ANSWER AND RATIONALE MATERNITY NURSING

Level II-Comprehensive Review November !!"

1. Anamarie is 22 years old and has missed two of her regular menstrual periods. Her doctor confirms an early, intrauterine pregnancy. she is married and works as a salesperson in a local department store. This is her first pregnancy. To determine Anamaries expected due date, which of the following assessments is most important? a. ates of the first menstrual period !. ate of the last intercourse c. ates of the last normal menstrual period d. Age at menarche

1. Answer ,. The dates of the last menstrual period, especially the first day of that period, will !e used in applying *ageles rule to determine the estimated date of deli$ery. The other information may !e gathered as part of general health history.

2. A 2"#year#old woman is pregnant with her first !a!y. uring her se$enth month, she complains of !ackache. The nurse teaches her to a. sleep on a soft mattress !. walk !arefoot at least once%day c. perform &egel exercises once%day d. wear low#heeled shoes

2. Answer . A fre-uent cause of !ackache in he third trimester of pregnancy is the com!ined effect of relaxation of the sacroiliac .oints and the change in the center of gra$ity of the pregnant woman due to the enlarging uterus. (earing low#heeled shoes, especially when on her feet for extended periods of time, will help to minimi/e this discomfort

'. The nurse is caring for a woman who is admitted to the hospital in acti$e la!or. (hat information is most important for the nurse to assess to a$oid respiratory complications during la!or and deli$ery? a. )amily history of lung disease !. )ood or drug allergies c. *um!er of cigarettes smoked daily d. (hen the client last ate

'. Answer . 0astric motility is decreased in pregnancy. )ood eaten se$eral hours prior to the onset of la!or may still !e in the stomach undigested. This will influence the type of anesthesia the client may recei$e. ,lient history of lung disease would !e more important than family history at this time. 1nformation on food or drug allergies will not help a$oid respiratory complications during la!or. 1nformation on the num!er of cigarettes smoked per day will not help a$oid respiratory complications during la!or

". +ean had a midline episiotomy performed at deli$ery. The primary purpose of the episiotomy is to a. allow forceps to !e applied !. enlarge the $aginal opening c. eliminate the possi!ility of lacerations d. eliminate the need for cesarean !irth

". Answer 2. An episiotomy is an incision made in the perineum to enlarge the $aginal opening, allowing additional room for the !irth of the !a!y. An episiotomy reduces the likelihood of perineal lacerations !ut does not eliminate it. cesarean !irth for women with large !a!ies is related to the si/e of the pel$is not the si/e of the $aginal opening.

3. +ean is admitted to the hospital in la!or. 4aginal examination re$eals that she is 5 cm dilated. At this point in her la!or, which

of the following statements would the nurse hear to make? a. 1 cant decide what to name my !a!y !. 1t feels good to push with each contraction c. Take your hand of my stomach when 1 ha$e a contraction d. This isnt as !ad as 1 expected

experience hyperesthesia of the skin at this time and would not to !e touched during a contraction. Transition is the most difficult stage of la!or. The client would not !e trying to decide what to name the !a!y at this time. The client would not !e instructed to push until the cer$ix is fully dilated.

6. The nurse is caring for a woman who is in la!or. 7he is 5 cm dilated. To support her during this phase of her la!or, the nurse should a. lea$e her alone most of the time !. offer her a !ack ru! during contractions c. offer her sips of oral fluids d. pro$ide her with warm !lankets

6. Answer 2. The counterpressure of a !ack ru! during a contraction may relie$e discomfort. The nurse should stay with the client at this time. The client should not !e ha$ing sips of water !y mouth at this time. 7he will most likely !e getting 14 fluids. The client will most likely !e hot !ecause of the increased meta!olic demands of la!or.

8. 9n the second day postpartum, the nurse asks the new mother to descri!ed her $aginal !leeding. The nurse should expect her to say that it is a. red and moderate c. scant and !rown !. red with clots d. thin and white

8. Answer a. <ochia ru!ra is moderate red discharge, present for the first 2#' days postpartum. :ultiple clots are a sign of lack of tone in the uterine musculature. 7cant, !rown discharge =lochia serosa> would !e present 8# 1? days after deli$ery. Thin, white discharge =lochia al!a>!egins around the tenth day and ends a!out three weeks following deli$ery. 5. Answer A. 0lucose can !e transferred from the serum to the !reast, and hyperglycemia may !e reflected in the !reastmilk. The production f milk will not !e impaired !ecause the mother is hyperglycemic. The !a!y will not recei$e insulin in the milk. 1f the mother is hyperglycemic her !lood sugar will !e no more difficult to manage. Howe$er, the nurse must stress as close to normal as possi!le at all times.

