Maternity and Women's Health Nursing - Women's Health
Having support persons use back massage techniques
The nurse is teaching a prenatal breathing and relaxation class. What does the nurse suggest to best ease back discomfort during labor?
"My sister is lucky, because she won't have a period again."
A 17-year-old client tells the nurse that her sister had an ectopic pregnancy about 3 months ago and had to have her fallopian tube removed. The nurse determines that this young woman needs additional information when she states:
Notifying the surgeon that the client needs more information
A female client is scheduled for a hysterectomy. While discussing the preoperative preparations, the nurse determines that the client's understanding of the surgery is inadequate. What is the next nursing intervention?
Ova can be harvested and frozen for future use.
A female client with Hodgkin's disease is to start chemotherapy. She and her husband have been trying to have a child and are quite concerned when they learn that sterility may result. On what information should the nurse base the reply?
May be related to an increased human chorionic gonadotropin level
A pregnant client is experiencing nausea and vomiting. The nurse determines that this discomfort:
An incisional nick in the bladder
After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect?
Taking-in
After an emergency cesarean birth, the client tells the nurse that she was hoping for a "natural" childbirth but is glad that she and her baby are all right." Which postpartum phase of adjustment does this statement most closely typify?
"Let's unwrap your baby so you can see for yourself."
After an uneventful 8-hour labor a client gives birth. Once the airway has been ensured and the neonate has been dried and wrapped in a blanket, the nurse places the newborn in the mother's arms. The mother asks, "Is my baby normal?" What is the best response by the nurse?
Blood pressure
After the client gives birth her vital signs are temperature 99.3° F (37.4° C); pulse 80 beats/min, regular and strong; respirations 16/min, slow and even; and blood pressure 148/92 mm Hg. Which vital sign should the nurse check more frequently?
Active phase
Although a client in labor is prepared and plans to participate in the labor and birth process, she states that she is in severe discomfort. The nurse administers the prescribed butorphanol (Stadol). Which phase of labor is the safest time for the nurse to administer this medication?
Talk softly and cuddle the baby when crying occurs
An adolescent who gave birth one day ago confides to the nurse that she hopes that her baby will be good and sleep through the night. What should the nurse include in the plan of care to facilitate a realistic expectation of a nighttime newborn schedule?
Chest pain Breast soreness Calf tenderness
An estrogen-progestin oral contraceptive is prescribed for a client. Which adverse effects should the nurse teach the client to report to the health care provider? (Select all that apply.)
"Yes, you're risking kidney damage."
An older female client tells the nurse in the clinic that she has a cystocele that was diagnosed a year ago. She has urinary frequency and burning on urination. The client asks, "The doctor wanted me to have surgery for the cystocele last year, but I can manage with peripads. It won't hurt not to have surgery, will it?" How should the nurse respond?
Oral drugs Transdermal agents
Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component? (Select all that apply.)
Obtaining the client's weight and blood pressure
During a routine prenatal office visit at 26 weeks' gestation, a client states that she is getting fat all over and that she even needed to buy bigger shoes. What is the next nursing action?
Many women incorrectly equate hysterectomy with loss of libido.
During discharge teaching a client who just had a hysterectomy states, "After this surgery, I don't expect to be interested in sex anymore." What should the nurse consider before responding?
Avoid sitting for long periods of time.
During the discharge conference with a client who has had a hysterectomy the nurse includes instructions for avoiding the thromboembolic phenomena that may occur as a complication. What should these instructions include?
Helping the client void
During the fourth stage of labor, the assessment of a primipara who has had a vaginal birth reveals a moderate to large amount of lochia rubra, a firm fundus that is at the umbilicus and deviated to the right, and pain that she rates as a 3 on a scale of 1 to 10. What is the priority nursing action?
"You should use foam with a condom to prevent pregnancy — this is the safest method for women with your illnesses."
During the postpartum period a client with heart disease and type 2 diabetes asks a nurse, "Which contraceptives will I be able to use to prevent pregnancy in the near future?" How should the nurse respond?
Abdominal pain Rising temperature
Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. Which symptoms are suggestive of a vaginal infection? (Select all that apply.)
Type A or B
Laboratory studies reveal that a pregnant client's blood type is O, and she is Rh positive. The client asks whether her newborn will have a problem with blood incompatibility. Before responding, the nurse must remember that fetal problems may develop if the fetus is:
Pelvic rocking Forward tilting Sacral pressure
Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching has been understood? (Select all that apply.)
Symptoms of the disease are vague. The incubation period is relatively short. Causative organisms have become resistant to treatment.
The nurse is teaching a sex education course to high school students. What should the nurse teach them about why gonorrhea is difficult to control? (Select all that apply.)
Palpating each breast while in the sitting position
The nurse presents a program on breast self-examination. After a return demonstration the nurse concludes that she needs to review certain aspects of the teaching program. Which behavior by one of the students supports this conclusion?
To consider that someone recorded the gravida and para incorrectly
The nurse reads the history of a neonate admitted to the nursery and discovers that the infant's mother was listed as gravida 1 para 1 before the baby was born. How should the nurse use these data to gather more information?
Electronic Doppler ultrasonography at 10 to 12 weeks
The nurse should explain to the newly pregnant primigravida that the fetal heartbeat will first be heard with:
Carrots Sweet potatoes
The nurse teaches a client about the increased need for vitamin A to meet the demands imposed by rapid fetal tissue growth during pregnancy. Which foods should the nurse encourage the client to ingest to meet this increased need? (Select all that apply.)
Although exacerbations occur they are not as severe as the initial episode.
The nurse teaches a high school sex education class that herpes genitalis infection cannot be cured but that the disease is marked by remissions and exacerbations. What else should the students be taught about this infection?
Neural tube defects
The nurse teaches a pregnant client why she needs a folic acid supplement. Which neonatal disorder does folic acid prevent?
d
The partner of a woman experiencing back pain in labor asks what he can do to help. The nurse demonstrates how to apply counterpressure to his partner's back. Where on the image should counterpressure be applied?
24 hours
The school nurse is teaching a group of 16-year-old girls about the female reproductive system. One student asks how long after ovulation it is possible for conception to occur. The most accurate response by the nurse is based on the knowledge that an ovum is no longer viable after:
Propranolol (Inderal)
What antidote to the side effects of terbutaline (Brethine) should a nurse have available?
Will be encouraged to participate in his care as much as possible
When seeing her preterm infant son in the neonatal intensive care unit for the first time, a mother exclaims, "He's so little! How will I ever be able to take care of him?" The nurse explains to the mother that she:
Pinkish brown
The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day?
60 g
The nurse instructs a pregnant client in the sources of protein that can be used to meet the increased daily requirement during pregnancy. How many grams of protein should the client eat each day?
