Test Bank Maternal Child Nursing Care, 6th Edition, Shannon Perry, Marilyn Hockenberry, De, Exams of Nursing

Download Test Bank Maternal Child Nursing Care, 6th Edition, Shannon Perry, Marilyn Hockenberry, De and more Exams Nursing in PDF only on Docsity! Test Bank Maternal Child Nursing Care, 6th Edition, Shannon Perry, Marilyn Hockenberry, Deitra Lowdermilk, David Wilson, Kathryn Alden, Mary Catherine Cashion Comprehensive Examination Study Guide 2023 Guaranteed Grade A+ MULTIPLE QUESTIONS WITH 100% CORRECT ANSWERS! TEST BANK MATERNAL CHILD NURSING CARE, 6TH EDITION, SHANNON PERRY, MARILYN HOCKENBERRY, DEITRA LOWDERMILK, DAVID WILSON, KATHRYN ALDEN, MARY CATHERINE CASHION RATED A+ Chapter 01: 21st Century Maternity Nursing MULTIPLE CHOICE 1. 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. c. Chronic hypertension. b. Mitral valve prolapse (MVP). d. Anemia. ANS: A The most frequently reported maternal medical risk factors are diabetes and hypertension associated with pregnancy. Both of these conditions are associated with maternal obesity. There are no studies that indicate MVP is among the most frequently reported maternal risk factors. Hypertension associated with pregnancy, not chronic hypertension, is one of the most frequently reported maternal medical risk factors. Although anemia is a concern in pregnancy, it is not one of the most frequently reported maternal medical risk factors in pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: 6 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 2. To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery, The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym? a. Situation, baseline assessment, response b. Situation, background, assessment, recommendation c. Subjective background, assessment, recommendation d. Situation, background, anticipated recommendation ANS: B The situation, background, assessment, recommendation (SBAR) technique provides a specific framework for communication among health care providers. Failure to communicate is one of the major reasons for errors in health care. The SBAR technique has the potential to serve as a means to reduce errors. PTS: 1 DIF: Cognitive Level: Comprehension REF: 14 OBJ: Nursing Process: Assessment, Planning MSC: Client Needs: Safe and Effective Care Environment 3. The role of the professional nurse caring for childbearing families has evolved to emphasize: a. Providing care to patients directly at the bedside. b. Primarily hospital care of maternity patients. c. Practice using an evidence-based approach. d. Planning patient care to cover longer hospital stays. ANS: C Professional nurses are part of the team of health care providers who collaboratively care for patients throughout the childbearing cycle. Providing care to patients directly at the bedside is one of the nurses tasks; however, it does not encompass the concept of the evolved professional nurse. Throughout the prenatal period, nurses care for women in clinics and physicians offices and teach classes to help families prepare for childbirth. Nurses also care for childbearing families in birthing centers and in the home. Nurses have been critically important in developing strategies to improve the well-being of women and their infants and have led the efforts to implement clinical practice guidelines using an evidence-based approach. Maternity patients have experienced a decreased, rather than an increased, length of stay over the past 2 decades. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 4. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments. ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but a nutrition assessment is not the most important action a nurse should take in this situation. The patient may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a patient is to receive. PTS: 1 DIF: Cognitive Level: Comprehension REF: 6 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 5. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year- old Hispanic patient with limited English proficiency. It is important for the nurse to: a. Use maternity jargon in order for the patient to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the patient with handouts. d. Assess whether the patient understands the discussion. ANS: D 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 client with limited English proficiency. PTS: 1 DIF: Cognitive Level: Application REF: 5 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 6. 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 womans: a. Age. c. Educational level. b. Minority status. d. Inability to pay. ANS: D 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 clients 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 significant 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 5 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 7. What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies 12. 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. b. Limited access to technology. c. Increased usage of health care services along with lower prices. d. Homogeneity of the population. ANS: A Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the gross domestic product is spent on health care. Higher spending in the United States compared with 12 other industrialized countries is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. Of the U.S. population, 16% is uninsured and has limited access to health care. Maternal morbidity and mortality are directly related to racial disparities. PTS: 1 DIF: Cognitive Level: Analysis REF: 5 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 13. The term used to describe legal and professional responsibility for practice for maternity nurses is: a. Collegiality. c. Evaluation. b. Ethics. d. Accountability. ANS: D Accountability refers to legal and professional responsibility for practice. Collegiality refers to a working relationship with ones colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. PTS: 1 DIF: Cognitive Level: Evaluation REF: 12 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 14. Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for patients. The most concerning pitfall for nurses using this technology is: a. Violation of patient privacy and confidentiality. b. Institutions and colleagues may be cast in an unfavorable light. c. Unintended negative consequences for using social media. d. Lack of institutional policy governing online contact. ANS: A The most significant pitfall for nurses using this technology is the violation of patient privacy and confidentiality. Furthermore, institutions and colleagues can be cast in unfavorable lights with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and nurses. All institutions should have policies guiding the use of social media, and nurses should be familiar with these guidelines. PTS: 1 DIF: Cognitive Level: Analysis REF: 7 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 15. An important development that affects maternity nursing is integrative health care, which: a. Seeks to provide the same health care for all racial and ethnic groups. b. Blends complementary and alternative therapies with conventional Western treatment. c. Focuses on the disease or condition rather than the background of the client. d. Has been mandated by Congress. ANS: B Integrative health care tries to mix the old with the new at the discretion of the client and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them. PTS: 1 DIF: Cognitive Level: Application REF: 4 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 16. Recent trends in childbirth practices in the United States indicate that: a. More than 15% of mothers had late or no prenatal care. b. The percentage of Hispanics, non-Hispanic African Americans, and Caucasians who received prenatal care was essentially the same. c. Births occurring in the hospital accounted for 99% of births. d. Cesarean births have been declining as a percentage of live births. ANS: C Almost all births occur within the hospital setting. Only 5.2% of Caucasians mothers had either late care or no care. There are disparities in the receipt of prenatal care by ethnicity: 12.2% of Hispanic women and 11.8% of non-Hispanic black women received either late or no prenatal care. The percentage of cesarean births is increasing. PTS: 1 DIF: Cognitive Level: Knowledge REF: 7 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 17. Recent trends in childbirth practice indicate that: a. Delayed pushing is now discouraged in the second stage of labor. b. Episiotomy rates are increasing. c. Midwives perform more episiotomies than physicians. d. Newborn infants remain with the mother and are encouraged to breastfeed. ANS: D Breastfeeding is encouraged for newborns immediately after birth. Delayed pushing is encouraged for several reasons. Episiotomy rates are declining. Midwives perform fewer episiotomies than physicians. PTS: 1 DIF: Cognitive Level: Knowledge REF: 8 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment 18. The nurse caring for a pregnant client should be aware that the U.S. birth rate shows which trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years old are beginning to decline. c. Cigarette smoking among pregnant women continues to increase. d. The rates of maternal death owing to racial disparity are elevated in the United States. ANS: A Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. In the United States, there is significant racial disparity in the rates of maternal death. PTS: 1 DIF: Cognitive Level: Comprehension REF: 6 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment ANS: C The abbreviations i.u. and I.U. are no longer acceptable because they could be misread as I.V. or the number 10. The abbreviation q.o.d. or Q.O.D. should be written out as every other day. The period after the Q could be mistaken for an I; the o could also be mistaken for an i. With MSO4 or MgSO4, it is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client 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). PTS: 1 DIF: Cognitive Level: Analysis REF: 13 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 24. Healthy People 2020 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 continuum. 