Multi-choice (From Website/Lectures & Tutorial) Flashcards
What are foods high in potassium?
Foods high in POTASSIUM #1: White Beans #2: Dark Leafy Greens (Spinach) #3: Baked Potatoes (With Skin) #4: Dried Apricots #5: Baked Acorn Squash #6: Yogurt (Plain, Skim/Non-Fat) #7: Fish (Salmon) #8: Avocados #9: Mushrooms (White) #10: Bananas
What are foods high in MAGNESIUM?
Foods high in MAGNESIUM
#1: Dark Leafy Greens (Raw Spinach) #2: Nuts and Seeds (Squash and Pumpkin Seeds) #3: Fish (Mackerel) #4: Beans and Lentils (Soy Beans) #5: Whole Grains (Brown Rice #6: Avocado #7: Low-Fat Dairy (Plain Non Fat Yogurt) #8: Bananas #9: Dried Fruit (Figs) #10: Dark Chocolate
What are foods high in IRON?
Foods High in Iron
#1: Mollusks (Clams, Mussels, Oysters) #2: Liver (Pork, Chicken, Turkey, Lamb, Beef) #3: Squash and Pumpkin Seeds #4: Nuts (Cashew, Pine, Hazelnut, Peanut, Almond) #5: Beef and Lamb (Lean Tenderloin) #6: Beans and Pulses (White Beans, Lentils) #7: Whole Grains, Fortified Cereals, and Bran #8: Dark Leafy Greens (Spinach, Swiss Chard) #9: Dark Chocolate and Cocoa Powder #10: Tofu
During her first clinic visit, the patient states that she is divorced and remarried to a divorced man with two children. The two stepchildren alternate living with their father and their natural mother. The nurse recognizes that the patient is describing the family model called:
Rationale: The binuclear family is a postdivorced family in which the children are members of two nuclear households and alternate living between the two homes. The extended family consists of a couple who shares household responsibilities, chores, and expenses with parents, siblings, or other relatives living in the same home. The extended kin network family consists of two families living in close proximity. The family shares a social support network and resources. The stepparent family includes a biological parent, with children, and a new spouse, all living together.
A nurse is working in a prenatal clinic where many of the patients come from a variety of cultural backgrounds. Which of the following would assist the nurse in understanding the beliefs, values, and customs of these patients?
Rationale: Using a cultural assessment tool will assist the nurse in gathering information about health practices that are based on the patient’s beliefs, values, and customs. A family assessment is a collection of data about the family’s type, structure, level of functioning, support system, and needs. Taboos focus only on behaviors that the patient should avoid. An herbalist may be seen as a healer within the Asian culture
An Asian couple is excited about the upcoming birth of their baby. The nurse conducts a cultural assessment and understands that since their arrival in the United States, they have adapted to a new cultural norm in preparation for the birth of their fist baby. This process is called:
Rationale: Acculturation is the process by which people adapt to a new cultural norm. Cultural competency is acquiring the skills and knowledge necessary to respect and work with individuals from different cultures. Ethnocentrism is the conviction that the values and beliefs of one’s own cultural group are the best or only acceptable ones. Enculturation occurs when cultural norms and beliefs are passed down from one generation to the next.
When the nurse is assessing the patient’s use of complementary therapies, the nurse will be most concerned with the patient who uses: (Select all that apply.)
Rationale: Acupuncture is a complementary therapy, and often is used with conventional medical care. Herbal therapies, homeopathy, and magnet therapy are considered alternative therapy, and have not undergone rigorous scientific testing in this country.
During her first clinic visit, the patient states that she wants to use alternative therapies during her pregnancy. The nurse knows that one resource for evaluating alternative therapies is the:
Rationale: The National Center for Complementary and Alternative Medicine (NCCAM) promotes research into complementary and alternative therapies, and dissemination of information to consumers.
During a prenatal home visit, the patient informs the nurse that she cannot come to the evening childbirth preparation classes because the night air may cause her to become ill. The nurse recognizes that the patient’s statement reflects a cultural:
Rationale: Taboos refer to behaviors to be avoided. The equilibrium model of health is based on a concept of life balances such as “hot” and “cold.” Health practices are behaviors that are influenced by many factors, including home remedies and folk beliefs. Attitudes about pregnancy dictate whether the pregnancy is viewed as a normal state of wellness or a state of increased vulnerability and illness.
The nurse is working with a patient to identify a complementary therapy that may help control pregnancy-induced hypertension. The patient asks, “Is there a system where I can learn to focus and control my blood pressure with my thoughts?” The nurse recommends:
Rationale: Biofeedback helps patients to control their physiologic responses based on the concept that the mind controls the body. Naturopathy is a healing system that uses natural means to prevent and treat diseases such as nutrition, hydrotherapy, and homeopathy. Hypnosis is a state of mental and physical relaxation during which a patient is very open to suggestions. Chiropractic care is based on the concepts of manipulation to address health problems thought to be a result of abnormal nerve transmission in the spine.