Perineal care
The nurse is caring for a client who is in the taking-in phase of the postpartum period. The area of health teaching that the client will be most responsive to is:
Ambivalence and anxiety about mothering are common.
The nurse is caring for a first-time mother at her first prenatal visit. The client confides, "I'm not sure about all this." Which research-based knowledge guides a nurse regarding the emotional factors of pregnancy?
Giving birth to a baby weighing 9 lb 8 oz
The nurse is caring for a group of postpartum clients. Which factor puts a client at increased risk for postpartum hemorrhage?
"This seems to be uncomfortable for you, but I have to estimate the amount of blood loss to prevent any problems."
As the nurse helps a postpartum client change her perineal pad, the client comments, "I wish you didn't have to look at the pad it's embarrassing for me." What is the best nursing response?
Administering RhoGAM within 72 hours
At 12 weeks' gestation, a client who is Rh negative expels the total products of conception. What is the nursing action after it has been determined that she has not been previously sensitized?
October 28
At a client's first visit to the prenatal clinic, the nurse asks the client when she had her last menstrual period so the estimated date of birth (EDB) can be determined. The client responds, "January 21." According to Nägele's rule, what is the month and day of the client's EDB?
Reddish streaks on the abdomen and breasts
At a routine monthly visit, while assessing a client who is in her 26th week of gestation, the nurse identifies the presence of striae gravidarum. The nurse describes this condition as:
Asking her whether she has had German measles and when she had the disease
At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. What intervention is important when the nurse discusses this finding with the client?
Rh-negative and Coombs negative
Before the administration of Rho(D) immune globulin (RhoGAM) the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs test result must a pregnant woman have to receive RhoGAM after giving birth?
10 g
By how much should the nurse instruct a pregnant client to increase her daily protein intake?
Metrorrhagia Bowel strictures Voiding difficulties
The nurse is obtaining a health history from a client with endometriosis. What consequences can occur as a result of this disorder? (Select all that apply.)
Massaging their abdomens gently with their fingertips
During a childbirth class the nurse determines that the women understand how to use effleurage correctly when they are observed:
"The widespread use of elective induction increases the risk of unfavorable outcomes."
During a childbirth class, several participants have questions about the elective induction of labor. One participant states that it is more convenient for a woman with a busy schedule. What evidenced-based information should the nurse provide to the participant?
Fatigue may influence pain medication requirements.
During a class for prepared childbirth, the nurse teacher discusses the importance of the spurt of energy that occurs before labor. Why is it important to conserve this energy?
By ensuring that the client is Rh negative and the neonate is Rh positive
How should a nurse prepare to administer Rho(D) immune globulin (RhoGAM) to a postpartum client?
Cleansing breaths, in which the woman breathes in through the nose and out through the mouth, are used at the beginning and end of each contraction. Slow, deep breaths are used early in the first stage of labor to promote relaxation of abdominal muscles. Modified paced breathing may be used when the woman can no longer walk or talk through contractions; it requires concentration and promotes relaxation and oxygenation. As contractions increase in frequency and intensity, more complex breathing techniques require enhanced concentration and therefore block painful stimuli more effectively. Patterned, paced breathing, such as pant-blow, is used during the transition phase of the first stage of labor. Slow exhalation pushing is used during the second stage to facilitate a controlled birth, minimizing maternal trauma and the need for an episiotomy.
In childbirth classes the nurse is teaching paced breathing techniques for use during labor. In which order should the breathing techniques be used as labor progresses?
Assisting the client to the bathroom to empty her bladder
In the second hour after a client gives birth, her uterus is found to be firm, above the level of the umbilicus, and to the right of midline. What is the appropriate nursing intervention at this time?
An examination of semen will be needed.
On a return visit to the fertility clinic a couple requests fertility drugs because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. What should the nurse explain to the couple?
"They will help stimulate peripheral circulation."
On the first day after a mastectomy, a nurse encourages the client to perform exercises such as flexion and extension of the fingers and pronation and supination of the hand. The client asks why she has to do these exercises. The best response by the nurse is:
Rh positive with a negative Coombs result
Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin ?
Administration of azithromycin (Zithromax) 1 g orally in a single dose
The clinic nurse is planning care for a client found to have chlamydia. Which treatment should the nurse plan to implement?
Fowler
The clinic nurse is providing home care instructions for a client with pelvic inflammatory disease. What resting position should be recommended by the nurse?
Asking the client, "How many servings of dairy do you generally consume each day?"
The clinic nurse is reviewing the dietary intake of a 16-year-old who is 12 weeks pregnant. What is the nurse's next action?
Client voids 300 mL of urine within 4 hours of catheter removal
The day after a client has a cesarean birth, the indwelling catheter is removed. The nurse concludes that urinary function has returned when the:
Menstruation will not occur because the uterus has been removed.
The day after a hysterectomy, the client asks for sanitary pads because she feels that she is going to menstruate. What information should influence the nurse's response?
To prevent social isolation
The healthcare provider of a woman who had a mastectomy has prescribed a Reach to Recovery visit. What does the nurse identify as the primary reason for the referral?
Having four children is tiring and assistance may be needed.
The husband of a woman who had her fourth child 3 weeks ago states she has been irritable and crying frequently since bringing her newborn home. He asks the nurse whether this is normal. The nurse tries to help him understand the situation by stating that:
"I won't have unprotected sex again, and I'll tell my partners to be tested for STIs."
The nurse determines that a young female client who is being treated for a sexually transmitted infection (STI) understands instructions regarding future sexual contacts. Which statement confirms the nurse's conclusion?
During the third trimester
The nurse discusses fetal weight gain with a pregnant client. When does it usually show a marked increase?
150 lb
The nurse discusses the recommended weight gain during pregnancy with a newly pregnant client who is 5 feet 3 inches tall and weighs 125 lb. The nurse explains that with the recommended weight gain, at term the client should weigh about:
"Potential defects caused by chromosomal errors can be detected."
A client who is scheduled for an amniocentesis says, "I'm glad that this test will show if my baby is well." How should the nurse respond?
Instructions relative to diet and exercise
A thin older adult client is found to have osteoporosis. What should the nurse include in the discharge plan for this client?
Screening and testing of sexual partners Intramuscular benzathine penicillin G, 2.4 million units, one dose
A client appears at the clinic after getting a positive result on a home pregnancy test. She states that her last menstrual period began 10 weeks ago. The client expresses fear because she has been recently found to have syphilis. What prescriptions will the nurse expect to receive from the health care provider because of this information? (Select all that apply.)
Insist that her partner use a condom when having sex
A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do?
Abstaining from sexual intercourse
A 16-year-old girl who has become sexually active asks the nurse, "What's the most effective way to prevent a pregnancy?" Which method of preventing pregnancy should the nurse tell her is most effective?