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. ANS: A 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 Dimes, persistent disparities still exist between African Americans and non- Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. This demonstrates the need for comprehensive community-based care for all mothers, infants, and families. PTS: 1 DIF: Cognitive Level: Knowledge REF: 3 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment MULTIPLE RESPONSE 25. Which interventions would help alleviate the problems associated with access to health care for maternity patients (Select all that apply)? a. Provide transportation to prenatal visits. b. Provide childcare so that a pregnant woman may keep prenatal visits. c. Mandate that physicians make house calls. d. Provide low-cost or no-cost health care insurance. e. Provide job training. ANS: A, B, D Lack of transportation to visits, lack of childcare, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. House calls are not a cost-effective approach to health care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote. PTS: 1 DIF: Cognitive Level: Implementation REF: 5 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 26. Which of the following statements indicate that the nurse is practicing appropriate family-centered care techniques (Select all that apply)? a. The nurse commands the mother to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the patients sister, who is a nurse, that she cannot be in the room during the delivery. ANS: B, C Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the mother what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave). PTS: 1 DIF: Cognitive Level: Analysis REF: 8 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity MATCHING Medical errors are a leading cause of death in the United States. The National Quality Forum has recommended numerous safe practices that nursing can promote to reduce errors. Match each safe practice with the correct statement. a. Ask the patient to teach back. b. Comply with CDC guidelines. c. Ensure that information is documented in a timely manner. d. Promote interventions that will reduce patient risk. e. Reduce exposure to radiation. 27. Hand hygiene 28. Informed consent 29. Culture measurement, feedback, and intervention 30. Pediatric imaging 31. Patient care information 27. ANS: B PTS: 1 DIF: Cognitive Level: Application REF: 5 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 28. ANS: A PTS: 1 DIF: Cognitive Level: Application REF: 5 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 29. ANS: D PTS: 1 DIF: Cognitive Level: Application REF: 5 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. 30. ANS: E PTS: 1 DIF: Cognitive Level: Application REF: 5 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: The National Quality Forum updated its publication Safe Practices for Better Healthcare in 2010, outlining 24 safe practices that should be used in all health care settings to reduce the risk of harm from the environment of care, processes, and systems. These are only a few of the recommended practices; however, nurses should be familiar with these guidelines. Meeting nutritional requirements is a fundamental health promotion behavior. Although creating a family budget may be helpful, it does not indicate that funds will be allotted to meet health needs if money is scarce. Often families cannot afford preventive care and rely on emergency departments for their health care needs. Socialization of children may be important, but it is not directly related to the health care of individuals in a family unit. Birth control may be important, but it is not a basic survival health care function. PTS: 1 DIF: Cognitive Level: Comprehension REF: 28 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 4. The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on family: a. Rituals and customs. c. Boundaries and channels. b. Values and beliefs. d. Socialization processes. ANS: B Values and beliefs are the most prevalent factors in the decision-making and problem-solving techniques of families. Although culture may play a part in the decision-making process of a family, ultimately values and beliefs dictate the course of action taken by family members. Boundaries and channels affect the relationship between the family members and the health care team, not the decisions within the family. Socialization processes may help families with interactions with the community, but they are not the criteria used for decision making within the family. PTS: 1 DIF: Cognitive Level: Comprehension REF: 25 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 5. Using the family stress theory as an intervention approach for working with families experiencing parenting, the nurse can help the family change internal context factors. These include: a. Biologic and genetic makeup. b. Maturation of family members. c. The familys perception of the event. d. The prevailing cultural beliefs of society. ANS: C The family stress theory is concerned with the familys reaction to stressful events; internal context factors include elements that a family can control such as psychologic defenses. It is not concerned with biologic and genetic makeup, maturation of family members, or the prevailing cultural beliefs of society. PTS: 1 DIF: Cognitive Level: Comprehension REF: 20 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 6. 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. c. Subcultural group. b. Income level. d. Individual beliefs. ANS: D The patients 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 womans concerns from her own point of view will have the most influence on her compliance. PTS: 1 DIF: Cognitive Level: Application REF: 22 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 7. The nurses 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 meconium. ANS: C 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. PTS: 1 DIF: Cognitive Level: Application REF: 26 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 8. The womans family members are present when the home care maternal-child nurse arrives for a postpartum and newborn visit. What should the nurse do? a. Observe the family members interactions with the newborn and one another. b. Ask the woman to meet with her and the baby alone. c. Do a brief assessment on all family members present. d. Reschedule the visit for another time so that the mother and infant can be assessed privately. ANS: A The nurse should introduce herself to the patient and the other family members present. Family members in the home may be providing care and assistance to the mother and infant. However, this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new postpartum mother and her infant, not to all family members. The nurse can politely ask about the other people in the home and their relationships with the woman. Unless an indication is given that the woman would prefer privacy, the visit may continue. PTS: 1 DIF: Cognitive Level: Analysis REF: 33 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. The nurse should be aware that during the childbearing experience an African-American woman is most likely to: a. Seek prenatal care early in her pregnancy. b. Avoid self-treatment of pregnancy-related discomfort. c. Request liver in the postpartum period to prevent anemia. d. Arrive at the hospital in advanced labor. ANS: D African-American women often arrive at the hospital in far-advanced labor. These women may view pregnancy as a state of wellness, which is often the reason for delay in seeking prenatal care. African- American women practice many self-treatment options for various discomforts of pregnancy, and they may request liver in the postpartum period, but this is based on a belief that the liver has a high blood content. PTS: 1 DIF: Cognitive Level: Comprehension REF: 