An adolescent boy asks, “Does the scrotum have a function?” The nurse’s best response is:
Rationale: The scrotum’s main purpose is to protect the testes and maintain a temperature that is lower than body temperature so spermatogenesis can occur. Because it is sensitive to touch, pain, and pressure, the scrotum defends against potential harm to the testes. Ejaculation occurs with sexual stimulation and expulsion of semen by rhythmic contractions of the penile muscles.
A nurse is teaching a sex education class about the female reproductive system for sixth-grade girls in a local middle school. The nurse explains that the primary components of the external female reproductive system are:
Rationale: Mons, labia, and the clitoris make up part of the external female reproductive system. They can be seen directly and inspected. The vaginal canal, urethra, and vagina are all part of the internal female reproductive system.
A nurse is teaching a class about the reproductive system, and correctly states that the purpose of the labia minora is to:
Rationale: The labia minora contain sebaceous glands that lubricate the vulvar skin and have a bactericidal effect. The clitoris assists with sexual stimulation by secreting smegma. Skene’s glands aid in lubricating the vaginal opening. Bartholin’s glands secrete a mucus that aids in the viability and motility of the sperm.
The nurse is assessing the pH level of the vaginal environment of a 26-year-old patient. Which of the following would be an expected finding for this patient?
Rationale: The normal range for vaginal pH levels for a patient during the childbearing years is 4.0–5.0. The environment of the vagina is acidic. Below 4.0 is too low and above 5.0 is too high.
A nurse is teaching a class for adolescents about the female reproductive system. When the nurse asks the class what the function of the vagina is, she knows that further teaching is necessary when a student answers:
Rationale: The vagina does not protect the labia minora. The vagina is an internal structure, and the labia minora are an external structure. The vagina provides a passageway for menstrual flow, sperm, and the fetus, and helps protect against infection.
A male patient is having some problems with infertility, and is waiting for a report on his semen sample. The nurse knows that the problem may not be related to the pH level of the semen based on the following pH lab value:
Rationale: Adequate pH level for semen is 7.5, which aids in the effective transport of sperm. A pH of 4.5–6.5 is too low.
A patient relates that she cracked her pelvis in a car accident and wants to know the purpose of the pelvis during childbirth. The nurse’s best response is:
Rationale: The two main purposes of the bony pelvis are to support and protect the contents of the pelvic cavity and to form a relatively fixed axis for the birth passage. The muscles of the pelvic floor help overcome the force of gravity and provide stability. The ovum is fertilized in the fallopian tubes. The ovaries are the main site for estrogen and progesterone secretion.
A nurse is reviewing a patient’s record and notices a physician’s report of a malformation in one of the fallopian tubes. The patient is most at risk for:
Rationale: A malformation within the fallopian tube may decrease the ability for the ovum to pass through, resulting in infertility, ectopic pregnancy, or even sterility. Urinary tract infections and early menopause are not related to fallopian tube malformations. Estrogen is secreted by the ovaries.
Which statement best describes the correct order of the four phases of the menstrual cycle?
Rationale: Menstrual, proliferative, secretory, ischemic is the correct order for the four phases of the menstrual cycle. There is no luteal or follicular phase in the menstrual cycle.
A nurse is teaching a couple about the process of fertilization. Which statement by the couple would indicate understanding of fertilization?
“Fertilization takes place in the ampulla (outer third) of the fallopian tube.”
Rationale: The ampulla is the outer third of the fallopian tube. The word comes from the Latin word ampullae, meaning “jug.” Ampulla is a general term used in anatomy to designate a flasklike dilation of a tubular structure. The fimbria is a funnel-like enlargement with many fingerlike projections reaching out to the ovary at the end of the fallopian tube. The isthmus is the straight and narrow portion of the inner third of the fallopian tube, and it opens into the uterus; this is the site for tubal ligation.
A pregnant patient is concerned about a blow to the abdomen if she continues to play basketball during her pregnancy. The nurse’s response is based upon her knowledge of which of the following facts concerning amniotic fluid?
Amniotic fluid functions as a cushion to protect against mechanical injury.
Rationale: During pregnancy, the amniotic fluid protects against injury. After 20 weeks of pregnancy, fluid volume ranges from 700 to 1000 mL. Some of the amniotic fluid is contributed by the fetus’s excreting urine. Amniotic fluid is slightly alkaline.
A patient states that she had a spontaneous abortion 12 months ago and asks if her hormones may have contributed to the loss of the pregnancy. The nurse’s response is based upon which fact?
Progesterone decreases the contractility of the uterus.
Rationale: Progesterone decreases the contractility of the uterus, thus preventing uterine contractions that might cause spontaneous abortion. Progesterone must be present in high levels for implantation to occur. After 10 weeks, the placenta takes over the production of progesterone. hCG reaches its maximum level at 50–70 days gestation.
A nurse is teaching a group of student nurses about amniotic fluid. Which statement by the student nurse reflects an understanding of the fetus’s contribution to the quantity of amniotic fluid?