5. :iss ianne a dia!etic, plans to !reast# feed her !a!y. The nurse explains that, if she is hyperglycemic a. the glucose content of her !reast milk may !e high !. the production of milk may !e impaired c. her !a!y will recei$e insulin in the milk d. her !lood sugar ill !e extremely difficult to manage

;. +asmine deli$ered a male infant yesterday. (hile caring for her on her first postpartum day, which of the following !eha$iors would you expect? a. Asking specific -uestions a!out home care of the infant !. ,oncern a!out when her !owels will mo$e c. )re-uent crying spells for unexplained reasons d. Acceptance of the nurses suggestions a!out personal care
3. Answer ,. At 5 cm dilated the client is in the transition of het la!or. :any women

;. Answer . uring the first few days after deli$ery, the mother in a dependent phase, initiating little acti$ity herself, and is usually content to !e directed in her acti$ities !y a health care pro$ider. The other choices represent !eha$iors that are seen after his dependent phase

1?. +asmine deli$ered this morning. 2ecause this is +asmine first child, which of the following goals is most appropriate?

a. !. c. d.

@arly discharge for mother and !a!y Aapid adaptation to role of parent @ffecti$e education of !oth parents :inimal need for expression of negati$e feelings

information a!out the !a!y ha$e an information component, a skills component and a psychologic component

11. A new mother is going to !reastfeed her !a!y. (hat is the !est indication that the letdown reflex has !een achie$ed in a nursing mother? a. 1ncrease prolactin le$els !. :ilk dripping from the opposite !reast c. Brogressi$e weight gain in the infant d. Aelief of !reast engorgement 12. To pre$ent crackled nipples while she is !reast feeding, the mother should !e taught to a. apply lanolin prior to feedings !. nurse at least 2? minutes on each !reast the first day c. use plastic !ra liners d. wash her nipples with water only 1'. (hat is the !est indication that the !east fed !a!y is digesting the !reast milk properly? a. The !a!y does not experience colic !. The !a!y passes dark green, pasty stools c. The !a!y passers soft, golden yellow stools d. The !a!y sleeps for se$eral hours after each feeding 1". A 2"#year#old woman comes to the clinic !ecause she thinks she is pregnant. (hich of the following is the pro!a!le sign of pregnancy that the nurse would expect this client to ha$e? a. )etal heart tones !. *ausea and $omiting c. Amenorrhea d. ,hadwicks sign 13. A woman is entering the 2?th week of pregnancy. (hich normal change would the nurse expect to find on assessment? a. )undus .ust !elow diaphragm !. Bigment changes in skin c. ,omplaints of fre-uent urination d. 2lood pressure returning to prepregnancy le$el
1?. Answer ,. 2oth parents will need education a!out the new !a!yC how to care for the !a!y,

11. Answer 2. The nursing infant will stimulate let down, resulting in milk dripping form the other !reast. Brolactin indicator of milk let#down. 2reast engorgement will ultimately !e relie$ed

12. Answer . *ipples should !e washed with water =no soap> only to pre$ent drying. <anolin should !e applied after feeding. 2? minutes on each !reast the first day is much too long. The nursing mother should !egin with 3 minutes on each !reast as tolerated. The !reast should !e left open to air as much as possi!le. A plastic !ra liner would create and hold in moisture 1'. Answer ,. 2reast#fed !a!ies will pass 6 to 1? small, loose, yellow stools per day. There is no relationship !etween !reast#fed !a!ies and !a!ies who experience colic. ark green, pasty stools are seen in formula#fed infants. 7leeping relates more to the components of the milk and the fact that the !a!y is satisfied than the fact that the milk has !een digested properly.

