NSG 432 Final Exam Questions with Answers 100% Correctly Verified Updates, Exams of Nursing

Download NSG 432 Final Exam Questions with Answers 100% Correctly Verified Updates and more Exams Nursing in PDF only on Docsity! 1 / 88 NSG 432 Final Exam Questions with Answers 100% Correctly Verified Updates 1.A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine several times durin the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a. Blood pressure, age, and BMI b. Drug/alcohol use, age, and family history c. Family history, blood pressure, and BMI d. Family history, BMI, and drug/alcohol abuse: Family history, BMI, and drug/al- cohol abuse Her family history of NTD, low BMI, and substance abuse all are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal. 2.A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST): Ultrasound examination 2 / 88 An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester. 3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height mea- surements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts: Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasive- ly in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR. 4.A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some dif- ficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein (MSAFP) screening 5 / 88 hour stretch off. c. the fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. obese mothers familiar with their bodies can assess fetal movement as well as average-size women.: the fetal alarm signal should go off when fetal movements stop entirely for 12 hours. No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity ( kick counts ) two or three times daily for 60 minutes each time Obese women have a harder time assessing fetal movement. 9. In comparing the abdominal and transvaginal methods of ultrasound exam- ination, nurses should explain to their patients that a. both require the woman to have a full bladder. b. the abdominal examination is more useful in the first trimester. c. initially the transvaginal examination can be painful. d. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail.: the transvaginal examination allows pelvic anatomy to be evaluated in greater detail. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman feels pressure as the probe is moved. 10.In the first trimester, ultrasonography can be used to gain information on a. amniotic fluid volume. b. location of gestational sacs. c. placental location and maturity. d. cervical length.: location of gestational sacs. 6 / 88 During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestational sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating. 11.Nurses should be aware that the biophysical profile (BPP) a. is an accurate indicator of impending fetal death. b. is a compilation of health risk factors of the mother during the later stages of pregnancy. c. consists of a Doppler blood flow analysis and an amniotic fluid index. d. involves an invasive form of ultrasound examination.: is an accurate indicator of impending fetal death. An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure. 12.Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment a. has no known contraindications. b. has fewer false-positive results. c. is more sensitive in detecting fetal compromise. d. is slightly more expensive.: has no known contraindications. CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive. 13.The nurse providing care for the antepartum woman should understand that contraction stress test (CST) a. sometimes uses vibroacoustic stimulation. b. is an invasive test; however, contractions are stimulated. c. is considered negative if no late decelerations are observed with the con- tractions. d. is more effective than nonstress test (NST) if the membranes have already been ruptured.: is 7 / 88 considered negative if no late decelerations are observed with the contractions. No late decelerations are good news. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured. 14.Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring patient with diabetes mellitus, the nurse is aware that she is at a greater risk for a. oligohydramnios. b. polyhydramnios. c. postterm pregnancy. d. chromosomal abnormalities.: polyhydramnios. Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and after birth hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced transloca- tion (maternal and paternal) are risk factors for chromosome abnormalities. 15.A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is a. The test results are within normal limits. b. Immediate delivery by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.: The test results are within normal limits. The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should 10 / 88 Poor material weight gain, chronic infections disease, gestational hypertension, and smoking are all risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR. 21.Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6- week gestation patient for this procedure, she express- es concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply.) a. Establish gestational age b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy: A, B, C, E Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used. 22.In assessing the knowledge of a pregestational woman with type 1 dia- betes concerning changing insulin needs during pregnancy, the nurse recog- nizes that further teaching is warranted when the patient states a. I will need to increase my insulin dosage during the first 3 months of pregnancy. b. Insulin dosage will likely need to be increased during the second and third trimesters. c. Episodes of hypoglycemia are more likely to occur during the first 3 months. d. Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.: I will need to increase my insulin dosage during the first 3 months of pregnancy. Insulin needs are reduced in the first trimester because of increased insulin produc- tion by the pancreas and increased peripheral sensitivity to insulin. Insulin dosage will likely need to be increased during the second and third trimesters, Episodes of 11 / 88 hypoglycemia are more likely to occur during the first 3 months, and Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy 23.Preconception counseling is critical to the outcome of diabetic pregnan- cies because poor glycemic control before and during early pregnancy is associated with a. frequent episodes of maternal hypoglycemia. b. congenital anomalies in the fetus. c. polyhydramnios. d. hyperemesis gravidarum.: congenital anomalies in the fetus. Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the de- creased food intake by the mother and glucose transfer to the fetus contributes to hypoglycemia. 24.In planning for the care of a 30-year-old woman with pregestational dia- betes, the nurse recognizes that the most important factor affecting pregnan- cy outcome is the a. mother's age. b. number of years since diabetes was diagnosed. c. amount of insulin required prenatally. d. degree of glycemic control during pregnancy.: degree of glycemic control during pregnancy. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. 25.Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes 12 / 88 mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight.: macrosomia Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman. 26.A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 lbs less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern: Imbalanced nutrition: less than body requirements This patient's clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This patient reports weight loss, not weight gain. Imbalanced nutrition: more than body require- ments is not an appropriate nursing diagnosis. Although the patient reports nervousness based on the patient's other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements. 27.Maternal phenylalanine hydroxylase deficiency (PAH) is an important health concern during pregnancy because 15 / 88 c. would be considered evidence of good diabetes control with a result of 5% to 6%. d. is done on the patient's urine, not her blood.: would be considered evidence of good diabetes control with a result of 5% to 6%. A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood. 32.A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.: 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. 60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL. 33.A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? a. Hyperthyroidism b. Phenylalanine hydroxylase deficiency (PAH) c. Hypothyroidism d. Thyroid storm: Phenylalanine hydroxylase deficiency (PAH) PAH is a cause of mental retardation in infants; mothers with PAH pass on pheny- lalanine. A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism. 16 / 88 34.When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include a. a regular heart rate and hypertension. b. an increased urinary output, tachycardia, and dry cough. c. shortness of breath, bradycardia, and hypertension. d. dyspnea; crackles; and an irregular, weak pulse.: dyspnea; crackles; and an irregular, weak pulse. Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increas- ing fatigue; and cyanosis of the lips and nail beds. A regular heart rate and hy- pertension are not generally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not. 35.While providing care in an obstetric setting, the nurse should understand that after birth care of the woman with cardiac disease a. is the same as that for any pregnant woman. b. includes rest, stool softeners, and monitoring of the effect of activity. c. includes ambulating frequently, alternating with active range of motion. d. includes limiting visits with the infant to once per day.: includes rest, stool softeners, and monitoring of the effect of activity. Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the after-birth period is tailored to the woman's functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated. 36.A woman with asthma is experiencing a after birth hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma? 17 / 88 a. Pitocin b. Nonsteroidal anti-inflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl: Hemabate Prostaglandin derivatives should not be used to treat women with asthma because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman's bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding 37.The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this patient population the nurse must be cognizant that methamphetamine a. is similar to opiates. b. is a stimulant with vasoconstrictive characteristics. c. should not be discontinued during pregnancy. d. is associated with a low rate of relapse.: is a stimulant with vasoconstrictive characteristics. Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methampheta- mine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high. 38.Which heart condition is not a contraindication for pregnancy? a. Peripartum cardiomyopathy b. Eisenmenger syndrome c. Heart transplant d. All of these contraindicate pregnancy: Heart transplant Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be 20 / 88 The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bell's palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth. 43.With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, treatment is the current standard of care during pregnancy. a. methadone maintenance b. detoxification c. smoking cessation d. 4 Ps Plus: methadone maintenance Methadone maintenance treatment (MMT) is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for opioid addiction treatment that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease rates of infections such as hepatitis B and C, HIV, and other sexually transmitted infections. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse. 44.Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia: Hypoglycemia 21 / 88 The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonate's circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate presents with hyperinsulinemia. 45. Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus: Previous birth of large infant Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy. 46.Glucose metabolism is profoundly affected during pregnancy because a. pancreatic function in the islets of Langerhans is affected by pregnancy. b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. the pregnant woman increases her dietary intake significantly. d. placental hormones are antagonistic to insulin, thus resulting in insulin resistance.: placental hormones are antagonistic to insulin, thus resulting in insulin resistance. Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin is also broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glu- cose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day. 22 / 88 47.To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by a. eating six small equal meals per day. b. reducing carbohydrates in her diet. c. eating her meals and snacks on a fixed schedule. d. increasing her consumption of protein.: eating her meals and snacks on a fixed schedule. Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates. 48.When the pregnant diabetic woman experiences hypoglycemia while hos- pitalized, the nurse should intervene by having the patient a. eat six saltine crackers. b. drink 8 ounces of orange juice with 2 tsp of sugar added. c. drink 4 ounces of orange juice followed by 8 ounces of milk. d. eat hard candy or commercial glucose wafers.: eat six saltine crackers Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides. 49.Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin a. increases throughout pregnancy and the after-birth period. b. decreases throughout pregnancy and the after-birth period. c. varies depending on the stage of gestation. d. should not change because the fetus produces its own insulin.: varies depending on the 25 / 88 b. have vomiting severe and persistent enough to cause weight loss, dehydra- tion, and electrolyte imbalance. c. need intravenous (IV) fluid and nutrition for most of their pregnancy. d. often inspire similar, milder symptoms in their male partners and mothers.- : have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance. Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 80% of pregnant women experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy because some authorities believe that difficult relationships with mothers and/or partners may be the cause. 55.Because pregnant women may need surgery during pregnancy, nurses should be aware that a. the diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy. b. rupture of the appendix is less likely in pregnant women because of the close monitoring. c. surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy. d. when pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.: the diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy. Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems 56.What laboratory marker is indicative of disseminated intravascular coag- ulation (DIC)? a. Bleeding time of 10 minutes b. Presence of fibrin split products 26 / 88 c. Thrombocytopenia d. Hyperfibrinogenemia: Presence of fibrin split products Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC. 57.In caring for an immediate after birth patient, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder a. disseminated intravascular coagulation (DIC). b. amniotic fluid embolism (AFE). c. hemorrhage. d. HELLP syndrome.: disseminated intravascular coagulation (DIC). The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the after birth patient. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP is not a clotting disorder, but it may contribute to the clotting disorder DIC. 58.In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? a. Administration of blood b. Preparation of the patient for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids: Administration of blood Primary medical management in all cases of DIC involves correction of the underly- ing cause, volume replacement, blood component therapy, optimization of oxygena- tion and perfusion 27 / 88 status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. 59.A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. Blood pressure (BP) increase to 138/86 mm Hg. b. Weight gain of 0.5 kg during the past 2 weeks. c. A dipstick value of 3+ for protein in her urine. d. Pitting pedal edema at the end of the day.: A dipstick value of 3+ for protein in her urine. Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. 60.The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse noti- fies the physician because the laboratory results are indicative of a. eclampsia. b. disseminated intravascular coagulation (DIC). c. HELLP syndrome. d. idiopathic thrombocytopenia.: HELLP syndrome. HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low 30 / 88 presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding. 65.The patient that you are caring for has severe preeclampsia and is receiv- ing a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits a. a sleepy, sedated affect. b. a respiratory rate of 10 breaths/min. c. deep tendon reflexes of 2. d. absent ankle clonus.: a respiratory rate of 10 breaths/min. A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a central nervous system depressant, the patient will most likely become sedated when the infusion is initiated. Deep tendon reflexes of two and absent ankle clonus are normal findings. 66.The nurse caring for pregnant women must be aware that the most com- mon medical complication of pregnancy is a. hypertension. b. hyperemesis gravidarum. c. hemorrhagic complications. d. infections.: hypertension. Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. 67.Nurses should be aware that HELLP syndrome a. is a mild form of preeclampsia. b. can be diagnosed by a nurse alert to its symptoms. 31 / 88 c. is characterized by hemolysis, elevated liver enzymes, and low platelets. d. is associated with preterm labor but not perinatal mortality.: is characterized by hemolysis, elevated liver enzymes, and low platelets. The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased, and so is perinatal mortality. 68.Nurses should be aware that chronic hypertension a. is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy. b. is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg. c. is general hypertension plus proteinuria. d. can occur independently of or simultaneously with gestational hyperten- sion.: can occur independently of or simultaneously with gestational hypertension. Hypertension is present before pregnancy or diagnosed before 20 weeks of ges- tation and persists longer than 6 weeks after birth. The range for hypertension is systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg. It becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic. 69.In planning care for women with preeclampsia, nurses should be aware that a. induction of labor is likely, as near term as possible. b. if at home, the woman should be confined to her bed, even with mild preeclampsia. c. a special diet low in protein and salt should be initiated. d. vaginal birth is still an option, even in severe cases.: induction of labor is likely, as near term as possible. Induction of labor is likely, as near term as possible; however, at less than 37 weeks of 32 / 88 gestation, immediate delivery may not be in the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery. 70.Magnesium sulfate is given to women with preeclampsia and eclampsia to a. improve patellar reflexes and increase respiratory efficiency. b. shorten the duration of labor. c. prevent and treat convulsions. d. prevent a boggy uterus and lessen lochial flow.: prevent and treat convulsions. Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy. 71.A woman presents to the emergency department with complaints of bleed- ing and cramping. The initial nursing history is significant for a last menstru- al period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic: Threatened A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would present with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion manifests with the same symptoms as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix 35 / 88 74.Methotrexate is recommended as part of the treatment plan for which obstetric omplication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae: Unruptured ectopic pregnancy Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae. 75.A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks preg- nant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure? a. Amniocentesis for fetal lung maturity b. Ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring: Ultrasound for placental location The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be given corticosteroids to aid in fetal lung maturity. A CST would not be performed at a preterm gestational age. Furthermore, bleeding would be a contraindication to this test. Internal fetal monitoring would be contraindicated in the presence of bleeding. 76.A laboring woman with no known risk factors suddenly experiences spon- taneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to 36 / 88 decline rapidly after the ROM. The nurse should suspect the possibility of a. placenta previa. b. vasa previa. c. severe abruptio placentae. d. disseminated intravascular coagulation (DIC).: vasa previa. Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. They are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity would typically be tetanus (i.e., a board-like uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors and causes widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as HELLP syndrome. This woman did not have any prior risk factors. 