26 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. To provide competent care to an Asian-American family, the nurse should include which of the following questions during the assessment interview? a. Do you prefer hot or cold beverages? b. Do you want milk to drink? c. Do you want music playing while you are in labor? d. Do you have a name selected for the baby? ANS: A Asian-Americans often prefer warm beverages. Milk usually is excluded from the diet of this population. Asian-American women typically labor in a quiet atmosphere. Delaying naming the child is common for Asian-American families. PTS: 1 DIF: Cognitive Level: Application REF: 27 the practices of the dominant society. PTS: 1 DIF: Cognitive Level: Knowledge REF: 22 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 17. When attempting to communicate with a patient who speaks a different language, the nurse should: a. Respond promptly and positively to project authority. b. Never use a family member as an interpreter. c. Talk to the interpreter to avoid confusing the patient. d. Provide as much privacy as possible. ANS: D Providing privacy creates an atmosphere of respect and puts the patient at ease. The nurse should not rush to judgment and should make sure that he or she understands the patients message clearly. In crisis situations, the nurse may need to use a family member or neighbor as a translator. The nurse should talk directly to the patien to create an atmosphere of respect. PTS: 1 DIF: Cognitive Level: Application REF: 23 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. In which culture is the father more likely to be expected to participate in the labor and delivery? a. Asian-American c. European-American b. African-American d. Hispanic ANS: C European-Americans expect the father to take a more active role in the labor and delivery than the other cultures. PTS: 1 DIF: Cognitive Level: Comprehension REF: 26 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 19. Which statement about cultural competence is not accurate? a. Local health care workers and community advocates can help extend health care to underserved populations. b. Nursing care is delivered in the context of the clients culture but not in the context of the nurses culture. c. Nurses must develop an awareness of and sensitivity to various cultures. d. A cultures economic, religious, and political structures influence practices that affect childbearing. ANS: B The cultural context of the nurse also affects nursing care. The work of local health care workers and community advocates is part of cultural competence; the nurses cultural context is also important. Developing sensitivity to various cultures is part of cultural competence, but the nurses cultural context is also important. The impact of economic, religious, and political structures is part of cultural competence; the nurses cultural context is also important. PTS: 1 DIF: Cognitive Level: Comprehension REF: 25 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 20. The nurse is preparing for a home visit to complete a newborn wellness checkup. The neighborhood has a reputation for being dangerous. Identify which precautions the nurse should take to ensure her safety (Select all that apply). a. Having access to a cell phone at all times. b. Visiting alone due to the agencys staffing model. c. Carrying an extra set of car keys. d. Avoiding groups of strangers hanging out in doorways. e. Wearing her usual amount of jewelry. ANS: A, C, D Nurse safety is an important component of home care. The nurse should be fully aware of the home environment and the neighborhood in which the home care is being provided. In this situation, nurses should visit in pairs, have access to a cell phone at all times, and wear a limited amount of jewelry. The car should be parked in a well-lit area and locked at all times. An extra set of keys kept in the nursing home care bag avoids time and frustration if the nurse should become locked out of her automobile. Car keys spread between the fingers can also be used of the weapon if necessary. Groups of strangers, dark alleys, and unrestrained dogs should be avoided at all times. PTS: 1 DIF: Cognitive Level: Application REF: 33 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment MATCHING You are getting ready to participate in discharge teaching with a nonEnglish-speaking new mother. The interpreter has arrived on the patient care unit to assist you in providing culturally competent care. In the correct order, from 1 through 6, number the steps that you would take to work with the interpreter. a. Introduce yourself to the interpreter and converse informally. b. Outline your statements and questions, listing the key pieces of information you need to know. c. Make sure the interpreter is comfortable with technical terms. d. Learn something about the culture of the patient. e. Make notes on what you learned for future reference. f. Stop every now and then and ask the interpreter How is it going? 21. Step One 22. Step Two 23. Step Three 24. Step Four 25. Step Five 26. Step Six 21. ANS: B PTS: 1 DIF: Cognitive Level: Application REF: 24 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: To work successfully with an interpreter, the nurse must organize her teaching into four categories. These include actions that are necessary before the interview, meeting with the interpreter, during the interview, and after the interview. The nurse must be sensitive to cultural and situational differences (e.g., a woman from the Middle East may not wish to have a male interpreter present). 22. ANS: D PTS: 1 DIF: Cognitive Level: Application REF: 24 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: To work successfully with an interpreter, the nurse must organize her teaching into four categories. These include actions that are necessary before the interview, meeting with the interpreter, during the interview, and after the interview. The nurse must be sensitive to cultural and situational differences (e.g., a woman from the Middle East may not wish to have a male interpreter present). 23. ANS: A PTS: 1 DIF: Cognitive Level: Application REF: 24 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: To work successfully with an interpreter, the nurse must organize her teaching into four categories. These include actions that are necessary before the interview, meeting with the interpreter, during the interview, and after the interview. The nurse must be sensitive to cultural and situational differences (e.g., a woman from the Middle East may not wish to have a male interpreter present). 24. ANS: C PTS: 1 DIF: Cognitive Level: Application the birth process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os. PTS: 1 DIF: Cognitive Level: Application REF: 41 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. The hormone responsible for maturation of mammary gland tissue is: a. Estrogen. c. Prolactin. b. Testosterone. d. Progesterone. ANS: D 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 43 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. 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. c. Midmenstrual cycle. b. Day 1 of the endometrial cycle. d. Any time during a shower or bath. ANS: A 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 44 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 6. 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. ANS: C 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 is shed. Lack of fertilization leads to menstruation. PTS: 1 DIF: Cognitive Level: Knowledge REF: 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. Individual irregularities in the ovarian (menstrual) cycle are most often caused by: a. Variations in the follicular (preovulatory) phase. b. An intact hypothalamic-pituitary feedback mechanism. c. A functioning corpus luteum. d. A prolonged ischemic phase. ANS: A 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 mechanism 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 8. Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are: a. Ovaries. c. Menstrual blood. b. Breast milk. d. The vagina. ANS: C 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 47 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. Physiologically, sexual response can be characterized by: a. Coitus, masturbation, and fantasy. c. Erection and orgasm. b. Myotonia and vasocongestion. d. Excitement, plateau, and orgasm. ANS: B 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 47 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. 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. ANS: D 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 individuals body image. PTS: 1 DIF: Cognitive Level: Application REF: 54 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 11. 