OB Exam 1-NCLEX2

During routine preconception counseling, a client asks how early a pregnancy can be diagnosed. What is the nurse's best response?

"8 days after conception." Based on human chorionic gonadotropin (hCG) levels in the blood and urine, pregnancy can be diagnosed as early as 8 days after conception, when the syncytiotrophoblast produces hCG. Sensitive and specific pregnancy tests can detect hCG in the blood and urine even before the first missed menstrual period. A missed period may also be related to other factors, such as poor nutrition, strenuous athletic activity, and certain drugs. Levels of hCG rise rapidly until about the 20th week of gestation. By the 20th week, they decline gradually and stay low for the remainder of gestation. Other hormones, such as human placental lactogen, estrogen, and progesterone, increase during pregnancy.

A nulliparous client says that she and her husband plan to use a diaphragm with spermicide to prevent conception. Which of the following should the nurse include as the action of spermicides when teaching the client?

Destruction of spermatozoa before they enter the cervix. Spermicidal agents work by destroying the spermatozoa before they enter the cervix. In addition, some spermicides alter the vaginal pH to a strong acidic environment, which is not conducive to survival of spermatozoa. Spermicides do not prevent the spermatozoa from entering the uterus, but the diaphragm or condom is a barrier.

When developing a series of parent classes on fetal development, which of the following should the nurse include as being developed by the end of the third month (9 to 12 weeks)?

External genitalia. Although sex is not easily discerned at 9 to 12 weeks, external genitalia are developed at this period of fetal development. Myelinization of the nerves begins at about 20 weeks' gestation. Brown fat stores develop at approximately 21 to 24 weeks. Air ducts and alveoli develop later in the gestational period, at approximately 25 to 28 weeks.

A dilatation and curettage (D&C;) is scheduled for a primigravid client admitted to the hospital at 10 weeks' gestation with abdominal cramping, bright red vaginal spotting, and passage of some of the products of conception. The nurse should assess the client further for the expression of which of the following feelings?

Guilt. With a spontaneous abortion, many clients and their partners feel an acute sense of loss. Their grieving commonly includes feelings of guilt, which may be expressed as wondering whether the woman could have done something to prevent the loss. Anger, sadness, and disappointment are also common emotions after a pregnancy loss. Ambivalence, anxiety, and fear are not common emotions after a spontaneous abortion.

A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse anticipates that at 16 weeks' gestation, the client's fetus will:

Have audible heart sounds. Fetal heart tones are usually audible using Doppler ultrasound around 12 weeks' gestation. The fetus can suck and swallow at about 20 weeks' gestation. The eyes are open at approximately 28 weeks' gestation. The nostrils are open at about 21 to 28 weeks' gestation.

When teaching a group of pregnant adolescents about reproduction and conception, the nurse is correct when stating that fertilization occurs:

In the first third of the fallopian tube. Fertilization occurs in the first third of the fallopian tube. After ovulation, an ovum is released by the ovary into the abdominopelvic cavity. It enters the fallopian tube at the fimbriated end and moves through the tube on the way to the uterus. Sperm cells "swim up" the tube and meet the ovum in the first third of the fallopian tube. The fertilized ovum then travels to the uterus and implants. Nurses must know where fertilization occurs because of the risk of an ectopic pregnancy.

A nurse is doing an assessment of a pregnant client who states that she smokes one pack of cigarettes each day. The nurse should:

Inform the client of the risks to the fetus and ask if she'd like a referral to a smoking cessation support group. Smoking can be detrimental to fetal development and cause low birth weight and preterm birth. Informing the client of the risk factors and offering to help with a referral to a support group provides encouragement and respect for the client's right to make the decision. Reducing the number of cigarettes won't lessen the risks to the fetus. Insisting that the client stop smoking could result in a breakdown of established trust. Not taking any action results in not providing adequate health care information.

During an annual checkup, a client tells the nurse that she and her partner have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end?

It should begin before conception and end 3 months after childbirth. Ideally, childbirth education should begin before conception (or as soon after conception as possible) and continue for about 3 months after the client gives birth. Beginning childbirth education later and ending it earlier wouldn't provide enough time for optimal preparation of the client and her partner.

A primigravid client attending parenthood classes tells the nurse that there is a history of twins in her family. What should the nurse tell the client?

Monozygotic twins occur by chance regardless of race or heredity. Monozygotic twinning is independent of race, age, parity, or heredity. Monozygotic twins result from the fertilization of one ovum that divides. Dizygotic twinning occurs with the fertilization of more than one ovum during conception. Dizygotic twins may be of the same sex or different sexes. Dizygotic twinning is correlated with increased parity, becoming pregnant within 1 month after stopping oral contraception, and infertility treatments. A primigravid client is less likely to conceive dizygotic twins.

Which of the following would be important to include in the teaching plan for the client who wants more information on ovulation and fertility management?

Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. For a client with a typical menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5° to 1.0° F (0.28° to 0.56°C) when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.

Which of the following instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?

Severe cramping may occur when the IUD is inserted. Severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common adverse effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.

A primigravida at 8 weeks' gestation tells the nurse that she wants an amniocentesis because there is a history of Hemophilia A in her family. The nurse informs the client that she will need to wait until she is 15 weeks gestation for the amniocentesis. Which of the following provides the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation?

The volume of amniotic fluid needed for testing will be available by 15 weeks. The volume of fluid needed for amniocentesis is 15 ml and this is usually available at 15 weeks' gestation. Fetal development continues throughout the prenatal period. Cells necessary for testing for Hemophilia A are available during the entire pregnancy but are not accessible by amniocentesis until 12 weeks' gestation. Anomalies are not associated with amniocentesis testing.

A client in the first trimester of pregnancy joins a childbirth education class. During this trimester, the class is most likely to cover which physiologic aspect of pregnancy?

Warning signs of complications. In early childbirth education classes, instruction on the physiologic aspects of pregnancy may include warning signs of complications, the anatomy and physiology of pregnancy, nutrition, and fetal development. Signs and symptoms of labor, quickening and fetal movements, and false and true labor are usually discussed in later classes.

A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which of the following responses would be most helpful?

What is it that concerns you about pregnancy, labor, and childbirth?" The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helpful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States and Canada, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client's concerns and block further therapeutic communication. Also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety.

A client has undergone a vasectomy. The nurse instructs the client that he can begin having unprotected intercourse:

When the sperm count reflects sterilization. After vasectomy, a sperm analysis will be performed every 4 to 6 weeks. A sperm-free analysis is necessary before the man can be considered sterile. Sperm gradually disappear from the ejaculate. Clients must be informed that conception is possible in the immediate postvasectomy period.

Which of the following statements made by a pregnant woman in the first trimester are consistent with this stage of pregnancy? Select all that apply.

• "I wonder how it will feel to buy maternity clothes and be fat." • "Oh my, how did this happen? I don't need this now." • "My husband told his friends we will have to give up the Mustang for a minivan." The first trimester is when the couple works through the psychological task of accepting the pregnancy. These statements describe the client and her partner coping with the pregnancy, how it feels, and how it will impact their lives. The feelings include pleasure, excitement, and ambivalence. Wondering what the baby will look like and planning for the baby's room occur later in the pregnancy.

A nurse is teaching a female client, who is positive for human immunodeficiency virus, about pregnancy. The nurse should know more teaching is necessary when the client says:

"I'll need to have a cesarean birth if I become pregnant and have a baby." The client requires more teaching if she states she'll need to have a cesarean birth if she becomes pregnant. HIV is transmitted from mother to child via the transplacental route, but a cesarean birth isn't necessary when the mother is HIV-positive. The use of birth control will prevent the conception of a child who might have HIV. It's true that a mother who's HIV-positive can give birth to a baby who's HIV-negative; however, all neonates born to HIV-positive mothers will be HIV-positive for about 6 months because of maternal antibodies.

A nurse is providing care for a pregnant 16-year-old. The client says that she is concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying:

"Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems." Depriving the developing fetus of nutrients can cause serious problems and the nurse should discuss this issue with the client. The client isn't eating for two; this belief is a misconception. Exploring feelings helps the client understand her concerns, but the nurse also needs to make the client aware of the risks at this time. The vitamins are supplements and don't contain everything a mother or developing fetus needs; they work in conjunction with a balanced diet.

According to the antenatal record, a newborn is 12 days post-mature. A nurse completes the initial assessment of the newborn and notes increased amounts of vernix. The mother asks why the nurse seems concerned about the presence of the vernix. Which of the following statements by the nurse is most appropriate?

"The vernix indicates a different gestational age than expected." Vernix caseosa is a whitish substance that serves as a protective covering over the fetal body throughout the pregnancy. Vernix usually disappears by term gestation. It is highly unusual for a 12-day post-mature baby to have increased amounts of vernix. A discrepancy between EDC (estimated date of conception) and gestational age by physical examination must have occurred.

After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective?

"Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy." Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait until after intercourse to take steps to prevent conception. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility that fertilization can occur. Before fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality.