FINAL: Test 4 Review

Question 1

When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate?

A) One who has undergone a previous myomectomy
B) One who had a previous cesarean birth via a low transverse incision
C) One who has a history of a contracted pelvis
D) One who has a vertical incision from a previous cesarean birth

Answer 1

One who had a previous cesarean birth via a low transverse incision

Question 2

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which of the following?

moderate lochia serosa
bruising
a fever

Answer 2

moderate lochia serosa

Question 3

To assist the woman in regaining control of the urinary sphincter for urinary incontinence, the nurse should teach the client to do which of the following?

Answer 3

Fucking kegels.

Question 4

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, which of the following would the nurse expect to find?

Answer 4

Stress incontinence with feeling of low abdominal pressure

Question 5

A nurse is assessing a postpartum woman. Which finding would cause the nurse to be most concerned?

Answer 5

Sharp stabbing chest pain with shortness of breath

Question 6

When assessing a client with suspected breast cancer, which of the following would the nurse expect to find?

Answer 6

Nipple retraction

Question 7

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching?

A) “Holding a pillow against my incision will help me when I cough.”
B) “I’m going to have to wait a few days before I can start breast-feeding.”
C) “I guess the nurses will be getting me up and out of bed rather quickly.”
D) “I’ll probably have a tube in my bladder for about 24 hours or so.”

Answer 7

“I’m going to have to wait a few days before I can start breast-feeding.”

Question 8

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman states that if she experiences any symptoms, she will do which of the following?

Answer 8

Sit down & drink (dehydration)

I’ll lie down with my legs raised

Question 9

A client with polycystic ovarian syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. The nurse understands that the rationale for this therapy is to:

a. Restore menstrual regularity
b. Improve insulin uptake
c. Induce ovulation
d. Alleviate hirsutism

Answer 9

Restore menstrual regularity

Question 10

A group of students are reviewing information about benign and malignant breast masses. The students demonstrate understanding when they identify which of the following as indicating a benign breast mass. (Select all the apply.)

Firm consistency
Fixed to the chest wall
Bloody d/c
Absence of dimpling

Answer 10

Firm consistency

Absence of dimpling

Question 11

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following?

laceration
hematoma
bladder distension
uterine atony

Answer 11

Hematoma

The woman most likely has a hematoma based on the findings: firm uterus with bright-red bleeding; localized bluish bulging area just under the skin surface in the perineal area; severe perineal or pelvic pain; and difficulty voiding. A laceration would involve a firm uterus with a steady stream or trickle of unclotted bright-red blood in the perineum. Bladder distention would be palpable along with a soft, boggy uterus that deviates from the midline. Uterine atony would be noted by a uncontracted uterus.

Question 12

A laboratory technician arrives to draw blood for a complete blood count (CBC. for a client who had a right-sided mastectomy 8 hours ago. The client has an intravenous line with fluid infusing in her left antecubital space. To obtain the blood specimen, the technician places a tourniquet on the client’s right arm. Which action by the nurse would be most appropriate?

Answer 12

Finger prick - distal to the IV

Tell the technician to obtain the blood sample from the client’s left arm.

Question 13

A woman who is 2 weeks postpartum calls the clinic and says, “My left breast hurts.” After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would assess for which of the following?

A) An inverted nipple on the affected breast
B) No breast milk in the affected breast
C) An ecchymotic area on the affected breast
D) Hardening of an area in the affected breast

Answer 13

Hardening of an area in the affected breast

Question 14

The nurse is assessing a woman with abruption placentae who has just given birth. The nurse would be alert for which of the following?

Severe uterine pain
Board-like abdomen
uterine inversion
appearance of petechiae

Answer 14

Appearance of petechiae

A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with abruptio placentae.

Question 15

Review of a primiparous woman’s labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which of the following?

Thrombophlebitis
Retained placental fragments
Hypertension

Answer 15

Thrombophlebitis

Question 16

As part of an inservice program, a nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse correctly identifies this as postpartum:

Blues
Depression
Psychosis
Bipolar disorder

Answer 16

Blues

Question 17

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which of the following would the nurse most likely include as the most common problem?

