Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse Family 8th Edition By Patricia W. Ladewig - Test Bank

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Chapter 03 Question 1 Type: MCSA A nurse is teaching a classroom of teenage girls about the female reproductive system. After teaching, the nurse asks the students to describe the release of an ovum during ovulation. Which student's response suggests she correctly understood the nurse's teaching? 1. “During ovulation, an egg is released from the ovary and enters the fallopian tube.” 2. "Around the middle of the menstrual cycle, one of the fallopian tubes releases an egg." 3. "Ovulation is when the uterus releases an unfertilized egg or ovum." 4. "The endometrium is where the eggs are formed and released into the fallopian tube." Correct Answer: 1 Rationale 1: The egg is formed in the ovary and once released, it enters the fallopian tube. Rationale 2: The egg is formed in the ovary and then released near the fimbria of the fallopian tube. Rationale 3: The egg is formed in the ovary and travels by way of the fallopian tube to the uterus. Rationale 4: The uterine endometrium is the site of implantation of a fertilized egg. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO01 - Identify the structures and functions of the female reproductive system. Question 2 Type: MCSA The clinic nurse is caring for a young woman seeking contraception because she has recently married and become sexually active. The teen states, “The opening of my husband’s penis isn’t at the tip; it’s around the corner below the tip. He tells me that he was born that way. Will that cause problems if we want to have children?” What is the best response for the nurse to give? “This variation is called: 1. “Epispadias. It is not likely to impact his fertility.” 2. “Epispadias. It will likely cause him to be infertile.” 3. “Hypospadias. It is not likely to impact his fertility.” 4. “Hypospadias. It will likely cause him to be infertile.” Correct Answer: 3 Rationale 1: Epispadias is the condition where the urethral opening is on the upper aspect of the penis. The patient is describing hypospadias, when the urethral opening is on the lower side of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. Rationale 2: Epispadias is the condition where the urethral opening is on the upper aspect of the penis. The patient is describing hypospadias, when the urethral opening is on the lower side of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. Rationale 3: The patient is describing hypospadias, which is the urethral opening on the lower aspect of the penis. Mild hypospadias, when the urethral opening is on the glans of the penis, does not impact fertility. Rationale 4: The patient is describing hypospadias, where the urethral opening is on the lower side of the penis. Mild hypospadias, where the urethral opening is on the glans of the penis, does not impact fertility. Global Rationale: Cognitive Level: Evaluating Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO02 - Identify the structures and functions of the male reproductive system. Question 3 Type: MCSA A prenatal patient states, "The doctor said he might have to cut my cervix so the baby can get out during delivery." Based upon this statement, the nurse should provide teaching related to episiotomy, which includes defining: 1. The perineal body. 2. The labia majora. 3. The mons pubis. 4. The vaginal vestibule. Correct Answer: 1 Rationale 1: The perineal body, which is located between the lower part of the vagina and the anus, is often the site of an episiotomy or lacerations during childbirth. Rationale 2: The labia majora are longitudinal, raised folds of pigmented skin located on either side of the vulvar cleft. Rationale 3: The mons pubis is a softly rounded mound of subcutaneous fatty tissue that covers the front portion of the symphysis pubis. Rationale 4: The vaginal vestibule contains the vaginal opening, which is the border between the external and internal genitals. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO03 - Explain the significance of specific female reproductive structures during childbirth. Question 4 Type: MCSA A pregnant patient asks, "What's the difference between the true pelvis and the false pelvis?" The nurse's best response is: 1. "The true pelvis doesn't affect fetal passage during labor and childbirth." 2. "The false pelvis consists of the inlet, the pelvic cavity, and the outlet." 3. "The true pelvis helps direct the presenting fetal part into the false pelvis." 4. "The false pelvis helps support the weight of the pregnant uterus." Correct Answer: 4 Rationale 1: The size and shape of the true pelvis must be adequate for normal fetal passage during labor and childbirth. Rationale 2: The true pelvis consists of the inlet, the pelvic cavity, and the outlet. Rationale 3: The false pelvis helps direct the presenting fetal part into the true pelvis. Rationale 4: The false pelvis helps support the weight of the pregnant uterus. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO03 - Explain the significance of specific female reproductive structures during childbirth. Question 5 Type: MCSA A pregnant adolescent asks the nurse, “Why does the physician call measuring my uterus a ‘fundal height’?” The nurse’s answer is based on the fact that the fundus of the uterus is located: 1. In the elongated portion where the fallopian tubes enter. 2. In the lower third area. 3. At the uppermost (dome-shaped top) portion. 4. Between the internal cervical os and the endometrial cavity. Correct Answer: 3 Rationale 1: The elongated portion where the fallopian tubes enter the uterus is called the cornua. Rationale 2: The lower third of the uterus is called the cervix or neck. Rationale 3: The rounded, uppermost (dome-shaped top) portion of the uterus that extends above the points of attachment of the fallopian tubes is called the fundus. Rationale 4: The isthmus is the portion of the uterus between the internal cervical os and the endometrial cavity. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO03 - Explain the significance of specific female reproductive structures during childbirth. Question 6 Type: MCSA A nurse teaches newly pregnant patients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is: 1. Estrogen. 2. Human chorionic gonadotropin (hCG). 3. Progesterone. 4. Luteinizing hormone. Correct Answer: 2 Rationale 1: Estrogen is an ovarian hormone. Rationale 2: When the ovum is fertilized and implants in the endometrium, the fertilized egg begins to secrete human chorionic gonadotropin (hCG) hormone to maintain the corpus luteum. Rationale 3: Progesterone is an ovarian hormone. Rationale 4: Luteinizing hormone is excreted by the anterior pituitary. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO04 - Summarize the actions of the hormones that affect reproductive functioning. Question 7 Type: MCSA A school nurse is teaching a health class to middle school children. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are secreted by the: 1. Hypothalamus. 2. Ovaries and testes. 3. Posterior pituitary. 4. Anterior pituitary. Correct Answer: 4 Rationale 1: The hypothalamus secretes gonadotropin-releasing hormone to the pituitary gland in response to signals from the central nervous system. Rationale 2: The ovaries secrete the female hormones estrogen and progesterone, and the testes secrete testosterone. Rationale 3: The posterior pituitary gland secretes oxytocin and anti-diuretic hormone. Rationale 4: The anterior pituitary secretes FSH and LH, which are primarily responsible for maturation of the ovarian follicle. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO04 - Summarize the actions of the hormones that affect reproductive functioning. Question 8 Type: MCSA The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information? 1. “Estrogen is what causes females to look female.” 2. “The presence of some hormones causes other to be secreted.” 3. “Progesterone is present at the end of the menstrual cycle.” 4. “Prostaglandin is responsible for achieving conception.” Correct Answer: 4 Rationale 1: This is a true statement. The question is asking for an incorrect statement. Estrogen causes secondary sex characteristics, such as enlarged breasts and widened hips. Rationale 2: This is a true statement. The question is asking for an incorrect statement. One example is that the production of gonadotropin-releasing hormone (GnRH) causes the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Rationale 3: This is a true statement. The question is asking for an incorrect statement. Progesterone is present in large quantities during the secretory phase of the menstrual cycle. Rationale 4: Prostaglandin is not related to conception. Prostaglandin is called the hormone of pregnancy because it maintains pregnancy. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO04 - Summarize the actions of the hormones that affect reproductive functioning. Question 9 Type: MCSA A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone? 1. Estrogen 2. Progesterone 3. FSH (follicle-stimulating hormone) 4. LH (luteinizing hormone) Correct Answer: 2 Rationale 1: Estrogen primarily assists in maturation of the ovarian follicles and causes endometrial mucosa to proliferate. Rationale 2: Progesterone is the likely cause because it decreases uterine motility and contractibility caused by estrogens, thereby preparing the uterus for implantation. Rationale 3: FSH is a hormone secreted by the pituitary gland. Rationale 4: LH is a hormone secreted by the pituitary gland. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO04 - Summarize the actions of the hormones that affect reproductive functioning. Question 10 Type: MCSA The nurse is explaining the menstrual cycle to a group of women. The teaching on phases of the menstrual cycle should include the fact that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and the blood supply to the endometrium is reduced in which phase? 1. Menstrual phase 2. Proliferative phase 3. Secretory phase 4. Ischemic phase Correct Answer: 4 Rationale 1: The menstrual phase is the menses. Rationale 2: The proliferative phase is characterized by proliferation of the endometrium. Rationale 3: The secretory phase involves glycogen secretion by the endometrium after ovulation. Rationale 4: The ischemic phase is characterized by ischemia of the endometrium. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO05 - Identify the two phases of the ovarian cycle and the changes that occur in each phase. Question 11 Type: MCSA Which statement best indicates that the patient understands the differences in the follicular and luteal phases of the ovarian cycle? 1. “My period will be every 28 days.” 2. “The first part of my period might vary in length, but not the second.” 3. “The follicular phase is the second half of my cycle.” 4. “The follicular phase is when the egg is fertilized.” Correct Answer: 2 Rationale 1: The follicular phase can vary, resulting in cycle length other than 28 days. Rationale 2: For a female with a 28-day cycle, the follicular phase comprises days 1–14 of the menstrual cycle, and the luteal phase comprises days 15–28. The luteal phase does not vary. Rationale 3: The luteal phase is the second half of the cycle. Rationale 4: The follicular phase comprises days 1–14 of the menstrual cycle, not when the egg is fertilized. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO05 - Identify the two phases of the ovarian cycle and the changes that occur in each phase. Question 12 Type: MCSA The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include? 1. There are two phases of the ovarian cycle: luteal and follicular. 2. Irregular menstrual cycles have varying lengths of the follicular phase. 3. The ovum travels from the ovary to the tube during the luteal phase. 4. The hormone human chorionic gonadotropin stimulates ovulation. Correct Answer: 1 Rationale 1: The two phases of the ovarian cycle are follicular (days 1–14 of the menstrual cycle) and luteal (days 15–28 of the menstrual cycle). Rationale 2: Menstrual cycles that are irregular in length have a consistent follicular phase but a varying luteal phase. Rationale 3: The ovum is released from the graafian follicle of the ovary and travels to the fallopian tube during the follicular phase of the ovarian cycle. Rationale 4: Human chorionic gonadotropin (hCG) is secreted by a fertilized ovum and does not stimulate ovulation. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO05 - Identify the two phases of the ovarian cycle and the changes that occur in each phase. Question 13 Type: MCSA The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation? 1. “The menstrual cycle has five distinct phases that occur during the month.” 2. “One hormone controls the phases of the menstrual cycle.” 3. “The secretory phase occurs when a woman is most fertile.” 4. “Menstrual cycle phases vary in order from one woman to another.” Correct Answer: 3 Rationale 1: There are four phases of the menstrual cycle: menstrual, proliferative, secretory, and ischemic phases. Rationale 2: Four hormones control ovulation and therefore the menstrual cycle: progesterone, estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Rationale 3: During the secretory phase, the endometrium is thickest, and glycogen is produced to nourish a fertilized ovum. Rationale 4: Although the length of the menstrual cycle might vary, the phases of the menstrual cycle always occur in the same order. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO06 - Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase. Question 14 Type: MCSA In preparation for teaching a women's community center class about physiologic changes during menopause, the nurse is preparing a handout for students. Which information should the nurse include in her teaching? 1. The ovaries remain small after puberty, but they increase in size following menopause. 2. Ovarian secretion of estrogen decreases between the ages of 45 to 55, after which point ovulatory activity ceases. 3. Due to changes in estrogen levels, the labia minora increase in size after menopause. 4. After menopause, the endometrium continues to undergo monthly degeneration and renewal. Correct Answer: 2 Rationale 1: The ovaries of girls are small, but they become larger after puberty and then decrease in size following menopause. Rationale 2: Between the ages of 45 and 55, a woman’s ovaries secrete decreasing amounts of estrogen. Eventually, ovulatory activity ceases and menopause occurs. Rationale 3: The labia minora decrease in size after menopause because of changes in estrogen levels. Rationale 4: From menarche to menopause, the endometrium undergoes monthly degeneration and renewal in the absence of pregnancy. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO04 - Summarize the actions of the hormones that affect reproductive functioning. Question 15 Type: MCSA A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0° F) for the past 36 hours. This most likely indicates that: 1. Menstruation is about to begin. 2. Ovulation will occur soon. 3. Ovulation has occurred. 4. She is pregnant and will not menstruate. Correct Answer: 3 Rationale 1: A temperature increase does not occur when menstruation is about to begin. Rationale 2: A temperature increase does not occur before ovulation has occurred. Rationale 3: Signs that ovulation has occurred include: pain associated with rupture of the ovum (mittelschmerz), increased vaginal discharge, and a temperature increase of 0.6°C over the past 36 hours. Rationale 4: Pregnancy can be detected only through testing the urine or serum for the presence of human chorionic gonadotropin hormone. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO06 - Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase. Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Chapter 06 Question 1 Type: MCSA The nurse is teaching a class to women who were recently diagnosed with benign breast disease (BBD), commonly known as fibrocystic breast disease. One of the participants reports increased swelling, pain, and pressure in her breasts just before menstruation. What is the best response by the nurse? 1. “Consider asking your nurse practitioner about adding a mild diuretic to your regimen.” 2. “The pain may be caused by thinning of the normal breast tissue.” 3. “Breast swelling and pressure are expected symptoms, but pain is abnormal and should be evaluated by your physician.” 4. “It's best to make an appointment with an oncologist.” Correct Answer: 1 Rationale 1: Treatment of BBD may include taking a mild diuretic during the week prior to the onset of menses to counteract fluid retention, relieve pressure in the breast, and help decrease pain. Rationale 2: The pathology of BBD involves fibrosis, which is a thickening of the normal breast tissue. Rationale 3: Common symptoms associated with BBD include cyclical breast pain, tenderness, and swelling. Rationale 4: Cyclical breast pain, swelling, and tenderness are common symptoms associated with BBD. Generally fibrocystic changes are not a risk factor for breast cancer. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO01 - Contrast the contributing factors, signs and symptoms, treatment options, and nursing care management of women with common benign breast disorders. Question 2 Type: MCSA The nurse is caring for a patient diagnosed with endometriosis. Which statement by the patient requires immediate follow-up? 1. “I am having many hot flashes since I had the Lupron injection.” 2. “The pain I experience with intercourse is becoming more severe.” 3. “My leg has become painful and swollen since I started taking birth control pills.” 4. “I’ve noticed my voice is lower since I started taking danazol.” Correct Answer: 3 Rationale 1: Leuprolide acetate (Lupron) is a GnRH agonist and causes symptoms of a hypo-estrogenic state (hot flashes, vaginal dryness, decreased libido, and bone density loss). Hot flashes are expected and not a complication. Rationale 2: Dyspareunia is a common symptom of endometriosis and therefore is not a complication. Rationale 3: Combination oral contraceptive pills contain estrogen. A painful, swollen lower extremity can be a sign of deep vein thrombosis, which can cause thromboembolus, which is potentially life threatening. This is a complication and must be addressed immediately. Rationale 4: Danocrine (danazol) is a testosterone derivative that suppresses GnRH and has high-androgen and low-estrogen effects. A lowered voice is one side effect of danazol. This patient is not experiencing a complication. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO02 - Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis. Question 3 Type: MCSA The nurse is creating a care plan for a patient who is unable to conceive as a consequence of endometriosis. Which statement accurately reflects a nursing diagnosis that may apply to the care of this patient? 1. Acute pain related to dysuria and renal pain secondary to endometriosis 2. Hyperandrogenism related to elevated serum androgen levels secondary to endometriosis 3. Compromised family coping related to depression secondary to infertility 4. Infertility related to endometrial inflammation and adhesions secondary to endometriosis Correct Answer: 3 Rationale 1: Pelvic pain is a frequent symptom of endometriosis, while dysuria and renal pain are more commonly associated with conditions such as upper urinary tract infections (UTI). Rationale 2: Hyperandrogenism is a medical diagnosis that pertains to elevated serum androgen levels. Hyperandrogenism is associated with polycystic ovarian syndrome (PCOS). Rationale 3: Infertility may lead to depression and subsequent compromised family coping, which is a nursing diagnosis. Rationale 4: Although associated with the medical condition of endometriosis, infertility is a medical diagnosis. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: LO02 - Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis Question 4 Type: MCSA The patient has been diagnosed with endometriosis. She asks the nurse if there are any long-term health risks associated with this condition. The nurse should include which statement in the patient teaching about endometriosis? 1. “There are no other health risks associated with endometriosis.” 