Mosby's NCLEX Review-MATERNITY

A client who is scheduled to have an abdominal panhysterectomy asks how the surgery will affect her periods. How should the nurse respond? 1. "You will not have any more periods." 2. "Your periods will become more regular." 3. "Your periods will become lighter until they disappear." 4. "You will notice that the time between periods will be longer.

1 An panhysterectomy in the premenopausal woman produces artificial onset of menopause. 2, 3, 4 Because the uterus is removed, there will be no uterine endometrial proliferation and no desquamation

At 6 weeks' gestation a client is diagnosed with gonorrhea. What medication does a nurse expect the health care provider to prescribe? 1. Ceftriaxone (Rocephin) 2. Levofloxacin (Levaquin) 3. Sulfasalazine (Azulfidine) 4. Trimethoprim/sulfamethoxazole (Bactrim)

1 Ceftriaxone (Rocephin) is a broad-spectrum antibiotic and is preferred during pregnancy. 2 Levofloxacin (Levaquin), although listed as an unlabeled use for gonococcal infection, should not be prescribed during pregnancy. 3 Sulfonamides may cause hemolysis in the fetus. 4 Trimethoprim/sulfamethoxazole (Bactrim) contains a sulfonamide and is contraindicated during pregnancy

A client's membranes rupture while her labor is being augmented with an oxytocin (Pitocin) infusion. A nurse observes variable decelerations in the fetal heart rate on the fetal monitor strip. What action should the nurse take next? 1. Change the client's position. 2. Take the client's blood pressure. 3. Stop the client's oxytocin infusion. 4. Prepare the client for an immediate birth

1 Variable decelerations usually are seen as a result of cord compression; a change of position will relieve the pressure on the cord. 2 Variable decelerations are not related to the mother's blood pressure. 3 Variable decelerations are not oxytocin related. 4 This is premature; other nursing measures should be tried first.

A client is bleeding excessively after the birth of a neonate. The health care provider orders fundal massage and prescribes an IV infusion containing 10 units of oxytocin (Pitocin) at 100 mL/hr. A nurse's evaluation of the client's responses to these interventions is BP: 135/90 mm Hg; uterus: boggy at 3 cm above the umbilicus and displaced to the right; perineal pad: saturated with bright red lochia. What is the nurse's next action? 1. Increase the infusion rate. 2. Assess for a distended bladder. 3. Continue to perform fundal massage. 4. Continue to assess the blood pressure

2 A displaced and boggy uterus usually is caused by a full bladder; ifthe bladder is distended, the nurse should have the client void and then reassess the fundus, and if still boggy, massage until firm

A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Her last menses started on January 1st. On what day in January should the nurse respond? 1. 7th 2. 16th 3. 24th 4. 29th

2 January 16. The time between ovulation and the next menstruation is relatively constant. Within a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory

A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect? 1. Estrogen (Premarin) 2. Leuprolide (Lupron) 3. Diclofenac (Voltaren) 4. Ergonovine (Ergotrate)

2 Leuprolide (Lupron) is administered once a month via IM injection; it decreases LH and FSH levels, as well as hormone-dependent tissue. One of its side effects is hot flashes. 1 Estrogen (Premarin) affects the release of pituitary gonadotropins and inhibits ovulation; it is contraindicated because the goal of treatment is to suppress the action of estrogen on the endometrial tissue. 3 Diclofenac (Voltaren) is used for primary dysmenorrhea; it is an NSAID that inhibits prostaglandin synthesis. 4 Ergonovine (Ergotrate) is used to contract the postpartum uterus.

What change does a nurse expect in a client's hematologic system during the second trimester of pregnancy? 1. An increase in hematocrit 2. An increase in blood volume 3. A decrease in sedimentation rate 4. A decrease in white blood cells

2 The blood volume increases by approximately 50% during pregnancy. Peak blood volume occurs between 30 and 34 weeks' gestation. 1 The hematocrit decreases as a result of hemodilution. 3 The sedimentation rate increases because of a decrease in plasma proteins. 4 WBC values remain stable during the antepartum period.

During a physical in the prenatal clinic the client's vaginal mucosa is observed to have a purplish discoloration. What sign should the nurse document in the client's clinical record? 1. Hegar 2. Goodell 3. Chadwick 4. Braxton Hick

3 A purplish color results from the increased vascularity and blood vessel engorgement of the vagina. 1 This is softening of the lower uterine segment. 2 This is softening of the cervix. 4 After the fourth month of pregnancy, uterine contractions can be felt through the abdominal wall. They are irregular and painless, and they increase blood flow to the placenta.