1". Answer . Bro!a!le signs of pregnancy are the result of psychologic changes in the pel$ic organs and hormonal influences. )or example, the mucus mem!rane of the $ul$a, $agina, and cer$ix !ecome !luish =,hadwicks sign> as a result of hyperemia and proliferation of cells.

13. Answer 2. )rom 2?#2" weeks gestation, pigment changes in skin may occur from actions of hormones, These include the linea nigra, melasma on the face and striae gra$idarum =stretch marks>

16. :r. Aoda had her pregnancy confirmed and has completed her first prenantal $isit. ,onsidering that all data were found to !e

within normal limits, the nurse would plan that the next $isit should !e in a. one week c. one month !. two weeks d. two months 18. The pregnant couple asks the nurse what is the purpose of prepared child!irth classes. The nurses !est response would !e a. DThe main goal of the most types of child!irth classes is to pro$ide information that will help eliminate fear and anxiety.E !. DThe desired goal is child!irth without the use of analgesics.E c. DThese classes help to reduce the pain of child!irth exercise and relaxation methods.E d. DThe primary aim is to keep you and your !a!y healthy during pregnancy and afterFE 15. A pregnant woman, in the first trimester, is to ha$e a transa!dominal ultrasound. The nurse would include which of the following instructions? a. *othing !y mouth =*B9> from 6C??A: the morning of the test !. rink one of two -uarts of water and do not urinate !efore the test c. ,ome to the clinic first for in.ection of the contrast dye d. *o special instructions are need for this test 1;. :rs. )e, pregnant for the first time, calls the clinic to say she is !leeding. To o!tain important information the nurse should next asks a. D(hen did you last feel the !a!y mo$e?E !. DHow long ha$e you !een pregnant?E c. D(hen was your pregnancy test done?E d. DAre you ha$ing any uterine cramping?E 2?. :rs. Tina, "? weeks gestation, is admitted to the la!or and deli$ery unit with possi!le placenta pre$ia. 9n the admission assessment the nurse would expect to find a. signs of ,ou$elaire uterus !. se$ere lower a!dominal pain c. painless $aginal !leeding d. a !oard like a!domen

16. Answer ,. 1n a low risk pregnancy, the recommended fre-uency of prenatal $isits isC e$ery " weeks for the first 25 weeks, e$ery 2 weeks until the '6th week, then e$ery week until !irth.

18. Answer A. All programs in prepared child!irth ha$e some similaritiesG all ha$e an educational component to help eliminate fear

15. Answer 2. To o!tain clearer images during the first trimester, women are re-uired to drink one to -uarts of clear fluid to fill the urinary !ladder where it can !e more accurately scanned

1;. Answer 2. (hen a pregnant woman is !leeding $aginally, the nurse should first ask her how many weeks or months pregnant she isC management of !leeding differs in an early pregnancy contrasted with !leeding in late pregnancy. Additional information would include if tissue amniotic fluid was discharged and what other symptoms, such as cramps or pain, are present

2?. Answer ,. Blacenta pre$ia, when the placenta is implanted in the lower uterine segment, often is characteri/ed !y the sudden onset of !right red !leeding in the third trimester. Hsually this !leeding is painless and may or may not !e accompanied !y contractions.

21. Hsing <eopolds maneu$er to determine fetal position, the nurse finds that :rs.

<aura Is fetus is in a $ertex position with the !ack on the left side. (here is the !est place for the nurse to listen for fetal heart tones? a. in the right upper -uadrant of the mothers a!domen !. in the left upper -uadrant of the mothers a!domen c. 1n the right lower -uadrant of the mothers a!domen d. in the left lower -uadrant of the mothers a!domen 22. (hich of the following is the !est way for the nurse to asses contractions in a client presenting to the la!or and deli$ery area? a. Blace the client on the electronic fetal monitor with the la!or toco at the fundus !. Ask the client to descri!e the fre-uency duration, and strength of her contractions c. Hse <eopolds maneu$ers to determine the -uality of uterine contractions d. Blace the fingertips of one hand on the fundus to determine fre-uency, duration and strength of contraction 2'. :rs. 2erna is in acti$e la!or at " cm dilated, 1??J effaced, and ? station. As she is am!ulating she experiences a gush of fluid. (hat is the most appropriate initial action for the nurse to take? a. 7end a specimen of the amniotic fluid to the la!oratory for analysis !. Ha$e :rs. 2erna return to her room and place her in Trendelen!urg position to pre$ent cord prolapsed c. Ha$e :rs. 2erna return to her room so that you can assess fetal status, including auscultation of fetal heart tones or one full minute d. ,all :rs. 2ernas physician !ecause a cesarean deli$ery will !e re-uired 2". :rs. &athy deli$ered her infant son three hours ago. 7he had an episiotomy to facilitate deli$ery. As the nurse assigned to care for :rs. &athy, which of the following would !e the most appropriate action? a. Blace an ice pack on the perineum !. Apply a heat lamp on the perinuem c. Take :rs. &athy for a sit/ !ath d. Administer analgesics medication as ordered

