EXAM 2

complications of estrogen therapy

-increased blood clotting -causing venous thromboembolism -elevated blood glucose -hypertension -fluid retention.

why can pregnant women handle blood loss so well

-increased blood volume -compensating for baby

interventions for utero-placental insufficiency

-increasing IV fluids -oxygen

Which routes are used for testosterone administration? Select all that apply.

-oral -buccal -transdermal -intramuscular

A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure?

-placing the patient in a supine position -holding down the patients head to prevent injury

Which of the following are NOT considered presumptive signs of pregnancy? Select all that apply:

-positive pregnancy test -bottlement these are probable signs

why are erythromycin drops necessary for newborns

-prevents pink eye transmitted through STIs (chlamydia)

medications that cause erectile dysfunction

-propranolol -amitryptyline -cimetidine -clondadine -despiramine -digoxin -hydralazine -methyldopa -nortyrptyline -thiazide diuretics -trancylcypromide

bad foods for pregnancy

-raw/undercook meat or fish -raw eggs -unwashed produce -foods high in mercury (tuna) -caffeine

The purpose of a vaginal examination for a client in labor is to specifically assess the status of which findings? Select all that apply.

-station -dilation -effacement

The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instruction?

"I should wear knee-high hose, but I should not leave them on longer than 8 hours." Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities

A pregnant client has been instructed on the prevention of genital tract infections. Which client statement indicates an understanding of these preventive measures?

"I should wear underwear with a cotton panel liner."

The nursing student is assigned to care for a client in the postpartum unit. The coassigned registered nurse asks the student to identify the most objective method to assess the amount of lochial flow in the client. Which statement, if made by the student, indicates an understanding of this method?

"I should weigh the perineal pad before and after use and note the amount of time between each pad change."

The nurse should include questions about which factors when assessing a patient's sexuality? Select all that apply.

-Sexual activity -Sexual behaviors -Protection measures -History of sexually transmitted diseases

Shortly after receiving epidural anesthesia, a laboring woman's blood pressure drops to 95/43 mm Hg. Which immediate actions should the nurse take? Select all that apply.

-turn the woman to a lateral position -increase the rate of IV infusion -administer oxygen by face mask at 10L/hour Maternal hypotension results in decreased placental perfusion, so the focus of nursing care should be to initiate interventions that increase oxygen perfusion to the fetus.

Select below the positive signs of pregnancy:

-ultrasound detecting fetus -visible movement of baby seen by the examiner -the delivery of the baby -doppler detects fetal heart tones -fetal movement felt by examiner

The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? Select all that apply.

-use of fertility medications -History of Chlamydia -Use of an intrauterine device -History of pelvic inflammatory disease (PID)

The nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. Based on her last normal menstrual period, she is 8 weeks' gestation. Appropriate physical assessments are completed. Which findings are anticipated to be present at this time? Select all that apply.

-a softening of the cervix -Bluish discoloration of the vaginal tissue -The presence of human chorionic gonadotropin in the urine

What are the most common side effects of testosterone therapy? Select all that apply.

-acne -edema -headaches

priority for when the water breaks

-assess fetal HR for 1 minute -chance of cord prolapse

manifestations of primary syphilis

-chancre -Enlarged regional lymph nodes

A 39 week pregnant woman arrives to labor triage. The patient's prenatal history includes gravidity 3, parity 2. What signs and symptoms below indicate the patient is experiencing true labor? Select all that apply:

-changing positions and walking does not decrease discomfort -the contractions are regular -the cervix is 90% effaced and dilated to 4 cm

how to tell if mom is not handling blood loss well

-decreased BP -pale -syncope -increased HR

the results of a nonstress test shows three fetal heart rate accelerations with fetal movement that peak at 15 beats per minute above baseline and last 15 seconds. The nurse's nextaction should be to:

do nothing A reactive sign is at least two fetal heart rate accelerations with or without fetal movement, occurring within a 20-minute period, peaking at least 15 beats per minute above the baseline, and lasting 15 seconds. This is reassuring, and no further testing is necessary.

How is painful intercourse documented in a patient's medical record?

dyspareunia

A client who is 8 weeks' pregnant calls the prenatal clinic and tells the nurse that she is experiencing nausea and vomiting every morning. The nurse should suggest which measure that will best promote relief of the signs and symptoms?

eating dry crackers before arising

Fill-in-the-blank: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the _________________ in mom's body, which injures organs.

endothelial cells

A client decides not to use hormone therapy after menopause. What is the best instruction the nurse should provide to this client to decrease the serious effects of menopause?

engage in aerobic, weight bearing exercise •Menopause and decreased estrogen levels increase the risk for osteoporosis (secondary to bone density loss). A regular moderate program (3 to 4 times per week) of aerobic and weight-bearing exercises can slow the process of bone loss and a tendency toward weight gain.

A pregnant woman of 30 weeks' gestation is admitted to the maternity unit in preterm labor. The woman asks the nurse about the purpose of betamethasone, which has been prescribed by the health care provider (HCP). The nurse should tell the client that the medication will promote which action?

enhance fetal lung maturity

In the prenatal clinic, the nurse is interviewing a new client and obtaining health history information. Which action should the nurse plan to elicit the most accurate responses to the questions that refer to sexually transmitted infections?

establish a therapeutic relationship

A postpartum unit nurse is caring for a stable client 12 hours after delivering a healthy newborn. At this time in the postpartum period, what is the recommended frequency for the nurse to assess the client's vital signs?

every 4 hours

after induction of the anesthetic how often are vitals taken

every 5 to 10 minutes

True or False: Stage 4 of labor starts with the full delivery of the baby and ends with the full delivery of the placenta.

false

True or False: Stage 2 of labor begins with the delivery of the baby and ends with the delivery of the placenta.

false Stage 2 begins with the full dilation of the cervix (10 cm) and ends with the full delivery of the baby.

True or False: A normal fetal heart rate is between 100-120 bpm.

false a normal FHR is between 120-160

TRUE OR FALSE Labor: A 40 week pregnant patient is experiencing some contractions that are weak, while others are strong in intensity. When she walks or lies down it helps decrease the contraction pain. She states the contractions are hard to predict.

false labor

You're assessing a pregnant patient who is 38 weeks pregnant for signs of labor. The patient states she has been experiencing contractions that are 10-12 minutes apart. The contractions have decreased since she has been walking. The fetal station is -4. Based on these findings, is this TRUE or FALSE labor?

false labor

The male-to-female transgender patient was recently started on hormone therapy. She is at the clinic today complaining of dizziness, cold sweats, and chills. The nurse knows these are common side effects of which medication?

finasteride

primapara

first birth

Which term describes the patient whose gender identity does not conform to either male or female?

genderqueer

A patient reports painful urination and profuse yellowish-green urethral discharge. What might these symptoms indicate?

gonorrhea

The examiner notes there is softening of the cervix. This is known as?

goodells sign

Which of the following is a probable sign of pregnancy?

goodells sign

•While the vital signs of a pregnant woman in her third trimester are being assessed, the woman, who is lying supine, complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

have the patient turn to her left side, recheck BP in 5 minutes

A 35-year-old female suspects she may be pregnant. The physician notes in chart that the lower uterine segment is soft. As the nurse you know this is known as:

hegars sign

•uring labor, a woman has been hyperventilating. She begins to complain of tingling in her hands and dizziness. The next action by the nurse should be to:

help the woman slow her breathing and to breathe into a paper bag or nonrebreather

common side effects of spirolactone

hyperkalemia

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic?

is painless and indurated The lesion is referred to as a chancre.

What landmark is used to assess fetal station?

ischial spine

A patient asks the nurse about the human papilloma virus (HPV) test. What does the nurse tell the patient?

it detects cancerous cells from the cervix

amount of flow: light

light = less than 10 cm (<4 inches) on menstrual pad in 1 hour

For feminizing surgery, in what position should the patient be placed?

lithotomy

The patient was born with male genitalia but lives as a female. What is the most appropriate term to describe the patient?

male to female

multipara

many births

Your patient is suffering from constipation and is 8 months pregnant. Which statement is incorrect when educating the patient about relief measures?

taking a cap-ful of Ex-lax a day will help relieve constipation A pregnant patient should be discouraged from taking any type of medications (even over-the-counter) unless prescribed by the OB doctor. This option is out of the scope of practice for the nurse.

