EXAM 1 - REPRODUCTION
The nurse is preparing to counsel a client whose two previous pregnancies were uneventful, ending in term vaginal births of healthy children. What should the nurse consider regarding multiparas with previous uneventful pregnancies before beginning prenatal counseling? 1 - Multiparas cope more successfully with pregnancy than do primigravidas. 2 - Each pregnancy is a unique experience that is stressful despite multiparity. 3 - This pregnancy will provoke a situational crisis because the client has two children at home. 4 - Support people play a lesser role because the client has had two prior experiences with pregnancy.
2 - Each pregnancy is a unique experience that is stressful despite multiparity. RATIONALE: Each pregnancy creates a stress situation because it is a developmental crisis. It has not been determined that multiparas are more successful in coping with pregnancy than primigravidas are. Each pregnancy is unique, and this pregnancy may or may not be more stressful than the others. In addition, pregnancy is a developmental, not a situational, crisis. Support people are important during any crisis or stressful situation.
A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes? 1 - Uterine cancer 2 - Lack of estrogen 3 - Early cervical carcinoma 4 - Expected menopausal changes
4 - Expected menopausal changes RATIONALE: The adaptations described, along with the client's age, suggest that the client is experiencing menopause. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.
Which risk is associated with estrogen therapy in a client who smokes? 1 - Hypocalcemia 2 - Vaginal bleeding 3 - Multiple pregnancies 4 - Thromboembolic disorders
4 - Thromboembolic disorders RATIONALE: In chronic smokers, estrogen therapy increases the risk of thromboembolic disorders such as a stroke. Estrogen therapy does not cause hypocalcemia. Estrogen therapy along with oral contraceptives may cause abnormal vaginal bleeding in some clients; this condition is not dependent on a client's smoking habit. Multiple pregnancies may occur with the use of clomiphene.b
A nurse is reviewing the clinical record of a client with a diagnosis of benign prostatic hyperplasia (BPH). Which test result will the nurse check to confirm the diagnosis? 1 - Rectal examination 2 - Serum phosphatase level 3 - Biopsy of prostatic tissue 4 - Massage of prostatic fluid
3 - Biopsy of prostatic tissue RATIONALE: A definitive diagnosis of the cellular changes associated with benign prostatic hyperplasia (BPH) is made by biopsy, with subsequent microscopic evaluation. Palpation of the prostate gland through rectal examination is not a definitive diagnosis; this only reveals size and configuration of the prostate. The serum phosphatase level will provide information for prostatic cancer; a definitive diagnosis cannot be made with this test for BPH. A sample of prostatic fluid helps to diagnosis prostatitis.
A nurse withholds methylergonovine maleate from a postpartum client. What clinical finding supports the withholding of the medication? 1 -Urine output of 50 mL/hr 2 - Third-degree perineal laceration 3 - Blood pressure of 160/90 mm Hg 4 - Respiratory rate of 12 breaths/min
3 - Blood pressure of 160/90 mm Hg RATIONALE: Methylergonovine maleate can cause hypertension and should not be given to a client with an increased blood pressure. Urine output of 50 mL/hr is an expected finding in a healthy adult. Perineal lacerations are not related to methylergonovine maleate use. Methylergonovine maleate does not affect respiration.
A nonstress test (NST) is scheduled for a client with mild preeclampsia. During the test, the client asks the nurse what it means when the fetal heart rate goes up every time the fetus moves. How should the nurse respond? 1 - "These accelerations are a sign of fetal well-being." 2 - "These accelerations indicate fetal head compression." 3 - "Umbilical cord compression is causing these accelerations." 4 - "Uteroplacental insufficiency is causing these accelerations."
1 - "These accelerations are a sign of fetal well-being." RATIONALE: The NST is performed before labor begins. Accelerations with movement and a baseline variability of 5 to 15 beats/min indicate fetal well-being. This reactive NST is considered positive. Early decelerations are associated with fetal head compression during a contraction stress test (CST) or during labor. Variable decelerations are associated with cord compression during a CST or during labor. Late decelerations during a CST or during labor are associated with uteroplacental insufficiency.
