Obstetrics Exam #1 Prep

A nurse is reviewing the evolution of maternal, neonatal, and women's health nursing. Place the events below in their proper sequence from earliest to latest to demonstrate understanding of this evolution. All options must be used: The first cesarean birth was performed. Women faced birth with fear of death. A growing trend emerged to return birthing back to the basics. Amniocentesis was first performed. Nurseries were established to care for babies

1) Women faced birth with fear of death. 2) The first cesarean birth was performed. 3) Nurseries were established to care for babies. 4) Amniocentesis was first performed. 5) A growing trend emerged to return birthing back to the basics. Rationale: During the 1700s, women faced birth with the fear of death. The first cesarean birth was performed in 1894. Nurseries were started during the early 1900s to address the need of mothers who could not care for their babies for several days after receiving chloroform gas. Amniocentesis was first performed in 1966. The 1970s and 1980s saw a growing trend to return birthing back to the basics.

A nurse is conducting a class about breast cancer for a group of young adult women. Which statements by the class indicates to the nurse that the teaching was successful? Select all that apply. A. "A diet high in fat can be a risk factor for developing breast cancer." B. "My risk is increased if I had an irregular menstrual cycle starting at an early age." C. "If someone in the family has breast cancer, my risk would be increased."

A. "A diet high in fat can be a risk factor for developing breast cancer." B. "My risk is increased if I had an irregular menstrual cycle starting at an early age." C. "If someone in the family has breast cancer, my risk would be increased." Rationale: A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy.

A nurse is providing prenatal care to a pregnant woman. Understanding a major component of this care, the nurse would conduct a risk assessment for: A. genetic conditions and disorders. B. cultural differences. C. infant nutritional needs. D. family dynamics.

A. genetic conditions and disorders. Rationale: Nurses at all levels should be participating in risk assessment for genetic conditions and disorders, explaining genetic risk and genetic testing, and supporting informed health decisions and opportunities for early intervention.

After a birthing class, the nurse recognizes additional education is needed when one of the participant's states: A. "We will be storing the cord blood at the local facility." B. "We are going to save the cord blood, in case our baby needs it later." C. "We are going to donate our cord blood to the blood bank to help others." D. "We decided against signing the informed consent to save the cord blood."

B. "We are going to save the cord blood, in case our baby needs it later." Rationale: Parents should be aware that stem cells from cord blood cannot currently be used to treat inborn errors of metabolism or other genetic diseases in the same individual from which they were collected because the cord blood will have the same genetic mutation. Cord blood may be donated to a local blood bank or stored in a local facility. Parents also have the option to refuse giving permission to collect it.

The nurse is explaining the process of conception and implantation to a group of women attending a preconception planning education program. When describing the hormones involved in these events, the nurse would identify which hormone as being responsible for ensuring implantation of the embryo at the beginning of conception? A. estrogen B. human chorionic gonadotropin (hCG) C. progesterone D. luteinizing hormone

B. human chorionic gonadotropin (hCG) Rationale: Estrogen, progesterone, and LH are all important hormones of the female reproductive system; however, it is hCG that is responsible for ensuring the endometrium is receptive to the implanting embryo. It is this increased elevation of hormone levels that is measured in home pregnancy tests.

A nurse is conducting a presentation for a group of nurses at the prenatal clinic on basic genetic information. After teaching the group about genetics, the nurse determines that the teaching was effective based on which statement by the group? A. "Your outward characteristics show some interesting genotypes." B. "A secondary goal of determining my genome is to find new treatments." C. "My genome is my genetic blueprint." D. "My parents gave me good phenotypes."

C. "My genome is my genetic blueprint." Rationale: An individual's genome represents his or her genetic blueprint, which determines genotype (the gene pairs inherited from parents) and phenotype (observed outward characteristics of an individual). A primary goal of human genome project (HGP) is to translate the findings into new strategies for the prevention, diagnosis, and treatment of genetic diseases and disorders.

A couple has come in for genetic testing. The nurse is explaining the different types of numerical abnormalities that may occur within the chromosome pairs. The nurse determines that additional explanation is necessary when the couple identifies which trisomy as common? A. 18 B. 13 C. 10 D. 21

C. 10 Rationale: The most common trisomies include trisomy 21 (Down syndrome), trisomy 18, and trisomy 13.

A nurse is conducting a teaching program for a group of young adult women about the structures of the female reproductive system. After describing the internal structures, the nurse determines that the teaching was successful when the group identifies which structure as the neck of the uterus? A. clitoris B. introitus C. cervix D. fourchette

C. cervix Rationale: The neck of the uterus is referred to as the cervix. It connects to the vagina. The opening to the vagina is called the introitus, and the half-moon-shaped area behind the opening is called the fourchette. The clitoris is a small, cylindrical mass of erectile tissue and nerves. Most of the components of the clitoris are buried under the skin and connective tissue of the vulva. It is located at the anterior junction of the labia minora.

Some chromosomal abnormalities of number often result because of the failure of the chromosome pair to correctly separate during cell division. One type is referred to as polyploidy. The nurse recognizes that this type usually results in: A. Edward syndrome. B. Patau syndrome. C. early spontaneous abortion. D. Down syndrome.

C. early spontaneous abortion. Rationale: Polyploidy usually results in an early spontaneous abortion and is incompatible with life. Down syndrome, Edward syndrome, and Patau syndrome are types of trisomy disorders

A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth? A. Sleeping on the back B. Folic acid supplementation C. Newborn development support groups D. Breastfeeding

D. Breastfeeding Rationale: After birth, other health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of SIDS. Newborn development support groups will help provide education about normal child development and child rearing. Folic acid supplementation is used during pregnancy to prevent neural tube defects.

A nurse is putting together educational material for clients who desire to learn about how to get pregnant. Part of this information will explain that fertilization occurs: A. in the vagina. B. in the ovaries. C. in the uterus. D. in the fallopian tubes.

D. in the fallopian tubes. Rationale: Fertilization of the ovum can occur in the distal portion of the fallopian tubes. If the egg is fertilized, it will then be moved through the fallopian tube towards the uterus where it implants in the thick endometrium and begins its development.

A nurse is preparing a teaching plan for a woman who is planning to become pregnant. Which hormone secreted by the corpus luteum would the nurse include in the discussion when describing how the endometrium is prepped for egg implantation? A. prolactin B. luteinizing hormone C. testosterone D. progesterone

D. progesterone Rationale: After the follicle ruptures as it releases the egg, it closes and forms a corpus luteum. The corpus luteum secretes increasing amounts of progesterone and estrogen, which interact with the endometrium to prepare it for implantation. The corpus luteum does not secrete prolactin, testosterone, or luteinizing hormone.