2 to 3 oz
A 2-day-old infant who weighs 6 lb (2722 g) is fed formula every 4 hours. Newborns need about 73 mL of fluid per pound of body weight each day. In light of this information, approximately how much formula should the infant receive at each feeding?
25% or less
A 20-year-old woman is known to be heterozygous for the cystic fibrosis (CF) gene. Her husband's genotype is unknown at present and the couple is expecting their first child. What should the nurse tell the couple about the probability of their baby's having CF?
Late-onset menarche
A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed?
Decrease caffeine intake
A 24-year-old client complains to the nurse in the women's health clinic that her breasts become tender before her menstrual period. What should the nurse recommend that the client do 1 week before an expected menses?
21st day of the cycle
A 30-year-old client with a 35-day menstrual cycle is trying to become pregnant. The nurse counsels the client and her partner about the optimal timing of intercourse during the cycle. The nurse determines that the counseling has been effective when the couple state that they should have intercourse on the:
Loss of femininity
A 30-year-old woman is to undergo total abdominal hysterectomy for noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. What is the most common reason for this difficulty?
History of borderline hypertension
A 31-year-old client is seeking contraceptive information. Before responding to the client's questions about contraceptives, the nurse obtains a health history. What factor in the client's history indicates to the nurse that oral contraceptives are contraindicated?
"A hysterectomy doesn't affect the chronological age when menopause usually occurs."
A 35-year-old client is scheduled for a vaginal hysterectomy. She asks the nurse about the changes she should expect after surgery. How should the nurse respond?
Seven days after each menstrual period
A 36-year-old client undergoes a modified radical mastectomy. The nurse determines that the client understands the schedule for self-examination of her remaining breast when she states that she will examine her breast:
Pain with menses
A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. What is a description of dysmenorrhea?
"This must be so difficult for you. Children are really important to you?"
A 37-year-old woman is admitted to the unit with severe menorrhagia. During a conversation, the nurse learns that the client has a history of fibroids, menorrhagia, pelvic pain, and depression. The client has been undergoing hormone therapy in hopes of easing the symptoms and reducing fibroids' size, without success. The lab reports hemoglobin and hematocrit readings of 6.8 and 20.2, respectively. The client begins to sob and cries, "I don't know what to do — the doctor is recommending a hysterectomy, but I haven't had children yet!" What is the best response by the nurse?
Open neural tube defects
A 38-year-old client attends the prenatal clinic for the first time. A nurse explains that several tests will be performed, one of which is the serum alpha-fetoprotein test. The client asks what the test will reveal. What should the nurse include in the reply?
Expected menopausal changes
A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes?
"You'll need to take it for 5 years, after which it will be discontinued."
A 63-year-old woman with the diagnosis of estrogen-receptor positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen (Nolvadex) is prescribed. The client asks the nurse how long she will have to take the medication. The nurse responds:
Fat in human milk is easier to digest and absorb than the fat in cow's milk.
A breastfeeding mother asks the nurse how human milk compares with cow's milk. How should the nurse respond?
Frequent ambulation is begun within 24 hours.
A client who is pregnant for the first time and carrying twins is scheduled for a cesarean birth. What should preoperative teaching include?
Inform the health care provider of the client's request
A client arrives at the fertility clinic for a diagnostic workup and is told by the nurse to prepare for a Papanicolaou (Pap) test. The client states, "I do not want this test. I want to speak to the person in charge." How should the nurse respond to this statement?
Risk for perforation of the uterus Expulsion of the device Occasional dyspareunia
A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response? (Select all that apply.)
"On the next day take one pill in the morning and one before bedtime."
A client asks the nurse what she should do if she forgets to take the pill one day. How should the nurse respond?
Inevitable abortion
A client at 10 weeks' gestation phones the prenatal clinic to report that she is experiencing some vaginal bleeding and abdominal cramping. The nurse arranges for her to go to the local hospital. The vaginal examination reveals that her cervix is dilated 2 cm. What diagnosis should the nurse expect?
Domestic abuse
A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm:
To improve visualization of the fetus
A client at 16 weeks' gestation is scheduled for a sonogram followed by amniocentesis. The nurse instructs the client to drink 8 oz of fluid and not void before the sonogram. The nurse explains that this is done:
"This is vernix. It helps protect the baby while he's in the uterus."
A client at 37 weeks' gestation gives birth to a healthy boy. While inspecting her newborn in the birthing room, the client becomes concerned and asks, "What's this sticky white stuff all over him?" How should the nurse respond?
Focus on and repeat a rhythmic chant. Eat small, frequent meals and eat dry crackers in between.
A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? (Select all that apply.)
Whole-grain cereals and nuts
A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all the essential amino acids?
October 18
A client attending the prenatal clinic for the first time tells the nurse that her last menstrual period began on January 11 and that she suspects that she is pregnant. The client also states that she had one day of light spotting on February 7. What is the expected date of birth (EDB)?
Asking the client questions, using a postpartum depression scale
A client comes to the clinic for a 6-week postpartum checkup. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information?
May have some persistent shoulder pain for 14 hours after the test
A client comes to the fertility clinic for hysterosalpingography using radiopaque contrast material to determine whether her fallopian tubes are patent. When preparing for the test, the nurse explains to the client that she:
An opportunity for the client to express feelings about her decision should be provided.
A client elects to have her pregnancy terminated after finding out at 16 weeks' gestation that she is carrying a fetus with Down syndrome. What should the nurse conclude about an abortion at this stage of the pregnancy?
Eat a high-fiber diet with increased fluid intake.
A client had a fourth-degree perineal laceration during the birth of her neonate. What should the nurse recommend to protect the area from additional trauma?
"Have you considered the option of genetic counseling?"
A client has a child with Tay-Sachs disease and wants to become pregnant again. She tells the nurse, "I'm worried it will happen again." How should the nurse respond?
Keep the arm in an elevated position.
A client has a modified radical mastectomy because of a malignant tumor of the breast. What does the nurse plan to teach the client during the early postoperative period?
B
A client has a total hysterectomy with bilateral salpingo-oophorectomy for cancer of the ovary. In addition to encouraging ambulation, what exercise should the nurse instruct the client to perform to help prevent postoperative deep vein thrombosis (DVT)?
"They're usually benign, and a biopsy rules out a malignancy."
A client has just been informed by the health care provider that she has cervical polyps. The client asks the nurse whether she should worry about them. How should the nurse respond?
Cancer of the cervix
A client has just been told that she has cervical erosion. The nurse would expect to help explain that early treatment of the erosion can help prevent:
Promotes neonatal pulmonary maturity
A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it:
Pulse rate continuously
A client in preterm labor is receiving subcutaneous terbutaline (Brethine) tocolytic therapy. The nursing action that is most important during the initial administration of this medication is assessing the client's:
Lateral
A client in preterm labor is to receive a tocolytic medication, and bedrest is prescribed. Which position should the nurse suggest that the client maintain while on bedrest?
With food
A client is admitted in preterm labor. After intravenous tocolytic medications are administered, contractions cease and she is discharged. She is to receive oral terbutaline (Brethine) 5 mg every 6 hours at home. When should the nurse advise the client to take the medication?
Five-year survival rates for this cancer are nearly 100% with early treatment.
A client is admitted with a diagnosis of stage 0 cervical cancer (carcinoma in situ). What does the nurse emphasize while helping the client understand her diagnosis and prognosis?
"Irreversible damage occurs after a few hours."
A client is admitted with a diagnosis of torsion of the testes. How should the nurse respond when the client asks, "Why do I have to have surgery right now?"?
21
A client is found to have pelvic inflammatory disease, and the health care provider prescribes intravenous cefotetan 2 g twice a day. The instructions on the vial of cefotetan say to reconstitute 20 mL of diluent to yield 1 g/10.5 mL. How much solution should the nurse add to the 100-mL bag of 0.9% sodium chloride? Record your answer using a whole number. ___ mL
Eat yogurt daily
A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications?
"You will be admitted as an outpatient for same-day surgery."
A client is scheduled for a laparoscopic bilateral tubal ligation. What should the nurse include in preoperative teaching?
A temperature of 100.4° F (38° C) or higher should be reported immediately.
A client is scheduled for a vacuum aspiration abortion to terminate an unwanted pregnancy. What information should the nurse's teaching plan include?
Late
A client is scheduled to have a contraction stress test (CST) to determine fetal well-being. Which type of fetal heart rate (FHR) decelerations constitutes a nonreassuring outcome?
Whether an earlier tuberculin test's result was positive
A client is to undergo a tuberculin test as part of her prenatal workup. Before administering the test, what information about the client should the nurse obtain?
Inactive influenza
A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her?
Hydatidiform mole
A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse suspect the client is experiencing?
Her urine immunoassay test is positive,
A client presents to the clinic with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy?
"It produces a spermicidal intrauterine environment."
A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond?
Between the first and fourth days of the cycle
A client seeking family planning information asks the nurse during which phase of the menstrual cycle an intrauterine device (IUD) should be inserted. Before responding the nurse recalls that the insertion usually is done:
Longer gastrointestinal emptying time
A client starting her second trimester asks a nurse in the prenatal clinic whether she can safely take an over-the-counter (OTC) medicine now that she is past the first 3 months of pregnancy. The nurse explains why she should consult with her health care provider before taking any oral medications. What physiological alteration associated with pregnancy may change the client's response to medication?
Subtract 18 days from the length of my shortest cycle"
A client states that she wishes to use the calendar method of birth control. The nurse concludes that the client understands how to calculate the beginning of the fertile period when she states, "I will:
Discomfort is minimized. Retention of urine is prevented. Pressure on the suture line is relieved.
A client undergoes anterior and posterior surgical repair of a cystocele and rectocele and returns from the postanesthesia care unit with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter? (Select all that apply.)
"This must be a very hard experience for you to deal with."
A client undergoes dilation and curettage (D&C) after an early miscarriage (spontaneous abortion). The nurse finds her crying later in the day. What is the most appropriate statement by the nurse?
14 to 16 weeks' gestation
A client who had a child with Tay-Sachs disease is pregnant and is to have an amniocentesis to determine whether the fetus has the disease. The nurse counsels her to plan for the procedure at the optimal time for the procedure at:
The tumor cells generally exhibit a positive response to hormone therapy that reduces estrogen.
A client who has had a mastectomy asks what the term ERP-positive means. How should the nurse explain this finding?
Vitamins A, C, and E and selenium
A client who has had recurrent infections before and during pregnancy should be instructed to eat a nutrient-rich diet as a means of supporting the body's natural defense mechanisms. What should the nurse encourage the client to include in her diet?
Apply cool packs to her breasts to reduce the discomfort Take the analgesic medication prescribed to limit the discomfort Assume a different position when breastfeeding to adjust the infant's sucking
A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage the mother to do? (Select all that apply.)
Dark amber urine
A client who has just had a cesarean birth is receiving IV fluids and has an indwelling catheter. The client's fluid intake will need to be increased when the nurse identifies:
Promotion of maternal and fetal well-being during labor
A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be directed at this time?
"You think this operation will affect how your husband feels about you as his wife."
A client who is scheduled to have a hysterectomy starts to sob and says, "I told my husband that after this operation, I'll be only half a woman. He told me not to worry, but I know that he was just putting up a front." How should the nurse respond?
"You won't have any more periods."
A client who is scheduled to have an abdominal panhysterectomy asks how the surgery will affect her periods. How should the nurse respond?
Visual disturbances Persistent headaches
A client who is taking an oral contraceptive calls the nurse with concerns about side effects of the medication. Which adverse effect of this medication should alert the nurse to inform the client to immediately stop the contraceptive and contact the health care provider? (Select all that apply.)
Asking whether something is troubling the client and whether she'd like to talk about it
A client who is to undergo dilation and curettage, and conization of the cervix for cancer appears tense and anxious. What is the best approach for the nurse to support the client emotionally?
Breakthrough bleeding
A client who is visiting the family planning clinic is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of:
16
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?
Report the client's condition to the responsible staff member
A client who recently gave birth is transferred to the postpartum unit by the nurse. What must the nurse do first to avoid a charge of abandonment?
Increased alertness
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience?
"Losing power seems important to you."
A client who underwent mastectomy because of breast cancer is now undergoing chemotherapy, which has caused hair loss. The client states, "I feel like I've lost my sense of power." What is the nurse's best response?
Increased blood pressure
A client who wishes to postpone having children until she and her husband are financially sound tells the nurse she has been taking oral contraceptive pills for several years. What finding indicates a potential risk in regard to continued use of birth control pills?
Expect shoulder pain for 12 to 24 hours.
A client with a benign ovarian tumor undergoes laparoscopic surgery. What should the nurse include in the postoperative teaching?
Perineal pain will not be felt. The bearing-down reflex will be diminished.
A client with a large fetus is to have a pudendal block during the second stage of labor. What does the nurse plan to instruct the client about the effectiveness of the block? (Select all that apply.)
Apply moist compresses to the uterine prolapse.
A client with a third-degree uterine prolapse is scheduled for a vaginoplasty. What should the nurse anticipate the surgeon will prescribe?
Leaving the urinary catheter undisturbed
A client with cervical cancer is to undergo a course of internal radiation. The client returns to her lead-lined room on the oncology unit with an indwelling urinary catheter and a vaginal applicator in place. Once the practitioner has loaded the applicator with the radiation source, the nurse's plan of care should include:
Weight gain
A client with endometriosis asks the nurse what side effects to expect from leuprolide (Lupron). What should the nurse include in the response?