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 cant have an examination without removing all your clothes. b. Ill ask the doctor to modify the examination. c. Tell me about your undergarments. Ill explain the examination procedure, and then we can discuss how you can have your examination comfortably. d. What? Ive never heard of such a thing! That sounds different and strange. ANS: C This statement reflects cultural competence by the nurse and shows respect for the womans religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. In recognizing 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 motion. ANS: A 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 should also feel in my armpit area while performing my breast examination, and I should check each breast in a set way, such as in a circular motion all indicate successful learning. PTS: 1 DIF: Cognitive Level: Analysis REF: 64 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of intimate partner violence (IPV)? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions. ANS: B The patient may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and doesnt necessarily indicate IPV. . It is normal for the woman to have a flat affect. PTS: 1 DIF: Cognitive Level: Analysis REF: 61 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 18. A 20-year-old patient calls the clinic to report that she has found a lump in her breast. The nurses best response is: a. Dont worry about it. Im sure its nothing. b. Wear a tight bra, and it should shrink. c. Many women have benign lumps and bumps in their breasts. However, to make sure that its benign, you should come in for an examination by your physician. d. Check it again in 1 month and call me back if its still there. ANS: C The nurse should try to ease the clients fear, but provide a time for a thorough evaluation of the lump because it may indicate abnormal changes in the breast. Discrediting the patients findings may discourage her from continuing with breast self-examination. Wearing a tight bra may irritate the skin and would not cause the lump to shrink. Delaying treatment may allow proliferation of abnormal cells. PTS: 1 DIF: Cognitive Level: Analysis REF: 44 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 19. The female reproductive organ(s) responsible for cyclic menstruation is/are the: a. Uterus. c. Vaginal vestibule. b. Ovaries. d. Urethra. ANS: A 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 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 40 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 20. The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: a. Perineum. c. Vaginal vestibule. b. Bony pelvis. d. Fourchette. ANS: B 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 42 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 21. A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the phase of the endometrial cycle. a. Menstrual c. Secretory b. Proliferative d. Ischemic ANS: C 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 22. The stimulated release of gonadotropin-releasing hormone and follicle-stimulating hormone is part of the: a. Menstrual cycle. c. Ovarian cycle. b. Endometrial cycle. d. Hypothalamic-pituitary cycle. ANS: D The menstrual, endometrial, and ovarian cycles are interconnected. However, the cyclic release of hormones is the function of the hypothalamus and pituitary glands. PTS: 1 DIF: Cognitive Level: Knowledge REF: 45 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 23. 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). ANS: B 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 47 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 24. 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. b. Rectovaginal palpation. d. A four As procedure. ANS: C The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the clients 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 67 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 30. As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old client 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 you. ANS: C During adolescence, one breast may grow faster than the other. Discussion regarding 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 clients 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 patients stress, it does not correct the patients deficient knowledge related to normal growth and development. PTS: 1 DIF: Cognitive Level: Application REF: 69 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 31. 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. d. I will use the palm of the hand to perform the examination. ANS: B 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. PTS: 1 DIF: Cognitive Level: Analysis REF: 44 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 32. 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 ANS: C 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 53 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 33. A woman who is older than 35 years may have difficulty achieving pregnancy 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 ANS: C 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 50 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 34. The most dangerous effect on the fetus of a mother who smokes cigarettes 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 ANS: D 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 53 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 35. Despite warnings, prenatal exposure to alcohol continues to exceed by far exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which is category is not associated with a diagnosis of FAS? a. Respiratory conditions c. CNS abnormality b. Impaired growth d. Craniofacial dysmorphologies ANS: A Respiratory difficulties are not a category of conditions that are related to FAS. Abnormalities related to FAS include organ deformities, genital malformations, and kidney and urinary defects. Impaired growth is a visible marker for FAS. CNS abnormalities with neurologic and intellectual impairments are categories used to assist in the diagnosis of FAS. An infant with FAS manifests at least two craniofacial abnormalities, such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip, or flattening of the maxilla. PTS: 1 DIF: Cognitive Level: Knowledge REF: 54 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 36. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, It was all my fault. The house was so messy when he got home and I know he hates that. The best response by the nurse is: a. No one deserves to be hurt. Its not your fault. How can I help you? b. What else do you do that makes him angry enough to hurt you? c. He will never find out what we talk about. Dont worry. Were here to help you. MSC: Client Needs: Health Promotion and Maintenance NOT: These guidelines are applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman. 43. ANS: C PTS: 1 DIF: Cognitive Level: Application REF: 71 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: These guidelines are applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman. 44. ANS: B PTS: 1 DIF: Cognitive Level: Application REF: 71 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: These guidelines are applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman. Chapter 04: Reproductive System Concerns MULTIPLE CHOICE 1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. c. Lack of exercise. b. Type 1 diabetes mellitus. d. Hysterectomy. ANS: C Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities, type 1 diabetes mellitus, and hysterectomy all are possible causes of amenorrhea. PTS: 1 DIF: Cognitive Level: Comprehension REF: 74 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping ANS: D Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia. PTS: 1 DIF: Cognitive Level: Analysis REF: 76 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. I feel irritable and moody a week before my period is supposed to start. b. I have lower abdominal pain beginning the third day of my menstrual period. c. I have nausea and headaches after my period starts, and they last 2 to 3 days. d. I have abdominal bloating and breast pain after a couple days of my period. ANS: A PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS. However, the timing reflected is inaccurate. PTS: 1 DIF: Cognitive Level: Application REF: 78 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. c. Primary dysmenorrhea. b. PMS. d. Secondary dysmenorrhea. ANS: A Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea. PTS: 1 DIF: Cognitive Level: Comprehension REF: 80 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness. ANS: D Nafarelin is a GnRH agonist, and its side effects are similar to effects of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH and is administered twice daily by nasal spray. PTS: 1 DIF: Cognitive Level: Comprehension REF: 80 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 11. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established. ANS: C PMS may manifest with one or more of a hundred or so physical and psychologic symptoms. PMDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea; the medical treatment is much the same. The cause of PMS is unknown. It may be a collection of different problems. PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 12. With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility. ANS: C Symptoms vary among women, ranging from nonexistent to incapacitating. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis is found equally in white and African-American women and is slightly more prevalent in Asian women. Women can experience painful intercourse and impaired fertility. PTS: 1 DIF: Cognitive Level: Knowledge REF: 80 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. c. Leiomyoma. b. Menorrhagia. d. Metrorrhagia. ANS: D Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants. Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding. PTS: 1 DIF: Cognitive Level: Knowledge REF: 82 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 14. As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids. ANS: A Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen. PTS: 1 DIF: Cognitive Level: Knowledge REF: 82 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 15. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin. ANS: C NSAIDs are prostaglandin inhibitors and show the strongest research results for pain relief. Often if one NSAID is not effective, another one can provide relief. Approximately 80% of women find relief from NSAIDs. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have numerous potential side effects. NSAIDs are the drug of choice. If a woman is taking a NSAID, she should avoid taking aspirin. PTS: 1 DIF: Cognitive Level: Application REF: 76 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 16. The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors. ANS: D Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals and individuals with less education may be unaware of proper prevention techniques; however, these are not the primary areas of risk for STIs. Having a large number of sexual partners is a risk-taking behavior, but race does not increase the risk for STIs. PTS: 1 DIF: Cognitive Level: Knowledge REF: 83 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. c. Chlamydia. b. Syphilis. d. Candidiasis. ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Gonorrhea and syphilis are bacterial STIs, but they are not the most common ones among American women. Candidiasis is caused by a fungus, not by bacteria. PTS: 1 DIF: Cognitive Level: Knowledge REF: 85 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 18. The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). PTS: 1 DIF: Cognitive Level: Comprehension REF: 96 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 24. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. c. Podophyllin. b. Ofloxacin. d. Zidovudine. ANS: D Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for HSV. Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus. PTS: 1 DIF: Cognitive Level: Knowledge REF: 95 OBJ: Nursing Process: Planning, Implementation MSC: Client Needs: Health Promotion and Maintenance 25. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV) ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of HSV infection commonly have only local symptoms that usually are less severe than the symptoms of the initial infection. With HPV infection, lesions are a chroni problem. HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with HIV infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection. PTS: 1 DIF: Cognitive Level: Comprehension REF: 91 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 26. The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. c. 6 to 8 weeks. b. 2 to 4 weeks. d. 6 months. ANS: C Seroconversion to HIV positivity usually occurs within 6 to 8 weeks after the virus has entered the body. PTS: 1 DIF: Cognitive Level: Knowledge REF: 94 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 27. A 25-year-old single woman comes to the gynecologists office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, What is that? Can you get rid of it? Your best response is: a. Its just a little lump on your cervix. We can freeze it off. b. HPV stands for human papillomavirus. It is a sexually transmitted infection (STI) that may lead to cervical cancer. c. HPV is a type of early human immunodeficiency virus (HIV). You will die from this. d. You probably caught this from your current boyfriend. He should get tested for this. ANS: B It is important to inform the patient about STIs and the risks involved with HPV. The health care team has a duty to provide proper information to the patient, including information related to STIs. HPV and HIV are both viruses that can be transmitted sexually, but they are not the same virus. The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is the initial symptom. The client may have had HPV before her current boyfriend. You cannot make any deductions from this limited information. PTS: 1 DIF: Cognitive Level: Analysis REF: 91 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 28. Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing. ANS: B Contaminated milk and shellfish are common sources of infection with hepatitis A. A vaccine exists for hepatitis B but not for hepatitis C. Hepatitis B is more contagious than HIV. The incidence of hepatitis C is increasing. PTS: 1 DIF: Cognitive Level: Knowledge REF: 92 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 29. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely. ANS: A When the nurse opens discussion on safe sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills. These include role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, this is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about this. If they appear reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. This information is important; however, it is not germane if the woman cannot even discuss strategies on how to enhance condom use. PTS: 1 DIF: Cognitive Level: Analysis REF: 92 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 30. The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown. ANS: D The exact cause of breast cancer is unknown. Risk factors help to identify less than 30% of women in whom breast cancer eventually will develop. Women detect about 90% of all breast lumps. Of this 90%, only 20% to 25% are malignant. One in eight women in the United States will develop breast cancer in her lifetime. ANS: C The woman should not be advised to wear snug clothing. Rather, she should be advised to avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected arm. As part of the teaching plan, the woman should be instructed to empty surgical drains, to avoid lifting more than 10 lb or reaching above her head, and to report the development of incision site inflammation. PTS: 1 DIF: Cognitive Level: Application REF: 100 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 36. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages. ANS: D Fibroadenomas are characterized by discrete, usually solitary lumps smaller than 3 cm in diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages. Inflammation of the milk ducts is associated with mammary duct ectasia, not fibroadenoma. A thick, sticky discharge is associated with galactorrhea, not fibroadenoma. Lumpiness before menstruation is associated with fibrocystic changes of the breast. PTS: 1 DIF: Cognitive Level: Knowledge REF: 100 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 37. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the womans side. ANS: A The affected arm should not be used for BP readings, IV therapy, or venipuncture. The affected arm should be elevated with pillows above the level of the right atrium. PTS: 1 DIF: Cognitive Level: Application REF: 105 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 38. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. c. Intraductal papilloma. b. Lipoma. d. Mammary duct ectasia. ANS: C Intraductal papilloma is the only benign breast mass that is nonpalpable. Fibroadenoma is well delineated, palpable, and movable. Lipoma is palpable and movable. Mammary duct ectasia is not well delineated and is immobile, but it is palpable and painful. PTS: 1 DIF: Cognitive Level: Application REF: 100 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 39. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary. ANS: A Diuretic administration plus a decrease in sodium and fluid intake are recommended. Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced. Vitamin E supplements are recommended; however, the client should avoid megadoses because this is a fat-soluble vitamin. Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs. PTS: 1 DIF: Cognitive Level: Application REF: 79 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 40. The nurse providing care in a womens health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia ANS: D The usual treatment for infection by the bacterium Chlamydia is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. There is no known cure for herpes, and treatment focuses on pain relief and preventing secondary infections. Because there is no known cure for AIDS, prevention and early detection are the primary focus of care management. Condylomata acuminata are caused by human papillomavirus. No treatment eradicates the virus. PTS: 1 DIF: Cognitive Level: Knowledge REF: 85 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 41. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. c. Chronic cystic disease. b. Intraductal papilloma. d. Fibroadenoma. ANS: A Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. Fibroadenoma is evidenced by fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules. PTS: 1 DIF: Cognitive Level: Knowledge REF: 100 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 42. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman c. A 16-year-old girl b. A 50-year-old woman d. A 27-year-old woman ANS: C Although it may occur at any age, fibroadenoma is most common in the teenage years. Ductal ectasia and intraductal papilloma become more common as a woman approaches menopause. Fibrocystic breast changes are more common during the reproductive years. PTS: 1 DIF: Cognitive Level: Comprehension REF: 100 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 43. The drug of choice for treatment of gonorrhea is: a. Penicillin G. c. Ceftriaxone. one alcoholic beverage per day. Early menarche and late menopause are risk factors for breast malignancy, not late menarche and early menopause. PTS: 1 DIF: Cognitive Level: Comprehension REF: 101 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance MATCHING Herbal preparations have long been used for the management of menstrual problems, including dysmenorrhea cramping and discomfort, and breast pain. For the nurse to counsel adequately the client who elects to use this alternative modality, it is important to understand the action of these herbal preparations. Match the herbal medicine with the appropriate action. a. Uterine antispasmodic b. Uterotonic c. Antiinflammatory d. Estrogen-like luteinizing hormone suppressant e. Decreases prolactin levels 48. Fennel, dong quai 49. Chaste tree fruit 50. Black cohosh 51. Valerian, wild yam 52. Ginger 48. ANS: B PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions. 49. ANS: E PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions. 50. ANS: D PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions. 51. ANS: A PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions. 52. ANS: C PTS: 1 DIF: Cognitive Level: Comprehension REF: 78 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions. Chapter 05: Infertility, Contraception, and Abortion MULTIPLE CHOICE 1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle? a. Hysterosalpingogram b. Endometrial biopsy c. Laparoscopy d. Follicle-stimulating hormone (FSH) level ANS: B Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy usually is scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. PTS: 1 DIF: Cognitive Level: Knowledge REF: 111 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 2. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurses most appropriate response is: a. Your sperm count seems to be okay in the first semen analysis. b. Only marijuana cigarettes affect sperm count. c. Smoking can give you lung cancer, even though it has no effect on sperm. d. Smoking can reduce the quality of your sperm. ANS: D Use of tobacco, alcohol, and marijuana may affect sperm counts. Your sperm count seems to be okay in the first semen analysis is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. A single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. PTS: 1 DIF: Cognitive Level: Application REF: 111 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 3. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but a. Is perceived differently by women and men. b. Has a relatively stable prevalence among the overall population and throughout a womans potential reproductive years. c. Is more likely the result of a physical flaw in the woman than in her male partner. d. Is the same thing as sterility. ANS: A Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a womans age, especially after age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility, or subfertility, is a state of requiring a prolonged time to conceive. PTS: 1 DIF: Cognitive Level: Comprehension REF: 114 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 8. With regard to the assessment of female, male, and couple infertility, nurses should be aware that: a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation takes 3 to 4 months and a significant financial investment. c. The woman is assessed first; if she is not the problem, the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women. ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple. PTS: 1 DIF: Cognitive Level: Application REF: 112 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. In their role of implementing a plan of care for infertile couples, nurses should: a. Be comfortable with their sexuality and nonjudgmental about others to counsel their clients effectively. b. Know about such nonmedical remedies as diet, exercise, and stress management. c. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid. d. Do all of the above plus be knowledgeable about potential drug and surgical remedies. ANS: D Nurses should be open to and ready to help with a variety of medical and nonmedical approaches. PTS: 1 DIF: Cognitive Level: Comprehension REF: 109 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? a. Risks of multiple gestation b. Whether or how to disclose the facts of conception to offspring c. Freezing embryos for later use d. Financial ability to cover the cost of treatment ANS: D Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Risk of multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time. PTS: 1 DIF: Cognitive Level: Application REF: 111 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 11. A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse: a. Obtain a history of menstrual cycle lengths for the past 6 to 12 months. b. Determine the clients weight gain and loss pattern for the previous year. c. Examine skin pigmentation and hair texture for hormonal changes. d. Explore the clients previous experiences with conception control. ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but it is not the most important aspect to assess for discussion of the calendar method. PTS: 1 DIF: Cognitive Level: Analysis REF: 121 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 12. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. The nurses most appropriate response is: a. This probably means that youre pregnant. b. Dont worry; its probably nothing. c. Have you been sick this month? d. You probably didnt ovulate during this cycle. ANS: D The absence of a temperature decrease most likely is the result of lack of ovulation. Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as Dont worry; its probably nothing discredits the clients concerns. Illness would most likely cause an increase in BBT. PTS: 1 DIF: Cognitive Level: Application REF: 122 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is: a. Theyre not very effective, and its very likely youll get pregnant. b. They can be effective for many couples, but they require motivation. c. These methods have a few advantages and several health risks. d. You would be much safer going on the pill and not having to worry. ANS: B avoid? a. Cervical cap c. Vaginal film b. Condom d. Vaginal sheath ANS: A Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS. PTS: 1 DIF: Cognitive Level: Comprehension REF: 127 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 19. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurses most appropriate response is: a. The IUD does not interfere with sex. b. The risk of pelvic inflammatory disease (PID) will be higher for you. c. The IUD will protect you from sexually transmitted infections (STIs). d. Pregnancy rates are high with IUDs. ANS: B Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing a STI. The IUD does not protect against infection, as does a barrier method. Although the statement The IUD does not interfere with sex may be correct, it is not the most appropriate response. The IUD offers no protection from STIs. The typical failure rate of the IUD in the first year of use is 0.8%. PTS: 1 DIF: Cognitive Level: Application REF: 133 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 20. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. Dilation and evacuation (D&E). b. Instillation of hypertonic saline into the uterine cavity. c. Intravenous administration of Pitocin. d. Vacuum aspiration. ANS: A The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester. PTS: 1 DIF: Cognitive Level: Comprehension REF: 137 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 21. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by: a. Limiting sexual contact for one cycle after starting the pill. b. Using condoms and foam instead of the pill for as long as she takes an antibiotic. c. Taking one pill at the same time every day. d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle. ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users. If the client misses two pills during week 1, she should take two pills a day for 2 days, finish the package, and use a backup method the next 7 consecutive days. PTS: 1 DIF: Cognitive Level: Application REF: 131 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 22. A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her fertile time. She asks the nurse about emergency contraception. The nurse tells her that: a. It is too late; she needed to begin treatment within 24 hours after intercourse. b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy. c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting. d. The most effective approach is to use a progestin-only preparation. ANS: C To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogen- progestin pills. Women with contraindications to estrogen use should use progestin-only pills. PTS: 1 DIF: Cognitive Level: Analysis REF: 132 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 23. Which statement is true about the term contraceptive failure rate? a. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b. It refers to the minimum level that must be achieved to receive a government license. c. It increases over time as couples become more careless. d. It varies from couple to couple, depending on the method and the users. ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience. PTS: 1 DIF: Cognitive Level: Knowledge REF: 120 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 24. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning: a. Is the same as coitus interruptus, or pulling out. b. Uses the calendar method to align the womans cycle with the natural phases of the moon. c. Is the only contraceptive practice acceptable to the Roman Catholic church. d. Relies on barrier methods during fertility phases. ANS: C Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. Natural family planning is the only contraceptive practice acceptable to the Roman Catholic church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. PTS: 1 DIF: Cognitive Level: Comprehension REF: 121 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance that the womans social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge about contraception and commitment to any particular method. c. Assess the womans willingness to touch her genitals and cervical mucus. d. Evaluate the womans contraceptive life plan. ANS: B This is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partners willingness to participate. Although important, obtaining data about the frequency of coitus is not th first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive. PTS: 1 DIF: Cognitive Level: Analysis REF: 119 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 31. Postcoital contraception with Ovral: a. Requires that the first dose be taken within 72 hours of unprotected intercourse. b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose. c. Must be taken in conjunction with an IUD insertion. d. Is commonly associated with the side effect of menorrhagia. ANS: A Emergency contraception is most effective when used within 72 hours of intercourse; however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. The most common side effect of postcoital contraception is nausea. PTS: 1 DIF: Cognitive Level: Comprehension REF: 132 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 32. Informed consent concerning contraceptive use is important because some of the methods: a. Are invasive procedures that require hospitalization b. Require a surgical procedure to insert c. May not be reliable d. Have potentially dangerous side effects ANS: D To make an informed decision about the use of contraceptives, it is important for couples to be aware of potential side effects. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this should be included in the teaching. PTS: 1 DIF: Cognitive Level: Comprehension REF: 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment 33. A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurses most appropriate response is: a. This is a legitimate concern. Would you like to discuss this further before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound so that this will not happen. d. Ten percent is a very low risk, so you dont need to worry too much. ANS: A The incidence of multiple pregnancies with the use of these medications is significantly increased. The patients concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets is inaccurate and negates the patients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur. The percentage quoted in this statement is inaccurate. The comment dont worry discredits the patients concern. PTS: 1 DIF: Cognitive Level: Application REF: 116 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 34. You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out (Select all that apply)? a. It is highly unlikely that you will become pregnant after the procedure. b. This is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against sexually transmitted infections (STIs). d. Sterilization offers no protection against STIs. e. Your menstrual cycle will greatly increase after your sterilization. ANS: A, D A woman is unlikely to become pregnant after tubal ligation, although it is not 100% effective. Sterilization offers no protection against STIs. The menstrual cycle typically remains the same after a tubal ligation. PTS: 1 DIF: Cognitive Level: Application REF: 134 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance MATCHING Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause. a. Ovarian d. Vaginal/cervical b. Tubal/peritoneal e. Other factors c. Uterine 35. Endometrial or myometrial tumors 36. Anorexia 37. Isoimmunization 38. Thyroid dysfunction or obesity 39. Endometriosis 35. ANS: C PTS: 1 DIF: Cognitive Level: Comprehension REF: 110 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance NOT: Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Ashermans syndrome. Vaginal- cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions. 36. ANS: A PTS: 1 DIF: Cognitive Level: Comprehension Chapter 06: Genetics, Conception, and Fetal Development MULTIPLE CHOICE 1. A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby wont be affected. What response by the nurse is most accurate? a. Good planning; you need to take advantage of the odds in your favor. b. I think youd better check with your doctor first. c. You are both carriers, so each baby has a 25% chance of being affected. d. The ultrasound indicates a boy, and boys are not affected by PKU. ANS: C The chance is one in four that each child produced by this couple will be affected by PKU disorder. This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder because PKU is an autosomal recessive disorder. PTS: 1 DIF: Cognitive Level: Application REF: 142 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 2. The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: a. Tell the couple they need to have an abortion within 2 to 3 weeks. b. Explain that the fetus has a 50% chance of having the disorder. c. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. d. Refer the couple to a psychologist for emotional support. ANS: C Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. The couple eventually may need emotional support, but the status of the pregnancy must be determined first. PTS: 1 DIF: Cognitive Level: Comprehension REF: 153 OBJ: Nursing Process: Planning, Implementation MSC: Client Needs: Physiologic Integrity 3. The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that: a. Both genes of a pair must be abnormal for the disorder to be expressed. b. Only one copy of the abnormal gene is required for the disorder to be expressed. c. The disorder occurs in males and heterozygous females. d. The disorder is carried on the X chromosome. ANS: A MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed. MSUD is not an X-linked dominant or recessive disorder or an autosomal dominant inheritance disorder. PTS: 1 DIF: Cognitive Level: Comprehension REF: 146 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as: a. Anxiety and altered family relationships. b. Denial of insurance benefits. c. High false-positive results associated with genetic testing. d. Ethnic and socioeconomic disparity associated with genetic testing. ANS: B Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing. PTS: 1 DIF: Cognitive Level: Comprehension REF: 143 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 5. A mans wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: a. Occurrence risk. c. Predictive testing. b. Recurrence risk. d. Predisposition testing. ANS: B The couple already has a child with a genetic disease so they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing. PTS: 1 DIF: Cognitive Level: Comprehension REF: 147 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 6. A key finding from the Human Genome Project is: a. Approximately 20,000 genes make up the genome. b. All human beings are 80.99% identical