What is the most appropriate dietary adjustment for a patient with an intrauterine device who has heavy menstrual bleeding?

taking oral iron supplements

The nurse obtains information related to reproductive function from a female client. What question should the nurse ask first?

tell me about your menstrual periods •The nurse should begin with questions about the least sensitive areas, such as menstrual history, before asking questions about more sensitive issues such as sexual practice or sexually transmitted infections.

The nurse is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which finding should alert the nurse to a compromise?

the passage of meconium Signs of fetal or maternal compromise include a persistent, nonreassuring fetal heart rate; fetal acidosis; and the passage of meconium.

A patient is undergoing an amniocentesis. Which statement is correct about this procedure?

the patient is to be in the supine position

•One side effect of oxytocin stimulation is hypertonic contractions. This can be detrimental to the fetus because:

there is a reduction of placental blood flow

What does the nurse know about patients who identify themselves as transgender?

these patients have a sense of being born in the wrong body

A nurse is caring for a genderqueer patient. What is the most appropriate way for the nurse to refer to the patient?

they

A newborn is delivered via spontaneous vaginal delivery. On reception of the crying newborn, the nurse's highest priority at this time is to perform which action?

thoroughly dry the infant

True or False: Variable Deceleration may appear at random and may be unrelated to the mother's contractions.

true

TRUE OR FALSE Labor: A 37 week pregnant patient is having consistent contractions, the cervix is 90% effaced, and cervix is 6 cm dilated. The fetal station is +1.

true labor

You are measuring the fundal height on a patient who is 20 weeks pregnant. Where do you expect to locate the fundus of the uterus?

umbilicus

lanolin cream

used for nipples/diaper rash *WOOL ALLERGY* cannot use

slidenefil

used to treat ED *CANNOT* take with nitroglycerine

The nurse is caring for a patient with secondary syphilis. What manifestations does the nurse expect in this patient?

wart like lesions

lochia alba

white/yellow lasts 10-28 days

A health care facility has different visitation policies for families of lesbian, gay, bisexual, transgender, and queer/question (LGBTQ) patients; gender-segregated restrooms; a patient's bill of rights and nondiscrimination policies displayed in the visible places; Safe Zone, rainbow, or pink triangle signs displayed in and around the waiting area; and medical forms and documents containing relationship status details. Which aspects of the facility violate the recommendations of The Joint Commission's (TJC)? Select all that apply.

-visitation policies -restroom segregation -medical forms and document format

Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby?

calcium gluconate

fetal heart week 10-12

can be heard by Doppler

fetal heart week 20

can be heard by fetoscope

why cant you take slidenfil and nitroglycerin together

can cause severe hypotension

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding?

ceftriaxone

A nurse is educating a patient who will receive a penile implant. Which statement demonstrates correct patient teaching by the nurse?

contact your provider for a temp over 100.4 Infection and bleeding are the major disadvantages to a penile implant and should be a prominent part of the patient's education

lochia serosa

pink/brown lasts 4-10 days

why is the vitamin K shot necessary for newborns

provides clotting factor

early decelerations characteristics

the fetal heart rate would be returned to normal by the end of the contraction

fetal heart week 5

the heart can be visualized only by ultrasound

variable deceleration characteristics

the nurse would hear a sudden drop in the fetal heart rate and a sudden return to normal rate.

why is oxytocin given after birth

to contract the uterus

penile injections transurethral suppository

tried before using the option of last resort

A 55-year-old male reports difficulty maintaining an erection. After discussing the patient's history, which statement by the patient would bestsupport a diagnosis of erectile dysfunction?

"After a motor vehicle accident last year, I received a laminectomy Lumbosacral injuries are noted to cause organic erectile dysfunction.

A pregnant client asks the nurse, "What should I expect during a nonstress test?" Which information should the nurse provide to the client?

"An ultrasound transducer that records fetal heart activity is secured over the abdomen where the fetal heart is heard most clearly."

A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What should the nurse tell the client to provide relief from the leg cramps?

"Bend your foot toward your body while extending the knee when the cramps occur."

A patient with syphilis is prescribed benzathine penicillin G administered intramuscularly for 3 weeks. Which statement made by the patient indicates an increased risk for progression of the disease?

"I need to visit the health care provider at 12, 16, and 24 months." After treatment, a patient with syphilis is recommended for follow-up evaluation, which includes blood tests at 6, 12, and 24 months; repeating the treatment may be needed if the patient does not respond to the initial antibiotic therapy

The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions?

"I should avoid eating foods that produce gas and fatty foods."

Which statement made by a nursing student about health disparities indicates a need for further education regarding health disparities?

"I should never discuss sexual orientation and gender issues."

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction?

"I will maintain strict bed rest throughout the remainder of the pregnancy."

A pregnant client in the prenatal clinic is scheduled for a biophysical profile (BPP). The client asks the nurse what this test involves. The nurse should make which appropriate response?

"This test measures amniotic fluid volume and fetal activity."

A 65-year-old patient who is still sexually active asks the nurse if she continues to need a Papanicolaou (Pap) test. How would the nurse respond?

"You don't need a Pap smear if you have had regular testing with normal results for the past 10 years.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? Select all that apply.

-The client has a history of intravenous drug use. -The client has a history of sexually transmitted infections.

nagels rule

-add 7 days -count back 3 months -add 1 year

What complications may result if a patient discontinues the treatment of chlamydia infection without completing the full course of antibiotics? Select all that apply.

-infertility -ectopic pregnancy -PID

danger signs in pregnancy

-vaginal bleeding -convulsions -headaches/blurred vision -SOB -fever -abdominal pain

You're assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 97, no response to stimulation, flaccid, absent respirations, cyanotic throughout. What is your patient's APGAR score?

APGAR 1

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 101, cyanotic body and extremities, no response to stimulation, no flexion of extremities, and strong cry. What is your patient's APGAR score?

APGAR 4

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 130, pink body and hands with cyanotic feet, weak cry, flexion of the arms and legs, active movement and crying when stimulated. What is your patient's APGAR score?

APGAR 8

The nurse is monitoring a new mother in the fourth stage of labor for signs of hemorrhage. Which indicates an early sign of excessive blood loss?

An increased pulse rate of 88 to 102 beats/min

The nurse is orienting a new unlicensed assistive personnel (UAP) to the clinic. One of the patients has self-identified as a transgender individual. The UAP states "I don't want to say the wrong thing. What do I call him or her?" What is the nurse's best response?

Ask how the patient would like to be addressed.

Which bacterial infection may result in inflammation of the fallopian tubes?

Chlamydia trachomatis

For the 12 proceeding months prior to surgery, what is one of the requirements for a patient requesting a vaginoplasty or a phalloplasty?

Continuously living in the role of the desired gender identity Continuously living in the gender role that is congruent with the patient's gender identity for 12 months is required prior to surgery. It is highly recommended that the patient is engaged in regular visits with a mental health professional.

The nurse is caring for a 40-year-old overweight patient who has secondary hypertension with onset consistent with beginning an estrogen-containing oral contraceptive drug. What is the priority recommendation for this patient?

Discontinue the estrogen-containing oral contraceptive drug The use of estrogen-containing oral contraceptives is the most likely cause of secondary hypertension in women

The nurse is caring for a client in active labor. Which nursing intervention would be the bestmethod to prevent fetal heart rate (FHR) decelerations?

Encourage an upright or side-lying maternal position.

The nurse in the delivery room is performing an initial assessment on a newborn infant. When examining the umbilical cord, the nurse observes only 2 vessels. How should the nurse interpret this finding?

Finding 2 vessels may indicate an increased risk for other congenital anomalies.

Which statement, if made by the laboring client, most likely indicates that the client is in the second stage of labor?

I feel like I need to push

A patient tells you her last menstrual period was September 10th, 2014. According to the Nagele's rule when is her expected due date?

June 17, 2015

Which of the following statements describe a variable deceleration?

