Antepartal Care

Question 1

A client has obtained Plan B (levonorgestrel 0.75mg, 2 tablets) as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which of the following responses?

1: “I can wait 3 to 4 days after intercourse to start taking these to prevent pregnancy.”
2: “My boyfriend can buy Plan B from the pharmacy if he is over 18 years old.”
3: “The birth control works by preventing ovulation or fertilization of the egg.”
4: “I may feel nauseated and have breast tenderness or a headache after using the contraceptive.”

Answer 1

1. Plan B is a series of contraceptive pills similar in composition to birth control pills that have been used for the past 30 years. Plan B is the brans name for levonorgestrel 0.75mg. Pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later. Males can purchase this contraceptive as long as they are over 18 years of age. Common side effects include nausea, breast tenderness, vertigo, and stomach pain.

Question 2

An antenatal G 2, T 1, P 0, Ab 0, L 1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options?

1: Satisfaction with prior methods.
2: Preference of sexual partner.
3: Breast- or bottle-feeding plan.
4: Desire for another child in 2 years.

Answer 2

3. Birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding her infant. The maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. Low-dose oral contraceptives would be the exception. Use of estrogen-/progesterone-based pills and progesterone-only pills are commonly initiated from 4 to 6 weeks post-partum because the milk supply is well established by this time. Prior experiences with birth control methods have an impact on the method chosen as do the preferences of the client’s partner; however, they are not the most influential factors. Desire to have another child in two years would make some methods, such as an IUD, less attractive but would still be a secondary to the choice to breast-feed.

Question 3

After the nurse instructs a 20-year-old nulligravid client on how to perform a breast self-examination, which of the following statements indicates that the teaching has been successful?

1: “I should perform breast self-examination on the day my menstrual flow begins.”
2: “It’s important that I perform breast self-examination on the same day each month.”
3: “If I notice that one of my breasts is much smaller than the other, I shouldn’t worry.”
4: “If there is discharge from my nipples, I should call my health care provider.”

Answer 3

4.
The nurse determines that the client has understood the instructions when the client says that she will notify her primary health care provider id she notices discharge or bleeding because this may be symptomatic of underlying disease. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this time. The client should perform breast self-examination on the same day each month only if she has stopped menstruating (as with menopause). The client’s breasts should mirror each other. If one breast is significantly larger than the other, or if there is “pitting” of breast tissue, a tumor may be present.

Question 4

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?

1: The ovum survives for 96 hours after ovulation making conception possible during this time.
2: The basal body temperature falls at least 0.2 degrees fahrenheit after ovulation has occurred.
3: Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle/
4: Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus/

Answer 4

3.
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 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5 degrees fahrenheit to 1.0 degrees fahrenheit when ovulation occurs. Although some women experience some pelvic discomfort during during ovulation (mittelschmerz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.

Question 5

Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate?

1: Take a mild analgesic if needed for menstrual pain.
2: Avoid cold foods if menstrual pain persists.
3: Stop exercise while menstruating.
4: Avoid sexual intercourse while menstruating.

Answer 5

1.
The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual pain or “cramps” are present. The client, also should eat food rich in iron and should continue moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the male should wear a condom to prevent exposure to blood.

Question 6

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?

1: :Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy.”
2: “I won’t become pregnant if I abstain from intercourse during the last 14 days of my menstrual cycle.”
3: “Sperms from a healthy male usually remain viable in the female reproductive tract for 96 hours.”
4: After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes,”

Answer 6

1.
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 women 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 10-14) and 3 to 4 days after ovulation (days 15-18). Sperm from a healthy male can remain viable 24-72 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.

Question 7

A 20-year-old nulligravid client expresses the desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan?

1: The method has a 50% failure rate during the first year of use.
2: Couples must abstain from coitus for 5 days after the menses.
3: Cervical mucus is carefully monitored for changes.
4: The male partner uses condoms for significant effectiveness.

Answer 7

3.
The symptothermal method is a natural method of fertility management that depends on knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 to 2 days in either direction, the symptothermal method requires daily basal body temperature assessments plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approximately 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during that time period (days 1 through 10). Typically, the failure rate for this method is between 10% and 20%. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning.

Question 8

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following?

1: Anemia
2: Hypertension
3: Dysmenorrhea
4: Acne vulgaris

Answer 8

2.
Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives commonly improves facial acne.

Question 9

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which of the following as an adverse effect?

1: Weight gain
2: Nausea
3: Headache
4: Ovarian Cancer

Answer 9

4.
The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis.

Question 10

A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions should the nurse include about the use of condoms as a method for family planning?