How does the nurse distinguish true labor from false labor? 1 - Cervical dilation is evident. 2 - Contractions stop when the client walks around. 3 - The client's contractions progress only when she is in a side-lying position. 4 - Contractions occur immediately after the membranes rupture.
1 - Cervical dilation is evident RATIONALE: Progressive cervical dilation is the most accurate indication of true labor. With true labor, contractions will increase with activity. Contractions of true labor persist in any position. Contractions may not begin until 24 to 48 hours after the membranes rupture.
What is the first line drug used to manage intrauterine fetal death? 1 - Dinoprostone 2 - Misoprostol 3 - Mifepristone 4 - Methylergonovineb
1 - Dinoprostone RATIONALE: Dinoprostone is a synthetic derivative of hormone prostaglandin E 2. It is to manage intrauterine fetal death up to 28 weeks of gestational age. Misoprostol is used for cervical ripening, and it is used along with mifepristone to induce abortion. Methylergonovine is prescribed to reduce postpartum hemorrhage.
An infusion of oxytocin is administered to a client for induction of labor. After several minutes the uterine monitor indicates contractions lasting 100 seconds with a frequency of 130 seconds. What is the next nursing action? 1 - Discontinuing the infusion 2 - Checking the fetal heart rate 3 - Slowing the oxytocin flow rate 4 - Turning the client on her left side
1 - Discontinuing the infusion RATIONALE: Contractions lasting too long and occurring too frequently can lead to fetal hypoxia; stopping the oxytocin infusion should stop the contractions, thereby increasing oxygen flow to the fetus. The fetal heart rate should be monitored, but this is not the priority. Oxytocin will continue to promote uterine contractions; this is unsafe because the prolonged, frequent contractions decrease oxygen flow to the fetus. Turning the client on her left side will promote placental perfusion, but it is not the priority at this time.
A nurse is counseling a pregnant client who maintains a vegetarian diet. What should the nurse plan to do to ensure optimal nutrition during the pregnancy? 1 - Refer the client to a dietitian to help plan her daily menu. 2 - Encourage the client to join a group that teaches nutrition. 3 - Explain that she needs to include meat in her diet at least once a day. 4 - Advise the client that it is unhealthy to continue a vegetarian diet during pregnancy.
1 - Refer the client to a dietitian to help plan her daily menu. RATIONALE: The dietitian can give the client specific information that would help her plan nutritious meals. Specific foods, such as nuts and soy products, may be substituted for meat or animal-related products. The client may know healthy nutrition; she needs help to adapt the vegetarian diet to meet pregnancy needs. Explaining that she needs to include meat in her diet at least once a day or advising the client that it is unhealthy to continue a vegetarian diet during pregnancy ignores the client's beliefs and lifestyle; a nutritious vegetarian diet is available during pregnancy.
A pregnant client's history reveals opioid abuse. What is the nurse's initial plan for providing pain relief measures during labor? 1 - Scheduling pain medication at regular intervals 2 - Administering the medication only when the pain is severe 3 - Avoiding the administration of medication unless it is requested 4 - Recognizing that less pain medication will be needed by this client compared with other women in labor
1 - Scheduling pain medication at regular intervals RATIONALE: This client will have a lower tolerance for pain and a greater need for pain relief. Larger doses may be needed if pain medication is administered only when the pain is severe. Delays increase anxiety and discomfort, and larger doses will be necessary. Individuals who abuse drugs require more medication than do others because of tolerance to the addictive drug.
A nurse explains to a nursing class that the efficiency of the basal body temperature method of contraception depends on fluctuation of the basal body temperature. Which factor can alter the effectiveness of this method? 1 - Stress 2 - Length of abstinence 3 - Age of those involved 4 - Frequency of intercourse
1 - Stress RATIONALE: Stress or infection can alter the body's metabolism, causing an elevation in temperature; a rise in temperature from these causes may be misinterpreted as ovulation. Length of abstinence may increase sperm volume, but does not affect the female's basal temperature. Age is not a factor in the efficiency of the basal body temperature method of contraception in premenopausal woman. Frequency of intercourse may affect the volume of sperm, but does not alter the female's basal temperature.