Correct Answer:
“The fetus contributes to the volume of amniotic fluid by excreting urine.”
Rationale: “The fetus contributes to the volume of amniotic fluid by excreting urine.” Approximately 400 mL of amniotic fluid flows out of the fetal lungs each day. The fetus swallows about 600 mL of the fluid in 24 hours. A normal volume of amniotic fluid is necessary for good fetal movement. Normal movement is necessary for good musculoskeletal development.
The nurse is preparing an educational workshop on fetal development. Which statement by the student would require the nurse to explain further?
Correct Answer:
“The umbilical cord is made of two veins and one artery.”
Rationale: A nuchal cord exists when the umbilical cord encircles the fetal neck. Fetal movement causes the umbilical cord to knot. The umbilical cord is made of two arteries and one vein. The high blood volume and Wharton’s jelly content of the umbilical cord prevents compression of the cord.
At 17 weeks pregnant, a mother asks the nurse questions about the development of her baby. The mother states that it may be too early to visualize any body structures via ultrasound. The nurse’s best response in relation to fetal development at 17 weeks is:
Your Answer:
The earlobes are soft with little cartilage.
Rationale: Differentiation of hard and soft palate are structures developed by 17 weeks gestation. Myelination of the spinal cord begins at 20 weeks gestation. Soft earlobes with little cartilage develop at 36 weeks gestation. Teeth form hard tissue (enamel) at 18 weeks gestation.
The nurse is preparing an educational workshop on the time frames for fetal exposure to potential teratogens. Which defect is most likely to occur at seven weeks gestation?
Correct Answer:
A cleft palate
Rationale: Cleft palate is the defect most likely to occur at seven weeks gestation. Shortening of fingers and toes most likely occurs at eight weeks gestation. Cleft lip most likely occurs at six weeks gestation. Septal or aortic abnormalities are most likely to occur at six weeks gestation.
A patient in the prenatal clinic tells the nurse that her sister has twins and is concerned that she may also have twins. The nurse’s response is based upon which fact?
Your Answer:
Genetic factors in the mother may lead to elevated serum gonadotropin levels, causing double ovulation.
Rationale: A genetic factor that results in elevated serum gonadotropin levels may cause double ovulation. The chance of dizygotic twins increases with maternal age up to about 35 years and then decreases abruptly. Monozygotic twins share a common amniotic sac only if division occurs 7–13 days after fertilization. The survival rate of dizygotic twins is about 10% lower than that of monozygotic twins.
A nurse is instructing her students where to listen for a uterine souffle. Each student has placed the fetoscope on the pregnant women’s abdomen. Based on the following placements of the fetoscopes, the student most likely to hear a uterine souffle is the one who placed her fetoscope on which of the following areas?
Your Answer:
Just above the symphysis pubis
The nurse must choose an appropriate location and method of taking a sexual health history. Which of the following would be the best choice?
Correct Answer:
An interview in the examination room with the door closed
Rationale: A quiet, private environment is important for conducting a sexual history. Waiting areas and interviews in the presence of other individuals are not appropriate. The patient’s comfort is important. The nurse uses effective communication skills to elicit this important data.
Which statement made by a preteen girl indicates successful adaptation to menarche?
Correct Answer:
“My cycle should occur every 28 days and last about five days.”
Rationale: Young girls will adapt successfully to the initiation of menses and cope better when they have correct information concerning cycle length, amount of flow, length of menses, and management issues.
A 20-year-old woman reports to the nurse about her menstrual flow. Which statement made by the patient would be cause for further investigation?
Correct Answer:
“I had to change my maxi pad at least 14 times today.”
Rationale: Saturation of a maxi pad more often than every one to two hours, especially for more than a day, could put a patient at risk for anemia.
Which content area is important to include in a teaching plan presented to young girls to assist them in preventing toxic shock syndrome?
Correct Answer:
Change tampons every three to six hours and wash hands before insertion.
Rationale: Toxic shock syndrome is associated with the use of super-absorbent tampons and the bacteria Staphylococcus aureus. This bacteria is commonly found on the hands. Handwashing may avoid the transmission to the genital tract.
When asked if douching is appropriate, how should the nurse respond?
Correct Answer:
“Douching is associated with susceptibility to infection.”
Rationale: Douching washes away the natural cervical mucus plug and changes the vaginal flora, increasing susceptibility to infection. It should be avoided during the menstrual cycle, as the cervix is dilated and fluid may be propelled into the uterus.
A young woman states that her menstrual cycle occurs every 20 days. What additional data should the nurse gather?
Correct Answer:
The amount of flow per cycle
Rationale: Polymenorrhea is characterized by bleeding occurring at intervals of less than 20 days. It is important to ascertain the amount of flow per cycle to determine if menorrhagia is present. Type of protection, number of sexual partners, and mother’s age at menopause are not applicable to this scenario.