1: Using a spermicide with the condom offers added protection against pregnancy.
2: Natural skin condoms protect against sexually transmitted diseases.
3: The typical failure rate for couples using condoms is about 25%.
4: Condom users commonly report penile gland sensitivity.

Answer 10

1. The typical failure rate of a condom is approximately 12% to 14% . Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.

Question 11

Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning?

1: Douching with an acidic solution after intercourse is recommended.
2: Diaphragms should not be used if the client develops acute cervicitis.
3: The diaphragm should be washed in a weak solution of bleach and water.
4: The diaphragm should be left in place for 2 hours after intercourse.

Answer 11

2. The teaching plan should include a caution that a diaphragm should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.

Question 12

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching?

1: “I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case.”
2: “If I get pregnant, I will have to be refitted for another diaphragm after the delivery.”
3: “Before inserting the diaphragm, I should coat the rim with contraceptive jelly.”
4: “If I gain or lose 20lb, I can still use the same diaphragm.”

Answer 12

4. The client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20lb. Gaining or losing more than 15lb can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and delivery of a newborn because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.

Question 13

A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which of the following foods? Select all that apply.

1: Leafy green vegetables
2: Strawberries
3: Beans
4: Milk
5: Sunflower seeds
6: Lentils

Answer 13

1,2,3,5,6.
The pregnancy requirement for folic acid is 600mcg/day. Major sources of folic acid include leafy green vegetables, strawberries and oranges, beans, particularly black and kidney beans, sunflower seeds, and lentil. Milk and fats contain no folic acid.

Question 14

A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan?

1: “Another method of contraception is needed until the sperm count is 0.”
2: “Vasectomy is easily reversed if children are desired in the future.”
3: “Vasectomy is contraindicated in males with prior history of cardiac disease.”
4: “Vasectomy requires only a yearly follow-up once the procedure is complete.”

Answer 14

1. Another method of contraception is needed all sperm has been cleared from the body. The number of ejaculates for this t occurs is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need for follow-up after verification that there is no sperm in the system.

Question 15

A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching?

1: “My fallopian tubes will be tied off through a small abdominal incision.”
2: “Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%.”
3: “After this procedure, I must abstain from intercourse for at least 3 weeks.”
4: “Both of my ovaries will be removed during the tubal ligation procedure.”

Answer 15

1.
Tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure. The ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.

Question 16

A 23-year-old nulliparous client visiting the client for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following?

1: Check the cervical mucus to see if it is thick and sparse.
2: Take her temperature at the same time every morning before getting out of bed.
3: Document ovulation when her temperature decreases at least 1 degree fahrenheit.
4: Avoid coitus for 10 days after a slight rise in temperature.

Answer 16

2. The basal body temperature method requires that the client take her temperature each morning before getting out of bed, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5 degrees fahrenheit. At the time of ovulation, the temperature rises 0.4 degrees fahrenheit to 0.8 degrees fahrenheit because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the menstrual cycle. The client should keep a diary of about 6 months of menstrual cycles to calculate “safe” days. There is no mucus for the first 3 or 4 days after menses, and then thick, sticky mucus begins to appear. As estrogen increases, the mucus changes to clear , slippery and stretchy. This condition, termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid pregnancy.

Question 17

A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines that an appropriate outcome for the couple would be to accomplish which of the by the end of this visit?

1: Choose an appropriate infertility treatment method.
2: Acknowledge that only 50% of infertile couples achieve a pregnancy.
3: Discuss alternative methods of having a family, such as adoption.
4: Describe each of the potential causes and possible treatment modalities.

Answer 17

4.
By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple needs time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couples may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. The success rate for achieving pregnancy depends on both the cause and the effectiveness of the treatment, and in some cases it may be only as high as 30%. The couple may desire information about alternatives to treatment but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at the time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a pregnancy, the couple should have time to consider their options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming and sometimes painful treatment of infertility.

Question 18

A client is scheduled to have in vitro fertilization (IVF) as an infertility. Which of the following client statements about IVF indicates that the client understands this procedure?

1: “IVF requires supplemental estrogen to enhance the implantation process.”
2: “The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer.”
3: “IVF involves bypassing the blocked or absent fallopian tubes.”
4: “Both ova and sperm are instilled into the open end of a fallopian tube.”