Which statement about varicocele is true? 1 - Varicocele occurs most often on the left side. 2 - The left testicle is larger when associated varicocele is present. 3 - Testicular size increases with increasing duration of a varicocele. 4 - Dihydrotestosterone level increases with the duration of a varicocele
1 - Varicocele occurs most often on the left side. RATIONALE: Varicocele occurs most often on the left side. The left testicle is smaller when associated varicocele is present. Testicular size decreases with increasing duration of varicocele. Dihydrotestosterone levels decrease with increasing duration of a varicocele.
A woman is being prepared for a contraction stress test (CST). Which information should the nurse provide the client before the test? 1 - "The test will be discontinued after at least six contractions are observed." 2 b- "You'll need to provide a double-voided urine specimen before the test." 3 - "The fetal heart rate will be monitored for about 20 minutes before the test begins." 4 - "You'll be placed in a right lateral position that must be maintained throughout the test."
3 - "The fetal heart rate will be monitored for about 20 minutes before the test begins." RATIONALE: The fetal heart rate (FHR) is measured for about 20 minutes before the CST to determine baseline variability and to detect any FHR alterations without induced stress. The test involves monitoring the fetal heart rate during three to five uterine contractions over a 10-minute period. A urine sample is unnecessary. The semi-Fowler position with a left-sided tilt is the position of choice.
An Rh-negative mother who gave birth at 10:30 AM on January 7 should receive her Rh immune globulin injection no later than when? 1 - 10:30 PM on January 11 2 - 10:30 PM on January 11 3 - 10:30 AM on January 10 4 - 10:30 PM on January 10
3 - 10:30 AM one January 10 RATIONALE: When a Rhesus negative mother gives birth to a rhesus positive child, it is expected that she gets a shot of rhesus immune globulin within 72 hours postpartum but when this is known during during pregnancy it is expected that the injection is given around 26-28 weeks gestation however it can be given postpartum not later than 72 hrs after birth. So for this woman who gave birth at 10:30 am January 7th, assuming she was not given a shot of Rhesus immune globulin at 26-28 weeks gestation, she should be given the shot before 10:30am January 10th Read more on Brainly.com - https://brainly.com/question/14319160#readmore
Of what does the nurse expect the primary health care provider to advise the parents after their child is diagnosed with a mitochondrial disorder? 1 - "There is no risk of recurrence of this disease in the next child." 2 - "You may need to use a donor egg or sperm for future children." 3 - "There are more chances of miscarriage in the next pregnancy." 4 - "You can find additional information of this disease on the Internet."
2 - "You may need to use a donor egg or sperm for future children." RATIONALE: The nurse informs the parents about alternative options, such as the use of a donor egg or sperm for the next pregnancy. This is because there is an increased risk for mitochondrial disorder in future children. The diagnosis of mitochondrial disorder in this child does not carry an increased chance of miscarriage for the mother in future pregnancies. It is not a good idea to encourage the parents to look for additional information on the Internet, because some information may be inaccurate.
The nurse knows that when a magnesium sulfate infusion is given to a client with preeclampsia, it can build to a toxic level. Which assessment finding should prompt the nurse to withhold the medication and notify the primary healthcare provider? 1 - Respirations of 14 breaths/min 2 - Absence of deep tendon reflexes 3 - Urine output of 30 mL/hr 4 - Blood pressure of 140/100 mm Hg
2 - Absence of deep tendon reflexes RATIONALE: A side effect of magnesium sulfate is depressed reflex responses; this may indicate toxicity, and intervention is necessary. Respirations of 14 breaths/min is a positive sign that toxicity has not occurred. A respiratory rate of 12 breaths/min or slower is a concern that requires nursing intervention. The amount of urine output is important, because oliguria may signify magnesium toxicity, but 30 mL/hr is within the acceptable range. The blood pressure is expected to increase; this medication is administered to prevent a seizure, not to lower blood pressure.
Which of these statements about the transition from intrauterine to extrauterine life is true? 1 - Hyperthermia is observed in the newborn. 2 - Newborns are susceptible to heat loss and cold stress. 3 - Apgar assessments are conducted 5 and 10 minutes after birth. 4 - Physiological changes in the newborn occur during the first 12 hours of life.