On the fetal tracing, the heart rate will go up and down and present when the cord is being compressed

what is bloody show

Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.

Which statement regarding health insurance coverage for transgender patients is accurate?

Patients are often denied coverage for gender-reassignment surgery and hormone therapy by insurance companies.

Which additional daily dietary intake will mostclosely match the number of additional calories needed by the breast-feeding mother?

Peanut butter and jelly sandwich and glass of 2% milk

On assessment of the fetal heart rate (FHR) of a laboring woman, the nurse discovers decelerations that have a gradual onset, last longer than 30 seconds, and return to the baseline rate with the completion of each contraction. The nurse plans care, knowing that this identifies which category of decelerations?

Periodic, early decelerations that indicate fetal head compression

A patient with HIV is 6 weeks pregnant. What would you educate the patient about?

Practice safe but total abstinence from sexual intercourse during the pregnancy is recommended

The public health nurse manager is working on a policy designed to decrease the number of recurrences of gonorrhea and chlamydia. Which approach is most effective?

Provide patients with oral antibiotic treatment for their partners

The nurse is obtaining a personal health history on a 24-year-old male whose male partner is present. How should the nurse approach questions about his sexual practices?

Respect the patient's choice to answer or refuse to answer questions about sexual practices.

The postpartum nurse is caring for a woman who just delivered a healthy newborn. The nurse should be most concerned about the presence of subinvolution if which occurs?

Retained placental fragments from delivery

Which intervention is appropriate for a transgender individual experiencing gender dysphoria?

Surgery to change primary and/or secondary sex characteristics

During the assessment of a laboring woman, it is noted the fetal station is +2. You interpret this to mean?

The baby's presenting part is 2 cm below the ischial spine.

Many studies show that LGBTQ individuals are not comfortable with health care professionals due to experience with discrimination. The nurse is committed to offering equal care to all patients and wants his or her patients to trust him or her with their care. When working with a new patient, what action does the nurse take to support this?

The nurse asks the patient a series of questions including if the patient has sex with men, women, both, or neither.

what is placenta previa

The placenta partially or completely covers the cervical opening -painless vaginal bleeding

The nurse is discussing the prevention of sexually transmitted infections (STIs) with a group of young adults. What information does the nurse include?

The risk of STIs increases with the number of sexual partners

What statement is FALSE about the transition phase of stage 1?

The transition phase is the longest phase of stage 1 and contractions are very intense and long in duration

A 25-year-old woman arrives on the maternity unit on February 2. She states that her estimated date of delivery (EDD) is March 22. She is verbalizing complaints of dull lower back pain, pelvic heaviness, and diarrhea for the past few days. On admission for observation, the client's blood pressure is 128/80 mm Hg, pulse is 100 beats/minute, respirations are 16 breaths/minute, and temperature is 99°F. The nurse plans care based on which interpretation?

The woman requires further evaluation for preterm labor.

What should a nurse advise women of childbearing age who are getting treated with macitentan for pulmonary arterial hypertension (PAH)?

Use at least two types of contraceptive methods during treatment. Macitentan, an endothelin receptor antagonist drug, is used to treat pulmonary arterial hypertension (PAH). Its use is contraindicated in women as it causes birth defects if taken during pregnancy.

genital warts

\characterized by cauliflower-like growths or growths that are soft and fleshy.

The nurse is teaching a group of young men about sexually transmitted infections (STIs). What does the nurse tell them to look for in the primary stage of syphilis?

a painless chancre

After birth, where do you expect to assess fundal height?

at or near the umbilicus

Which client teaching about testosterone therapy will the nurse provide to a female transitioning to male (FtM) client?

avoid sharing needles, as this can transmit HIV or hepatitis

treatment for chlamydia

azithromyacin

Lochia rubra

dark red lasts 3-4 days

best instruction to decrease side effects of menopause

engage in aerobic, weight bearing exercise

early signs of magnesium sulfate toxicity

flushing feeling hot/warm

A patient with chlamydia infection is prescribed a single dose of azithromycin 1 g orally. What is the most important advantage of this therapy compared to doxycycline 100 mg orally twice daily for 7 days?

increased compliance

Which of the following laboratory changes are expected with the use of testosterone therapy?

increased liver enzymes

how can the nurse help the mother who is breastfeeding and has engorged breasts

instruct and assist the mother to massage her breasts

Which is the most effective route of administration for benzathine penicillin G to a patient with early latent syphilis?

intramuscular

Why is spironolactone prescribed for the male-to-female transgender patient?

it inhibits testosterone secretion

A 15 year old found out she is 10 weeks pregnant. Which of the following would NOT be the MOST important information for you to assess during your prenatal evaluation?

job status

•The nurse is monitoring the fetal heart rate periodically with Doppler auscultation. At the end of a contraction, the fetal heart rate is 100 and gradually increases to 140 within 30 seconds. The nurse would need to assess the rate further, because this is an indication of:

late deceleration

•An important nursing intervention after a woman in labor has had an epidural block is to:

monitor the woman's bladder With the large quantity of IV solutions the woman has received, her bladder fills quickly. The epidural block decreases the sensation of a full bladder so the woman may not be aware of her need to void

For which manifestations does the nurse assess a male patient with chlamydia infection?

mucoid discharge

A patient who is 35 weeks pregnant states she thinks her "water broke" but she isn't sure because it is a very little amount. What do you anticipate the MD will order first?

nitrazine strip test The nitrazine strip test is quick and easy to do and will assess for the presence of amniotic fluid in the vaginal secretions. Because 35 weeks is still early for the delivery of a baby, an ultrasound and nonstress test will probably be ordered after the confirmation via the Nitrazine strip test that the membranes have ruptured

nullipara

no births

vacuum constriction device

often first option that is tried

fetal heart at week 3

only 2 parallel tubes

The nurse teaches a client about drugs used to treat genital herpes. Which drug should the nurse include in the client's instructions?

oral acyclovir

The nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the health care provider's prescriptions and should expect to note which prescribed treatment for this condition?

oxytocin infusion

•The classic sign of placenta previa is the sudden onset of:

painless, uterine bleeding in the latter half of pregnancy

A 39 week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify the physician?

patient reports flushing or feeling hot Signs of this include: EARLY: flushing or feeling hot/warm, later on: decreased or absent reflexes, Respiratory rate less than 12 breaths per minute, Urinary output of less than 30 mL/hr, EKG changes.

The nurse is providing instructions about treatment for hemorrhoids to a client in the second trimester of pregnancy. Which statement made by the client indicates a need for further teaching?

"I should apply heat packs to the hemorrhoids to help them shrink."

The nurse provides teaching on how to relieve discomfort to a client in her second trimester of pregnancy who is having frequent low back pain and ankle edema at the end of the day. Which statement made by the client indicates an understanding of the teaching?

"When I get home I should lie on the floor, with my legs elevated on a couch, and turn my hips and knees at right angles."

The nursing instructor asks a nursing student who is preparing to assist with the assessment of an 18 weeks' gestation gravida 2, para 1 (G2P1) pregnant woman to describe expectations related to the process of quickening. Which statements, if made by the student, indicate an understanding of this process? Select all that apply.

-"It is the fetal movement that is felt by the mother." -It is typically experienced by the multigravida client between 16 and 18 weeks' gestation."

The nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Which interventions should the nurse include in planning nursing care for this client? Select all that apply.

-Assess blood pressure. -Check the urine for protein. -Assess deep tendon reflexes. -teach the importance of keeping track of a daily weight. The nurse must assess blood pressure, weight, and the presence of protein in the urine because an increase in these areas would indicate a worsening condition.

The nurse is performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. The nurse should assess for which probable signs of pregnancy? Select all that apply.

-Ballottement -Chadwick's sign -Uterine enlargement -Positive pregnancy test

The nurse has provided discharge instructions to a client who delivered a healthy newborn by cesarean delivery. which of the following are appropriate instructions

-I will notify the health care provider if I develop a fever. -I will turn on my side and push up with my arms to get out of bed. -I will lift nothing heavier than my newborn baby for at least 2 weeks.

The nurse is counseling a pregnant woman diagnosed with gestational diabetes at 29 weeks' gestation. Which information should the nurse discuss with the client? Select all that apply.

