Womens Health/Disorders and Childbearing Health EVOLVE

A client is trying to become pregnant. The nurse should teach the client that a postcoital test to evaluate fertility should be performed at what time?

1 1 week after ovulation 2 Immediately after menses 3 Just before the next menstrual period Correct4 Within 1 to 2 days of presumed ovulation Because of an increased estrogen level, the cervical mucus is abundant within 1 to 2 days of ovulation, and its quality changes in such a way as to optimize sperm survival time. Cervical mucus 1 week after ovulation is no longer receptive to spermatozoa. Cervical mucus is destructive to spermatozoa and sperm penetration immediately after the menses. The cervical mucus is not yet receptive to spermatozoa just before the next menstrual period.

A client is admitted to the postanesthesia care unit after abdominal hysterectomy. Which assessment should the nurse report to the primary healthcare provider immediately?

Correct1 Decreased urine output 2 Apical pulse of 90 beats/min 3 Increased drainage from the nasogastric tube 4 Serosanguineous drainage on the perineal pad Accidental ligation of a ureter is a serious complication of total abdominal hysterectomy. A decrease in urine output should be reported immediately to the surgeon. An apical rate of 90 beats/min falls within expected limits but should be evaluated in relation to the client's previous vital signs. A nasogastric tube is not inserted routinely. Serosanguineous drainage on the perineal pad is expected.

A 30-year-old client with a 35-day menstrual cycle is trying to become pregnant. The nurse counsels the client and her partner about the optimal timing of intercourse during the cycle. The nurse determines that the counseling has been effective when the couple state that they should have intercourse when?

1 On the 12th day of the cycle 2 On the 14th day of the cycle Correct3 On the 21st day of the cycle 4 On the 25th day of the cycle Ovulation usually occurs 14 days before menses; in a 35-day cycle, ovulation may occur as late as the 21st day. Day 12 of the cycle is the proliferative phase; ovulation has not yet occurred. If the woman had a 28-day cycle, ovulation is expected on the 14th day of the cycle. By the 25th day of the cycle, the ovum in this woman has passed out of the fallopian tube and can no longer be fertilized.

A 28-year-old woman who has phenylketonuria (PKU) visits the fertility clinic for genetic counseling. After deciding that she wants to become pregnant, she tells the nurse that she ate a low-phenylalanine diet until she was 18 years old. What is the nurse's best response?

1 "Eat a regular pregnancy diet after becoming pregnant." 2 "Start the low-phenylalanine diet during the third trimester." 3 "Maintain a low-protein diet starting in the second trimester." Correct4 "Return to the low-phenylalanine diet before becoming pregnant." It is essential that a woman with PKU return to a low-phenylalanine diet before becoming pregnant; phenylalanine crosses the placenta, and a high blood level can damage the fetus, especially during organogenesis. Eating a regular pregnancy diet can endanger the fetus. Starting the low-phenylalanine diet in the third trimester is too late to protect the fetus. Advising a client to eat a low-protein diet is too vague, and starting the diet in the second trimester is too late to protect the fetus.

The public health nurse presents a program on breast self-examination. After a return demonstration, the nurse concludes that she needs to review certain aspects of the teaching program. Which behavior by one of the students supports this conclusion?

Correct1 Palpating each breast while in the sitting position 2 Checking her breasts for any deviation from what is expected 3 Palpating each breast with the palmar surface of her extended fingers 4 Checking her breasts for symmetry while holding her arms above her head Breast palpation should be performed in the supine position with a small rolled towel under the shoulder of the palpated side; it may also be done standing in the shower, but the sitting position is not recommended. Checking the breasts for deviations from expected findings, palpating each breast with the palmar surfaces of the extended fingers, and checking the breasts for symmetry while holding the arms over the head are all correct procedures for breast self-examination.

A nurse is teaching breast-feeding to a newly delivered client. Which statement by the client indicates the need for further instruction?

1 "I'll try to empty my breasts at each feeding." 2 "I'll alternate between breasts to start feedings." Correct3 "I need to wash my breasts with soapy water before I breast-feed." 4 "I need to stroke my baby's cheek gently when I'm ready to breast-feed." Soap irritates, cracks, and dries breasts and nipples, making it painful for the mother when the baby sucks; it also increases the risk for mastitis. The client should empty the breasts at each feeding to keep milk flowing. Alternating between breasts to start feedings is a permissible and often-used technique of breast-feeding. Gently stroking the baby's cheek elicits the rooting reflex; the infant's head turns toward and touches the mother's breast.

Before discharge, a breastfeeding postpartum client and the nurse discuss methods of birth control. The client asks the nurse, "When will I begin to ovulate again?" How should the nurse respond?

1 "You should discuss this at your first clinic visit." 2 "Ovulation will occur after you stop breastfeeding." Correct3 "Ovulation may occur before you begin to menstruate." 4 "I really can't tell you, because everyone is so different." If the client is breastfeeding, ovulation and fertility may occur before menstruation resumes. It is the nurse's responsibility to answer the client's questions rather than putting the client off. Ovulation may occur while a woman is breastfeeding because the process of follicular maturation begins when the prolactin level decreases. Declining to answer by claiming that every woman is different evades the question; there are general guidelines that the nurse can share with the client.