Persistent OP position
Macrosomia
Breech
Multifetal pregnancy

Answer 17

Persistent occiput posterior position

Question 18

A nurse suspects that a postpartum client is experiencing postpartum psychosis. Which of the following would most likely lead the nurse to suspect this condition?

anxiety
sadness
delirium
insomnia

Answer 18

Delirium

Question 19

A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also complains of acute abdominal pain that is continuous. Which of the following would the nurse suspect?

Shoulder dystocia
Umbilical cord prolapse
Amniotic fluid embolism
Uterine rupture

Answer 19

Uterine rupture

Question 20

A 42-year-old woman is scheduled for a mammogram. Which of the following would the nurse include when teaching the woman about the procedure?

Answer 20

“Each breast will be firmly compressed between two plates.”

Question 21

A nurse is conducting a class on breast cancer prevention. Which statement would the nurse most likely include in the discussion?

Answer 21

Feeling a lump means it’s been there a while

Answer is not “Most often a lump is felt before it is seen.”

Question 22

A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?

A) Asphyxia
B) Clavicular fracture
C) Caput succedaneum
D) Central nervous system injury

Answer 22

Caput succedaneum

Question 23

The nurse would be least likely to find which of the following in a client with uterine fibroids?

Answer 23

Abdominal pain

Answer is not “Regularly shaped, shrunken uterus”

Question 24

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which of the following findings would require immediate intervention?

A) Fetal heart rate of 150 beats/minute
B) Contractions every 2 minutes, lasting 45 seconds
C) Uterine resting tone of 14 mm Hg
D) Urine output of 20 mL/hour

Answer 24

Urine output of 20 mL/hour. Normal = 30 ml/hr

Question 25

A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

Lacerations of the birth canal
Uterine Atony
Uterine inversion
Labor augmentation

Answer 25

Uterine Atony

Question 26

A woman with breast cancer is undergoing chemotherapy. Which of the following side effects would the nurse interpret as being most serious?

a. Myelosuppression
b. Hair loss
c. Fatigue
d. Vomiting

Answer 26

Myelosuppression

Question 27

A home health care nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels “lousy.” Which of the following findings would lead the nurse to suspect metritis? (Select all that apply.)

Urgency & flank pain
Lower abdominal tenderness 
Anorexia
Breast tenderness
Foul-smelling lochia
Enlarged uterus

Answer 27

Lower abdominal tenderness
Anorexia
Foul-smelling lochia
Enlarged uterus

Metritis is characterized by an enlarged uterus and a watery red-brown fluid to viscous off-white purulent uterine discharge, which often has a bad smell

Manifestations of metritis include lower abdominal tenderness or pain on one or both sides, elevated temperature, foul-smelling lochia, anorexia, nausea, fatigue and lethargy, leukocytosis and elevated sedimentation rate. Urgency and flank pain would suggest a urinary tract infection. Breast tenderness may be related to engorgement or suggest mastitis.

Question 28

The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate?

Answer 28

There is no standard/routine testing for ovarian cancer.

Question 29

The nurse is developing the discharge plan for a woman who has had a left-sided modified radical mastectomy. The nurse is including instructions for ways to minimize lymphedema. Which suggestion would most likely increase the woman’s symptoms?

Wear gardening gloves
Wear clothing w/ elasticized sleeves
Do all heavy lifting w/ affected arm
Avoid raising the arm above the breast

Answer 29

“Wear clothing with elasticized sleeves.”

Question 30

When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage based on the knowledge that:

Answer 30

These measurements may not change until after the blood loss is large

Question 31

A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect?

a. Vaginitis
b. Urinary tract infection
c. Increased vaginal discharge
d. Vaginal ulceration

Answer 31

Vaginal ulceration

Question 32

Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and –1 station. Diane has been feeling most of her pain in her lower back. Based upon this information, answer the following questions. Given your understanding of the 5 P’s and the cardinal movements of labor, which “P” is Diane experiencing difficulty with? [1] What is the best way to attempt to remediate this problem? [2] What nonpharmacologic pain intervention is the most effective for lower back pain in early labor? [3]

Answer 32

1 - Passenger
2 - Reposition mom
3 - counterpressure

Question 33

A nurse is conducting a class for a local woman’s group about recommendations for a Pap smear. One of the participants asks, “At what age should a woman have her first Pap smear?” The nurse responds by stating that a woman should have her first Pap smear at which age?