Turnip greens
A client with osteoporosis has been receiving dietary information from the nurse. Which food selection by the client indicates that the nurse's dietary instruction was effective?
"We'll be monitoring your baby's condition continuously. Would you like to listen to the baby's heartbeat?"
A client with severe preeclampsia who was admitted to the high-risk unit anxiously asks the nurse, "Will my baby be all right?" How should the nurse respond?
38 The nurse should administer 38 gtt/min. Solve the problem with the following formula: Total milliliters to be infused × drop factor (drops per milliliter delivered by infusion set) Total time in minutes 150 mL × 15 gtt/mL 60 minutes 2250 ÷ 60 = 37.5; round 37.5 up to 38 gtt/min. A delivery rate of 15 gtt/min is too few drops per minute, as is a rate of 25 gtt/mL. A rate of 42 gtt/mL is too many drops per minute.
A client with stage 4 ovarian cancer is admitted for dehydration. The client is to receive an intravenous bolus of 500 mL D5W for 1 hour, after which the rate is to be changed to 150 mL/hr. The drop factor is 15 gtt/mL. At what rate, in drops per minute, should the nurse regulate the IV after delivery of the 500-mL bolus?
Expose the nipples to air several times a day. Apply hydrogel pads to the nipples after each feeding.
A client's nipples become sore and tender as a result of her newborn's vigorous suckling. What should the nurse recommend that the mother do to alleviate the soreness? (Select all that apply.)
Dehydration
A client's temperature is 100.4° F 12 hours after a spontaneous vaginal birth. What does the nurse suspect is the cause of the increased temperature?
There is a 25% chance the baby will be affected and a 50% chance that the baby will be a carrier.
A couple at the prenatal clinic for a first visit tells the nurse that their 2-year-old child has just been found to have cystic fibrosis. They state there is no family history of this disorder. They ask the nurse about the chances of their having another child with cystic fibrosis. Knowing that this disorder has an autosomal recessive mode of inheritance, how should the nurse respond?
14 days before the start of the next menses
A couple expresses a desire to use the rhythm method of birth control. The woman tells the nurse that she menstruates every 32 days. What should the nurse teach the couple about when the client's ovulation probably occurs?
Families are helped to understand the diagnosis, the probable cause of the disorder, and how the condition can be managed.
A couple in their late 30s who wish to have a child are referred for genetic counseling. They tell the nurse that they have a family history of an inheritable problem but have reservations about genetic counseling because they believe that genetic clinics favor abortion when the studies reveal a defective fetus. How should the nurse respond regarding genetic counseling?
After the 14th week of pregnancy
A couple in their late 30s, expecting their first child, plans to have an amniocentesis. At what point in the pregnancy should the nurse tell the couple that the test it will be scheduled?
25%
A couple seeking genetic counseling are heterozygous carriers of Tay-Sachs disease. They ask the nurse what the chances are that each of their children will inherit the disease. The nurse responds that the probability is:
"My partner has to use a condom all the time."
A female client who has been sexually active for 5 years is found to have gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective?
Repeatedly drops abruptly to 90 beats/min unrelated to contractions
A fetal monitor is applied to a client in labor. The nurse should take action in response to a fetal heart rate that:
Breastfeed often to keep the breasts empty.
A few weeks after discharge, a postpartum client experiences mastitis and telephones for advice concerning breastfeeding. The nurse notifies the practitioner to have antibiotics prescribed. What should the nurse recommend that the client do?
"There is a 1-in-4 chance of having a child with the disorder."
A genetic counselor is working with a couple, each of whom is a carrier of an autosomal recessive disorder. Which statement indicates that the couple has understood the teaching about this disorder?
Anger
A husband sits in the waiting room while his wife is getting her infertility prescription refilled by the clinic pharmacist. As the nurse sits down beside him, he blurts, "It's like there are three of us in bed—my wife, me, and the doctor." What feeling is reflected by this statement?
Take quick, shallow breaths, and then blow
A husband who is coaching his wife during labor demonstrates an understanding of the transition phase of labor when, as his wife starts to push with each contraction, he instructs her to:
Has a son and daughter and feels that her family is complete
A married 35-year-old client is to undergo a tubal ligation. The factor in the history that contributes most to the healthy resolution of any emotional problem associated with sterilization is that the client:
Passive natural
A mother is concerned that her newborn will be exposed to communicable diseases when she goes home. While teaching the mother ways to decrease the risk of Infection; what type of immunity should the nurse explain was transferred to her baby through the placenta?
"You have relaxation of the muscles in your lower pelvis."
A multipara who is admitted to the hospital for repair of a rectocele and cystocele asks a nurse why these problems happened to her. How should the nurse respond?
Caring for the newborn in the same manner as any other newborn
A neonate is born with exstrophy of the bladder, and the parents are upset. They are told that corrective surgery will be performed as soon as possible. How can the nurse best help the parents at this time?
"You'll need extra amounts of the same foods you've been eating, plus more fluids."
A new mother who wishes to breastfeed her infant asks a nurse whether she needs to alter her diet. How should the nurse respond?
"You'll need greater amounts of the same foods you've been eating and more fluids."
A new mother wishes to breastfeed her infant and asks the nurse whether she needs to alter her diet. How should the nurse respond?
Will put a baby's picture on my bathroom mirror so I'll see it every morning"
A nurse at a women's health clinic confirms that client teaching regarding the use of an oral contraceptive is understood when the client states, "I:
The woman has injuries to the breasts and abdomen. The partner answers questions that are asked of the woman. The woman has visited the clinic several times in the last month.
A nurse caring for a pregnant client and her partner suspects domestic violence. Which observations support this suspicion? (Select all that apply.)
Responsible for local as well as systemic reactions
A nurse discusses herpes genitalis as part of a high school sex education program. The nurse explains to the students that herpes genitalis is:
Epidural
A nurse discusses the type of anesthesia that will be used for a vaginal birth with a client who has class I cardiac disease. Which type of block is most appropriate for this client?
Folic acid."
A nurse evaluates that a client who is taking oral contraceptives understands the related dietary teaching when the client states, "While I'm taking birth control pills I should increase my intake of foods containing:
Is involved in seeking her own identity
A nurse has learned that infants born to very young mothers are at risk for neglect or abuse primarily because an adolescent characteristically:
6 hours
A nurse in a family planning clinic determines that a client understands the discussion about using a cervical cap with a spermicide when the client states that after intercourse, a cervical cap must be left in place for at least:
Not be contacted, because treatment at the clinic is confidential
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. The nurse explains that her parents will:
Enlarged, tender breasts
A nurse in the fertility clinic is instructing a client who will be using progesterone gel vaginally in the treatment of luteal phase infertility. When discussing the side effects of progesterone, what should the nurse tell the client to expect?