Answer 18

3.
The client’s understanding of the procedure is demonstrated by the statement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The primary health care provider removes the ova by laparoscope- or ultrasound-guided transvaginal retrieval and mixes them with prepared sperm from the woman’s partner or donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen, is given to enhance the implantation process. Gamete intrafallopian transfer (GIFT) and tubal embryo transfer have a higher pregnancy rate than IVF. However, these procedures can not be used for clients who have blocked or absent fallopian tubes because the fertilized ova is placed into the fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF, fertilization of the ova by the sperm occurs outside the client’s body. In GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman’s body.

Question 19

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 delivery. Which of the following responses would be most helpful?

1: “Today’s modern technology has resulted in a low maternal mortality rate.”
2: “Don’t concern yourself with things that happened in the past.”
3: “In the United States, mothers seldom die in childbirth.”
4: “What is it that concern you about pregnancy, labor, and delivery?”

Answer 19

4.
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 State, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States 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 blocks further therapeutic communication. Also, postponing or ignoring the client’s need for a discussion about complications of pregnancy may further increase the clients anxiety.

Question 20

A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the clients teaching plan?

1: About midway through the menstrual cycle, cervical mucus is thick and sticky.
2: During ovulation, the cervix remains dry without any mucus production.
3: As ovulation approaches, cervical mucus is abundant and clear.
4: Cervical mucus disappears immediately after ovulation, resuming with menses.

Answer 20

3.
As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg whites. Ovulation generally occurs 14 days (+/-2 days) before thee beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.

Question 21

When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness?

1: Place the condom over the erect penis before coitus.
2: Withdraw the condom after coitus when the penis is flaccid.
3: Ensure that the condom is pulled tightly on the penis before coitus.
4: Obtain a prescription for a condom with nonoxynol 9.

Answer 21

1.
To ensure maximum effectiveness, the condom should always be placed over the erect penis before coitus. Some couples find condom use objectionable because foreplay may have to be interrupted to apply the condom. The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise sperm may escape from the condom, providing an opportunity for possible fertilization. Rather than having the condom pulled tightly over the penis before coitus, space should be left at the tip of the penis to allow the condom to hold the sperm. The client does not need a prescription for a condom with nonoxynol 9 because these are sold over the counter.

Question 22

A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching?

1: “This method of family planning requires monthly injections.”
2: “I should have my first injection during my menstrual cycle.”
3: “ One possible adverse effect is absence of a menstrual period.”
4: “This drug will be given by subcutaneous injections.”

Answer 22

3.
With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. Other adverse effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses

Question 23

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?

1: Amenorrhea is a common adverse effect of IUDs.
2: The client needs to use additional protection for conception.
3: IUDs are more costly than other forms of contraception.
4: Severe cramping may occur when the IUD is inserted.

Answer 23

4. Severe cramping and pain may occur as the device is passed through the internal cervical os. 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.

Question 24

After instructing a 40-year-old woman about osteoporosis after menopause, the nurse determines that the client needs further instruction when the client state which of the following?

1: “One cup of yogurt is the equivalent of one glass of milk.”
2: “Women who do not eat dairy products should consider calcium supplements.”
3: “African American women are at the greatest risk for osteoporosis.”
4: “Estrogen therapy at menopause can reduce the risk of osteoporosis.”

Answer 24

3. Small-boned, fair-skinned women of northern European descent are at the greatest risk for osteoporosis, not African American women. One cup of yogurt or 1.5oz of hard cheese is the equivalent of one glass of milk. Women who do not eat dairy products, such as women who are lactose intolerant, should consider using calcium supplements. Inadequate lifetime intake of calcium is a major risk factor for osteoporosis. Estrogen therapy, or some of the newer medications that are not estrogen based, can greatly reduce the incidence of osteoporosis.

Question 25

When developing a teaching plan for an 18-year-old client who asks about treatments for sexually transmitted diseases, the nurse should explain that:

1: Acyclovir (Zovirax) can be used to cure herpes genitalis.
2: Chlamydia trachomatis infections are usually treated with penicillin,
3: Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections.
4: Metronidazole (Flagyl) is used to treat condylomata acuminata.

Answer 25

3. 
Ceftriaxone sodium (Rocephin) may be used to treat N. gonorrhoeae infections and is commonly combined with with doxycycline hyclate (Vibramycin). Both the client and her partner should be treated if gonorrhea is present. Acyclovir (Zovirax) can be used to treat herpes genitalis; however the drug does not cure the disease. C. trachomatis infections are usually treated with antibiotics such as doxycycline or azithromycin (Zithromax). Metronidazole (Flagyl) is used to treat trichomoniasis vaginitis, not condylomata acuminata (genital warts).

Question 26

A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus, After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause?