-Plan for weekly nonstress tests at 32 weeks. -Obtain nutritional counseling with a dietitian. Gestational diabetes can result in delayed lung maturity and complications, and carrying the baby until full term is the goal.

The nurse is reviewing fetal development with a client who is at 36 weeks' gestation. Which statements describe the characteristics that are present in a fetus at this time? Select all that apply.

-The fetus is approximately 42 to 48 cm long. -The lecithin-sphingomyelin (L/S) ratio is greater than 2:1.

A contraction stress test is scheduled for a pregnant woman, and she asks the nurse to describe the test. What should the nurse include in the teaching? Select all that apply.

-an external monitor is attached in order to view fetal heart rate response to an established contraction pattern. -The uterus is stimulated to contract by the administration of small amounts of oxytocin or by nipple stimulation.

The prenatal clinic nurse asks a nursing student to identify the physiological adaptations of the cardiovascular system that occur during pregnancy. The nurse determines that the student understands these physiological changes if the student makes which statement?

-an increase in pulse rate occurs Between 14 and 20 weeks' gestation, the maternal pulse rate increases slowly by 10 to 15 beats/minute, which lasts until term.

when does the primigravida patient experience quickening

-between weeks 18 and 20.

probable signs of pregnancy

-blood and urine tests -Chadwick's sign -Goodell's sign -Hegar's sign

goal for gestational diabetes

-carrying baby until full term -need lungs to be mature

The nurse is providing teaching to a transgender female to male client who will be started on testosterone therapy. Which information should the nurse include in the teaching session? Select all that apply.

-expect the clitoris to enlarge -Liver enzymes and cholesterol levels will need to be monitored.

positive signs of pregnancy

-fetal heart rate detected by electronic device (Doppler) at 10 to 12 weeks -by nonelectronic device (fetoscope) at 20 weeks of gestation -active fetal movements palpable by the examiner -an outline of the fetus by radiography or ultrasonography.

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, should alert the nurse that the client is at risk for a spontaneous abortion?

-history of syphilis Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion.

A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a -2 station. The health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply.

-increased efficiency of contractions -The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a -2 station. The health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply.

-increased sufficiency of contractions -The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply.

-it is the way the baby gets food and oxygen -It provides an exchange of nutrients and waste products between the mother and developing fetus.

how to decrease morning sickness

-keeping crackers, Melba toast, or dry cereal at the bedside to eat before getting up in the morning -eating smaller, more frequent meals -decreasing fats -consuming adequate fluid between meals but not with meals.

The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediatelydiscontinue the oxytocin infusion? Select all that apply.

-late decelerations of fetal heart rate -uterine hyperstimulation

During a woman's 38-week prenatal visit, the nurse assesses the fetal heart rate to be 180 beats/minute. What might the nurse suspect as the most likely cause of this tachycardia?

-maternal infection A fetal heart rate of 180 beats/minute indicates tachycardia and could indicate intrauterine infection and fetal distress.

warning signs for pregnancy

-rapid weight gain -generalized or facial edema -visual disturbances

Signs of magnesium sulfate toxicity

-relate to the central nervous system depressant effects of the medication -respiratory depression -loss of deep tendon reflexes -sudden decline in fetal heart rate, maternal heart rate and BP *urine output should be at least 25-30mL/hr*

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply.

-respirations of 10 breaths/minute -urine output of 20mL in an hour

A nursing student is doing a presentation on human papillomavirus (HPV) for a young adult group aged 18 to 20 years old. What information should the nursing student include in this presentation? Select all that apply.

-some forms of HPV can lead to cervical cancer -"HPV is most commonly spread during vaginal or anal sexual contact. -In some types, HPV will go away on its own and does not cause health issues.

what is oxytocin

-stimulates uterine contractions and is a pharmacological method to induce labor.

The nurse is monitoring a client in labor who is receiving oxytocin and notes that the client is experiencing hypertonic uterine contractions. In order of priority, how should the nurse plan the actions to take? Arrange the actions in the order that they should be performed. All options must be used.

-stop the oxytocin infusion -reposition the client -administer oxygen -perform vaginal examination -check the clients blood pressure -Administer medication as prescribed to reduce uterine activity.

The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply.

-the cervix is dilated completely -the spontaneous urge to push is initiated from perineal pressure

what should a patient do if a threatened abortion is suspected

-watch for the evidence of the passage of tissue. -count the number of perineal pads used daily and to note the quantity and color of blood on the pad. -curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider.

Rho(D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition?

Being affected by Rh incompatibility

The nurse is reviewing the record of a pregnant woman and notes that the health care provider has documented the presence of Chadwick's sign. Which assessment finding supports the presence of Chadwick's sign?

Bluish discoloration of cervix and vagina

the nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart?

G = 2, T = 1, P = 0, A = 0, L = 1

The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement?

My contractions will increase in duration and intensity."

extrusion reflex

Thrusting tongue movements that automatically push food out of the mouth

several patients have just come into the OB unit. which patient should the nurse assess first

a 22 year old G3 P2 woman at 38 weeks gestation who is requesting to go to the bathroom to have a bowel movement

A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding?

a normal test result

which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus

assist the client in emptying her bladder

what is the best way for the nurse to promote and support the maternal infant bonding process

assist the family with rooming in

The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client required an episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client?

client pain level

A labor room nurse is performing an assessment on a client in labor and notes that the fetal heart rate (FHR) is 158 beats/minute and regular. The client's contractions are every 5 minutes, with a duration of 40 seconds and of moderate intensity. On the basis of these assessment findings, what is the appropriate nursing action?

continue to monitor the client

in neonatal resuscitations, which should be done first

dry the infant and position the head -drying the infant to prevent heat loss is the first action -it is followed by positioning to open the airway

amount of flow: excessive

excessive = menstrual pad saturated in 15 minutes. If the client is experiencing excessive bleeding, the nurse should contact the HCP in the event that postpartum hemorrhage is occurring

amount of flow: heavy

heavy = saturated menstrual pad in 1 hour

The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that which may be required during the second half of pregnancy?

increased insulin

A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate?

inform the client that these contractions are common and may occur throughout the pregnancy.

the most important reason to protect the preterm infant from cold stress is that

it could make respiratory distress syndrome worse

amount of flow: moderate

moderate = less than 15 cm (<6 inches) on menstrual pad in 1 hour

a 24 year old gravid 2, para 1 woman is being admitted in active labor at 39 weeks gestation. what prenatal data would be most important for the nurse to address at this time

positive result on test for group B streptococci at 36 weeks gestation

proper education about developmental aspects of sexuality in children

-I should explain sexuality to my 9-year-old in a factual manner when she asks me questions about her body. -I should explain about body changes to my 11-year-old prior to them happening to alleviate her fears."

risk factors for ED

-age (geriatric) - 70 -medications disrupting blood flow -diabetes -alcohol, drug, tobacco use -obesity -cardiovascular disease -BP medications (propranolol) -hypertension

what can be seen in embryo at 6 weeks

-babys heartbeat

A pregnant client asks the nurse in the clinic, "When will I begin to feel fetal movement?" Which response should the nurse make

-between 16 and 20 weeks

What are some characteristics of contractions associated with false labor? Select all that apply:

-changing positions help alleviate contraction pain -fetal station is -5 -contractions are unpredictable

The nurse is assisting in the care of a client in labor who is having an amniotomy performed. The nurse should report which abnormal findings to the health care provider (HCP)? Select all that apply.

-clear, dark amber amniotic fluid -Light green amniotic fluid with no odor -Thick white amniotic fluid with no odor

The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36 weeks of gestation. During the measurement the client begins to feel lightheaded. On the basis of knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of the lightheadedness?

-compression of the vena cava Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome late in pregnancy.

late signs of magnesium toxicity

-decreased/absent deep tendon reflexes -RR < 12 -urinary output < 30mL/hr

Select all the probable signs of pregnancy:

-enlarged uterus -goodells signs -Braxton Hicks contractions

The contractions associated with true labor tend to have what type of characteristics: Select all that apply

-felt in the back and radiate to the abdomen -increase in intensity -consistent

what does the biophysical profile assess

-fetal heart rate -fetal breathing movements -gross fetal movements -fetal tone -amniotic fluid volume.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply.

