. It is the nurse's responsibility to give information that is as accurate as possible. 4. This statement is correct. No specific information can be given until or unless the potential father decides to be tested

A client wants to undergo amniocentesis because she has a family history of breast cancer. Which of the following choices is the most important information for the nurse to discuss with the client regarding the request? 1. The breast cancer gene is highly penetrant. 2. The breast cancer gene has moderate expressivity. 3. The amniocentesis could result in a miscarriage. 4. The majority of breast cancers are not inherited.

ANS 4 1. The breast cancer genes are highly penetrant, but this is not the most important information 2. The breast cancer genes are moderately expressive, but this is not the most important information. 3. Amniocentesis does, although rarely, end in miscarriage, but this is not the most important information. 4. The most important information for the nurse to provide the client is that the vast majority of cases of breast cancer are not inherited.

A male client has green color blindness, an X-linked recessive genetic disorder. His wife has no affected genes. Which of the following statements by the nurse is true regarding the couple's potential for having a child who is color blind? 1. All male children will be color blind. 2. All female children will be color blind. 3. All male children will be carriers for color blindness. 4. All female children will be carriers for color blindness.

ANS 4 1. This response is incorrect. None of their male children will be green color blind. 2. This response is incorrect. None of their female children will be green color blind. 3. This response is incorrect. Males do not carry X-linked recessive traits. 4. This response is correct. All of the females will be carriers

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the woman's cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

dominant

trait that is expressed or phenotypically apparent when only one copy of alleles associated with the trait is present

Which statement best describes Kegel exercises? a. Kegel exercises were developed to control or reduce incontinent urine loss. b. Kegel exercises are the best exercises for a pregnant woman because they are so pleasurable. c. Kegel exercises help manage stress. d. Kegel exercises are ineffective without sufficient calcium in the diet.

ANS: A Kegel exercises help control the urge to urinate. Although these exercises may be fun for some, the most important factor is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but not related to Kegel exercises.

A nurse is assessing the knowledge of new parents of a child born with Klinefelter syndrome. Which statement accurately describes this genetic disorder? a. Klinefelter syndrome is a sex chromosome abnormality. b. It affects only female children. c. The disorder is expressed as trisomy XYY. d. The child with this disorder will grow to be infertile.

ANS: A Klinefelter syndrome, also known as trisomy XXY, is a sex chromosomal deviation that is expressed in males. Turner syndrome (monosomy X) is displayed in females. Most males with Klinefelter syndrome are tall, may be infertile, and are slow to learn; however, those who have mosaic Klinefelter syndrome may be fertile as adults.

A client is 5 months pregnant. On a routine ultrasound scan, the physician discovers that the fetus has a diaphragmatic hernia. The woman becomes distraught and asks the nurse what she should do. Which response would be most suitable? a. Talk to the client, and refer her to a genetic counselor. b. Suggest that the client travel to a fetal treatment center for intrauterine surgery. c. Tell her that everything is going to be fine. d. Sit with the client, and calmly suggest that she consider terminating this pregnancy.

ANS: A Before the client makes any decisions, she should discuss this newly discovered information with a genetic counselor. Genetic counselors can help with the diagnosis and management of families affected by genetic conditions. The discussion of potential surgery should be pursuant to genetic counseling. Telling the woman that everything is going to be fine may give her false hope and is not accurate. All options should be discussed with the genetic counselor. Furthermore, the guiding principle for genetic counseling is nondirection, which respects the right of the individual or family who are being counseled to make autonomous decisions.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester? a. Dilation and evacuation (D&E) b. Methotrexate administration c. Prostaglandin administration d. Vacuum aspiration

ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

Which statement indicates that a client requires additional instruction regarding BSE? a. "Yellow discharge from my nipple is normal if I'm having my period." b. "I should check my breasts at the same time each month, after my period." c. "I should also feel in my armpit area while performing my breast examination." d. "I should check each breast in a set way, such as in a circular motion."

ANS: A Discharge from the nipples requires further examination from a health care provider. The breasts should be checked at the same time each month. The armpit should also be examined. A circular motion is the best method during which to ascertain any changes in the breast tissue.

Which statement regarding emergency contraception is correct? a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b. Emergency contraception may be taken right after ovulation. c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d. Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

Which condition or treatment reduces the risk of morbidity in women with the inherited factor V Leiden disorder? a. Anticoagulant therapy b. Pregnancy c. Oral contraceptives d. Hormone replacement therapy

ANS: A Factor V Leiden is the most common inherited risk factor for primary or recurrent venous thromboembolism. It is an autosomal recessive disorder that increases an individual's risk for blood clots in the legs and pulmonary emboli. This risk significantly increases if the woman is pregnant or is taking oral contraceptives or hormone replacement therapy. Prophylactic anticoagulation therapy decreases the risk of comorbidities.

Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a. Family planning b. Birth control c. Contraception d. Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility.

In evaluating the level of a pregnant woman's risk of having a low-birth-weight (LBW) infant, which factor is the most important for the nurse to consider? a. African-American race b. Cigarette smoking c. Poor nutritional status d. Limited maternal education

ANS: A For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor.

What is the minimum level of practice that a reasonably prudent nurse is expected to provide? a. Standard of care b. Risk management c. Sentinel event d. Failure to rescue

ANS: A Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

A recently graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Which information gathered from her research best explains the rationale for these higher costs compared with other developed countries? a. Higher rate of obesity among pregnant women b. Limited access to technology c. Increased use of health care services along with lower prices d. Homogeneity of the population

ANS: A Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the gross domestic product is spent on health care. Higher spending in the United States, as compared with 12 other industrialized countries, is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. In the population in the United States, 16% are uninsured and have limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.

types of structural abnormalities of chromosomes

translocation duplication deletion microdeletion inversion

A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are declining. c. Cigarette smoking among pregnant women continues to increase. d. Rates of pregnancy and abortion among teenagers are lower in the United States than in any other industrialized country.

ANS: A LBW infants and preterm births are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

A married couple lives in a single-family house with their newborn son and the husband's daughter from a previous marriage. Based on this information, what family form best describes this family? a. Married-blended family b. Extended family c. Nuclear family d. Same-sex family

ANS: A Married-blended families are formed as the result of divorce and remarriage. Unrelated family members join to create a new household. Members of an extended family are kin or family members related by blood, such as grandparents, aunts, and uncles. A nuclear family is a traditional family with male and female partners along with the children resulting from that union. A same-sex family is a family with homosexual partners who cohabit with or without children.

Which type of genetic tests in clinical practice are most often offered to clients with a family history of disease? a. Single-gene disorders b. Carrier screening c. Predictive value testing d. Predispositional testing

ANS: A Most tests now offered are tests for single-gene disorders in clients with clinical symptoms or clients who have a family history of a genetic disease. Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms. Predictive value testing is used only to clarify the genetic status of asymptomatic family members. Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance of developing the condition.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a. Bacterial vaginosis b. Candidiasis c. Trichomoniasis d. Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

Which health care service represents a primary level of prevention? a. Immunizations b. Breast self-examination (BSE) c. Home care for high-risk pregnancies d. Blood pressure screening

ANS: A Primary prevention involves health promotion and disease prevention activities to reduce the occurrence of illness and enhance the general health and quality of life. This level of care includes, for example, immunizations, using infant car seats, and providing health education to prevent tobacco use. BSE is an example of secondary prevention that involves early detection of health problems. Home care for a high-risk pregnancy is an example of tertiary prevention. This level of care follows the occurrence of a defect or disability. Blood pressure screening is an example of secondary prevention and is a screening tool for early detection of a health care problem.

Maternity nurses can enhance communication among health care providers by using the SBAR technique. The acronym SBAR stands for what? a. Situation, background, assessment, recommendation b. Situation, baseline, assessment, recommendation c. Subjective, background, analysis, recommendation d. Subjective, background, analysis, review

ANS: A SBAR is an easy-to-remember, useful, and concrete mechanism for communicating important information that requires a clinician's immediate attention. Baseline is not discussed as part of SBAR. Subjective and analysisare not specific to the SBAR acronym. Subjective, analysis, and review are not specific to the SBAR acronym.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a. Wear gloves. b. Wear mouth, nose, and eye protection. c. Wear a mask. d. Wash the hands after medication administration.

ANS: A Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a. Vomiting and diarrhea b. Headache, myalgias, and arthralgia c. Preterm labor d. Jarisch-Herxheimer in the first 24 hours after treatment

ANS: A The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self-examination (BSE)? a. Between 5 and 7 days after menses ceases b. Day 1 of the endometrial cycle c. Midmenstrual cycle d. Any time during a shower or bath

ANS: A The physiologic alterations in breast size and activity reach their minimal level approximately 5 to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After the midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be performed while in the shower.

A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a. Obtain a history of the woman's menstrual cycle lengths for the past 6 to 12 months. b. Determine the client's weight gain and loss pattern for the previous year. c. Examine skin pigmentation and hair texture for hormonal changes. d. Explore the client's previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Ovarian function and hormone production decline during which transitional phase? a. Climacteric b. Menarche c. Menopause d. Puberty

ANS: A The climacteric phase is a transitional period during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period.Puberty is a broad term that denotes the entire transitional period between childhood and sexual maturity.

Nurses who elect to practice in the field of obstetrics must have a basic working knowledge of genetics. What is the correct term used to describe an individual's genetic makeup? a. Genotype b. Phenotype c. Karyotype d. Chromotype

ANS: A The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual's genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual's chromosomes. Genotype refers to an individual's genetic makeup.

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus 2 (HSV-2) b. HPV c. HIV d. CMV

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for clients. Which factor is the most concerning pitfall for nurses using this technology? a. Violation of client privacy and confidentiality b. Institutions and colleagues who may be cast in an unfavorable light c. Unintended negative consequences for using social media d. Lack of institutional policy governing online contact

ANS: A The most significant pitfall for nurses using this technology is the violation of client privacy and confidentiality. Furthermore, institutions and colleagues can be cast in an unfavorable light with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and the nurse. All institutions should have policies guiding the use of social media, and the nurse should be familiar with these guidelines.

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal? a. "You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash." b. "You should remove your diaphragm right after intercourse to prevent TSS." c. "It's okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS." d. "Make sure you don't leave your diaphragm in for longer than 24 hours, or you may get TSS."

ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.

The woman's family members are present when the nurse arrives for a postpartum and newborn visit. What should the nurse do? a. Observe the family members' interactions with the newborn and one another. b. Ask the woman to meet with her and the baby alone. c. Perform a brief assessment on all family members who are present. d. Reschedule the visit for another time so that the mother and infant can be privately assessed.

ANS: A The nurse should introduce her or himself to the client and to the other family members who are present. Family members in the home may be providing care and assistance to the mother and infant. However, this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new postpartum mother and to her infant, not to all family members. The nurse can politely ask about the other people in the home and their relationships with the mother. Unless an indication is given that the woman would prefer privacy, the visit may continue.

recessive x-linked traits

expressed in males ONLY = only one X chromosome females somatic cell only one X chromosome is functioning = x-inactivation hemophilia - manifest in female known to be heterozygous carrier

Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a. Standard days' variation b. Periodic abstinence c. Postovulation d. Coitus interruptus

ANS: A The standard days' variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

Which female reproductive organ(s) is(are) responsible for cyclic menstruation? a. Uterus b. Ovaries c. Vaginal vestibule d. Urethra

ANS: A The uterus is responsible for cyclic menstruation and also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and the production of estrogen. The vaginal vestibule is an external organ that has openings to the urethra and vagina. The urethra is not a reproductive organ, although it is found in the area.

Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and are providing care across the perinatal continuum. Which of these priorities has made the most significant progress? a. Reduction of fetal deaths and use of prenatal care b. LBW infants and preterm births c. Elimination of health disparities based on race d. Infant mortality and the prevention of birth defects

ANS: A Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of LBW infants and preterm births. According to the March of Dimes, persistent disparities still exist between African-Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. These preventable negative outcomes demonstrate the need for comprehensive community-based care for all mothers, infants, and families.

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a. Only one vaccine for the HPV is available. b. The vaccine is given in three doses over a 6-month period. c. The vaccine is recommended for both boys and girls. d. Ideally, the vaccine is administered before the first sexual contact.

ANS: A Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a. Strategies to enhance condom use b. Choice of colors and special features c. Leaving the decision up to the male partner d. Places to carry condoms safely

ANS: A When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a. Fellatio b. Unprotected anal intercourse c. Multiple sex partners d. Dry kissing e. Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a. Menstruation b. Trauma c. Febrile illness d. Soap e. Ultraviolet light

ANS: A, B, C, E Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

Many pregnant teenagers wait until the second or third trimester to seek prenatal care. What should the nurse recognize as reasons for this delay? (Select all that apply.) a. Lack of realization that they are pregnant b. Uncertainty as to where to go for care c. Continuing to deny the pregnancy d. Desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E These reasons are all valid explanations why teens delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic, and many appointments are usually missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases her feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the teen's positive self-image.

recessive

expressed only when two copies of alleles associated with the trait are present

pelvic outlet diameters

transverse outlet presents the smallest plane of the pelvic canal

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction and stroke c. Hypotension d. Breast tenderness and fluid retention e. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a. Intrapartum treatment with antiviral medications b. Cesarean birth c. Postpartum treatment with antiviral medications d. Avoidance of breastfeeding e. Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

Which congenital malformations result from multifactorial inheritance? (Select all that apply.) a. Cleft lip b. Congenital heart disease c. Cri du chat syndrome d. Anencephaly e. Pyloric stenosis

ANS: A, B, D, E Cleft lip, congenital heart disease, anencephaly, and pyloric stenosis are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosomal deletion.

Which statements regarding menstruation (periodic uterine bleeding) are accurate? (Select all that apply.) a. Menstruation occurs every 28 days. b. During menstruation, the entire uterine lining is shed. c. Menstruation begins 7 to 10 days after ovulation. d. Menstruation leads to fertilization. e. Average blood loss during menstruation is 50 ml.

ANS: A, B, E Menstruation is the periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days; however, variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. The average blood loss is 50 ml with a normal range of 20 to 80 ml. Menstruation occurs 14 days after ovulation. The lack of fertilization leads to menstruation.

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama in early 2010. The Act provides some immediate benefits, and other provisions will take place over the next several years. The practicing nurse should have a thorough understanding of how these changes will benefit his or her clients. Which outcomes are goals of the ACA? (Select all that apply.) a. Insurance affordability b. Improve public health c. Treatment of illness d. Elimination of Medicare and Medicaid e. Cost containment

ANS: A, B, E The ACA goals are to make insurance more affordable, contain costs, and strengthen Medicare and Medicaid. The Act contains provisions that promote the prevention of illness and improve access to public health. The ultimate goal of the Act is to improve the quality of care for all Americans while reducing waste, fraud, and abuse of the current system.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a. Toxoplasmosis b. Other infections c. Roseola d. Clostridium e. Herpes simplex

ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a. Number of partners b. Level of physical activity c. Prevention of pregnancy d. Protection from STIs e. Past history

ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history

Which activities are included in the role of a nurse practicing in the field of genetics? (Select all that apply.) a. Assessing the responses of family members to a genetic disorder b. Performing genetic testing, such as amniocentesis c. Constructing a family pedigree of three or more generations d. Advising a pregnant mother whose fetus has a genetic disorder to have an abortion e. Offering parents information about genetics

ANS: A, C, E Assessing the responses of family members, constructing a family pedigree, and offering parents information about genetics are activities that a genetics nurse would carry out in caring for a family undergoing genetic counseling. Physicians perform amniocentesis, but the nurse may assist in this procedure. Being aware of their own values and beliefs and refraining from attempting to influence the family are important responsibilities for nurses. The nurse must respect the right of the individual or family to make autonomous decisions.

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a. "It is highly unlikely that you will become pregnant after the procedure." b. "Tubal ligation is an effective form of 100% permanent sterilization. You won't be able to get pregnant." c. "Sterilization offers some form of protection against STIs." d. "Sterilization offers no protection against STIs." e. "Your menstrual cycle will greatly increase after your sterilization."

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.

Neisseria gonorrhoeae

treatment Ceftriaxone (add doxycycline to cover likely concurrent Chlamydia) CEPHALOSPORINS (penicilin-producing Neisseria gonorrhoeae) for drug resistant gonirrhea reported communicable disease

Which information regarding substance abuse is important for the nurse to understand? a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health. b. Women, ages 21 to 34 years, have the highest rates of specific alcohol-related problems. c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects. d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed.

ANS: B Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low-birth-weight infants. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

Which statement about the development of cultural competence is inaccurate? a. Local health care workers and community advocates can help extend health care to underserved populations. b. Nursing care is delivered in the context of the client's culture but not in the context of the nurse's culture. c. Nurses must develop an awareness of and a sensitivity to various cultures. d. Culture's economic, religious, and political structures influence practices that affect childbearing.

ANS: B Although the cultural context of the nurse affects the delivery of nursing care and is very important, the work of local health care workers and community advocates, developing sensitivity to various cultures, and the impact of economic, religious, and political structures are all parts of cultural competence.

Which statement regarding chromosomal abnormalities is most accurate? a. Chromosomal abnormalities occur in approximately 10% of newborns. b. Abnormalities of number are the leading cause of pregnancy loss. c. Down syndrome is a result of an abnormal chromosomal structure. d. Unbalanced translocation results in a mild abnormality that the child will outgrow.

ANS: B Aneuploidy is an abnormality of number that is also the leading genetic cause of mental retardation. Chromosomal abnormalities occur in fewer than 1% of newborns. Down syndrome is the most common form of a trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosomal structure that often has serious clinical effects.

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a. Miconazole ointment b. Topical podofilox 0.5% solution or gel c. Two doses of penicillin administered intramuscularly (IM) d. Metronidazole by mouth

ANS: B Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse's best response? a. "Oral contraceptives are a highly effective method, but they have some side effects." b. "Your current medications will reduce the effectiveness of the pill." c. "Oral contraceptives will reduce the effectiveness of your seizure medication." d. "The pill is a good choice for a woman of your age and with your personal history."

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Which key factors play the most powerful role in the behaviors of individuals and families? a. Rituals and customs b. Beliefs and values c. Boundaries and channels d. Socialization processes

ANS: B Beliefs and values are the most prevalent factors in the decision-making and problem-solving behaviors of individuals and families. This prevalence is particularly true during times of stress and illness. Although culture may play a part in the decision-making process of a family, ultimately, values and beliefs dictate the course of action taken by family members. Boundaries and channels affect the relationship between the family members and the health care team, not the decisions within the family. Socialization processes may help families with interactions within the community, but they are not the criteria used for decision making within the family.

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a. Vaccine exists for hepatitis C virus (HCV) but not for HBV. b. HAV is acquired by eating contaminated food or drinking polluted water. c. HBV is less contagious than HIV. d. Incidence of HCV is decreasing.

ANS: B Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

Which statement best exemplifies contemporary maternity nursing? a. Use of midwives for all vaginal deliveries b. Family-centered care c. Free-standing birth clinics d. Physician-driven care

ANS: B Contemporary maternity nursing focuses on the family's needs and desires. Fathers, partners, grandparents, and siblings may be present for the birth and participate in activities such as cutting the baby's umbilical cord. Both midwives and physicians perform vaginal deliveries. Free-standing clinics are an example of alternative birth options. Contemporary maternity nursing is driven by the relationship between nurses and their clients.

Which statement describes a key finding of the Human Genome Project? a. Humans produce one protein per gene. b. All human beings are 99.9% identical at the deoxyribonucleic acid (DNA) level. c. The Human Genome Project has not yet been able to translate the accumulating raw research into anything medically practical. d. Humans have more genes than other species.

ANS: B The majority of the 0.1% genetic variations are found within and not among populations. Most human genes produce at least three proteins. The project's research has been very valuable in the identification of genes involved in disease and in the development of genetic testing. There are 20,500 genes in the human genome; scientists originally estimated more than 50,000 genes. Human genes are more efficient than the genes in other species, thereby increasing the human genetic complexity.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the woman's level of knowledge concerning contraception and her commitment to any particular method. c. Assess the woman's willingness to touch her genitals and cervical mucus. d. Evaluate the woman's contraceptive life plan.

ANS: B Determining the woman's level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partner's willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partner's objections. Assessing the woman's willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the client's plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a. "The IUD does not interfere with sex." b. "The risk of pelvic inflammatory disease will be higher with the IUD." c. "The IUD will protect you from sexually transmitted infections." d. "Pregnancy rates are high with the IUD."

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response by the nurse would be what? a. Reassure the woman that the examination will reveal any problems. b. Explain the process of vulvar self-examination, and reassure the woman that she should become familiar with normal and abnormal findings during the examination. c. Reassure the woman that "bumps" can be treated. d. Reassure her that most women have "bumps" on their labia.

ANS: B During the assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the "bumps" would not be an accurate response.

Which statement best describes maternity nursing care that is based on knowledge gained through research and clinical trials? a. Maternity nursing care is derived from the Nursing Intervention Classification. b. Maternity nursing care is known as evidence-based practice. c. Maternity nursing care is at odds with the Cochrane School of traditional nursing. d. Maternity nursing care is an outgrowth of telemedicine.

ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a. "They're not very effective, and it is very likely that you'll get pregnant." b. "FAMs can be effective for many couples; however, they require motivation." c. "These methods have a few advantages and several health risks." d. "You would be much safer going on the pill and not having to worry."

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client's part.

What is the primary difference between hospital care and home health care? a. Home care is routinely and continuously delivered by professional staff. b. Home care is delivered on an intermittent basis by professional staff. c. Home care is delivered for emergency conditions. d. Home care is not available 24 hours a day.

ANS: B Home care is generally delivered on an intermittent basis by professional staff members. The primary difference between health care in a hospital and home care is the absence of the continuous presence of professional health care providers in a client's home. In a true emergency, the client should be directed to call 9-1-1 or to report to the nearest hospital's emergency department. Generally, home health care entails intermittent care by a professional who visits the client's home for a particular reason and provides on-site care for periods shorter than 4 hours at a time.

The secondary level of prevention is best illustrated by which example? a. Approved infant car seats b. BSE c. Immunizations d. Support groups for parents of children with Down syndrome

ANS: B Infant car seats are an example of primary prevention. BSE is an example of the secondary level of prevention, which includes health-screening measures for early detection of health problems. Immunizations are an example of the primary level of prevention. Support groups are an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., Down syndrome).

The unique muscle fibers that constitute the uterine myometrium make it ideally suited for what? a. Menstruation b. Birth process c. Ovulation d. Fertilization

ANS: B The myometrium is made up of layers of smooth muscle that extend in three directions. These muscles assist in the birth process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os.

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide? a. "It's just a little lump on your cervix. We can just freeze it off." b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." c. "HPV is a type of early human immunodeficiency virus. You will die from this." d. "You probably caught this from your current boyfriend. He should get tested for this."

ANS: B Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a. "The lubricant prevents vaginal irritation." b. "Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions." c. "The additional lubrication improves sex." d. "Nonoxynol-9 improves penile sensitivity."

ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

What fatty acids (classified as hormones) are found in many body tissues with complex roles in many reproductive functions? a. GnRH b. Prostaglandins (PGs) c. FSH d. Luteinizing hormone (LH)

ANS: B PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.

How would the physiologic process of the sexual response best be characterized? a. Coitus, masturbation, and fantasy b. Myotonia and vasocongestion c. Erection and orgasm d. Excitement, plateau, and orgasm

ANS: B Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.

Which factor is least likely to influence the decision to undergo genetic testing? a. Anxiety and altered family relationships b. Cost of testing or denial of insurance benefits c. Imperfection of test results d. Ethnic and socioeconomic disparity associated with genetic testing

ANS: B Testing is not 100% accurate and has a high percentage of false-negative results. An individual may not take these results seriously and subsequently fail to have testing completed or to seek necessary follow-up consultation. Anxiety and altered family relationships are often the result of genetic testing. The results of genetic testing may be difficult to keep confidential, and family members may feel pressured to have testing performed. Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Caucasian middle-class families have greater access to genetic screening; therefore, this population is less at likely to decide against genetic testing.

The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a. LAM is effective until the infant is 9 months of age. b. This popular method of birth control works best if the mother is exclusively breastfeeding. c. Its typical failure rate is 5%. d. Feeding intervals should be 6 hours during the day.

ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.