21. Answer . The left lower -uadrant is the correct location since the !ack is on the left and the $ertex is in the pel$is

22. Answer . The fingertips of one hand allow the nurse to feel when the contraction !egins and ends and to determine the strength of !y the firmness of the uterus

2'. Answer ,. The most important nursing action after rupture of the mem!ranes us careful fetal assessment, including fetal heart tones counted for one minute.

2". Answer A. 1ce during the first 12 hours after deli$ery causes $asoconstriction and there!y pre$ents edema. 1ce also pro$ides pain relief through num!ing of the area

23. :rs., ,aren is scheduled for a cesarean section deli$ery due to a trans$erse fetal lie. (hat is the !est way for the nurse to

e$aluate that :rs. ,aren understands the procedure? a. Asks :rs. ,aren a!out the help she will ha$e at home after her deli$ery !. 0i$e :rs. ,aren a diagram of the !ody and ask her to draw the procedure to you c. Ask :rs. ,aren to tell you what she knows a!out the scheduled surgery d. Bro$ide :rs. , with a !ooklet explaining cesarean deli$eries when she arri$es at the hospital 26. (hich of the following o!ser$ations in the postpartum period would !e of most concern to the nurse? a. After deli$ery, the mother touches the new!orn with her fingertips !. The new parents asked the nurse to recommend a good !a!y care !ook c. A new father holds his son in the en face position while $isiting d. A new mother sits in !ed while her new!orn lies awake in the cri! 28. The nurse is assigned to assist in caring for a client admitted to the la!or unit, The client is dilated ;cm and is experiencing precipitous la!or. A priority nursing action is to a. Brepare for an oxytocin infusion !. &eep the client in a side#lying position c. Brepare the client for an epidural anesthesia d. @ncourage the client to start pushing with the contractions 25. A nurse is assigned to assist in caring for a client with a!ruption placenta who is experiencing $aginal !leeding. The nurse collects data from the client knowing hat a!ruption placentae is accompanied !y which additional finding? a. A!domen soft upon palpation !. *o complaints of a!dominal pain c. <ack of uterine irrita!ility or titanic contractions d. Hterine tenderness upon palpation

a additional -uestions, the nurse can then clarify or amplify the information

26. Answer . uring the early postpartum period, e$idence of maladapti$e mothering may include limited handling or smiling at the infant, studies ha$e shown that a predicta!le group of reciprocal interactions, !etween mother and !a!y, should take place with each encounter to foster and reinforce attachment.

28. Answer 2. Briority care of this client includes promotion of fetal oxygenation. Brecipitous la!or progresses -uickly with fre-uent contraction and short periods of relaxation !etween contractions. This does not allow for maximal reperfusion of the placenta with oxygenated !lood. A side#lying position can assist in !lood flow to the uterus !y pre$enting $ena ca$a and a!dominal aorta compression. )urther stimulation with oxytocin is contraindicated. There may not !e enough time to administer an epidural anesthesia !efore deli$ery with such -uick progression. Bushing with contractions is not indicated, especially with this type of la!or. ,ontrolled deli$ery of the fetus is essential to pre$ent maternal and fetal in.ury. 25. Answer . 4aginal !leeding in a pregnant client most often is caused !y placenta pre$ia or a placental a!ruption. Hterine tenderness accompanies a!ruptio placentae, especially with a central a!ruption and trapped !lood !ehind placenta. The a!domen will feel hard and !oarlike on palpitation as the !lood penetrates the myometrium and causes uterine irrita!ility. A sustained titanic contraction can occur if the client is in la!or and the uterine muscle cannot relax.