77.A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On ex- amination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as a. normal integumentary changes associated with pregnancy. b. Turner's sign associated with appendicitis. c. Cullen's sign associated with a ruptured ectopic pregnancy. d. Chadwick's sign associated with early pregnancy.: Cullen's sign associated with a ruptured ectopic pregnancy. Cullen's sign, the blue ecchymosis seen in the umbilical area, indicates hematoperi- toneum associated with an undiagnosed ruptured intraabdominal ectopic pregnan- cy. Linea nigra on 37 / 88 the abdomen is the normal integumentary change associated with pregnancy. It manifests as a brown, pigmented, vertical line on the lower abdomen. Turner's sign is ecchymosis in the flank area, often associated with pancreatitis. Chadwick's sign is the blue-purple color of the cervix that may be seen during or around the eighth week of pregnancy. 78.As related to the care of the patient with miscarriage, nurses should be aware that a. it is a natural pregnancy loss before labor begins. b. it occurs in fewer than 5% of all clinically recognized pregnancies. c. it often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise. d. if it occurs before the 12th week of pregnancy, it may manifest only as mod- erate discomfort and blood loss.: if it occurs before the 12th week of pregnancy, it may manifest only as moderate discomfort and blood loss Before the sixth week the only evidence may be a heavy menstrual flow. After the 12th week more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but by definition it occurs before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in approximately 10% to 15% of all clinically recognized preg- nancies. Miscarriage can be caused by a number of disorders or illnesses outside of the mother's control or knowledge. 79.Which condition would not be classified as a bleeding disorder in late pregnancy? a. Placenta previa b. Abruptio placentae c. Spontaneous abortion d. Cord insertion: Spontaneous abortion Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy. Placenta previa is a cause of bleeding disorders in later pregnancy. Abruptio placentae is a cause of bleeding disorders in later pregnancy. Cord inser- tion is a cause of bleeding disorders in later pregnancy. 80.In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the 40 / 88 a. Decrease in abdominal pain b. Bradycardia c. Hard, board-like abdomen d. Decrease in fundal height: Hard, board-like abdomen Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, board-like abdomen. Abdominal pain may increase. The patient will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height will increase 86.The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.: assess fetal heart rate (FHR) and maternal vital signs. Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later. It is important to assess future bleeding; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not the top priority. 87.A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of a. anxiety due to hospitalization. b. worsening disease and impending convulsion. c. effects of magnesium sulfate. d. gastrointestinal upset.: worsening disease and impending convulsion. 41 / 88 Headache and visual disturbances are caused by increased cerebral edema. Epi- gastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. These are danger signs showing increased cerebral edema and impending convulsion and should be treated immediately. The patient has not been started on magnesium sulfate treatment yet. Also, these are not anticipated effects of the medication. 88.Which order should the nurse expect for a patient admitted with a threat- ened abortion? a. Bed rest b. Ritodrine IV c. NPO d. Narcotic analgesia every 3 hours, prn: Bed rest Decreasing the woman's activity level may alleviate the bleeding and allow the preg- nancy to continue. Ritodrine IV is not the first drug of choice for tocolytic medications. There is no reason for having the woman placed NPO. At times dehydration may produce contractions, so hydration is important. Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions. 89.A 32-year-old primigravida is admitted with a diagnosis of ectopic preg- nancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.: hemorrhage is the major concern. Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be removed, the woman's fertility will decrease; however, she will not be infertile. D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes. 90.Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is 42 / 88 the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors: Chromosomal abnormalities At least 50% of pregnancy losses result from chromosomal abnormalities that are incompatible with life. Maternal infection may be a cause of early miscarriage. Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss. Women who have repeated early pregnancy losses appear to have immunologic factors that play a role in spontaneous abortion incidents. 91.The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.: IV therapy to correct fluid and electrolyte imbalances. Initially, the woman who is unable to keep down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum; however, they are not the expected initial treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient. 92.patient who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply.) 45 / 88 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia. 96.In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Urine output of 160 mL in 4 hours b. Deep tendon reflexes 2+ and no clonus c. Respiratory rate of 16 breaths/min d. Serum magnesium level of 10 mg/dL: Serum magnesium level of 10 mg/dL The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings. 97.A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to a. stimulate fetal surfactant production. b. reduce maternal and fetal tachycardia associated with ritodrine administra- tion. c. suppress uterine contractions. d. maintain adequate maternal respiratory effort and ventilation during mag- nesium sulfate therapy.: stimulate fetal surfactant production. Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine adminis- tration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy. 98.A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. 46 / 88 b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.: The cervix is effacing and dilated to 2 cm. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes. 99.A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia.: She is exhibiting hypertonic uterine dysfunction. Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent con- tractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically, uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures 47 / 88 of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, mid-pelvis, outlet, or any combination of these planes. 100. Which assessment is least likely to be associated with a breech presen- tation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Postterm gestation: Postterm gestation Postterm gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births. 101. A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Arrest of active phase d. Protracted descent: Arrest of active phase With an arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor. 102. In evaluating the effectiveness of oxytocin induction, the nurse would expect a. contractions lasting 80 to 90 seconds, 2 to 3 minutes apart. 50 / 88 preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 lbs. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency. 107. With regard to the care management of preterm labor, nurses should be aware that a. all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.: the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor. 108. As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that a. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. b. there are no important maternal (as opposed to fetal) contraindications. c. its most important function is to afford the opportunity to administer ante- natal glucocorticoids. d. if the patient develops pulmonary edema while receiving tocolytics, intra- venous 51 / 88 (IV) fluids should be given.: its most important function is to afford the opportunity to administer antenatal glucocorticoids. Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids. 109. With regard to dysfunctional labor, nurses should be aware that a. women who are underweight are more at risk. b. women experiencing precipitous labor are about the only dysfunctionals not to be exhausted. c. hypertonic uterine dysfunction is more common than hypotonic dysfunc- tion. d. abnormal labor patterns are most common in older women.: women experi- encing precipitous labor are about the only dysfunctionals not to be exhausted. Precipitous labor lasts less than 3 hours. Short women more than 30 lbs overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women less than 20 years of age. 110. The least common cause of long, difficult, or abnormal labor (dystocia) is a. midplane contracture of the pelvis. b. compromised bearing-down efforts as a result of pain medication. c. disproportion of the pelvis. 52 / 88 d. low-lying placenta.: disproportion of the pelvis The least common cause of dystocia is disproportion of the pelvis. 111. Nurses should be aware that the induction of labor a. can be achieved by external and internal version techniques. b. is also known as a trial of labor (TOL). c. is almost always done for medical reasons. d. is rated for viability by a Bishop score.: is rated for viability by a Bishop score. Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons. 112. While caring for the patient who requires an induction of labor, the nurse should be cognizant that a. ripening the cervix usually results in a decreased success rate for induction. b. labor sometimes can be induced with balloon catheters or laminaria tents. c. oxytocin is less expensive than prostaglandins and more effective but createsgreater health risks. d. amniotomy can be used to make the cervix more favorable for labor.: labor sometimes can be induced with balloon catheters or laminaria tents. Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe 113. With regard to the process of augmentation of labor, the nurse should be aware that it a. is part of the active management of labor that is instituted when the labor process is 55 / 88 a. a wide pelvic outlet. b. maternal exhaustion. c. a history of rapid deliveries. d. failure to progress past 0 station: maternal exhaustion. A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction. 119. The priority nursing intervention after an amniotomy should be to a. assess the color of the amniotic fluid. b. change the patient's gown. c. estimate the amount of amniotic fluid. d. assess the fetal heart rate.: assess the fetal heart rate. The fetal heart rate must be assessed immediately after the rupture of the mem- branes to determine whether cord prolapse or compression has occurred. Sec- ondary to FHR assessment, amniotic fluid amount, color, odor, and consistency is assessed. Dry clothing is important for patient comfort; however, it is not the top priority. 120. The priority nursing care associated with an oxytocin (Pitocin) infusion is a. measuring urinary output. b. increasing infusion rate every 30 minutes. c. monitoring uterine response. d. evaluating cervical dilation.: monitoring uterine response. Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is also important; however, it is not the top priority during the administration of Pitocin. The infusion rate may be increased after proper assessment that it is an appropriate interval to do so. Monitoring labor progression is the standard of care for all 56 / 88 labor patients. 121. Immediately after the forceps-assisted birth of an infant, the nurse should a. assess the infant for signs of trauma. b. give the infant prophylactic antibiotics. c. apply a cold pack to the infant's scalp. d. measure the circumference of the infant's head.: assess the infant for signs of trauma. The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would put the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment. 122. Surgical, medical, or mechanical methods may be used for labor induc- tion. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins: Transcervical catheter Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydro- scopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induc- tion. 123. Complications and risks associated with cesarean births include (Select all that apply.) a. placental abruption. b. wound dehiscence. c. hemorrhage. d. urinary tract infections. 57 / 88 e. fetal injuries.: B, C, D, E Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section. 124. Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse in the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply.) a. rupture of membranes at or near term. b. convenience of the woman or her physician. c. chorioamnionitis (inflammation of the amniotic sac). d. postterm pregnancy. e. fetal death.: A, C, D, E These are all acceptable indications for induction. Other conditions include intrauter- ine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation. 125. When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is a. diabetes mellitus. b. mitral valve prolapse (MVP). c. chronic hypertension. d. anemia.: diabetes mellitus. The most frequently reported maternal medical risk factors are diabetes and hy- pertension associated with pregnancy. Both of these conditions are associated with maternal 60 / 88 c. provide the patient with handouts. d. assess whether the patient understands the discussion.: assess whether the patient understands the discussion. Nurses contribute to health literacy by using simple, common words; avoiding jargon; and evaluating whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding. Most patient education materials are written at too high a level for the average adult and may not be useful for a patient with limited English proficiency. 130. When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman's a. age. b. minority status. c. educational level. d. inability to pay.: inability to pay. The most significant barrier to health care access is the inability to pay for services; this is compounded by the fact that many physicians refuse to care for women who cannot pay. Although adolescent pregnant patients statistically receive less prenatal care, age is not the most significant barrier. Significant disparities in morbidity and mortality rates exist for minority women; however, minority status is not the most sig- nificant barrier to access of care. Disparities in educational level are associated with morbidity and mortality rates; however, educational level is not the most significant barrier to access of care. 131. When the nurse is unsure about how to perform a patient care procedure, the best action would be to a. ask another nurse. b. discuss the procedure with the patient's physician. c. look up the procedure in a nursing textbook. d. consult the agency's procedure manual and follow the guidelines for the procedure.: consult the 61 / 88 agency's procedure manual and follow the guidelines for the procedure. It is always best to follow the agency's policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe patient care delivery. Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or individual state or hospital policies. 132. From the nurse's perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further? a. Implementing programs to ensure women's early participation in ongoing prenatal care b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days c. Expanding the number of neonatal intensive care units (NICUs) d. Mandating that all pregnant women receive care from an obstetrician: Imple- menting programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high-risk infants after they are born. Expanding the number of NICUs would offer better access for high-risk care, but this factor is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women. 133. Alternative and complementary therapies 62 / 88 a. replace conventional Western modalities of treatment. b. are used by only a small number of American adults. c. recognize the value of patients' input into their health care. d. focus primarily on the disease an individual is experiencing.: recognize the value of patients' input into their health care. Many popular alternative healing modalities offer human-centered care based on philosophies that recognize the value of the patient's input and honor the individual's beliefs, values, and desires. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person, not just the disease. 134. A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence? a. She is Hispanic. b. She delivered a girl. c. The standards of care were not met. d. She refused fetal monitoring.: The standards of care were not met. Not meeting the standards of care is a legitimate factor for a case of negligence. The patient's race is not a factor for a case of negligence. The infant's gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the patient has the right to refuse treatment. This refusal is not a case for negligence; however, informed consent should be properly obtained, and the patient should sign an against medical advice form for refusal of any treatment that is within the standard of care. 135. A newly graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Her research finds that these costs are much higher compared with other developed countries as a result of a. a higher rate of obesity among pregnant women. 65 / 88 continue to increase. Fewer pregnant women smoke. In the United States, there is significant racial disparity in the rates of maternal death. 140. Maternity nursing care that is based on knowledge gained through re- search and clinical trials is a. derived from the Nursing Intervention Classification. b. known as evidence-based practice. c. at odds with the Cochrane School of traditional nursing. d. an outgrowth of telemedicine.: known as evidence-based practice. Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care. 141. The level of practice a reasonably prudent nurse provides is called a. the standard of care. b. risk management. c. a sentinel event. d. failure to rescue.: the standard of care. Guidelines for standards of care are published by various professional nursing or- ganizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care. 142. While obtaining a detailed history from a woman who has recently emi- grated from Somalia, the nurse realizes that the patient has undergone female genital mutilation (FGM). The nurse's best response to this patient is a. This is a very abnormal practice and rarely seen in the United States. 66 / 88 b. Do you know who performed this so that it can be reported to the authori- ties? c. We will be able to restore your circumcision fully after delivery. d. The extent of your circumcision will affect the potential for complications. : The extent of your circumcision will affect the potential for complications. The extent of your circumcision will affect the potential for complications is the most appropriate response. The patient may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. With the growing number of immigrants from countries where FGM is practiced, nurses will increasingly encounter women who have undergone the procedure. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Responding with, This is a very abnormal practice and rarely seen in the United States is culturally insensitive. The infibulation may have occurred during infancy or childhood. The patient will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman's health. 143. To ensure patient safety, the practicing nurse must have knowledge of the current Joint Commission's Do Not Use list of abbreviations. Which of t following is acceptable for use? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero: International Unit The abbreviations i.u. and I.U. are no longer acceptable because they could misread as I.V. or the number 10. The abbreviation q.o.d. or Q.O.D. should be writt every other day. The period after the Q could be mistaken for an I ; the be mistaken for an i. With MSO4 or MgSO4, it is too easy to confuse one medicati for 67 / 88 another. These medications are used for very different purposes and could put a patient at risk for an adverse outcome. They should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number to avoid confusion (i.e., 0.4 rather than .4). 144. Healthy People 2030 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal con- tinuum. Therefore, it is important for the nurse to be aware that significant progress has been made in a. the reduction of fetal deaths and use of prenatal care. b. low birth weight and preterm birth. c. elimination of health disparities based on race. d. infant mortality and the prevention of birth defects.: the reduction of fetal deaths and use of prenatal care. Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of low birth weight and preterm births. According to the March of 70 / 88 The family stress theory is concerned with the family's reaction to stressful events; internal context factors include elements that a family can control such as psycho- logic defenses. It is not concerned with biologic and genetic makeup, maturation of family members, or the prevailing cultural beliefs of society. 150. While working in the prenatal clinic, you care for a very diverse group of patients. When planning interventions for these families, you realize that acceptance of the interventions will be most influenced by a. educational achievement. b. income level. c. subcultural group. d. individual beliefs.: individual beliefs. The patient's beliefs are ultimately the key to acceptance of health care interventions. However, these beliefs may be influenced by factors such as educational level, income level, and ethnic background. Educational achievement, income level, and subcultural group all are important factors. However, the nurse must understand that a woman's concerns from her own point of view will have the most influence on her compliance. 