Which benefit regarding FAMs makes it an appealing choice for some women? a. Adherence to strict recordkeeping b. Absence of chemicals and hormones c. Decreased involvement and intimacy of partner d. Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

A 32-year-old woman is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The client and her husband wonder what chance this child has of having cystic fibrosis. This type of testing is most commonly known as what? a. Occurrence risk b. Recurrence risk c. Predictive testing d. Predisposition testing

ANS: B The couple already has a child with a genetic disease; therefore, this couple will be given a recurrence risk test. If a couple has not yet had a child but is known to be at risk for having a child with a genetic disease, then an occurrence risk test is administered. Predictive testing clarifies the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family physician has retired, and she is going to see the women's health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience for this client? a. Remind the woman that she is long overdue for her examination and that she should come in annually. b. Carefully listen, and allow extra time for this woman's health history interview. c. Reassure the woman that a nurse practitioner is just as good as her old physician. d. Encourage the woman to talk about the death of her husband and her fears about her own death.

ANS: B The nurse has an opportunity to use reflection and empathy while listening, as well as ensure an open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women older than age 50 years can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches.

Which key point is important for the nurse to understand regarding the perinatal continuum of care? a. Begins with conception and ends with the birth b. Begins with family planning and continues until the infant is 1 year old c. Begins with prenatal care and continues until the newborn is 24 weeks old d. Refers to home care only

ANS: B The perinatal continuum of care begins with family planning and continues until the infant is 1 year old. It takes place both at home and in health care facilities. The perinatal continuum does not end with the birth. The perinatal continuum begins before conception and continues after the birth. Home care is one delivery component; health care facilities are another.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a. HIV screening b. HIV antibody testing c. Cluster of differentiation 4 (CD4) counts d. Cluster of differentiation 8 (CD8) counts

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

Importantly, the nurse must be aware of which information related to the use of IUDs? a. Return to fertility can take several weeks after the device is removed. b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c. IUDs offer the same protection against STIs as the diaphragm. d. Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

Which statement by the client indicates that she understands BSE? a. "I will examine both breasts in two different positions." b. "I will examine my breasts 1 week after my menstrual period starts." c. "I will examine only the outer upper area of the breast." d. "I will use the palm of the hand to perform the examination."

ANS: B The woman should examine her breasts when hormonal influences are at their lowest level. The client should be instructed to use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. The client should use the sensitive pads of the middle three fingers.

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a. Oral antiviral therapy b. Bed rest in a semi-Fowler position c. Antibiotic regimen continued until symptoms subside d. Frequent pelvic examination to monitor the healing progress

ANS: B The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. Which information is most appropriate for the nurse to share with this client? a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. b. She will receive fewer interventions during the birth process. c. She should be aware that midwives are not certified. d. Her delivery can take place only at home or in a birth center.

ANS: B This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low-risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body to ensure that core competencies are met. In the United States, this body is the American College of Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.

A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. Which nursing diagnosis would be the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury

ANS: B This mother will likely experience a disruption in the family process related to the birth of a baby with an inherited disorder. Therefore, the probable nursing diagnosis for this family is "Interrupted family processes." Women commonly experience "body image disturbances in the postpartum period"; however, this nursing diagnosis is unrelated to giving birth to a child with Down syndrome. The mother will likely have a mix of emotions that may include anxiety, guilt, and denial, but this nursing diagnosis is not the most essential for this family. "Risk for injury" is not an applicable nursing diagnosis.

When the services of an interpreter are needed, which is the most important factor for the nurse to consider? a. Using a family member who is fluent in both languages b. Using an interpreter who is certified, and documenting the person's name in the nursing notes c. Directing questions only to the interpreter d. Using an interpreter only in an emergency

ANS: B Using a certified interpreter ensures that the standards of care are met and that the information exchanged is reliable and unaltered. The name of the interpreter should be documented for legal purposes. Asking a family member to interpret may not be appropriate, although many health care personnel must adopt this approach in an emergency. Furthermore, most states require that certified interpreters be used when possible. When using an interpreter, the nurse should direct questions to the client. The interpreter is simply a means by which the nurse communicates with the client. Every attempt should be made to contact an interpreter whenever one is needed. During an emergency, health care workers often rely on information interpreted by family members. This information may be private and should be protected under the rules established by the Health Insurance Portability and Accountability Act (HIPAA). Furthermore, family members may skew information or may not be able to interpret the exact information the nurse is trying to obtain.

Which statements indicate that the nurse is practicing appropriate family-centered care techniques? (Select all that apply.) a. The nurse commands the pregnant woman to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the client's sister, who is a nurse, that she cannot be in the room during the delivery.

ANS: B, C Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the client what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).

One of the most promising clinical applications of the Human Genome Project has been pharmacogenomic testing (the use of genetic information to guide a client's drug therapy). Which conditions are potential candidates for pharmacogenomic application? (Select all that apply.) a. Fragile X syndrome b. Deep vein thrombosis (DVT) c. Breast cancer d. Myocardial infarction e. Hemophilia

ANS: B, C, D Associations between genetic variation and drug effect have been observed for a number of commonly used drugs. The conditions for which these are applicable include: DVT, breast cancer, and myocardial infarction. Gene therapy has been unsuccessfully used in hemophilia treatment. Fragile X syndrome is the leading cause of intellectual disability and lacks effective treatment of any kind.

Women of all ages will receive substantial and immediate benefits from smoking cessation. The process is not easy, and most people have attempted to quit numerous times before achieving success. Which organizations provide self-help and smoking cessation materials? (Select all that apply.) a. Leukemia and Lymphoma Society b. March of Dimes c. American Cancer Society d. American Lung Association e. Easter Seals

ANS: B, C, D The March of Dimes, the American Lung Association, and the American Cancer Society have self-help materials available. The Leukemia and Lymphoma Society support research for these two types of cancer. Easter Seals is best known for its work with disabled children.

Which statements regarding the HPV are accurate? (Select all that apply.) HPV infections: a. are thought to be less common in pregnant women than in women who are not pregnant. b. are thought to be more common in pregnant women than in women who are not pregnant. c. were previously called genital warts. d. were previously called herpes. e. may cause cancer.

ANS: B, C, E HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a. Fever higher than 39° C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than four pads in 2 hours e. Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38° C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a. Sterilization should be performed under general anesthesia. b. Pain, bleeding, and infection are possible complications. c. Pregnancy may still be possible. d. Vasectomy may affect potency. e. Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

What are the two primary functions of the ovary? (Select all that apply.) a. Normal female development b. Ovulation c. Sexual response d. Hormone production e. Sex hormone release

ANS: B, D The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and ovaries.

Estrogen Related Side Effects

exsess: - nausea - breast tenderness - fluid retention - chloasma deficiency: - spotting deficiency (Days 1-14)(deficiency in estrogen) - atrophic vaginitis (deficiency in estrogen) - hypomenorrhea (deficiency) - nervousness (deficiency in estrogen)

Greater than one third of women in the United States are now obese (body mass index [BMI] of 30 or greater). Less than one quarter of women in Canada exhibit the same BMI. Obesity in the pregnant woman increases both maternal medical risk factors and negative outcomes for the infant. The nurse is about to perform an assessment on a client who is 28 weeks pregnant and has a BMI of 35. What are the most frequently reported complications for which the nurse must be alert while assessing this client? (Select all that apply.) a. Potential miscarriage b. Diabetes c. Fetal death in utero d. Decreased fertility e. Hypertension

ANS: B, E The two most frequently reported maternal medical risk factors associated with obesity are hypertension associated with pregnancy and diabetes. Decreased fertility, miscarriage, fetal death, and congenital anomalies are also associated with obesity. These clients often experience longer hospital stays and increased use of health services.

To ensure client safety, the practicing nurse must have knowledge of The Joint Commission's current "Do Not Use" list of abbreviations. Which term is acceptable for use regarding medication administration? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero

ANS: C "I.U." and "i.u." are no longer acceptable because they could be misread as "I.V." or the number "10." "Q.O.D." should be written out as "every other day." The period after the "Q" could be mistaken for an "I" and the "o" could also be mistaken for an "i." Confusing one medication for another is too easy. Medications are used for very different purposes and could place a client at risk for an adverse outcome. For example, these medications should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number (e.g., 0.4 rather than .4). A leading zero is the preferred form.

Which questionnaire would be best for the nurse to use when screening an adolescent client for an eating disorder? a. Four Cs b. Dietary Guidelines for Americans c. SCOFF screening tool d. Dual-energy x-ray absorptiometry (DEXA) scan

ANS: C A screening tool specifically developed to identify eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions: • Do you make yourself Sick because you feel too full? • Do you worry about loss of Control over the amount that you eat? • Have you recently lost more than One stone (14 pounds) in a 3-month period? • Do you think that you are too Fat, even if others think you are thin? • Does Food dominate your life? The 4 Cs are used to determine cultural competence. Dietary Guidelines for Americans provide nutritional guidance for all, not only for those with eating disorders. The DEXA scan is used to determine bone density.

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a. The ideal candidate for DMPA wants menstrual regularity and predictability. b. The client has a history of thrombotic problems or breast cancer. c. The ideal candidate has difficulty remembering to take oral contraceptives daily. d. The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond? a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled. b. Reassure the woman that using vaginal cream is not a problem for the examination. c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection. d. Ask the woman to reschedule the appointment for the examination.

ANS: C An important element of the health history and physical examination is the client's description of any symptoms she may be experiencing. The best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

What is the drug of choice for the treatment of gonorrhea? a. Penicillin G b. Tetracycline c. Ceftriaxone d. Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a. Gonorrhea b. Syphilis c. Chlamydia d. Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

A client who is gravida 2 and 16 weeks of gestation comes in for her prenatal appointment. Her 2-year-old daughter is with her and is wearing a sleeveless top. While interacting with her daughter, you note axillary freckling and several café-au-lait spots (>2 cm). In reviewing her chart, the nurse should assess for documentation of which genetic disease? a. Tay-Sachs disease b. Galactosemia c. Neurofibromatosis (NF) d. PKU

ANS: C Clinical manifestations of NF may include axillary freckling and café-au-lait spots. Tay-Sachs disease is an incurable lipid-storage disorder and is not associated with café-au-lait spots. Galactosemia is an inborn error of metabolism and is also not associated with café-au-lait spots. PKU is not associated with café-au-lait spots. A child with PKU would have difficulty manufacturing the liver enzyme phenylalanine.

what drug is used to decrease the perinatal transmission of HIV?

Antiretroviral prophylaxis = zidovudine • Administer to pregnant women in prenatal and perinatal periods Antiretroviral prophylaxis • Decrease perinatal transmission of HIV • Administer to pregnant women in prenatal and perinatal periods • HIV infected women with viral loads of more than 400 or unknown HIV status • Administered 3 hours before scheduled cesarean and continued until born • Given continuously if vaginal birth

Cancer is now recognized as a genetic disorder that begins with one or more genetic mutations. Which type of cancer is specifically being investigated in this regard? a. Lung cancer b. Liver cancer c. Colorectal cancer d. Oral cancer

ANS: C Colorectal cancer usually results from one or more predisposing genes and is the third leading cause of cancer deaths in women. Although tobacco smoke is a known causative factor for lung cancer, an acquired mutation of an oncogene may also be present. Liver cancer is not being investigated in this regard. Oral cancer may be caused by an inherited mutation of one or more oncogenes.

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has the condition. The couple tells the nurse that they are having a second baby. Because their daughter has PKU, they are certain that this baby will not be affected. Which response by the nurse is the most accurate? a. "Good planning. You need to take advantage of the odds that are in your favor." b. "I think you'd better first check with your physician." c. "You are both carriers; therefore, each baby has a 25% chance of being affected." d. "The ultrasound indicates a boy, and boys are not affected by PKU."

ANS: C Each child conceived by this couple has a one-in-four chance of being affected with the PKU disorder. This couple still has an increased likelihood of having a child with PKU; having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.

The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman replies, "I have special undergarments that I do not remove for religious reasons." Which is the most appropriate response from the nurse? a. "You can't have an examination without removing all your clothes." b. "I'll ask the physician to modify the examination." c. "Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can comfortably have your examination." d. "I have no idea how we can accommodate your beliefs."

ANS: C Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the woman's religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. The examination can be modified to ensure that modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the plan of care to meet the needs of each woman. Telling the client that her religious practices are different or strange is inappropriate and disrespectful to the client.

If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? a. Spermicides b. Female condoms c. Male condoms d. Diaphragms

ANS: C For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%.

Which STI does not respond well to antibiotic therapy? a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis

ANS: C Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

Which condition is the most life-threatening virus to the fetus and neonate? a. Hepatitis A virus (HAV) b. Herpes simplex virus (HSV) c. Hepatitis B virus (HBV) d. Cytomegalovirus (CMV)

ANS: C HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a. Avoid sexual contact for at least 10 days after starting the pill. b. Use condoms and foam for the first few weeks as a backup. c. Use another method of contraception for 1 week after starting the pill. d. Begin sexual relations once vaginal bleeding has ended.

ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.

The nurse is developing a plan of care for a Hispanic client who just delivered a newborn. Which cultural variation is most important to include in the care plan? a. Breastfeeding is encouraged immediately after birth. b. Male infants are typically circumcised. c. Maternal grandmother participates in the care of the mother and her infant. d. Bathing is encouraged immediately after delivery.

ANS: C In the Hispanic family, the expectant mother is strongly influenced by her mother or mother-in-law. Breastfeeding is often delayed until the third postpartum day. Hispanic male infants are not usually circumcised. Bathing after delivery is most often delayed.

In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a. B stands for birth control. b. R stands for reproduction. c. A stands for alternatives. d. I stands for ineffective.

ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Which description is most accurate? a. "Karyotyping will reveal if the baby's lungs are mature." b. "Karyotyping will reveal if the baby will develop normally." c. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes." d. "Karyotyping will detect any physical deformities the baby has."

ANS: C Karyotyping provides genetic information such as gender and chromosomal structure. The lecithin/sphingomyelin (L/S) ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive, and not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word, and physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a. The natural family planning method is the same as coitus interruptus or "pulling out." b. This contraception method uses the calendar method to align the woman's cycle with the natural phases of the moon. c. This practice is the only contraceptive method acceptable to the Roman Catholic Church. d. The natural family planning method relies on barrier methods during the fertility phases.

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. "Pulling out" is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

A client at 24 weeks of gestation says she has a glass of wine with dinner every evening. Why should the nurse counsel her to eliminate all alcohol intake? a. Daily consumption of alcohol indicates a risk for alcoholism. b. She is at risk for abusing other substances as well. c. Alcohol places the fetus at risk for altered brain growth. d. Alcohol places the fetus at risk for multiple organ anomalies.

ANS: C No period during pregnancy is safe to consume alcohol. The documented effects of alcohol consumption during pregnancy include fetal mental retardation, learning disabilities, high activity level, and short attention span. The fetal brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use.

A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence? a. Inexperienced maternity nurse was assigned to care for the client. b. Client was past her due date by 3 days. c. Standard of care was not met. d. Client refused electronic fetal monitoring

ANS: C Not meeting the standard of care is a legitimate factor for a case of negligence. An inexperienced maternity nurse would need to display competency before being assigned to care for clients on his or her own. This client may have been past her due date; however, a term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should have signed an against medical advice form when refusing any treatment that is within the standard of care.

What is the primary reason why a woman who is older than 35 years may have difficulty achieving pregnancy? a. Personal risk behaviors influence fertility. b. Mature women have often used contraceptives for an extended time. c. Her ovaries may be affected by the aging process. d. Prepregnancy medical attention is lacking.

ANS: C Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviors than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged.

The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process is most commonly known as what? a. Best practices network b. Clinical benchmarking c. Outcomes-oriented practice d. Evidence-based practice

ANS: C Outcomes-oriented practice measures the effectiveness of the interventions and quality of care against benchmarks or standards. The term best practice refers to a program or service that has been recognized for its excellence. Clinical benchmarking is a process used to compare one's own performance against the performance of the best in an area of service. The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials.

Which statement regarding genetic health care is most important to the nurse practicing in this specialty? a. Genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups. b. Genetic health care is more concerned with populations than individuals. c. Providing emotional support to the family during counseling is the most important of all nursing functions. d. Taking genetic histories is the province of large universities and medical centers.

ANS: C Perhaps the most important of all nursing functions is the ability to provide emotional support. Nurses should be prepared to help with various stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

Preconception and prenatal care have become important components of women's health. What is the guiding principal of preconception care? a. Ensure that pregnancy complications do not occur. b. Identify the woman who should not become pregnant. c. Encourage healthy lifestyles for families desiring pregnancy. d. Ensure that women know about prenatal care.

ANS: C Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and in their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. For many women, counseling can allow behavior modification before any damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, then she is likely aware of prenatal care.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a. 6 to 10 days b. 2 to 4 weeks c. 6 to 12 weeks d. 6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

Obstetric conjugate

extends from the sacral promontory to the top of the symphysis pubis. It is the smallest front-to-back distance through which the fetal head must pass in moving through the pelvic inlet

The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called what? a. Bimanual palpation b. Rectovaginal palpation c. Papanicolaou (Pap) test d. Four As procedure

ANS: C The Pap test is a microscopic examination for cancer that should be regularly performed, depending on the client's age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The four As procedure is an intervention to help a client stop smoking.

Using the family stress theory as an interventional approach for working with families experiencing parenting challenges, the nurse can assist the family in selecting and altering internal context factors. Which statement best describes the components of an internal context? a. Biologic and genetic makeup b. Maturation of family members c. Family's perception of the event d. Prevailing cultural beliefs of society

ANS: C The family stress theory is concerned with the family's reaction to stressful events. Internal context factors include elements that a family can control such as psychologic defenses, family structure, and philosophic beliefs and values. The family stress theory focuses on ways that families react to stressful events. Maturation of family members is more relevant to the family life-cycle theory. The family stress theory focuses on internal elements that a family might be able to alter.

Which statement regarding female sexual response is inaccurate? a. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. b. Vasocongestion is the congestion of blood vessels. c. Orgasmic phase is the final state of the sexual response cycle. d. Facial grimaces and spasms of the hands and feet are often part of arousal.

ANS: C The final state of the sexual response cycle is the resolution phase after orgasm. Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. Arousal is characterized by increased muscular tension (myotonia).

Which traditional family structure is decreasing in numbers and attributable to societal changes? a. Extended family b. Binuclear family c. Nuclear family d. Blended family

ANS: C The nuclear family has long represented the traditional American family in which husband, wife, and children live as an independent unit. As a result of rapid changes in society, this number is steadily decreasing as other family configurations are socially recognized. Extended families involve additional blood relatives other than the parents. A binuclear family involves two households. A blended family is reconstructed after divorce and involves the merger of two families.

Which phase of the endometrial cycle best describes a heavy, velvety soft, fully matured endometrium? a. Menstrual b. Proliferative c. Secretory d. Ischemic

ANS: C The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this secretory phase, the endometrium becomes fully mature again. During the menstrual phase, the endometrium is shed. The proliferative phase is a period of rapid growth. During the ischemic phase, the blood supply is blocked and necrosis develops.

Which statement accurately describes the walking survey as a data collection tool? a. The walking survey determines how much exercise an expectant mother has been getting, to help her make health care decisions. b. The walking survey usually takes place on the maternity ward but can be expanded to other areas of the hospital. c. The walking survey is a method of observing the resources and health-related environment of the community. d. The walking survey is performed by government census takers as part of their canvas.

ANS: C The walking survey is a valuable tool for the nurses in the community and has nothing to do with exercise. It is an observational method used to assess the health environment of the community. A walking survey takes place in the community, not the maternity ward, and is not part of the census; it is conducted by nurses in the community.

A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a. Limit sexual contact for one cycle after starting the pill. b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c. Take one pill at the same time every day. d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.

When weighing the advantages and disadvantages of planning home care for perinatal services, what information should the nurse use in making the decision? a. Home care for perinatal services is more dangerous for vulnerable neonates at risk of acquiring an infection from the nurse. b. Home care for perinatal services is more cost-effective for the nurse than office visits. c. Home care for perinatal services allows the nurse to interact with and include family members in teaching. d. Home care for perinatal services is made possible by the ready supply of nurses with expertise in maternity care.

ANS: C Treating the whole family is an advantage of home care. Forcing neonates out in inclement weather and in public is more risky. Office visits are more cost-effective for the providers such as nurses because less travel time is involved. Unfortunately, home care options are limited by the lack of nurses with expertise in maternity care.

What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

ANS: C When problems are identified, research can be properly conducted. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is another factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

mosaicism DS

extra chromosome 21 material found in some but not all cells - 1-2% of DS

Which resource best describes a health care service representing the tertiary level of prevention? a. Stress management seminars b. Childbirth education classes for single parents c. BSE pamphlet and teaching d. Premenstrual syndrome (PMS) support group

ANS: D A PMS support group is an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., PMS). Stress management seminars are a primary prevention technique for preventing health care issues associated with stress. Childbirth education is a form of primary prevention. BSE information is a form of secondary prevention, which is aimed toward early detection of health problems.

During the childbearing experience, which behavior might the nurse expect from an African-American client? a. Seeking prenatal care early in her pregnancy b. Avoiding self-treatment of pregnancy-related discomfort c. Requesting liver in the postpartum period to prevent anemia d. Arriving at the hospital in advanced labor

ANS: D African-American women often arrive at the hospital in far-advanced labor and may view pregnancy as a state of wellness, which is often the reason for the delay in seeking prenatal care. African-American women practice many self-treatment options for various discomforts of pregnancy. African-American women may also request liver in the postpartum period, which is based on a belief that liver has a higher blood content.

The National Quality Forum has issued a list of "never events" specifically pertaining to maternal and child health. These include all of the following except: a. infant discharged to the wrong person. b. kernicterus associated with the failure to identify and treat hyperbilirubinemia. c. artificial insemination with the wrong donor sperm or egg. d. foreign object retained after surgery.

ANS: D Although a foreign object retained after surgery is a never event, it does not specifically pertain to obstetric clients. A client undergoing any type of surgery may be at risk for this event. An infant discharged to the wrong person specifically pertains to postpartum care. Death or serious disability as a result of kernicterus pertains to newborn assessment and care. Artificial insemination affects families seeking care for infertility.

The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The U.S. Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. Why is this initiative significant to nurses? a. Few genetic tests are available that identify this information. b. Only physicians should obtain this detailed information. c. Clients cannot accurately complete these histories on their own. d. Family history is the single most cost-effective source for genetic information.

ANS: D Although more than 1000 genetic tests are available, the single most cost-effective piece of genetic information is the family history. Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information. A computerized tool called My Family Health Portrait is available free of charge (https://familyhistory.hhs.gov/fhh-web/home.action). Other tools designed to help the lay community in completing their family histories are available to the public.

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a. Bacterial vaginosis b. Candidiasis c. Yeast infection d. Trichomoniasis

ANS: D Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

What is the importance of obtaining informed consent for a number of contraceptive methods? a. Contraception is an invasive procedure that requires hospitalization. b. The method may require a surgical procedure to insert a device. c. The contraception method chosen may be unreliable. d. The method chosen has potentially dangerous side effects.

ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.

As part of their participation in the gynecologic portion of the physical examination, which approach should the nurse take? a. Take a firm approach that encourages the client to facilitate the examination by following the physician's instructions exactly. b. Explain the procedure as it unfolds, and continue to question the client to get information in a timely manner. c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for developing cancer. d. Help the woman relax through the proper placement of her hands and proper breathing during the examination.

ANS: D Breathing techniques are important relaxation techniques that can help the client during the examination. The nurse should encourage the client to participate in an active partnership with the health care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the examination. Vulvar self-examination on a regular basis should be encouraged and taught during the examination.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments.

ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, then her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive.

Which statement regarding the term contraceptive failure rate is the most accurate? a. The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b. It refers to the minimum rate that must be achieved to receive a government license. c. The contraceptive failure rate increases over time as couples become more careless. d. It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

Which statement most accurately describes dominant genetic disorders? a. With a dominant disorder, the likelihood of the second child also having the condition is 100%. b. An autosomal recessive disease carries a one-in-eight risk of the second child also having the disorder. c. Disorders involving maternal ingestion of drugs carry a one-in-four chance of being repeated in the second child. d. The risk factor remains the same no matter how many affected children are already in the family.

ANS: D Each pregnancy is an independent event. The risk factor (e.g., one-in-two, one-in-four) remains the same for each child, no matter how many children are born to the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (i.e., one-in-two). An autosomal recessive disease carries a one-in-four chance of recurrence. In disorders involving maternal ingestion of drugs, subsequent children would be at risk only if the mother continued to take the drugs; the rate of risk would be difficult to calculate.

When the nurse is unsure how to perform a client care procedure that is high risk and low volume, his or her best action in this situation would be what? a. Ask another nurse. b. Discuss the procedure with the client's physician. c. Look up the procedure in a nursing textbook. d. Consult the agency procedure manual, and follow the guidelines for the procedure.

ANS: D Following the agency's policies and procedures manual is always best when seeking information on correct client procedures. These policies should reflect the current standards of care and the individual state's guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be a safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they, as nurses, are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or the individual state or hospital policies.