-flushing -depressed respirations -extreme muscle weakness

common side effects of estrogen

-headache -breast tenderness -nausea/vomiting -weight gain.

A 37-year-old female patient who is 36 weeks pregnant is diagnosed with mild preeclampsia. The nurse will include what information in the patient's education? Select all that apply:

-incorporate foods like eggs, nuts, fish, and meat in your diet -importance of monitoring urine at home -lying on left side is recommended along with rest -report a decrease in fetal activity immediately

The nurse is describing cardiovascular system changes that occur during pregnancy to a client. Which findings are normal for a client in the second trimester? Select all that apply.

-increase in pulse rate -increase in red blood cell production Between 14 and 20 weeks' gestation, the pulse rate increases about 10 to 15 beats/minute, which then persists to term. During pregnancy, there is an accelerated production of red blood cells. During the second trimester, systolic and diastolic pressures decrease by about 5 to 10 mm Hg until 24 to 32 weeks

Stage 1 of labor includes which phases in the correct order?

-latent -active -transition

Periodic labs will be monitored for a female-to-male patient who is taking testosterone. Which lab tests does the nurse tell the patient to anticipate will be monitored? Select all that apply.

-lipid profile -liver profile -blood glucose

classic signs and symptoms of preterm labor

-lower abdominal cramping -diarrhea -dull and intermittent low back pain -painful menstrual-like cramps -suprapubic pain or pressure -pelvic pressure or heaviness -urinary frequency -change in character and amount of vaginal discharge -rupture of amniotic membranes.

With whom should a nurse collaborate to provide a safe and effective care environment to reduce health disparities in the transgender population? Select all that apply.

-mental health provider -vocal or speech therapist -surgeon

interventions for mom with epidural

-monitor bladder -assess feeling in legs before getting up to walk

What methods are used to confirm a diagnosis of syphilis? Select all that apply.

-performing a rapid plasma regain test -assessing the patient for presence of chancre

Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient's lab results correlate with HELLP Syndrome?

-platelets 90,000 -ALT 100 -AST 90 -abnormal RBC peripheral smear HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or ALT), Low Platelets (<100,000 μL ).

Select all the risk factors below that increases a woman's risk for developing preeclampsia:

-primigravida -BMI 34 -pregnant with twins -maternal history of preeclampsia -history of lupus and diabetes

priority for prolapsed cord

-sit mom up into knee to chest/trendelenburg -IF protruding from vagina, wrap in warm sterile water/towel

what is placenta accreta

-stays attached inside mom -placenta grows too deeply into the uterine wall

true statements about the transition phase of stage 1

-the mother may experience intense pain, irritation, nausea, and deep concentration -the transition phase is the shortest phase -the cervix will dilate from 8 to 10 cm -the transition phase ends and progresses to stage 2 of labor when the cervix has dilated to 10 cm

A pregnant client at 16 weeks' gestation reports to the health care clinic for a triple screen test. The nurse determines that the client understands the purpose of this test when the client makes which statements? Select all that apply.

-this test can be used for screening of spina bifida -"This test is a screening test, and I will need other testing if I have abnormal results." -This test can indicate if I may be at an increased risk for having a child with Down syndrome."

true statements regarding constipation relief measures

-try to eat foods rich in fiber such as beans, fruits, and vegetables, alone with fluid intake -exercise regularly -constipation is experienced in the 2nd and 3rd trimesters because of decreased intestinal motility

medication for HPV

-vaccination -podofilox topical ointment for warts

The prenatal client asks the nurse about substances that can cross the placental barrier and potentially affect the fetus. The nurse most appropriately explains that which substances can cross this barrier? Select all that apply.

-viruses -nutrients -antibodies -medications

In a patient with preeclampsia, what signs and symptoms indicate that the patient has a high risk of experiencing a seizure due to central nervous system irritability? Select all that apply:

-you note bouncing of the foot when it is quickly dorsiflexed -patellar and bicep deep tendon reflexes are graded 4+ Option A indicates positive clonus and Option B is indicative of hyperreflexia. If these findings are present it demonstrates that the central nervous system is irritated and there is a high risk of potential seizure activity. Seizure precautions should be initiated and the physician notified.

A 35-year-old female is in labor. The baby is engaged in the pelvis. As the nurse you know that this means that the fetal station is approximately?

0

The nurse is planning to teach a group of adolescents about the use of condoms as part of a risk reduction program for sexually transmitted infections (STIs). The nurse should plan to include which recommendation in the teaching plan?

Always apply the condom before inserting the penis into the vagina.

Chadwicks sign

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

A pregnant 39-week-gestation gravida 1, para 0 client arrives on the labor and delivery unit with signs and symptoms of active labor. The nurse reviews the client's prenatal record and discovers that she has had a positive group B streptococcus (GBS) laboratory report during her prenatal course. After performing a cervical exam, the nurse confirms that the cervix is dilated 6 cm and 90% effaced. Which should be the nurse's firstaction?

Call the health care provider (HCP) to obtain a prescription for intravenous antibiotic prophylaxis (IAP). ecause the client has had a positive GBS result during pregnancy, her neonate is at risk for becoming infected with GBS via vertical transmission during birth. GBS poses a significant risk for infant morbidity and mortality. To decrease this risk, it is recommended that IAP be administered during labor

A pregnant 39-week-gestation client arrives at the labor and delivery unit in active labor. On confirmation of labor, the client reports a history of herpes simplex virus (HSV) to the nurse, who notes the presence of lesions on inspection of the client's perineum. Which should be the nurse's initial action?

Explain to the client why a cesarean delivery is necessary. Because neonatal infection of HSV is life-threatening, prevention of neonatal infection is critical. Current recommendations state that a cesarean delivery within 4 hours after labor begins or membranes rupture is necessary if visible lesions are present on the woman's perineum.

A 39-week-gestation pregnant client calls the maternity unit, stating, "My baby has not moved very much in the past few days. Should I be concerned?" Which is the best response made by the nurse?

Fetal movements do not decrease as a woman nears term; therefore, you should be seen by your health care provider for further evaluation." Fetal movements may decrease during fetal sleep cycles and while a woman is taking depressant medication, drinking alcohol, or smoking cigarettes

Which is the most appropriate diagnostic test for syphilis?

Venereal Disease Research Laboratory (VDRL) serum test

The nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. Which instruction should the nurse provide?

Wash the breasts with warm water and keep them dry.

The nurse is assigned to care for a client who has chosen to formula-feed her infant. The nurse should plan to provide which instruction to the client?

Wear a supportive brassiere continuously for 72 hours.

While teaching a health promotion class to a group of women, the nurse identifies which client as most at risk for cervical cancer?

a 32 year old who has had about 10 sexual partners

treatment for genital herpes

acyclovir

manifestations of late syphilis

benign lesions (gummas)

duncan mechanism

dirty duncan maternal side is delivered first

A patient is the third trimester of her pregnancy states she has been getting "terrible" leg cramps at night. Which statement is true about leg cramps during pregnancy?

dorsiflexing the foot will help the affected leg

•A woman has been diagnosed with iron deficiency anemia. The nurse knows that client teaching about increasing iron intake has been effective if the woman chooses:

green salad with broccoli, black beans, and strawberries.

•Pregnant women can usually tolerate the normal blood loss associated with childbirth because they have:

increased blood volume volume during pregnancy by 1 to 2 L. Because of the high fluid volume level with pregnancy, the hematocrit level normally decreases.

A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit?

monitor for fetal movement bedrest with bathroom privileges The priority intervention of the home care nurse is to monitor for fetal movement. The expectant mother also is asked to keep a record of fetal movements

A pregnant client is admitted in labor. The nursing assessment reveals that the client's hemoglobin and hematocrit levels are low, indicating anemia. What should the nurse observe for following the client's labor?

postpartum infection

what is placenta abruption

premature separation of the placenta -painful vaginal bleeding

A newborn's one minute APGAR score is 8. Which of the following nursing interventions will you provide to this newborn?

routine post delivery care

To what does gender identity refer?

sense of being male or female

Goddell's sign

softening of the cervix

What is the lecithin:spingomyelin ratio?

test of fetal amniotic fluid to assess for fetal lung immaturity

A pregnant client is receiving oxytocin for the induction of labor. The nurse should immediatelydiscontinue the oxytocin infusion if which is noted in the client?

uterine hyperstimulation A major danger associated with oxytocin induction of labor is hyperstimulation of uterine contractions, which can cause fetal distress as a result of decreased placental perfusion.

