Practice EAQ Womens Health Disorders

Question 1

Which drug would be excluded from the prescription of a lactating mother being treated for heart problems?

• Tenormin
• Labetalol
• Metoprolol
• Propranolol

Answer 1

• Tenormin

Rational

Tenormin is contraindicated for lactang mothers because this drug highly concentrates in breast milk. Labetalol, metoprolol, and propranolol are safe to prescribe to lactating mothers.

Question 2

Which drug impairs fertility when administered along with fertility drugs?

• Clomiphene
• Menotropins
• Promethazine
• Choriogonadotropin alfa

Answer 2

• Promethazine

Rational

When taken with fertility drugs, promethazine increases prolactin concentration, which may impair fertility. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Choriogonadotropin alfa is a recombinant form of human gonadotropin hormone; this drug is an ovulation stimulant.

Question 3

An adolescent who gave birth 1 day ago confides to the nurse that she hopes that her baby will be good and sleep through the night. Which would the nurse include in the plan of care to facilitate a realistic expectation of a nighttime newborn schedule?

• Talk softly and cuddle the baby when crying occurs.
• Keep the baby awake for longer periods during the day.
• Ensure sleep by adding cereal to the baby’s bedtime bottle.
• Put a soft, brightly colored toy next to the crib at bedtime.

Answer 3

• Talk softly and cuddle the baby when crying occurs.

Rational

The mother needs to learn the realities of infant behaviors and how to cope with them; holding and talking to her infant are consoling measures. It is unhealthy to disrupt a neonate’s sleep pattern. The infant is too young to be given cereal.
According to the American Academy of Pediatrics, a soft toy is not appropriate in a crib unless it adheres to the crib because of the risk to the newborn.

Question 4

Which test would the nurse expect the health care provider to order to assess the status of the fetus? Select all that apply. One, some, or all responses may be correct.

• Amniocentesis
• Ultrasonography
• Biophysical profile
• Fetal movement counts
• Contraction stress testing

Answer 4

All of the above

Rational

Amniocentesis, ultrasonography, biophysical profile, fetal movement counts, and contraction stress testing are all methods of assessing the status of a fetus and inspect fetal lung maturity, as well as detect fetal disorders.

Question 5

Which intervention would the nurse implement in a client with preeclampsia? Select all that apply. One, some, or all responses may be correct.

• Pad the bed rails
• Instruct client to lay flat
• Encourage intake of fluids
• Monitor deep tendon reflexes
• Immediately report hyperreflexia
• Assess urine for protein every hour

Answer 5

All of the above

Rational

The nurse would implement seizure precautions by padding the bed rails when caring for a client with preeclampsia. The nurse would maintain the client on bed rest in a lateral position to reduce the amount of pressure on the vena cava and promote blood flow to the placenta. Adequate fluid intake is vital, and intake and output should be monitored closely. The nurse would assess deep tendon reflexes and report any hyperreflexia immediately because this indicates that the client is at high risk for seizure activity. Proteinuria is characteristic of preeclampsia, and the urine should b assessed for protein every hour.
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Question 6

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

• Birth as a family experience
• Labor without the use of analgesics
• Education, exercise, and breathing techniques
• Hydration, relaxation, and pain control during labor

Answer 6

• Education, exercise, and breathing techniques

Rational

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

Question 7

Which instruction would the nurse include in the discharge plan of an older adult client with a low body mass index (BMI) found to have osteoporosis?

• Encouraging gradual weight gain
• Monitoring for decreased urine calcium
• Providing instructions relative to diet and exercise
• Teaching about safety factors in the use of opioids and nonsteroidal anti-inflammatory drugs

Answer 7

• Providing instructions relative to diet and exercise

Rational

Exercise and a diet high in calcium are the most important factors in limiting the extent of osteoporosis and help to deposit calcium into bone. Weight gain should be discouraged to limit stress on the client’s bones. Increased urine calcium should be monitored because it reflects demineralization of bone. Opioids are usually not prescribed because other analgesics are used for pain. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or sin in nature to those in one or two of the options.

Question 8

Which type of surgery would a nurse need to obtain informed consent for when preparing a client with a ruptured tubal pregnancy for immediate surgery?

• Myomectomy
• Hysterectomy
• Salpingectomy
• Oophorectomy

Answer 8

• Salpingectomy

Rational

The ruptured fallopian tube may be removed rather than repaired; repair of the tube may result in scarring, predisposing the client to another tubal pregnancy.
Myomectomy is a procedure for removing leiomyomas (fibroids) from the uterus. The uterus is uninvolved in a tubal pregnancy and does not need to be removed. The ovaries should not be removed, especially if another pregnancy is desired.