A client has given birth to an infant with Patau syndrome, or trisomy 13. Based on the nurse's understanding of this condition, the nurse would counsel this couple that the care of this infant is: A. long-term. B. therapeutic. C. complicated. D. supportive.

D. supportive. Rationale: An infant born with Patau syndrome, or trisomy 13, has the life expectancy of only a few days due to the severe abnormalities. Care is supportive for these infants and parents.

A nurse is conducting a class about breast cancer for a group of young adult women. Which statements by the class indicates to the nurse that the teaching was successful? Select all that apply. A. "A diet high in fat can be a risk factor for developing breast cancer." B. "My risk is increased if I had an irregular menstrual cycle starting at an early age." C. "If someone in the family has breast cancer, my risk would be increased." D. "Using condoms and spermicides increase a woman's risk for breast cancer." E. "Being underweight is a major risk factor for developing breast cancer."

A. "A diet high in fat can be a risk factor for developing breast cancer." B. "My risk is increased if I had an irregular menstrual cycle starting at an early age." C. "If someone in the family has breast cancer, my risk would be increased." Rationale: A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors. Other risk factors include excess weight, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, and long-term use of hormone replacement therapy.

A woman who is 16 weeks' pregnant asks the nurse, "I am curious about how my fetus is growing. What is happening now?" Which information would the nurse include in the response? Select all that apply. A. "Your fetus is making sucking movements." B. "Your fetus's eyelids can open and close." C. "Your baby has some fine hair on the head." D. "Your fetus has eyebrows now." E. "Your fetus's fingernails and toenails are present."

A. "Your fetus is making sucking movements." C. "Your baby has some fine hair on the head." E. "Your fetus's fingernails and toenails are present." Rationale: Between 13 and 16 weeks' gestation, the fetus has fine hair called lanugo developing on the head, makes sucking motions with the mouth, and has fingernails and toenails. Eyebrows do not form until 17 to 20 weeks' gestation. Eyelids open and close between 25 to 28 weeks' gestation.

A woman with sickle cell anemia has just found out that she is 6 weeks' pregnant. The woman is being scheduled for chorionic villus testing to determine her child's risk for sickle cell anemia. The nurse would inform the woman that the earliest time she may undergo this test would be at which week of gestation? A. 10 weeks B. 16 weeks C. 15 weeks D. 18 weeks

A. 10 weeks Rationale: Chorionic villus sampling is typically performed between 10 and 12 weeks' gestation with results available in less than 1 week. So the earliest time would be 10 weeks. An alpha-fetoprotein test is typically performed between 15 and 18 weeks' gestation. An amniocentesis is usually performed between 15 and 20 weeks' gestation to allow for adequate amniotic fluid volume to accumulate. Percutaneous umbilical blood sampling is generally performed after 16 weeks' gestation.

The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate? A. Check the medical record for written client approval with whom to share information. B. Tell the partner that no information can be shared with him or her at this time. C. Ask the partner for identification first before sharing any information. D. Answer the partner's questions honestly and without hesitation.

A. Check the medical record for written client approval with whom to share information. Rationale: In maternal and newborn health care, information is shared only with the client, legal partner, parents, legal guardians, or individuals as established in writing by the client or the child's parents. This law promotes the security and privacy of health care and health information for all clients. Therefore, the nurse needs to check the medical record for written documentation that allows the partner to have this information. Any other action would be inappropriate.

A nurse is teaching a group of adolescent girls about the menstrual cycle. The nurse would integrate information about which hormones as being predominant during the cycle? Select all that apply. A. FSH B. prolactin C. GnRH D. LH E. testosterone

A. FSH C. GnRH D. LH Rationale: The predominant hormones involved in the menstrual cycle are gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and prostaglandins. Testosterone and prolactin do have a role in the female reproductive system are not considered predominant hormones for the menstrual cycle.

A nurse is teaching a group of pregnant women about fetal development. When describing how the various organs form, the nurse describes the primary germ layers involved. Which organ(s) would the nurse explain as developing from the mesoderm? Select all that apply. A. Heart B. Kidneys C. Brain D. Bones E. Lungs

A. Heart B. Kidneys D. Bones Rationale: The mesoderm forms the skeletal (bones), urinary (kidneys), circulatory (heart), and reproductive organs. The ectoderm forms the central nervous system (brain), special senses, skin, and glands. The endoderm forms the respiratory system (lungs), liver, pancreas, and digestive system.

A 58-year-old woman comes to the clinic for a routine evaluation. When reviewing the woman's health history, which finding(s) would lead the nurse to suspect that the woman is at risk for heart disease? Select all that apply. A. History of polycystic ovary syndrome B. Menopause at age 50 years C. Hemoglobin A1c levels at 6% (0.06) D. History of gestational hypertension E. Recent loss of 10 lb (4.5 kg) over 6 months

A. History of polycystic ovary syndrome B. Menopause at age 50 years D. History of gestational hypertension Rationale: Causes of heart disease for women may include: menopause (associated with a significant rise in coronary events); history of preeclampsia; diabetes, high cholesterol levels, and left ventricular hypertrophy; smoking, including secondhand smoke (which have a greater effect on women due to smaller body size); gestational hypertension; polycystic ovary syndrome; blood vessel inflammation and repeated episodes of weight loss and gain (increased coronary morbidity and mortality). An A1c level of 6% (0.06) is considered within normal parameters. Repeated episodes of weight loss and gain, not a single weight loss episode, would be a risk factors.

A nurse is conducting a health education class for a group of female high school students about the female reproductive system. The nurse determines that the teaching was successful when the students identify which structure(s) as part of the external female reproductive system? Select all that apply. A. Mons pubis B. Vestibule C. Vagina D. Perineum E. Ovaries

A. Mons pubis B. Vestibule D. Perineum Rationale: The external female reproductive organs collectively are called the vulva (which means "covering" in Latin). It encompasses both sets of labia (majora and minora), the head of the clitoris, the opening of the urethra, and the opening of the vagina. The structures that make up the vulva include the mons pubis, the labia majora and minora, the clitoris and prepuce, the structures within the vestibule, and the perineum. The ovaries and vagina are internal genitalia.