1: Seminal fluid with an alkaline pH.
2: Frequent exposure to heat sources.
3: Abnormal hormonal stimulation.
4: Immunologic factors.

Answer 26

1.
The client needs further instruction when he says that one cause of male infertility is decreased sperm count due to seminal fluid that has an alkaline pH. A slightly alkaline pH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. An alkaline pH is not associated with decreased sperm count. However, seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation, or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Frequent exposure to heat sources, such as saunas and hot tubs, can decrease sperm production, as can abnormal hormonal stimulation. Immunologic factors produced by the man against his own sperm (autoantibodies) or by the woman can cause the sperm to clump or be unable to penetrate the ovum, thus contributing to infertility.

Question 27

A 24-year-old woman is being assessed for a malformation of the uterus.

1: Septate uterus
2: Bicornuate uterus
3: Double uterus
4: Uerus didelphys

Answer 27

2. A bicornuate uterus has a “Y” shape and appears to be a double uterus but in fact has only one cervix A separate uterus contains a septum that extends from the fundus to the cervix, thus dividing the uterus into two separate compartments. A double uterus has two uteri, each of which has a cervix. A uterus didelphys occurs when both uteri of a double utter are fully formed.

Question 28

A primigravid client at 16 weeks’ gestation has had an amniocentesis and has received teaching concerning signs and symptoms to report. Which statement indicated that the client needs further teaching?

1: “I need to call if I start to leak fluid from my vagina.”
2: “If I start bleeding, I will need to call back.”
3: “If my baby does not move, I need to call my health care provider.”
4: “If I start running a fever, I should let the office know.”

Answer 28

3.
At 16 weeks’ gestation, a primipara will not feel the baby moving. Quickening occurs between 18 and 20 weeks’ gestation for a primipara and between 16 and 18 weeks’ gestation for a multipara. Leaking fluid from the vagina should not occur until labor begins and may indicate a rupture of the membranes. Bleeding and a fever are complications that warrant further evaluation and should be reported at any time during the pregnancy.

Question 29

During a visit to the prenatal clinic, a pregnant client at 32 weeks’ gestation has heartburn. The client needs further instruction when she says she must do what?

1: Avoid highly seasoned foods
2: Avoid lying down right after eating
3: Eat small, frequent meals
4: Consume liquids only between meals

Answer 29

4.
Consuming most liquids between meals rather than at the same time as eating is an excellent strategy to deter nausea and vomiting in pregnancy but does not relieve heartburn. During the third trimester, progesterone causes relaxation of the sphincter and the pressure of the fetus against the stomach increases the potential of heartburn. Avoiding highly seasoned foods, remaining in an upright position after eating, and eating small, frequent meals are strategies to prevent heartburn.

Question 30

The nurse is teaching a new prenatal client about her iron deficiency anemia during pregnancy. Which statement indicates that the client needs further instruction about her anemia?

1: “I will need to take iron supplements now.”
2: “I may have anemia because my family is of Asian descent.”
3: “I am considered anemic if my hemoglobin is below 11g/dL.”
4: “The anemia increases the workload on my heart.”

Answer 30

2. Iron deficiency anemia is caused by insufficient iron stores in the body, poor iron content in the diet of the pregnant woman, or both. Other thalassemias and sickle cell anemia, rather than iron deficiency anemia, can be associated with ethnicity but occur primarily in clients of African American or Mediterranean origin. Because red blood cells increase by about 50% during pregnancy, many clients will need to take supplemental iron to avoid iron deficiency anemia. A pregnant client is considered anemic when the hemoglobin is below 11mgdL. In most types of anemia, the heart must pump more often and harder to deliver oxygen to cells

Question 31

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which of the following information about changes the client can anticipate in the first trimester?

1: Differentiating the self from the fetus.
2: Enjoying the role of nurturer
3: Preparing for the reality of parenthood.
4: Experiencing ambivalence about pregnancy.

Answer 31

4. Many women in their first trimester feel ambivalent about being pregnant because of the significant life changes that occur for most women have a child. Ambivalence can be expressed as a list of positive and negative consequences of having a child, consideration of financial and social implications, and possible char changes. During the second trimester, the infant becomes a separate individual to the mother. The mother will begin to enjoy the role of nurturer postpartum. During the third trimester, the mother begins to prepare for parenthood and all if the tasks that parenthood includes.

Question 32

An antenatal primigravid client has just been informed that she is carrying twins. The plan of care includes educating the client concerning factors that put her at risk for problems during the pregnancy. The nurse realizes the client needs further instruction when she indicates carrying twins puts her at risk for which of the following?