at the DNA level. c. Human genes produce only one protein per gene; other mammals produce three proteins per gene. d. Single gene testing will become a standardized test for all pregnant clients in the future. ANS: A Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care. PTS: 1 DIF: Cognitive Level: Knowledge REF: 141 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 7. You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome What nursing diagnosis would be the most essential in caring for the mother of this infant? a. Disturbed body image c. Anxiety b. Interrupted family processes d. Risk for injury ANS: B This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Women commonly experience body image disturbances in the postpartum period; however, this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. Risk for injury is not an applicable nursing diagnosis. PTS: 1 DIF: Cognitive Level: Application REF: 143 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity ANS: A The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individuals genotype. The karyotype is a pictorial analysis of the number, form, and size of an individuals chromosomes. Genotype refers to an individuals genetic makeup. PTS: 1 DIF: Cognitive Level: Knowledge REF: 143 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. With regard to chromosome abnormalities, nurses should be aware that: a. They occur in approximately 10% of newborns. b. Abnormalities of number are the leading cause of pregnancy loss. c. Down syndrome is a result of an abnormal chromosome structure. d. Unbalanced translocation results in a mild abnormality that the child will outgrow. ANS: B Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Chromosome abnormalities occur in less than 1% of newborns. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects. PTS: 1 DIF: Cognitive Level: Comprehension REF: 144 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity 14. A womans cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. We dont really know when such defects occur. b. It depends on what caused the defect. c. They occur between the third and fifth weeks of development. d. They usually occur in the first 2 weeks of development. ANS: C The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. We dont really know when such defects occur is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. They usually occur in the first 2 weeks of development is an inaccurate statement. PTS: 1 DIF: Cognitive Level: Application REF: 156 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 15. A pregnant woman at 25 weeks gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a. That must have been a coincidence; babies cant respond like that. b. The fetus is demonstrating the aural reflex. c. Babies respond to sound starting at about 24 weeks of gestation. d. Let me know if it happens again; we need to report that to your midwife. ANS: C Babies respond to sound starting at about 24 weeks of gestation is an accurate statement. That must have been a coincidence; babies cant respond like that is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, Let me know if it happens again; we need to report that to your midwife is not appropriate; it gives the impression that something is wrong. PTS: 1 DIF: Cognitive Level: Application REF: 159 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 16. At approximately weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 c. 28 b. 24 d. 30 ANS: C These milestones human development occur at approximately 28 weeks. PTS: 1 DIF: Cognitive Level: Knowledge REF: 161 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. The nurse caring for the laboring woman should know that meconium is produced by: a. Fetal intestines. c. Amniotic fluid. b. Fetal kidneys. d. The placenta. ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. PTS: 1 DIF: Cognitive Level: Knowledge REF: 158 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 18. A woman asks the nurse, What protects my babys umbilical cord from being squashed while the babys inside of me? The nurses best response is: a. Your babys umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby. b. Your babys umbilical floats around in blood anyway. c. You dont need to worry about things like that. d. The umbilical cord is a group of blood vessels that are very well protected by the placenta. ANS: A Your babys umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby is the most appropriate response. Your babys umbilical floats around in blood anyway is inaccurate. You dont need to worry about things like that is an inappropriate response. It negates the clients need for teaching and discounts her feelings. The placenta does not protect the umbilical cord. The cord is protected by the surrounding Wharton jelly. PTS: 1 DIF: Cognitive Level: Application REF: 153 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 19. The is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream. a. Decidua basalis c. Germ layer b. Blastocyst d. Chorionic villi ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst. PTS: 1 DIF: Cognitive Level: Comprehension REF: 151 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 20. A woman who is 8 months pregnant asks the nurse, Does my baby have any antibodies to fight infection? The most appropriate response by the nurse is: a. Your baby has all the immune globulins necessary: IgG, IgM, and IgA. b. Your baby wont receive any antibodies until he is born and you breastfeed him. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing. ANS: B The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side. PTS: 1 DIF: Cognitive Level: Comprehension REF: 155 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 26. With regard to the development of the respiratory system, maternity nurses should be understand that: a. The respiratory system does not begin developing until after the embryonic stage. b. The infants lungs are considered mature when the lecithin/sphingomyelin (L/S) ratio is 1:1, at about 32 weeks. c. Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d. Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks. ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and accelerates lung maturity. Development of the respiratory system begins during the embryonic phase and continues into childhood. The infants lungs are mature when the L/S ratio is 2:1, at about 35 weeks. Lung movements have been seen on ultrasound scans at 11 weeks. PTS: 1 DIF: Cognitive Level: Knowledge REF: 158 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance 27. Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: a. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c. Identical twins are more common in white families. d. Fraternal twins are same gender, usually male. ANS: A If the parents-to-be are older and have taken fertility drugs, they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender. PTS: 1 DIF: Cognitive Level: Knowledge REF: 164 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 28. The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: a. In a side-lying position. b. On her back with a pillow under her knees. c. With the head of the bed elevated. d. On her abdomen. ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women find lying on her abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus. PTS: 1 DIF: Cognitive Level: Analysis REF: 156 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 29. Some of the embryos intestines remain within the umbilical cord during the embryonic period because the: a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing. ANS: D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas. PTS: 1 DIF: Cognitive Level: Knowledge REF: 158 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 30. A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is: a. You should have felt the baby move by now. b. Within the next month, you should start to feel fluttering sensations. c. The baby is moving; however, you cant feel it yet. d. Some babies are quiet, and you dont feel them move. ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that you should have felt the baby move by now is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary. PTS: 1 DIF: Cognitive Level: Knowledge REF: 162 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 31. A new mother asks the nurse about the white substance covering her infant. The nurse explains that the purpose of vernix caseosa is to: a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature. ANS: A Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system is dependent on nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. The amniotic fluid aids in maintaining fetal temperature. PTS: 1 DIF: Cognitive Level: Knowledge REF: 160 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 32. A woman who is 16 weeks pregnant asks the nurse, Is it possible to tell by ultrasound if the baby is a boy or girl yet? The best answer is: a. A babys sex is determined as soon as conception occurs.