The nurse educator describes the key changes that happen to the newborn's heart and lungs at birth. Which information would the nurse likely include? Select all that apply. A. With the newborn's first breaths, the lungs inflate, increasing blood flow to the lungs. B. The ductus venosus closes with the clamping of the umbilical cord. C. The ductus arteriosus opens in response to the increase in oxygen levels with the first breaths. D. The foramen ovale closes within 1 to 2 hours after birth and permanently by 6 months. E. The ductus arteriosus opens in response to the oxygen levels after the first breaths.

A. With the newborn's first breaths, the lungs inflate, increasing blood flow to the lungs. B. The ductus venosus closes with the clamping of the umbilical cord. D. The foramen ovale closes within 1 to 2 hours after birth and permanently by 6 months. Rationale: With the newborn's first breath, the lungs inflate, which leads to an increase in blood flow to the lungs. Typically the foramen ovale is functionally closed within 1 to 2 hours after birth. Permanent closure occurs by the sixth month of life. The ductus venosus closes with the clamping of the umbilical cord. The ductus arteriosus constricts partly in response to the higher arterial oxygen levels that occur after the first few breaths. Functional closure of the ductus arteriosus in a term infant usually occurs within the first 72 hours after birth

A nurse is conducting a class for a group of women who are planning on becoming pregnant. As part of the class, the nurse describes how teratogens can affect a pregnancy. The nurse determines that the teaching was successful when the class identifies which effects that may result with the use of cocaine? Select all that apply. A. abruptio placenta B. microcephaly C. intrauterine growth restriction D. premature birth E. limb malformations

A. abruptio placenta B. microcephaly D. premature birth Rationale: Cocaine use during pregnancy can lead to abruptio placenta, premature birth, and microcephaly. Intrauterine growth restriction is associated with the use of ACE inhibitors for treating hypertension. Limb malformations are associated with thalidomide exposure.

It is important that nurses include a discussion about teratogens in their prenatal discussions to help prevent deformities or abnormalities. Which substance(s) would the nurse include as a teratogen(s)? Select all that apply. A. alcohol B. certain medications C. multivitamin supplement D. caustic chemicals

A. alcohol B. certain medications D. caustic chemicals Rationale: A teratogen is any substance, organism, physical agent, or deficiency state present during gestation that is capable to inducing abnormal postnatal structure or function by interfering with normal embryonic and fetal development. They include alcohol, certain drugs/medications, infections, and certain chemicals.

A nurse is working as part of a team to address health literacy issues in the community. Which indicators would the team use to determine that efforts are effective in addressing these issues? Select all that apply. A. decreased emergency department visits B. increased use of preventive services C. decreased number of healthcare visits D. improved health outcomes E. lower morbidity rates

A. decreased emergency department visits B. increased use of preventive services D. improved health outcomes E. lower morbidity rates Rationale: Low health literacy is associated with poor health outcomes, increased emergency room visits, higher morbidity and mortality rates, and less use of preventive health services. Thus effective programs would reverse these events.

A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour-old infant's chest. The nurse recognizes this as most likely the result of which condition? A. delayed fetal shunt closure B. congenital defect C. dysfunctional foramen ovale D. attached umbilical cord stump

A. delayed fetal shunt closure Rationale: Functional closure of all fetal shunts usually occurs anywhere from the first hour to three to four weeks after birth. These delayed fetal shunt closures are usually not associated with a heart lesion. If they are still present at a later date, evaluation may be warranted.

A client is returning with a third vaginal infection within a six-month period. During the health assessment, the nurse should ask about the client's use of which products? Select all that apply. A. deodorants B. herbs C. douches D. yogurt

A. deodorants C. douches Rationale: Antibiotic therapy, douching, perineal hygiene sprays, and deodorants upset the acid balance within the vaginal environment and can predispose women to infections. The vagina depends on its acidic environment to protect it against ascending infections.

A client presents for her routine prenatal visit, but on examination the nurse notices multiple bruises in various stages of healing. The nurse's most appropriate action would be to: A. document findings. B. call the authorities. C. report her findings to the primary care provider. D. send the client to the women's shelter.

A. document findings Rationale: Nurses serve their clients best not by trying to rescue them but by helping them build on their strengths and providing support. The first step is to document the findings and then alert others. Using a screening tool like "RADAR" can prove beneficial in assessing potential violence. (R: routinely screen every client for abuse; A: affirm feelings and assess abuse; D: document findings; A: assess the client's safety; R: review options and make referrals).

After a reproductive class at the local school, the public health nurse realizes more training is needed when the class identifies the layers of the uterus to include: A. epimetrium. B. myometrium. C. serosa. D. endometrium.

A. epimetrium. Rationale: The three layers of the uterus are the endometrium, myometrium, and serosa. The epimetrium is not a layer of the uterus.

After teaching a health education class on the female reproductive cycle, the nurse determines that the teaching was effective when the group identifies which phase as belonging to the ovarian cycle? A. follicular phase B. secretory phase C. ischemic phase D. proliferative phase

A. follicular phase Rationale: The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase. The proliferative, secretory, and ischemic phases occur in the endometrial cycle.

A nurse is preparing a presentation on genetic disorders. Which condition would the nurse most likely include as the most common form of male autism spectrum disorder? A. fragile X syndrome B. Down syndrome C. Patau syndrome D. cri du chat syndrome

A. fragile X syndrome Rationale: Fragile X syndrome is a common form of intellectual disability and autism spectrum disorder. Conservative estimates report that fragile X syndrome affects approximately one in 3,600 males and one in 6,000 females (National Fragile X Foundation, 2020). Typically, a female becomes the carrier and will be mildly affected. The male who receives the X chromosome that has a fragile site will exhibit the full effects of the syndrome. Cri du chat syndrome is a rare genetic disorder. Most children with Down syndrome have an intellectual disability in the mild-to-moderate range. Children with Patau syndrome (rate genetic disorder) have a life expectancy of only a few days after birth. Although intellectual disability may be associated with these other disorders, typically autism spectrum disorders are not.

The nurse is updating the records of a woman who recently gave birth to a healthy 7-lb (3,175-g) newborn. Which action could jeopardize the privacy of the woman's medical records? A. letting another nurse use the nurse's login session B. closing files before stepping away from the computer C. changing identification and passwords monthly D. printing out confidential information for transmittal

A. letting another nurse use the nurse's login session Rationale: It is important to log off whenever leaving the computer. The person who shares the nurse's login session may get called away from the computer, leaving the nurse responsible for any breach in security. Keeping IDs and passwords confidential is basic computer security.