Which statement is the most complete and accurate description of medical abortions? a. Medical abortions are performed only for maternal health. b. They can be achieved through surgical procedures or with drugs. c. Medical abortions are mostly performed in the second trimester. d. They can be either elective or therapeutic.

ANS: D Medical abortions can be either elective (the woman's choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

A Native-American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for bottle feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of what? a. Delayed attachment b. Embarrassment c. Disappointment in the sex of the baby d. Belief that babies should not be fed colostrum

ANS: D Native Americans often use cradle boards and often avoid handling their newborn. They also believe that the infant should not be fed colostrum. Delayed attachment is a developmental concern, not a cultural belief. Embarrassment is not likely the cause for a delay in the initiation of breastfeeding and should be explored further by the nurse. The mother may voice her disappointment that the infant is a girl; however, this would rarely cause her to delay breastfeeding and would exhibit itself in other ways.

During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the most important for the nurse to perform? a. Use maternity jargon to enable the client to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the client with handouts. d. Assess whether the client understands the discussion.

ANS: D Nurses contribute to health literacy by using simple, common words, avoiding jargon, and evaluating whether the client understands the discussion. Speaking slowly and clearly and focusing on what is important will increase understanding. Most client education materials are written at a level too high for the average adult and may not be useful for a client with limited English proficiency.

What is a limitation of a home postpartum visit? a. Distractions limit the nurse's ability to teach. b. Identified problems cannot be resolved in the home setting. c. Necessary items for infant care are not available. d. Home visits to different families may require the nurse to travel a great distance.

ANS: D One limitation of home health visits is the distance the nurse must travel between clients. Driving directions should be obtained by telephone before the visit. The home care nurse is accustomed to distractions but may request that the television be turned off so that attention can be focused on the client and her family. Problems cannot always be resolved; however, appropriate referrals may be arranged by the nurse. The nurse is required to bring any necessary equipment, such as a thermometer, baby scale, or laptop computer, for documentation.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a. Positive prenatal culture b. Preterm birth at 37 weeks or less of gestation c. Maternal temperature of 38° C or higher d. Premature rupture of membranes (PROM) 24 hours or longer before the birth

ANS: D PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

translocational DS

extra chromosome 21 material present in every cell of the individual - attached to another chromosome - 3-4% of DS

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a. Fever, headache, and malaise b. Widespread rash c. Identified by serologic testing d. Appearance of a chancre 2 months after infection

ANS: D Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

Which hormone is responsible for the maturation of mammary gland tissue? a. Estrogen b. Testosterone c. Prolactin d. Progesterone

ANS: D Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland; it is produced in response to infant suckling and an emptying of the breasts.

When attempting to communicate with a client who speaks a different language, which action is the most appropriate? a. Promptly and positively respond to project authority. b. Never use a family member as an interpreter. c. Talk to the interpreter to avoid confusing the client. d. Provide as much privacy as possible.

ANS: D Providing privacy creates an atmosphere of respect and puts the client at ease. The nurse should not rush to judgment and should ensure she or he clearly understands the client's message. In crisis situations, the nurse may need to use a family member or neighbor as a translator. The nurse should speak directly to the client to create an atmosphere of respect.

A new father has just been told that his infant has trisomy 18. Which identifying physical feature is unique to an infant with this genetic disorder? a. Microcephaly and capillary hemangiomas b. Epicanthal folds and a simian crease c. Oblique palpebral fissures and Cri du chat syndrome d. Rocker-bottom feet and clenched hands with overlapping fingers

ANS: D Rocker-bottom feet and clenched hands with overlapping fingers are associated with trisomy 18. Microcephaly and capillary hemangiomas are associated with trisomy 13. Epicanthal folds and a simian crease are associated with trisomy 21 (Down syndrome). Deletion of the short arm of chromosome number 5 is manifested by Cri du chat syndrome.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." What is the nurse's mostappropriate response? a. "This probably means that you're pregnant." b. "Don't worry; it's probably nothing." c. "Have you been sick this month?" d. "You probably didn't ovulate during this cycle."

ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, "Don't worry; it's probably nothing," discredits the client's concerns. Illness is most likely the cause of an increase in BBT.

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a. "No spermicide is used with the cervical cap, so it's less messy." b. "The diaphragm can be left in place longer after intercourse." c. "Repeated intercourse with the diaphragm is more convenient." d. "The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later."

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, "I've never had a pelvic examination." What response from the nurse would be most appropriate? a. "Don't worry. It will be over before you know it." b. "Try to relax. I'll be very gentle, and I won't hurt you." c. "Your anxiety is common. I was anxious when I first had a pelvic examination." d. "I'll let you touch each instrument that I'll use during the examination as I tell you how it will be used."

ANS: D The client who is visually impaired needs to be oriented to the examination room and needs a full explanation of what the examination entails before the nurse proceeds. Telling the client that the examination will be over quickly diminishes the client's concerns. The nurse should openly and directly communicate with sensitivity. Women who have physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their abilities. Telling the client that she will not be hurt does not reflect respect or sensitivity. Although anxiety may be common, the nurse should not discuss her own issues nor compare them to the client's concerns.

While working in the prenatal clinic, nurses care for a very diverse group of clients. Which cultural factor related to health is most likely to drive acceptance of planned interventions? a. Educational achievement b. Income level c. Subcultural group d. Individual beliefs

ANS: D The client's beliefs are ultimately the key to the acceptance of health care interventions. However, these beliefs may be influenced by factors such as educational level, income level, and ethnic background. Educational achievement, income level, and being part of a subcultural group all are important factors. However, the nurse must understand that a woman's concerns from her own point of view will have the most influence on her compliance and acceptance of health care interventions.

Which part of the menstrual cycle includes the stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH)? a. Menstrual phase b. Endometrial cycle c. Ovarian cycle d. Hypothalamic-pituitary cycle

ANS: D The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that simultaneously occur in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.

Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a. COCs can cause TSS if the prescription is wrong. b. Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c. COCs increase the risk of endometrial and ovarian cancers. d. Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

While obtaining a detailed history from a woman who has recently immigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation. What is the nurse's most appropriate response in this situation? a. "This is a very abnormal practice and rarely seen in the United States." b. "Are you aware of who performed this mutilation so that it can be reported to the authorities?" c. "We will be able to restore fully your circumcision after delivery." d. "The extent of your circumcision will affect the potential for complications."

ANS: D The extent of the circumcision is important. The client may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in the United States is culturally insensitive. The infibulation may have occurred during infancy or childhood; consequently, the client will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman's health.

What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive central nervous system damage. Addiction to tobacco is not usually a concern related to the neonate.

In what form do families tend to be the most socially vulnerable? a. Married-blended family b. Extended family c. Nuclear family d. Single-parent family

ANS: D The single-parent family tends to be economically and socially vulnerable, creating an unstable and deprived environment for the growth potential of children. The married-blended family, the extended family, and the nuclear family are not the most socially vulnerable.

what is recommended for women who are HIV positive and giving birth?

ART and cesarean birth recommended • Prevent vertical transmission Scheduled cesarean birth at 38 weeks of gestation • Viral load more than 1000 Vaginal birth option if • Viral load less than 1000 at 36 weeks • Ruptured membranes and pregnancy progressing quickly • Women declines cesarean IV zidovudine: • HIV infected women with viral loads of more than 400 or unknown HIV status • Administered 3 hours before scheduled cesarean and continued until born • Given continuously if vaginal birth

With regard to abnormalities of chromosomes, nurses should be aware that: They occur in approximately 10% of newborns. Abnormalities of number are the leading cause of pregnancy loss. Down syndrome is a result of an abnormal chromosomal structure. Unbalanced translocation results in a mild abnormality that the child will outgrow.

Abnormalities of number are the leading cause of pregnancy loss. Chromosomal abnormalities occur in less than 1% of newborns. Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

disadvantages oral contraceptives

Absolute and relative contraindications - History of Thromboembolic disorder, cerebrovascular or coronary artery disease - Gallbladder disease - Jaundice with prior pill use - Breast cancer or estrogen dependent tumors - Liver tumor or severe cirrhosis - Lactation < 6wks postpartum - Smokers > 35 years - Diabetes Mellitus with vascular disease (>20 yrs duration) - hypertension (140/90) - Headaches with focal neurologic symptoms - Surgery on legs OR with prolonged immobilization

The process by which people retain some of their own culture while adopting the practices of the dominant society is known as: Acculturation. Assimilation. Ethnocentrism. Cultural relativism.

Acculturation. Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures.

what are the effects of gonorrhea during pregnancy?

Affect mother and fetus Cervical gonorrhea → salpingitis develop in first trimester Perinatal complications • Premature rupture of membranes • Preterm birth • Chorioamnionitis • Neonatal sepsis • Intrauterine growh restriction • Maternal postpartum sepsis • Amniotic infection syndrome o Placental, fetal and umbilical cord inflammation after premature rupture of membranes Ophthalmia neonatorum: • Most common manifestations in neonatal gonococcal infection • Highly contageious • Lead to blindness if untreated

factors of infertility in men and women

factors, affecting fertility in both men and women, such as age, medical conditions such as diabetes, unhealthy habits, such as smoking, excessive weight or being underweight, exposure to toxins, as well as excessive exercise

The nurse plans to conduct a health promotion program for a group of African-American pregnant women to aide in the prevention of infant morbidity and mortality. What are the reasons for the nurse to specifically choose this group of people instead of Caucasians for this program? African-Americans have a shorter life expectancy than Caucasians. African-Americans generally have lower socioeconomic status than Caucasians. African-Americans have more occurrences of birth defects than Caucasians. African-Americans have more occurrences of genetic defects than Caucasians. African-Americans are more likely to have sexually transmitted infections than Caucasians.

African-Americans have a shorter life expectancy than Caucasians. African-Americans generally have lower socioeconomic status than Caucasians. African-Americans have more occurrences of birth defects than Caucasians African-Americans are more likely to have sexually transmitted infections than Caucasians. African-Americans have higher infant morbidity and mortality rates when compared to those of Caucasians. This disparity in African-Americans and Caucasians results from different factors, including increased incidence of birth defects, sexually transmitted infections, relatively low socioeconomic status, and a shorter life expectancy. Genetic defects are not known to occur more commonly in African-Americans. Moreover, occurrence of genetic defects in children cannot be prevented.

Colon cancer screening

Ages 50-74 FOBT (fecal occult blood test) annually Colonoscopy q 10y 50-74 Sigmoidoscopy q 5y with FOBT 50-74

Human Genome Project: Two Key Findings

All human beings are >99% identical at the DNA level • A new explanation for human complexity, given the relatively small number of genes, is that humans are more efficient with their genes. • Humans are able to do much more with their genes than are other species. • Instead of producing only one protein per gene, most human genes produce at least three proteins. There are probably about 20,500 genes in the human genome

The antepartum nurse is caring for a couple whose amniocentesis results indicated a positive neural tube defect. The couple is visibly upset and concerned about the future of the pregnancy. Which nursing care is appropriate for this couple? Select all that apply. Allow the couple time to grieve the loss of the normal infant they had anticipated. Provide the couple with contact information for available counseling services. Caution the couple against terminating the pregnancy before determining the nature of the defect. Explain to the couple that the decision to continue or to terminate the pregnancy is entirely their choice. Ask for clarification when the couple states they are "not making a decision" as to whether to continue the pregnancy.

Allow the couple time to grieve the loss of the normal infant they had anticipated. The couple who has received abnormal fetal diagnostic test results should be given time to grieve for the expected normal infant. Provide the couple with contact information for available counseling services. The couple should be given resources necessary to process the shock of the abnormal test result and to grieve the loss of the expected normal infant. Explain to the couple that the decision to continue or to terminate the pregnancy is entirely their choice. Perinatal counseling is nondirective. The couple should be informed that the decision to terminate or continue the pregnancy is entirely their choice.

Vaginal vestibule

Almond-shaped area enclosed by the labia minora that contains openings to the urethra, Skene glands, vagina, and Bartholin glands

bacterial vaginosis: vaginal discharge

Alters normal acidic pH of vagina = anaerobic bacteria o Epithelial cells slough = bacteria attach to surfaces o Amines volatilized → ODOR FISHY ODOR o After sex - semen releases vaginal amines a o Appears profuse, thin, white/gray, milk o Mild irritation or pruritus • Fishy odor and increased thin vaginal discharge • Increased odor after intercourse

stillbirth

An infant who at birth demonstrates no signs of life such as breathing, heartbeat, or voluntary muscle movements

what are some negative consequences to a false negative result?

fail to follow surveillance strategies to help improve health outcomes

Failure to rescue

failure to recognize or act on early signs of distress

pelvis divided into

false pelvis true pelvis

skin examination

family history of skin cancer every 3 years (20-40) annually after 40

vulvovaginal candidiasis: treatment

Antifungal drugs: OTC • Miconazole • Clotrimazole Exogenous lactobacillus • Dairy products (yogurt) or powder, supplements • Garlic Vaginal debridement • If vaginal discharge thick and copious Sitz baths if irritation • Colloidal oatmeal powder • Not wearing underpants to bed • Complete full course of treatment • Avoid tampons during menses - absorb meds • Avoid intercourse - condom to prevent more organisms

A key finding from the Human Genome Project is: Approximately 20,000 to 25,000 genes make up the genome. All human beings are 80.99% identical at the DNA level. Human genes produce only one protein per gene; other mammals produce three proteins per gene. Single-gene testing will become a standardized test for all pregnant women in the future.

Approximately 20,000 to 25,000 genes make up the genome. Approximately 20,500 genes make up the human genome, only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single-gene testing (e.g., alpha-fetoprotein test) is already standardized for prenatal care.

5 A's of smoking cessation

Ask- u smoke? Advise- u should stop Attempt- do u want to stop? Assist- give them patch or bupropion or verencline Arrange- meet with them and f/u

what are the symptoms for gonorrhea in women?

Asymptomatic Symptoms: less specific than men • Purulent endocervical discharge - usually minimal/absent • Menstrual irregularities = presenting symptom • Pain - chronic or acute severe pelvic or lower abdominal pain • Longer, more painful menses Infrequently: • Dysuria • Vague abdominal pain • Low backache

Uterine tubes/fallopian tubes

Attach to the uterine fundus and are approximately 8-14 cm long Interstitial portion (closes to the uterus) Isthmus and ampulla (middle portions) Infundibulum (closest to the ovary)

Which precaution does the nurse take when gathering information about a treatment procedure using social media? Avoid sharing the client's age and clinical reports. Avoid sharing the client's name with the illness details. Take a note of all available content related to the treatment. Ignore the content that relates to the adverse effects of the treatment.

Avoid sharing the client's name with the illness details. The American Nurses Association has published six guiding principles for the responsible use of social media by nurses. The nurse should not place any information online that could harm a client's privacy, rights, or confidentiality such as the client's name and disease complications. The nurse can share the client's age and clinical details to obtain disease-related information because it does not violate the client's privacy. The nurse need not take a note of all available content, because some of the information may be inaccurate. The nurse needs to take note of information about adverse effects of the treatment.

Oral contraception in the form of a combination of a low-dose estrogen and progesterone A. Reduces the pH of cervical mucus, thereby destroying sperm B. Protects against iron deficiency anemia by reducing menstrual blood loss C. Prevent the transmission of sexually-transmitted actions D. Is 90% effective in preventing pregnancy when used correctly

B Benefits of low-dose pills are decrease the menstrual blood loss and iron deficiency anemia Cervical mucus is thickened, thereby inhibiting sperm penetration Ovulation and the development of the endometrium are also inhibited There is no protection from STI The overall effectiveness rate is nearly 100%

When using a cervical cap, the woman should be taught to you A. Apply spermicide only to the outside of the cap around the rim B. Leave it in place for a minimum of six hours after the last act of coitus C. Continue to use the During menstrual. D. Check the position of the cap and insert additional spermicide before next act of coitus

B Spermicide should be applied inside the cab but not around the room because a seal will not form keeping the cap in place Use during menses increases the risk for a toxic shock syndrome Checking the cap position is all that is required before each subsequent act of Coitus

A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimulation. Which of the following is a common side effect of this therapy? A. Piercing rectal pain B. Mood swings C. Visual disturbances D. Jerky tremors

B Mood swings and depression are common side effects of the hormonal therapy.

A client is to receive Pergonal (menotropins) injections for infertility prior to in-vitro fertilization. Which of the following is the expected action of this medication? A. Prolongation of the luteal phase B. Stimulation of ovulation C. Suppression of menstruation D. Promotion of cervical mucus production

B Pergonal is administered to infertile women to increase follicular growth and maturation of the follicles and to stimulate ovulation.

Which instruction by the nurse should be included in the teaching plan for an infertile woman who has been shown to have a 28-day biphasic menstrual cycle? A. Douche with a cider vinegar solution immediately before having intercourse B. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle C. Be placed on follicle-stimulating hormone therapy by the fertility specialist D. Assess the basal body temperature pattern for at least 6 more months

B This action is recommended. Pregnancy is most likely to occur with daily intercourse from 6 days before ovulation up to the day of ovulation.

A nurse is educating a client who has been diagnosed with infertility on how to complete a basal body temperature chart to determine her ovulation pattern. The client states, "I really don't want to take my temperature every day. Is there any other way to find out if and when I ovulate?" A. "There are a number of other ways to determine ovulation, but they all require you to be examined by an obstetrician every month." B. "A test you can do at home requires you to spit on a microscopic slide and then look at the slide under a microscope." C. "You can test your vaginal discharge each day to determine when you should have intercourse because the hormone progesterone is elevated." D. "Although there are some tests that you can perform at home, they all cost well over a hundred dollars to purchase."

B This statement is correct. One of the at-home ovulation predictor kits requires women to place saliva on a microscopic slide and, after allowing the saliva to dry, to look at the slide under a microscope. If ovulation is occurring, the saliva appears ferned, that is, the image on the slide looks like the leaflets of a fern. The test detects the presence of high levels of estrogen in the woman's saliva.

What is the pneumonic for informed consent

BRAIDED B- benefits R Risks A Alternatives I Inquires and questions D Decisions may change mind E Explanation D Documentation E Education

additional ways to encourage woman to share info

fascilitation reflection clarification empathic response confrontation interpretation

viral hepatitis: hepatitis A - transmission

fecal oral route - contaminated food = milk, shellfish, polluted water person to person contact

Which infections can be contracted by methods other than sexual contact? Select all that apply. Syphilis Chlamydia Bacterial vaginosis Human immunodeficiency virus (HIV) Condylomata acuminata (genital warts)

Bacterial vaginosis Bacterial vaginosis can be contracted by methods other than sexual contact. Other activity, such as douching, may upset the vagina's natural flora and allow infecting bacteria to proliferate. Correct Human immunodeficiency virus (HIV) Human immunodeficiency virus (HIV) can be contracted by methods other than sexual contact. The most common methods of transmission other than intimate contact with infected fluid are exposure to infected blood products and perinatal transmission from mother to infant.

gene

Basic physical units of inheritance that are passed from parents to off- spring and contain the coded information (DNA) needed to determine an individual's unique characteristics.

A woman has a six-month history of abnormal Pap tests. Which screening procedures should be used to further examine any persistent abnormalities? Select all that apply. Biopsy Colposcopy Pelvic examination Bimanual examination Vulvar self-examination

Biopsy Biopsy of suspicious lesions should be performed for women with a history of abnormal Pap smears in order to further examine the abnormal tissue. Further examination helps determine if the abnormal tissue is the result of precancerous growth. Correct Colposcopy Colposcopy (the examination of vaginal and cervical tissue with a colposcope for cell magnification) should be performed for women with a history of abnormal Pap smears in order to further examine the abnormal tissue. Further examination helps determine if the abnormal tissue is the result of precancerous growth.

autosomal recessive inheritance

Both genes of a pair are forms associated with a disorder to be expressed • Heterozygous - Only one variant allele - unaffected because normal gene overshadows = CARRIERS recessive train • Increase incidence in consanguineous matings - closely related parents Horizontal pattern of inheritance • Observed in one or more siblings but NOT in earlier generations

Place the changes in female sexual maturation in the typical order of occurrence.

Breast development Pubic hair development Axillary hair growth Menstruation This order of physical changes is the expected order of sexual maturation for females. Breast development begins first; it is followed by pubic hair growth, then axillary hair growth, and then menarche.

A couple is seeking advice regarding actions that they can take to increase their potential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? A. The couple should use vaginal lubricants during intercourse B. The couple should delay having intercourse until the day of ovulation C. The woman should refrain from douching D. The man should be on top during intercourse

C The woman should refrain from douching. Douching can change the normal flora and the pH in the vagina, making the environment hostile to the sperm.

A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states, "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? A. "Please take a urine sample to the lab so they can check it for an infection." B. "Those changes indicate that you are likely already pregnant." C. "It is important for you to come into the office to be examined today." D. "Abdominal bloating is an expected response to the medications.

C This client should be seen by her infertility doctor.

A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? A. Since the man is healthy, he could not possibly have cystic fibrosis B. Men with cystic fibrosis often have no epididymis C. The expressivity of cystic fibrosis is variable D. Cystic fibrosis is a respiratory illness having nothing to do with reproduction

C This statement is correct. Cystic fibrosis can be expressed in a number of ways. Some affected individuals have very serious illness resulting in early death, while others experience few symptoms.

cultural consideration 4 Cs

CALL - what do you call your problem? CAUSE - what do you think caused your problem? COPE - how do you cope with your condition CONCERNS - what are your concerns regarding your condition

hepatitis C: risks

CDC = born between 1945 and 1965 are 75% of cases • Chronic viral hepatitis • STIs = HBV and HIV • Multiple partners • Blood transfusions • IV drug use

what is the parenteral treatment for PID?

Cefotetan, 2 g IV q12h OR cefoxitin, 2 g IV q6h for at least 24 hours after improvement PLUS doxycycline, 100 mg orally or IV q12h for 14 days Regimen B Clindamycin, 900 mg IV q8h PLUS Gentamicin, loading dose IV or IM (2 mg/kg of body weight), followed by maintenance dose (1.5 mg/kg) q8h. Single daily dosing may be substituted. Parenteral therapy can be discontinued 24 hours after clinical improvement; ongoing oral therapy should consist of doxycycline 100 mg orally twice a day, or clindamycin 450 mg orally four times a day to complete a total of 14 days of therapy.

african american view on newborn

feeding very important good baby eat well early introduction to solid foods breastfeeding may be considered embarrassing parents fearful of spoiling baby commonly call baby by nicknames may use excessive clothing to keep baby warm bally banded to prevent umbilical hernia abundant use of oil on baby scalp and skin strong feeling of family

what is the oral treatment for PID?

Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT Metronidazole 500 mg orally twice a day for 14 days OR Cefoxitin 2 g IM in a single dose and probenecid, 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT Metronidazole 500 mg orally twice a day for 14 days OR Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) PLUS Doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT Metronidazole 500 mg orally twice a day for 14 days

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? Cervical cap Condom Vaginal film Vaginal sheath

Cervical cap Women with a history of TSS should not use a cervical cap. Condoms, vaginal film, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

When assessing women it is important for a nurse to keep in mind the possibility that they are victims of violence. The nurse should: A. Use an abuse assessment screen during the assessment of every woman B. Recognize that abuse rarely occurs during pregnancy C. Assess a woman's legs and back as the most commonly injured areas D. Notify the woman's partner immediately if abuse is suspected

Choice A is correct; all women should be screened because abuse can happen to any woman; abuse can begin or escalate during pregnancy; the most com- monly injured sites are head, neck, chest, abdomen, breasts, and upper extremities. If abuse is suspected, the nurse needs to assess further to encourage disclo- sure and then assist the woman to take action and formulate a safety plan. Nurses should follow the laws of their state with regard to reporting instances of abuse. A. Use an abuse assessment screen during the assessment of every woman

Which statement is most accurate regarding persons who should participate in preconception counseling? A. All women and their partners as they make decisions about their reproductive future, including becoming parents B. Women older than 40 years of age who wish to become pregnant C. Sexually active women who do not use birth control D. Women with chronic illnesses such as diabetes who are planning to get pregnant

Choice A is correct; all women—not just specific groups—should participate in preconception care approximately 1 year before planning to become pregnant. A. All women and their partners as they make decisions about their reproductive future, including becoming parents

Infections of the female midreproductive tract such as chlamydia are dangerous primarily because they: A. Are asymptomatic or silent B. Cause infertility C. Lead to pelvic inflammatory disease (PID) D. Are difficult to treat effectively

Choice A is correct; because these infections are often asymptomatic, they can go undetected and untreated, causing more severe damage, including ascent of the pathogen into uterus and pelvis, resulting in PID and infertility; many effective treatment measures are available, including treatment for chlamydia. A. Are asymptomatic or silent

A family with open boundaries: A. Uses available support systems to meet its needs B. Is more prone to crisis, related to increased exposure to stressors C. Discourages family members from setting up channels D. Strives to maintain family stability by avoiding outside influences

Choice A is correct; choices B, C, and D reflect the characteristics of families with closed boundaries; they are more prone to crises because they have a narrow network to help them in times of stress." B. Is more prone to crisis, related to increased exposure to stressors C. Discourages family members from setting up channels D. Strives to maintain family stability by avoiding outside influences

A nurse is teaching a 20-year-old woman about risk-reduction measures. Which measure should the nurse emphasize as the most important? A. Using a female condom B. Knowing her partner C. Reducing the number of partners D. Getting the HPV vaccination"

Choice B is correct; although choices A, C, and D are measures that should be followed, knowing her partner—including the partner's sexual history and presence of any manifestations of infection—is essential. B. Knowing her partner

52-year-old woman asks the nurse practitioner about how often she should be assessed for the common health problems that women of her age could experience. The nurse recommends: A. An endometrial biopsy every 3 to 4 years B. A fecal occult blood test annually C. A mammogram every other year D. Bone mineral density testing annually

Choice B is correct; bone mineral density testing should be initiated at 65 years of age or older unless risk factors are present; endometrial biopsies are not recommended on a routine basis for most women but women at risk for endometrial cancer should have one done at menopause; mammograms should be done annually for women 50 years of age and older. B. A fecal occult blood test annually

A finding associated with human papillomavirus (HPV) infection includes: A. White, curdlike adherent discharge B. Soft papillary swellings occurring singly or in clusters C. Vesicles progressing to pustules and then to ulcers D. Yellow to green frothy, malodorous discharge

Choice B is correct; choice A is indicative of candi- diasis; choice C is indicative of genital HSV; choice D is indicative of trichomoniasis. B. Soft papillary swellings occurring singly or in clusters

A women's health nurse practitioner is going to perform a pelvic examination on a female client. Which nursing action would be least effective in enhancing the client's comfort and relaxation during the examination? A. Encourage the client to ask questions and express feelings and concerns before and after the examination. B. Ask the client questions as the examination is performed. C. Allow the client to keep her shoes and socks on when placing her feet in the stirrups. D. Instruct the client to place her hands over her diaphragm and take deep, slow breaths.

Choice B is correct; do not ask questions during the examination because it may distract the client, inter- fering with relaxation measures she may be using; offer explanations only as needed during the exami- nation. B. Ask the client questions as the examination is performed.

A recommended medication effective in the treatment of vulvovaginal candidiasis is: A. Metronidazole B. Clotrimazole C. Benzathine penicillin G D. Acyclovir

Choice B is correct; metronidazole is used to treat bacterial vaginosis and trichomoniasis; benzathine penicillin G is used to treat syphilis; acyclovir is used to treat genital herpes. B. Clotrimazole

Which nursing action is most likely to reduce a woman's anxiety and enhance her personal security as it relates to the concept of personal space needs? A. Touching the woman before and during procedures B. Providing explanations when performing tasks C. Making eye contact as much as possible D. Reducing the need for the woman to make decisions

Choice B is correct; providing explanations, espe- cially when performing tasks that require close con- tact, can help to avoid misunderstandings; touching the client, putting the client in proximity to others, overuse of eye contact, and taking away the right to make decisions can be interpreted by clients in some cultures as invading their personal space and thereby increase the level of anxiety and stress experienced." B. Providing explanations when performing tasks

Cervical neoplasia has been linked to which of the following sexually transmitted infections? A. Herpes simplex virus (HSV) B. Human papillomavirus (HPV) C. Human immunodeficiency virus (HIV) D. Chlamydia

Choice B is correct; several HPV serotypes are thought to have oncogenic potential and are there- fore the primary cause of cervical cancer. B. Human papillomavirus (HPV)

A student nurses' association is planning a health fair that will emphasize secondary-level prevention activities. Which activity would the faculty adviser tell them to eliminate because it does not fit into their stated focus? A. Teaching participants how to check their radial pulse for rate and regularity B. Blood glucose monitoring C. Demonstration of relaxation measures to manage stress D. Breast models that participants can use to learn breast palpation techniques

Choice C is correct because it represents the primary level of prevention." C. Demonstration of relaxation measures to manage stress

A woman is determined to be group B streptococci (GBS) positive at the onset of her labor. The nurse should prepare this woman for: A. Cesarean birth B. Isolation of her newborn after birth C. Intravenous antibiotic prophylaxis (IAP) using penicillin G during labor D. Application of acyclovir to her labial lesions

Choice C is correct; cesarean section or isolation is not required; there are no lesions with this bacterial infection; antiviral medication is not appropriate. C. Intravenous antibiotic prophylaxis (IAP) using penicillin G during labor

A nurse instructed a female client regarding vulvar self-examination (VSE). Which statement made by the client indicates that further instruction is needed? A. I will perform this examination at least once a month, especially if I change sexual partners or am sexually active. B. I will become familiar with how my genitalia look and feel so that I will be able to detect changes. C. I will use the examination to determine when I should get medications at the pharmacy for infections. D. I will wash my hands thoroughly before and after I examine myself.

Choice C is correct; self-examination should not be used for self-diagnosis but rather to detect early changes, which would call for the guidance of a health care provider. C. I will use the examination to determine when I should get medications at the pharmacy for infections

A student nurse is planning to communicate with her postpartum client using an interpreter. Her instructor should provide further guidance if the student: A. Arranges for a female from the woman's country of origin to act as interpreter B. Stops periodically during the interaction to ask the interpreter how things are going C. Asks the woman questions while looking at the interpreter D. Gathers culturally appropriate learning aids and reading materials to use during the interaction

Choice C is correct; the student should be looking at the woman while speaking and asking questions through the interpreter; a normal tone of voice should be used." C. Asks the woman questions while looking at the interpreter

A nurse has just taught a group of parents at a grade school PTA meeting regarding the vaccine Gardisil. Which statement by one of the parents would indicate a need for further instructions? A. "I should make sure that my child receives this vaccine before becoming sexually active." B. "This vaccine will prevent my child from being infected by some of the most common strains of HPV that can cause cervical cancer." C. "My child will need to receive the vaccine in two doses every 6 months for 1 year." D. "Both my daughter and my son should receive the vaccine around the age of 11 to 12 years."

Choice C is correct; the vaccine is given in three doses over a 6-month period. C. "My child will need to receive the vaccine in two doses every 6 months for 1 year."

To enhance the accuracy of the Pap test, the nurse should instruct the woman to: A. Schedule the test just prior to the onset of menses B. Stop taking birth control pills for 2 days before the test C. Avoid intercourse for 24 to 48 hours before the test D. Douche with a specially prepared antiseptic solution on the night before the test

Choice C is correct; women should not use vaginal medications or douche for 24 to 48 hours before the test; oral contraceptives can continue; the best time for the test is midcycle. C. Avoid intercourse for 24 to 48 hours before the test

When making a home visit, it is essential that the nurse use appropriate infection control measures. Of the measures listed below, which one is the most important? A. Including personal protective equipment in the home care bag B. Designating a dirty area with a trash bag to collect soiled equipment and supplies C. Wearing clean vinyl gloves for procedures that involve touching the client D. Performing hand hygiene using either soap and running water or a self-drying antiseptic solution

Choice D is correct; although choices A and B are appropriate, they are not the most important; gloves are not needed unless the possibility of contacting body substances is present." D. Performing hand hygiene using either soap and running water or a self-drying antiseptic solution

A Native-American woman gave birth to a girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she returns home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: A. Embarrassment B. Delayed attachment C. Disappointment that the baby is a girl D. Cultural beliefs regarding the best way to care for newborns

Choice D is correct; choices A, B, and C are incorrect interpretations based on the woman's culture and customs; Native Americans may use cradleboards and avoid handling their newborn often; newborns should not be fed colostrum." D. Cultural beliefs regarding the best way to care for newborns

fertile period

fertile period - day of first temperature drop or elevation through 3 consecutive days - abstinence: begins first day of menstrual bleeding and lasts through 3 consecutive days of sustained temperature raise

Cooper ligaments

fibrous suspensory ligaments which separate and support the galndurar structure and ducts

When palpating the small breasts of a young, slender woman the nurse should: A. Wear clean gloves B. Lift the hands when moving from one segment of the breast to another C. Use both hands D. Follow a systematic, overlapping pattern

Choice D is correct; clean gloves are required only if open lesions are present and when compressing the nipple if discharge is anticipated; fingers should not be lifted; two hands are used for women with large, pendulous breasts. D. Follow a systematic, overlapping pattern

A 20-year-old woman tells the nurse that she performs breast self-examination (BSE) on a regular basis. The nurse evaluates the woman's understanding of BSE and ability to perform the technique correctly. Which actions by the woman indicate that she needs further instruction regarding BSE? (Circle all that apply.) A. Performs BSE every month on the first day of her menstrual cycle. B. Observes the size of her breasts, direction of her nipples, and appearance of her skin, including the presence of dimpling, when looking at her breasts in the mirror. C. Lies down on a bed and puts a pillow under the shoulder of the breast she is going to palpate. Then she places the arm on that side under her head. D. Uses the tips of two fingers to palpate her breast E. Palpates her breast, using an overlapping circular pattern around her entire breast. F. Palpates her breasts again, including up into her axillae, while taking a shower.

Choices A and D are correct; a woman should perform BSE every month at the end of menstruation when the breasts are the least tender; she should use the finger- pads of her three middle fingers for palpation. A. Performs BSE every month on the first day of her menstrual cycle. D. Uses the tips of two fingers to palpate her breast

Regarding pregnancy and childbirth, European-American women are likely to believe that: (Circle all that apply.) A. The father of the baby should be actively involved in the labor and birth B. Pregnancy requires medical attention, so prenatal care should begin early in pregnancy C. Birthing at home should be valued D. Pregnant women should participate in childbirth education E. The doctor is the head of the obstetric care team F. Mothers should not begin to breastfeed until milk comes in

Choices A, B, D, and E are correct; birthing in an institutional setting is valued and breastfeeding should start as soon as possible after birth." A. The father of the baby should be actively involved in the labor and birth B. Pregnancy requires medical attention, so prenatal care should begin early in pregnancy D. Pregnant women should participate in childbirth education E. The doctor is the head of the obstetric care team

When caring for a pregnant woman who is Hispanic, the nurse should recognize that the woman may be guided by which of the following cultural beliefs and practices during her pregnancy? (Circle all that apply.) A. Cool air currents can be dangerous during pregnancy. B. Prenatal care should begin very early in pregnancy. C. Milk should be avoided because it results in big babies and difficult births. D. Drinking chamomile tea should be avoided because it can cause preterm labor. E. The advice of both mothers and mothers-in-law should be followed during pregnancy. F. Pelvic examinations should not be performed by a male health care provider.

Choices A, C, E, and F are correct; prenatal care should begin late in pregnancy and chamomile tea is thought to ensure effective labor." A. Cool air currents can be dangerous during pregnancy. C. Milk should be avoided because it results in big babies and difficult births. E. The advice of both mothers and mothers-in-law should be followed during pregnancy. F. Pelvic examinations should not be performed by a male health care provider.

When providing a woman who is recovering from primary herpes with information regarding the recurrence of herpes infection of the genital tract, the nurse tells her that: (Circle all that apply.) A. Fever and flulike symptoms occur only with primary infection B. Little can be done to control the recurrence of infection C. Transmission of the virus is possible only when lesions are open and draining D. Itching and tingling often occur as prodromal symptoms prior to the appearance of vesicles E. Cleaning lesions twice a day with saline will help to prevent secondary infections F. Acyclovir therapy will cure herpes

Choices A, D, and E are correct; recurrent infections commonly involve only local symptoms that are less severe; stress reduction, healthy lifestyle practices, cleansing lesions, and acyclovir can reduce recur- rence rate and prevent secondary infection; viral shedding can occur before lesions appear during the prodromal stage; acyclovir cannot cure herpes but can keep it in control. A. Fever and flulike symptoms occur only with primary infection D. Itching and tingling often occur as prodromal symptoms prior to the appearance of vesicles E. Cleaning lesions twice a day with saline will help to prevent secondary infections

Which health services represent the primary level of preventive care? (Circle all that apply.) A. Breast self-examination and testicular self-examination education programs B. Providing flu immunizations in pharmacies C. A safer-sex informational pamphlet provided to adolescents during a health education class D. Blood pressure and cholesterol screening at a health fair E. Instituting a wheelchair, cane, and walker exchange program for persons whose health insurance does not cover these items F. A car-seat fitting fair at local automobile dealerships

Choices B, C, and F are correct; choices A and D are secondary levels of prevention and choice E is a tertiary level of prevention." B. Providing flu immunizations in pharmacies C. A safer-sex informational pamphlet provided to adolescents during a health education class F. A car-seat fitting fair at local automobile dealerships

nonpharmacological treatments for HSV

Clean lesions twice daily with sailing = prevents secondary infection Warm sitz bath with baking soda; keep dry and cool; loose clothing; drying aids = hydrogen peroxide, burrow solution, oatmeal baths, cool wet tea bags, compress with infusion of cloves, peppermint oil and clove oil Oral analgesics for pain • Topical agents • AVOID: nonantiviral ointments = cortisone lidocaine may me applied

A woman visiting the health care provider for a routine well-woman visit has a history of stroke and has right-sided hemiparesis, or weakness. The nurse anticipates that the results of which screening procedure may be impacted by these symptoms? Pap test Fecal occult blood test (FOBT) Clinical breast examination (CBE) Thyroid stimulating hormone (TSH)

Clinical breast examination (CBE) During the clinical breast examination (CBE), the woman is instructed to lift both arms above the head. Hemiparesis will impact the woman's ability to lift both arms; therefore the results of the visual inspection made by the nurse will be impacted.

what are the challenges of gene therapy?

figure how to target right gene to right location in right cells expressing transferred gene at right time minimizing AE

Which ethical issues are related to perinatal nursing and Women's health care? Abortion Euthanasia Cloning of humans Rights of an embryo Fetal tissue transplantation

Cloning of humans Rights of an embryo Fetal tissue transplantation Abortion The increased use of technology in health care and scientific advances has given rise to ethical issues such as abortion, cloning of humans, rights of an embryo, and fetal tissue transplantation. Abortion laws vary from state to state and abortion is a huge ethical issue for women's health nursing. Cloning of humans may have benefits, but the technology is not developed enough to be safe. Care providers and legislators are divided on the rights of an embryo. Many believe that it is unethical to harm the embryo because it is a living being. Fetal tissue transplantation is an ethical issue because it induces abortion. Euthanasia is not legally allowed and is not an ethical issue in perinatal nursing and Women's health care.

The term used to describe professional interaction amongst healthcare providers in the clinical nursing practice is what? Collegiality Ethics Evaluation Accountability

Collegiality Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. Accountability refers to legal and professional responsibility for practice.

The term used to describe professional interaction among health care providers in the clinical nursing practice is: Collegiality Ethics Evaluation Accountability

Collegiality Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. Accountability refers to legal and professional responsibility for practice.

Nursing Interventions Classification (NIC)

Comprehensive standardized language that describes interventions performed by generalist or specialist nurses.

Mosaicism

Condition in which there is a mixture of cells, some with a normal number of chromosomes and others either missing a chromosome or containing an extra chromosome.

The nurse is working in a community center. Which intervention implemented by the nurse would help to achieve the objectives of Healthy People 2020? Conducting awareness programs to reduce low birth weight in the infants Promoting formula feeding for infants of mothers who work outside the home Suggesting that clients avoid taking folate supplements during pregnancy Suggesting that clients get regular exercise to avoid weight gain during pregnancy

Conducting awareness programs to reduce low birth weight in the infants The nurse should conduct awareness programs to prevent low birth weight in newborns. This helps in preventing mortality and cerebral palsy in newborns. Inadequate maternal weight gain during pregnancy may cause complications that could result in fetal and maternal death. Therefore, the nurse should not suggest that the clients avoid weight gain altogether, and instead the nurse may focus on healthy weight gain during pregnancy. Folate supplements prevent anemia in pregnant clients and neural tube defects in the newborn; therefore, the nurse should suggest that the clients take folate supplements. Breast milk helps enhance immunity and fetal growth and development. Therefore, the nurse should make suggestions for how to breastfeed newborns in work environments, rather than suggesting that the clients use alternative feeding methods such as formula.

When a nurse is unsure about how to perform a client care procedure, the best action would be to what? Ask another nurse Discuss the procedure with the client's physician Look up the procedure in a nursing textbook Consult the agency procedure manual and follow the guidelines for the procedure

Consult the agency procedure manual and follow the guidelines for the procedure It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies.

When a nurse is unsure about how to perform a client care procedure, what is the best action? Ask another nurse. Discuss the procedure with the client's physician. Look up the procedure in a nursing textbook. Consult the agency procedure manual and follow the guidelines for the procedure.

Consult the agency procedure manual and follow the guidelines for the procedure. It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies.

When a nurse is unsure about how to perform a client care procedure, the best action would be to: Ask another nurse. Discuss the procedure with the client's physician. Look up the procedure in a nursing textbook. Consult the agency procedure manual and follow the guidelines for the procedure.

Consult the agency procedure manual and follow the guidelines for the procedure. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies. Each nurse is obligated to follow the standards of care for safe client care delivery. It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines.

The antepartum nurse is caring for a patient with a family history of neural tube defects. The patient declines genetic counseling after listening to the health care provider's explanation. Which nursing intervention is appropriate for this patient? Continue to the next part of the visit. Inform the patient that declining genetic counseling may lead to inadequate preparation if the infant is born with a defect. Provide the patient with printed material regarding genetic counseling to take home should the patient have a change of mind. . Explain to the patient that the test must be done because a family history of neural tube defects indicates a need for genetic counseling.

Continue to the next part of the visit. Whether to receive genetic counseling is ultimately the patient's decision. The nurse should acknowledge the patient's choice and continue with the visit.

Which describes the function of the cremaster muscle in the male reproductive system? Carries urine from the bladder Controls temperature of the testes Enhances the motility of the sperm Traps blood within the spongy tissue

Controls temperature of the testes The function of the cremaster muscle in the male reproductive system is to control the temperature of the testes by relaxing or tightening to keep sperm within the testes cooler than the core body temperature.

The nurse who provides preconception care understands that it: Is designed for women who have never been pregnant. Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions. Avoids teaching about safe sex to avoid political controversy. Could include interventions to reduce substance use and abuse.

Could include interventions to reduce substance use and abuse. Preconception care is designed for all women of childbearing potential. Risk factor assessment includes financial resources and environmental conditions at home and work. Health promotion can include teaching about safe sex. If assessments indicate a drug problem, treatment can be suggested or arranged.

Which description represents the normal anatomical structure of the external os of the cervix in a nullipara? Rounded with tags Curved and smooth Large, slit-like opening Irregular and softened

Curved and smooth The normal anatomical structure of the external os of the cervix in a nullipara should be curved and smooth.

"Hypothalamic-pituitary cycle"

Cycle that involves secretion of hormones required to stimulate ovulation.

Ovarian Cycle:

Cycle that involves the changes in the ovary, leading to ovulation. It con- sists of two phases, namely, follicular and luteal.

The uterus is a muscular pear-shaped organ that is responsible for: Cyclic menstruation. Sex hormone production. Fertilization. Sexual arousal.

Cyclic menstruation. The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

When teaching women about the effective use of chemical barriers, the nurse should tell them to A. Insert at least two hours prior to intercourse B. Use the Nanoxynol nine to inhibit the transmission of HIV C. Douche immediately after the intercourse D. Reply before each act of coitus

D Spermicide should be inserted no longer than one hour prior to intercourse Douching should not occur for at least six hours after coitus Frequent use of N-9 especially for anal intercourse, may disrupt mucosa, increasing rather than increasing the risk of HIV transmission

A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months and that a friend had recently advised her partner to take ginseng to improve the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? A. Based on their history, the client and her partner have made the appropriate decision regarding their fertility. B. Ginseng can cause permanent chromosomal mutations and should be stopped immediately. C. It is unnecessary to become concerned about this woman's fertility because she has tried to become pregnant for only a few months. D. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling.

D Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complementary therapy to maximize their potential of becoming pregnant.

An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been unable to conceive? A. Her kosher diet is lacking the essential nutrients needed for achieving optimal reproductive health. B. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization C. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases D. Orthodox Jewish couples refrain from intercourse during menses and for seven days after it ends

D Jewish law does prohibit intercourse during the menses and for 7 days following menses. The woman then goes through a cleansing bath called a mikvah before she and her husband may have intercourse. With such a short cycle, she is ovulating during the time frame in which intercourse is restricted

if a pt has a positive HIV antibody test, what is done?

first antibody test is done with a sensitive screening test such as enzyme immunoassay, if confirmed positive reactive screening must be confirmed by confirmed by supplemental test - western blot - immunofluorescence assay capable of infecting others if positive

A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling? A. "You will have the test the day after your menstruation ends." B. "You will have a dye put into your vein that will show up on x-ray." C. "You should refrain from having intercourse for the four days immediately before the test." D. "You should experience the same sensations you feel when your doctor does your Pap test."

D The client will undergo a speculum examination when cervical mucus will be harvested.

A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? A. Whether or not the ovaries are maturing properly B. If the endometrium is fully vascularized C. If the cervix is incompetent D. Whether or not the fallopian tubes are obstructed

D The primary goal of a hysterosalpingogram is to learn whether or not the fallopian tubes are patent.

A client is hospitalized in the acute phase of severe ovarian hyperstimulation syndrome. The following nursing diagnosis has been identified: Fluid volume excess (extravascular) related to third spacing. Which of the following nursing goals is highest priority in relation to this diagnosis? A. Client's weight will be within normal limits by date of discharge B. Client's skin will show no evidence of breakdown throughout hospitalization C. Client's electrolyte levels will be within normal limits within one day D. Client's lung fields will remain clear throughout hospitalization

D This is the priority nursing goal related to ovarian hyperstimulation syndrome.

A client has been notified that because of fallopian tube obstruction, her best option for becoming pregnant is through in-vitro fertilization. The client asks the nurse about the procedure. Which of the following responses is correct? A. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." B. "Preimplantation genetic diagnosis will be performed on your partner's sperm before they are mixed with your eggs." C. "After ovarian stimulation, you will be artificially inseminated with your partner's sperm." D. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

D This response is correct. Since multiple embryos are usually created during the in-vitro process, there are often more embryos created than are implanted. The couple may preserve the embryos

A client is to have a hysterosalpingogram. Which of the following information should the nurse provide to the client prior to the procedure? A. "The test will be performed through a small incision next to your belly button." B. "You will be on bedrest for a full day following the procedure." C. "An antibiotic fluid will be instilled through a tube in your cervix." D. "You will be asked to move from side to side so that x-ray pictures can be taken."

D This statement is correct. A number of pictures will be taken throughout the procedure. The client, who will be awake, is asked to move into positions for the x-rays.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? Obtain data about the frequency of coitus. Determine the woman's level of knowledge about contraception and commitment to any particular method. Assess the woman's willingness to touch her genitals and cervical mucus. Evaluate the woman's contraceptive life plan.

Determine the woman's level of knowledge about contraception and commitment to any particular method. All of these actions are part of the assessment, but determination of the woman's level of knowledge regarding contraception and her commitment to a method is the primary step and is necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with her to compare options, reliability, cost, comfort level, protection from sexually transmitted infections (STIs), and a partner's willingness to participate. Data about frequency of coitus should include the number of sexual partners, level of partner contraceptive involvement, and any partner objections. A woman's willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss only if the client expresses interest in using one of the fertility awareness methods of contraception.

Which noticeable change is first expected during the process of sexual maturation in females? Development of breast buds Increasing height and weight Secretion of endometrial glands Growth of axillary and pubic hair

Development of breast buds Development of breast buds is the first noticeable change expected during the process of sexual maturation in females.

how is syphilis diagnosed?

Diagnosis: microscopic exam of primary and secondary lesion tissue Serology during latency and late infection • Nontreponemal antibody test: • Flase positive - not unusual • Treponemal tests: • Fluorescent treponemal antibody absorbed • Used to confirm positive results Tests in early primary or incubating syphilis can be negative • Seroconverstion usually 6-8 weeks after exposure → testing repeated in 1-2 months when suggestive genital lesion exists

what is the most common form of gonorrhea in prepubertal girls? what are the symptoms?

Diffuse vaginitis with vulvitis • Vaginal discharge • Dysuria • Swollen, reddened labia

A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: Tell the couple they need to have an abortion within 2 to 3 weeks. Explain that the fetus has a 50% chance of having the disorder. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. Refer the couple to a psychologist for emotional support.

Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

"Inborn error of metabolism"

Disorder that follows the autosomal recessive pattern of inheritance; it occurs when a gene mutation reduces the efficiency of encoded enzymes to a level at which normal metabolism cannot occur.

monophasic pills

fixed dosage of estrogen and progestine

The Centers for Disease Control and Prevention (CDC)-recommended medication for the treatment of chlamydia is: Doxycycline Podofilox Acyclovir Penicillin

Doxycycline Doxycycline is effective for treating chlamydia; however, it should be avoided if a woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papillomavirus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is the preferred medication for syphilis.

PID increases the risk for what?

ECTOPIC PREGNANCY* Infertility chronic pelvic pain • Dyspareunia (painful intercourse) • Pyosalpinx (pus in uterine tubes) • Tuboovarian abscess • Pelvic adhesions

Which of the following conditions has not contributed to an increase in maternity-related health care costs? Early postpartum discharges Maternal medical risk factors, such as diabetes The use of high-tech equipment The cost of care for low-birth-weight (LBW) infants

Early postpartum discharges Early postpartum discharges are associated with decreased health care costs. High-risk factors and high-tech equipment both increase such costs. Clinical evidence indicates that maternity-related health care costs are increased for LBW and high-risk infants.

Effect of prostaglandins

Effect of prostaglandins Regression of corpus luteum, regression of endometrium, sloughing of endometrium --> menstruation, enhance uterine contractions, cause cervical dilation May be involved in initiation of labor, maintenance of labor, or both

what are the reasons for resistance of using condoms?

Embarrassed to buy Cultural barriers - Hispanic difficult to suggest use of condoms = implies sexually active → "seeking" sex = overprepared and oversexed, willing to have sex with any man

Which changes are part of the normal process of male sexual maturation? Select all that apply. Fine hair growth Enlarged testicles Darkened scrotum Nocturnal emission Rapid growth spurt

Enlarged testicles Enlarged testicles are a part of the normal process of male sexual maturation. Darkened scrotum A darkened scrotum is a part of the normal process of male sexual maturation. Nocturnal emission Nocturnal emissions, or "wet dreams," are a part of the normal process of male sexual maturation. Rapid growth spurt A rapid growth spurt, especially in height, is a part of the normal process of male sexual maturation.

What is the role of the nurse while performing a research study on perinatal women? Apply for the approvals from the concerned authority. Formulate and reinforce ethics of conducting research. Ensure that women are fully informed and aware of their rights. Decide the number and type of subjects to be included in the study.

Ensure that women are fully informed and aware of their rights. Participation of perinatal women in a research study is an ethical dilemma due to the risks involved. Therefore, the nurse should make sure that the women participating in the research study are well informed and fully aware of their rights. Formulating and reinforcing ethical guidelines is a responsibility of the ethical committee. The principal investigator is the one who decides the number and types of subjects to be included in the study. Applying for approvals from the authorities is the responsibility of the principal investigator.

Which hormone stimulates the growth of the breast by inducing fat deposition, development of stromal tissue, and growth of the extensive ductile system?

Estrogen

Which hormones are necessary for normal sperm formation in the testes? Select all that apply. Estrogen Testosterone Luteinizing hormone Follicle-stimulating hormone Gonadotropin-releasing hormone

Estrogen A small amount of estrogen is necessary for normal sperm formation. Testosterone Testosterone is necessary for normal sperm formation.

Which hormones are responsible for development of female secondary sex characteristics? Select all that apply. Oxytocin Estrogen Prolactin Progesterone Luteinizing hormone

Estrogen Estrogen is released from the ovaries and is responsible for development of female secondary sex characteristics. Progesterone Progesterone is released from the ovaries and is responsible for development of female secondary sex characteristics.

abnormalities of chromosomal number

Euploid cell: • Correct or normal number of chromosomes within cell Haploid: • Gametes (1N, 23 chromosomes) Diploid: • Somatic cells (2N, 46 chromosomes) Polypoidal: triploid (3N, 69); tetraploid (4N, 92) Aneuploidy

In which culture is the father more likely to be expected to participate in the labor and delivery? Asian-American African-American European-American Hispanic

European-American Asian-American fathers do not actively participate in labor or birth. African-American men view pregnancy as a sign of virility; however, they may be less likely to participate actively in labor or birth. European-Americans expect the father to take a more active role in the labor and delivery than the other cultures. Hispanic men often view labor and birth as a female affair.

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: Reassure the woman that the examination will not reveal any problems. Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. Reassure the woman that "bumps" can be treated. Reassure her that most women have "bumps" on their labia.

Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. During assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client's discomfort or the results of examination, any comments about findings or their treatment would be incorrect and inappropriate. The statement in D is not accurate and should not be used in this situation.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? Perform a nutrition assessment. Refer the woman to a social worker. Advise the woman to see an obstetrician, not a midwife. Explain to the woman the importance of keeping her prenatal care appointments.

Explain to the woman the importance of keeping her prenatal care appointments. Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but this is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. Additionally, this is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive.

A 23-year-old African-American woman is pregnant with her first child. On the basis of the statistics for infant mortality, which plan is most important for the nurse to implement? Perform a nutrition assessment. Refer the woman to a social worker. Advise the woman to see an obstetrician, not a midwife. Explain to the woman the importance of keeping her prenatal care appointments.

Explain to the woman the importance of keeping her prenatal care appointments. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but this also is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. Additionally, this is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive. Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.

Types of Pelvis: Platypelloid

flat with an oval inlet wide transverse diameter, but short anteroposterior diameter, making labot and vaginal birth difficult

Which of the following conditions have contributed to an increase in maternity-related health care costs? Early postpartum discharges Maternal medical risk factors, such as diabetes The use of high-tech equipment The cost of care for low-birth-weight (LBW) infants Early prenatal care

Maternal medical risk factors, such as diabetes The use of high-tech equipment The cost of care for low-birth-weight (LBW) infants High risk factors and high-tech equipment increase healthcare costs. Clinical evidence indicates that there are increased healthcare costs when providing care to LBW or high risk infants. Early prenatal care and postpartum discharges are associated with decreased healthcare costs.

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful and most cost-effective on the day after discharge? Visiting a pediatric screening clinic at the hospital Placing a call to the hospital nursery warm line Calling the pediatrician for a lactation consult referral Requesting a home visit

Placing a call to the hospital nursery warm line The first course of action should be to call a warm line for advice from a nurse. Warm lines are telephone lines offered as a community service, in this case to provide new parents with support, encouragement, and basic parenting education.

treatment of GBS

treatment of GBS penicillin G • 5 million units IV loading dose • Then 2.5 million units IV every 4 hours during labor Ampicillin • 2g IV loading dose • Followed by 1g IV every 4 hours • Alternative therapy

how is gonorrhea treated?

Rapid cure with antibiotics Factors in choosing: • Single dose efficacy • Coexisting chlamydial infections • Treatment for chlamydia • Treatment for syphilis Ceftriaxone: • Uncomplicated urethral, endocervical and rectal infections in pregnant/nonpregnant women treat chlamydia at the same time

what bacteria causes syphilis?

treponema pallidum motile spirochete

What is not a trend in the delivery of health care in the United States? Greater emphasis has been placed on curing disease and disability than on preventing them. Hospital stays for many conditions have been shortened. Acute care is increasingly provided through home-based services. Hospital-based nurses are increasingly involved in follow-up care after discharge.

Greater emphasis has been placed on curing disease and disability than on preventing them. Prevention now is emphasized. Hospitalization has been shortened to reduce cost. Acute care is increasingly done at home. Nurses now are more involved in postdischarge follow-up care.

Function of the uterus

Reception, implantation, retention, nutrition of the fertilized ovum and later of the fetus during pregnancy, and or expulsion of the fetus during childbirth, and cyclic menstruation

HIV testing for pregnant women

HIV counseling during initial prenatal care visit • Unless opt out of screening • Universal screening vs. selective testing for materal HIV • Retest in third trimester for high risk • Rapid HIV testing in labor for unknown HIV status

phases of sexual response in women/ plateau phase

HR and BP continue to raise, respiration increase myotonia becomes pronounced grimacing occurs clitoral head retracts under the clitorial hood. lower 1/3 of vagina becomes engorged. skin color changes occur -flush may be observed across breasts, abdomen and other surfaces

phases of sexual response in men/ plateau phase

HR and BP continue to raise, respiration increase myotonia becomes pronounced grimacing occurs head of penis may enlarge slightly scrotum continues to grow tense and thicken testes continue to elevate and enlarge preorgasmic emisssion or 2-3 drops of fluid appears on the head of the penis

phases of sexual response in men/ resolution phase

HR, BP and RR return to normal nipple erection subside. Myotonia subside 50% or erection is lost immediately with ejaculation; penis gradually returns to normal size testes and scrotum return to normal size refractory eriod ( time needed for erection to occur again) varies according to age an dgeneral physical condition

phases of sexual response in women/ resolution phase

HR, BP and RR return to normal nipple erection subside. Myotonia subside engorgement in external egnitalia and vagina resolves. Uterus descend to normal position. cervis dips into seminal pool. breast sizes decreases. skin flush disappear. women do not have a refractory period before they can have another orgasm

ART:

triple-drug antiretroviral therapy • Taken orally - continued throughout pregnancy o Treatment of infected HIV women → decrease mother to child transmission

down syndrome

trisomy 21 extra chromosome 21 47, XX, +21, female with DS 47, XY, +21, male with DS

what are the pre-exposure vaccines to prevent STIs?

Hep B and HPV • Hep B recommended for high risk for STIs • Two HPV vaccines for females aged 9-26 to prevent cervical precancer • Quadrivalent (HPOV types 6, 11, 16, 18) HPV vaccine = Gardasil o Also prevents genital warts • Bivalent (HPV types 16 and 18) HPV vaccine = Cervarix • Recommended routine vaccine for 11-12 years • Catch up vaccine for 13-26 years

"Endometrium"

Highly vascular lining of the uterus.

diagnosis of trichomoniasis

History of symptoms • Sexual history Speculum exam always done • Relaxation and breathing = uncomfortable Normal saline wet prep → flagellate trichomonads Pap tests

prepuce of clitoris

Hoodlike covering of the clitoris.

hepatitis B: vaccine

Recommended for anyone with multiple partners in past 6 months o IV drug users o Correctional facilities or long-term care facilities o Getting care for STI o Prostitutes o Women whose partners are IV drug users or bisexual o High risk occupations Series of three doses over 6 month period o First two 1 month apart o Given in DELTOID muscle

Which technique does the nurse use to evaluate the outcome of the care provided? OASIS SBAR QSEN TeamSTEPPS

OASIS OASIS stands for the Outcome and Assessment Information Set. It helps to evaluate the outcome of any nursing intervention. SBAR stands for situation-background-assessment-recommendation. It is a technique of communication among the health care team. QSEN stands for Quality and Safety Education for Nurses and is an initiative to provide nurses with the competencies to improve the quality and safety of the systems of health care in which they practice. TeamSTEPPS is a teamwork system for health professionals to provide higher quality, safer client care.

when does majority of trisomies occur?

OOGENESIS process by which a premeiotic female germ cell divides into a mature egg maternal meiosis errors

Skene glands

On each side of the urethra and produce mucus, which aids in lubrication of the vagina

Effects of smoking

Reduces fertility of men and women, may reduce the age for menopause, and increases the risk for osteoporosis after menopause During pregnancy: decrease in placental perfusion and is a cause of low birth weight

A woman is giving birth to her third child in a setting that allows her husband and other two children to be actively involved in the process. The nurse caring for the woman also must consider the husband and family as clients and work to meet their needs. What is this type of setting termed? Family-centered care Emergency care Hospice care Individual care

Family-centered care Family-centered care occurs in any setting in which the pregnant woman and family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the client who is having difficulty. In hospice care settings, the nurse deals with clients who have terminal illnesses. Individual care deals only with the client and does not include the family.

Which screening procedure should be performed for a woman whose parents both have diabetes mellitus? Lipid profile Bone density scan Fasting glucose test Thyroid-stimulating hormone (TSH) level

Fasting glucose test A fasting glucose test is an appropriate preventive screening procedure for a woman with a family history of diabetes mellitus. Early detection and treatment of diabetes mellitus can prevent serious complications that may develop if the disease goes undetected for a long period of time.

Klinefelter Syndrome (KS) method of inheritance

Females will most likely pass this gene onto their offspring. Only males who have KS can pass this disorder on to their offspring. This is because Klinefelter syndrome is an X-linked inherited disorder, which is similar to autosomal dominant inheritance disorders. autosomal dominant inheritance disorders are those in which only one copy of a variant allele is needed for phenotypic expression. The variant allele may be a result of a mutation, a spontaneous and permanent change in the normal gene structure, in which case the disorder occurs for the first time in the family

"X-linked recessive inheritance"

Form of inheritance in which the abnormal gene is carried on the female chro- mosome; if the male receives the abnormal gene, the disorder will be expressed; a common example of this type of disorder is hemophilia."

In what way are the studies reviewed and ranked in the Cochrane Pregnancy and Childbirth Database? From beneficial care practices to harmful or ineffective practices From advanced care practices to traditional care practices From expensive care practices to cost-effective care practices From western care practices to alternative care practices

From beneficial care practices to harmful or ineffective practices The Cochrane Collaboration ranks studies in the following six categories: beneficial forms of care, forms of care that are likely to be beneficial, forms of care that have a tradeoff between beneficial and adverse effects, forms of care with unknown effectiveness, forms of care that are unlikely to be beneficial, and forms of care that are likely to be ineffective or harmful. The nurse can refer to these studies to implement measures that are beneficial and discard those that are ineffective. The nurse can refer to journals and medical reference books to understand traditional, advanced, cost-effective and costly or western and alternative care practices.

Which statement about genital herpes is inaccurate? Genital herpes is also known as genital warts. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences. Genital herpes is chronic and recurring and has no known cure. Plain soap and water are all that is needed to clean hands that have come into contact with herpetic lesions.

Genital herpes is also known as genital warts. Genital warts are one of the most common sexually transmitted infections (STIs); however, it is also known as human papillomavirus (HPV), not genital herpes.

Which statement explains how a 5-year-old female could present with pubic hair growth? Estrogen is released prematurely by the anterior pituitary. Luteinizing hormone (LH) is released in large quantities from the ovaries. Gonadotropin-releasing hormone (GnRH) is released prematurely by the hypothalamus. Follicle-stimulating hormone (FSH) is released in large quantities from the hypothalamus.

Gonadotropin-releasing hormone (GnRH) is released prematurely by the hypothalamus. A 5-year-old female who presents with pubic hair growth is experiencing isosexual precocious puberty caused by premature release of GnRH.

Karyotype

Pictorial analysis of the number, form, and size of an individual's chromosomes.

areola

Pigmented section of wrinkled skin that surrounds the nipple.

"Follicle-stimulating hormone "

Pituitary hormone that stimulates the development of follicles in the ovary.

From the nurse's perspective, what measure should be the focus of the health care system to reduce further the rate of infant mortality? Implementing programs to ensure Women's early participation in ongoing prenatal care Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days Expanding the number of neonatal intensive care units (NICUs) Mandating that all pregnant women receive care from an obstetrician

Implementing programs to ensure Women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs offers better access for high risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

From the nurse's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? Implementing programs to ensure women's early participation in ongoing prenatal care Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days Expanding the number of neonatal intensive care units (NICUs) Mandating that all pregnant women receive care from an obstetrician

Implementing programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

From the nurse's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? Implementing programs to ensure women's early participation in ongoing prenatal care Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days Expanding the number of neonatal intensive care units (NICUs) Mandating that all pregnant women receive care from an obstetrician

Implementing programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education; however, it does not affect the incidences of leading causes of infant mortality, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high-risk infants after they are born. Expanding the number of NICUs would offer better access for high-risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetrician care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have been demonstrated to provide reliable, safe care for pregnant women.

What has had the greatest impact on reducing infant mortality in the United States? Improvements in perinatal care Decreased incidence of congenital abnormalities Better maternal nutrition Improved funding for health care

Improvements in perinatal care The improvements in perinatal care, particularly care of the mother-baby dyad before birth, have had the greatest impact. There has been a decrease in some congenital anomalies, such as spina bifida, but this has not had the greatest impact. Better maternal nutrition has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact.

In the United States, what are the possible barriers that a client may face while accessing health care? Inability to pay medical costs Lack of insurance coverage Lack of providers for low-income women Inadequate transportation Lack of neonatal intensive care units

Inability to pay medical costs Lack of insurance coverage Lack of providers for low-income women Inadequate transportation Inability to pay medical costs, lack of insurance, and a lack of health care providers for low-income women are some of the barriers to accessing health care in the United States. Lack of transportation also hampers access to health care. Improvements in technology have resulted in greater availability of neonatal intensive care units in hospitals.

What are the leading causes of maternal mortality in the United States? . Infection Hemorrhage Preterm birth History of diabetes Cardiovascular disease

Infection Hemorrhage Cardiovascular disease Maternal mortality is a major problem in the United States. The three leading causes of maternal death in the United States are infection, hemorrhage, and cardiovascular disease. Preterm birth is a reason for infant mortality; it is not related to maternal mortality. A history of diabetes is not related to maternal mortality. However, gestational diabetes is a risk factor for maternal mortality.

infertility

Infertility is inability to get pregnant and is diagnosed if the couple wasn't able to conceive within 12 months. Infertility also means when a woman cannot carry a fetus to term.

The nurse is teaching nursing students about ethical issues in perinatal nursing and women's health care. Which questions on ethical issues does the nurse include in the teaching? Is fetal tissue transplantation safe? What are the rights of the embryo? Is abortion safe in ectopic pregnancy? Should cloning of humans be permitted? Is the use of oxytocin (Pitocin) safe after delivery?

Is fetal tissue transplantation safe? What are the rights of the embryo? Should cloning of humans be permitted? Rights of an embryo, cloning of humans, and fetal tissue transplantation are ethical issues related to perinatal nursing and women's health care whereas safety of abortion with ectopic pregnancy and use of oxytocin are questions that can be answered by evidence based research. Some people consider it unethical to harm an embryo because they consider it a living being; therefore, many issues are raised for rights of the embryo. Cloning of humans may be beneficial; however, there is not enough evidence yet to show that it is safe. Fetal tissue transplantation is also controversial, because there is not enough evidence to show there is no harm to the unborn fetus. Abortion of an ectopic pregnancy is legally allowed, because ectopic pregnancies can lead to severe complications. Use of oxytocin (Pitocin) is safe after delivery, because it can help to strengthen uterine contractions and to prevent hemorrhage. These issues are not considered ethical issues, because they can be sufficiently answered with systematic research, unlike the issues of fetal tissue transplantation, the rights of an embryo, and human cloning.

Hemophilia method of inheritance

It is X-linked recessive, meaning that a mother has 50% chance of passing to her daughters, who will be carrier and to sons, who will be hemophilia. Hemophilia mostly affect males and about 30% of patient with hemophilia have no family history

NuvaRing

It is a flexible ring made of ethylene vinyl acetate copolymer that releases progestin and ethinyl estradiol The hormones released from the ring suppress the production of luteinizing hormone which prevents ovulation I would explain the ring stays in the vagina for three weeks at a time. The ring is removed for the fourth week and a period happens during this time. The process then repeats itself. The benefits to using the ring is that is it discrete and it does not require remembering to take medication daily. It is a convenient method that requires little attention from the user. The ring is inserted into the vagina similar to the use of a tampon. Those who are not comfortable with the insertion of a tampon, or inserting the ring into their vagina may not be the best candidates for this option. A con reported from users is the discomfort of the ring during intercourse The ring is able to be taken out during intercourse if the patient prefers. The ring should not be taken out for more than three hours at a time. Side effects of the NucaRing are headaches, nausea, breast tenderness and slight weight gain discomfort that can be experienced--vaginitis, leukorrhea, and vaginal discomfort when beginning a contraceptive, they should use back up birth control, such as a condom for a month until all of the hormones are effective in the body.

How does the ovum travel?

It is pushed along the tubes to the uterus by rhythmic contractions of the muscles of the tubes and by the current that is produced by the movement of cilia that line the tubes

What are the expected outcomes of the Patient Protection and Affordable Care Act (ACA)? It makes medical insurance affordable. It reforms the health care delivery system. It improves the quality of care for all Americans. It provides free health care for those over 50 years. It provides low-cost health care for people in rural areas.

It makes medical insurance affordable. It reforms the health care delivery system. It improves the quality of care for all Americans. The ACA aims to make insurance affordable and contain costs. It aims to reform the health care delivery system by reducing waste, fraud, and abuse. It helps to improve the quality of care for all Americans by improving public health and promoting prevention. This act also strengthens and improves Medicare and Medicaid by reforming the insurance market. The ACA makes insurance affordable, not only to people in rural areas, but to all Americans. This act does not ensure free health care to people over 50 years of age. The ACA only reduces the total cost of health care for clients across all age groups.

In which way is the hypothalamus responsible for sexual maturation? It produces estrogen to stimulate growth of breast tissue. It releases luteinizing hormone (LH) to stimulate growth of the ovaries. It produces follicle-stimulating hormone (FSH) to stimulate maturation of the follicles. It releases gonadotropin-releasing hormone (GnRH) to stimulate the anterior pituitary gland.

It releases gonadotropin-releasing hormone (GnRH) to stimulate the anterior pituitary gland. The hypothalamus is responsible for sexual maturation by releasing GnRH to stimulate the anterior pituitary gland to release FSH and LH.

Which statement is true about the term contraceptive failure rate? It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. It refers to the minimum level that must be achieved to receive a government license. It increases over time as couples become more careless. It varies from couple to couple, depending on the method and the users.

It varies from couple to couple, depending on the method and the users. The contraceptive failure rate is strictly a statistical measure of likely accidental pregnancy over a couple's first year of use. Failure rates decline over time because users gain experience. Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple.

infertility tests in women

Laboratory tests, performed to determine the cause of infertility in women are blood tests to measure various levels of hormones ( LH, FSH, PRL, estradiol, progesterone, estrogen, AMH), as well as tests to check thyroid function (TSH and free T4), steroids (testosterone, DHEA-S). Sometimes it is necessary to perform imagine procedures to determine if there are any physical problems, such as fibroids, polyps, abscesses, tumors, scarring (adhesions), infections. These tests include Fiber-Optic endoscopy, x-rays, ultrasound sonogram (polycystic ovaries, ovarian cysts, fibroids, to check the shape of the uterus and the thickness of the uterine lining, as well as antral follicle count to predict the quantity of eggs available in a woman's ovaries). The last option is the most invasive of the test - diagnostic laparoscopy ( in case of endometriosis or blocked fallopian tubes) (AACC, 2017). Similar tests are Hysteroscopy (placing a telescope-like camera through the cervix into the uterus to take a closer look at the inside of the uterus) and Sonohysterogram (placing sterile liquid inside the uterus (via a catheter), and then evaluating the uterus and uterine walls via ultrasound)

Which effect would secretion of human chorionic gonadotropin during the luteal phase have on the endometrial cycle of the female reproductive cycle? Lack of menstruation Release of multiple ova Necrosis of the endometrium Decreased levels of follicle-stimulating hormone (FSH)

Lack of menstruation Human chorionic gonadotropin is secreted from a fertilized ovum and results in maintenance of the corpus luteum and lack of menstruation during the endometrial cycle.

Anovulatory cycle

Lack of ovulation (estrogen drive proliferative phase without progesterone drive secretory phase) -Proliferative glands break down and shed resulting in uterine bleeding -Common cause of dysfunctional uterine bleeding during menarche and menopause

Plan B One Step

Levonorgestrel 1.5 mg

Bartholin glands

Lie under the constrictor muscles of the vagina and are located posteriorly on he sides of the vaginal opening; secrete a clear mucus to lubricate the vaginal introitus

true pelvis

Lies below the pelvic brim Consists of the pelvic inlet, midpelvis, and pelvic outlet

When teaching self-care prevention of genital tract infections, the nurse should instruct the woman to: Increase dietary sugar and avoid yogurt. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. Choose underwear or hosiery with a nylon crotch. Douche frequently.

Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. Clinical observations and research have suggested that tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials (like nylon) create an environment in which a vaginal fungus can grow. Bathing in bath salts or bubble bath may further irritate sensitive genital tissue. Douching can irritate tissue, alter pH, and create an environment conducive to fungal growth. Prevention of genital tract infections includes reducing dietary sugar and eating yogurt.