A 16-year-old patient states that she has never started her menstrual cycle. The nurse asks about marked weight loss, excessive exercise, and prolonged stress. Which cause of amenorrhea is he inquiring about?
Your Answer:
Hypothalmic dysfunction
Your Answer:
Hypothalmic dysfunction
Rationale: Hypothalmic dysfunction is characterized by marked weight loss, excessive exercise, and prolonged stress. Pituitary dysfunction usually is related to medication used to treat anxiety or psychiatric disorders, head trauma, and cancer. Ovarian failure can be related to Turner’s syndrome, exposure to radiation, chemotherapy, viral infection, and surgical removal of the ovary. Anatomic abnormalities that would cause amenorrhea would be disorders such as congenital absence of the uterus, ovaries, or vagina.
A patient at the family planning clinic is diagnosed with primary dysmenorrhea. What should be included in the nurse’s teaching plan for nonpharmacologic comfort measures?
Correct Answer:
Balanced meals and adequate rest
Rationale: Self-care measures to treat dysmenorrhea would include regular exercise, rest, application of heat, and good nutrition.
The nurse is taking a neurologic health history from a female patient who is concerned with symptoms of premenstrual syndrome. Which symptom should the nurse inquire?
Correct Answer:
Vertigo
Rationale: Symptoms of PMS occur between ovulation and the onset of menses, and can affect all body systems. Neurologic symptoms include migraine headache, vertigo, and syncope.
A married couple is planning a pregnancy. She suffers from premenstrual syndrome, and asks the nurse which relief measure would be appropriate. What is the nurse’s best response?
Correct Answers:
Increase intake of complex carbohydrates.
Exercise.
Rationale: Women considering pregnancy should refrain from pharmacologic treatment of PMS. Methylxanthine-containing foods should be decreased, and intake of complex carbohydrates should be increased. Exercise has been shown to increase the body’s natural endorphins to relieve pain, and boosts energy and mood as well.
A nurse is teaching a group of college women about prevention of toxic shock syndrome (TSS). Which of the following statements should be included in the seminar?
Correct Answer:
Women with a history of TSS should never use tampons.
Rationale:
- Usually, the causative organism of TSS is is a toxin released by a strain of Pseudomonas aeruginosa. (False - The usual causative organism is a toxin released by a strain of Staphylococcus aureus)
- Hypertension is often seen in patients with TSS (False - TSS is associated with hypotension)
- To avoid TSS, tampons should be changed every 6 to 9 hours (False - tampons should be changed every 3 - 6 hours to avoid TSS)
- Women with a history of TSS should never use tampons. (True)
A nurse is educating a group of patients about the risk factors for developing toxic shock syndrome (TSS). Which statement by a patient would indicate that she would benefit from more teaching on the risk factors of TSS?
Correct Answer:
“I should use super-absorbent tampons only at night during my period.”
Rationale: “I should use super-absorbent tampons only at night during my period” indicates that a patient would benefit from more teaching on the risk factors of TSS. The risk of TSS is reduced when alternating between pads and tampons. The risk of TSS is reduced when a diaphragm or cervical cap is not used during the menses. The risk of TSS is reduced when tampons are changed every three to six hours during the menses.
A patient describes breast swelling and tenderness. Gathering what piece of data would be most important?
Correct Answer:
Timing of the symptoms
Rationale: The breast undergoes regular cyclical changes in response to hormonal stimulation. The nurse will want to determine when the swelling and tenderness occurs within the menstrual cycle. Birth control method, method of BSE, and diet history may contribute to the database, but do not have priority.
A 24-year-old female patient is being treated with tinidazole for bacterial vaginosis. Which information should the nurse include in this patient’s discharge instructions?
Correct Answer:
Alcohol should be avoided when taking tinidazole
Rationale:
- Alcohol should be avoided when taking tinidazole (true)
- Tinidazole may be administered orally in tablet form or vaginally as a cream (false - this medication is administered orally)
- Side effects of tinidazole include white or gray vaginal discharge with a foul odor described as “fishy.” (false - these are signs and symptoms of bacterial vaginosis infection)
- Tinidazole is contraindicated in pregnant patients (false)
In order to assess the origin of galactorrhea, the nurse must gather data about what?
Correct Answer:
Color and consistency of discharge
Rationale: Galactorrhea is nipple discharge not associated with lactation. Determining color and consistency of that discharge assists the nurse in distinguishing between physiologic discharge and pathologic discharge. Masses, dimpling, and presence of rash will not give the nurse data concerning galactorrhea.
A 32-year-old woman who is at 29 weeks’ gestation presents to the clinic for a routine prenatal visit. Her physician orders a urinalysis, which reveals asymptomatic bacteriuria (ASB). Which of the following plans of care should the nurse anticipate?