21
30
15
40

Answer 33

21

Question 34

You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 pounds 2 ounces was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. Based on the above scenario, answer the following questions: 1. What complications in the maternal history will lead you to increase your newborn assessment frequency? [1] 2. What complications in the delivery history will lead you to increase your newborn assessment frequency? [2]

Answer 34

1 - gestational diabetes - hypoglycemia

2 - vacuum extraction - caput succedaneum

Question 35

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition?

A) A low-lying placenta
B) Fetopelvic disproportion
C) Contraction ring
D) Uterine bleeding

Answer 35

Fetopelvic disproportion r/t large fetus

Question 36

The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following?

Answer 36

Gestational hypertension

Question 37

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which of the following in the mother and the newborn?

Infection
Hemorrhage
Trauma
Hypovolemia

Answer 37

Infection

Question 38

A woman comes to the clinic and asks the nurse about when she should have her first mammogram. Using the recommendations of the American Cancer Society, which would the nurse suggest?

40
50
60
75

Answer 38

40 years

Question 39

Which finding would indicate to the nurse that a woman’s cervix is ripe in preparation for labor induction?

a) Closed
b) Posterior position
c) Firm
d) Shortened

Answer 39

Shortened

Question 40

A woman comes to the clinic for a routine checkup. A history of exposure to which of the following would alert the nurse that she is at increased risk for cervical cancer?

HIV
CMV
HPV
Toxoplasmosis

Answer 40

Human papillomavirus

Question 41

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

A) Supine
B) Lithotomy
C) Upright
D) Knee-chest

Answer 41

knee-chest

Steep trendelenburg is OK too but the right answer is knee chest

Question 42

After presenting a class on measures to prevent postpartum hemorrhage, the presenter determines that the teaching was successful when the class states which of the following as an important measure to prevent postpartum hemorrhage due to retained placental fragments?

administer ABX
inspect placenta after delivery for intactness
manually remove placenta

Answer 42

Inspecting the placenta after delivery for intactness

Question 43

The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the client’s statement that she is worried that she won’t be the same. Which of the following would be an appropriate outcome for this client?

Answer 43

Client will verbalize positive statements about self and sexuality.

Question 44

A nurse is massaging a postpartum client’s fundus and places the nondominant hand on the area above the symphysis pubis based on the understanding that this action:

Answer 44

Helps support the lower uterine segment - aka, anchor the fucking uterus

Question 45

Which of the following would be most appropriate when massaging a woman’s fundus?

Wait until the uterus is firm to express clots
Use an up and down motion

Answer 45

Wait until the uterus is firm to express clots.

Should be circular motion, NOT up and down

Question 46

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

A) Sedatives
B) Tocolytics
C) Oxytocins
D) Corticosteroids

Answer 46

Oxytocins

Question 47

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately?

A) Respiratory rate of 16 breaths per minute
B) Diminished deep tendon reflexes
C) Urine output of 45 mL/hour
D) Alert level of consciousness

Answer 47

Diminished deep tendon reflexes

Question 48

When describing the various types of reproductive tract cancers to a local women’s group, which of the following would the nurse identify as the least common type?

Vaginal
Cervical
Endometrial
Ovarian

Answer 48

Vaginal

Question 49

A breast biopsy indicates the presence of malignant cells, and the client is scheduled for a mastectomy. Which nursing diagnosis would the nurse most likely include in the client’s preoperative plan of care as the priority?

Answer 49

Disturbed body image

Question 50

A woman experiencing postpartum hemorrhage is ordered to receive a uterotonic agent. Which of the following would the nurse least expect to administer?

Oxytocin
Methylergonovine
Carboprost
Terbutaline

Answer 50

Terbutaline