23. Answer ,. Asking for clarification of what :rs. , knows is the !est way to e$aluate what she understands of the procedure. 1f the client has

2;. A nurse is assigned to work in the deli$ery room and is assisting in caring for a client who has .ust deli$ered a new!orn infant. The nurse is monitoring for signs of

placental separation knowing that which of the following indicates that the placenta has separated? a. 7hortening of the um!ilical cord !. ecrease in !lood loss from the introitus c. ,hange in the uterine contour d. 7udden sharp a!dominal pain

a firmly contracted uterus, and the uterus changing from a discoid to glu!olar shape. The client may experience$aginal fullness, !ut not sudden and sharp a!dominal pain

'?. A nurse is assisting in caring for a client with a!ruption placenta. (hile caring for the client, the nurse notes that the client !egins to de$elop signs of shock. A first priority nursing action would !e toC a. Turn the client onto her side !. :onitor the maternal pulse c. :onitor urinary output d. :onitor the maternal !lood pressure

'?. Answer A. (ith a client in shock, the nurse want to increase perfusion to the placenta. A simple way to achie$e this that re-uires no e-uipment is to turn the mother on her side. This would increase !lood flow to the placenta !y relie$ing pressure from the gra$id uterus on the great $essels The nurse would immediately contact the registered nurse who would then contact the physician. The other option would follow -uickly.

'1. A nurse is asked to assist the primary health care pro$ider in performing <eopold maneu$ers on a client. (hich priority nursing inter$ention should !e implemented !efore this procedure is performed? a. <ocal fetal heart tones !. Ha$e the client drink 5 ounces of water c. (arm the sonogram gel d. Ha$e the client empty her !ladder

'1. Answer . An empty !ladder contri!utes to a womans comfort during the examination. rinking water to fill the !ladder in warming sonogram gel may !e done !efore a sonogram =ultrasound>. 9ften the <eopold maneu$ers are performed to aid the examiner in fetal heart tones.

'2. <eopolds maneu$ers will !e performed on a pregnant client. The client asks the nurse a!out this procedure. The nurse responds knowing that this procedureC a. etermines the DlieE and DattitudeE of the fetus !. is a systemic method for palpating the fetus through the maternal !ack c. 1s a systemic method for palpating the fetus through the maternal !ack d. :easures the height of maternal fundus

'2. Answer ,. <eopolds maneu$ers is a systemic method for palpating the fetus through the maternal a!dominal wall. 9ption A,2 and are incorrect.

2;. Answer ,. 7igns of placental separation include lengthening of the um!ilical cord, a sudden gush of dark !lood from the introitus,

''. A nurse is assigned to care for a client who is in early most important for the nurse to first determine which of the following? a. 1ntensity of contraction !. )re-uency of contractions

c. 2aseline fetal heart rate d. :aternal !lood pressure

'". A nurse is caring for a client in la!or. The nurse rechecks the clients !lood pressure and notes that it has dropped. To decrease the incidence of supine hypotension, the nurse should encourage the client to remain in which position? a. left lateral c. s-uatting !. semi#fowlers d. tailor sitting

'". Answer A. Bressure form the enlarged uterus and the aorta and $ena ca$a when the coma is supine can result in hypotension. This can !e relie$ed !y ha$ing the woman lie on her left side. 9ption 2,, and are incorrect

'3. A primigra$idas mem!ranes rupture spontaneously. The nurses first action is to a. :onitor contraction pattern !. etermine the fetal heart rate c. *ote the amount, color, and odor of the amniotic fluid d. Brepare fro immediate deli$ery

'3. Answer 2. (hen the mem!ranes rupture, the nurse immediately assess the fetal heart rate to detect exchanges associated with prolapsed or compression of the um!ilical cord. :onitoring the contraction pattern and noting the amount, color, and odor of the amniotic fluid may !e done !ut would not !e the first action. There is no information in the -uestion that indicates the necessity to prepare the client for immediate deli$ery. '6. Answer . The color of the lochia during the fourth stage of la!or is !right red. This may last form 1 to ' days. The color of the lochia then changes to a pinkish !rown that lasts " to 1? days. )inally, the lochia changes to a creamy white color that lasts approximately 1? to 1" days

