UPREP Flashcards
- When describing the menstrual cycle to a group of young women, the nurse explains that estrogen levels are highest during which phase of the endometrial cycle?
A. menstrual B. proliferative C. secretory
D. ischemic
Answer: B
Rationale: Estrogen levels are the highest during the proliferative phase of the endometrial cycle,
when the endometrial glands enlarge in response to increasing amounts of estrogen. Progesterone
is the predominant hormone of the secretory phase. Levels of estrogen and progesterone drop
sharply during the ischemic phase and fall during the menstrual phase.
3. A client with a 28-day cycle reports that she ovulated on May a1b0irb. .Wcomh/etenst would the nurse expect the client's next menses to begin? A. May 24 B. May 26 C. May 30 D. June 1
Answer: A
Rationale: For a woman with a 28-day cycle, ovulation typically occurs on day 14. Therefore, her next menses would begin 14 days later, on May 24.
- The nurse is reviewing the process of oocyte maturation and ovulation with a client. What occurs during the follicular phase of the ovarian cycle that the nurse should include in the teaching session?
A. Under the influence of follicle-stimulating hormone, several follicles begin to ripen, and the ovum with each begins to mature.
B. The empty ruptured graafian follicle becomes the corpus luteum, and it begins to secrete
progesterone and estrogen.
C. About day 14, a surge of hormones cause the ovum to burst through the ovary. D. The uterus prepares for implantation of an ovum.
D. The uterus prepares for implantation of an ovum.
- During this time, under the influence of follicle-stimulating hormone, several follicles begin to ripen and the ovum within each begins to mature. About day 14, a surge of hormones causes the ovum to burst
through the ovary; this act is called ovulation. During the luteal phase, the empty, ruptured Graafian follicle becomes the corpus , and it begins to secrete progesterone and estrogen.
Answer: A
The endometrium of the uterus has a similar cycle. It is called the uterine cycle or endometrial cycle. This process prepares the uterus for implantation of an ovum (egg).
- A nurse has been invited to be a guest speaker for a female high school health class about the
menstrual cycle and reproduction. When describing the hormones involved in the menstrual
cycle, a nurse identifies which hormone as responsible for initiating the cycle?
A. estrogen
B. luteinizing hormone C. progesterone
D. prolactin
Answer: B
Rationale: With the initiation of the menstrual cycle, luteinizing hormone rises and stimulates the follicle to produce estrogen. As this hormone is produced by the follicle, estrogen levels rise, inhibiting the output of LH. Ovulation occurs after an LH surge damages the estrogen-producing estrogen and progesterone. These two levels rise, suppressing LH. Lack of LH promotes degeneration of the corpus luteum, which then leads to a decline in estrogen and progesterone. The decline of ovarian hormones ends their negative effect on the secretion of LH, which is then secreted and the menstrual cycle begins again. Prolactin is the hormone responsible for breast milk production.
- When discussing contraceptive options, the nurse would recommend which option as being
the most reliable?
A. coitus interruptus
B. lactational amenorrheal method (LAM) C. natural family planning
D. intrauterine system
Answer: D
Rationale: An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planninag are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These behavioral methods must be followed exactly as prescribed.
4. The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription? A. condom B. spermicide C. diaphragm D. basal body temperature
Answer: C
Rationale: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body
temperature requires the use of a special thermometer that is available over the counter.
4. The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription? A. condom B. spermicide C. diaphragm D. basal body temperature
Answer: C
Rationale: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body
temperature requires the use of a special thermometer that is available over the counter.
- A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that
she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what
she will most likely experience during this period. Which possible effect would the nurse
include?
A. ankle edema
B. urinary frequency
C. backache
D. hemorrhoids
Answer: B
Rationale: The client is in her first trimester and would most likely experience urinary frequency
as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be
more common during the later stages of pregnancy.
- A woman is at 20 weeks’ gestation. The nurse would expect to find the fundus at which area?
A. just above the symphysis pubis
B. midway between the pubis and umbilicus
C. at the level of the umbilicus
D. midway between the umbilicus and xiphoid process
Answer: C
Rationale: The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases
over width. By 20 weeks’ gestation, the fundus, or top of the uterus, is at the level of the
umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in
centimeters, which corresponds to the number of gestational weeks, is commonly used to date
the pregnancy
- A woman comes to the prenatal clinic for an evaluation because she thinks that she may be
pregnant. The nurse is assisting the health care provider with the vaginal examination. The exam
reveals a vaginal mucosa and cervix that are bluish-purple in color. Based on this information,
the nurse suspects that the client is most likely how many weeks pregnant?
A. 5 weeks
B. 6 weeks
C. 14 weeks
D. 16 weeks
Answer: B
Rationale: The finding indicates Chadwick’s sign, a bluish-purple discoloration of the vaginal
mucosa and cervix. This typically occurs between 6 to 8 weeks. Goodell’s sign (softening of the
cervix) occurs at about 5 weeks. Abdominal enlargement typically begins at about 14 weeks and
ballottement (when the examiner pushes against the woman’s cervix during a pelvic examination
and feels a rebound from the floating fetus) usually occurs at about 16 weeks.
- A nurse is providing nutritional counseling to a pregnant woman and gives her suggestions
about consuming foods that are high in folic acid. As part of the plan of care, the client is to keep
a food diary that the client and nurse will review at the next visit. When reviewing the client’s
diary, which meals would indicate to the nurse that the client is increasing her intake of folic
acid? Select all that apply.
A. chicken breast with baked potato and broccoli
B. cheeseburger with spinach and baked beans
C. pork chop with mashed potatoes and green beans
D. strawberry walnut salad with romaine lettuce
E. fried chicken sandwich with mayonnaise and avocado
Answer: A, B, D
Rationale: Good food sources of folic acid include dark green vegetables, such as broccoli,
romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. So
the meals containing chicken breast with baked potato and broccoli, cheeseburger with spinach
and baked beans, and the strawberry walnut salad with romaine lettuce demonstrate an intake of
foods high in folic acid.
- A nurse is teaching a pregnant woman about ways to prevent the development of the foodborne illness listeriosis. The nurse determines that the teaching was successful when the woman
identifies the need to avoid which food(s)? Select all that apply.
A. Soft cheeses
B. Refrigerated meat spreads
C. Canned tuna fish
D. Store-made chicken salad
E. Pasteurized milk
Answer: A, B, D
Rationale: To prevent listeriosis, the woman should avoid soft cheeses such as feta, Brie,
Camembert, and blue-veined cheeses, refrigerated pâté or meat spreads, refrigerated smoked
seafood unless it is an ingredient in a cooked dish such as a casserole, salads made in the store
such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad, and unpasteurized milk.
It is safe to eat canned or shelf-stable pâté and meat spreads and canned fish such as salmon and
tuna or shelf-stable smoked seafood.
15. A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A. 9 B. 7 C. 5 D. 3
Answer: A
Rationale: The biophysical profile is a scored test with five components, each worth 2 points if
present. A total score of 10 is possible if the NST is used. Overall, a score of 8 to 10 is
considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious,
possibly indicating a compromised fetus; further investigation of fetal well-being is needed.
- The nurse is assessing the latest laboratory results of a pregnant client who is at 17 weeks
gestation. The nurse should prepare to teach the client about which possible defects after noting
the maternal serum alpha-fetoprotein level is elevated above normal?
A. fetal hypoxia
B. open spinal defects
C. Down syndrome
D. maternal hypertension
Answer: B
Rationale: Elevated MSAFP levels are associated with open neural tube defects, underestimation
of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight,
oligohydramnios, material age, diabetes, and decreased maternal weight. Lower-than-expected
MSAFP levels are seen when fetal gestational age is overestimated or in cases of fetal death,
hydatidiform mole, increased maternal weight, maternal type 1 diabetes, and fetal trisomy 21
(Down syndrome) or 18. Fetal hypoxia would be noted with fetal heart rate tracings and via
nonstress and contract
- A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of
labor. When describing this stage to the client, which event would the nurse identify as the major
change occurring during this stage?
A. regular contractions
B. cervical dilation (dilatation)
C. fetal movement through the birth canal
D. placental separation
Answer: B
Rationale: The primary change occurring during the first stage of labor is progressive cervical
dilation (dilatation). Contractions occur during the first and second stages of labor. Fetal
movement through the birth canal is the major change during the second stage of labor. Placental
separation occurs during the third stage of labor.
- A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse
prepares the client for this monitoring based on the understanding that which criterion must be
present?
A. intact membranes
B. cervical dilation of 2 cm or more
C. floating presenting fetal part
D. a neonatologist to insert the electrode
Answer: B
Rationale: For continuous internal electronic fetal monitoring, four criteria must be met: ruptured
membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow
placement of the electrode, and a skilled practitioner available to insert the electrode.
- When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The
nurse interprets this finding as indicating which type of contraction?
A. intense
B. strong
C. moderate
D. mild
Answer: C
Rationale: A contraction that feels like the chin typically represents a moderate contraction. A
contraction described as feeling like the tip of the nose indicates a mild contraction. A strong or
intense contraction feels like the forehead.
- A nurse palpates a woman’s fundus to determine contraction intensity. What would be most
appropriate for the nurse to use for palpation?
A. finger pads
B. palm of the hand
C. finger tips
D. back of the hand
Answer: A
Rationale: To palpate the fundus for contraction intensity, the nurse would place the pads of the
fingers on the fundus and describe how it feels. Using the finger tips, palm, or back of the hand
would be inappropriate.
- A nurse is explaining the use of effleurage as a pain relief measure during labor. Which
statement would the nurse most likely use when explaining this measure?
A. “This technique focuses on manipulating body tissues.”
B. “The technique requires focusing on a specific stimulus.”
C. “This technique redirects energy fields that lead to pain.”
D. “The technique involves light stroking of the abdomen with breathing.”
Answer: D
Rationale: Effleurage involves light stroking of the abdomen in rhythm with breathing.
Therapeutic touch is an energy therapy and is based on the premise that the body contains energy
fields that lead to either good or ill health and that the hands can be used to redirect the energy
fields that lead to pain. Attention focusing and imagery involve focusing on a specific stimulus.
Massage focuses on manipulating body tissues.
- A nurse is describing the different types of regional analgesia and anesthesia for labor to a
group of pregnant women. Which statement by the group indicates that the teaching was
successful?
A. “We can get up and walk around after receiving combined spinal–epidural analgesia.”
B. “Higher anesthetic doses are needed for patient-controlled epidural analgesia.”
C. “A pudendal nerve block is highly effective for pain relief in the first stage of labor.”
D. “Local infiltration using lidocaine is an appropriate method for controlling contraction pain.”
Answer: A
Rationale: When compared with traditional epidural or spinal analgesia, which often keeps the
woman lying in bed, combined spinal–epidural analgesia allows the woman to ambulate
(“walking epidural”). Patient-controlled epidural analgesia provides equivalent analgesia with
lower anesthetic use, lower rates of supplementation, and higher client satisfaction. Pudendal
nerve blocks are used for the second stage of labor, an episiotomy, or an operative vaginal birth
with outlet forceps or vacuum extractor. Local infiltration using lidocaine does not alter the pain
of uterine contractions, but it does numb the immediate area of the episiotomy or laceration.
- A pregnant woman admitted to the labor and birth suite undergoes rapid HIV testing and is
found to be HIV-positive. Which action would the nurse expect to include when developing a
plan of care for this woman? Select all that apply.
A. administrating of penicillin G at the onset of labor
B. avoiding scalp electrodes for fetal monitoring
C. refraining from obtaining fetal scalp blood for pH testing
D. administering antiretroviral therapy at the onset of labor
E. electing for the use of forceps-assisted birth
Answer: B, C, D
Rationale: To reduce perinatal transmission, HIV-positive women are given a combination of
antiretroviral drugs. To further reduce the risk of perinatal transmission, ACOG and the U.S.
Public Health Service recommend that HIV-infected women with plasma viral loads of more
than 1,000 copies per milliliter be counseled regarding the benefits of elective cesarean birth.
Additional interventions to reduce the transmission risk would include avoiding use of scalp
electrode for fetal monitoring or doing a scalp blood sampling for fetal pH, delaying amniotomy,
encouraging formula feeding after birth, and avoiding invasive procedures such as forceps or
vacuum-assisted devices
- Which suggestion by the nurse about pushing would be most appropriate to a woman in the
second stage of labor?