Correct Answer:
Explaining that treatment will be necessary even if fever, chills, or any other signs and symptoms of infection do not develop
Rationale:
- Instructing the patient about the risks of developing a descending urinary tract infection (false - urinary tract infections are ascending)
- Explaining that treatment will be necessary even if fever, chills, or any other signs and symptoms of infection do not develop (true - because untreated ASB can lead to pyelonephritis in the pregnant woman and low birth weight in the newborn, treatment will be necessary despite the absence of symptoms)
- Preparing for administration of a broad-spectrum antibiotic, as ASB is usually caused by two separate organisms (false - ASB is almost always caused by a single organism, typically Escherichia coli, and treatment should target the causative organism)
- Facilitating additional diagnostic testing, including a blood culture, and encouraging strict bedrest until antibiotic therapy is completed (false - in the treatment of pyelonephritis, a blood culture is necessary and bed rest is advised)
The nurse is teaching a group of female teenagers about prevention of sexually transmitted infection (STI). Which student’s statement suggests the need for additional teaching?
Your Answer:
“If I test positive for the human papillomavirus (HPV), my sexual partner and I both have to be treated with medication”
Rationale:
- “I can get venereal warts by having anal sex” (false - this statement is correct) - “The same STI that causes genital warts can cause cancer of the cervix” (false - this statement is correct)
- “If I test positive for the human papillomavirus (HPV), my sexual partner and I both have to be treated with medication” (true - this is incorrect; sex partners do not require treatment unless large lesions are present)
- “Human papillomavirus (HPV) can be spread from one person to another during oral sex” (false - this statement is correct)
Upon reviewing the patient’s chart, which piece of data would suggest to the nurse the doctor may diagnose endometriosis?
Correct Answer:
Pelvic cramping and dyspareunia
Rationale: The most common symptom of endometriosis is pelvic pain. Other symptoms include dysmenorrhea, dyspareunia, abnormal uterine bleeding, and infertility.
The community health nurse is creating an educational brochure about sexually transmitted infections (STIs). Which information should the nurse include when discussing the two types of herpes infections?
Correct Answer:
Both HSV-1 and HSV-2 can cause genital herpes
Rationale:
- Both HSV-1 and HSV-2 can cause genital herpes (true)
- HSV-1 may cause cold sores but does not cause genital herpes (false - HSV-1 can lead to genital herpes through oral–genital contact)
- If administered early in the course of treatment, acyclovir, valacyclovir, or famciclovir are effective cures for either type of HSV (false - no known cure for herpes exists)
- Emotional stress does not impact the recurrence of HSV (false)
A married woman presents to the clinic with complaints of grayish vaginal discharge with a “fishy” odor. Which of the following statements demonstrates that your teaching regarding BV has been understood?
Correct Answer:
“It is not necessary to treat my partner.”
Rationale: Bacterial vaginosis is not a sexually transmitted disease. Studies have not found a lower risk of reinfection with treating male partners. Metrogel (Flagyl) now is considered safe in pregnancy. However, alcohol should be avoided while on this medication, due to ill side effects from the combination.
The nurse is teaching a class on infertility. Which statement correctly describes infertility?
Your Answer:
Lack of conception despite unprotected sexual intercourse for at least 12 months
Rationale: Infertility is defined as lack of conception despite unprotected sexual intercourse for at least 12 months. When there is an absolute factor preventing reproduction, it is described as sterility. A couple having difficulty conceiving because both partners have decreased fertility is subfertility (reduced ability to conceive). Being a woman over 35 and having difficulty conceiving is a possible risk factor for infertility but does not describe infertility.
The nurse is teaching a couple about fertility during the female reproductive cycle. The couple asks the nurse, “When is the most fertile time for intercourse?” What is the best response by the nurse?
Your Answer:
Three days before and after ovulation
Rationale: The best response by the nurse is, “Three days before and after ovulation.” Follicular phase is the first fourteen days of the ovarian cycle, and includes both fertile and nonfertile days. Twelve to 24 hours before and after ovulation is too short of a time frame. The luteal phase is the last 14 days of the ovarian cycle, and includes both fertile and nonfertile days.
A nurse is reviewing a basal body temperature chart. Which change would indicate probable ovulation?
Your Answer:
Decrease in temperature followed by an increase for several days
Rationale: A decrease in temperature is followed by an increase in temperature occurring about a day after ovulation, which is maintained for several days.
A nurse is teaching a patient with infertility about the medication Clomid (clomiphene citrate). What side effect of Clomid would indicate the need to discontinue the medication?
Correct Answer:
Visual disturbances
Rationale: Visual disturbances are a contraindication for continuing the medication. Hot flashes are related to the antiestrogenic effects of Clomid, and do not merit discontinuation. Abdominal distention and headaches also are anticipated side effects.
A 34-year-old female patient has been diagnosed with recurrent pregnancy loss (RPL). Which of the following statements accurately represents this condition?
Your Answer:
RPL is another term for infertility
Rationale:
- RPL is another term for infertility (false)
- Research has demonstrated that there is no link between RPL and autoimmune disorders (false)
- RPL is defined by three or more failed pregnancies (false)
- Thrombotic causes are associated with RPL (true)
A nurse is teaching a class on the environmental factors affecting male fertility. Which factors could reduce the sperm count? (Select all that apply.)