Explore ways to promote communication with family and friends
A nurse in the fertility clinic works with couples who have been trying to become pregnant for more than 1 year. How can the nurse help ease the feeling of isolation that infertile couples often experience?
Vitamin C
A nurse instructs a client who is taking oral contraceptives to increase her intake of dietary supplements. Which supplement should be increased?
Painful intercourse Bearing-down sensations
A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs or symptoms does the nurse expect the client to report? (Select all that apply.)
Lightheadedness
A nurse is caring for a client in labor whose cervix is dilated 6 cm. The client is receiving epidural analgesia. What common response to regional anesthesia does the nurse anticipate?
Metronidazole (Flagyl)
A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the health care provider will most likely prescribe?
Urine output of less than 100 mL in 4 hours
A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which adverse side effect alerts the nurse to notify the health care provider?
Hemorrhage Increased temperature
A nurse is caring for a client who is receiving internal radiation for cancer of the cervix. For which adverse reactions to the radiotherapy should the client be monitored? (Select all that apply.)
Cardiovascular
A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely?
Maintaining bed rest
A nurse is caring for a client with vaginal bleeding caused by placenta previa. What is the best nursing intervention to delay the birth of the fetus?
Telling the adolescent what to expect with each procedure Identifying risk factors that contraindicate epidural anesthesia Performing a baseline vaginal examination
A nurse is caring for an adolescent in labor an hour after she was admitted to the birthing unit. The adolescent is anxious and tense. She cries during contractions and asks the nurse for epidural anesthesia. The nurse obtains the adolescent's current vital signs and reviews her history and admission information. What nursing interventions are essential before epidural anesthesia is administered? (Select all that apply.)
Human immunodeficiency virus
A nurse is caring for four clients, each with a different medical condition. Which condition should the nurse anticipate will result in the client's being instructed by the health care provider not to breastfeed?
Perineal care
A nurse is caring for several new mothers in the birthing unit, all in the taking-in phase of the postpartum period. What information is most appropriate for these clients at this time?
Diaphragm
A nurse is counseling a client with type 1 diabetes who has requested contraceptive information. On which method of contraception should the nurse place the most emphasis?
Refer the client to a dietitian to help plan her daily menu
A nurse is counseling a pregnant client who is a vegetarian. What should the nurse plan to do to ensure optimal nutrition during the pregnancy?
Before breakfast with orange juice
A nurse is counseling a pregnant client with iron-deficiency anemia about when and how to take supplemental iron. What time of day and with what drink is iron absorption most efficient?
Protein substances are formed by the body to destroy or neutralize antigens.
A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including that the client will understand with regard to active immunity?
Explanation of available alternative treatments Answers to questions and concerns about the procedure Complete description of the possible dangers and discomforts
A nurse is discussing informed consent with a client who is scheduled for a hysterectomy. What should the informed consent include? (Select all that apply.)
Swelling with erythema
A nurse is evaluating a client's understanding regarding postoperative concerns after mastectomy. Which development near and around the incision noted by the client should be reported to her practitioner?
" For discomfort I can try using warm compresses on my abdomen."
A nurse is giving discharge instructions to a client who has undergone anterior colporrhaphy. The nurse knows the teaching has been understood if the client says:
"Wash your hands before and after changing your sanitary napkins."
A nurse is giving discharge instructions to a new mother. What is the most important instruction to help prevent postpartum infection?
"If you can't cough, try taking six very deep breaths."
A nurse is instructing a client to cough and deep-breathe after an emergency cesarean birth. The client says, "Get out of here. Can't you see that I'm in pain?" Which response will be the most effective?
Inhabits the intestinal tract
A nurse is interviewing a female client with a tentative diagnosis of cystitis pending laboratory results. The nurse anticipates that the causative agent of the cystitis is Escherichia coli. The nurse anticipates this microorganism because it:
Fetal head compression
A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this usually indicate?
Support system
A nurse is obtaining a health history from a client with newly diagnosed cervical cancer. What aspect of the client's life is most important for the nurse to explore at this time?
Gestational age and birthweight
A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn?
Nesting needs increase. Anxiety about childbirth increases. Gastrointestinal motility decreases.
A nurse is planning a childbirth education class about maternal psychological and physiological changes as pregnancy nears term. Which problems and concerns should the nurse include in the presentation? (Select all that apply.)
Feelings of failure and loss of control
A nurse is planning care for a client who gave birth to a preterm male infant. What most common response does the nurse anticipate that the mother may experience?
Surgical menopause
A nurse is planning care with a client for the recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included among the changes that the client should expect after surgery?
Salpingectomy
A nurse is preparing a client with a ruptured tubal pregnancy for immediate surgery. What type of surgery should the informed consent include?
Raw shellfish Herbal supplements Soft-scrambled eggs
A nurse is providing dietary counseling to a client at 14 weeks' gestation. The client is a recent immigrant from Asia, and the nurse explores the foods that the client usually eats. Which foods should the nurse counsel the client to avoid during pregnancy? (Select all that apply.)
Breast cancer
A nurse is reviewing a postmenopausal client's history, which reveals that the client previously received hormonal replacement therapy (HRT) as treatment for osteoporosis. For which problem does HRT increase the client's risk?
Propylthiouracil (PTU)
A nurse is teaching a breastfeeding client about medications that are safe and unsafe for her to take. Which medication is contraindicated?
Wash the breasts and nipples with water when bathing.
A nurse is teaching a breastfeeding mother about cleansing her nipples. What technique should the nurse emphasize?
Tension of the client
A nurse is teaching a childbirth preparation class about the discomfort of labor. What is the greatest influence on the perception of pain for a woman in labor?
Linea nigra Chloasma
A nurse is teaching a class of expectant parents about changes that are to be expected during pregnancy. What changes does the nurse explain result from the melanocyte-stimulating hormone? (Select all that apply.)
Protein needs increase to at least 70 g/day during pregnancy.
A nurse is teaching a class of expectant parents about nutritional needs during pregnancy. What information should the nurse include?
Toward the sacrum
A nurse is teaching a client how to self-administer a medicated douche. In which direction should the nurse instruct the client to direct the douche nozzle?
Headaches Visual disturbances
A nurse is teaching a female client about using oral contraceptives and when to report complications. What clinical findings should alert the client to stop taking the contraceptive and notify the health care provider immediately? (Select all that apply.)
"I'll notify the clinic if my lochia starts to smell bad."
A nurse is teaching a postpartum client the characteristics of lochia and any deviations that should be reported immediately. What client statement indicates that the teaching was effective?