A primipara delivered 12 hours ago. Although an ice bag has been applied to her perineal area, the client continues to complain of rectal pressure resulting in excruciating pain in the area of the episiotomy. This has also not been relieved by the administration of analgesics. What does the nurse conclude is the cause of the client's pain?

1 A normal response after delivery 2 Low tolerance of pain Correct3 Hematoma in the perineal area 4 Infection at the episiotomy site Pain becomes excruciating with hematoma development at the episiotomy site because of pressure on surrounding nerve endings. This pain is not relieved by the application of ice because ice only reduces edema formation around the incision. There is no data to indicate that the client has a low tolerance for pain. It is too early to assume that an infection has developed; pyrexia and local signs of infection would support this conclusion.

Which content should the nurse emphasize in a prepared childbirth class?

1 Birth as a family experience 2 Labor without the use of analgesics Correct3 Education, exercise, and breathing techniques 4 Hydration, relaxation, and pain control during labor The objective of childbirth classes is to adequately prepare parents for childbearing. Birth as a family experience is only part of the class content. Labor without the use of analgesics is not an absolute; in most childbirth methods parents are informed that analgesics are available if necessary. Hydration, relaxation, and pain control during labor is only part of the class content.

A nurse teaches a postpartum client how to care for her episiotomy at home. Which statement indicates to the nurse that the client understands the priority instruction?

1 "I should discontinue the antiinflammatories once I'm home." 2 "I mustn't climb up or down stairs for at least 3 days after discharge." 3 "I should continue the sitz baths three times a day if they make me feel better." Correct4 "I need to continue perineal care after I go to the bathroom until everything is healed." Prevention of infection—in this case, perineal care—is the priority. Stair climbing may cause some discomfort, but is not detrimental to healing. It is not necessary to stop sitz baths as long as they provide comfort. The sitz bath provides comfort, but is not the priority.

A pregnant client in the first trimester is experiencing nausea and vomiting. What does the nurse determine about this discomfort?

1 It is always present during early pregnancy. 2 It will disappear when lightening occurs. 3 It is a common response to an unwanted pregnancy. Correct4 It may be related to an increased human chorionic gonadotropin level. An increased level of human chorionic gonadotropin, or hCG, may cause nausea and vomiting, but the exact reason is unknown. Some pregnant women do not experience nausea and vomiting. Lightening occurs at the end of the third trimester; nausea and vomiting usually cease at the end of the first trimester. Nausea and vomiting are unrelated to whether a pregnancy is desired or unwanted.

A pregnant woman asks the nurse when she may expect her baby to be born. She tells the nurse that her last menstrual period began on April 14. According to Nägele's rule, what is the client's expected date of birth (EDB)?

1 February 1 2 January 7 Correct3 January 21 4 February 7 To use Naegele's rule to calculate the EDB, subtract 3 months and add 7 days to the date of the last menstrual period. January 7 is too early. February 1 is too late, as is February 7.

A nurse at the fertility clinic is counseling a couple about the tests that will be necessary in order to determine the cause of their infertility. Which test will most likely be used to evaluate the woman's organs of reproduction?

1 Biopsy 2 Cystogram 3 Culdoscopy Correct4 Hysterosalpingogram A hysterosalpingogram enables the examiner to visualize the uterus and fallopian tubes and the pelvic organs of reproduction. A biopsy is the surgical excision of tissue for diagnostic purposes. A cystogram is used to visualize the urinary bladder. Culdoscopy is the direct examination of female pelvic viscera with the use of an endoscope introduced through a perforation in the vagina.

During the postpartum period a client with heart disease and type 2 diabetes asks a nurse, "Which contraceptives will I be able to use to prevent pregnancy in the near future?" How should the nurse respond?

1 "You may use oral contraceptives—they're almost completely effective in preventing pregnancy." Correct2 "You should use foam with a condom to prevent pregnancy—this is the safest method for women with your illnesses." 3 "You'll find that the intrauterine device is best for you, because it prevents a fertilized ovum from implanting in the uterus." 4 "You have little to worry about regarding becoming pregnant in the near future, because women with your illnesses usually become infertile." Some type of barrier contraceptive (condom with foam or jelly or a diaphragm) is usually recommended for the client with diabetes and heart disease. Oral contraceptives are not recommended for this client because of their tendency to alter glucose tolerance. An intrauterine device is not recommended, because it may predispose this client to infection. Clients with heart disease and diabetes can become pregnant again in the future

A 30-year-old woman is scheduled for a total abdominal hysterectomy because of noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. What is the most common reason for this difficulty?

Correct1 Loss of femininity 2 Body image changes 3 Diminished sexual desire 4 Slow postmenopausal recovery Removal of the uterus may produce changes in how some women view themselves sexually because it is a reproductive organ. Although body image changes are possible, they are more likely to occur with surgery that involves obvious external changes. The libido of a postmenopausal woman will probably not be altered unless she has concerns about sexuality. A 30-year-old otherwise healthy woman should have an uneventful recovery.