A nurse is working as part of a team to address health literacy issues in the community. Which indicators would the team use to determine that efforts are effective in addressing these issues? Select all that apply. A. lower morbidity rates B. improved health outcomes C. increased use of preventive services D. decreased emergency department visits E. decreased number of healthcare visits

A. lower morbidity rates B. improved health outcomes C. increased use of preventive services D. decreased emergency department visits Rationale: Low health literacy is associated with poor health outcomes, increased emergency room visits, higher morbidity and mortality rates, and less use of preventive health services. Thus effective programs would reverse these events.

A nurse is teaching a client about the reproductive system and the hormones involved. The nurse would include which structures as the source of these hormones? Select all that apply. A. pituitary B. uterus C. hypothalamus D. ovaries E. placenta

A. pituitary C. hypothalamus D. ovaries Rationale: The reproductive cycle is influenced and controlled by hormones secreted by the ovaries, hypothalamus, and pituitary gland. The placenta secretes a temporary hormone that assists with maintaining pregnancy. The uterus does not secrete hormones.

A young mother is expressing the frustration of not being able to breastfeed her infant. A potential cause could be the lack of the hormone: A. prolactin. B. oxytocin. C. luteinizing hormone. D. estrogen.

A. prolactin Rationale: The hormone prolactin is responsible for the stimulation of milk production. Oxytocin is responsible for uterine contractions during labor. Luteinizing hormone and estrogen are important hormones responsible for the monthly cycles.

A nurse is counseling a client preconception and describes pregnancy risk factors for genetic disorders. What risk factors would the nurse include? Select all that apply. A. the partner of a pregnant client is 53 years old B. an incestuous relationship resulting in pregnancy C. the pregnant mother has been exposed to teratogens D. a pregnant client who is 35 years old E. the mother has a history of hypothyroidism

A. the partner of a pregnant client is 53 years old B. an incestuous relationship resulting in pregnancy C. the pregnant mother has been exposed to teratogens D. a pregnant client who is 35 years old Rationale: Those who may benefit from genetic counseling are women aged 35 years or older when the baby is born; a paternal age 50 years or older; a previous child, parents, or close relatives with an inherited disease or chromosomal abnormalities; consanguinity or incest; teratogen exposure or risk. Hypothyroidism must be treated during pregnancy, but this disorder does not create a risk for genetic disorders.

A client is presenting with possible signs of menopause. The nurse recognizes that menopausal symptoms are related to: A. vasomotor activities. B. psychiatric activities. C. autonomic activities. D. hypersecretion of hormones.

A. vasomotor activities Rationale: Vasomotor symptoms are the most commonly reported during the menopausal transition. These include hot flashes, irregular menstrual cycles, sleep disruptions, forgetfulness, irritability, mood disturbances, decreased vaginal lubrication, night sweats, fatigue, vaginal atrophy, and depression.

When teaching a group of adolescents about the menstrual cycle, the nurse describes the ovarian and endometrial cycles. Which phase(s) would the nurse explain as part of the ovarian cycle? Select all that apply. A. Secretory phase B. Luteal phase C. Ischemic phase D. Proliferative phase E. Follicular phase

B. Luteal phase E. Follicular phase Rationale: The ovarian cycle consists of three phases: the follicular phase, ovulation, and the luteal phase. The four phases of the endometrial cycle are the proliferative phase, secretory phase, ischemic phase, and menstrual phase.

A woman experiencing menopausal symptoms asks the nurse about herbal remedies for managing her symptoms. Which response by the nurse would be most appropriate? A. "Herbal remedies have been proven quite reliable in alleviating the symptoms of menopause." B. "Most of the information about herbal therapies is based on reports by those who have used them, not scientific studies." C. "Your symptoms are not severe enough to warrant any treatment or therapy." D. "You should avoid herbal remedies and ask your primary care provider for hormone replacement therapy."

B. "Most of the information about herbal therapies is based on reports by those who have used them, not scientific studies." Rationale: Information about the efficacy of herbal therapies is largely anecdotal. Research to validate the efficacy, safety, and potential harmful effects of herbal therapies is lacking. Until recently, hormone replacement therapy was the mainstay of treatment, but in light of the results of the Women's Health Initiative trial, it has become controversial. Telling the woman that her symptoms are not severe enough is demeaning and inappropriate: the woman's symptoms are significant to her, regardless of what the nurse may think.

A woman is to undergo quad screening testing. The nurse would anticipate that this test would be done at which time? A. 20 weeks gestation B. 16 weeks gestation C. 24 weeks gestation D. 12 weeks gestation

B. 16 weeks gestation Rationale: Typically, a triple or quad screening test would be done between 15 and 18 weeks gestation.

It is important that couples who wish to practice natural forms of birth control understand that the mucus-secreting glands of the cervix can store live sperm for up to: A. 24 hours. B. 48 hours. C. 12 hours. D. 36 hours.

B. 48 hours. Rationale: The mucus-secreting glands of the cervix are capable of storing live sperm for 48 to 72 hours (2 to 3 days), enabling pregnancy to occur after intercourse has occurred 1 or 2 days before ovulation.

A nurse is providing care to several clients at the clinic. The nurse would obtain legal consent for care from the parent or legal guardian for which client? A. A 14-year-old client who is an emancipated minor B. A 15-year-old adolescent who is a high school student C. A 17-year-old client who is married D. A 20-year-old client who is a college student

B. A 15-year-old adolescent who is a high school student Rationale: Generally, only people over the age of majority (18 years old) can legally provide consent for health care except in the case of an emancipated minor and of a person who is no longer subject to parental control, (e.g., one who marries). Therefore, the 15-year-old adolescent would require parental consent for treatment.

A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care? A. Language B. Health insurance C. Low health literacy D. Transportation

B. Health insurance Rationale: Although transportation, language and culture, and low health literacy are barriers to health care, health insurance is a major factor affecting access to health care. The existence of financial barriers is one of the most important factors that limits access to care. Many families do not have health insurance so they cannot afford to see health care providers for maintenance and prevention services. Many do not have enough health insurance to cover services they need or cannot pay for services.

A nurse is conducting an assessment of a pregnant woman on a routine follow-up prenatal visit. Assessment findings suggest that the client may have a substance use disorder. Which action by the nurse would be most appropriate to ensure proper care of the client and the unborn fetus? A. Document the suspicious findings in the client's medical record. B. Initiate a referral to available community services. C. Begin a referral for the client to attend an inpatient detox facility. D. Call child protective services.