The nurse is assessing a woman who is seeing the health care provider for a routine well-woman visit. The woman is 54 years old and has a 20-year history of smoking. Her mother is still living but her father passed away due to myocardial infarction (MI) six years ago. She does not exercise regularly and states she is "prediabetic." Which screening procedure is a priority for this woman? Lipid profile Mammogram Bone density scan Fasting glucose test

Lipid profile A lipid profile would be the first priority for this woman due to her history of smoking, risk for diabetes, and family history of coronary artery disease (CAD). A high lipid concentration in the blood puts the woman at greater risk for developing coronary artery disease, atherosclerosis, and other diseases.

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is coming to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should: Remind the woman that she is long overdue for her examination and that she should come in annually. Listen carefully and allow extra time for this woman's health history interview. Reassure the woman that a nurse practitioner is just as good as her old doctor. Encourage the woman to talk about the death of her husband and her fears about her own death.

Listen carefully and allow extra time for this woman's health history interview. The nurse has an opportunity to use reflection and empathy while listening and can ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. The comment in A is inappropriate. The client should be given positive reinforcement for coming in for her appointment even though it has been some time. A respectful and reassuring approach will ensure that women ages 50 and older will continue to seek care. The comment in C should be rephrased in a more positive manner. The nurse has an opportunity to use empathy and reflection; however, this is not the purpose of the client's visit. If the client continues to express grief over the loss of her husband, she can be referred to an appropriate support group or counseling.

what are HPV symptoms in men?

Long latency period, lack of symptoms in men

luteinizing hormone (LH)

Pituitary hormone that stimulates the expulsion of the ovum from the graafian follicle and formation of the corpus luteum.

When caring for pregnant women, the nurse should keep what in mind regarding violence during pregnancy? Affects more than 25% of pregnant women in the United States Increases a pregnant woman's risk for gestational hypertension May be associated with substance abuse by both the pregnant woman and her partner Has decreased in incidence as a result of better assessment techniques and record keeping

May be associated with substance abuse by both the pregnant woman and her partner Alcoholism and substance abuse by the woman or her abuser are associated with violence. Approximately 8 percent of pregnant women are battered; the incidence of battering increases during pregnancy. Violence itself has no correlation with the incidence of gestational hypertension. The rates of violence have increased, possibly because of better assessment and reporting mechanisms.

When caring for pregnant women, the nurse should keep in mind that violence during pregnancy: Affects more than 25% of pregnant women in the United States. Increases a pregnant woman's risk for gestational hypertension. May be associated with substance abuse by both the pregnant woman and her partner. Has decreased in incidence as a result of better assessment techniques and record-keeping..

May be associated with substance abuse by both the pregnant woman and her partner. Approximately 8% of pregnant women are battered; the incidence of battering increases during pregnancy. Violence itself has no correlation with the incidence of gestational hypertension. Alcoholism and substance abuse by the woman or her abuser are associated with violence. The rates of violence have actually increased, possibly because of better assessment and reporting mechanisms.

Which aspects of STI prevention and detection should be included in nursing education for every woman, regardless of infection status? Select all that apply. Methods of contraception that can prevent STIs Circumstances in which testing may be necessary How STI infection may impact romantic relationships Specific signs and symptoms that require medical attention Diagnostic and screening tests that can help diagnose STIs

Methods of contraception that can prevent STIs Methods of contraception that can prevent STIs should be taught to every woman, regardless of infection status, in order to help prevent future infection. Correct Circumstances in which testing may be necessary Circumstances in which testing may be necessary, such as an infected partner, should be taught to every woman, regardless of infection status, in order to prevent future infection. Specific signs and symptoms that require medical attention Signs and symptoms that require medical attention are important knowledge that can facilitate early detection and treatment of STIs. These should be part of nursing education for every woman, regardless of infection status. Correct Diagnostic and screening tests that can help diagnose STIs Diagnostic and screening tests that can help diagnose STIs are important procedures in early detection and treatment, and they should be taught to every woman, regardless of infection status.

The nurse is preparing a care plan for an obese pregnant client. Which pregnancy complications should be addressed when planning care? Anemia Miscarriage Hypertension Gestational diabetes Multifetal pregnancy

Miscarriage Hypertension Gestational diabetes Obesity can lead to many complications during pregnancy. Miscarriage, hypertension, and gestational diabetes are all pregnancy complications associated with obesity. Therefore, the nurse should include preventive care plans for these complications. Obesity does not affect the hemoglobin level. Therefore, anemia is not an obesity-associated complication during pregnancy. Obesity does not result in more than one embryo in a single pregnancy. Therefore, it does not cause multifetal pregnancy. Multifetal pregnancy occurs due to heredity, race factosr, age factors, and high parity.

The nurse is teaching prepregnancy planning to a borderline obese patient. About which maternal risk factors associated with obesity does the nurse caution the client? Septicemia Miscarriage Hypertension Gestational diabetes Congenital anomalies

Miscarriage Hypertension Gestational diabetes Congenital anomalies Obesity during pregnancy increases the risk of miscarriage, hypertension, diabetes, and congenital anomalies. Such clients may need increased health care services and longer hospital stays. Septicemia is a pregnancy complication and is not associated with obesity.

HPV lesions must be differentiated from what??

Molluscum contagiosum lesions • Are half-domed, smooth, flesh-colored to pearly white papules with depressed centers. Condylomata lata • Are a form of secondary syphilis and generally flatter and wider than genital warts. A serologic test for syphilis confirms the diagnosis of secondary syphilis.

External structures/vulva include...

Mons pubis, labia majora, labia minora, clitoris, vestibular glands, vaginal vestibule, vaginal orifice, urethral opening

HPV lesions are most frequent in which women?

More frequent in pregnant women - increase from first to third trimester o HPV lesions enlarge during pregnancy = immunosuppression during pregnancy o Large lesions → affect urination, defecation, mobility, fetal descent, obstruct birth canal o Acquired by neonate during birth

symptoms of initial HSV genital infection

Multiple painful lesions → progress from macules to papules • Form vesicles, pustules and ulcers that crust and heal without scarring • Extremely tender , bilateral Fever, chills, malaise, severe dysuria for 2-3 weeks Itching, inguinal tenderness, lymphadenopathy Severe vulvar edema severe dysuria and urinary retention may develop HSV cervictitis: • Cervix friable, red, ulcerated, necrotic • Heavy watery-to-purulent vaginal discharge

Match the female reproductive structure with its role during childbirth.

Muscle contracts to expel fetus Uterus Fibrous tissue opens to accommodate fetus's passage into the birth canal Cervix Muscle expands as fetus moves through birth canal Vagina Muscle stretches as fetal head emerges Perineum

NF2 (neurofibromatosis)

NF2 (neurofibromatosis) Bilateral vestibular schwannomas o Tumors on the eighth cranial nerves, which are hearing and balance nerves o These tumors often cause pressure damage to nearby nerves that may result in the individual with NF2 experiencing headaches, facial pain, and facial numbness. • Other symptoms typically experienced by individuals with NF2 include tinnitus (ringing noise in the ear) and poor balance. o Some individuals with NF2 experience hearing loss in their teen years • Mapped to chromosome 22 o Gene product → merlin = cytoskeleton protein = tumor suppressor • No treatment

HIV: cure?

NO CURE • Opportunistic infections managed with treatment to specific infection Routine gynecologic care • Pelvic exam every 6 months • Pap screening • Screened for syphilis, gonorrhea, chlamydia, vaginal infections Prevention strategies • Smoking cessation • Nutrition

HSV: treatment

NO CURE - chronic recurring disease Systemic antiviral meds → control symptoms • Acyclovir • Valacyclovir • Famiclvir • Safety during pregnancy unknown

What resources does the nurse utilize in order to obtain information related to nursing interventions for maternal-child, perinatal, and neonatal health care? The Joint Commission's "Do Not Use" list American Nurses Association (ANA) Code of Ethics Situation-background-assessment-recommendation (SBAR) framework National Association of Neonatal Nurses (NANN) standards of practice Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards

National Association of Neonatal Nurses (NANN) standards of practice Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards NANN publishes standards of practice that contain current knowledge for neonatal care by specialists. The standards define acceptable levels of care in nursing practice and are also used for clinical benchmarking. The nurse can refer to standards published by AWHONN to understand perinatal care practices. The Joint Commission's "Do Not Use" list contains abbreviations that should be avoided to reduce risk of errors in medication administration. The ANA Code of Ethics helps the nurse ensure the ethical conduct of research. The SBAR report illustrates the technique for communication between the primary health care providers.

hepatitis B: treatment

No specific treatment • Usually spontaneous recover = 3-16 weeks Modifications: • Increase rest • High protein, low fat diet • Increase fluid intake • Avoid meds metabolized in liver and alcohol

When is full breast development achieved?

Not until after the end of the first pregnancy or in the early period of lactation

Perinatal mortality rate

Number of stillbirths and number of neonatal deaths per 1000 live births

Nonoxynol-9

Reduces sperm motility/mobility - chamicals attack sperm flagella and body, preventing sperm from reaching cervical os. - Frequent use (> 2x QD) increases HIV transmission and causes lesions

klinefelter syndrome

trisomy XXY extra x chromosome = male • Exhibits poorly developed secondary sexual characteristics and small testes. • He is infertile, usually tall, and may be slow to learn

oral contraceptives

Oral contraceptives suppress secretion of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), preventing follicles from maturing and ovulation from occurring. Oral contraceptives also change the environment of the reproductive system, making the endometrium of the uterus less favorable for implantation (combination oral contraceptives) and the cervical mucus less suitable for sperm penetration (combination and progestin-only oral contraceptives) Some BCP allow for a menstrual cycle each month, and some prevent bleeding more frequently than once every three months, for four cycles per year most effective if the pill is taken at the same time each day. If the patient has vomiting or diarrhea within two hours of taking the pill, or if taking some medications such as certain antibiotics, anticonvulsants, anti-tuberculosis drugs, and anti-HIV protease inhibitors, the use of condoms or abstinence is recommended. If a pill is missed, it should be taken as soon as it is noticed. If more than 12 hours have passed, use a backup method for 7 days. If you have had unprotected sex in the last week, emergency contraception should be used Non-contraceptive advantages to oral contraceptives include knowing when to expect the next menstrual cycle, decreased bleeding and iron deficiency anemia, reduced incidence of premenstrual syndrome, protection against some cancers and the development of ovarian cysts, reduction in occurrence of benign breast disease and ectopic pregnancy, and improvement in acne

In providing health promotion education to reduce the likelihood of transmission of sexually transmitted diseases, the nurse would describe which of the following practices as having a low but potential risk for disease transmission? Select all that apply. Erotic conversation Oral-anal contact Oral sex with female or male wearing condom Vaginal intercourse with condom Blood contact during sexual act due to menses

Oral sex with female or male wearing condom Erotic conversation would be considered a safe risk reduction practice. Oral-anal contact and blood contact during a sexual act due to menses would be considered high-risk practices. Both oral sex and vaginal sex while wearing condoms are practices with low but potential risks. Vaginal intercourse with condom

"Progesterone"

Ovarian hormone that is responsible for the changes in the endometrium that occur after ovulation to facilitate implantation should fertilization occur; it is also responsible for the rise in temperature that occurs after ovulation.

estrogen

Ovarian hormone that stimulates the thickening of the endometrium that occurs after menstruation and prior to ovulation; it is also responsible for changes in the cervix and cervical mucus.

Which statements describe how the uterus, ovaries, and Fallopian tubes function together to assist in conception? Select all that apply. Ovaries mature the ovum. The uterus stores glycogen. Fallopian tubes transport the ovum. The uterus supports pelvic structures. The ovary releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Ovaries mature the ovum. The ovaries develop an ovum to maturity during each reproductive cycle to assist in conception. Correct The uterus stores glycogen. The uterus prepares for conception during each reproductive cycle by storing large quantities of glycogen, proteins, lipids, and minerals in the endometrium. Correct Fallopian tubes transport the ovum. The Fallopian tubes transport the ovum during each reproductive cycle to assist in conception.

Prostaglandins

Oxygenated fatty acids classified as hormones. They are thought to play an essential role in ovulation, transport of sperm, regression of the corpus luteum, and menstruation. By increasing the myometrial response to oxytocin, they also play a role in labor and dysmenorrhea."

what are the symptoms for PID?

PAIN = symptoms for subacute, acute, or chronic • Dull, cramping, intermittent (subacute) • Severe, persistent, incapacitating (Acute) • Fever, chills, nausea, vomiting • Increased vaginal discharge • UTI symptoms • Irregular bleeding • *Abdominal pain always present

genital herpes simplex virus

Painful recurrent genital ulcers Two antigen subtypes: HSV-1: transmitted non-sexually • Oral labial ulcers = fever blisters, cold sores HSV-2: transmitted sexually • Genital lesions • More common in women • Many asymptomatic = undiagnosed → transmit when infected not reportable disease

5 P's of sexual history

Partners Prevention of pregnancy Protection from STIs Practices Past history of STIs

functions of vagina

Passageway for elimination of menstrual fluids Receives spermatozoa during sexual intercourse Forms inferior portion of birth canal

Uterine (fallopian) tubes

Passageways between the ovaries and the uterus; they are attached at each side of the dome-shaped uterine fundus.

how do you treat syphilis?

Penicillin G • Preferred drug • Only proven therapy → neurosyphilis, congenital syphilis, syphilis during pregnancy • Intramuscular benzathine penicillin G • Primary, secondary, early latent • Complication → Jarisch-Herxheimer reaction Doxycycline, tetracycline, erythromycin • Alternatives if penicillin allergy • Tetracycline and doxycycline = contraindicated in pregnancy • Erythromycin = unlikely cure fetal infection Monthly follow up repeated • Necessity of long term serologic testing - even if no symptoms • Sexual abstinence until treatment completed

"Perimenopause"

Period preceding the last menstrual period that lasts about 4 years; during this time ovarian function declines, ova diminish, more menstrual cycles become anovulatory, and irregular bleeding occurs.

"Menstruation"

Periodic uterine bleeding that begins approximately 14 days after ovula- tion and lasts an average of 5 days.

"Ischemic phase"

Phase during which the blood supply to the functional uterine lining is blocked and necrosis develops; the functional layer separates from the basal layer and menstrual bleeding begins.

"Secretory phase"

Phase of the menstrual cycle during which the uterine lining becomes luxuriant with blood and glandular secretions suitable to protect and nurture a fertilized ovum.

diagnosis of vulvovaginal candidiasis?

Physical exam of vulva and vagina • Speculum exam always done • Obtain saline and KOH wet smears • Check vaginal pH = NORMAL • If pH greater than 4.5 → trichomoniasis or BV Characteristic pseudohyphae: • Bud or branching of fungus • Seen on wet smear done with normal saline

Group B streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which of the following would not be considered to be a risk factor for neonatal GBS infection? Positive prenatal culture result Preterm birth at less than 37 weeks of gestation Maternal fever of 38° C or greater Premature rupture of membranes for longer than 24 hours

Premature rupture of membranes for longer than 24 hours Premature rupture of membranes for 18 hours or more increases the risk for neonatal GBS infection.

Practices such as providing recommended immunizations, infant car seats, and school health education are part of: Primary preventive care. Secondary preventive care. Tertiary preventive care. Primordial preventive care.

Primary preventive care. These activities are designed to improve general health and the quality of life, which is the focus of primary preventive care. Mammograms and prostate screening are examples of secondary preventive care. Rehabilitation for a stroke victim is an example of tertiary care. Eliminating the cause of illness beginning in childhood would be in keeping with primordial prevention (i.e., healthy eating and the elimination of fast food to prevent obesity).

The hormone responsible for maturation of mammary gland tissue is: Estrogen. Testosterone. Prolactin. Progesterone.

Progesterone. Progesterone causes maturation of the mammary gland tissue, specifically the lobules acinar structures. Estrogen increases the vascularity of the breast tissue.Prolactin is produced after birth and is released from the pituitary gland; it is produced in response to infant suckling and emptying of the breasts. Testosterone has no bearing on breast development.

What are the goals of Healthy People 2020? Promote good health for all. Attain longer lives free of disease and premature death. Promote the use of advanced and costly health care services. Achieve health equity and eliminate disparities in health care. Promote healthy development and behaviors across all life stages. Increase the proportion of infants who receive formula supplementation.

Promote good health for all. Attain longer lives free of disease and premature death. Achieve health equity and eliminate disparities in health care. Promote healthy development and behaviors across all life stages. The Healthy People 2020 goals are based on the evaluation of major risks to health and wellness and changes in public health priorities. Creating environments that promote good health, attaining high-quality, longer lives, achieving health equity, and promoting quality of life are the goals of Healthy People 2020. Use of costly health care services in public health care is contrary to the goals of eliminating disparity and achieving health equity. One of the objectives of Healthy People 2020 specific to maternal, infant, and child health is increasing the proportion of infants who are breastfed and reducing the proportion of breastfed newborns that receive formula supplementation within the first 2 days of life.

Which internal structure of the male reproductive system ensures sperm survive during intercourse? Epididymis Vas deferens Prostate gland Urinary meatus

Prostate gland The prostate gland is an internal structure of the male reproductive system that ensures sperm survive during intercourse by secreting seminal fluid that protects the sperm from the acidic environment of the vagina.

The nurse is discussing strategies to decrease maternal mortality in a health care facility that has high maternal mortality rates. What strategies does the nurse suggest during this discussion? Provide postabortion care. Improve family planning services. Instruct obese women to delay pregnancy. Improve access to skilled attendants at birth. Provide adolescents with better reproductive health services.

Provide postabortion care. Improve family planning services. Improve access to skilled attendants at birth. Provide adolescents with better reproductive health services. Women and teenagers receiving postabortion care are less likely to develop infections and complications. Access to family planning services prevents unwanted pregnancies. Having access to skilled attendants at birth ensures a safe birthing process. Providing adolescents with better reproductive health services improves safe and supportive environments, preventing unintended pregnancies and other health risks. The nurse does not instruct obese women to delay pregnancy but informs clients about the risks associated with obesity, such as miscarriage or fetal death, so that the client can make an informed decision.

The nurse is teaching nursing students about maternal mortality in a health care facility. Which strategies should be implemented in the health care facility to decrease high maternal mortality rates? Providing postabortion care to clients Improving access to skilled attendants at birth Instructing overweight client to delay pregnancy Improving family planning services in the health care facility Encouraging pregnant women to get plenty of vigorous exercise

Providing postabortion care to clients Improving access to skilled attendants at birth Improving family planning services in the health care facility Health care facilities should focus on postabortion care to prevent infections and complications after the abortion procedure. Improvement to access of skilled intrapartum obstetrical professionals may also prevent complications and can ensure a safe birthing process. Improving family planning services can prevent unwanted pregnancies.The nurse should not instruct overweight clients to delay pregnancy, but should encourage them to lose weight before pregnancy and to and to eat well and stay active during pregnancy. The nurse should not encourage the client to perform vigorous exercise, but should instead teach clients about safe exercise parameters. Clients should be encouraged to do light to moderate exercise throughout their pregnancies.

What action does the nurse take to provide perinatal care that is based on information gained through research and clinical trials? Use telehealth technology. Refer to evidence-based practice. Refer to the Nursing Intervention Classification (NIC). Refer to the Cochrane Pregnancy and Childbirth Database.

Refer to evidence-based practice. Evidence-based practice is based on the knowledge gained from research and clinical trials. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Standards and Guidelines for Professional Nursing Practice in the Care of Women and Newborns (AWHONN, 2009) and the Standards for Professional Perinatal Nursing Practice and Certification in Canada (AWHONN, 2002) include an evidence-based approach to practice. Telehealth is the use of communication technologies to provide health care to patients who are separated by distance from health care providers. The NIC is a method of standardizing and categorizing the language used in care. The Cochrane Pregnancy and Childbirth Database is an up-to-date, systematic review of randomized controlled trials of health care.

What actions does the nurse take to ensure that nursing care is based on evidence-based practice? Refer to the Cochrane Database. Obtain results of randomized clinical trials that pertain to the clinical area in question. Consult specialists and health care providers. Refer to the notes of experienced nurses. Refer to Agency for Healthcare Research and Quality (AHRQ) guidelines.

Refer to the Cochrane Database. Obtain results of randomized clinical trials that pertain to the clinical area in question. Refer to Agency for Healthcare Research and Quality (AHRQ) guidelines. The Cochrane Database contains reviews of randomized controlled trials, which help the nurse understand the effects of care. The nurse refers to well-designed primary studies such as randomized controlled trials to understand and implement best practices. The nurse can adapt practice recommendations published by the AHRQ. It may not be feasible to consult specialists and health care providers during emergencies, so the nurse needs to refer to journals and reference books and be prepared in advance. The nurse uses notes to document events and interventions that are implemented during patient care. Therefore, they are not a good source of evidence.

The nurse is concerned about "failure of rescue" during perinatal emergencies. Which nursing intervention would prevent this unwanted outcome? Regular assessments of the client for any complications Identification of complications in the client immediately Preparation for the quick management of complications Proper documentation of interventions given to the client Teaching the client about the complications in perinatal period

Regular assessments of the client for any complications Identification of complications in the client immediately Preparation for the quick management of complications Failure to rescue refers to the failure to recognize or act on early signs of distress. The nurse should assess the client on a regular basis to check if the client is developing any complications. The nurse should be able to identify the signs of perinatal complications immediately. The nurse should be prepared for quick response to any complication. All the tools and medications required for the management should be ready before any complication arises. Proper documentation of the client 's status and condition is important to assess the prognosis of the client. However, documentation does not prevent failure to rescue. The client is taught about complications in perinatal period. However, the client cannot identify certain complications, and the nurse must identify them and take the necessary and appropriate actions.

Development of female breast tissue is related to which process of sexual maturation? Luteinizing hormone production Oxytocin production by pituitary Release of estrogen from ovaries Release of prolactin from breasts

Release of estrogen from ovaries Estrogen is released from the ovaries and is responsible for breast development related to female sexual maturation.

At a routine well-woman visit, a woman expresses pain when the cervix and uterus are moved during bimanual examination. She states she believes her cervix is tender due to her menstrual cycle. What is the next step in nursing management? Reschedule the bimanual examination for a later date. Ask the woman to breathe deeply and bear down. Continue the examination with more gentle movement. Report symptoms to the health care provider immediately.

Report symptoms to the health care provider immediately. Uterine and cervical pain during the bimanual examination is a sign of pelvic inflammatory infection (PID) and should be reported to the health care provider immediately.

A 38-year-old maternity patient receives information based on genetic testing that her fetus has a deformity and decides to terminate the pregnancy. There is a family history of genetic abnormalities. Following the termination of pregnancy, the pathology report indicates that the fetus had no structural abnormalities. This finding suggests that: The patient should have asked for a second opinion from a perinatal specialist. The genetic test results provided indicated a false-negative finding. Genetic testing results vary with patient demographics and information provided. Results indicated a false-positive finding leading to an adverse outcome.

Results indicated a false-positive finding leading to an adverse outcome. Because the pathology report identified no abnormalities, the results of genetic testing in this case were false-positive, in that they indicated that there was an abnormality when there was not. This information unfortunately led to a poor health outcome. Although no genetic test provides 100% reassurance, most patients do not automatically seek a second opinion unless there are additional variables that may influence the reliability of the result. Because the patient had a family history of genetic abnormalities, it is unlikely that the patient and/or provider would necessarily have opted for a second opinion. A false-negative result would indicate that a condition was not present even though it was; the patient was provided with a negative result. Genetic test results do not vary with patient demographics or information provided.

Tay Sachs symptoms

THis disorder has some easy detectable but common to many other disorders, symptoms such as neurodegenerative symptoms in infants- hypotension, inability to sit or hold their head unsupported, eye movement abnormalities, dysphagia, spasms, and hypomyelination Young child's symptoms include ataxia, dysarthria, dysphagia development, hypotension, and spasm progression. Child usually doesn't live past 15. Adolescent's disorder is less severe with such symptoms as limb muscle weakness and abnormal gait genetic screening can provide early recognition, before the signs and symptoms occur

secretory phase

from day of ovulation to 3 days before next menstrual period after ovulation large amountpf progesterone produced at the end of this phase fully matured secretory endometrium reaches the thickness of heavy, soft velvet implantation of fertilized oval occurs 7-10 days after ovulation if fertilization doesn't occur, the corpus ileum, which secrets estrogen and progesterone regress

Rett Syndrome

Rett Syndrome is characterized by classically normal development of the infant up until between 6 - 18 months old, when development stagnates. Difficulties may be seen with feeding, mobility, and speech and the child may no longer show interest in toys or being stimulated. Many children are misdiagnosed with autism. There can be hypotonia and jerky hand and limb movements. This progresses to rapid regression, which marks the second stage of Rett Syndrome. Cognitive impairment is seen and repetitive hand movements are difficult to regulate. The disorder can also cause episodes of screaming for no apparent reason and visible distress, as well as teeth grinding. The third stage, which is the longest, is where the patient plateaus. Apnea, which has been linked to spontaneous death in Rett Syndrome patients, and other breathing problems may worsen, and seizures can be present Self-injury and aggression can be present ( In the fourth stage, the patient experiences further decline in movement which can lead to total loss of independent mobility. the developmental disabilities associated with the syndrome leads to a premature death between the average ages of 12 and 40 years the death can happen very sudden and unexpected. It happens mostly due to the heart irregularities, specifically a prolonged QT interval and T-wave abnormalities Currently, no treatments are available so interventions focus on finding adaptations to the disability.