Correct Answers:
Heavy use of marijuana, alcohol, or cocaine
Exposure to pesticides
Correct.
Rationale: Exposure to pesticides could reduce the sperm count, as could heavy use of marijuana, alcohol, or cocaine. All have been shown to depress sperm count and testosterone levels. Use of hot tubs and wearing of briefs are not proven factors in reducing sperm count, although they are thought to decrease fertility. Cigarette smoking decreases sperm motility.
A nurse is teaching an educational seminar about genetic disorders. The nurse correctly responds to a question about mosaicism by stating that individuals who have this chromosomal abnormality also may have which characteristic?
Correct Answer:
Normal intelligence
Rationale: Severe mental retardation, congenital heart defects, and underdeveloped sex characteristics describe trisomic individuals.
Which disorder would not result in a higher-than-normal AFP level?
Correct Answer:
Down syndrome
Rationale: Open neural tube defects, anencephaly, omphalocele, gastroschisis, and multiple gestations cause higher-than-normal AFP levels. Down syndrome causes lower-than-expected levels.
Which test or workup do you think is most appropriate for a patient who has no children, a history of two ectopic pregnancies, and currently reports an inability to get pregnant?
Correct Answer:
Hysterosalpingography
Rationale: Ectopic pregnancies can cause scarring in the fallopian tubes, thereby causing an obstruction between the ovaries and the uterus. Hysterosalpingography is the test to determine tubal patency and uterine structure.
A nurse is working with four patients interested in in vitro fertilization. Which patient would be a good candidate for using a gestational carrier?
Rationale: IVF using a gestational carrier is appropriate for the woman who is genetically sound but unable to carry a pregnancy due to absence of her uterus. The patient with tubal blockage is a candidate for in vitro fertilization with intrauterine embryo transfer. The patient whose husband has a very low sperm count is a candidate for in vitro fertilization. The patient with isoimmunization is a high-risk pregnancy, but this condition does not preclude pregnancy.
Assessment; Health Promotion and Maintenance; Analysis
Which patient would be most likely to experience a Bradley type labor and birth?
Correct Answer:
23 Y/O G1P0 – Married, supportive partner
Rationale: The Bradley method’s foundation is husband-coached childbirth. Lamaze is a disassociation type with incorporation of breathing patterns; Hypnobirth incorporates hypnosis type state; Kitzinger uses chest breathing and relaxation.
Which statement indicates the need for further teaching as it relates to vitamin recommendations in pregnancy?
Correct Answers:
“The doctor prescribed vitamins for me, but they make me sick so I quit taking them.”
“My doctor said that I need to take vitamins to stay healthy. I am taking the ones he prescribed, as well as my own multivitamin.”
Rationale: Increased amounts of certain vitamins and nutrients are recommended in pregnancy. However, there is a possibility of an overdose, which could cause fetal problems. It is important to determine what amount is needed and to keep track of intake.
Which statement indicates the need for further teaching regarding pregnancy and exercise? (Select all that apply.)
Correct Answers:
“I have gained so much weight during my pregnancy. I am going to start jogging.”
“I feel so tired after my workouts; I need to push myself to remain in shape.”
Correct.
Rationale: A regular exercise plan should be initiated and in place three months prior to pregnancy. Initiating or increasing exercise during pregnancy is not generally recommended.
Regarding cesarean section and vaginal birth after cesarean (VBAC), which statement is accurate?
Your Answer:
According to the American College of Obstetricians and Gynecologists (ACOG), VBAC is a safe alternative for most women
Rationale:
- According to the American College of Obstetricians and Gynecologists (ACOG), VBAC is a safe alternative for most women (true)
- The Agency on Healthcare Research and Quality published findings that 95% of VBACs were successful (false)
- Women over the age of 40 give birth via cesarean at rates of 80% (false)
- VBAC should be considered only in women under the age of 35 (false)
A married couple are apprehensive about their labor and delivery. They report a loss of control and a reckless regard to their wishes with their previous hospital birth. Which nursing interventions/responses would be most appropriate? (Select all that apply.)
Correct Answers:
Assisting this couple with a birth plan.
Offering information to allow for informed choices.
Correct.
Rationale: A birth plan allows for the parents’ wishes to be made known to those providing care. It is important for the nurse to provide means for a couple to make plans and gain comfort about their care. It is good to suggest that they discuss their wishes with their physician; however, it is within nursing’s scope to further help them. They are not interested in routine care; they are concerned with loss of control and not having their wishes respected. Patient teaching is important. Allowing the couple to make decisions is their wish. It is important that they are making decisions with appropriate and true information.
A married couple have decided to have their older children present in the delivery room. During labor, the patient is verbalizing and writhing in pain. There is bloody show, and her youngest child begins to cry and say, “No! No!” What would be an appropriate nursing intervention? (Select all that apply.)
Correct Answers:
Encourage the support person to take the child from the room.
Avoid generalized reassurance.