•During prenatal teaching it is important for the nurse to inform the client about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider?

vaginal bleeding It may be an indication of several complications of pregnancy, such as placenta previa or abruptio placenta

treatment for gonorrhea

antibiotic therapy -ceftriaxone -doxycycline

•The purpose of initiating contractions in a contraction stress test is to:

apply stressful stimulation to the fetus

The nurse is assisting the health care provider to perform Leopold's maneuvers on a pregnant client. Which action should the nurse perform before the procedure?

ask the client to urinate An empty bladder contributes to a woman's comfort during this examination

The nurse assists the health care provider to perform an amniotomy on a client in labor. Which is the priority nursing action after this procedure?

assess the fetal heart rate

•A woman in active labor and has been admitted to the birthing unit. She calls the nurse and says her "water just broke." The first nursing action should be:

assess the fetal heart rate for 1 minute When the membranes rupture, there is a risk for the umbilical cord to be displaced. Assessment of the fetal heart rate at this time will identify compression of the cord if it occurs

Which statement below correctly describes Chadwick's Sign?

"Chadwick's Sign occurs when there is a bluish color to the vulva, cervix and vagina."

When obtaining a patient's sexual history, which nursing question most reflects a nonjudgmental approach?

"Do you have sex with men, women, or both?"

A patient tells a nurse, "I'm in the process of male-to-female transition, and I plan to have surgery to change my sex." What is the appropriate nursing response?

"Exogenous hormone therapy, such as estrogen, can increase the risk of blood clotting, which can result in venous thromboembolism (VTE)."

A 55-year-old male client confides in the nurse that he is concerned about his sexual function. What is the nurse's best response?

"Please share with me more about your concerns."

You're providing an in-service to a group of new labor and delivery nurse graduates about the pathophysiology of preeclampsia. Which statement by one of the group participants demonstrates they understood how this condition develops?

"The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter."

signs of uterine hyperstimulation

- 1 contraction lasting longer than 2 minutes - 5 or more contractions over 10 minutes

normal fetal heart rate near or at term

110-160 bpm

calcium intake for menopausal women

1200-1600mg/day

reactive sign of non stress test

15 + 15 = 20

The nurse is preparing to care for a client in the immediate postpartum period who has just delivered a healthy newborn. How often should the nurse plan to take the client's vital signs?

15 minutes during the first hour and then every 30 minutes for the next 2 hours

normal fetal heart rate in the first trimester

160-170 bpm

From what age may a child begin to feel a sense of maleness or femaleness?

2 years

when is babys natal sex identified

20 weeks

therapeutic range for magnesium

4 to 7.5 mEq/L

in stage 1 of labor, during the active phase, the cervix dilates?

4-7cm

You're assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: pink body and hands with cyanotic feet, heart rate 109, grimace to stimulation, flaccid, and irregular cry. What is your patient's APGAR score?

APGAR 5

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: weak cry, some flexion of the arm and legs, active movement and cries to stimulation, heart rate 145, and pallor all over the body and extremities. What is your patient's APGAR score?

APGAR 6

Regarding the scenario in the question above, when would you reassess the APGAR?

5 minutes after the previous APGAR assessment

The nurse is providing nutritional counseling to a new mother who is breast-feeding her newborn. The nurse should instruct the client that her calorie needs should increase by approximately how many calories a day?

500

Four women phone the gynecology clinic about having new-onset vaginal bleeding. Which call does the RN decide to return first?

62-year-old with no previous gynecologic problems Vaginal bleeding in a postmenopausal woman is abnormal and may be an indication of serious problems, such as endometrial cancer

Your patient has underwent testing of her blood type and Rh factor. She has A- blood type. Which of the following statement is correct?

At 28 weeks she should receive the Rh immune globulin. The patient's Rh factor is negative so she will need to receive the Rh immune globulin at 28 weeks. If the patient was A+ (meaning her Rh factor is positive) she would not have to receive the Rh immune globulin.

A patient is having an abdominal ultrasound to assess fetal gestational age and estimated date of delivery. Which statement is incorrect about this type of testing

Before the abdominal ultrasound is performed the patient should empty bladder. A patient should have a full bladder before the procedure so better images of the fetus can be obtained. So instructing the patient to drink water to fill the bladder for the procedure would be ideal.

During a vaginal assessment on a patient who is 8 weeks pregnant, you note a bluish coloration of the mucous membrane of the cervix, vagina, and vulva. You would document this finding as what?

Chadwicks sign

To prevent health disparities, what will the nurse do for a young, homeless patient who states that he or she is attracted to people of the same sex?

Help provide a safe environment to prevent the risk of violence

The health care provider (HCP) is assessing the client for the presence of ballottement. To make this determination, the HCP should take which action?

Initiate a gentle upward tap on the cervix.

phytonadine

Needed for synthesizing clotting factor Monitor PT and INR

The mother has delivered the placenta. You note that the shiny surface of the placenta was delivered first. What delivery mechanism is this known as AND is this the maternal or baby's surface of the placenta?

Schultze mechanism, baby "SHINY" Schultze. This is the side from the baby

A patient is wanting to become pregnant and has underwent prenatal counsel and testing. Her rubella titer is lower than 1:8. She consents to receiving the rubella vaccine. What education will you provide to the patient?

She must use an effective birth control method at the time of immunization and not become pregnant for 1-3 months.

A newborn's five minute APGAR score is 5. Which of the following nursing interventions will you provide to this newborn?

Some resuscitation assistance such as oxygen and rubbing baby's back and reassess APGAR score.

when is stage 4 of labor

Stage 4 is 1-4 hours AFTER the delivery of the placenta.

The nurse is interviewing a 16-year-old client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation?

"I don't like my face anymore. I always look like I have been crying." there is an implication of periorbital and facial edema, which could be indicative of gestational hypertension

A health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy, and the client asks the nurse about the procedure. How should the nurse respond to the client?

"The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel."

A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client?

"The vaginal discharge may be bothersome, but is a normal occurrence." Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection

A pregnant woman has a positive history of genital herpes but has not had lesions during this pregnancy. What should the nurse plan to tell the client?

"You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed."

diagnostic criteria for menopause

-12 months of amenorrhea -vaginal dryness -dyspareunia -sleep and mood dysfunction.

A nurse is performing sexual assessments of male patients in a long-term care facility. Which patients would the nurse flag as having an increased risk for erectile dysfunction? Select all that apply.

-A 72-year-old male with a history of diabetes -An 80-year-old male who is an alcoholic -An 85-year-old male who takes antihypertensive medication

The nurse presents a seminar on sexually transmitted infections. Which information about syphilis should the nurse include in this presentation? Select all that apply.

-A blood test will confirm the diagnosis. -Syphilis signs and symptoms are divided into stages. -Syphilis can be spread through vaginal, anal, or oral sex.

The nurse is teaching a new mother how to care for her newborn. The nurse notes that the client is very fearful and reluctant to handle the newborn and also notes that this is the client's first child. Which nursing interventions are most appropriate in assisting the promotion of mother-infant interaction and bonding? Select all that apply.

-Accepting the client's feelings -Acknowledging the client's apprehension -Assisting the client with giving the baths to allow her to become more at ease

The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply.

-Allows for fetal movement -Surrounds, cushions, and protects the fetus -Maintains the body temperature of the fetus -Can be used to measure fetal kidney function

danger signs after induction of anesthetic

-BP <100 maternally -fetal distress -minimal/absent variability -late decelerations

•When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? Select all that apply.

-FHR of 100bpm -minimal variability on fetal heart monitor

The nurse is performing an assessment of a primigravida who is being evaluated in a clinic during her second trimester of pregnancy. Which findings concern the nurse and indicate the need for follow-up? Select all that apply.

-Fetal heart rate of 180 beats/minute -Elevated level of maternal serum alpha-fetoprotein (MSAFP)

The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The health care provider has documented the presence of first trimester pregnancy signs. Which signs should the nurse anticipate as being present during this time frame? Select all that apply.

-Goodell's sign -Chadwick's sign -Hegars sign

A 16-year-old female visits a local women's health clinic to obtain contraception. She asks the nurse, "What can I do to protect myself from diseases like AIDS?" Which recommendations are appropriate for anyone who is sexually active to prevent STIs? Select all that apply.

-Have regular checkups for STIs even in the absence of symptoms. -Learn the common symptoms of STIs and seek help immediately if any develop—even if the symptom is mild. -Avoid anal intercourse, but if practiced, use a male condom.

The nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The nurse determines that the client has understood the instructions if she makes which statements? Select all that apply.

-I should wear a bra that provides support -drinking alcohol can effect my milk supply -the use of caffeine can reduce my milk production -"I plan on having bottled water available in the refrigerator so I can get additional fluids easily."

The nurse is assessing the fundus in a postpartum woman and notes that the uterus is soft and spongy and not firmly contracted. The nurse should prepare to implement which interventions? Select all that apply.

-Massaging the uterus -Assisting the woman to urinate -Checking for a distended bladder

What are the recommendations of The Joint Commission for creating a safe, welcoming environment for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients? Select all that apply.

-Provide information on the special health care concerns of LGBTQ patients. -Use the patient's choice of terminology in communication and documentation. -Keep a patient's bill of rights and nondiscrimination policies visible to patients.

what is an ectopic pregnancy

-Tubal pregnancy, fertilized egg develops outside the uterus -establishes itself somewhere other than inside the uterus.

signs that the placenta is about to be delivered

-Umbilical cord starts to lengthen -Trickling/gush of blood -uterus changes from an oval shape to globular.

A nurse is teaching parents about normal developmental aspects of sexuality in their children. Which statements from parents would warrant further teaching? Select all that apply.

-When my 2-year-old son touches his genitals, I push his hand away and tell him 'No'. -I should wean my infant by 4 months and encourage him to use a sippy cup. -I should teach my 10-year-old about contraception and ways to avoid sexually transmitted diseases. -I should allow my teenager to establish her own beliefs and moral value system by not sharing my own beliefs."

A patient is currently 34 weeks pregnant with her first baby. Which findings below could indicate the development of preeclampsia in this patient that would need to be reported to the physician? Select all that apply:

-a 3+ dipstick urine protein -0800 : BP 142/92, 1230: BP 144/98

A male-to-female patient is beginning estrogen therapy. Which pieces of data obtained from the patient's history are of particular concern to the nurse? Select all that apply.

-body mass index of 32 -one pack per day smoker -takes multiple medications for blood pressure control Estrogen therapy is associated with various health risks, including venous thromboembolism, hypertension, and elevated glucose levels

increased risk for cervical cancer

-low socioeconomic status -early sexual activity (before 17 years of age) -multiple sexual partners -infection with human papillomavirus (HPV) -immunosuppression -smoking.

medication to treat erectile dysfunction

-sildenefil (avoid nitrase can cause hypotension) -vardenefil *end in "FIL"*

The nurse is caring for a client in labor and notes that minimal variability is present on a fetal heart rate (FHR) monitor strip. Which conditions are most likely associated with minimal variability? Select all that apply.

-tachycardia -fetal hypoxia -metabolic academia -congenital anomalies Minimal variability is defined as fluctuations that are fewer than 6 beats/minute. Tachycardia, fetal hypoxia, metabolic acidemia, and congenital anomalies are all associated with possible minimal variability.

The nurse is providing instructions to a pregnant client with genital herpes about the measures that are needed to protect the fetus. Which instruction should the nurse provide to the client?

A cesarean section will be necessary if vaginal lesions are present at the time of labor.

Which statement by the patient (who is 5'5 127 lbs) would cause you to re-educated the patient about nutrition during her pregnancy?

I can expect to gain 50-60lbs during my pregnancy If a woman has a normal pre-pregnancy weight she should expect to gain 25 to 35 lbs during her pregnancy.

A patient in the early stages of pregnancy is suffering from "morning sickness". Which statement by the patient requires you to further educate the patient about this condition?

I have been addicted to Mexican food and fried pickles recently

The nurse is teaching a patient about taking tadalafil (Cialis) for erectile dysfunction. Which statement by the patient indicates a need for further teaching?

I must have sex within an hour after taking the drug.

The male-to-female transgender patient has been prescribed estrogen therapy. Which statement made by the patient indicates she understands the potential side effects of the medication?

I shouldn't sit for long periods of time because this medication increases my risk of blood clots."

The male-to-female (MtF) patient is seeking gender reassignment surgery. Which statement made by the patient indicates she will not be a candidate for this surgery?

I take a beta blocker for my coronary artery disease Patients who have poorly controlled diabetes with vascular complications, coronary artery disease, or another systemic disease that limits functional ability are not candidates for gender reassignment surgery.

The nurse is teaching a group of young women about screening for chlamydia. Which patient statement shows a correct understanding of these practices?

If I am a 40-year-old woman with a 'new' partner, I should be screened again. Women older than 25 years with new or multiple partners should be screened annually for chlamydia. All sexually active women 25 years old or younger should be screened annually for chlamydia.

The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2°F (37.8°C). What is the priority nursing action?

Increase hydration by encouraging oral fluids. Temperatures up to 100.4°F (38°C) in the first 24 hours after birth often are related to the dehydrating effects of labor.

A patient tells you she has used bath salts and marijuana during the first 10 weeks of her pregnancy because she "didn't know she was pregnant". Which statement is correct about substance abuse during pregnancy?

Substance abuse places the pregnancy at risk for fetal growth restriction and abruptio placentae

A pregnant client tells the clinic nurse that she wants to know the sex of her baby as soon as it can be determined. The nurse informs the client that she should be able to find out the sex at 12 weeks' gestation because of which factor?

The appearance of the fetal external genitalia

A pregnant client being admitted to the labor room tells the nurse that she felt a large gush of fluid before arriving at the hospital. The nurse performs an assessment on the client and notes that the fetal heart rate is 90 beats/minute and that the umbilical cord is protruding from the vagina. What is the appropriate nursing action?

Wrap the cord loosely in a sterile towel saturated with warm, sterile normal saline.

A client who has just been told that she is pregnant wants to know when the baby's heart will be completely developed and beating. The nurse reads in the client's chart that the health care provider has determined the client to be at 6 weeks' gestation. What is the nurse's bestresponse?

Your baby's heart right now has double heart chambers and has begun to beat, so we should be able to see it beat using an ultrasound machine.

What clinical finding in a postmenopausal patient with urethritis does the nurse attribute to low estrogen levels?

a pelvic examination shows tissue changes

The nurse is caring for a client in the active stage of labor. The nurse notes that the fetal pattern shows a late deceleration on the monitor strip. Based on this finding, the nurse should prepare for which appropriate nursing action?

administering oxygen via face mask Late decelerations are caused by uteroplacental insufficiency as a result of decreased blood flow and oxygen to the fetus during the uterine contractions.