Rett syndrome method of inheritance

Rett Syndrome is normally caused by a spontaneous mutation on the X chromosome of the MECP2 gene, which alters production of a protein that is necessary for brain development Most commonly, neither parent is a carrier and there is no family history of the disorder. While it is primarily a disorder experienced by females, males can be affected and usually on a more severe scale with symptoms that include congenital encephalopathy Approximately 90-95% of Rett syndrome cases are caused by identifiable mutations of the MECP2 gene. However, 99% of cases, these mutations occur sporadically and are not possessed or transmitted by a child's parents , so it is not inherited.

hepatitis A: treatment

SELF-LIMITING = supportive treatment • Dehydration • Avoid meds metabolized in liver: • Acetaminophen • Alcohol

trichomoniasis

STI and vaginal infection trichomonas vaginalis

Acinus

Saclike terminal part of a compound gland emptying through a narrow lumen or duct Lined with epithelial cells that secrete colostrum and milk

Which categories are included in the Quality and Safety Education for Nurses (QSEN) competencies? Safety Education Collegiality Teamwork Informatics

Safety Teamwork Informatics QSEN stands for Quality and Safety Education for Nurses. It is an initiative to provide nurses with the adequate skills and competencies to help them improve the quality and safety of the health care systems in which they practice. The categories include teamwork, safety, and informatics. The other categories are client-centered care, collaboration, evidence-based practice, and quality improvement. Education and collegiality are standards of professional performance that delineate roles and behaviors for which the professional nurse is accountable.

Which personal safety precaution should guide the nurse working in home care? Do not carry personal items, such as extra car keys or a cellular phone. Avoid making a visit with another nurse. Schedule visits during daylight hours. Never wear a name tag.

Schedule visits during daylight hours. The nurse should carry keys and a cell phone in the event that the keys must be used for self-defense or the cell phone is needed to call for help. Making a visit in pairs is a good personal strategy for nurses visiting families with a history of violence or substance abuse. For the nurse's personal safety, all home visits should be conducted during daylight hours. Dress should be casual but professional and should include a name tag.

Montgomery glands (tubercles)

Sebaceous glands that cause the areola to appear rough.

How do structures of the male reproductive system enhance motility of sperm? Select all that apply. Sertoli cells nourish the sperm. Leydig cells secrete testosterone. Seminal vesicles produce an alkaline fluid. The prostate gland secretes seminal fluid. The bulbourethral glands add fluid to semen.

Seminal vesicles produce an alkaline fluid. The seminal vesicles secrete an alkaline seminal fluid that enhances both the motility of the sperm and the ability to survive in the acidic environment of the vagina. Correct The prostate gland secretes seminal fluid. The prostate gland secretes seminal fluid that enhances motility of the sperm. Correct The bulbourethral glands add fluid to semen. The bulbourethral glands secrete seminal fluid that enhances motility of the sperm.

Which term defines a neonatal death caused by a birth weight greater than 2500 g? Sentinel event Failure to rescue Legal negligence Ethical dilemma

Sentinel event A sentinel event is an unexpected occurrence involving death or serious injury. Events like maternal death during delivery or perinatal death that is not related to any congenital disease is a sentinel event. Such events need to be attended to promptly. Failure to rescue is the failure to recognize or act on early signs of distress. Legal negligence is established by comparing the level of care provided against the accepted standards of care. A perinatal death does not represent an ethical dilemma.

side effects of birth control pills

Serious complications of BCP can include stroke, blood clots, heart attack, high blood pressure, liver tumors, and gallbladder disease. Seek immediate medical care if you experience rapid onset of shortness of breath or chest pain, severe leg pain, sudden numbness or weakness of face, arm or leg, sudden confusion or trouble seeing, sudden severe headache, pain in one or both arms, or discomfort of the neck, jaw, shoulder, upper back, or abdomen. chances of blood clots, including obesity, smoking, varicose veins, immobility, and infection and caution them to modify those they are able to. Adding a daily walk is something almost anyone can do and it can help with both obesity and mobility

physical examination

general appearance vital signs skin head eyes ears nose mouth and throat neck lymphatic breasts heart peripheral vascular lungs abdomen extremities GU rectal MU neurologic

sickle cell disease

Sickle cell disease, formerly called sickle cell anemia, is one of several related genetic hemoglobin disorders that result in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death as a result of poor blood perfusion This is a disorder that causes extreme amounts of pain when exposed to environmental factors. Patients with sickle cell disease are highly advised to avoid these factors that include traveling by airplane, high altitudes, extremes in temperature and overly strenuous activity that causes shortness of breath. The pathophysiology of sickle cell disease results in the formation of abnormal hemoglobin chains resulting in the red blood cells acquiring a sickle shape Though this is a disease that will never be cured, it can be controlled by avoiding the factors that causes the flare ups. should avoid things like traveling by airplane and strenuous activity most often found in people with ancestry from Africa, South and Central America, the Caribbean, Saudi Arabia, India, Sri Lanka, and Mediterranean countries. and is commonly found in areas with severe malaria, which the disease provides protection against. Other treatments that can ease symptoms are blood transfusions, hematopoietic stem cell transplantation, and penicillin prophylaxis.

Most of the genetic tests now offered in clinical practice are tests for: Single-gene disorders. Carrier screening. Predictive values. Predispositional testing.

Single-gene disorders. Most tests now offered are tests for single-gene disorders in clients who have clinical symptoms or a family history of a genetic disease. Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms. Predictive testing is used only to clarify the genetic status of asymptomatic family members. Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance that the condition will develop.

What is the most common place for neoplastic changes?

Squamocolumnar junction aka transformation zone

The release of hormones from the anterior pituitary gland has which effect on the testes? Results in normal sperm formation Induces development of sex organs Stimulates secretion of testosterone Causes pulsatile release of gonadotropin-releasing hormone (GnRH)

Stimulates secretion of testosterone The release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary gland stimulates secretion of testosterone by the testes.

An essential component of counseling women regarding safe sex practices is discussion about avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: Strategies to enhance condom use. Choice of colors and special features. Leaving the decision up to the male partner. Places to safely carry condoms.

Strategies to enhance condom use. When the nurse opens discussion on safe sex practices, the woman is given permission to clear up any concerns or misapprehensions she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills, such as role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms (such as size ranges, where to purchase, and price), this issue is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about using condoms; if a man appears reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely carry condoms in shoes, wallets, or inside their bras. They should be taught to keep condoms away from heat. This information is important but is not germane if the woman cannot even discuss strategies on how to enhance condom use.

"Spinnbarkeit"

Stretchable quality of the cervical mucus at the time of ovulation.

"Graafian follicle"

Structure that encloses the developing ovum; it ruptures at the time of ovulation, releasing the ovum.

A woman taking an oral contraceptive pill (OCP) as her birth control method of choice should notify her health care provider immediately if she notes: Breast tenderness and swelling Weight gain Swelling and pain in one of her legs Mood swings

Swelling and pain in one of her legs Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. Breast tenderness and weight gain are expected side effects of OCPs, and mood swings are a common side effect.

bulimia nervosa

uncontrolled binge eating with methods to prevent weight gain - vomiting, laxatives, diet, fasting, exercise

Tay-Sachs disease

Tay-Sachs is a lipid-storage disorder due to a deficiency of the enzyme hexosaminidase (Lowdermilk, Perry, Cashion, & Alden, 2016). The lack of this enzyme allows the GM2 ganglioside lipid to accumulate in the cell's of the infant causing toxicity to the nerve cells in the brain (Crawford, 2018). This disorder is a considered an inborn error of metabolism, meaning that a gene mutation has interrupted the action of a particular enzyme. This disorder manifests with apathy, regression in motor and social development and decreased vision, but not until the child is between 4 and 6 months of age. At around 3 and 4, death occurs as there is no treatment for the disorder. There are three forms of Tay-Sachs, the most common beginning during pregnancy resulting in the symptoms discussed above. The disorder can also appear during childhood or late childhood. The later the disease manifests, the less aggressive the symptoms are

Providing treatment and rehabilitation for people who have developed disease is part of: Primary preventive care. Secondary preventive care. Tertiary preventive care. Primordial preventive care.

Tertiary preventive care. Primary preventive care involves promoting healthy lifestyles. Secondary preventive care involves targeting populations at risk. Tertiary preventive care is the treatment or rehabilitation of those who already have a specific disease. Primordial preventive care refers to prevention of the risk factors themselves at either the social or environmental level.

Which hormone is responsible for the "cracking" of the voice during male sexual maturation? Estrogen Testosterone Luteinizing hormone (LH) Follicle-stimulating hormone (FSH)

Testosterone Testosterone is responsible for "cracking" in the voice during male maturation and for other secondary sex characteristics.

Which processes explain the development of the deepened voice and increased muscle mass during male sexual maturation? Select all that apply. Testosterone targets adrenal glands. Estrogen is produced by Sertoli cells. Gonadotropin-releasing hormone (GnRH) stimulates release of testosterone. Luteinizing hormone (LH) causes the testes to secrete testosterone. Follicle-stimulating hormone (FSH) stimulates spermatogenesis in the testes.

Testosterone targets adrenal glands. Testosterone targets adrenal glands, causing development of secondary sex characteristics. Luteinizing hormone (LH) causes the testes to secrete testosterone. LH causes the testes to secrete testosterone, which results in development of secondary sex characteristics, including a deepened voice and increased muscle mass.

Endometrial cycle

The 28 days of the menstrual cycle as they apply to the events in the uterus. The endometrial cycle is also known as the uterine cycle, and has the 4 subphases: menstruation, the proliferative phase, the secretory phase. ischemic phase

To what type of studies does the nurse refer as reliable sources for evidence-based practice? The Cochrane Database Well-designed primary studies The notes of experienced nurses Consultations with the senior nurse The Agency for Healthcare Research and Quality's (AHRQ's) guidelines

The Cochrane Database Well-designed primary studies The Agency for Healthcare Research and Quality's (AHRQ's) guidelines The nurse should refer to the Cochrane Database, becauseit includes systematic scientific reviews that provide authentic information, which can help the nurse provide evidence-based practice. The nurse should refer to well-designed primary studies, such as randomized controlled trials, which provide the most accurate source of evidence. The nurse should follow the Agency for Healthcare Research and Quality's (AHRQ's) guidelines, because it may not be possible to consult with a health care provider during an emergency. The nurse uses notes to document interventions, which are implemented during client care, but they are not a good source of evidence. Therefore, the nurse should not follow the notes of an experienced nurse. The nurse may take the advice of a senior nurse, but should always follow only the standard guidelines.

What resource does the nurse use to understand the effectiveness of care provided to a client? The Outcome and Assessment Information Set (OASIS) The Agency for Healthcare Research and Quality (AHRQ) The Nursing Interventions Classification (NIC) The American Nurses Association (ANA) standards

The Outcome and Assessment Information Set (OASIS) The OASIS is an outcome system that measures the effectiveness of care by using quality indicators. It helps the nurse determine whether a client benefits from the care provided. AHRQ is an organization that uses evidence-based practice to recommend best nursing practices for effective care. The NIC includes interventions for client care that are performed by nurses. The ANA publishes standards for maternal-child health.

What are the provisions of the Patient Protection and Affordable Care Act? Make insurance affordable. Reform the health care delivery system. Improve the quality of care for all Americans. Provide free health care for those over 70 years. Strengthen and improve Medicare and Medicaid.

The Patient Protection and Affordable Care Act aims to make insurance affordable and contain costs. It aims to reform the health care delivery system by reducing waste, fraud, and abuse. It also improves the quality of care for all Americans by promoting prevention and improving public health. It also strengthens and improves Medicare and Medicaid by reforming the insurance market. The act does not discriminate on the basis of age.

An infant born to a 38-year-old Hispanic client dies 3 days after birth due to sepsis. On what grounds could the client have a legitimate case for negligence? The fetal heart rate was inconsistent. The client was neglected because of her Hispanic origins. The client could not understand care instructions, even after interpretation. The client was not given the standard level of care.

The client was not given the standard level of care. If a client is not given the standard level of care, and some kind of harm to the client results, then she can make a case for negligence. Inconsistent fetal heart rate is not a case for negligence by itself; negligence occurs if care was not provided even after the findings. Not providing care because of cultural differences is a case of racial discrimination, not negligence. If the client does not understand the care instructions, even after interpretation, then the responsibility for negligence lies with the client.

Diaphragm

The diaphragm is a contraceptive that is shallow dome-shaped and will be either latex or silicone The flexible rim of the diaphragm will cover the cervix using the diaphragm with spermicide because it increases the effectiveness. An annual gynecologic examination should also be done to assess how the diaphragm fits The women will also need to know that the diaphragm should be inspected with every use and replaced every 2 years. The diaphragm may also have to be refitted if there is a significant weight fluctuation, after any abdominal or pelvic surgery, and after every pregnancy The diaphragm should be inspected before insertion by holding it to a light source and carefully stretching the rim on all sides to ensure that there are no holes The diaphragm can also be checked for holes by filling with water The diaphragm should not be used if there are any problems with it. Another method of birth control should be used or sexual intercourse should be avoided until the health care provider can be consulted about replacing the diaphragm When preparing to use the diaphragm it should be rinsed off. Approximately 2 teaspoons of contraceptive jelly or contraceptive cream should be put on the part of the diaphragm that will rest against the cervix The jelly or cream should be spread around to ensure that it coats the surface and the rim to help with the insertion and offer a complete seal positions to use when inserting the diaphragm which are squatting, leg-up method, chair method, and reclining Also, the diaphragm needs to be inserted 6 hours before intercourse The largest most comfortable size should be worn in order to protect against sperm from passing through there are four types of diaphragms ( coil spring, arcing spring, flat spring, and wide seal rim) and they come in various sizes signs of toxic shock syndrome, signs include a sunburn type of rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever, and vomiting if a patient is at a very high risk for contracting HIV, they should avoid using N-9 spermicides alongside the diaphragm

Menarche

The first menstruation.

How does the endometrium assist in the reproductive cycle? The myometrium causes blood loss during menarche. The functional layer of the endometrium releases estrogen and progesterone. The functional layer of the endometrium is shed during the menstrual period. The basal layer of the endometrium regenerates the myometrium each month.

The functional layer of the endometrium is shed during the menstrual period. The functional layer of the endometrium is shed during each menstrual period and is responsible for blood loss during menarche.

An African American newborn died 5 days after birth due to infection. In which condition can the newborn's parents file a legitimate case of negligence? The newborn had breathing difficulty after birth. The newborn had been neglected due to cultural differences. The newborn was not provided with the standard level of care. The newborn's parents did not understand the instructions due to linguistic problems.

The newborn was not provided with the standard level of care. Standard of care refers to that level of practice that a reasonably prudent nurse would provide to other clients in the same or similar circumstances. If the newborn was not given the standard level of care and that resulted in harm or sudden death, a case can be filed for medical negligence. The case of a newborn dying because of a breathing difficulty is not necessarily medical negligence. Negligence of patients due to cultural differences would fall under racial discrimination laws, and would not likely be treated as a traditional malpractice suit. If the newborn's parents speak a different language, the nurse can give instructions to the parents through an interpreter, either in-person, by phone, or online.

chlamydia: lab diagnosis

• Culture = expensive, labor intensive • DNA probe = less expensive, less sensitive • Enzyme immunoassay = less expensive, less sensitive • NAATs test = expensive, higher sensitivity

prevention of genital tract infections

genital hygiene cotton crotch underwear avoid tight clothing cloth car seat - NOT vinyl limit time spent in damp exercise clothes limit exposure to bath salts or bubble bath avoid colored or scented toilet tissue use condoms discontinue feminine deodorant sprays void before/after intercourse decrease dietary sugar drink yeast-active milk or yogurt (with lactobacilli) do not douche

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: With a dominant disorder, the likelihood of the second child also having the condition is 100%. An autosomal recessive disease carries a one in eight risk that the second child will also have the disorder. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. The risk factor remains the same no matter how many affected children are already in the family.

The risk factor remains the same no matter how many affected children are already in the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children of a mother who used drugs would be at risk only if she continued to do so; the rate of risk would be difficult to calculate. Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

What technique is commonly used by the maternity nurse to communicate with the team of primary health care providers? Telehealth TeamSTEPPS Nursing Intervention Classification (NIC) The situation-background-assessment-recommendation (SBAR) technique

The situation-background-assessment-recommendation (SBAR) technique The nurse uses the SBAR technique to communicate critical information that warrants prompt attention by the primary health care provider. Telehealth is a communication technology that provides health care for patients who are separated by distance. TeamSTEPPS is a system that helps medical teams to improve their communication skills and teamwork. The NIC is a comprehensive standardized language describing interventions performed by a generalist or specialist nurse.

"Genetics"

The study of individual genes.

"Pharmacogenomics"

The use of genetic information to individualize drug therapy. Primary benefits are the potential to reduce adverse drug reactions and to develop target therapies.

Which is correct concerning the performance of a Papanicolaou (Pap) test? The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. It should be performed once a year beginning with the onset of puberty. A lubricant such as Vaseline should be used to ease speculum insertion. The specimen for the Pap test should be obtained after specimens are collected for cervical infection.

The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before a Pap smear specimen is collected so as not to alter the cytology results. Also, only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first. Pap tests are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women after three negative results on consecutive annual examinations.

"Gene therapy"

Therapeutic approach that is based on the use of genetic information to correct inherited diseases.

Autosomes

There are 22 pairs of these on each chromosome, one from each parent; they control most traits in the body.

What important aspects do all the fertility awareness-based (FAB) methods have in common? They all require a woman to be able to touch her genitals to assess cervical mucus. They all involve abstinence at some point. They all rely on measurement of body temperature. They all require the cooperation of the woman's partner.

They all require the cooperation of the woman's partner. Fertile phases can be determined in a number of ways, but the sexual partner must cooperate in the method. Not all FAB methods calculate fertility phases by examining mucus; some use body temperatures and other signs. Some methods use chemical or physical barriers to conception during fertile periods.

Which physical change indicates impending ovulation? Necrotic endometrium Thin, stringy cervical mucus Thickened endometrial secretions Dilation of endometrial blood vessels

Thin, stringy cervical mucus Thin, stringy cervical mucus aids sperm entry into the uterus and that indicates impending ovulation.

Tay Sachs transfer

This disorder is an autosomal recessive inheritance disorder indicating that both genes need to be expressed. Each parent contributes the allele for the disorder. If only one parent contributes the allele, the child is said to be a carrier. Tay-Sachs is most common among Ashkenazi Jews and French-Canadians from Quebec. If two carriers of the gene have children, there is a 25% chance that each child could have the disorder. All children of two carriers will minimally be carriers themselves. There is a carrier frequency of 1 in 30

Chromosome

Threadlike strands of genes and other DNA in a cell nucleus.

. Human papillomavirus (HPV); condylomata acuminata; Gardisil; Cervarix

______________________________ Infection that is the most common viral STI seen in ambulatory health care settings; also called genital warts. _______________________________ The visible lesions caused by infection with certain strains of this virus. _______________________________ and _______________________________ Vaccines currently available to protect against some of the most common strains of this infection.

What are the objectives of Healthy People 2020 Maternal, Infant, and Child Health? To decrease the workload of the nurses To decrease the incidence of child deaths To decrease the total costs of health care To increase the accessibility of the health care facilities To increase the number of women attending pregnancy classes

To decrease the incidence of child deaths To increase the number of women attending pregnancy classes Healthy People 2020 is an initiative that aims to improve the health of all Americans. Healthy People 2020 Maternal, Infant, and Child Health aims to decrease the incidence of child deaths. It also promotes self-management during pregnancy and aims to have an increase in the number of women attending pregnancy classes. The purpose of Healthy People 2020 Maternal, Infant, and Child Health is to restore health in pregnant women and children. Healthy People 2020 Maternal, Infant, and Child Health does not aim to decrease the workload of nurses or the total costs of health care. This initiative also does not aim to increase the accessibility of health care facilities.

doulas

Trained and experienced female labor attendants provide a continuous one-on-one caring presence throughout the labor and birth

"Climacteric"

Transitional phase during which ovarian function and hormone produc- tion decline.

Climateric

Transitional phase during which ovarian function and hormone production decline

Puberty

Transitional stage between childhood and sexual maturity.

Which statement best describes the function of the Fallopian tube? Receives the male sperm Contracts to expel a fetus Transports ovum to uterus Contains mammary glands

Transports ovum to uterus The function of the Fallopian tube is best described as transporting an ovum to the uterus.

Which describes the function of the penis in the male reproductive system? Inhibits motility of the semen Keeps sperm cooler than the body Transports semen from the vas deferens Protects sperm from the acidic environment of the vagina

Transports semen from the vas deferens The function of the penis is to transport semen from the vas deferens to the vagina for reproduction.

Rugae

Transverse folds that allow the vagina to expand during childbirth

Tay-Sachs disease treatment

Treatment is palliative with the lack of cure and focuses on nutrition, hydration, and controlling seizures There are several therapies available - substrate reduction, bone marrow transplantation, hematopoietic or neural stem cell transplantation, use of anti-inflammatory drugs , administration of purified enzyme, and gene therapy to restore expression of a dysfunctional protein (

Trisomy 18 (Edwards Syndrome)

Trisomy 18 is a genetic disorder that results due to the presence of three copies of chromosome 18, rather than the normal two copies. Some of the complications include low birth weight, an enlarged posterior portion of the cranium, heart abnormalities, and kidney defects Other complications include cleft lip, small mouth/jaw, extremity malfunctions, and intellectual disabilities. Prognosis is usually poor; most infants with trisomy 18 die before they reach their first birthday. Trisomy 18 appears to occur mostly with chance upon conception; however, it is suggested that single critical region genes are likely to be responsible for the specific clinical features of the syndrome such as portions of chromosome 18 that manipulate extremities Trisomy 18 is the second most common trisomy disorder behind trisomy 21 (Down's Syndrome). It is more prevalent in females; about a 3:1 ratio, and the females are more likely to survive than the males. infnant is born with trisomy 18, reaching their first birthday is rare. In most cases, there is only about a 50% chance of live birth for a fetus with trisomy 18

Turner Syndrome

Turners syndrome is caused by nondisjunction during gametogenesis in wither parent Females are affected by only having one X chromosome. Physical traits that are exhibited with this syndrome is juvenile external genitalia, underdeveloped ovaries, short in height, webbing of the neck and lymphedema of the hands and feet. Biological factors are also affected later on in life. Liver failure is commonly seen in Turners syndrome Hormonal replacement such as estrogen is also provided to many of those who are diagnosed with Turners Syndrome in order to provide a more normal and balanced puberty onset Turner's Syndrome is caused by the junction of X chromosomes having an improper junction. Typically, women have two X chromosomes, with Turners syndrome, the affected woman only has one X chromosome. Turner's Syndrome happens one in every 2,000 pregnancies. It is common for the fetus to not make it to term and end up in a spontaneous abortions

labia majora

Two rounded folds of fatty tissue covered with skin that extend downward and backward from the mons pubis; their purpose is to protect the inner vulvar structures.

monosomy

Union of a normal gamete and a gamete missing a chromosome, resulting in a cell with 45 chromosomes.

HIV: Diagnosis

Use HIV-1 and HIV-2 antibody tests Antibody testing: Enzyme immunoassay • Done FIRST Supplemental testing: • Western blot • Immunofluorescence assay • If positive antibody test confirmed by supplemental test → capable of infecting others • Negative tests do NOT guarantee pt does not have HIV FDA approves 6 rapid HIV antibody screening tests • Use blood sample from fingerstick or venipuncture o Oral fluid sample o Urine sample • Results in 20 minutes • Sensitivity rates of 99% • If reactive → further testing needed

carrier screening test

Used to identify individuals who have a gene mutation for a genetic condition but do not show symptoms of the condition because it is an autosomal recessive condition • e.g., CF, sickle cell disease, and Tay-Sachs disease

vulvovaginal candidiasis: symptoms

Vulvar and vaginal pruritus • Mild or intense • Maybe after intercourse Feel dry Painful urination as urine flows over vulva • Excoriations from scratching Discharge: thick, white, lympy, cottage-cheese like • Found in patches • Yeasty or musty smell Vulva: red and swollen Labial folds, vagina, cervix = red and swollen not characteristic but sometimes yeasty or musty smell is noted

Bacterial vaginosis (BV)

______________________________ Vaginal infection formerly called nonspecific vaginitis, Haemophilus vaginitis, or Gardnerella. It is the most common type of vaginal infection and is characterized by discharge that is usually profuse, thin, and white, gray, or milky in appearance with a characteristic "fishy" odor.