Correct.
Rationale: Children should have their own support person present. They should never be made to feel uncomfortable. They should have the option to come and go from the room as they desire.
A co-worker is teaching prenatal classes. She is covering physiologic changes of pregnancy. Select the changes that are correctly matched with the appropriate times to present them. (Select all that apply.)
Correct Answers:
Enlarged, tender breasts; first trimester
Vasodilation and its association with hemorrhoids, etc.; first trimester
Rationale: Enlarged, tender breasts occur in the first trimester. Quickening occurs prior to the third trimester. This is an appropriate time to address vasodilation and its association with hemorrhoids, etc. Uterine involution occurs after delivery. Better to wait until third trimester for teaching on this topic.
Which person would be the best candidate to provide support to a sibling attending a birth?
Correct Answer:
The child’s close aunt, who has had children before.
Rationale: Siblings should have their own separate support person with whom they are comfortable, who is familiar with the birthing process and is comfortable talking about sexuality.
A married woman has given birth to a seven-pound, seven-ounce baby boy. She is breast-feeding. You enter the room to provide care. Her husband states, “I don’t know why she has to do that. None of our other kids like me because they all were breastfed. They want nothing to do with me.” What nursing intervention would be most appropriate? (Select all that apply.)
Correct Answers:
Encourage the husband to rock and hold the baby.
Encourage the husband to provide other baby care, such as diapering, burping, changing, etc.
Correct.
Rationale: Encourage activities that promote the father’s involvement and bonding. Informing him that breastfeeding is best and that he needs to support his wife in her decision doesn’t recognize his needs. They have decided to breast-feed, so offering formula is not an option. Exclusive breastfeeding is best in the first few weeks. There are better ways to incorporate the husband in care.
A married woman is having a scheduled repeat cesarean delivery. She states that she doesn’t know if she can do that again. Upon further questioning, she states that she “labored for 29 hours then had an emergency C-section.” She wasn’t able to see her baby until hours later, and had terrible pain in the recovery period. She states that she was unable to provide infant care for many days due to her discomfort. Choose an appropriate nursing intervention. (Select all that apply.)
Correct Answers:
Teach the patient about C-sections and plan of care.
Inform the patient that every delivery is different. She will not be so fatigued going into things this time, and that should help with the pain and recovery time.
Rationale: Don’t provide a false sense of security or over-generalized reassurance. This doesn’t address her concerns. Subsequent C-sections often are less painful than the first. Fatigue and fear play a part in pain and pain perception. There previously may not have been time for teaching. It is good to reiterate and teach to help eliminate some fear. Although the same incision line may be used, there still may be discomfort.
A 25-year-old patient at 18 weeks gestation has returned to the clinic for her second prenatal visit. Her initial pulse was 60. The nurse can expect her pulse to be bpm at term.
Correct Answer:
70-75
Rationale: The pulse may increase by 10–15 bpm at term.
A nurse is teaching a prenatal patient about cardiovascular changes during pregnancy. The patient asks the nurse why she becomes dizzy when getting out of a chair or out of bed. What is the best explanation?
Correct Answer:
Increased blood volume in the lower extremities.
Rationale: Increased blood volume in the lower extremities is the rationale the nurse should provide for the cause of supine hypotensive syndrome during pregnancy. Hormones, fibrinogen, plasma production, and hemoglobin are not related to orthostatic hypotension.
A nurse is assessing a prenatal patient’s cardiovascular function. When should the nurse expect this patient’s cardiac output (CO) to begin rising?
Correct Answer:
Eight to 10 weeks
Rationale: Cardiac output (CO) begins to rise early in pregnancy. 8 to 10 weeks is the best answer. Twelve to 18, 20 to 24, and 34 to 38 weeks are too late.
A nurse is teaching a group of first-trimester prenatal patients about the discomforts of pregnancy. A patient asks the nurse, “What causes my nausea and vomiting?” The nurse knows the primary contributing factor to first-trimester emesis is:
Correct Answer:
Human chorionic gonadotropin.
Rationale: The primary cause of prenatal nausea and vomiting is an elevated level of human chorionic gonadotropin. Estrogen stimulates the growth of the uterus and breast tissue. Progesterone prepares the breasts for lactation and decreases uterine contractions. Prostaglandins stimulate uterine contractions.
A nurse is researching the topic of fluid retention during pregnancy. Which factor contributes to fluid retention?
Correct Answer:
Increased level of steroid sex hormones
Rationale: Increased level of steroid sex hormones contributes to fluid retention during pregnancy. Decreased serum protein influences the fluid balance. Increased intracapillary pressure and permeability influences the fluid balance. Nitrogen retention does not influence fluid balance.
The nurse is taking an initial history of a prenatal patient. Which sign would first indicate a positive, or diagnostic, sign of pregnancy?
