Maternal Health EAQ
What is the best advice a nurse can provide to a pregnant woman in her first trimester? "Cut down on drugs, alcohol, and cigarettes." "Avoid drugs and don't smoke or drink alcohol." "Avoid smoking, limit alcohol consumption, and don't take aspirin." "Take only prescription drugs, especially in the second and third trimesters."
"Avoid drugs and don't smoke or drink alcohol." The first trimester is the period when all major embryonic organs are forming; drugs, alcohol, and tobacco may cause major defects. Cutting down on these substances is insufficient; they are teratogens and should be eliminated. Even 1 oz of an alcoholic drink is considered harmful; baby aspirin may be prescribed to some women who are considered at risk for pregnancy-induced hypertension; however, not during the first trimester. Medications, unless absolutely necessary, should be avoided throughout pregnancy; however, the first trimester is most significant.
During an assessment interview the nurse concludes that the client has been experiencing menorrhagia. Which client statement led to this conclusion? "It hurts when I have intercourse." "I have a foul-smelling vaginal discharge." "I have bleeding between my menstrual periods." "I have severe bleeding during my menstrual periods."
"I have severe bleeding during my period." Menorrhagia is severe bleeding during a menstrual period. Painful intercourse is the definition of dyspareunia. Foul-smelling vaginal discharge is a sign of a vaginal infection. Metrorrhagia is uterine bleeding that occurs at any time other than during the menstrual period. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.
A client on her first prenatal clinic visit is at 6 weeks' gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond? "What activities does your job entail?" "How do you feel about continuing to work?" "Most women work throughout their pregnancies." "Usually women quit work at the start of their third trimester."
"What activities does your job entail?" More information is needed before the nurse can give a professional response. Although it is important to ascertain the client's feelings about continuing to work, at this time she is seeking information. Although it is true that most women work throughout their pregnancies, more information is needed before the nurse can respond. It is misinformation to state that usually women quit work at the start of the third trimester.
A pregnant client is now in the third trimester. The client tells the nurse, "I want to be knocked out for the birth." How should the nurse respond? "You are worried about too much pain." "You don't want to be awake during the birth." "I can understand that because labor is uncomfortable." "I will tell your healthcare provider about this request."
"You don't want to be awake during the birth."
A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January? 7 16 24 29
16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.
The nurse teaches a high school sex education class that herpes genitalis infection cannot be cured, but the disease is marked by remissions and exacerbations. What else should the students be taught about this infection? A healthy lifestyle will prevent exacerbations. Once the infection is effectively treated, exacerbations are rare. Although exacerbations occur, they are not as severe as the initial episode. The most effective way to prevent exacerbations is to abstain from sexual activity.
Although exacerbations occur, they are not as severe as initial episode. The initial infection is both local and systemic; exacerbations are milder and localized. Although optimum health habits may limit exacerbations, they will not prevent them. There is no treatment that will limit the number of exacerbations. Exacerbations are precipitated by physical and emotional stress, not by sexual activity.
All women of childbearing age are advised to include at least 400 mcg of folic acid in the daily diet to decrease the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. Vitamin A Vitamin B6 Vitamin B9 Vitamin B12 Legumes, dark-green leafy vegetables, and citrus fruits Eggs, meat, and poultry
B9 Legumes, leafy greens, veggies, citrus Vitamin B9 is folic acid, and legumes, dark-green leafy vegetables, and citrus fruits are natural sources of folic acid. Most women receive adequate vitamin A in their diets, and too much may cause birth defects. Vitamin B6 aids in metabolism conversion and the formation of red blood cells. Vitamin B12 is associated with nerve cells and red blood cells. Eggs, meat, and poultry are sources of vitamin B12.
A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely? Respiratory Reproductive Integumentary Cardiovascular
Cardiovascular Syphilis is primarily a vascular disease; aortitis, valvular insufficiency, and aortic aneurysms are the most prevalent problems in tertiary syphilis. Although lesions may occur around the mouth (chancre in primary syphilis, mucous patches in secondary syphilis), the structures of the respiratory tract are not the major structures involved in tertiary syphilis. Although lesions occur on the genitalia in primary and secondary syphilis, the reproductive system is not the major body system affected by tertiary syphilis. A gumma skin lesion is the least commonly occurring lesion associated with tertiary syphilis; skin lesions, such as macular and papular eruptions, most commonly occur in secondary syphilis.