Fourchette

Where the labia minora join to form a thin flat tissue underneath the vaginal opening at midline

Which statements are true regarding the occurrence of obesity in the United States? Select all that apply. 25% of women in the United States are currently considered to be obese. Women in the age group 40 to 59 years have the highest prevalence. Obesity is associated with hypercholesterolemia. Obesity is associated with a decreased incidence of diabetes. Women who are obese may be more likely to have irregularities of the menstrual cycle.

Women in the age group 40 to 59 years have the highest prevalence. More than 33% of women in the United States are currently considered to be obese. Obesity is associated with an increased incidence of diabetes. The statements in B, C, and E are true according to reported evidence. Obesity is associated with hypercholesterolemia. Women who are obese may be more likely to have irregularities of the menstrual cycle.

The recommended treatment to prevent transmission of human immunodeficiency virus (HIV) to the fetus during pregnancy is: Acyclovir Ofloxacin Podophyllin Zidovudine

Zidovudine Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for herpes simplex virus (HSV). Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus.

. TORCH

____________________________ A group of infections that can affect a pregnant woman and her fetus. The infecting organisms are capable of crossing the placenta and adversely affecting the development of the fetus.

Gonorrhea

____________________________ The oldest communicable disease in the United States and second most common in terms of reported cases. Because it is a reportable communicable disease, health care providers are legally responsible for reporting all cases to health authorities.

Hepatitis A virus (HAV)

____________________________ Viral infection acquired primarily through a fecal-oral route by ingestion of contaminated food—particularly milk, shellfish, or polluted water—or person-to-person contact.

Hepatitis B virus (HBV)

____________________________ Viral infection involving the liver that is transmitted parenterally, perinatally, and through intimate contact. A vaccine is available to protect infants, children, and adults.

Human immunodeficiency virus (HIV); cellular im- mune; acquired immunodeficiency syndrome (AIDS)

_____________________________ A retrovirus that is transmitted primarily through exchange of body fluids. Severe depression of the _______________________________ system is associated with this infection and characterizes _______________________________. 13. Human immunodeficiency virus (HIV); cellular im- mune; acquired immunodeficiency syndrome (AIDS)

Cytomegalovirus (CMV)

_____________________________ Viral infection that may be asymptomatic or present with mild influenza-like symptoms. It is transmitted by transfusion of infected blood, sexual contact, or contact with contaminated saliva or urine. It can lead to profound neurologic and sensory disorders if transmitted to the fetus. 21. Cytomegalovirus (CMV)

Condom (male, female)

_____________________________The physical barrier promoted for theprevention of sexual transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).

Group B streptococci (GBS)

______________________________ A normal vaginal flora found in nonpregnant women. It is present in 25% of healthy pregnant women. It has been associated with poor pregnancy outcomes and neonatal morbidity and mortality resulting from vertical transmission from the birth canal of the infected mother to the infant during birth.

Trichomoniasis

______________________________ A vaginal infection caused by an anaerobic one-celled protozoan with charac- teristic flagella. It is characterized by a copious yellowish green, frothy, mucopurulent, malodorous discharge.

Vulvovaginal candidiasis

______________________________ A yeast infection that is the second most common type of vaginal infection in the United States. It is characterized by itching and a thick, white, lumpy discharge with a cottage cheese-like consistency. A yeasty or musty odor may be present.

Chlamydia

______________________________ Bacterial infection that is the most commonly reported STI in American women. This infection is often silent and is highly destructive to the female reproductive tract

Standard Precautions

______________________________ Infection control measures that must be followed by health care providers when caring for all clients. 22. Standard Precautions

types of IUD

copper or hormonal. The copper device is approved for use up to 10 years and provides no hormonal control, only endometrium inflammation and spermicidal control The hormonal IUD devices are approved for 5 years (Mirena) and 3 years (Skyla) and thicken the cervical mucus, along with decreasing sperm movement, and decreasing lining of uterus With the long-term use of the devices, satisfaction with the copper IUD, specifically, has been shown despite a potential increase in bleeding the first 3-months of use

deletion of the short arm of chromosome 5

cri du chat syndrome • Typical mewing cry of the affected infant, • Causes severe intellectual disability with microcephaly and unusual facial appearance

cervix changes of oculation

crvical os dilated slightly cervix softens and rises in the vagina cervical mucus is copious and slippery

both worldwide and in the US, the leading cause of maternal mornatiliyt is a. hemmorage b. infection or sepsis c. diabbetus d. cardiovascular disiease, including hypertensive disorder

d. cardiovascular disiease, including hypertensive disorder

pregnant women who are obese are more likely to develop one or both of the two most frquently reported naternl risk factors a. premature labor and infection b. hemorrae and hypertension associated with pregnancy c. infection and diabetes d. diabetes and hypertension associated with pregnancy

d. diabetes and hypertension associated with pregnancy

thermal shift

decrease and subsequent increase in temperature

treatment of infertility

depend on the factor, causing infertility and how long the couple had been trying. The first step would be adjustment of nutrition, lifestyle, and environment. Medications are useful if infertility is caused by low sperm count or to stimulate women to ovulate Surgery is reserved if there is a blockage of sperm, growth in the uterus ( polyps or fibroids) Intra-uterine insemination, when placing sperm directly in a women's reproductive tract is often used, as well as assisted reproductive technologies when eggs and sperms are handled in the lab and inserted ( fertilized egg) back into the women's uterus (AACC, 2017). Sometimes doctor might find it useful to perform genetic karyotyping to look for genetic disorders ( blood test). PCT (post-coital testing) is rarely performed now, and consists of taking sample of cervical mucus from the woman several hours after the couple had sexual intercourse to evaluate the interaction between the woman's cervical mucus and the man's sperm In addition to IVF, where the fertilization of the egg is still somewhat left to nature because there are multiple sperm that could enter the ovum, there is a procedure called Intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the oocyte by a trained embryologist. The major difference between the two is that research suggests that IVF is superior for men with normal sperm counts; ICSI is a better choice for men with low sperm counts because a sperm can be selected that have shown "progressive motility and normal morphology

most common mental health problem in women

depression and anxiety

medical conditions/particular concern during pregnancy

diabetes UT disorders thyroid disease hypertensive disorders cardiac disease seizure disorders

diagnosis of HSV?

diagnosis may be suspected from physical and history lab studies = confirm • Viral culture = swabbing exudate during vesicular stage • Type specific serologic tests for HSV-2 antibodies

pelvic inlet diameters

diagonal conjugate true conjugate or conjugate vera obstetric conjugate

Hispanic views on Postpartum

diet may be restricted after birth - for first 2 days only boiled milk and toasted tortillas are permitted - bed rest for 3 days after birth - keep warm - delay bathing - mothers head and feet protected from cold air - bathing permitted after 14 days - mother often cared for by her own mother - 40 days restrictions on intercourse - mother may want baby's first wet diaper to wipe her face in belief that it aids in making "mask of pregnancy" go away

what are some negative risks to gaining info through genetic testing?

difficult to keep confidential increased anxiety discrimination and stigmatization gap between ability identify and treat condition

dilation and evaculation

dilation and evaculation - up to 20 weeks gestation - most common performed 13-16 weeks - insertion of osmotic dilators (laminaria) several hours or days before procedure or misoprostol applied to cervix - similar to aspiration

diagonal conjugate diameter

distance from the lower margin of the symphysis pubis to the sacral promontory

posterior saggital diameter

distance from the point where the anteriorposterior and transverse diameters cross each other to the middle of the sacral promontory

true conjugate or conjugate vera

distance from the upper margin of the symphysis pubis to the sacral promontory

meiosis

division of a sex cell into two and four haploid cells

intrauterine environmental hazards

drugs viruses chemicals

HPV maternal effects

dystocia from large lesions exsessive bleeding from large lesions after birth trauma

binge eating disorder

eating large amount in short period ( 2 hours) and not being able to stop

exogenous hormones

effective but involves user dependent - contraceptive injections - oral contraceptive pills - contraceptive patches - vaginal rings

QSEN (Quality and Safety Education for Nurses)

effort to provide nurses with the competencies to improve the quality and safety of the systems of health care in which they practice

balanced translocation

either parts of the two chromosomes are exchanged equally phenotypically normal reciprocal translocation

european american view on postpartum

emphasis on early bonding medical intervention for dealing with discomfort early ambulation and activity emphasized self-management valued

What is a trend in the delivery of health care in the United States? Greater emphasis has been placed on curing disease and disability than on preventing them. Hospital stays for many conditions have been shortened. Acute care increasingly is provided through home-based services. Hospital-based nurses are increasingly involved in follow-up care after discharge. Prevention is secondary to making sure the client is comfortable and satisfied.

stays for many conditions have been shortened. Acute care increasingly is provided through home-based services. Hospital-based nurses are increasingly involved in follow-up care after discharge. Hospitalization has been shortened to reduce cost. Acute care increasingly is done at home. Nurses now are more involved in post discharge follow-up care. Prevention is emphasized now.

strategies for care delivery and providing culturally appropriate care

strategies: - break down the language barrier - explain your rationale and reasons for suggestions - integrate folk and western treatments - enlist family caretaker and others get consent from the right person - provide language appropriate materials providing appropriate care: - ask about traditional beliefs, such as role of hot/cold - be sensitive regarding interpreters and language barriers - ask about important dietary practices - ask about group practices and beliefs - ask about woman's fears, and those of her family, regarding an unfamiliar care setting

penis

structures include the body or shaft, gland penis, and urethra primary functions include pathaway for urination and the organ used for intercourse

scrotum

structures include the testes, epifidymus, and vas deferens normal temperature is slightly cooler than body temperature

dilation and evacuation

surgical method used for a second-trimester abortion. it accounts for almost all procedures performed in the US and results in more complications and greater costs that first-trimester abortions.

sterilization

surgical procedures intended to render the person infertile. for the female the oviducts (uterine fallopian tubes) are occluded. for the male, the sperm ducts (vas deferens )Are occluded during a vasectomy

Turner syndrome symptoms

symptoms of Turner's Syndrome usually appear slowly. During early infancy, affected girls show no psychological developmental differences from unaffected girls. As they grow older their phenotypical, psychosocial and intellectual development is seen to more clearly diverge from that of their normally developing peers. For example, affected girls show weakness in areas of arithmetic, visuospacial processing, and reading social cues which can later lead to impaired social interactions

warm line

telephone lines that are offered as a community service to provide new parents with support, encouragement, and basic parenting education

lactation amenorrhea method

temporary method of birth control based on the surge of prolactin that occus with breastfeeding

family planning

term that refers to the conscious decision on when to conceive, or to avoid pregnancy, throughout the reproductive years.

sentinel event

term used by The Joint Commission to describe an unexpected occurence involving death or serious physical or psychologic injury or risk thereof

Contraception

term used for intentional prevention of pregnancy during sexual intercourse

birth control

term used for the device and/or practice to decrease ris of conceiving or bearing offspring

health literacy

term used to refer to a spectrum of abilities, ranging from reading an appointment slip to interpreting medication instructions health care providers contribute to health literacy by using simple, common words, avoiding jargon, assessing whether the client understands the discussion, speaking slowly and clearly and focusing on what is important to increase understanding

human trafficking

term used to refer to the forcing of individuals, mostly women and children into hard labor, sex work, and even organ donation

standard of care

term used to refer to the level of practice that is a reasonably prudent nurse would provide in the same or similar circumstances

spinnbarkeit

term used to refer to the stretchiness of cervical mucus

what are some negative consequences to a false positive result?

terminate an unaffected pregnancy

female genital mutilation, infibulation, circumcision

terms used to describe procedures in which part or all of the female external genitalia are removed for cultural or nontherapeutic reasons

what is the issue that can arise when testing for early primary or incubating syphilis?

tests can be NEGATIVE • Seroconverstion usually 6-8 weeks after exposure → testing repeated in 1-2 months when suggestive genital lesion exists

cervix

the internal os of the cervix opens into the body of the uterine cavity the cervical canal is located between the internal os and the external os the external cervical os opens into vagina

condoms

the male condom is a thin, stretchable sheath that covers the penis before genital, oral, or anal contact and is removed when the penis is withdrawn from the partner's orifice after ejaculation Condoms are made from different materials such as latex, rubber, and plastic. Latex condoms have a decreased amount of pores in them (different from the natural kind) which allows them to effectively form a barrier that can block organisms and HIV. Plastic condoms provide an effective barrier against HIV as well as bacterial STDs while at the same time allowing better transfer of heat; however, they are more expensive than latex condoms Advantages include the safety, no side effects, condoms are readily available, and this is a method for male use Some disadvantages include the interruption of lovemaking to apply the condom, sensation may be altered for both male and female, if used improperly, spillage can occur and possible pregnancy results, and condoms can also tear

fertility rate

the number of births per 1,000 women of childbearing age (15-44) (inclusive), calculated on a yearly basis

birth rate

the number of live births in a year for every 1,000 people in a population

chlamydia: why is early identification important and what happens if it goes untreated?

untreated leads toacute salpingitis or PID past infections are associated with: • Ectopic pregnancy and tubal factor infertility • Chlamydia of cervix → inflammation → microscopic cervical ulcerations → increase risk for HIV Infants born of mothers with chlamydia → conjunctivitis or pneumonia • C. trachomatis → cause ophthalmia neonatorum o Neonatal ocular prophylaxis with silver nitrate solution or antibiotic ointment • Does NOT prevent perinatal transmission from mother to infant, nor does it adequately treat chlamydial infection

african american view on labor

use granny midwife varied emotional responses woman may arrive to the hospital in far advanced labor emotional support often provided by other women, especially women's mother

chlamydia: Symptoms

usually asymptomatic spotting or postcoital bleeding • Bleeding from inflammation and erosion of the cervical columnar epithelium Mucoid or purulent cervical discharge Dysuria

candidiasis

vulvovaginal candidiasis = candida albicans yeast infection HIV infection = more severe/persistent • Genital candidiasis lesions • Painful coalescing ulcerations

pregnant women pelvic examination

watch for supine hypotension ( pallor, dizziness, faintness, breathlessness, tachycardia, nausea, clammy skin, sweating)

what are some common x-linked recessive diseases?

what are some common x-linked recessive diseases? • Hemophilia • Color blindness • Duchenne muscular dystrophy • Receive allele from carrier mother on her affected X chromosome • Males can pass to daughters - NOT to sons • Daughters will be carriers if receive normal gene from mother o Fragile X syndrome

vulneralble population include

women racial and ethnic minorities adolescent girls older women (greater life expectancy than men, but more illnesses) incarcerated women immigrant,refugee, migrant women homeless women rural women (pay more, less access)

lyon hypothesis

x-inactivation random occurrence female somatic cell only one x-chromosome is functioning

fragile X syndrome

x-linked recessive disorder - complex pattern of inheritance leading cause of intellectual disability and autism • caused by a trinucleotide repeat expansion (CGG) at a "fragile site" on the long arm of the X chromosome • Affects males more severely = only one X chromosome • FXS is not generally detectable through a physical examination at birth. Delays and behavioral abnormalities gradually become apparent during the first 2 years of life, but ultimately the diagnosis of FXS can be verified only through DNA testing

chlamydia

yearly if sexually active until 25

noninvasive prenatal testing for fetal aneuploidy

• A blood test that uses cell-free DNA from the plasma of pregnant women to screen for Down syndrome and, in some cases, trisomy 13 and trisomy18

maternal serum screening

• A blood test used to see if a pregnant woman is at increased risk for carrying a fetus with a neural tube defect or a chromosomal abnormality such as Down syndrome, trisomy 18 or trisomy 13

mutation

• A spontaneous and permanent change in the normal gene structure, in which case the disorder occurs for the first time in the family usually individuals come from a multiple generations having disorder parent heterozygous and has 50% chance of passing

what are the safest ways to prevent STIs and pregnancy?

• Abstinence • Self-masturbation • Monogamous (both partners and no high risk activities) and tested negative for HIV and other STIs • Hugging, massage, touching (assuming no break in skin) • Dry kissing • Mutual masturbation without contact with semen or vaginal secretions and no broken skin • Drug abstinence • Sexual fantasy • Erotic conversation, books, movies • Erotic bathing, showering • Eroticizing feet, fingers, buttocks, abdomen, ears

what factors predispose you to yeast infections?

• Abx therapy • Broad spectrum: ampicillin, tetracycline, cephalosporins, metronidazole • DM - uncontrolled • Pregnancy • Obesity • Immunosuppression • Diets high in refined sugars or artificial sweeteners • Corticosteroids and endogenous hormones • Tight clothing and underwear of nonasborbant material

what should be avoided to prevent inoculation of the fetus with HIV?

• Artificial rupture of membranes • Fetal scalp electrode • Scalp pH sampling • Forceps or vacuum extractor

hepatitis B: risks

• Asian, Pacific Island, Alasakn descent • Acute/chronic liver disease • Receive dialysis or work in • Household contact with hemodialysis client • Institutions for mentally challenged • Multiple blood transfusions • Health care workers and public safety workers exposed to blood • Multiple sex partners • IV drug use

what are the symptoms of rectal gonorrhea?

• Asymptomatic • Severe symptoms → profuse purulent anal discharge • Rectal pain • Blood in stool • Rectal itching, fullness, pressure and pain • Diarrhea

hepatitis B - transmission

• Blood, saliva, sweat, tears, vaginal secretions, semen • Drug users who share needles • Blood and needlesticks • Perinatal transmission in infants of mothers with acute hepatitis in late third trimester or postpartum • Artificial insemination • Blood transfusions

what are strategies for talking to partner about the use of condoms?

• Bring it up when not having sexual activity • Role play with possible reactions and alternative responses • Rehearse how topic is useful • Be open about how hard it is to talk about - sort feelings and fears before talking to partner • Hardest part is getting started • Help clarify what will and will not do sexually

what are some common diseases caused by multifactorial inheritance?

• Cleft lip/palate • Cleft lip: males • Cleft palate: females • Congenital heart disease • Neural tube defects • Pyloric stenosis • More common in males

hepatitis C: diagnosis

• Confirmed through presence of anti-C antibody during lab testing • Recommend one time testing for 1945-1965

what should be avoided when being treated with metronidazole for bacterial vaginosis?

• Do NOT drink alcohol → abdominal distress, nausea, vomiting, HA • NOT recommended to treat sexual partners • NOT recommended if breastfeeding • Suspend breastfeeding during treatment for 12-24 hours after last dose = reduce infant's exposure

hepatitis C: transmission

• Exposure to blood • Semen, saliva or urine

what is the fear surrounding enforcing the use of condoms with men?

• Fear partner offended, rejection or abandonment, conflict or violence - especially if mention for STI prevention • Signs of extra-relationship activity

when do you have greater amounts of (normal) vaginal discharge?

• Greater amounts at ovulation and just before menses • Increased during pregnancy

what should be monitored frequently in pts taking ART?

• Hematocrit • WBC count • Platelet count

HIV positive women should be vaccinated against?

• Hepatitis B • Pneumococcal infection • Haemophilus influenza type B • Viral influenza

hepatitis B: antigens and their antibodies

• Hepatitis B surface antigen (HBsAg) • HBV antigen (HBeAg) • HBV core antigen (HBcAg) • Antibody to HBsAg (anti-HBs) • Antibody to HBeAg (ani-HBe) • Antibody to HBcAg (anti-HBc)

genetic testing

• Involve analysis of human DNA, RNA, chromosomes or proteins → detect abnormalities related to inherited condition • Look at markers that are co-inherited with a gene that causes genetic condition = linkage analysis • Look directly at DNA/RNA = direct or molecular testing • Examine protein products of genes = biochemical testing • Examine chromosomes = cytogenetic testing

Factor V Leiden

• Most common inherited risk factor for primary and recurrent venous thromboembolisms • Deep vein thrombosis (blood clots in the large veins of the legs) • Pulmonary emboli (blood clots that travel through the bloodstream and become embedded in the lungs • Increased risk: women on oral contraceptives, pregnant, hormone replacement therapy • Detected with genetic testing • Careful family and individual history = cost effective activated protein C resistance

HIV - transmission

• Mother to child throughout perinatal period • Exposure to fetus through maternal circulation = first trimester to infant during labor and birth or through breast milk

clinical manifestations: tertiary syphilis

• Multiorgan complications (neurologic, cardiovascular, musculoskeletal or multiorgan system complications in the third stage) • If left untreated

de novo mutation

• New mutation that spontaneously occurred in a gene carried by an individual germ cell

clinical manifestations: secondary syphilis

• Occurs 6 weeks - 6 months after appearance of chancre • Widespread symmetric maculopapular rash on plams and soles and lymphadenopathy • Fever, headache, malaise Condylomata lata: o Broad, painless, pink-gray wartlike infection lesions o On vulva, perineum, anus

mandatory infant genetic screening

• Phenylketonuria: PKU • Currently - test 31 core disorders and 26 secondary disorders • Population based screening

HIV: opportunistic diseases

• Pneumocystis (jirovecii) pneumonia = PCP • Candida esophagitis • Wasting syndrome • HSV • Cytomegalovirus • PID more severe • Rates of HPV and cervical dysplasia LOWER • Accelerated rate of HPV infection

Immunosuppressed (HIV positive) women are at risk for WHAT postpartum?

• Postpartum UTI • Vaginitis • Postpartum endometrititis • Poor wound healing Stress good hygiene and perineum care Refer to physician experienced in treating HIV/AIDS

clinical manifestations: primary syphilis

• Primary lesion = chancre • Appears 5-90 days after infection • Begins as painless papule at site of inoculation → erodes to form nontender, shallow, indurated, clean ulcer several mm to cm in size

how do you prevent PID?

• Primary prevention: education about STIs • Secondary prevention: prevent lower genital tract infection from ascending to upper genital tract • Detection of chlamydia and gonorrheal infections (asymptomatic) through routine screening

what must be done for a pt with HIV positive test?

• Privacy with no interruptions • Risk reduction practices • Referral to medical evaluation and follow up • Desire for psychosocial or psychiatric referrals • Baseline assessment and prophylactic meds

what are some resources for a HIV positive pt?

• Psychological referral • Counseling • Financial assistance • Legal advocacy • SI prevention • Substance abuse program • Contraceptive info → oral, hormonal implants, latex condoms, tubal sterilization or vasectomy

hepatitis B: screening and diagnosis

• Screening for HBsAg = all pregnant women on first prenatal visit; admission for labor and birth for high risk women • Rise in HBsAg at onset of symptoms = active infection • If persist in blood - carrier

hepatitis A: diagnosis

• Serologic testing → detect immunoglobulin M (IgM) antibody • 5-10 days after exposure • Positive for 6 months

what are triggers for HSV?

• Stress, menstruation, trauma, febrile illnesses, chronic illnesses, and ultraviolet light • Stress reduction techniques • Acyclovir if pregnant = risks outweigh benefits

pharmacogenetic testing

• Use of genetic information to guide a client's drug therapy • Associations between genetic variation and drug effect • Warfarin - anticoagulant o Narrow therapeutic index o Result in serious bleeding andthromboembolic events o Genotype guided warfarin dosing - reduce serious AE, increase dosing accuracy, shorten time to dose stabilization, help identify those who need additional monitoring o CYP2C9 and VKORC1 genes = require lower initial dose of warfarin • Target therapies • Monoclonal antibody = trastuzumab → breast tumors o Drug with obligatory genetic test o Overexporess HER2/neu gene = only ones who benefit

what symptoms should you look for when assessing the history of HSV?

• Viral symptoms: malaise, HA, fever, myalgia suggestive • Local symptoms: vulvar pain, dysuria, itching, burning, painful genital lesions that heal spontaneously - Inguinal and generalized lymphadenopathy and elevated temp primary infection - prodromal symptoms, vaginal discharge, dyspareunia inspect for vulvar, perineal, vaginal and cervical areas for vesicles and crusts

what are practices that have a LOW but potential risk for STI transmission or pregnancy?

• Wet kissing∗ • Vaginal intercourse with condom; anal intercourse with condom • Monogamous (both partners and no high risk activities) but not tested for HIV or other STIs • Oral sex with woman wearing female condom • Oral sex with man wearing condom • Mutual masturbation without contact with semen or vaginal secretions; healthy intact skin or use of latex or plastic barrier • Urine contact with intact skin

inversions

• Which a portion of the chromosome has been rearranged in reverse order • Few birth defects have been attributed to the presence of inversions