A client states that she wishes to use the calendar method of birth control. The nurse concludes that the client understands how to calculate the beginning of the fertile period when she makes which statement?

1 "I will subtract 11 days from the length of my longest cycle." Correct2 "I will subtract 18 days from the length of my shortest cycle." 3 "I will abstain from having sex after the 10th day of my cycle." 4 "I will abstain from sex from the 10th day before the middle of my average cycle." The fertile period is determined by subtracting 18 days from the length of the shortest cycle to determine the first unsafe day and subtracting 11 days from the length of the longest cycle to determine the last unsafe day. Subtracting 11 days from the length of the client's longest cycle is how the last day, not the first day, of the unsafe period is determined. Abstaining from sexual intercourse after the 10th day of the client's cycle is correct only if the shortest cycle is 28 days; the date depends on a calculation based on the length of the woman's shortest and longest cycles. The longest and shortest cycles are used, not the average length of a cycle.

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor?

1 "I will go, but it is against my beliefs and values." 2 "I won't do it, because I do not believe in birth control at all." Correct3 "I would prefer another assignment that is not contrary to my beliefs." 4 "I will have to stress that the rhythm method is the method of choice." Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area where the nurse's personal values will not pose a problem. Fulfilling the request even though it is against the nurse's beliefs is an ineffective way to resolve value conflict; undoubtedly a client would sense this conflict. The nurse may not have the legal, ethical, or professional right to refuse this assignment if employed by the facility. Stressing that the rhythm method is the method of choice is unethical and unprofessional.

During the postpartum period a nurse determines that a client's rubella titer is negative. Which action should the nurse plan to take next?

1 Checking for allergies to penicillin 2 Alerting the staff in the newborn nursery 3 Assuring the client that she has active immunity Correct4 Obtaining a prescription for immunization at discharge A negative rubella titer indicates no immunity. Immunizations can be given safely during the immediate postpartum period but are teratogenic when given during pregnancy. Penicillin allergy is not a contraindication to the vaccine; only egg allergy is. The mother's negative rubella titer does not affect the infant. A client with a negative titer has no immunity to rubella.

A nurse is caring for four postpartum clients, each with a different medical condition. Which condition will result in the primary healthcare provider advising the new mother not to breast-feed?

1 Mastitis 2 Inverted nipples 3 Herpes genitalis Correct4 Human immunodeficiency virus (HIV) Breast-feeding by a mother infected with HIV is contraindicated, because breast milk can transmit the virus to the infant. Breast-feeding by a mother with mastitis is not always contraindicated; during antibiotic treatment the mother can maintain lactation by pumping the breasts and discarding the milk. Once the infection has resolved, breast-feeding may be resumed. Breast-feeding is not contraindicated with inverted nipples, because a breast shield can provide mild suction to help evert the nipples. Breast-feeding is not contraindicated in a client with genital herpes. The newborn may contract the infection during a vaginal birth, not from breast milk.

After the client gives birth, her vital signs are temperature 99.3° F (37.4° C); pulse 80 beats/min, regular and strong; respirations 16/min, slow and even; and blood pressure 148/92 mm Hg. Which vital sign should the nurse check more frequently?

1 Pulse 2 Respirations 3 Temperature Correct4 Blood pressure This blood pressure is higher than anticipated; therefore intervention may be necessary. A pulse of 80 beats/min is within expected limits. A respiratory rate of 16/min is within expected limits. The temperature of 99.3° F (37.4° C) is slightly high but consistent with the physiology of the birthing process.

A 37-year-old client with a nontender palpable breast mass has an inconclusive mammogram. She is undergoing further diagnostic tests to determine whether the mass is malignant. What information should the nurse take into consideration before planning health teaching for this client?

1 Squamous cell carcinomas are neoplasms arising from glandular tissues. Correct2 Results of a biopsy are necessary before a specific form of therapy is selected. 3 Mammographies should be repeated to confirm the presence of malignancies. 4 Waiting for several weeks before receiving confirmation of cancer is helpful to the client. The therapy selected depends on whether there is a malignancy and, if so, the type of cancer cells, the extent of nodal involvement, and the presence and extent of metastasis. Adenocarcinomas, not squamous cell carcinomas, arise from glandular tissue; squamous cell carcinomas arise from epithelial tissue. Only a biopsy will confirm the diagnosis of a malignancy. Waiting several weeks for a diagnosis is not advisable; an extended waiting period increases the client's stress and anxiety.

A breastfeeding mother asks the nurse what she can do to ease the discomfort caused by a cracked nipple. What should the nurse instruct the client to do?

1 Stop nursing for a few days and allow the nipple to heal. 2 Manually express milk and feed it to the baby in a bottle. Correct3 Start feedings on the unaffected breast until the affected breast heals. 4 Use a breast shield to keep the baby from making direct contact with the nipple. The most vigorous suckling occurs during the first few minutes of nursing, as the infant suckles on the unaffected breast; suckling on the affected breast later is less traumatic. Stopping nursing for several days is unnecessary and will interfere with lactation. Manual expression may not completely empty the breast, interfering with lactation. A breast shield confuses an infant because it requires a different suckling pattern to obtain milk.