"My mother can't believe that babies are supposed to sleep on their backs, not their stomachs."
A nurse is teaching a prenatal class about infant safety. After the class several of the students are heard discussing what they have learned. The nurse determines that the teaching has been effective when one of the future parents states:
Cardiac output increases. Blood pressure decreases. The heart is displaced upward.
A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? (Select all that apply.)
"My breasts are so tender right before my period that I hate doing it."
A nurse is teaching a woman how to perform breast self-examination. Which statement indicates that the client needs further education?
It involves a decrease in bone substance.
A nurse is writing a teaching plan about osteoporosis. How should the nurse explain what osteoporosis is?
"Applying heat to my breasts will help ease the discomfort."
A nurse on the postpartum unit discusses breast care with a client who is formula feeding her newborn. Which statement indicates to the nurse that more teaching is needed?
"I can use my albuterol inhaler if it's absolutely necessary."
A nurse teaches a client with asthma about her illness during pregnancy. Which statement by the client indicates that the nurse's teaching has been effective?
Milk Eggs Cheese
A nurse teaches a pregnant woman about the need to increase her intake of complete proteins. Which foods identified by the client indicate that the teaching is effective? (Select all that apply.)
Breastfeed the infant less frequently
A nurse teaches a woman who is planning to breastfeed how to relieve breast engorgement. The nurse determines that further teaching is necessary when the woman states that she will:
"Have you talked to your wife about your concerns?"
A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have exploratory surgery. How should the nurse respond?
Pork and beef should be cooked well before being eaten.
A pregnant client asks a nurse for information about toxoplasmosis during pregnancy. What should the nurse teach the client about how to prevent the transmission of toxoplasmosis?
Dexamethasone
A pregnant client at 30 weeks' gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy her cervix continues to dilate, and it is determined that a preterm birth is inevitable. Which medication does the nurse expect the health care provider to prescribe?
"This information will be in your prenatal record, but please remind your labor and delivery nurse of this finding."
A pregnant client has a positive group B Streptoccus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan?
It provides relaxation and techniques that can be used during labor.
A pregnant client interested in childbirth education asks how the Lamaze method differs from the Read method. What should the nurse explain about the Lamaze method?
"That is an expected occurrence; the increased hormones are responsible for the congestion."
A pregnant client tells the nurse that she thinks she has developed an allergy because her nose is often very congested and she has difficulty breathing. How should the nurse reply?
Fetal physical activity
A pregnant client who is scheduled for a nonstress test (NST) asks a nurse how the test can show that "my baby is all right." The nurse explains that it is a way of evaluating the condition of the fetus by comparing the fetal heart rate (FHR) with:
Influences the fetus's teeth buds
A pregnant client with an infection tells the nurse that she has taken tetracycline (Tetracyn) for infections on other occasions and prefers to take it now. The nurse tells the client that tetracycline is avoided in the treatment of infections in pregnant women because it:
The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary
A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program?
It acts as an anticonvulsant.
A pregnant client with severe preeclampsia is receiving an infusion of magnesium sulfate. What does the nurse identify as the main reason that this medication is administered?
Kegel exercises
A pregnant couple is attending preparation-for-childbirth classes. Which exercise should the nurse teach the mother to increase the tone of the muscles of the pelvic floor?
January 21 To use Nägele's rule to calculate the EDB, subtract 3 months and add 7 days to the date of the last menstrual period.
A pregnant woman asks the nurse when she may expect her baby to be born. She tells the nurse that her last menstrual period began on April 14. According to Nägele's rule, what is the client's expected date of birth (EDB)?
Human chorionic gonadotropin (hCG)
A primigravida at 12 weeks' gestation complains of nausea and vomiting during a visit to the prenatal clinic. Which pregnancy hormone should the nurse explain is thought to be responsible for nausea and vomiting during the first trimester?
A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an examination reveal at this time?
A primigravida at 8 weeks' gestation is visiting the prenatal clinic for the first time. What should an examination reveal at this time?
Cervical edema
A primigravida at term is admitted to the birthing room in active labor. Later, when the client is dilated 8 cm, she tells the nurse that she has the urge to push. The nurse instructs her to pant-blow at this time because pushing can cause which of the following?
Avoid long periods without food
A primigravida complains of morning sickness. What should the nurse plan to teach her?
20th week
A primigravida in her seventh week of gestation asks the nurse when she can expect to feel her baby move. The nurse replies that quickening usually occurs in the:
"It's all right for you to walk as long as you feel comfortable and your membranes are intact."
A primigravida is admitted to the birthing suite at term with contractions occurring every 5 to 8 minutes and a bloody show. She and her partner attended childbirth preparation classes. Vaginal examination reveals that the cervix is dilated 3 cm and 75% effaced. The fetus is at +1 station in occiput anterior position, and the membranes are intact. The client is cheerful and relaxed and asks the nurse whether it is all right for her to walk around. In light of the nurse's observations regarding the contractions and the client's knowledge of the physiology and mechanism of labor, how should the nurse respond?
Avoiding long periods without food
A primigravida tells the nurse that she has morning sickness. What suggestion should the nurse make to help relieve the nausea?
Fundus at the umbilicus
A primigravida, unsure of the date of her last menstrual period, is told by the nurse that she appears to be at 22 weeks' gestation. What data support this conclusion?
Taking-hold
A primipara about to be discharged with her newborn asks the nurse many questions regarding infant care. What phase of maternal adjustment does this behavior illustrate?
Hematoma in the perineal area
A primipara delivered 12 hours ago. Although an ice bag has been applied to her perineal area, the client continues to complain of rectal pressure resulting in excruciating pain in the area of the episiotomy that is not relieved with analgesics. What does the nurse conclude is the cause of the client's pain?
Explaining why a vaginal examination should not be performed
A resident practitioner in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a low-lying placenta who is in early labor. What is the priority nursing action?
Plan to eat from specific groups of vegetable proteins each day.
A strict vegetarian (vegan) becomes pregnant and asks the nurse whether there is anything special she should do in regard to her diet during pregnancy. What is most the important measure for the nurse to instruct the client to take?
To provide the client with correct, unbiased information
A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information about an abortion. After verifying that the woman is at 8 weeks' gestation, the nurse counsels her that having an abortion is controversial and that many women have long-lasting feelings of guilt after an abortion. What is the nurse's legal responsibility?
Start taking prenatal vitamins
A woman comes into the clinic and states that she is thinking about becoming pregnant. What can the woman do to improve the health of her baby before she becomes pregnant?
Avoid taking aspirin or NSAIDs (e.g., ibuprofen [Advil]) for pain relief. Sleep with your head and torso elevated for at least 1 week. Take your temperature daily and notify the clinic if it goes above 99.6° F.
A woman has made the decision to have breast augmentation surgery, and the procedure is to be performed on an outpatient basis. As part of the preoperative protocol, the nurse provides teaching regarding the discharge instructions. Which instructions apply to this type of surgery? (Select all that apply.)
Large uterine fibroids
A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecological history. What condition does the client have that causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy?
User motivation
A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question?
Easing the pain of the client's menstruation.
A woman visits the clinic because she has dysmenorrhea. What goal should the nurse identify for this client?
Sleep needs increase. Fluid retention increases. Calcium requirements increase.
A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. (Select all that apply.)
Uterine pain during the menstrual period
A young client tells the nurse that her mother complains about having dysmenorrhea and asks the nurse what this means. How should the nurse describe dysmenorrhea?
"You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective."
A young woman has been using oral contraceptives. When she misses her regular menstrual period, she visits the women's health clinic and tells the nurse that she may be pregnant because she missed taking her contraceptive pills for 1 week when she had the flu. How should the nurse respond?
"I'll start the pills on the fifth day of my cycle."
After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate (Clomid) is prescribed. The nurse concludes that the client understands the teaching about the correct time to take the clomiphene when the she states:
"This must be very difficult for you with this added pressure."
After 5 years of unprotected intercourse, a childless couple comes to the fertility clinic. The husband tells the nurse that his parents have promised to make a down payment on a house for them if his wife gets pregnant this year. What is the nurse's best response to this comment?
"I'll be here if you want to talk."
After a client has a spontaneous abortion at 12 weeks' gestation, the nurse notes that she and her partner are visibly upset. The partner has tears in his eyes, and the client is sobbing quietly with her face turned to the wall. At this time, what is the nurse's most therapeutic statement?
"I feel washed out; there isn't much left."
After a mastectomy or a hysterectomy a client may feel incomplete as a woman. What statement should alert the nurse to this feeling in a client who has undergone total hysterectomy?
Compressing the drainage receptacles after emptying them to maintain suction
After a modified radical mastectomy a client has two portable wound drainage systems in place. What is an important intervention as the nurse cares for these drainage systems?
Apply warm, moist cloths to both breasts before nursing.
On the third postpartum day a client who is breastfeeding calls the clinic complaining of hot, hard, aching breasts. What recommendation should the nurse include in the response?
Massage the uterus until firm
One hour postpartum a nurse evaluates the amount of vaginal bleeding and determines that a client's uterus has become relaxed and boggy. What should the nurse do next?
Apply warm packs and massage my breasts before each feeding."
One statement by a breastfeeding mother that indicates that the nurse's teaching about stimulating the let-down reflex has been successful is "I will:
Massage the uterus
Thirty minutes after a client gives birth, the nurse palpates the client's uterus. It is relaxed and the lochia is excessive. What is the nurse's initial action?
An expected response to the process of labor and birth
Twenty-four hours after an uncomplicated labor and birth a client's complete blood count reveals a white blood cell (WBC) count of 17,000/mm3. How should the nurse interpret this WBC count?
When she leans forward to place her breast in the infant's mouth
What client behavior indicates to the nurse that a woman needs further teaching about breastfeeding her newborn?
Squeeze the nipples to examine for discharge
What does the nurse teach a client to do when performing breast self-examination?
Late beginning of childbearing
What factor identified by the nurse in a client's history places the client at increased risk for breast cancer?
Why self-examination of the remaining breast is important
What is most important information to teach to a client who has had a mastectomy before she leaves the hospital?
Explaining the procedure and maintaining eye contact while touching the client gently
What is the best nursing intervention to achieve the cooperation of an extremely anxious pregnant client during her first pelvic examination?
Evaluating the lochia to identify the complication of hemorrhage
What is the priority nursing intervention during the 2 hours after a cesarean birth?
Diaphragm with a spermicidal gel
What is the safest and most reliable birth control method for the nurse to recommend to a client with type 1 diabetes?
Keeping the new family together immediately after the birth
What nursing action best promotes parent-infant attachment behaviors?
Limiting the client's activity to avoid dislodging the radium insert
What nursing care is required for a client with a radium implant for cancer of the cervix?
A condom must be held in place by the rim when the penis is withdrawn from the vagina.
What should a nurse include in the teaching plan for a couple seeking information about family planning?
Education; exercise, and breathing techniques
What should the nurse emphasize in a class about childbirth?
Compress the nipples to check for discharge.
What should the nurse teach a client about performing breast self-examination?
Wear a tightly fitted brassiere.
What should the nurse teach a formula-feeding mother about breast engorgement when it occurs?
"I must be careful when I have sex because herpes is a lifelong problem."
What statement helps the nurse determine that a woman with genital herpes (HSV-2) understands her self-care in regard to this infection?
Calcium gluconate
When a client is being given an intravenous infusion of magnesium sulfate, the nurse should have its antidote readily available. Which of the following medications would the nurse administer if toxicity were to occur?
"You seem shocked by the way you look now."
When a client who had a mastectomy sees her incision for the first time, she exclaims, "I look horrible! Will it ever look better?" What is the nurse's best response?
Treat constipation when it occurs and continue drinking milk.
When discussing dietary needs during pregnancy, a client tells the nurse that milk causes her to be constipated at times. What should the nurse teach the client?
Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future.
When discussing future health management with a client who has had a total hysterectomy, the nurse advises regular physical examinations. The client agrees and adds, "It won't be so hard to go now that I won't need the pelvic examination and Pap smear." How should the nurse respond?
"What's your pain level right now?"
When encouraging a client to cough and deep breathe after a bilateral mastectomy, the client says, "Leave me alone! Don't you know I'm in pain?" What is the nurse's most therapeutic response?
Should remain in place for at least 6 hours after intercourse
When teaching a client about using a diaphragm as a form of contraception, the nurse should tell her that the diaphragm:
Providing ice chips to a primigravida in early labor per order
Which action involving client needs may a nurse delegate to a nursing assistant?
Calling the baby by name
Which behavior indicates to a nurse that a new mother is in the taking-hold phase?
Assisting a client who is recovering from an abdominal hysterectomy to the bathroom
Which client care activity may a nurse safely delegate to a nursing assistant?
A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal
Which client is most at risk for osteoporosis?
Prolonged immobility
Which factor in a client's history increases the risk for osteoporosis?
Familial predisposition Cigarette smoking Inadequate intake of dietary calcium
Which risk factors are associated with the future development of osteoporosis in women? (Select all that apply.)
"I'll start limiting my carbohydrates." "I'll lie down for at least 2 hours after I eat."
Which statements by a client with hyperemesis gravidarum would confirm that the client needs further teaching? (Select all that apply.)
"Breast size is not related to milk production."
While teaching a prenatal class about infant feeding, the nurse is asked about the relationship between breast size and ease of breastfeeding. How should the nurse respond?