2. “Pain with intercourse rarely occurs as a long-term problem.” 3. “You are at increased risk for ovarian and breast cancer.” 4. “Most women with this condition develop fibromyalgia.” Correct Answer: 3 Rationale 1: There are long-term health risks associated with endometriosis, including increased risk for cancer of the ovary and breast, melanoma, non-Hodgkins lymphoma, and an increased incidence of fibromyalgia. Rationale 2: Dyspareunia is a common symptom of endometriosis. Rationale 3: An increased risk for cancer of the ovary and breast is associated with endometriosis. Rationale 4: There is a risk of increased incidence of fibromyalgia. Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO02 - Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis. Question 5 Type: MCSA A patient diagnosed with polycystic ovarian disease (PCOS) asks her nurse why her treatment regimen includes spironolactone (Aldactone). How should the nurse respond? 1. "Spironolactone may be used to decrease symptoms associated with PCOS, such as excessive hair growth and acne." 2. "Menstrual irregularities related to polycystic ovarian disease are treated using spironolactone." 3. "Spironolactone is often used to reduce complications associated with PCOS, including rectocele." 4. "Condylomata acuminata, which are sometimes caused by polycystic ovarian disease, are treated with spironolactone." Correct Answer: 1 Rationale 1: Spironolactone may be used to treat symptoms of hyperandrogenism that are secondary to PCOS, including excessive hair growth and acne. Rationale 2: Combined oral contraceptive (COC) or cyclic progesterone are used to treat menstrual irregularities associated with PCOS. Rationale 3: A rectocele, which may develop when the posterior vaginal wall is weakened, is associated with pelvic relaxation. Rationale 4: Condylomata acuminata, also called genital or venereal warts, is a sexually transmitted condition unrelated to PCOS. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO04 - Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome (PCOS). Question 6 Type: MCMA The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Standard Text: Select all that apply. 1. “Infertility can be stressful for a marriage.” 2. “The doctor will be able to tell why you have not conceived.” 3. “Your insurance will pay for the infertility treatments.” 4. “Keep communicating with one another through this process.” 5. “Taking a vacation usually results in pregnancy.” Correct Answer: 1,4 Rationale 1: Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and pay for treatments and the societal expectation to have children. Rationale 2: Some infertility cannot be explained, despite extensive treatments. Rationale 3: Insurance often does not pay for infertility treatment. Rationale 4: Communication is important to help cope with stress. A nurse should always encourage patients to ask questions. Rationale 5: A common myth is that taking a vacation or just relaxing will result in conception. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO02 - Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis. Question 7 Type: MCSA Which patient in the gynecology clinic should the nurse see first? 1. 22-year-old, using tampons, T=102°F, P=122, BP=70/55 2. 15-year-old, no menses for past four months 3. 18-year-old seeking information on contraception methods 4. 31-year-old, reports increasing dyspareunia Correct Answer: 1 Rationale 1: A patient using tampons who is febrile, tachycardic, and hypotensive might have toxic shock syndrome. Hypotension is life-threatening; this patient should be seen immediately. Rationale 2: Secondary amenorrhea can be caused by pregnancy. Teen pregnancy is a high risk, but no indication is given that the patient is exhibiting a life-threatening condition. Rationale 3: Unplanned pregnancy and sexually transmitted infections can be problematic in the future, but this patient exhibits no signs or symptoms of a life-threatening condition at this time. Rationale 4: Although this patient might have endometriosis, dyspareunia is not a life-threatening condition. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO03 - Identify the risk factors, treatment options, and nursing interventions for a woman with toxic shock syndrome. Question 8 Type: MCSA Which statement indicates that patient teaching has been effective? 1. “I should douche weekly to prevent a recurrence of my bacterial vaginosis.” 2. “I can use this anti-yeast medication weekly to prevent another infection.” 3. “My diabetes is unrelated to the frequency of my vaginal yeast infections.” 4. “The fishy vaginal odor I have is caused by a bacterial infection.” Correct Answer: 4 Rationale 1: Douching disrupts normal flora by washing out desirable bacteria; douching is not recommended. Rationale 2: Medication for vaginal yeast infections should be used as treatment, not prophylaxis. Using medication as prescribed is important patient education. Medication should not be saved for future use. Rationale 3: Yeast vaginitis is more common in diabetic and pre-diabetic women. Four episodes or more per year of yeast vaginitis are an indication to screen a woman for diabetes. Rationale 4: Bacterial vaginosis is characterized by a fishy vaginal odor and greenish discharge with a vaginal pH over 4.5. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO05 - Compare the causes, signs and symptoms, treatment options, and nursing care for women with vulvovaginal candidiasis versus bacterial vaginosis. Question 9 Type: MCSA Which patient is at greatest risk for developing Chlamydia trachomatis infection? 1. 16-year-old, sexually active, using no contraceptive 2. 22-year-old mother of two, developed dyspareunia 3. 35-year-old woman on oral contraceptives 4. 48-year-old woman with hot flashes and night sweats Correct Answer: 1 Rationale 1: Teens have the highest incidence of sexually transmitted infections, especially Chlamydia. A patient not using contraceptives is not using condoms, which decrease the risk of contracting a STI. Rationale 2: Dyspareunia sometimes develops with Chlamydia infection, but dyspareunia is not a symptom specific to Chlamydia. Rationale 3: There is no correlation between oral contraceptive use and an increased rate of Chlamydia infection. Additionally, Chlamydia is more commonly seen in young women Rationale 4: This patient is experiencing signs of menopause, not Chlamydia infection. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO06 - Compare the prevention, causes, treatment, signs and symptoms, treatment options, and nursing care of women for the common sexually transmitted infections. Question 10 Type: MCSA The physician has prescribed metronidazole (Flagyl) for a woman diagnosed with trichomoniasis. The nurse’s instructions to the woman should include: 1. “Both partners must be treated with the medication.” 