B. Initiate a referral to available community services. Rationale: Nurses should employ a flexible approach to the care of women who have substance use disorders, and they should encourage the use of all available community resources. Women should be counseled about the risks of preconception, antepartum, and postpartum substance use in a calm, nonjudgmental manner by nurses (AWHONN, 2015). Pregnant women who have a substance use disorder should be afforded access to preventive, supportive, and recovery services that meet their special needs. The nurse can be instrumental in facilitation referral to community programs for both pregnant and postpartum women that can help ensure their full recovery and better lives for them and their children.

Prenatal education provided at a local clinic should include emphasizing to the mother to keep all routine prenatal visits. What is the rationale for this point? A. Identified problems can be treated earlier. B. Most pregnancy-related complications are preventable. C. By keeping scheduled appointments, expectant mothers' problems will be less severe. D. Complications can be better controlled.

B. Most pregnancy-related complications are preventable. Rationale: Most pregnancy-related complications are preventable. Adequate prenatal care includes education and assessments aimed at avoiding these complications. The leading causes of pregnancy-related mortality are hemorrhage, infection, preeclampsia-eclampsia, obstructed labor, and unsafe abortion.

A nurse is conducting an in-service program for a group of perinatal nurses. After teaching the group about autosomal dominant and recessive inheritance patterns, the nurse determines that the group needs additional teaching when they identify which condition as an example of an autosomal dominant disorder? A. neurofibromatosis B. Tay-Sachs disease C. achondroplasia D. Huntington disease

B. Tay-Sachs disease Rationale: Tay-Sachs disease is an example of an autosomal recessive disorder. Neurofibromatosis, achondroplasia, and Huntington disease are examples of autosomal dominant disorders.

When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information? A. It limits fetal movement in utero. B. The amount gradually fluctuates during pregnancy. C. It is usually an acidic fluid. D. It is composed primarily of organic substances.

B. The amount gradually fluctuates during pregnancy. Rationale: Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development.

A mother has come to the clinic with her 13-year-old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality? A. cri du chat syndrome B. Turner syndrome C. Klinefelter's syndrome D. fragile X syndrome

B. Turner syndrome Rationale: Turner syndrome is a common abnormality of the sex chromosome in which a portion or all of the X chromosome is missing. Only about one third of the cases are diagnosed as newborns; the remaining two thirds are diagnosed in early adolescence when they experience primary amenorrhea. No cure exists for this syndrome. Hormone replacement therapy may be used to induce puberty.

A group of nurses is working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply. A. Encouraging clients to use emergency services for minor problems B. Urging clients to participate in screening programs C. Educating clients about seeking help for problems early on D. Encouraging clients to consume organic foods to promote healthy lifestyle choices E. Creating easy access programs for clients to receive immunizations

B. Urging clients to participate in screening programs C. Educating clients about seeking help for problems early on E. Creating easy access programs for clients to receive immunizations Rationale: Nurses can be leaders in providing quality care within a limited-resource environment by emphasizing the importance of making healthy lifestyle and food choices, seeking early interventions for minor problems before they become major ones, and learning about health-related issues that affect clients. Mammograms, cervical cancer screenings, prenatal care, smoking cessation programs, and immunizations are a few examples of preventive care that yield positive outcomes and reduce overall health care costs. Prevention services and health education are the cornerstones of delivering quality maternal, newborn, and women's health care.

A nurse is working as part of an interdisciplinary team providing care to women and children at a local community center. The nurse advocates for and provides comprehensive care to the clients across the continuum of care. The nurse is acting as: A. case evaluator. B. case manager. C. education manager. D. quality control monitor.

B. case manager Rationale: Case management is the interdisciplinary collaborative type of care that involves the collaborative process of assessment, planning, application, coordination, follow-up, and evaluation of options and services required to meet the individual's health care needs. When the nurse effectively functions as the case manager, client and family satisfaction is increased, fragmentation of care is decreased, and outcome measurement for a homogenous group of clients is possible. Although education, evaluation, and quality control may be aspects of the role, the nurse is functioning as the case manager.

It is important that a nurse recognizes there are cultural differences that will have an influence on the care of the client. Some cultures practice female circumcision, which involves the removal of the: A. fourchette. B. clitoris. C. labia minora. D. hymen.

B. clitoris Rationale: Some cultures practice female circumcision, which involves the removal of the clitoris. It is important for the nurse to remain open-minded and nonjudgmental with all clients.

The nurse is providing care to a pregnant client from the Middle East. The client tells the nurse that she will not make a decision without her husband's approval. The nurse interprets this statement as reflecting: A. family preference. B. cultural difference. C. traditional values. D. religious submission.

B. cultural difference. Rationale: Different social groups have a specific view of the world and set of traditions that guide their actions, beliefs, and interactions with others. It is important that the nurse recognize these cultural differences and work with them when providing care. The client's statement reflects the specific cultural view, not a religious idea, family preference, or traditional value.

After teaching a class on the various structures formed by the embryonic membranes, the nurse determines that the teaching was successful when the class identifies which structure as being formed by the ectoderm? A. lungs B. ears C. stomach D. bones

B. ears Rationale: The ectoderm forms the structures of the special senses. The endoderm forms the structures of the respiratory and digestive systems. The mesoderm forms the structures of the skeletal system

A nurse is providing care to a woman who has just found out that she is pregnant. The nurse is describing the events that have occurred and the structures that are forming. When describing the trophoblast to the client, the nurse would explain that this structure forms: A. fetal membrane. B. zygote. C. morula. D. placenta.

D. placenta. Rationale: The trophoblast forms the placenta and chorion. The blastocyst forms the embryo and amnion. The zygote is formed from the union of the sperm and ovum. The morula is a mass of 16 cells that develop as cleavage cell division continues after fertilization.

A nurse is explaining to a pregnant client about the various events associated with pregnancy and its progression. Which placental hormone would the nurse identify as playing a key role in stimulating myometrial contractility? A. relaxin B. estrogen C. human chorionic gonadotropin D>progesterone

B. estrogen Rationale: Estrogen causes enlargement of a woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone maintains the endometrium, decreases uterine contractility, stimulates maternal metabolism and breast development, and provides nourishment for the early conceptus. Relaxin acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, and softens the cervix in preparation for birth. Human chorionic gonadotropin preserves the corpus luteum and its progesterone production so that the endometrial lining is maintained. It is the basis for pregnancy tests.