'6. A nurse palpates the fundus and checks the character of lochia of a postpartum client in the fourth stage of la!or. The nurse expects the lochia to !eC a. white c. serosaguinous !. pink d. red '8. A nurse is assigned to care for a client in the postpartum period. The client asks the nurse what the term in$olution means. The nurse responds to the client knowing that in$olution meansC a. A progressi$e descent of the uterus into the pel$ic ca$ity occurring approximately 1 cm per day !. The gradual re$ersal of the uterine muscle into the a!dominal ca$ity c. The descent of the uterus into the pel$ic ca$ity occurring at the rate of 2cm a day d. The in$erted uterus returning to normal

'8. Answer A. 1n$olution is a progressi$e descent of the uterus into the pel$ic acti$ity. After !irth, descent occurs approximately 1 finger!readth, or approximately 1 cm per day

''. Answer ,. The nurse should first determine the !aseline fetal heart rate, Although option A, 2 and will !e a component of the data collection process the fetal heart rate is the priority.

'5. A mother is !reastfeeding her new!orn !a!y and experiences !reast engorgement. The nurse encourages the mother to which of the following measures to pro$ide comfort for the engorgement a. 2reastfeed only during the daytime hours !. Apply cold compresses to the !reast

c. massage the !reast !efore feeding to stimulate let down d. a$oid the use of !ra while the !reasts are engorged ';. A nurse is assisting in de$eloping a plan of care for a client in the fourth stage of la!or. (hich of the following pro!lems is most likely to occur during this stage? a. Bain !ecause of the process of la!or or !irth !. Anxiety related to child!irth c. )atigue resulting from physical exertion during la!or d. Hrinary retention caused !y the loss of sensation to a$oid and rapid !ladder filling "?. After deli$ery, a nurse checks the height of the uterus fundus. The nurse expects that the position of the fundus would most likely !e notedC a. At the le$el of the um!ilicus !. a!o$e the le$el of the um!ilicus c. 9ne finger!readth a!o$e the symphysis pu!is d. To the right of the a!domen "1. A nurse is assigned to care for a client after cesarean section. To pre$ent throm!ophle!itis, the nurse encourages the woman toC a. Am!ulate fre-uently !. Apply warm moist packs to the legs c. Aemain on !ed rest with the legs ele$ated d. (ear support stockings "2. A postpartum client has de$eloped throm!ophle!itis. The nurse knows that the affected extremity should !e ele$ated !yC a. @le$ating it on a pillow !. @le$ating the foot of the !ed c. Blacing the !ed in re$erse trendelen!urg position d. Blacing the !ed Trendelen!urg position
';. Answer . The fourth stage of la!or is composed of the first hour postpartum when the womans !ody !egins to read.ust and relax. 9ption A and 2 relate to the first stage of la!or. 9ption , relates to the second stage of la!or. 9ption is related to the third and fourth stages of la!or

"?. Answer A. 1mmediately after deli$ery, the uterine fundus should !e at the le$el of the um!ilicus or 1 to ' finger!readths !elow it and in the midline of the a!domen. 1f the fundus is a!o$e the um!ilicus, this may indicate that there are !lood clot in the uterus that need to !e expelled !y fundal massage. 1f the fundus is noted to the right of the a!domen. 1t may indicate a full !ladder.

"1. Answer a. 7tasis is !elie$ed to !e a ma.or predisposing factor in the de$elopment of throm!ophle!itis. 2ecause cesarean deli$ery poses a $risk factor, the client should am!ulate early and fre-uently to promote circulation and pre$ent stasis. 9ption 2,, and are implemented if throm!ophle!itis occurs.

"2. Answer . Blacing the !ed in Trendelen!urg position rather than flexing the leg at the hip promotes $enous drainage. The re$erse Trendelen!urg position will not aid in promoting $enous return. @le$ating the extremity !y using a pillow, or ele$ating the foot of the !ed will cause flexion at the hip, thus impeding $enous drainage.

'5. Answer ,. ,omfort measures for !reast engorgement include massaging the !reast !efore feeding to stimulate let#down wearing a supporti$e well#fitting !ra at all times, taking a warm shower or applying warm compresses .ust !efore feeding and alternating !reasts during feeding.