2. “Alcohol does not need to be avoided while taking this medication.” 3. “It will turn your urine orange.” 4. “This medication could produce drowsiness.” Correct Answer: 1 Rationale 1: Both partners should be treated with the medication. Rationale 2: Alcohol should be avoided. Rationale 3: Metronidazole does not turn the urine orange. Rationale 4: Metronidazole does not cause drowsiness. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO06 - Compare the prevention, causes, treatment, signs and symptoms, treatment options, and nursing care of women for the common sexually transmitted infections. Question 11 Type: MCMA The couple demonstrates understanding of the consequences of not treating Chlamydia when they state: Standard Text: Select all that apply. 1. “She could become pregnant.” 2. “She could have severe vaginal itching.” 3. “He could get an infection in the tube that carries the urine out.” 4. “It could cause us to develop rashes.” 5. “She could develop a worse infection of the uterus and tubes.” Correct Answer: 3,5 Rationale 1: Chlamydia does not cause a woman to become pregnant. Rationale 2: Chlamydia does not cause vaginal itching. Rationale 3: Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Rationale 4: Chlamydia does not cause a rash. Rationale 5: Chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the uterus, fallopian tubes, and sometimes ovaries. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO06 - Compare the prevention, causes, treatment, signs and symptoms, treatment options, and nursing care of women with common sexually transmitted infections. Question 12 Type: MCSA Which of the following patients should be treated with ceftriaxone (Rocephin) IM and doxycycline (Vibramycin) orally? 1. A pregnant patient with gonorrhea and a yeast infection 2. A non-pregnant patient with gonorrhea and Chlamydia 3. A pregnant patient with syphilis 4. A non-pregnant patient with Chlamydia and trichomoniasis Correct Answer: 2 Rationale 1: Doxycycline is contraindicated during pregnancy. Rationale 2: This combined treatment provides dual treatment for gonorrhea and Chlamydia because the two infections frequently occur together. Rationale 3: Syphilis is treated with penicillin. Rationale 4: Trichomoniasis is treated with metronidazole. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO06 - Compare the prevention, causes, treatment, signs and symptoms, treatment options, and nursing care of women for the common sexually transmitted infections. Question 13 Type: MCSA The nurse is preparing a brochure that compares and contrasts cystitis and pyelonephritis. Which information should be included in the brochure? 1. Both conditions usually present with sudden onset of chills, high temperature, and flank pain. 2. Dysuria, especially at the end of urination, is often the initial symptom of both conditions. 3. Both conditions are associated with pregnancy complications including increased risk of preterm birth and of intrauterine growth restriction. 4. Urine culture is included in the evaluation of both cystitis and pyelonephritis. Correct Answer: 4 Rationale 1: Acute pyelonephritis has a sudden onset, with chills, high temperature, and flank pain (either unilateral or bilateral). Rationale 2: The initial symptom of cystitis is often dysuria, specifically at the end of urination. Rationale 3: Pyelonephritis during pregnancy is associated with an increased risk of preterm birth and intrauterine growth restriction. Rationale 4: Diagnosis of cystitis is made with a urine culture. Women with acute pyelonephritis should have a urine culture and sensitivity done to determine the appropriate antibiotic. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO09 - Contrast the causes, signs and symptoms, treatment options, and nursing care for women with cystitis versus pyelonephritis. Question 14 Type: MCMA The nurse is discharging a patient after hospitalization for pelvic inflammatory disease (PID). Which statements indicate that teaching was effective? Standard Text: Select all that apply. 1. “I might have infertility because of this infection.” 2. “It is important for me to finish my antibiotics.” 3. “Tubal pregnancy could occur after PID.” 4. “My PID was caused by a yeast infection.” 5. “I am going to have an IUD placed for contraception.” Correct Answer: 1,2,3 Rationale 1: Women sometimes become infertile because of scarring in the fallopian tubes as a result of the inflammation of PID. Rationale 2: Antibiotic therapy should always be completed when a patient is diagnosed with any infection. Rationale 3: The tubal scarring that occurs from tubal inflammation during PID can prevent a fertilized ovum from passing through the tube into the uterus, causing an ectopic or tubal pregnancy. Rationale 4: PID is caused by bacteria, most commonly Chlamydia trachomatis or Neisseria gonorrhoeae. Yeast infections do not ascend and become upper reproductive tract infections. Rationale 5: An intrauterine device (IUD) in place increases the risk of developing PID; a patient who has a history of PID is not a good candidate for an IUD. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO07 - Relate the implications of pelvic inflammatory disease (PID) for future fertility to its pathology, signs and symptoms, treatment, and nursing care. Question 15 Type: MCSA Which of the following diagnostic tests would the nurse question when ordered for a patient diagnosed with pelvic inflammatory disease (PID)? 1. CBC (complete blood count) with differential 2. Vaginal culture for Neisseria gonorrhoeae 3. Throat culture for Streptococcus A 4. RPR (rapid plasma reagin) Correct Answer: 3 Rationale 1: CBC with differential will give an indication of the severity of the infection. Rationale 2: Gonorrhea is a common cause of PID, and the patient should be tested for this. Rationale 3: Streptococcus of the throat is not associated with PID. Rationale 4: RPR is a test for syphilis, another cause of PID. Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO02 - Relate the implications of pelvic inflammatory disease (PID) for future fertility to its pathology, signs and symptoms, treatment, and nursing care. Question 16 Type: MCSA The nurse is to tell a patient that her Pap smear result was abnormal. Which statement should the nurse include? 1. “The Pap smear is used to diagnose cervical cancer.” 2. “A loop electrosurgical excision procedure (LEEP) is needed.” 3. “Colposcopy to further examine your cervix is the next step.” 4. “Your cervix needs to be treated with cryotherapy.” Correct Answer: 3 Rationale 1: The Pap smear is a screening tool for cervical abnormalities; it is not diagnostic. Rationale 2: Although LEEP (the removal of the surface tissue of the cervix) might be performed to treat cervical dysplasia or carcinoma in situ, this patient has not had a diagnostic examination yet. Rationale 3: Colposcopy is an examination of the cervix through a magnifying device. Solutions are often painted onto the cervix and surrounding tissue and observed for changes secondary to the application of the solution. Biopsy samples are taken of suspected abnormal tissue and sent for pathologic examination and diagnosis. Endocervical canal biopsy is often undertaken with colposcopy. Rationale 4: Cryotherapy, or freezing of the cervix, is one treatment option for precancerous cervical lesions. However, this patient does not yet have a diagnosis; she has only had an abnormal screening test. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO08 - Compare the cause and implications of an abnormal finding during a pelvic examination in the provision of nursing care. Question 17 Type: MCSA The nurse is preparing an education session for women on prevention of urinary tract infections (UTIs). Which statement should be included? 1. Lower urinary tract infections rarely occur in women. 2. The most common causative organism of cystitis is E. coli. 3. Wiping from back to front after a BM will help prevent a UTI. 4. Back pain often develops with a lower urinary tract infection. Correct Answer: 2 Rationale 1: About 60% of women will experience an episode of cystitis during their lifetime. Rationale 2: Because E. coli is a common bacterium in the bowel and the female urethra is short and close to the anus, cross-contamination of bowel bacteria into the female urinary tract is common. Rationale 3: Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being drawn towards the urethra. Women should be instructed always to wipe from front to back. Rationale 4: Low back or flank pain is a sign of pylonephritis, which is an upper urinary tract infection. Signs of a lower UTI include dysuria, urinary frequency, and urinary urgency. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO09 - Contrast the causes, signs and symptoms, treatment options, and nursing care for women with cystitis versus pyelonephritis. Question 18 Type: MCSA The nurse is caring for a patient who underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy several hours ago. The highest priority for the nurse is to: 1. Monitor blood pressure and pulse. 2. Assess the patient’s acceptance of not being able to have children. 3. Teach the patient how to splint her abdomen while taking deep breaths. 4. Verify that the IV pump is working correctly. Correct Answer: 1 Rationale 1: A post-surgical patient is at risk for internal bleeding at the site of the surgery. Monitoring blood pressure and pulse is necessary to verify that the patient is hemodynamically stable. Rationale 2: Although this patient will not be able to become pregnant because of the surgery, acceptance is a psychosocial issue and a lower priority than is physiologic stability. Rationale 3: Splinting while deep-breathing is a comfort measure to facilitate oxygenation and prevent atelectasis. But hemodynamic stability is a higher priority. Rationale 4: The patient needs IV fluids to replace blood loss during surgery and until oral intake is adequate. But hemodynamic stability is a higher priority. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO10 - Describe the nursing care management of a woman requiring a hysterectomy. Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Chapter 10 Question 1 Type: MCSA The pregnant patient has completed the prenatal questionnaire and asks the nurse why this form had to be completed. The best response by the nurse is: 1. “Some people have things that have happened in the past that could impact their current pregnancy.” 2. “The doctor wants all of the pregnant patients to complete the form so that our records are complete.” 3. “We occasionally identify a health problem that puts the current pregnancy at higher risk.” 4. “This form is designed to predict who will develop problems with their pregnancy or delivery.” Correct Answer: 3 Rationale 1: Although this is true, this statement is too vague to be the best response. It is best to explain specifically that the impact on the current pregnancy might put the pregnancy at higher risk. Rationale 2: The purpose of the form is to identify which patients have risk factors; the fact that records are complete is less important than identifying at risk pregnancies. Rationale 3: This is the reason for risk assessment during pregnancy, whether it is a patient-completed questionnaire or a nurse assessment form. Rationale 4: The form will identify those patients who have risk factors based on their medical history; prediction implies seeing into the future without a basis for the concern. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO01 - Use information provided on a prenatal history to identify risk factors for the mother and/or fetus. Question 2 Type: MCSA The pregnant patient's prenatal record indicates that she is a gravida 4 para 2022. The nurse understands that this indicates the patient had four pregnancies and: 1. Has four living children. 2. Delivered two infants preterm. 3. Is pro-abortion. 4. Delivered two term infants. Correct Answer: 4 Rationale 1: In the four digit number, the fourth number indicates the number of living children, which is 2. Rationale 2: In the four digit number, the second digit indicates the number of preterm births, so the patient has had no preterm births. Rationale 3: In the four digit number, the third digit indicates the number of abortions the patient has experienced. Because abortion may be spontaneous or therapeutic, this number does not does not necessarily reflect a woman's stance on surgical abortion. Rationale 4: In the four digit number, the first digit indicates the number of term infants born, which is two. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO02 - Define common obstetric terminology found in the history of maternity patients. Question 3 Type: MCSA A multigravida gave birth to an 18-week fetus last week. She is in the clinic for follow-up and notices that her chart states she has had one abortion. The patient is upset over the use of this word. How can the nurse best explain this terminology to the patient? 1. “Abortion is the medical term for all pregnancies that end before 28 weeks.” 2. “Abortion is the word we use when someone has miscarried.” 3. “Abortion is how we label pregnancies that end in the second trimester.” 4. “Abortion is what we call all babies who are stillborn.” Correct Answer: 1 Rationale 1: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Rationale 2: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Rationale 3: Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Rationale 4: Third-trimester losses are considered fetal death in utero, and the term abortion is not used. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO02 - Define common obstetric terminology found in the history of maternity patients. Question 4 Type: MCSA Which of the following patients would be considered a multipara? 1. A patient at 34 weeks’ gestation who previously had one spontaneous abortion 2. A patient at 13 weeks’ gestation who previously delivered two term infants 3. A patient at 28 weeks’ gestation with no previous pregnancies 4. A patient at 32 weeks’ gestation who previously delivered one term infant Correct Answer: 2 Rationale 1: A woman who has had no births at more than 20 weeks' gestation is considered a nullipara. Rationale 2: A woman who has had two or more births at more than 20 weeks’ gestation is considered a multipara. Rationale 3: A woman who has had no births at more than 20 weeks' gestation is considered a nullipara. Rationale 4: A woman who has had one birth at more than 20 weeks’ gestation, regardless of whether the infant was born alive or dead, is considered a primipara. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO02 - Define common obstetric terminology found in the history of maternity patients. Question 5 Type: MCSA The patient has delivered her first child at 39 weeks. The nurse would explain this to the patient as what type of delivery? 1. Preterm 2. Post-term 3. Term 4. Near term Correct Answer: 3 Rationale 1: Preterm deliveries are those that occur prior to 37 completed weeks’ gestation. Rationale 2: Post-term applies to birth that occur after 42 weeks' gestation. Rationale 3: Term births are those that occur from between gestation weeks 38 and 42. Rationale 4: Near term is not terminology used to describe birth. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO02 - Define common obstetric terminology found in the history of maternity patients. Question 6 Type: MCSA The prenatal clinic nurse is designing a new prenatal intake information form for pregnant patients. Which question is best to include on this form? 1. Where was the father of the baby born? 2. Do genetic diseases run in the family of the baby’s father? 3. What is the name of the baby’s father? 4. Are you married to the father of the baby? Correct Answer: 2 Rationale 1: This is not important information for pregnancy. Rationale 2: This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby. Rationale 3: Although it is helpful for the nurse to know the name of the father’s baby to include him in the prenatal care, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited. Rationale 4: Although the marital status of the patient might have cultural significance, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO03 - Identify factors related to the father’s health that are generally recorded on the prenatal record in assessing risk factors for the mother and/or fetus. Question 7 Type: MCSA The nurse is assessing a primiparous patient. The patient indicates that her religion is Judaism. This information is important for the nurse to assess because: 1. Religious and cultural background can impact what a patient eats during pregnancy. 2. It provides a baseline from which to ask questions about the patient’s religious and cultural background. 3. Knowing what the patient’s beliefs and behaviors regarding pregnancy are is important. 4. Patients sometimes encounter problems in their pregnancies based on what religion they practice. Correct Answer: 2 Rationale 1: Although this is true, much more than diet is impacted by religious and cultural background; values, beliefs, expectations for the birth, and acceptance or refusal of medical treatment are also influenced by religious or cultural background. Rationale 2: This is the best explanation because not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping patients. Thus, the nurse should use the information on the patient’s background as an educated starting point from which to base further questions about how this specific patient enacts her religious or cultural background. Rationale 3: Not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping patients based on what their background is. The nurse must use the information on the patient’s background as an educated starting point from which to base further questions about how this specific patient enacts her religious or cultural background. Rationale 4: How a patient enacts her religion occasionally will cause problems with pregnancy. But the most important reason for asking a patient for her religious or cultural background is to have a starting point from which to base further questions on the specifics of how this patient is impacted by or enacts her cultural or religious background as a unique individual. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO04 - Evaluate those areas of the initial assessment that reflect the psychosocial and cultural factors related to a woman’s pregnancy. Question 8 Type: MCSA The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings? 1. Document the findings on the prenatal chart. 2. Have the physician see the patient today. 3. Instruct the patient to avoid direct sunlight. 4. Analyze previous thyroid hormone lab results. Correct Answer: 2 Rationale 1: These abnormalities must be reported to the physician immediately. Rationale 2: Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and nail bed pallor can indicate either hypoxia or anemia. These abnormalities must be reported to the physician immediately. Rationale 3: Spider nevi are common in pregnancy due to the increased vascular volume and high estrogen levels. Nasal passages can be inflamed during pregnancy from edema, caused by increased estrogen levels. Rationale 4: The thyroid gland increases in size during pregnancy due to hyperplasia. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO05 - Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman. Question 9 Type: MCSA A 25-year-old primigravida is 20 weeks pregnant. At the clinic, her nurse begins a prenatal assessment and obtains the following vital signs. Which finding would require the nurse to contact the physician? 1. Pulse 88/min 2. Respirations 30/min 3. Temperature 37.4°C (99.3°F) 4. Blood pressure 134/82 Correct Answer: 2 Rationale 1: A slight increase in pulse is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism. Rationale 2: Tachypnea is not a normal finding and requires medical care. Rationale 3: Temperature is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism. Rationale 4: The blood pressure is within normal limits. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO05 - Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman. Question 10 Type: MCSA The nurse is seeing prenatal patients in the clinic. Which patient is exhibiting expected findings? 