A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation does this occur? 1. 8th week of pregnancy 2. 10th week of pregnancy 3. 12th week of pregnancy 4. 18th week of pregnancy

3 By this time the fetus and placenta have grown, expanding the size of the uterus. The enlarged uterus extends into the abdominal cavity. 1, 2 At this time the uterus is still within the pelvic area. 4 At this time the uterus has already risen out of the pelvis and is extending farther into the abdominal area.

A nurse examines a client who had a cesarean birth. It is 3 days since the birth and the client is about to be discharged. Where does the nurse expect the fundus to be located? 1. 1 fingerbreadth below the umbilicus 2. 2 fingerbreadths below the umbilicus 3. 3 fingerbreadths below the umbilicus 4. 4 fingerbreadths below the umbilicus

3 The fundus descends one fingerbreadth per day from the first postpartum day. 1, 2 If the fundus were at this level, the nurse should suspect that involution has been delayed and further investigation is required. 4 Although this is notexpected, it is a benign occurrence

A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. An increase in which hormone should the nurse explain is the precipitating cause of the nausea and vomiting? 1. Estrogen 2. Progesterone 3. Luteinizing hormone 4. Chorionic gonadotropin

4 Chorionic gonadotropin, secreted in large amounts by the placenta during gestation, and the metabolic changes associated with pregnancy can precipitate nausea and vomiting in early pregnancy; usually the manifestations of morning sickness disappear after the first trimester.

A primigravida who is at 35 weeks' gestation is diagnosed with hydramnios. For what should the nurse assess the newborn? 1. Cardiac defect 2. Kidney disorder 3. Diabetes mellitus 4. Esophageal atresia

4 Esophageal atresia is associated with hydramnios. 1 Cardiac defects are not associated with hydramnios. 2 Kidney disorders are associated with oligohydramnios, not hydramnios. 3 Diabetes in the newborn is not associated with hydramnios

A nurse at the fertility clinic is counseling a couple about the tests that will be needed to determine the cause of their infertility. Which test should the nurse describe that will evaluate the woman's organs of reproduction? 1. Biopsy 2. Cystogram 3. Culdoscopy 4. Hysterosalpingogram

4 This test enables the examiner to visualize the uterus and fallopian tubes and the pelvic organs of reproduction. 1 A biopsy is the surgical excision of tissue for diagnostic purposes. 2 Acystogram is used to visualize the urinary bladder. 3 A culdoscopy is the direct examination of female pelvic viscera using an endoscope introduced through a perforation in the vagina.

A nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care supervision throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain will occur? Select all that apply. 1. Systemic vasodilation 2. Increased blood volume 3. Elevated blood pressure 4. Increased cardiac output 5. Enlargement of the heart

Answer: 2, 4, 5. 1 Systemic vasodilation is not expected. 2 Blood volume is increased to meet the metabolic demands of pregnancy. 3 There is little variation in bloodpressure with a slight decrease during the second trimester. 4 An increased cardiac output is necessary to accommodate the increased blood volume needed to meet the demands of the growing fetus. 5 Cardiac hypertrophy is a result of the demands made by the increased blood volume and cardiac output. 6 Erythrocyte production increases; because the plasma volume increases more than the RBCs, the hematocrit is lower.

A pregnant woman at 39 weeks' gestation arrives in the triage area of the birthing unit, stating she thinks her "water broke." What should the nurse do first? 1. Auscultate the fetal heart to determine fetal well-being. 2. Perform Leopold's maneuvers to rule out a breech presentation. 3. Check the vaginal introitus for the presence of the umbilical cord. 4. Do a nitrazine test on the vaginal fluid for verification of ruptured membranes

3 The priority is to assess for a prolapsed umbilical cord. This is a lifethreatening emergency for the fetus and must be ruled out first. 1 This is done after verifying that the umbilical cord is not visible in the vaginal introitus. 2, 4 This is not the priority; this can be done after confirming fetal wellbeing

When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurrence of: 1. white vaginal discharge and itching. 2. sporadic bleeding and abdominal pain. 3. elevated temperature and intractable diarrhea. 4. stress incontinence and low abdominal pressure.

4 As the uterus drops, the vaginal wall relaxes. When the bladder herniates into the vagina (cystocele) and the rectal wall herniates into the vagina (rectocele), the individual feels pressure or pain in the lower back and/or pelvis. When there is an increase in intraabdominal pressure in the presence of a cystocele, incontinence results. 1 A white vaginal discharge (leukorrhea) and vaginal itching (pruritus) do notindicate cystocele and rectocele; they are common with a vaginal infection. 2 Sporadic bleeding is not expected with cystocele and rectocele. 3 These are not expected with cystocele and rectocele; a fever would indicate an infection; constipation, not diarrhea, is more likely to occur

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. 1. Painful intercourse 2. Crampy abdominal pain 3. Bearing-down sensations 4. Urinary stress incontinence 5. Recurrent urinary tract infections