2 - Newborns are susceptible to heat loss and cold stress. RATIONALE: During the transition from intrauterine to extrauterine life, newborns are susceptible to heat loss and cold stress. Newborns are susceptible to hypothermia, not hyperthermia. Apgar assessments are generally conducted between 1 and 5 minutes after birth. Physiological changes in the newborn are seen during the first 24 hours of life.
The client reports excessive bleeding during the menstruation. Which herbal therapies are unlikely to be prescribed by the primary healthcare provider? Select all that apply. 1 - Raspberry 2 - Chamomile 3 - Lady's mantle 4 - Chaste tree fruit 5 - Shepherd's purse
2, 4 RATIONALE: Chamomile is an antispasmodic agent that helps to reduce breast pain. Chaste tree fruit is used to reduce breast pain by reducing the prolactin levels. Raspberry, lady's mantle, and shepherd's purse are uterotonic drugs used to treat menorrhea.
What transformations occur during the mid-puberty stage of a normally developing adolescent female? 1 - Scanty and irregular menstrual periods 2 - Appearance of pubic hair and an increase in normal vaginal discharge 3 - Breast enlargement and the growth of pubic hair 4 - Changes in the nipple and areola and the development of a small bud of breast tissue
3 - Breast enlargement and the growth of pubic hair RATIONALE: During mid-puberty, the breast enlarges from a small bud of breast tissue, while pubic hair develops and covering the mons pubis and labia majora. Scanty and irregular menstrual periods are a characteristic feature of late-puberty. The first appearance of pubic hair, an increase in normal vaginal discharge, changes in the nipple and areola, and the development of a small bud of breast tissue occur during early-puberty.
Which type of drug readily enters the breast milk? 1 - H20 soluble 2 - Ionized drugs 3 - Lipid-soluble drugs 4 - Protein-bound drugs
3 - Lipid-soluble drugs RATIONALE: Drugs that are highly lipid soluble can enter the breast milk in high concentrations. Water-soluble drugs are not transferred in high concentrations into breast milk. Nonionized drugs are more likely to be transferred into the breast milk than ionized drugs. Protein-bound drugs are unable to enter breast milk due to their large molecular size, and this prevents them from crossing the barrier.
A client is visiting the prenatal clinic for the first time. While giving the nursing history the client states that her last menstrual period started on June 10. What is her expected date of birth (EDB), according to Nägele's rule? 1 - March 3 2 - March 10 3 - March 17 4 - March 24
3 - March 17 RATIONALE: The date is March 17 of the following year. Using Nägele's rule, subtract 3 months from the first day of the last menstrual period and add 7 days. March 3 and March 10 are too early. March 24 is too late.
A drug is administered to a client in her third trimester of pregnancy. Which statement regarding the drug administration is correct? 1 - All drugs should not be given to the pregnant client. 2 - The dose of a drug should not be altered for a pregnant client. 3 - The dose of a drug should be increased for pregnant clients. 4 - The dose of a drug should be decreased for pregnant clients.
3 - The dose of a drug should be increased for pregnant clients. RATIONALE: During pregnancy, a client's hepatic metabolism and glomerular filtration are increased. As a result, the excretion rate is faster. Therefore the dose of a drug should be increased for the drug action to be optimal. It is true that all drugs should not be given to the pregnant client, because of the teratogenic effects on the fetus. The client should see her healthcare provider if in doubt. The dose of a drug should be altered for a pregnant client depending on the trimester she is in. How a drug affects the fetus depends on the stage of development of the fetus and the dosage and strength of the drug administered. During the first 3-8 weeks after fertilization, the major organs are developing and the dose of a drug should be decreased or withdrawn for pregnant clients.
What type of lochia should the visiting nurse expect to observe on a client's pad on the fourth day after a vaginal delivery? 1 - Scant alba 2 - Scant rubra 3 - Moderate rubra 4 - Moderate serosa
4 - Moderate serosa RATIONALE: On the third to fourth day the uterine discharge becomes pink to brown; it continues until approximately the 10th day. After about 10 days the uterine discharge becomes yellow to white (alba); alba may continue until 2 to 6 weeks after the birth. It is unusual to have scant lochia rubra. Lochia rubra lasts from the first to about the third day; it is usually heavy but may be moderate after a few days.