"'. A nurse suspects that a client has a pulmonary em!olism. The most important nursing action is toC a. Administer oxygen !y facemask as prescri!ed !. @le$ate the head of the !ed c. 1ncrease the 14 rate d. :onitor $ital signs

"". A nurse notes that the "#hour postpartum client has cool, clammy skin, and is restless and excessi$ely thirsty. The nurse immediately notifies the registered nurse and thenC a. @ncourages am!ulation !. ,hecks $ital signs c. 2egins fundal massage d. @ncourages the client to drink fluids "3. The new !reastfeeding mother is !eing discharged from the hospital after !eing treated for mastitis. The nurse knows that the mother needs further teaching when the mother statesC a. D1 need to change my !reasts pads when they are wet.E !. D1 will wash my !reasts gently with plain water. c. D:y left !reast is sore, so 1 will offer the right !reast fre-uently for !reastfeeding.E d. D(hen my !reasts feel engorged, 1 will use an ice pack fro the pain.E "6. The inner mem!rane the encloses the fluid medium for the em!ryo is theC a. )unis c. ,horion !. amnion d. Kolk sac

cool, clammy, pale skinG sensation of anxiety, restlessnessG and thirst. The nurse would check the $ital signs, The nurse would am!ulate the client or encourage fluids until specific orders are gi$en to do so. There is no information in the -uestion to indicate the need for fundal massage.

"3. Answer ,. )ailure to nurse e-uality on !oth sides will decrease the flow of milk through the !reast, causing engorgement of the !reast offered less fre-uently. 9ption A, 2 and are appropriate measures.

"6. Answer 2. The amnion encloses the em!ryo and the shock#protecti$e amniotic fluid in which the em!ryo floats. A. This is another name for the um!ilical cord. ,. The chorion is the outermost mem!raneG it does not secret fluid . The yolk sec contains the stored nutrients of the o$um "8. Answer ,. Brogesterone stimulates differentiation of the emdometrium into a secretory type of tissue. A. This is influenced !y high le$els of luteini/ing hormone. 2. This is influenced !y estrogen . 7econdary male characteristics are influenced !y testosterone

"8. The chief function of progesterone is theC a. stimulation of follicles for o$ulation to occur !. e$elopment of female reproducti$e organs c. Breparation of the uterus to recei$ed a fertili/ed o$um d. esta!lishment of the secondary male sex characteristics

"'. Answer A. !ecause pulmonary circulation is compromised in the presence of an em!olus, cardiorespiratory support is initiated !y oxygen administration. 9ption 2 and may !e a component of the plan of care !ut are not the most important action. The nurse would not increase the 14 rate with a physicians order to do so. "". Answer 2. 7ymptoms of hypo$olemia include

"5. uring the process of gametogenesis, the male and female sex cells di$ide, and each mature sex cell contains a. twenty two pairs of autosomes in their nuclei !. )orty six pairs of chromosomes in their nuclei c. a diploid num!er of chromosomes in their nuclei d. A haploid num!er of chromosomes in their nuclei

";. The placenta does not produce a. somatotropin

!. chorionic gonadotropin c. follicle#stimulating hormone d. progesterone precursor su!stances

of the placenta .,horionic gonadotropin is a precursor of progesterone and is secreted !y the tropho!lastic tissue 3?. Answer 2. 1n the first 8 to 1" days the de$eloping o$um is know as a !lastocystG it is called an em!ryo until the eighth weekG the de$eloping cells are then called a fetus until !irth A. The fetal heart is heard !etween the twelfth and twentieth weeks, the de$eloping cells are known as a fetus at the end of the eighth week. ,. At the time of implantation the group of de$eloping cells is called a !lastocyst . The de$eloping cells are known as a fetus from eighth week until !irth 31. Answer 2. To allow for the larger intake of air, the normal adaptation is to increase the si/e of the thoracic ca$ity a. 2lood $olume is not related to tidal air $olume c.Hpward displacement would decrease tidal air $olume . there is no change in the height of the ri! cage

3?. The de$eloping cells are called a fetus from theC a. Time the fetal heart is heard !. @ighth week to the time of !irth c. 1mplantation of the fertili/ed o$um d. end of the second week to the onset of la!or