Which hormone would the nurse explain as being primarily responsible for maturation of the ovarian follicle? A. gonadotropin-releasing hormone B. follicle-stimulating hormone C. estrogen D. luteinizing hormone

B. follicle-stimulating hormone Rationale: Follicle-stimulating hormone is primarily responsible for the maturation of the ovarian follicle. Luteinizing hormone is required for the final maturation of preovulatory follicles and luteinization of the ruptured follicle. Gonadotropin-releasing hormone induces the release of follicle stimulating hormone and luteinizing hormone to assist with ovulation. Estrogen is crucial for the development and maturation of the follicle and induces proliferation of the endometrial glands.

A nurse at a community family clinic is working with other team members to develop programs to address issues related to infant mortality. As the priority, the team focuses interventions on addressing newborns who are: A. given soy-based formula. B. of low birth weight. C. born post-term. D. are first born.

B. of low birth weight. Rationale: congenital abnormalities remain the leading cause of infant mortality in the United States. Low birth weight and prematurity are major indicators of infant health & significant predictors of infant mortality. The high incident of low birth weight in the USA is a significant reason why its infant mortality rate is higher than that of other countries.

A nurse is reviewing the medical record of a woman who has given birth vaginally. The record reveals that the client required a right mediolateral episiotomy during birth. When assessing the client, the nurse would inspect which area to evaluate the status of the episiotomy? A. labia B. perineum C. clitoris D. vestibule

B. perineum Rationale: The perineum is the most posterior part of the external female reproductive organs. This external region is located between the vulva and the anus. It is made up of skin, muscle, and fascia. Incising the perineum area to provide more space for the presenting part is called an episiotomy. An episiotomy does not involve the clitoris, vestibule, or labia.

A nurse working in the emergency department has witnessed women arriving in labor and experiencing complications that have led to poor outcomes. When reviewing the medical records of these clients, the nurse notes that a lack of which factor appears to be a common thread? A. adequate nutrition B. prenatal care C. education D. employment

B. prenatal care Rationale: Evidence has shown that a lack of care during pregnancy is a major factor that contributes to the poor outcome. Prenatal care is well known to prevent complications of pregnancy and to support the birth of healthy infants. A lack of adequate nutrition may play a role, but it is only one aspect of prenatal care. Evidence has not shown that employment or education are contributing factors to poor outcomes.

On a routine prenatal visit, the nurse is concerned that the client may have a substance use disorder. To ensure proper care of her client, the nurse should: A. report the client to child protective services. B. refer the client to available community services. C. document the suspicions in the client's record. D. refer the client to an inpatient program.

B. refer the client to available community services. Rationale: Nurses should employ a flexible approach to the care of women who have substance use disorders, and they should encourage the use of all available community resources. Women should be counseled about the risks of preconception, antepartum, and postpartum substance use in a calm, nonjudgmental manner by nurses (AWHONN, 2015). Pregnant women who have a substance use disorder should be afforded access to preventive, supportive, and recovery services that meet their special needs. The nurse can be instrumental in facilitating referral to community programs for both pregnant and postpartum women that can help ensure their full recovery and better lives for themselves and their children.

After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies which action as the primary function of the ovaries? A. secreting mucus that supplies lubrication for intercourse B. secreting estrogen and progesterone C. implanting a fertilized ovum D. carrying the ovum to the endometrium

B. secreting estrogen and progesterone Rationale: The ovaries have two primary functions: development and release of the ovum and secretion of estrogen and progesterone. The fallopian tubes are responsible for conveying the ovum from the ovary to the uterus and sperm from the uterus toward the ovary. The Bartholin glands when stimulated secrete mucus that supplies lubrication for intercourse. The uterus is the site of implantation of a fertilized ovum

Genetic testing has revealed that a couple's unborn child shows the possibility of mosaicism. When counseling this couple, the nurse explains this means that: A. this genetic abnormality is a recessive trait that is familial. B. the genetic abnormality occurred after fertilization and during the mitotic cell division. C. this genetic trait generally occurs when both parents have the recessive trait in their DNA and pass it to their offspring. D. this genetic trait is generally passed from the mother to the child.

B. the genetic abnormality occurred after fertilization and during the mitotic cell division. Rationale: Mosaicism refers to when the chromosomal abnormalities do not show up in every cell and only some cells or tissues carry the abnormality. It occurs after fertilization and during the mitotic cell division. The symptoms are usually less severe.

A nurse manager is working with a group of staff nurses at a local women's health clinic on enhancing the staff's cultural humility. The clinic serves a culturally diverse client population. Which aspect would the nurse manager emphasize as a crucial first step? A. Urging the staff to read the literature highlighting the different cultures served by the clinic B. Viewing the members of a specific culture as being relatively the same in terms of beliefs C. Having each staff member identify their own preconceptions about the cultures being served D. Encouraging the staff to use open-ended questions with each client to develop a respectful partnership

C. Having each staff member identify their own preconceptions about the cultures being served Rationale: Cultural humility starts with self-knowledge and self-reflection, which helps nurses identify their own preconceptions of diverse cultures. The next step is to develop a respectful partnership with each client through open-ended questions and exploring similarities and differences. This fosters acceptance of the other person and culture and leads to a standard of care that clients deserve. Each client encounter increases the nurse's opportunity to learn more about the client, building knowledge of how to provide culturally based care. Reading literature about different cultures can help but this would not be the first step. Although there may be similarities related to health beliefs among individuals of a culture, nurses need to learn to view each individual of a culture as unique.

A nurse needs to ensure informed consent has been obtained to provide care to a young client. Which aspect would be the most important for the nurse to consider related to informed consent? A. Establishing if the parents are competent B. Contacting the parents prior to giving emergency care C. Knowing the laws in the state where care is being provided D. Determining if the child is emancipated

C. Knowing the laws in the state where care is being provided Rationale: Knowing the laws in the state where care is being given is the most important consideration because laws vary from state to state. Emancipation is a legal consideration that is viewed differently by laws of different states. Establishment of parental competency is a legal consideration that may be judged differently by laws of different states. Contacting the parents prior to giving emergency care is a legal consideration that may be judged differently by laws of different states.

A nurse is conducting a presentation for a group of parents of a local middle school. When describing puberty in girls, which event would the nurse identify as typically occurring last? A. Growth spurt B. Pubic hair appearance C. Menstruation D. Breast development

C. Menstruation Rationale: Pubertal events preceding the first menses have an orderly progression: thelarche, the development of breast buds; adrenarche, the appearance of pubic and then axillary hair followed by a growth spurt; and menarche (occurring about 2 years after the start of breast development).