A. “Lying flat with your head elevated on two pillows makes pushing easier.”
B. “Choose whatever method you feel most comfortable with for pushing.”
C. “Let me help you decide when it is time to start pushing.”
D. “Bear down like you’re having a bowel movement with every contraction.”
Answer: B
Rationale: The role of the nurse should be to support the woman in her choice of pushing method
and to encourage confidence in her maternal instinct of when and how to push. In the absence of
any complications, nurses should not be controlling this stage of labor, but empowering women
to achieve a satisfying experience. Common practice in many labor units is still to coach women
to use closed glottis pushing with every contraction, starting at 10 cm of dilation, a practice that
is not supported by research. Research suggests that directed pushing during the second stage
may be accompanied by a significant decline in fetal pH and may cause maternal muscle and
nerve damage if done too early. Effective pushing can be achieved by assisting the woman to
assume a more upright or squatting position. Supporting spontaneous pushing and encouraging
women to choose their own method of pushing should be accepted as best clinical practice.
- A nurse is performing Leopold maneuvers on a pregnant woman. The nurse determines
which information with the first maneuver?
A. Fetal presentation
B. Fetal position
C. Fetal attitude
D. Fetal flexion
Answer: A
Rationale: Leopold maneuvers are a method for determining the presentation, position, and lie of
the fetus through the use of four specific steps. The first maneuver determines presentation; the
second maneuver determines position; the third maneuver confirms presentation by feeling for
the presenting part; the fourth maneuver determines attitude based on whether the fetal head is
flexed and engaged in the pelvis.
- A pregnant woman with a fetus in the cephalic presentation is in the latent phase of the first
stage of labor. Her membranes rupture spontaneously. The fluid is green in color. Which action
by the nurse would be appropriate?
A. Check the pH to ensure the fluid is amniotic fluid.
B. Prepare to administer an antibiotic.
C. Notify the health care provider about possible meconium.
D. Check the maternal heart rate.
Answer: C
Rationale: Amniotic fluid should be clear when the membranes rupture. Green fluid may indicate
that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord
compression, intrauterine growth restriction, maternal hypertension, diabetes, or
chorioamnionitis. Therefore, the nurse would notify the health care provider. Antibiotic therapy
would be indicated if the fluid was cloudy or foul-smelling, suggesting an infection. Color of the
fluid has nothing to do with the pH of the fluid. Spontaneous rupture of membranes can lead to
cord compression, so checking fetal heart rate, not maternal heart rate, would be appropriate.
- A nurse is reviewing a client’s history and physical examination findings. Which information
would the nurse identify as contributing to the client’s risk for an ectopic pregnancy?
A. use of oral contraceptives for 5 years
B. ovarian cyst 2 years ago
C. recurrent pelvic infections
D. heavy, irregular menses
Answer: C
Rationale: In the general population, most cases of ectopic pregnancy are the result of tubal
scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy,
irregular menses are not considered risk factors for ectopic pregnancy
5. A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority? A. hemorrhage B. jaundice C. edema D. infection
ANS: A
Rationale: With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage.
Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.
- A client comes to the clinic for an evaluation. The client is at 22 weeks’ gestation. After
reviewing a client’s history, which factor would the nurse identify as placing her at risk for
preeclampsia?
A. Her mother had preeclampsia during pregnancy.
B. Client has a twin sister.
C. Her sister-in-law had gestational hypertension.
D. This is the client’s second pregnancy.
Answer: A
Rationale: A family history of preeclampsia, such as a mother or sister, is considered a risk factor
for the client. Having a twin sister or having a sister-in-law with gestational hypertension would
not increase the client’s risk. If the client had a history of preeclampsia in her first pregnancy,
then she would be at risk in her second pregnancy.
- A client with hyperemesis gravidarum is admitted to the facility after being cared for at home
without success. What would the nurse expect to include in the client’s plan of care?
A. clear liquid diet
B. total parenteral nutrition
C. nothing by mouth
D. administration of labetalol
Answer: C
Rationale: Typically, on admission, the woman with hyperemesis has oral food and fluids
withheld to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms.
Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may
be used if the client’s condition does not improve with several days of bed rest, gut rest, IV
fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat
gestational hypertension, not hyperemesis.