A nurse is teaching a class of expectant parents about changes that are to be expected during pregnancy. Which changes does the nurse explain result from the melanocyte-stimulating hormone? Select all that apply. Chloasma Linea nigra Effacement Morning sickness Cervical softening Urinary frequency
Cholasma Linea nigra Melanocyte-stimulating hormone during pregnancy causes pigmentation over the bridge of the nose and cheeks (chloasma, mask of pregnancy). The concentration of melanocyte-stimulating hormone increases from the end of the second month of pregnancy until term, causing in some women a line of pigmentation on the abdomen from the umbilicus to the symphysis pubis (linea nigra). Effacement of the cervix is a result of increased mucoidal secretion and the effects of labor. A high level of chorionic gonadotropin, secreted by the placental chorion, is associated with the nausea and vomiting that may occur early in pregnancy. Cervical softening occurs as a result of increased mucoidal secretions and the effects of labor. Urinary frequency is related to advancing growth and pressure of the uterus on the bladder. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
A 28-year-old woman comes into the clinic and tells the nurse that she fears that she is infertile, because she has been trying to become pregnant unsuccessfully for 2 years. While collecting the health history the nurse learns that the client experiences irregular and infrequent menstrual periods. The client is overweight and has severe acne and alopecia. The primary healthcare provider diagnoses the condition polycystic ovarian syndrome (PCOS). Which of the following interventions is the most important? Consoling the client over her inability to have children Discussing weight loss, exercise, and a balanced low-fat diet Providing information to the client on how to prepare for surgery Informing the client that there are no long-term complications of PCOS
Discussing weight loss, exercise, and a blanced low-fat diet Weight loss, exercise, and a balanced low-fat diet can reduce insulin and androgen levels related to PCOS. Meeting with a dietitian may be helpful. Surgery is not necessary at this time. The primary healthcare provider would most likely prescribe hormones, other medications, or both. If pregnancy does not occur, surgery is an option. Pregnancy may be possible with hormones, other medications, or both. Early detection of PCOS is important, because the condition can lead to type 2 diabetes; hypertension; cardiovascular disease; and ovarian, breast, and endometrial cancers. The nurse should encourage treatment compliance and positive lifestyle changes.
A 24-year-old woman wants to use her basal body temperature (BBT) in natural family planning but is unsure when to take her temperature. When should the nurse explain is the best time for accurate BBT assessment? Each night right before bed On the first day of her next menstrual cycle Each morning before getting out of bed or increasing her activity At bedtime beginning on day 14 of her menstrual cycle and continuing until her next period
Each morning before getting out of bed or increasing her activity. The most accurate BBT is taken before a woman gets out of bed and begins any type of activity that could increase the body's temperature even slightly. BBT should be charted daily on a calendar to permit interpretation of temperature fluctuations. A BBT taken in the evening may be increased after a day of activity. Daily assessment and recording of BBT during the first half of the menstrual cycle is also crucial, because a woman's BBT is lower then than during the second half of her cycle. The BBT temperature may rise slightly with ovulation.
Genetic testing is being discussed with a couple at the fertility clinic. What is the nurse's best response when they express concerns? "You should be tested because it will be to your benefit." "Environmental factors can have an effect on genetic factors." "This type of testing will determine whether you'll need in vitro fertilization." "If you have a gene for a disease there is a probability that your children will inherit it."
Environmental factors can have an effect on genetic factors. Stating that environmental factors can have an effect on genetic factors is an accurate, objective statement that should be included in a discussion of genetic factors that influence fertility. Telling the clients that they should get tested because it will be to their benefit is not the role of the nurse; the objective data imparted by the nurse should allow the couple to decide whether to be tested. Whether the couple will require in vitro fertilization or whether the couple's children might inherit a genetic disorder is not relevant at this time, and this information might cause unnecessary concern.
A nurse is discussing informed consent with a client who is scheduled for a hysterectomy. What components should the informed consent include? Select all that apply. Duplicate of the Patient's Bill of Rights Explanation of available alternative treatments Answers to questions and concerns about the procedure Complete description of the possible dangers and discomforts Countersignature by the person designated in the client's living will
Explanation of available alternative treatments Answers to questions and concerns about the procedure Complete description of the possible dangers and discomforts Alternative treatment regimens should be discussed so that the client may make an informed choice about which course of treatment to pursue. All questions should be answered honestly and in terms that the client can understand. A description of all potential complications is required for a client to give informed consent. A copy of the Patient's Bill of Rights is not necessary for informed consent for treatment. A countersignature is not necessary if the client is an independent adult.
A nurse is writing a teaching plan about osteoporosis. How would the nurse best explain what osteoporosis is? It is avascular necrosis. It is caused by pathologic fractures. It is hyperplasia of osteoblasts. It involves a decrease in bone substance.