The nurse is teaching a group of pregnant females about changes that occur in the uterus during pregnancy. The nurse identifies which area as experiencing marked hypertrophy? A. Lower perimetrium B. Cervix C. Upper myometrium D. Inner endometrium

C. Upper myometrium Rationale: The myometrium makes up the major portion of the uterus and is composed of smooth muscle linked by connective tissue with numerous elastic fibers. During pregnancy, the upper myometrium undergoes marked hypertrophy, but there is limited change in the cervical muscle content. Neither the endometrium (the innermost layer) nor the perimetrium (the outer serosal layer that covers the body of the uterus) undergo such a change.

A woman is to undergo karyotyping. The nurse best explains this testing as: A. a representation of the observable characteristics of an individual. B. a picture of a person's genetic blueprint. C. a picture-like analysis of the number, form, and size of the woman's chromosomes. D. the makeup of the gene pairs inherited from one's parents.

C. a picture-like analysis of the number, form, and size of the woman's chromosomes. Rationale: Karyotyping is a pictorial analysis of the number, form, and size of an individual's chromosomes. Genome is a representation of a person's genetic blueprint. Genotype refers to the specific genetic makeup or gene pairs inherited from one's parents. Phenotype refers to the observed outward characteristics of an individual.

A couple desires to undergo genetic testing for Huntington disease. The nurse recognizes that this is which type of genetic disorder? A. X-linked inherited disorder B. autosomal recessive inherited disorder C. autosomal dominant inherited disorder D. X-linked dominant inherited disorder

C. autosomal dominant inherited disorder Rationale: Autosomal dominant inherited disorders occur when a single gene in the heterozygous state is capable of producing the phenotype. Huntington's is a type of this genetic disorder.

A nurse has just started working at a clinic that has a large refugee client population. When providing care to this population group, which aspect would be most important for the nurse to recognize? A. language B. lack of understanding of American ways C. cultural differences D. ethnic background

C. cultural differences Rationale: Although an understanding of the groups ethnicity, language, and understanding of American ways may be helpful, it is important for nurses to recognize the various cultural differences among the clients. It is important to recognize these traditions and practices as a point of congruence rather than a potential source of conflict. With today's changing demographic patterns, nurses must be able to assimilate cultural knowledge into their interventions so they can care for culturally diverse women, children, and families. Nurses must be aware of the wide range of cultural traditions, values, and ethics. Cultural competence is the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs.

The nurse provides client education regarding the uterine corpus. Which part may fluctuate with changes of hormonal levels in the absence of pregnancy? A. myometrium B. epimetrium C. endometrium D. perimetrium

C. endometrium Rationale: The corpus, or main body of the uterus, undergoes cyclic changes as the result of changing levels of hormones secreted by the ovaries, in preparation of a pregnancy. When fertilization does not occur, most of the endometrium is shed, and the monthly period occurs.

A mother brings her 10-year-old daughter to the clinic for a routine visit. The mother tells the nurse that she has noticed her daughter beginning to develop and asks the nurse about when her daughter may begin menstruating. The nurse understands that many factors are involved in determining the age at which menstruation begins. Which factor would the nurse include in the response as most important? A. nutrition B. cultural practices C. genetics D. weight

C. genetics Rationale: Genetics is the most important factor in determining the age at which menarche starts, but geographic location, nutrition, weight, general health, nutrition, cultural and social practices, the girl's educational level, attitude, family environment, and beliefs are also important.

It is recognized that nutritional deficiencies are a common problem in the United States. A persistent problem that nurses should screen all prenatal clients for is: A. pernicious anemia. B. hypoglycemia. C. iron-deficiency anemia. D. hypocholesterolemia.

C. iron-deficiency anemia. Rationale: Iron-deficiency anemia is common among women. Inadequate food intake, unsound social and cultural food practices, presence of illness that interferes with ingestion, digestion, and absorption of nutrients, as well as menstruation are just a few factors that can affect the individual's nutritional status.

A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite? A. hemophilia B. color blindness C. spina bifida D. cystic fibrosis

C. spina bifida Rationale: Spina bifida is a multifactorial inherited disorder thought to be due to multiple genetic and environmental factors. Cystic fibrosis is considered an autosomal recessive inherited disorder, while color blindness and hemophilia are considered X-linked inheritance disorders.

During a prenatal visit, a pregnant woman tells the nurse, "I have had to buy some new bras because my breasts are getting bigger. I know this is supposed to happen, but what is going on in my body?" Which response by the nurse would be appropriate? A. "Your breasts are growing because fatty tissue is replacing the gland tissue." B. "Breast milk is being made already so it will be ready for your newborn." C. "All the good things in breast milk are collecting in your breasts." D. "Your hormones are causing the glands in your breasts to grow."

D. "Your hormones are causing the glands in your breasts to grow." Rationale: During pregnancy, placental estrogen and progesterone stimulate the development of the mammary glands. Because of this hormonal activity, the breasts may double in size during pregnancy in preparation for milk production. At the same time, glandular tissue replaces the adipose tissue of the breasts. Following childbirth and the expulsion of the placenta, levels of placental hormones (progesterone and lactogen) fall rapidly, and the action of prolactin (milk-producing hormone) is no longer inhibited. Prolactin stimulates the production of milk within a few days after child birth, but in the interim, dark yellow fluid called colostrum is secreted. The substances in breast milk are not present until breast milk is produced.

A newly pregnant 41-year-old woman is requesting genetic testing of the baby. She is concerned that due to her age the baby has an increased risk for which condition? A. cystic fibrosis B. muscular dystrophy C. Patau syndrome D. Down syndrome

D. Down syndrome Rationale: The risk of Down syndrome increases with advanced maternal age. According to the March of Dimes, the risk of having a baby with Down syndrome is about one in 1,340 for a woman at age 25; one in 940 at age 30; one in 353 at age 35; one in 85 at age 40; and one in 35 at age 45.

A pregnant client refuses treatment for an infection based on cultural beliefs. Which action by the nurse would be appropriate? A. Refuse to let the client leave until she consents to treatment. B. Coerce the client to have the treatment. C. Tell the client she can be arrested for neglect. D. Explain to the client why the treatment is important.

D. Explain to the client why the treatment is important. Rationale: When clients refuse treatment, it is important to educate the client and family about the importance of the recommended treatment without coercing or trying to force the client to agree. Sometimes, common ground may be reached between the family's religious or cultural beliefs and the health care team's recommendations. Communication and education are the keys in these situations. Telling the woman she can be arrested is untrue and also threatening. Refusing to let the woman leave is false imprisonment.