Question 9

The nurse is teaching a class about childbearing and contraceptive options. Which statement describes when the fertilization of the ovum by the sperm occurs?

• As the ovum leaves the ovary
• When one sperm penetrates the wall of the ovum
• When the ovum reaches the endometrium of the uterus
• As one sperm prevents the ovum from moving along the tube

Answer 9

• When one sperm penetrates the wall of the ovum

Rational

Fertilization occurs when one sperm penetrates one ovum, producing a viable zygote.
Fertilization occurs in a fallopian tube, not when the ovum is expelled from the ovary or in the uterus. After the sperm penetrates the ovum in a fallopian tube, the impregnated ovum travels down the tube to the uterus.

Question 10

A client at 16 weeks’ gestation is scheduled for a sonogram, followed by amniocentesis. The nurse instructs the client to drink 8 oz of fluid and not void before the sonogram. Which statement describes the reason for this instruction?

• To improve visualization of the fetus
• To hydrate the mother and increase circulation
• To hydrate the fetus and decrease fetal movement
• To replace fluid lost during the procedure

Answer 10

• To improve visualization of the fetus

Rational

A full bladder puts the uterus in the optimal position for imaging because it raises the uterus out of the pelvis. Increased circulation is not required before a sonogram and amniocentesis. The purpose of increasing maternal fluid intake before the sonogram is not to hydrate the fetus or decrease fetal movement. After amniocentesis, hydration is encouraged to decrease uterine activity caused by the amniocentesis and support fluid volume.

Question 11

The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching?

• “I know not to lift anything heavier than 5 to 10lb.”
• “I’ll limit my stair climbing to four times a day.”
• “I’ll avoid crossing my legs at the knees when I sit.”
• “‘m glad I’ll be able to get back into my jogging routine next week.”

Answer 11

• “‘m glad I’ll be able to get back into my jogging routine next week.”

Rational

Discharge instructions after abdominal hysterectomy include avoiding jogging, aerobic exercise, participating in sports, and other any strenuous activity for 2 to 6 weeks after the surgery. The statement indicating that the client plans to start jogging again by next week means that the client requires more teaching. Nothing heavier than 5 to 10 lb should be lifted. Stair climbing should be limited to fewer than five times per day. The client should not cross her legs at the knees when sitting. Those three statements by the client are accurate and indicate understanding of the teaching.

Question 12

Which statement by a breastfeeding mother indicates that the nurse’s teaching about stimulating the let-down reflex has been successful?

• “I will take a cool shower before each feeding.”
• “I will drink a couple of quarts of fat-free milk a day.”
• “I will wear a snug-fitting breast binder day and night.”
• “I will apply warm packs and massage my breasts before each feeding.”

Answer 12

• “I will apply warm packs and massage my breasts before each feeding.”

Rational

Applying warm packs and massaging the breasts before each feeding help dilate milk ducts, promote emptying of the breasts, and stimulate further lactation. Taking a cool shower before each feeding will contract the milk ducts and interfere with the letdown reflex. Heavy consumption of milk products is not required to stimulate the production of milk. Breast binders may inhibit lactation by fooling the body into thinking that milk secretion is no longer needed.

Question 13

A 28-year-old woman comes into the clinic and tells the nurse that she fears that she is infertile because she has been trying to become pregnant for 2 years. While collecting the health history, the nurse learns that the client experiences irregular and infrequent menstrual periods. The client is overweight and has severe acne and alopecia. The health care provider diagnoses polycystic ovarian syndrome (PCOS).
Which intervention would the nurse provide?

• Consoling the client over her inability to have children
• Discussing weight loss, exercise, and a balanced low-fat diet
• Providing information to the client on how to prepare for surgery
• Informing the client that there are no long-term complications of PCOS

Answer 13

• Discussing weight loss, exercise, and a balanced low-fat diet

Rational

Weight loss, exercise, and a balanced low-fat diet can reduce insulin and androgen levels related to PCOS. Meeting with a dietitian may be helpful. The health care provider would most likely prescribe hormones, other medications, or both. If pregnancy does not occur, surgery is an option. However, surgery is not necessary at this time. Early detection of PCOS is important because the condition can lead to type 2 diabetes; hypertension; cardiovascular disease; and ovarian, breast, and endometr cancel courage treatment compliance, and encourage positive lifestyle changes

Question 14

A nurse is counseling a pregnant client with iron-deficiency anemia about when and how to take supplemental iron. Which time of day and with which drink is iron absorption most efficient?

• Dinnertime with water
• Bedtime with a milkshake
• After lunch with cranberry drink
• Before breakfast with orange juice

Answer 14

• Before breakfast with orange juice

Rational

Iron should be taken before breakfast, on an empty stomach, to permit maximal absorption; ascorbic acid enhances the absorption of iron. Iron should not be taken with or after meals. Iron should not be taken with milk, which may interfere with its absorption.

Question 15

Question 46
A client who underwent mastectomy because of breast cancer is now undergoing chemotherapy, which has caused hair loss. The client states, “I feel like I’ve lost my sense of power.” Which response would the nurse give?

• “Hair does not empower a person.”
• “Losing power seems important to you.”
• “Knowledge is power; I’ll give you some pamphlets to read.”
• “Hair loss is common; it will grow back, so you shouldn’t worry.”

Answer 15

• “Losing power seems important to you.”

Rational

Stating that the loss of power seems important to the client provides an opportunity for the client to discuss her feelings. Stating that hair doesn’t empower a person is confrontational and may cut off further communication. Offering to get the client some pamphlets dismisses the client’s concern and does not promote the client’s further verbalization of feelings. Stating that hair loss is common and the client shouldn’t worry dismisses the client’s concerns and cuts off further communication.

Question 16

A client is to receive oral terbutaline 5 mg every 6 hours at home for preterm labor. Which timeframe would the nurse advise the client to take the medication?

• With food
• At bedtime
• Before breakfast
• One hour after lunch

Answer 16

• With food

Rational

One side effect of terbutaline is nausea and vomiting; to minimize this problem it should be ingested with food. Terbutaline should not be taken when the stomach is empty because it may cause gastrointestinal distress. One hour after a meal the digestive process has already begun and the stomach is emptying; terbutaline at this time may cause gastrointestinal distress.

Question 17

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

• February 1st
• January 7th
• January 21st
• February 7th

Answer 17

• January 21st

Rational
To use Naegele’s rule to calculate the EDB, subtract 3 months and add 7 days to the date of the last menstrual period (LMP). In this case, with the woman’s LMP on April 14, the EDB is January 21st. January 7th is too early. February Ist is too late, as is
February 7th.

Question 18

Which symptom of mild anxiety would a nurse expect in a client who suspects that she is 6 weeks pregnant as she is waiting for her first obstetric appointment?

• Dizziness
• Breathlessness
• Abdominal cramps
• Increased alertness

Answer 18

• Increased alertness

Rational

Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.

Question 19

Which day of the month would a nurse tell a client who menstruates regularly every 30 days and last menses started on the first that ovulation would be expected to occur?

• 7
• 16
• 24
• 29

Answer 19

• 16

Rational

Ovulation should occur on the 16th. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. The 7th, 24th, and 29th all reflect inaccurate calculation of the date of ovulation.

Question 20

Which complication related to a prolonged pregnancy would a nurse suspect is the reason that a nonstress test is ordered for a client at 42 weeks’ gestation?

• Polyhydramnios
• Placental insufficiency
• Postpartum infection
• Subclinical gestational diabetes

Answer 20

• Placental insufficiency

Rational

Placental function peaks at 37 weeks and declines slowly thereafter. The continuation of the pregnancy past term (42 weeks) places the fetus at risk because of placental insufficiency. Oligohydramnios (decreased amniotic fluid volume) may occur in postterm gestations. A prolonged pregnancy does not present a risk for a postpartum infection. A prolonged pregnancy is unrelated to gestational diabetes.

Question 21

Which teaching would the licensed practical nurse (LPN) reinforce to a client during the early postoperative period after a modified radical mastectomy regarding limiting edema in the affected arm?

• “Turn to the unaffected side every 2 hours.”
• “Avoid moving the affected arm for 24 hours.”
• “Use pillows to elevate the affected arm above the level of the heart.”
• “Maintain the positive pressure drainage bag below the level of the arm.”

Answer 21

• “Use pillows to elevate the affected arm above the level of the heart.”

Rational

Elevating the arm allows gravity to facilitate venous return and lymph drainage from the arm. Basic postoperative recovery involves frequent turning, but this has no effect on drainage from the affected arm. Movement of the affected arm is encouraged.
Wound drainage involves negative, not positive, pressure.

Question 22

Which information about the client’s activities indicates to the nurse that there is a need for a serology test for toxoplasmosis?

• The client cares for a neighbor’s cat.
• The client works as a dog trainer.
• The client uses chemical cleaners.
• The client consumes raw vegetables.

Answer 22

• The client cares for a neighbor’s cat.

Rational

Toxoplasmosis is caused by a protozoal parasite. Cats acquire the organism by ingesting infected mice or birds, and the cysts are found in their feces. Caring for or working with cats poses a potential problem with toxoplasmosis. Contact with dogs does not lead to toxoplasmosis. Chemical cleaners may be teratogenic but they do not cause toxoplasmosis. Eating raw vegetables of any kind will not cause toxoplasmosis.

Question 23

At which point in the monthly cycle would the nurse instruct a client taking a progesterone oral contraceptive (minipill) to take one pill daily?

• Five days of the ovulatory cycle
• Latter part of the ovulatory cycle
• First week of the menstrual cycle
• Entire menstrual cycle

Answer 23

• Entire menstrual cycle

Rational

Maintenance of serum progesterone levels keeps cervical mucus thick and hostile to sperm at all times. Telling the client to take the pills for 5 days of the ovulatory cycle is inaccurate information because the pill must be taken throughout the menstrual cycle. Whereas progesterone oral contraceptives (minipills) must be taken throughout the cycle, combined estrogen and progesterone oral contraceptives are taken during the second, third, and fourth weeks of the cycle. Fertility drugs are often taken during the first part of the cycle to encourage ovulation. These are not used for contraception.

Question 24

Which chemical may be responsible for Braxton Hicks contractions occurring during the final weeks of pregnancy?

• Estrogen
• Oxytocin
• Progesterone
• Prostaglandins

Answer 24

• Prostaglandins

Rational

During the final weeks of pregnancy there is an increase in prostaglandin concentration causing mild myometrial contractions known as Braxton Hicks contractions. Oxytocin is administered when there are weak contractions to assist in labor. Estrogen and progesterone are not involved in causing contractions.

Question 25

Which instruction for avoiding a deep vein thrombosis would a nurse include during the discharge conference of a client after a hysterectomy:

• Avoid sitting for long periods.
• Limit fluids to less than 2000 mL per day.
• Have a blood coagulation test every 2 weeks.
• Continue with hormone replacement therapy.

Answer 25

• Avoid sitting for long periods.

Rational

Sitting for long periods leads to pooling of blood in the pelvic area. This predisposes the client to thrombus formation. Fluids should be increased to 3000 mL daily to decrease blood viscosity. Blood coagulation tests are not done routinely because clotting elements are not usually disturbed by a hysterectomy. Hormone replacement therapy is not considered unless the client is premenopausal and an oophorectomy has been per red.

Question 26

At a client’s first visit to the prenatal clinic, the nurse asks the client when she had her last menstrual period so the estimated date of birth (EDB) can be determined. The client responds, “January 21st.” According to Naegele’s rule, which month and day is the client’s EDB?

• October 21st
• October 28th
• November 21st
• November 28th

Answer 26

• October 28th

Rational

Naegele’s rule for determining the EDB is to subtract 3 months from the first day of the last menstrual period and add 7 days, meaning that October 28th is the correct EDB. October 21st is too early. November 21st is too late, as is November 28th.

Question 27

Which action would a nurse recommend to do 1 week before an expected menses for a 24-year-old client who complains that her breasts become tender before her menstrual period?

• Take salt tablets daily.
• Increase protein intake.
• Eliminate daily exercise.
• Decrease caffeine intake.

Answer 27

• Decrease caffeine intake.

Rational

The client is exhibiting one symptom of premenstrual syndrome (PMS). Eliminating food and beverages containing caffeine can limit breast swelling. Salt intake should be reduced premenstrually to limit the development of edema. Increased protein intake is unnecessary if the client is eating a nutritious diet. Exercise should be increased before the menstrual period to help ease the symptoms of PMS.

Question 28

A client is instructed to eat a nutrient-rich diet as a means of supporting the body’s natural defense mechanisms. Which nutrients would the nurse encourage the client to include in her diet?

• Fat-soluble vitamins
• Dietary fiber and oat bran
• Low-fat foods with essential fatty acids
• Vitamins A, C, and E and selenium

Answer 28

• Vitamins A, C, and E and selenium

Rational

Vitamins A, C, and E and selenium are immune-stimulating nutrients. Too much emphasis on fat-soluble vitamins may result in an inadequate intake of important water-soluble vitamins and minerals. Dietary fiber, oat bran, and low-fat foods with essential fatty acids have no known effect on natural defenses.

Question 29

A client who has had a cesarean birth seems upset. She has been having difficulty breastfeeding for 2 days and now asks the nurse to bring her a bottle of formula. Which action would the nurse take?

• Obtaining the requested formula
• Administering the prescribed pain medication
• Observing the client’s breastfeeding technique
• Notifying the health care provider of the client’s request to switch feeding methods

Answer 29

• Observing the client’s breastfeeding technique

Rational

The nurse should assess the client to determine why she is having difficulty with breastfeeding. She may be uncomfortable or in need of assistance with her breastfeeding technique. Immediately providing the formula without assessing the situation does not meet the client’s needs at this time. Pain may be a factor in the client’s frustration with breastfeeding, but this should be determined through the assessment process. Notifying the health care provider of the client’s request to switch feeding methods is premature. It is the nurse’s responsibility to assess the situation and arrive at a solution in collaboration with the client.

Question 30

A client elects to have her pregnancy terminated after finding oút at 16 weeks’ gestation that she is carrying a fetus with Down syndrome.
Which conclusion would the nurse make about an abortion at this stage of the pregnancy?

• The client is exhibiting emotional instability.
• There is a high risk for a postabortion infection.
• Contraceptive counseling should be deferred to a later time.
• An opportunity for the client to express feelings about her decision should be provided.

Answer 30

• An opportunity for the client to express feelings about her decision should be provided.

Rational

The client must feel comfortable enough to verbalize her feelings; this will help her complete the grieving process. Concluding that the client is emotionally unstable is a false assumption. Induced abortion is a sterile procedure and should not predispose the client to postoperative infection. Studies show that contraceptive counseling at this time is most important, because the client may not return after the abortion.

Question 31

A client who is pregnant for the first time tells the nurse, “I’m worried about gaining too much weight because I’ve heard that it’s unhealthy.” Which response would the nurse provide?

• “Yes, too much weight gain results in complications during pregnancy.”
• “You’ll have to follow a low-calorie diet if you gain more than 15 lb.”
• “We’re more concerned that you won’t gain enough weight to ensure adequate growth of your baby.”
• “A 25-Ib (11.3-kg) weight gain is recommended; however, the pattern of weight gain is more important than the total amount.”

Answer 31

• “A 25-Ib (11.3-kg) weight gain is recommended; however, the pattern of weight gain is more important than the total amount.”

Rational

A sudden sharp increase in weight may indicate fluid retention related to preeclampsia. Weight gain is necessary to ensure adequate nutrition for the fetus. The term “too much” is vague; complications are rare when weight gain is more than 25 to 30 lb (11.3 kg to 13.6 kg) in an uncomplicated pregnancy. There is no specific number of pounds that the client should gain, but a low-calorie diet is contraindicated. Telling the client that the staff is more concerned that she won’t gain enough weight to ensure adequate growth of her baby closes off communication and does not allow t client to ask more questions about weight gain.

Question 32

Which effect may occur when clomiphene is coadministered with methyldopa to promote ovulation?

• Impaired fertility
• Induction of ovulation
• Reduced blood pressure
• Increased blood pressure

Answer 32

• Impaired fertility

Rational

Clomiphene interacts with methyldopa and may cause infertility. Clomiphene when taken alone induces ovulation. Methyldopa is an antihypertensive drug used to treat hypertension in pregnant women if taken alone. Neither clomiphene nor methyldopa increase blood pressure.

Question 33

Before administering a tuberculin test as part of a client’s prenatal workup, which information about the client would the nurse obtain?

• Has she had a previous tuberculin test
• Is she prone to respiratory diseases
• Has an earlier tuberculin test been positive
• Is there a family history of tuberculosis

Answer 33

• Has an earlier tuberculin test been positive

Rational

A tuberculin test should not be administered to a client with a previous positive result on a tuberculin test, because a severe reaction may occur at the test site in a previously sensitized individual. It is more important to know whether the test result was positive than whether a test was performed. Being prone to respiratory diseases is not a contraindication to having a tuberculin test unless the client is infected with tuberculosis. Although a family history may have involved exposure of the client to tuberculosis, the client may not have had a positive tuberculin test result; also many years may have elapsed since the exposure.
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Question 34

Which action involving client needs would a nurse delegate to an unlicensed health care worker?

• Assessing a newly admitted clients contraction pattern
• Discussing pain management options with a laboring client
• Providing ice chips to a client in early labor per the primary health care providers prescription
• Obtaining a sterile urine specimen for a suspected urinary tract infection

Answer 34

• Providing ice chips to a client in early labor per the primary health care providers prescription

Rational

Providing ice chips to a client in early labor per the primary health care provider’s prescription does not require clinical knowledge or judgment for safe, effective care.
Assessment, discussion of alternative actions, and the use of sterile technique during an invasive procedure all require clinical knowledge and judgment beyond the scope of practice of an unlicensed health care provider.

Question 35

A client presents to the clinic for an appointment for a mammogram.
Which guidance would the nurse provide the client in preparation for the test?

• Do not eat for 6 hours before the test.
• The room will be darkened throughout the procedure.
• The first mammogram is usually performed at 50 years of age.
• During the procedure, each breast will be compressed firmly between two plates

Answer 35

• During the procedure, each breast will be compressed firmly between two plates

Rational

Compression of the breast flattens mammary tissue and maximizes penetration of the breast by x-rays; this is especially important for the dense breast tissue of adolescents, young nulliparous women, and women with large breasts. Fasting before the test is not necessary. The room is usually darkened for sonography, not mammography. The American Cancer Society recommends that women at risk for breast cancer (the client’s sister had breast cancer) should have routine mammography, regardless of age or relationship to menopause. It is recommended that a woman have her first mammogram by age 40 to establish a baseline for futur annual mammograms.

Question 36

A nurse is obtaining a health history from a client with newly diagnosed cervical cancer. Which aspect of the client’s life is most important for the nurse to explore at this time?

• Sexual history
• Support system
• Obstetric history
• Elimination patterns

Answer 36

• Support system

Rational

During a health crisis, the client will need support from significant others. The sexual history is important in diagnosis, and the obstetric history and elimination patterns are important parts of the medical history; however, none are the priority at this time.

Question 37

A client is being treated for hypertension and obesity with a regimen of diet and exercise. During the past month, she has lost 8 lb (3.6 kg), and her blood pressure has decreased to 154/98 mm Hg. The client states that she is using self-control strategies to reduce her blood pressure and weight. Which is the nurse’s most therapeutic response?

• Explaining to the client that her current program needs revision to improve results

• Acknowledging the client’s achievement while encouraging continuation of her current program

• Emphasizing to the client the importance of exercise in addition to reduction of sodium and caloric intake

• Recommending that the client ask her health care provider about a prescription for an antihypertensive or a diuretic

Answer 37

• Acknowledging the client’s achievement while encouraging continuation of her current program

Rational

Acknowledging the client’s achievement while encouraging continuation of her current program recognizes achievement and reinforces the client’s behavior.
Explaining to the client that her current program needs revision to improve results focuses on the negative rather than the positive; small gains should be reinforced.
Emphasizing to the client the importance of exercising in addition to reducing sodium and caloric intake implies that the client is not doing enough; the focus should be on the positive, and the gains should be reinforced. The client has been successful in reducing her blood pressure and weight with nonpharmacologic strategies.

Question 38

A couple has been using oral contraceptives to delay pregnancy. When the wife misses her regular menstrual period, she decides to find out whether she is pregnant. She tells the nurse that pregnancy may have occurred because she missed her contraceptive pills for 1 week when she had the flu. Which response would the nurse provide?

• “That’s the trouble with using contraceptive pills. People frequently forget to take them.”

• “You may be correct. The effect of contraceptive pills depends on their being taken on a regular schedule.”

• “Let’s find out whether you really are pregnant. If you are, you may want to consider having an abortion.”

• “Contraceptive pills are unpredictable. You could have become pregnant even if you had taken them regularly.”

Answer 38

• “You may be correct. The effect of contraceptive pills depends on their being taken on a regular schedule.”

Rational

An oral contraceptive program requires the client to take one tablet daily from the fifth day of the cycle and continue taking tablets for 20 or 21 days. Interrupting the monthly dosage program may permit release of luteinizing hormone, resulting in ovulation and possibly pregnancy. Stating that people often forget to take oral contraceptive pills is judgmental; contraceptive practice is the client’s choice. It is premature to discuss abortion. Oral contraceptives that are taken on an exact schedule have a very high rate of success.

Question 39

The nurse obtains the health history from a client who is seeking contraceptive information. Which factor in the client’s history indicates that oral contraceptives are contraindicated?

• Older than 30 years
• Current hypothyroidism
• Two multiple pregnancies
• Blood pressure 162/110 mm Hg

Answer 39

• Blood pressure 162/110 mm Hg

Rational

Oral contraceptives may cause or exacerbate hypertension; even borderline hypertension places the client at risk for a cerebrovascular accident (CVA, or brain attack). Oral contraceptives are not contraindicated for women older than 30 years of age if there are no known risk factors. There is no relationship between oral contraceptives and multiple births. Contraceptives are not contraindicated in clients who have hypothyroidism.

Question 40

Which complication associated with douching will the nurse discuss with the client? Select all that apply. One, some, or all responses may be correct.

• Cervicitis
• Candidiasis
• Bacterial vaginosis
• Ectopic pregnancy
• Pelvic inflammatory disease

Answer 40

All of the above

Rational

Complications associated with douching include cervicitis, candidiasis, bacterial vaginosis, ectopic pregnancy, and pelvic inflammatory disease.

Question 41

Which method will the nurse include when discussing barrier methods of contraception with a client? Select all that apply. One, some, or all responses may be correct.

• Copper IUD
• Diaphragm
• Vasectomy
• Vaginal ring
• Medroxyprogesterone

Answer 41

• Diaphragm

Rational

The diaphragm is a method of barrier contraception. A copper IUD is an intrauterine contraceptive, vasectomy is the term for male sterilization, a vaginal ring is a hormonal contraceptive, and medroxyprogesterone is similar to the minipill and a hormone implant.

Question 42

A woman has been admitted for a vaginal hysterectomy and anterior and posterior repair of the vaginal wall. Which intervention would the nurse tell the client to expect in the immediate postoperative period?

• Placement of a pessary
• Insertion of a rectal tube
• Use of a douche periodically
• Presence of a urinary catheter

Answer 42

• Presence of a urinary catheter

Rationale

After surgery the urethral orifice may be distorted and edematous; a urine retention catheter keeps the bladder empty, limiting pressure on the operative site. A pessary placed in the vagina is used for a displaced uterus; after an anteroposterior repair (colporrhaphy), vaginal packing is used to support the surgical repair. A rectal tube is used for abdominal distention caused by flatulence; it is rarely necessary. A cleansing douche may be prescribed before, not after, surgery.

Question 43

Which response would a nurse give to a breastfeeding mother who asks how human milk compares with cow’s milk?

• Lactose content is higher in cow’s milk than in human milk.
• Protein content in human milk is higher than that in cow’s milk.
• Fat in human milk is easier to digest and absorb than the fat in cow’s milk.
• Immunologic and antiallergenic factors found in human milk are now added

Answer 43

• Fat in human milk is easier to digest and absorb than the fat in cow’s milk.

Rationale

Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Human milk is not heat-treated as is cow’s milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow’s milk, but this protein is easier for human beings to digest.
Human immunologic and antiallergenic factors are found only in human milk.

Question 44

Which statement by a pregnant woman indicates the need for additional teaching?

• “During pregnancy, it’s safe for me to use my regular herbal remedies.”
• “My doctor will tell me if it’s safe for me to take my allergy medications.”
• “I should avoid all x-rays unless absolutely necessary and tell the technician that I’m pregnant.”
• “I’m only 18 weeks pregnant, so it’s safe for me to go through the airport security check when I go on vacation next month.”

Answer 44

• “During pregnancy, it’s safe for me to use my regular herbal remedies.”

Rationale

Herbal remedies can be harmful to the fetus. All medications should be cleared through the health care provider. Radiation can be harmful to the fetus. The amount of radiation encountered in airport security over the course of a single trip would not pose a risk to the fetus.

Question 45

A client is concerned about regaining her figure after the baby is born and wishes to diet during pregnancy. Which advise would the nurse provide?

• Inadequate food intake can result in a low-birth-weight infant.
• Dieting is recommended to decrease the risk for stillbirth.
• Dieting is recommended to make the birthing process easier.
• Inadequate food intake may result in gestational diabetes mellitus.

Answer 45

• Inadequate food intake can result in a low-birth-weight infant.

Rationale

The recommended weight gain is at least 25 lb (11.3 kg) for this client; inadequate intake of nutrients during pregnancy results in an underweight newborn. The cause of stillbirth is usually not known; however, dieting during pregnancy is not recommended, because it can result in congenital anomalies, as well as low birth weight. Inadequate food intake is not a risk factor for gestational diabetes mellitus.

Question 46

A postpartum client tells the nurse that she wishes to breastfeed. When the nurse brings her newborn to be breastfed, the client asks whether she may drink a small glass of wine to help her relax. Which response would be given by the nurse?

• “I think drinking one glass of wine won’t be a problem. Go ahead.”
• “You seem a little tense. Tell me how you feel about breastfeeding.”
• “You seem to find it relaxing, but you should try to find another way to relax.”
• “I think drinking one glass of wine is all right, but you had better check with your doctor first.”

Answer 46

• “You seem a little tense. Tell me how you feel about breastfeeding.”

Rationale

Stating that the client seems tense and initiating a discussion honor the client’s feelings and encourage expression of them. There is no reference to alcohol consumption and its relaxing effects. Alcohol ingestion should not be encouraged because it enters the breast milk. Stating that the client needs to find another way to relax reflects the client’s statement but not her underlying feelings. Suggesting that she find another way to relax may make the client defensive and shut off communication. Although alcohol ingestion should not be encouraged because it enters breast milk, the health care provider need not be involved. Health educatior within the role of the nurse.

Question 47

Which condition would the nurse anticipate will result in the client being instructed by the health care provider not to breastfeed?

• Mastitis
• Inverted nipples
• Genital herpes
• Human immunodeficiency virus (HIV)

Answer 47

• Human immunodeficiency virus (HIV)

Rationale

Breastfeeding by a mother infected with HIV is contraindicated because breast milk can transmit the virus to the infant. Breastfeeding by a mother with mastitis is not always contraindicated. During antibiotic treatment, the mother can maintain lactation by pumping the breasts and discarding the milk. Breastfeeding may be resumed once the infection has resolved. Breastfeeding is not contraindicated with inverted nipples because a breast shield can provide mild suction to help evert the nipples. Breastfeeding is not contraindicated in a client with genital herpes. The newborn may contract the infection during a vaginal birth but not in breast milk.

Question 48

A client is diagnosed as having cancer of the left breast. A simple mastectomy is performed. Which would the plan of care include immediately after surgery?

• Changing the client’s pressure dressing as necessary
• Inviting a member of Reach to Recovery to visit the client
• Placing the client in the semi-Fowler position with the left arm elevated
• Waiting for a cessation of drainage before the client resumes any activity

Answer 48

• Placing the client in the semi-Fowler position with the left arm elevated

Rationale

The semi-Fowler position and elevation of the arm on the affected side minimize edema related to the inflammatory process. Pressure dressings are rarely used because portable wound drainage systems are used to remove accumulated fluid from the surgical site. A member of Reach to Recovery will not visit on the day of surgery; the visit will probably be made in the client’s home. Activities of daily living that necessitate only slight flexion of the elbow and do not involve abduction of the arm on the affected side are permitted.

Question 49

Which vitamin and other dietary supplement would the nurse recommend to prevent osteoporosis?

• Vitamin E and ginseng tea
• Vitamin B and ginkgo biloba
• Vitamin D and calcium citrate
• Vitamin C and glucosamine/chondroitin

Answer 49

• Vitamin D and calcium citrate

Rationale

All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C and glucosamine/chondroitin maintain cartilage and connective tissue integrity but do not help prevent osteoporosis. Vitamins E and B, ginseng, and ginkgo biloba do not help prevent osteoporosis.

Question 50

Which statement by a client who is being treated for a sexually transmitted infection (STI) confirms that she understands instructions regarding future sexual contacts?

• “If I have sex, nothing I do will really prevent me from getting another STI.”
• “If I get another STI, I can take any antibiotic, because I’m not allergic to any of them.”
• “I won’t have unprotected sex again, and I’ll tell my partners to be tested for STIs.”
• “I have to ask my partners if they have an STI, and if they don’t, I know that we can have sex.”

Answer 50

• “I won’t have unprotected sex again, and I’ll tell my partners to be tested for STIs.”

Rationale

The most effective strategies for preventing STis in one’s self and sex partners are the use of condoms and having sex partners tested to determine their status and get treatment if necessary. There are protective measures that can be used to help prevent the transmission of STls. The emphasis should be on prevention, not treatment; some STis have no cure. Asking partners whether they have an STI does not always elicit a truthful answer; protection is necessary to help prevent the transmission of do STIs.