151. The nurse's care of a Hispanic family includes teaching about infant care. When developing a plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic families a. breastfeeding is encouraged immediately after birth. b. male infants typically are circumcised. c. the maternal grandmother participates in the care of the mother and her infant. d. special herbs mixed in water are used to stimulate the passage of meconi- um.: the maternal grandmother participates in the care of the mother and her infant. In Hispanic families, the expectant mother is influenced strongly by her mother or mother-in- law. Breastfeeding often is delayed until the third postpartum day. Hispanic male infants usually are not circumcised. Olive or castor oil may be given to stimulate the passage of meconium. 152. The patient's family is important to the maternity nurse because a. they pay the bills. 71 / 88 b. the nurse will know which family member to avoid. c. the nurse will know which mothers will really care for their children. d. the family culture and structure will influence nursing care decisions.: the family culture and structure will influence nursing care decisions. Family structure and culture influence the health decisions of mothers. 153. A mother's household consists of her husband, his mother, and another child. She is living in a(n) a. extended family. b. single-parent family. c. married-blended family. d. nuclear family.: extended family. An extended family includes blood relatives living with the nuclear family. Both parents and a grandparent are living in this extended family. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults. Married-blended refers to families reconstructed after divorce. A nuclear family is where male and female partners and their children live as an independent unit. 154. A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n) a. extended family. b. binuclear family. c. nuclear family. d. blended family.: nuclear family. About two thirds of U.S. households meet the definition of a nuclear family. Extended families include additional blood relatives other than the parents. A binuclear family involves two households. A blended family is reconstructed after divorce and involves the merger of two 72 / 88 families. 155. Which statement about family systems theory is inaccurate? a. A family system is part of a larger suprasystem. b. A family as a whole is equal to the sum of the individual members. c. A change in one family member affects all family members. d. The family is able to create a balance between change and stability.: A family as a whole is equal to the sum of the individual members. A family as a whole is greater than the sum of its parts. The other statements are characteristics of a system that states that a family is greater than the sum of its parts. 156. A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the a. genogram. b. family values construct. c. life cycle model. d. human development wheel.: genogram. A genogram depicts the relationships of family members over generations. 157. The process by which people retain some of their own culture while adopting the practices of the dominant society is known as a. acculturation. b. assimilation. c. ethnocentrism. d. cultural relativism.: acculturation. Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of one's own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures. 75 / 88 c. prolactin. d. progesterone.: progesterone. Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland. It is produced in response to infant suckling and emptying of the breasts. 164. Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is a. 5 to 7 days after menses ceases. b. Day 1 of the endometrial cycle. c. mid-menstrual cycle. d. any time during a shower or bath.: 5 to 7 days after menses ceases. The physiologic alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. All women should perform BSE during this phase of the menstrual cycle. 165. Menstruation is periodic uterine bleeding a. that occurs every 28 days. b. in which the entire uterine lining is shed. c. that is regulated by ovarian hormones. d. that leads to fertilization.: that is regulated by ovarian hormones. Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: endometrial, hypothalamic-pituitary, and ovarian. The average length of a menstrual cycle is 28 days, but variations are normal. During the endometrial cycle, the functional two thirds of the endometrium are shed. Lack of fertilization leads to menstruation. 166. Individual irregularities in the ovarian (menstrual) cycle are most often caused by a. variations in the follicular (preovulatory) phase. 76 / 88 b. an intact hypothalamic-pituitary feedback mechanism. c. a functioning corpus luteum. d. a prolonged ischemic phase.: variations in the follicular (preovulatory) phase. Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mech- anism is regular, not irregular. The luteal phase begins after ovulation. The corpus luteum depends on the ovulatory phase and fertilization. During the ischemic phase, the blood supply to the functional endometrium is blocked and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins. 167. Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are a. ovaries. b. breast milk. c. menstrual blood. d. the vagina.: menstrual blood. Menstrual blood is a potent source of prostaglandins. Prostaglandins are produced in most organs of the body and in menstrual blood. The ovaries, breast milk, and vagina are neither organs nor a source of prostaglandins. 168. Physiologically, sexual response can be characterized by a. coitus, masturbation, and fantasy. 77 / 88 b. myotonia and vasocongestion. c. erection and orgasm. d. excitement, plateau, and orgasm.: myotonia and vasocongestion. Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle. 169. The long-term treatment plan for an adolescent with an eating disorder focuses on a. managing the effects of malnutrition. b. establishing sufficient caloric intake. c. improving family dynamics. d. restructuring perception of body image.: restructuring perception of body image. The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image. 170. The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, I have special undergarments that I do not remove for religious reasons. The most appropriate response from the nurse would be a. You can't have an examination without removing all your clothes. b. I'll ask the doctor to modify the examination. c. Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably. 80 / 88 b. menarche. c. menopause. d. puberty.: the climacteric The climacteric is a transitional phase during which ovarian function and hor- mone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period. Puberty is a broad term that denotes the entire transitional stage between childhood and sexual maturity. 175. Which statement would indicate that the patient requires additional in- struction about breast self-examination? a. Yellow discharge from my nipple is normal if I am having my period. b. I should check my breasts at the same time each month, like after my period. c. I should also feel in my armpit area while performing my breast examination. d. I should check each breast in a set way, such as in a circular motio:n. Yellow discharge from my nipple is normal if I am having my period. Discharge from the nipples requires further examination from a health care provider. I should check my breasts at the same time each month, like after my period, I sh also feel in my armpit area while performing my breast examination, and I shoul check each breast in a set way, such as in a circular motion all indicate successful learning. 