The nurse knows that preeclampsia tends to occur during what time in a pregnancy?

after 20 weeks

•A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:

alteration in the pattern of fetal movement

education for testosterone cream

always wash hands after use

The nurse is preparing to perform a fundal assessment on a postpartum client. The nurse understands that which is the initial nursing action when performing this assessment?

ask the client to urinate and empty her bladder

How would the nurse check for clonus in a patient with preeclampsia?

assess for beating of the foot when the foot is quickly dorsiflexed

The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks' gestation. What is the priority nursing action for this client?

assess for signs and symptoms of labor As a result of the sedative effect of the magnesium sulfate, the client may not perceive labor.

late deceleration characteristics

at end of contraction, FHR drops and then gradually increases

During physical assessment of a pregnant female, it is noted that there is movement and recoil of the fetus against the examiner's fingers when the uterus is palpated. This is termed as?

ballottement

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe

bloody show

The postpartum client asks the nurse about the occurrence of afterpains. The nurse informs the client that afterpains will be especially noticeable during which activity?

breastfeeding

hat is the most important nursing intervention during an interview with a patient suspected of having gonorrhea?

building a trusting relationship

Your laboring patient has transitioned to stage 2 of labor. What changes in the perineum indicate the birth of the baby is imminent?

bulging perineum and rectum with an increase in blood show

Which medication is the drug of choice for treating gonorrhea?

ciftriaxone

if baby is at a higher fetal station when the water breaks, what is baby at risk for

cord prolapse

The nurse is monitoring a client in labor whose membranes ruptured spontaneously. What is the initial nursing action?

determine the fetal heart rate When the membranes rupture in the birth setting, the nurse immediately assesses the fetal heart rate to detect changes associated with prolapse or compression of the umbilical cord

The nurse is caring for Brian Wayne, a patient whose natal sex is male. The patient tells the nurse that he identifies as a female. How should the nurse address the patient?

my name is Ann, how would you like me to address you

The nurse is teaching a female patient about managing her sexually transmitted infection (STI) with antibiotics. Which patient statement indicates that teaching has been effective?

my oral contraceptive might not be as effective

blood pressure medication giving with mag sulfate

nifedipine

based on the nurses knowledge pf the extrusion reflex, the nurse informs new parents to feed their baby solids when he or she

no longer pushes his tongue against anything that touches it, usually at about 4 to 6 months

The nurse has assisted in performing a nonstress test on a pregnant client and is reviewing the documentation related to the results of the test. The nurse notes that the health care provider has documented the test results as reactive. How should the nurse interpret this result?

normal findings

pathological jaundice

occurs before 24 hours and may indicate early hemolysis -physiologic jaundice is caused by blood incompatibilities between mother and infant blood types

A woman in active labor has requested a regional anesthetic. She is currently 5 cm dilated. The health care provider has prescribed an epidural block. Which nursing intervention should be implemented after the epidural block has been placed?

palpate the bladder at frequent intervals The woman loses the sensation that she needs to urinate

treatment for syphilis

penicillin G benzathine

The nurse is caring for a patient with erectile dysfunction who has not had success with other treatment modalities. The nurse anticipates that the health care provider will recommend which treatment for this patient?

penile implants Penile implants (prostheses), which require surgery, are used when other modalities fail. Devices include semirigid, flexible, or hydraulic inflatable and multicomponent or one-piece instruments. Penile injections are tried before using the option of last resort. Transurethral suppository is tried before using the option of last resort. A vacuum constriction device is easy to use and is often the first option that is tried.

You're performing a routine assessment on a mother post-delivery. The uterus is soft and displaced to the left of the umbilicus. What is your next nursing action?

perform fundal massage and assist the patient to the bathroom

The nurse has just started a new shift and is reviewing the chart for her assigned patient. The patient is 6 cm dilated, 100% effaced, -3 station with intact membranes. Ten minutes later, the patient informs the nurse that her membranes have just ruptured. The nurse notices variable decelerations on the monitor. The nurse's next action should be to:

perform vaginal exam •A vaginal exam may be performed to check for a prolapsed cord, with a pattern of variable decelerations. It is important to notify the primary care provider of this pattern; however, it is not the first priority. Variable decelerations are nonreassuring and not a normal pattern after membranes rupture.

Which medication, if present in the client's history, indicates a need for teaching related to the woman's potential risk for carrying a fetus with a congenital cleft lip or cleft palate?

phenytoin An antiseizure medication (specifically phenytoin) taken during pregnancy is a known risk factor

•A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority?

place the woman in the knee to chest position A. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord

•A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

placental abruption

genital herpes

presence of 1 or more vesicles that then rupture and heal.

Which category of pregnancy signs are subjective and can only be reported by the patient?

presumptive signs

You are doing an assessment on a female patient. She tells you she gave birth to twin girls at 39 weeks. You would chart the following regarding parity?

primipara

The nurse is taking a health history from a man who is concerned about sexual functioning and maintaining an erection. Which of the client's medications could be the cause of erectile dysfunction?

propranolol Patients taking antihypertensive medications such as amlodipine, lisinopril, propranolol, and clonidine should be closely assessed for erectile dysfunction. Beta-blockers can affect the nervous system reaction that leads to an erection

A 25-year-old female, who is 18 weeks pregnant, reports feeling fluttering in her lower abdomen. She states it feels like the baby is moving. This is known as:

quickening

Your patient who is 17 weeks pregnant describes to you she has been feeling the baby move. Which terms describes this movement?

quickening

A pregnant patient has a nonstress test performed. The results showed the baby had 4 fetal heart rate accelerations of at least 15 beats/min that lasted 15 seconds from start to finish in association with fetal movement during 20 minutes. The results of this would be documented as:

reactive non stress test baby is healthy

A patient who is 8 1/2 months pregnant tells you she has been counting her baby's kicks and is concerned because within a 4 hour period the baby has only kicked 32 times. What nursing intervention is correct?

reassure the patient this kick count is normal Reassuring the patient this is normal is the correct answer. The mother should feel the baby kick at least 10 times in two consecutive 2 hour periods.

Ballotement

rebound of unengaged fetus upon palpitation

The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primaryphysiological need at this time?

rest between contractions

amount of flow: scant

scant = less than 2.5 cm (<1 inch) on menstrual pad in 1 hour

what is a triple screen test

screening tool -Maternal blood is drawn -alpha-fetoprotein -human chorionic gonadotropin -estriol values *assessed to determine if the mother is at an increased risk for neural tube defects or chromosomal trisomies*

•A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:

seizures do not occur A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures

Debbie is a male-to-female transgender presenting to the clinic in a dress and heels. Debbie's gender is listed as male in the medical records. What pronoun does the nurse use when referring to Debbie?

she

During stage 3 of labor, you note a gush of blood and that the uterus changes shape from an oval shape to globular shape. This indicates?

signs of placental separation

hegars sign

softening of the lower uterine segment

A patient on long-term testosterone therapy should be monitored for which of the following comorbidities?

stroke Increased blood glucose and decreased clotting factors can occur when taking testosterone. These changes can lead to diabetes, heart disease, and stroke

The transgender patient is at highest risk for which of the following conditions?

substance abuse

Which bacterial sexually transmitted infection (STI) would the nurse suspect if a laboratory examination of a specimen collected from a patient's indurate lesion revealed the presence of spirochete?

syphilis

•After monitoring the fetal heart rate for 10 minutes, the nurse notices the rate is staying at 175 bpm. The nurse is correct in classifying this baseline rate as:

tachycardia Tachycardia is a heart rate greater than 160 bpm, persisting for at least 10 minutes

What does the nurse teach the patient about oral antibiotic therapy for sexually transmitted infections (STIs)?

take antibiotics on an empty stomach the patient must avoid taking antacids containing magnesium as they interfere with the effectiveness of the antibiotics. The patient should drink at least 8 to 10 glasses of fluids a day while on antibiotic therapy and must abstain from sexual activity until both the patient and partner(s) complete therapy.

On the fetal heart monitor you see early decelerations. What is the cause of this finding?

the baby head is pressing against the pelvis or soft tissue

•A woman who is 6 weeks' pregnant is scheduled for an ultrasound. She asks the nurse what can be seen at this stage of the pregnancy. The nurse would be correct if she responded:

the babys heartbeat

a first time father is concerned that his 3 day old daughters skin looks yellow. in the nurses explanation of physiologic jaundice, which point should be included

the bilirubin levels of physiological jaundice peak at 5 to 7 mg/dL between the second and fourth days of life -bili light -put them outside in the sun

•A woman had a chorionic villus sampling procedure. Prior to discharge the nurse should teach her to report what symptom that may be an indication of a complication?

vaginal bleeding or passage of amniotic fluid suggests possible miscarriage and should be reported. Chorionic villus sampling is done between 10 and 12 weeks of gestation

what should be the nurses initial action when caring for an infant with a slightly decreased temp

wrap the infant in two warmed blankets and place a cap on his or her head