1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope 2. Multip at 22 weeks who reports no fetal movement felt yet 3. Primip at 26 weeks with fundal height of 30 cm 4. Multip at 12 weeks reports bright red vaginal bleeding. Correct Answer: 1 Rationale 1: This is an expected finding because fetal heart tones should be heard by 12 weeks using an ultrasonic Doppler fetoscope. Rationale 2: This is an abnormal finding. Fetal movement should be felt by 20 weeks. Rationale 3: This is an abnormal finding. Beginning in the second trimester, the fundal height should correlate with weeks of gestation; thus, at 26 weeks’ gestation, the fundal height should be about 26 cm. Rationale 4: This is an abnormal finding. Bright red bleeding during pregnancy is never expected. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO05 - Predict the normal physiologic changes a nurse would expect to find when performing a physical assessment of a pregnant woman. Question 11 Type: MCSA The nurse receives a phone call from a patient who thinks she is pregnant. The patient reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What is the patient’s estimated date of delivery (EDD)? 1. November 13 2. January 17 3. January 10 4. December 3 Correct Answer: 2 Rationale 1: Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Rationale 2: Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Rationale 3: Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Rationale 4: Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO06 - Calculate the estimated date of birth using the common methods. Question 12 Type: MCSA The nurse explains to a pregnant woman that her antepartum assessment will include assessment of clinical pelvimetry. Which patient response reflects understanding of the reason for this test? 1. “It will help understand how big a baby I can have.” 2. “It will be used to find out whether my baby has a chromosomal abnormality." 3. “It will help tell whether my pelvis is big enough to deliver my baby vaginally." 4. “It will be used to screen for gestational diabetes.” Correct Answer: 3 Rationale 1: Clinical pelvimetry is performed to estimate the adequacy of pelvic size for the purpose of vaginal delivery; delivery of larger infants may be accommodated via Cesarean section. Rationale 2: Clinical pelvimetry involves estimating the adequacy of pelvic size for facilitating vaginal birth. Rationale 3: Clinical pelvimetry is performed to estimate the ease or difficulty associated with vaginal delivery of an infant. Rationale 4: Screening for maternal gestational diabetes requires some form of glucose screening. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO07 - Describe the essential measurements that can be determined by clinical pelvimetry. Question 13 Type: MCSA The nurse is assisting a physician during a prenatal examination. The physician seeks to estimate the adequacy of the patient’s pelvis for birth. The nurse understands that the physician will need to perform which measurement vaginally? 1. True conjugate 2. Diagonal conjugate 3. Transverse outlet diameter 4. Obstetrical conjugate Correct Answer: 2 Rationale 1: The true conjugate is a measurement of the pelvic inlet and cannot be directly measured. Rationale 2: The diagonal conjugate is measured from the lower edge of the symphysis to the sacral promontory. Rationale 3: The transverse outlet diameter is measured externally. Rationale 4: The obstetrical is a measurement of the pelvic inlet and cannot be directly measured. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO07 - Describe the essential measurements that can be determined by clinical pelvimetry. Question 14 Type: MCSA The nurse is working with a prenatal patient. Which statement indicates that additional teaching is necessary? 1. “I will have Rh testing, even though this is my first pregnancy.” 2. My vagina will be cultured at 36 weeks for group B strep.” 3. “Because I am married, I won’t have the STI screening.” 4. “My blood will be checked for hemoglobin level.” Correct Answer: 3 Rationale 1: This is a true statement. All patients are screened for blood type, Rh factor, and Rh antibodies, regardless of how many previous pregnancies (if any) they have had. Rationale 2: This is a true statement. Women are tested for group B strep to prevent neonatal infection. Rationale 3: All women should be screened for syphilis, gonorrhea, and hepatitis B. Rationale 4: This is a true statement. All women will have their hemoglobin assessed. Global Rationale: Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO08 - Describe the major screening tests used during the prenatal period in the assessment of the prenatal patient. Question 15 Type: MCSA Which phone call should the prenatal clinic nurse return first? 1. Primip at 32 weeks, reports headache and blurred vision 2. Multip at 18 weeks, reports no fetal movement this pregnancy 3. Primip at 16 weeks, reports increased urinary frequency 4. Multip at 40 weeks, reports sudden gush of fluid and contractions Correct Answer: 1 Rationale 1: Headache and blurred vision are signs of pre-eclampsia, which is potentially life-threatening for both mother and fetus. This patient has top priority. Rationale 2: Fetal movement should be felt by 19–20 weeks. Multips sometimes feel fetal movement prior to 19 weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This patient is a lower priority. Rationale 3: Increased urinary frequency is common during pregnancy as the increased size of the uterus puts pressure on the urinary bladder. Urinary frequency is expected. If the patient were reporting dysuria or hematuria, a UTI would be suspected, but this patient is only reporting increased urinary frequency. This patient is a lower priority. Rationale 4: A term patient who is experiencing contractions and a sudden gush of fluid is in labor. Although laboring patients should be in contact with their provider for advice on when to go to the hospital, labor at term is an expected finding. This patient is a lower priority. Global Rationale: Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO09 - Assess the prenatal patient for the danger signs of pregnancy. Question 16 Type: MCSA The nurse is completing an assessment for a prenatal visit. Which statement indicates that further teaching is necessary? 1. “Because I’m in my third trimester, I should return to the clinic in a month.” 2. “Now that I’ve felt fetal movement, I should feel movement regularly.” 3. “Before I take any over-the-counter medications, I should contact my doctor.” 4. “Alcohol is possibly harmful to my baby, even at the end of my pregnancy.” Correct Answer: 1 Rationale 1: This statement is incorrect because prenatal visits during the thi