A woman at 15 weeks' gestation asks the nurse what the fetus looks like. Which response by the nurse would be most accurate? A. Rhythmic breathing movements are occurring. B. The fetus is about 15 in (38 cm) in length. C. The fetus is covered with a white, greasy film called vernix. D. Fingernails are present.

D. Fingernails are present. Rationale: Vernix caseosa, a white, greasy film, covers the fetus at weeks 17 through 20. The fetus reaches a length of approximately 15 in (38 cm) by weeks 25 to 28. Fingernails and toenails are present by approximately week 13 through 16. Rhythmic breathing movements occur between weeks 29 through 32.

A new mother who is nervous about her baby developing sudden infant death syndrome (SIDS) asks the nurse how to prevent it. Which suggestion would be most appropriate for the nurse to make? A. Keep the newborn on the side as much as possible when sleeping. B. Let the newborn sleep in the bed with the parents. C. Place the newborn on the stomach with the face turned to one side. D. Lay the newborn on the back, not the stomach to sleep.

D. Lay the newborn on the back, not the stomach to sleep. Rationale: Health promotion strategies can significantly improve an infant's health and chances of survival. Evidence has shown that placing an infant on his or her back to sleep will reduce the incidence of SIDS. There is no evidence to support the use of the side-lying position to prevent SIDS. Sleeping on the stomach (prone) may limit the newborn's ability to move her head, which increases the chance of suffocation. Allowing the newborn to sleep in the bed with the parents is dangerous because the parent could inadvertently move and injure or possibly crush the baby.

When describing birth during the 18th century, which description would be most accurate regarding maternal care during pregnancy and birth? A. Books on birth education became readily available. B. Heavy doses of narcotics were used during labor. C. Streptococci were identified as the major cause of puerperal fever. D. The majority of births occurred in the home with female midwives in attendance.

D. The majority of births occurred in the home with female midwives in attendance. Rationale: During the 18th century (1700s), female midwives attended the majority of births and these births occurred in the home setting. Louis Pasteur demonstrated that streptococci were the major cause of puerperal fever during the 19th century (1800s). The use of twilight sleep, in which heavy doses of narcotics were used during labor, occurred during the early 20th century (1900s). Books on childbirth education also became readily available during the 20th century.

The nurse discusses measures to prevent infection of the reproductive tract with a client. The nurse determines that the client has understood the information when the client identifies which component as helping to protect against vaginal infections? A. rugae B. menstrual flow C. ovulation D. acidic environment

D. acidic environment Rationale: An acidic environment helps protect against ascending infections in the vagina. The client should be cautioned against using douches, hygiene sprays, or deodorants that might upset the acid balance. Rugae allow for extreme dilation of the vaginal canal during labor and birth. Menstrual flow and ovulation play no role in the prevention of vaginal infections.

After a teaching an in-service presentation on genes and genetics, the nurse determines that additional teaching is needed when the group identifies which component as a source of gene mutation? A. acquired B. inherited C. spontaneous D. chemical

D. chemical Rationale: Gene mutations can be inherited, spontaneous, or acquired. Inherited gene mutations are passed from parent to child in the egg and sperm. A spontaneous mutation can occur in individual eggs or sperm at the time of conception. Acquired mutations occur in body cells other than egg or sperm. Chemical could be the source but is not considered one of the types.

A nurse is providing care to a 10-month-old infant who is brought to the free clinic by her 18-year-old mother. Which action by the nurse would be the priority at this initial visit? A. observing the interaction between the mother and infant B. interviewing the mother about her beliefs C. obtaining a pregnancy history from the mother D. conducting an assessment of the infant's cognitive milestones

D. conducting an assessment of the infant's cognitive milestones Rationale: Assessment is the priority. A single mother using a free clinic suggests that she is living in poverty and that the child could be malnourished. Children living in poverty are more likely than other children to experience poor nutrition and inadequate health care. This could affect the child's cognitive development. Information about the mother's beliefs, mother-infant interaction, and maternal pregnancy history would be information that could be evaluated at a later time.

When preparing a presentation for a group of pregnant women about fetal circulation, the nurse would point out which structure is primarily responsible for ensuring that highly oxygenated blood reaches the fetal brain? A. umbilical vein B. ductus arteriosus C. ductus venosus D. foramen ovale

D. foramen ovale Rationale: The ductus venosus provides a passageway for oxygenated blood from the umbilical vein to reach the inferior vena cava. The ductus arteriosus is a shunt that receives deoxygenated blood and transports it to the descending aorta. The umbilical vein carries oxygenated blood from the placenta to the fetus. The foramen ovale deflects blood from the vena cava into the left atrium, then left ventricle, into the ascending aorta and into the head and upper body so that the brain receives blood with the highest level of oxygenation.

The nurse, while teaching a group of pregnant woman about the production of breast milk, describes colostrum and compares it with mature breast milk. Which information about colostrum would the nurse include in the description? A. limited protein content B. low mineral content C. high sugar content D. high maternal antibody content

D. high maternal antibody content Rationale: Colostrum is rich in maternal antibodies, especially IgA, which protects the newborn against enteric pathogens. Colostrum contains more minerals and protein but less sugar and fat than mature breast milk.

A nurse is leading a discussion with a local women's group about the importance of cancer screening and early detection. One of the women asks the nurse, "Which cancer kills the most women?" Which response by the nurse would be most accurate? A. uterine cancer B. breast cancer C. cervical cancer D. lung cancer

D. lung cancer Rationale: Although much attention is focused on cancer of the reproductive system such as uterine and cervical cancer, lung cancer is the number-one killer of women. This is largely the result of smoking and secondhand smoke. Lung cancer has no early symptoms, making early detection almost impossible. Breast cancer is the most common malignancy in women and second only to lung cancer as a cause of cancer mortality in women.

A nurse is obtaining a health history from a female client who reports that she started menstruating at age 11 years. The nurse would document this as: A. thelarche, age 11. B. adrenarche, age 11. C. mensis, age 11. D. menarche, age 11.

D. menarche, age 11. Rationale: Menarche refers to the start of menstruation, which in this case would be at age 11 years. Thelarche refers to the development of breast buds; adrenarche refers to the appearance of pubic and then axillary hair and subsequent growth spurt. Mensis is a general term referring to menstruation.