Your Answer:
Fetal heartbeat with fetoscope at 18 weeks gestation
Rationale: If the nurse practitioner hears the fetal heartbeat with a fetoscope between 17 and 20 weeks gestation, that would indicate a positive, or diagnostic, sign of pregnancy. The examiner can detect fetal movement at 20 weeks gestation. Fetal heart movement can be seen as early as eight weeks gestation with ultrasound. Fetal heartbeat can be detected with the electronic Doppler at 10–12 weeks gestation.
The nurse in the prenatal clinic assesses a 26-year-old patient at 13 weeks gestation. Which presumptive (subjective) signs and symptoms of pregnancy should the nurse anticipate?
Correct Answer:
Excessive fatigue and urinary frequency
Rationale: Excessive fatigue and urinary frequency both are presumptive (subjective) signs and symptoms of pregnancy. Hegar’s sign, ballottement, a positive pregnancy test, Chadwick’s sign, and uterine souffle are probable (objective) signs or symptoms of pregnancy.
The nurse is researching the topic of uteroplacental blood flow. Which statement accurately describes funic souffle?
Correct Answer:
A soft blowing sound of blood that is at the same rate as the fetal heart rate.
Rationale: Funic souffle is a soft blowing sound of blood that is at the same rate as the fetal heart rate. Increased blood pulsating through the placenta, a soft blowing sound of blood that is at the same rate as the maternal pulse, and increased blood pulsating through the uterine arteries relate to uterine souffle.
The nurse is taking a history from a prenatal patient at seven weeks gestation. The patient states, “I don’t know if I want this baby. How will I know if I’ll be a good mother?” What is the most appropriate response by the nurse?
Correct Answer:
“This is a normal reaction to parenthood in the first trimester.”
Rationale: Not knowing if she wants the baby and wondering if she’ll be a good mother are normal reactions to parenthood in the first trimester. Asking a newly pregnant woman to consider an abortion or adoption is a nontherapeutic response. The patient did not introduce the topic of not wanting her baby. Not knowing if she wants the baby and wondering if she’ll be a good mother are normal reactions to parenthood and not necessarily signs of depression, and do not warrant a referral.
The nurse is teaching a parenting class to prospective fathers. The nurse correctly teaches that couvade refers to the:
Rationale: Couvade is the unintentional development of the physical symptoms of pregnancy in the father of the baby. The expectant father’s fear of hurting the unborn baby during intercourse, transition from nonparent to parent, and development of attachment and bonding behaviors are third-trimester paternal concerns.
Implementation; Health Promotion and Maintenance; Application
The nurse is preparing an antenatal patient for an initial assessment. What is the first task that the nurse should perform?
Correct Answer:
Instruct the patient to provide a clean urine specimen.
Rationale: Instructing the patient to provide a clean urine specimen is the first task that the nurse should perform in preparing an antenatal patient for an initial assessment. Providing the patient with a gown is done after obtaining the urine specimen. Preparing the patient for a pelvic exam is done after or during the physical exam. Drawing blood for routine tests is the last task performed. Lab tests may be added based on assessment data from the physical exam.
The nurse in the prenatal clinic is planning care for a pregnant 15-year-old patient. The nurse knows that this adolescent is at risk for which maternal complication?
Correct Answer:
Preeclampsia
Rationale: Adolescents are at increased risk for preeclampsia. Postpartum hemorrhage is a complication of multiparity. Hypoglycemia is a complication of diabetes. Cesarean birth is a high-risk factor for patients over 35 years of age.
The nurse has completed the initial assessment on four prenatal patients. Which patient is at greatest risk for a spontaneous preterm birth?
Correct Answer:
A 19-year-old patient with twins.
Rationale: Twins place a patient at risk for preterm labor because of the overdistention of the uterus relative to the weeks of gestation. Diabetes places the patient at risk for preeclampsia and cesarean birth. Hyperthyroid disorders are associated with an increased risk of postpartum hemorrhage. Ppatients older than 35 are at risk for preeclampsia and cesarean birth.
The nurse is assessing the fundal height of a patient at 12 weeks gestation. The nurse should expect the fundus to be:
Your Answer:
Slightly above symphysis pubis.
Rationale: The fundal height is expected to be slightly above the symphysis pubis for a patient at 12 weeks gestation. The fundus is expected to be at the level of the umbilicus at 20–22 weeks gestation, and halfway between the symphysis and umbilicus at 16 weeks gestation. It is expected to be slightly below the ensiform cartilage at 36 weeks gestation.
A nurse is completing an assessment on a first-trimester antepartal patient with a hemoglobin level of 10.8 g/dL. What is the priority nursing action at this time?
Your Answer:
Obtain an order for iron supplementation.
Rationale: Obtaining an order for iron supplementation is the priority nursing action on a first-trimester antepartal patient with a hemoglobin level of 10.8 g/dL. Referring the patient for nutritional counseling is an important intervention at 12.0 g/dL but is not the priority at this time. An order for type and cross match is not needed at this time. Transfusions may be given at levels below 6.0–8.0 g/dL. Evaluating the patient for signs of infection is the appropriate action for an elevated white blood cell count.