176. The female reproductive organ(s) responsible for cyclic menstruation is/are the a. uterus. b. ovaries. c. vaginal vestibule. d. urethra.: uterus. The uterus is responsible for cyclic menstruation. It also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and production of estrogen; the uterus is responsible for cyclic menstruation. The vaginal vestibule 81 / 88 is an external organ that has openings to the urethra and vagina; the uterus is responsible for cyclic menstruation. The urethra is not a reproductive organ, although it is found in the area. 177. The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the a. perineum. b. bony pelvis. c. vaginal vestibule. d. fourchette.: bony pelvis. The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is formed by the labia minor. 178. A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the phase of the endometrial cycle. a. menstrual b. proliferative c. secretory d. ischemic: secretory The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this phase, the endometrium becomes fully mature. During the menstrual phase, the endometrium is being shed; the endometrium is fully mature again during the secretory phase. The proliferative phase is a period of rapid growth, but the endometrium becomes fully mature again during the secretory phase. During the ischemic phase, the blood supply is blocked, and necrosis develops. The endometrium is fully mature during the secretory phase. 179. The stimulated release of gonadotropin-releasing hormone and folli- cle-stimulating hormone is part of the a. menstrual cycle. 82 / 88 b. endometrial cycle. c. ovarian cycle. d. hypothalamic-pituitary cycle.: hypothalamic-pituitary cycle. The menstrual, endometrial, and ovarian cycles are interconnected. However, the cyclic release of hormones is the function of the hypothalamus and pituitary glands. 180. Certain fatty acids classified as hormones that are found in many body tissues and that have roles in many reproductive functions are known as a. gonadotropin-releasing hormone (GnRH). b. prostaglandins (PGs). c. follicle-stimulating hormone (FSH). d. luteinizing hormone (LH).: prostaglandins (PGs). PGs affect smooth muscle contraction and changes in the cervix. GnRH, FSH, and LH are part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. 181. Which statement regarding female sexual response is inaccurate? a. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. b. Vasocongestion is the congestion of blood vessels. c. The orgasmic phase is the final state of the sexual response cycle. d. Facial grimaces and spasms of hands and feet are often part of arousal.: The orgasmic phase is the final state of the sexual response cycle. The final state of the sexual response cycle is the resolution phase after orgasm. Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. Arousal is characterized by increased muscular tension (myotonia). 182. As part of their participation in the gynecologic portion of the physical examination, nurses should 85 / 88 c. a Papanicolaou (Pap) test. d. a four As procedure.: a Papanicolaou (Pap) test. The Pap test is a microscopic examination for cancer that should be performed reg- ularly, depending on the patient's age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The four As is an intervention procedure to help a patient stop smoking. 187. As a girl progresses through development, she may be at risk for a number of age- related conditions. While preparing a 21-year-old patient for her first adult physical examination and Papanicolaou (Pap) test, the nurse is aware of excessiveness shyness. The young woman states that she will not remove her bra because,There is something wrong with my breasts; one is way bigger. What is the best response by the nurse in this situation? a. Please reschedule your appointment until you are more prepared. b. It is okay; the provider will not do a breast examination. c. I will explain normal growth and breast development to you. d. That is unfortunate; this must be very stressful for yo:u. growth and breast development to you. I will explain norma 86 / 88 During adolescence, one breast may grow faster than the other. Discussion re- garding this aspect of growth and development with the patient will reassure her that there may be nothing wrong with her breasts. Young women usually enter the health system for screening (Pap tests begin at age 21 or 3 years after first sexual activity). Situations such as these can produce great stress for the young woman, and the nurse and health care provider should treat her carefully. Asking her to reschedule would likely result in the patient's not returning for her appointment at all. A breast examination at her age is part of the complete physical examination. Young women should be taught about normal breast development and begin doing breast self-examinations. Although the last response shows empathy on the part of the nurse and acknowledges the patient's stress, it does not correct the patient's deficient knowledge related to normal growth and development. 188. Which statement by the patient indicates that she understands breast self-examination? a. I will examine both breasts in two different positions. b. I will perform breast self-examination 1 week after my menstrual period starts. c. I will examine the outer upper area of the breast only.I will use the palm of the hand to perform the examinatio:n. breast self-examination 1 week after my menstrual period starts.I will perform The woman should examine her breasts when hormonal influences are at their lowest level. The patient should be instructed to use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. The patient should use the sensitive pads of the middle three fingers. 189. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior places her at a greater risk for a. depression of the central nervous system. b. hypotension and vasodilation. c. sexually transmitted diseases. d. postmature birth.: sexually transmitted diseases. 87 / 88 Sex acts exchanged for drugs places the woman at increased risk for sexually transmitted diseases because of multiple partners and lack of protection. Cocaine is a central nervous system stimulant that causes hypertension and vasoconstriction. Premature delivery of the infant is one of the most common problems associated with cocaine use during pregnancy. 190. A woman who is older than 35 years may have difficulty achieving preg- nancy primarily because a. personal risk behaviors influence fertility. b. she has used contraceptives for an extended time. c. her ovaries may be affected by the aging process. d. prepregnancy medical attention is lacking.: her ovaries may be affected by the aging process. Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviors than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged. 191. The most dangerous effect on the fetus of a mother who smokes ciga- rettes while pregnant is a. genetic changes and anomalies. b. extensive central nervous system damage. c. fetal addiction to the substance inhaled. d. intrauterine growth restriction.: intrauterine growth restriction The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction to tobacco is not a usual concern related to the neonate. 192. Despite warnings, prenatal exposure to alcohol continues to exceed by far exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS)