OB Exam #5 Flashcards
When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:
A. Anatomic abnormalities
B. Type 1 diabetes mellitus
C. Lack of exercise
D. Hysterectomy
C. Lack of exercise
Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Hysterectomy is a possible cause of amenorrhea.
When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
A. Increasing the intake of red meat and simple carbohydrates
B. Reducing the intake of diuretic foods, such as peaches and asparagus
C. Temporarily substituting physical activity for a sedentary lifestyle
D. Using a heating pad on the abdomen to relieve cramping
D. Using a heating pad on the abdomen to relieve cramping
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.
While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. The nurse should collect additional information with which statement?
A. The woman says her menstrual flow lasts 5 to 6 days.
B. She describes her flow as very heavy.
C. She reports that she has had a small amount of spotting midway between her periods for the past 2 months.
D. She says the length of her menstrual cycle varies from 26 to 29 days.
B. She describes her flow as very heavy.
Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.
While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?
A. African-American race
B. Low protein intake
C. Obesity
D. Cigarette smoking
D. Cigarette smoking
Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.
During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as:
A. Amenorrhea
B. Dysmenorrhea
C. Dysparunia
D. Premenstrual syndrome (PMS)
B. Dysmenorrhea
Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.
With regard to dysmenorrhea, nurses should be aware that:
A. It is more common in older women
B. It is more common in leaner women who exercise strenuously
C. Symptoms can begin at any point in the ovulatory cycle
D. Pain usually occurs in the suprapubic area or lower abdomen
D. Pain usually occurs in the suprapubic area or lower abdomen
Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Dysmenorrhea is more common in younger women ages 17 to 24. Dysmenorrhea is more common in women who smoke and who are obese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow.
Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?
True
False
True
Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.
Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence are a delayed result of childbearing. These defects do not appear in women who have never been pregnant. Is this statement true or false?
False
These problems are associated with older mothers; however, women who have never been pregnant can experience them as well. Incontinence is the direct result of congenital or acquired weakness of the pelvic support structures. This condition often appears during menopause when ovarian hormones and pelvic tissue are lost. The incidence does tend to remain higher in women who have given birth.
Tumors that are on pedicles (stalks) and present in either the endometrium or cervix are more commonly known as ______________.
Uterine polyps
Uterine polyps The etiology of this type of tumor is unknown, although they may develop in response to hormonal stimulus or be the result of inflammation. Polyps are benign lesions that can be removed surgically.
A ____________________ cyst is a germ cell tumor that contains substances such as hair, teeth, sebaceous secretions, and bones.
Dermoid
Some plant foods contain ________ and are capable of interacting with estrogen receptors in the body.
Phytoestrogens
Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):
A. Soy B. Vitamin C C. Vitamin K D. Vitamin E E. Vitamin A
A. Soy
D. Vitamin E
Both soy and vitamin E have been reported to help alleviate menopausal symptoms. Vitamins C, K, and A have no apparent effect on menopausal symptoms.
Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.
A. Consume large quantities of caffeine
B. Drink a glass of wine
C. Eat Mexican food
D. Drink ice water
E. Drink warm beverages
D. Drink ice water
Ice water may help alleviate the hot flashes. Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or drinking warm beverages most likely would exacerbate the hot flashes.
Your client is undergoing treatment for ovarian cancer. Please identify which common nutritional problems are related to gynecologic cancers and the treatment thereof. (choose all that apply)
A. Stomatitis B. Constipation C. Anorexia D. Diarrhea E. Nausea and vomiting
All of them
Stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client’s plan of care. To ensure recovery these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B and K.
During internal radiation therapy for cervical cancer, the nurse should:
A. Wear gloves when assessing the cervical intracavity implant
B. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours
C. Prepare the client for an enema before insertion
D. Limit staff or visitor exposure to 30 minutes or less per 8 hours
D. Limit staff or visitor exposure to 30 minutes or less per 8 hours
Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation. Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection. An indwelling catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel prep is necessary.
With regard to planning treatment for a pregnant woman with breast cancer, which statement about timing or type of treatment is correct?
A. The fetus is most at risk during the first trimester.
B. The fetus is most at risk during the second trimester.
C. The fetus is most at risk during the third trimester.
D. Surgery is more risky than chemotherapy in the first trimester.
A. The fetus is most at risk during the first trimester.
The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is less risky than chemotherapy in the first trimester.
The nurse should be aware that a pessary would be most effective in the treatment of what disorder?
A. Cystocele
B. Uterine prolapse
C. Rectocele
D. Stress urinary incontinence
B. Uterine prolapse
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. A pessary is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. It is unlikely that a pessary is the most effective treatment for stress incontinence.
Risky sexual behaviors and inadequate preventive health behaviors are the two primary areas of risk for sexually transmitted infections (STIs).
True
False
True
Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals with less education may not be aware of proper prevention techniques; however, these are not the primary areas for STIs. Having a large number of sexual partners is certainly a risk-taking behavior. Race does not increase the risk for STIs.
Which of the following sexually transmitted infections are bacterial?
A. Syphilis B. Trichominiasis C. Chlamydia D. Gonorrhea E. Group B strep F. Hepatitis B
A. Syphilis
C. Chlamydia
D. Gonorrhea
E. Group B strep
To detect the human immunodeficiency virus (HIV), most laboratory tests focus on:
A. HIV virus
B. HIV antibodies
C. CD4 counts
D. CD8 counts
B. HIV antibodies
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. In order to determine if the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed in order to detect HIV.
What is the nurse’s primary responsibility for a couple diagnosed with multiple severe fetal abnormalities?
A. refer the couple to a new OB/GYN
B. refer the couple for intrauterine fetal surgery
C. refer the couple for possible pregnancy termination
D. refer the couple for genetic counseling
D. refer the couple for genetic counseling
What is the chance for a fetus to have an autosomal dominant trait when one parent has the trait?
A. 25% for any child B. 50% for any child C. 75% for any child D. 50% for all male children E. 50% for all female children
B. 50% for any child
50% risk to have the trait, 50% risk to be normal
What is the chance of a baby having an autosomal recessive trait when both parents are carriers for that trait?
A. 50% if it’s a male
B. 50% if it’s a female
C. 25%
D. 75%
C. 25%
On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a “fishy” odor; complains of pruritus. Based on these findings, the nurse suspects that this woman has:
A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
D. Gonorrhea
A. Bacterial vaginosis
Most women with bacterial vaginosis (BV) complain of a characteristic “fishy odor.” The discharge usually is profuse, thin, and has a white, gray, or milky color. Some women also may have mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish to greenish, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.
A nurse must be cognizant that an individual’s genetic makeup is known as his/her:
A. Genotype
B. Phenotype
C. Karyotype
D. Chromotype
A. Genotype
The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual’s genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes. Genotype refers to an individual’s genetic makeup
How would you state the karyotype for Kleinfelter’s?
47XXY
Down Syndrome =
Trisomy 21
After a client has a positive Chlamydia trachomatis culture, she and her husband return for counseling. Which question should the nurse ask first during the assessment?
A. “Do you have contacts to identify?”
B. “What is your understanding regarding how Chlamydia is transmitted?”
C. “Do you have questions about the culture and its validity?”
D. “Do you have allergies to the medications?”
B. “What is your understanding regarding how Chlamydia is transmitted?”
The transmission of Chlamydia may or may not have been made clear to both partners so the nurse would have to assess this first. Chlamydia is a reported sexually tranmitted disease. A may be part of the follow up. C is a possibility but most cultures used today have few false positives. D would be done later in the assessment.
To promote safety, what priority action would the nurse implement in obtaining a blood specimen from a client with hepatitis B?
A. Clean area with antiseptic solution.
B. Wear a pair of clean gloves.
C. Apply pressure to site for 5 seconds.
D. Recap needle to avoid carrying exposed needle.
B. Wear a pair of clean gloves.
Clean gloves should be worn at all times when handling any client’s body fluids. A is correct but not higher priority over B. C is incorrect because venipuncture sites of clients with hepatitis B should be held for a longer period of time due to possibility of increased bleeding associated with an impaired liver. D is unsafe.
Which statement about the various forms of hepatitis is accurate?
A. A vaccine exists for hepatitis C but not for hepatitis B.
B. Hepatitis A is acquired by eating contaminated food or drinking polluted water.
C. Hepatitis B is less contagious than human immunodeficiency virus (HIV).
D. The incidence of hepatitis C is decreasing.
B. Hepatitis A is acquired by eating contaminated food or drinking polluted water.
For which of the following reasons would the nurse refer a client for a prenatal genetics consultation? (choose all that apply)
A. age 36 at delivery
B. abnormal quad screen result
C. one previous pregnancy loss
D a cousin with a birth defect
E. working in a factory where chemical exposure is possible
A. age 36 at delivery
B. abnormal quad screen result
D a cousin with a birth defect
E. working in a factory where chemical exposure is possible
All but C (the third answer) are reasons for referral. Guidelines state that need 2 or more pregnancy losses for referral.
What are the most common perinatal complications associated with bacterial sexually transmitted infections (STI’s)?
preterm labor preterm birth miscarriage IUGR - intrauterine growth restriction newborn eye infections
Which virus is most threatening to the fetus and neonate?
A. Hepatitis A virus
B. Herpes simplex virus (HSV)
C. Hepatitis B virus (HBV)
D. Cytomegalovirus (CMV)
C. Hepatitis B virus (HBV)
HBV is the virus most threatening to the fetus and neonate. Hepatitis A is not the most threatening to the fetus. HSV is not the most threatening to the neonate. Although serious, CMV is not the most threatening to the fetus.
A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner orders which preparation for treatment?
A. Clindamycin
B. Penicillin
C. Fluconozole
D. Acyclovir
C. Fluconozole
The symptoms suggest candidiasis/yeast infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis/yeast. Penicillin is used to treat syphilis. Clindamycin and metronidazole are used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.
When a client’s newborn dies immediately after birth due to a Trisomy 13, the nurse’s primary responsibility is to:
A. avoid letting the client see the infant
B. say “you can have another baby”
C. provide grief counseling and support
D. obtain tissue samples.
C. provide grief counseling and support
A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:
A. Occurrence risk
B. Recurrence risk
C. Predictive testing
D. Predisposition testing
B. Recurrence risk
Which of the following sexually transmitted infections are viral?
A. Trichomoniasis B. HIV C. HSV D. Pediculosis E. Group B strep F. CMV G. HPV
B. HIV
C. HSV
F. CMV
G. HPV
What is the most common bacterial sexually transmitted infection (STI)?
Chlamydia
What does TORCH stand for?
T = toxoplasmosis, O = other, R = rubella, C = cytomegalovirus (CMV), H = Herpes
The karyotype designated as female is______
46XX
The karyotype designated as male is _____
46XY
A saline wet smear (vaginal secretions mixed with normal saline on a glass slide) is the test for:
A. Bacterial vaginosis
B. Candidiasis
C. Yeast infection
D. Trichomoniasis
D. Trichomoniasis
The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. “Yeast infection” is the common name for candidiasis, for which the test is a potassium hydroxide preparation.
The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. This initiative is significant to nurses because:
A. There are few genetic tests available to identify this information
B. Only physicians should obtain this detailed information
C. Clients cannot accurately complete these histories on their own
D. This is the single most cost effective source of genetic information
D. This is the single most cost effective source of genetic information
Although there are more than 1000 genetic tests available, the single most cost-effective piece of genetic information is the family history. Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information. A computerized tool called My Family Health Portrait is available free of charge (www.hhs.gov/familyhistory/download.html). Other tools to aid the lay community in completing their family histories are available to the public.
Genetics
is the study of a single gene or gene sequences and their effects on a living organism.
The branch of biology that studies heredity and variation in organisms.
Genome
Complete Complement of an organisms DNA
All of the Chromosomes
Chromosomes
Carry Genes (physical structure)
A chromosome is one molecule of DNA
Gene
Unit of Heredity
Made of Segments of DNA
Allele
one version of a gene
Loci
location of specific gene on chromosome
Sex chromosomes
X and Y chromosomes only
Autosomes
all chromosomes except sex
Mutation
Definition - when a DNA gene is damaged or changed in such a way as to alter the genetic message carried by that gene.
Mutagen
An agent of substance that can bring about a permanent alteration to the physical composition of a DNA gene such that the genetic message is changed.
Genotype
all the genes of an organism
Phenotype
the expression of genes, an organism’s traits
Karyotype
photographic representation of chromosomes
Homozygous
pair of identical alleles for a characteristic/gene
Heterozygous
two different alleles for a characteristic/gene
Dominant
one copy of gene expressed
Recessive
requires two copies of gene to express
Clinically applicable genetic tests may be used for:
Diagnostic testing - confirm or r/o disorder
Predictive testing – assymptomatic individuals
Carrier testing - identify those with recessive disorder
Prenatal testing - performed during pregnancy
Preimplantation testing - done on early embryos in IVF
Newborn screening – identify disorder for treatment
What is a Genetics Consultation?
Evaluation of an individual or family for:
Confirm, diagnose or rule out genetic condition
Identify medical management issues
Calculate and communicate genetic risks
Provide or arrange for psychosocial support
Reasons for prenatal genetics consult
> 35 years at delivery
Abnormal triple/quad screen results or fetal ultrasound
Personal or family history of known or suspected genetic disorder, birth defect, or chromosomal abnormality
Exposure to a known or suspected teratogen
Medical condition known or suspected to affect fetal development
Two or more pregnancy losses
Close biological relationship of parents
Ethnic predisposition to certain genetic disorders
Reasons for a Newborn/Pediatric Genetics Consultation
Abnormal newborn screening results
One or more major malformations in any organ system
Abnormalities in growth
Mental retardation or developmental delay
Blindness or deafness
Presence of a known or suspected genetic disorder or chromosomal abnormality
Family history of a known or suspected genetic disorder, birth defect, or chromosomal abnormality
Reasons for an Adolescent/Adult Genetics Consultation
Mental retardation
Personal or family history of hereditary cancers
Personal or family history of a known or suspected genetic condition or chromosomal abnormality
Blindness or deafness
Development of a degenerative disease
Risk assessment for pregnancy planning
Prenatal Genetic Tests
Blood and non invasive tests
Maternal serum Quad screen (AFP plus other markers)
DNA in maternal blood – mainly for Trisomy 21 (Down Syndrome), but also report results from Trisomy 13 (Patau syndrome), 18 (Edwards syndrome), - very new testing, MaterniT21
Ultrasound – nuchal fold plus NT screen
Trisomy 21
Down Syndrome