Answer: 1, 3. 1 The posterior vaginal wall is pushed forward by the herniation of the rectum; this protrusion causes painful intercourse. 2 A rectocele is not accompanied by abdominal pain. 3 The posterior vaginal wall is pushed forward by the herniation of the rectum; this protrusion increases rectal pressure and causes the bearing-down sensation. 4 This is the primary sign of a cystocele. 5 A cystocele, not a rectocele, is associated with urinary tract infections

Epidural anesthesia was initiated 30 minutes ago for a client in labor. The nurse identifies that the fetus is experiencing late decelerations. List the following nursing actions in order of priority. 1. _____ Increase IV fluids. 2. _____ Reposition client on her side. 3. _____ Reassess fetal heart rate pattern. 4._____ If late decelerations persist notify the health care provider. 5. _____ Document interventions with related maternal/fetal responses

Answer: 2, 1, 3, 4, 5. 2 Repositioning to the side increases uterine blood flow, improves cardiac output, and moves pressure of the uterus off of the vena cava. 1 Increasing IV fluids augments uterine blood flow and improves cardiac output. 3 Reassessing the FHR pattern enables the nurse to determine if the FHR has returned to a safe level without reflex late decelerations. 4 Persistent late decelerations is a nonreassuring fetal sign; the health care provider should be informed. 5 Documentation of interventions and client responses includes the information in the client's legal clinical record and provides communication to other care providers. Client Need: Health Promotion and Maintenance;

A client is receiving an IV piggyback infusion of oxytocin (Pitocin) to augment labor. The nurse identifies that there have been three contractions lasting 80 to 90 seconds that are less than 2 minutes apart. There is a specific protocol that is followed in response to this observation. List in order of priority the nursing actions that should be taken. 1. _____ Check the fetal heart rate. 2. _____ Stop the piggyback infusion. 3. _____ Notify the health care provider. 4. _____ Administer oxygen via face mask. 5. _____ Document maternal/fetal responses. 6. _____ Determine if the contractions have diminished

Answer: 2, 1, 6, 3, 4, 5. 2 The nurse should first stop the oxytocin infusion when tetanic contractions occur; this should relax the uterus and prevent uterine tetany and rupture. 1 The FHR should be checked to determine the effect of the tetanic contractions on the fetus. 6 After the FHR is assessed then the maternal response to the interruption of the infusion should be assessed. 3 Following these measures, the primary care giver should be notified. 4 Fetal well-being will be improved when oxygen is administered. 5 After emergency measures have been taken, the maternal/fetal responses should be documented

A client has several tests during pregnancy. Place the tests in the order they should be performed during pregnancy. 1. _____ Fetal movement test 2. _____ Sickle cell screening 3. _____ Group B streptococcus culture 4. _____ Serum glucose for gestational diabetes 5. _____ Alpha-fetoprotein (AFP) testing for neural tube defects

Answer: 2, 5, 4, 1, 3. 2 Sickle cell screening, particularly for black women, should be done on the initial visit. 5 Alpha-fetoprotein (AFP) testing for neural tube defects should be done between 14 and 16 weeks. 4 Serum glucose testing for gestational diabetes should be done between 26 and 28 weeks. 1 Fetal movement tests can begin at 28 weeks gestation because the fetus' pattern of movement becomes stabilized at this time. 3

A client at the women's health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply. 1. Insomnia 2. Ecchymoses 3. Rectal pressure 4. Abdominal pain 5. Skipped periods 6. Pelvic infections

Answer: 3, 4. 1 This is not related to endometriosis. 2 This is not related to endometriosis. 3 Endometriosis is the presence of aberrant endometrial tissue outside the uterus. The tissue responds to ovarian stimulation and bleeds during menstruation, which causes rectal pressure. 4 Endometriosis is the presence of aberrant endometrial tissue outside the uterus. The tissue responds to ovarian stimulation and bleeds during menstruation, which causes abdominal pain. 5 This is not related to endometriosis. 6 Pelvic infections are not caused by endometriosis; they most frequently are sexually transmitted

Apregnant woman tells a nurse in the prenatal clinic that she knows that folic acid is very important during pregnancy and she is taking a prescribed supplement. She asks the nurse what foods contain folic acid (folate) so she can add them to her diet in its natural form. Which foods should the nurserecommend? Select all that apply. 1. Beef and fish 2. Milk and cheese 3. Chicken and turkey 4. Black and pinto beans 5. Enriched bread and pasta

Answer: 4, 5. 1 Beef and fish do not contain an adequate amount of folate. 2 Milk and cheese do not contain an adequate amount of folate. 3 Fowl does not contain an adequate amount of folate. 4 Legumes contain large amounts of folate. 5 Enriched grain products contain large amounts of folate