It involves a decrease in bone substance Osteoporosis involves as defect in bone matrix formation that weakens the bones, making them unable to withstand usual functional stresses. Avascular necrosis is death of bone tissue that results from reduced circulation to bone. Pathologic fractures can result from osteoporosis. Hyperplasia of osteoblasts is not related to osteoporosis. This occurs during bone healing.
During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because of the presence of a white curdlike vaginal discharge. What other finding supports a fungal vaginal infection? A foul odor An itchy perineum An ischemic cervix A forgotten tampon
Itchy perineum An itchy perineum usually occurs with candidiasis, a fungal infection; pruritus is the most common symptom. An odorous, frothy greenish discharge occurs with trichomoniasis, a protozoal infestation. Ischemia of the cervix is not associated with candidiasis; candidiasis causes vaginal and cervical inflammation. A forgotten tampon may cause bacterial, not fungal, vaginitis.
A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply.
Obestiy Cigarette Smoking Family history Previous hormone therapy Obesity is a risk factor for endometrial cancer because adipose cells store estrogen; the extent of exposure to estrogen is the most significant risk factor. Nulliparity, not multiparity, is a risk factor for endometrial cancer because of the increased exposure to estrogen. Cigarette smoking has been identified as a risk factor for endometrial cancer. Late, not early, onset of menopause is a risk factor for endometrial cancer because of the increased exposure to estrogen. Although endometrial cancer has not been proven to have a genetic predisposition, it is more common in families who have gene mutations for hereditary nonpolyposis colon cancer.
A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. Fluid overload Intermittent diarrhea Pale mucous membranes Difficulty emptying the bladder High hemoglobin and hematocrit levels
Pale mucous membranes Difficulty emptying the bladder Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.
The nurse is interviewing a 41-year-old woman who is being seen in the infertility clinic for her first visit. She and her husband have been married for 3 years and have not used any form of contraception during this time. Neither the woman nor her husband has children from previous relationships. She asks the nurse what test or treatment will be done first. What should the nurse inform her that she and her husband should expect? A laparoscopy The start of fertility medication A hysteroscopy Semen analysis
Semen analysis Semen analysis is painless, is less costly than other interventions, and provides important information regarding the male partner's fertility. Fertility medication would not be initiated until an evaluation of ovulatory function had been completed. Simpler evaluations and therapies are completed before more complex efforts such as surgical procedures like laparoscopy and hysteroscopy are performed.
Which cervical changes are observed during pregnancy? Select all that apply. The cervical tip becomes soft. The fragility of cervical tissues decreases. The volume of cervical muscles increases. The external cervical os appears as a jagged slit. The elasticity of cervical collagen-rich connective tissue increases.
The cervical tip becomes soft. The volume of cervical muscles increases. The elasticity of cervical collagen-rich connective tissue increases.
A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. What should the nurse explain regarding informing the client's parents? They need to know about and sign a consent form for testing and treatment. They will not be contacted, because treatment at the clinic is confidential. They will be notified when the insurance company is billed for testing and treatment. They will remain uninformed if the adolescent ensures that her sexual contacts will come for testing.
They will not be contacted, because treatment at clinic is confidential. Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations; there is a concern that these teenagers will not seek or continue treatment if they fear disclosure. To maintain confidentiality, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Most family planning clinics receive funding and charge on a sliding scale based on income, thus encouraging adolescents to seek treatment. Telling the client that her parents will not be notified as long as she ensures that her sexual contacts come in for testing could be viewed as coercion; if the STI is reportable, follow-up of sexual partners is indicated, but the adolescent is not responsible for ensuring that they report for testing.
A nurse is teaching a class regarding childbearing and contraceptive options. The nurse explains that fertilization of the ovum by the sperm occurs during a very specific time frame. Which statement best describes when fertilization occurs? As the ovum leaves the ovary When one sperm penetrates the wall of the ovum When the ovum reaches the endometrium of the uterus As one sperm prevents the ovum from moving along the tube
When one sperm penetrates the wall of the ovum. Fertilization occurs when one sperm penetrates one ovum, producing a viable zygote. Fertilization occurs in the fallopian tube, not when the ovum is expelled from the ovary or in the uterus. After the sperm penetrates the ovum in a fallopian tube, the impregnated ovum travels down the tube to the uterus.
Hysterosalpingography (HSG) is performed to determine whether a client has a tubal obstruction. The nurse explains to the client that infertility caused by a defect in the tube is most often related to what? tubal injury Past infection A fibroid tumor congenital anomaly
past infection Past pelvic infections may result in tubal occlusions, most of which are caused by postinfection adhesions. Although tubal injury is possible, tubal infections are more common. Fibroid tumor is a benign tumor of the uterus and does not affect the tube. Tubal congenital anomalies are rare; uterine anomalies are more common.