1: Preterm labor
2: Twin-to-twin transfusion
3: Anemia
4: Group B Streptococcus

Answer 32

4.
Group B Streptococcus is a risk factor for all pregnant women and is not limited to those carrying twins. The multiple gestation client is at risk for preterm labor because uterine distention, a major factor initiating preterm labor, is more likely with a twin gestation. The normal uterus is only able to distend to a certain point and when that point is reached, labor may be initiated. Twin-to-twin transfusion drains blood from one twin to the second and is a problem that may occur with multiple gestation. The donor twin may become growth restricted and can have oligohydramnios while the recipient twin may become polycythemic with polyhydramnios and develop heart failure. Anemia is a common problem with multiple gestation clients. The mother is commonly unable to consume enough protein, calcium, and iron to supply her needs and those of the fetuses. A maternal hemoglobin level below 11g/dL is considered anemic.

Question 33

A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings reflect this woman is experiencing a cluster of which signs of pregnancy?

1: Positive
2: Probable
3: Presumptive
4: Diagnostic

Answer 33

2. The plan of care should reflect that this woman is experiencing probable signs of pregnancy. She may be pregnant but the signs and symptoms may have another etiology. An enlarging abdomen and a positive pregnancy test may also be caused by tumors, hydatidiform mole, or other disease processes as well as pregnancy. Changes in the pigmentation of the face may also be caused by oral contraceptive use. Positive signs of pregnancy are considered diagnostic and include evident fetal heartbeat, fetal movement felt by a trained examiner, and visualization of the fetus with an ultrasound confirmation. Presumptive signs are subjective and can have another etiology. These signs and symptoms include lack of menses, nausea, vomiting, fatigue, urinary frequency, and breast changes. The word “diagnostic” is not used to describe the condition of pregnancy.

Question 34

An antenatal client receives education concerning medications that are safe to using during pregnancy. The nurse evaluates the client’s understanding of the instructions and determines that she needs further information when she states which of the following?

1: “If I am constipated, magnesium hydroxide (Milk of Magnesia) is okay but mineral oil is not.”
2: “If I have heartburn, it is safe to use chewable calcium carbonate (TUMs).”
3: “I can take acetaminophen (Tylenol) if I have a headache.”
4: “If I need to have a bowel movement, sennosides (Ex-Lax) are preferred.”

Answer 34

4.
Ex-Lax is considered too abrasive to use during pregnancy. In most instances, a Fleets enema will be given before Ex-Lax. Medications for constipation that are considered safe during pregnancy include compounds that produce bulk, such as Metamucil and Citrucel, Colace, Dulcolax, and Milk of Magnesia can also be used. Mineral oil prevents the absorption of vitamins and minerals within the GI tract. The strategies for heartburn are considered safe and Tylenol may be used as an over-the-counter analgesic.

Question 35

When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay pregnancy test, the nurse should tell the client which of the following about this test?

1: It has a high degree of accuracy within 1 week after ovulation.
2: It is identical in nature to an over-the-counter home pregnancy test.
3: A positive result is considered a presumptive pregnancy.
4: A urine sample is needed to obtain quicker results.

Answer 35

1. The radioimmunoassay pregnancy test, which uses an antiserum with specificity for the b-subunit of human chorionic gonadotropin (hCG) in blood plasma, is highly accurate within 1 week after ovulation. The test is performed in a laboratory. Over-the-counter or home pregnancy tests are performed on urine and use the hemagglutination inhibition method. Radioimmunoassay tests usually use blood serum. A positive pregnancy test is considered a probable sign of pregnancy. Certain conditions other than pregnancy, such as choriocarcinoma, can cause increased hCG levels.

Question 36

After instructing a female client about the radioimmunoassay pregnancy test, the nurse determines that the client understands the instructions when the client states that which of the following hormones is evaluated by this test?

1: Prolactin
2: Follicle-stimulating hormone
3: Luteinizing hormone
4: Human Chorionic Gonadotropin (hCG)

Answer 36

4.
The hormone analyzed in most pregnancy tests is hCG. In the pregnant woman, trace amounts of hCG appear in the serum as early as 24 to 48 hours after implantation owing to the trophoblast production of this hormone. Prolactin, follicle-stimulating hormone, and luteinizing hormone are not used to detect pregnancy. Prolactin is the hormone secreted by the pituitary gland to prepare the breasts for lactation. Follicle-stimulating hormone is involved in follicle maturation during the menstrual cycle. Luteinizing hormone is responsible for stimulating ovulation