31. uring pregnancy the $olume of tidal air increases !ecause there is a. an increased in total !lood $olume !. an increased expansion of the lower ri!s c. upward displacement of the diaphragm d. a relati$e increase in the height of the ri! cage

32. The uterus rises out of the pel$is and !ecomes an a!dominal organ at a!out the a. tenth week of pregnancy !. eighth week of pregnancy c. twelfth week of pregnancy d. eighteenth week of pregnancy

32. Answer c. 2y this time the fetus and placenta ha$e grown, expanding the si/e of the uterus. The extended uterus expands into the a!dominal ca$ity A. The uterus is till within the pel$ic area 2. The uterus is still within he pel$ic area at this time . The uterus has already risen out of the pel$is and is expanding farther into the a!dominal are

"5. Answer . This is the result of a reduced chromosome num!er, from "6 to 2', reducing the sex cells for fertili/ation A. They each ha$e one set of chromosomes =2'> 2. There are only 2' parts of chromosomes in the nuclei ,. The diploid num!er ="6 chromosomes> is reached when fertili/ation occurs

3'. )irst fetal mo$ements felt !y the mother are known as a. lightening c. !allottement !. -uickening d. engagement

";. Answer ,. )ollicle stimulating hormone is secreted form anterior pituitary gland. A. This is produced !y syncytiotropho!lastic tissue, a preplacental tissue. 2. ,horionic gonadotropin is secreted !y the tropho!lastic tissue, which makes up part

3". 1n prenatal de$elopment, fetal weight gain is greatest in theC a. first trimester c. second trimester !. third trimester d. implantation period

. This is the period of the !lastocyst, when initial cell di$ision takes place.

33. After the first ' months of pregnancy the chief source of estrogen and progesterone is the a. Blacenta c. ,orpus luteum !. Adrenal cortex d. anterior hypophysis

36. 1n fetal !lood $essels the oxygen content is highest in theC a. um!ilical artery c. pulmonary artery !. ductus $enosus d. ductus arteriosus

33. Answer A. (hen placental formation is complete, around the twelfth week of pregnancy, it produces progesterone and estrogen 2. This is not the chief source of progesterone and estrogenG only small amounts are secreted. ,. The corpus lutuem supplies the estrogen and progesterone needed to sustain the pregnancy until the placenta is ready to take o$er . )7H is secreted !y the anterior hypophysis, !ut it is not secreted during pregnancy 36. Answer 2. The um!ilical $ein carries !lood high in oxygen from the placenta and empties it into the fetal $ena ca$a !y way of the ductus $enosus A. The !lood in the um!ilical artery is more deoxygenated ,.The pulmonary artery carries only a small amount of oxygenated !lood, since the lungs are not functioning . This contains a mixture of arterial and $enous !lood. 38. Answer . 1ncreasing the clients knowledge of physical and physiologic changes resulting from pregnancy is done during the first trimester A. This is too early this would !e done in the last trimester The #lien$ sho%l& be 'ler$e&

38. Anticipatory guidance during the first trimester of pregnancy is primarily directed toward increasing the pregnant womans knowledge ofC a. <a!or and deli$ery !. signs of complication c. role transition into parenthood d. physical changes resulting from pregnancy

3'. Answer 2. The word originates the :iddle @nglish word -uik, which means ali$e. A. <ightening is the descent of the fetus into the !irth canal ,.2allotelment is the !ouncing of the fetus in the amniotic fluid against the examiners hand . @ngagement occurs when the presenting part is at the le$el of the ischial spines 3". Answer 2. This is the period in which the fetus stores deposits of fat. A.The first trimester is the period of organogenesis, when cells differentiate into ma.or organ system ,. 0rowth is occurring, !ut fat deposition does not occur in this period ,. 0rowth is occurring, !ut fat deposit deposition does not occur in this period

35. The nurse recogni/es that a normal, expected change in the hematologic system that occurs during the second trimester of pregnancy isC a. a decrease in (2,s !. an increase in hematocrit c. an increased in !lood $olume d. a decrease in sedimentation rate

3;. The nurse is aware that a normal adaptation of pregnancy is an increased !lood supply to the pel$ic region that results in a purplish discoloration of the $aginal mucosa, which is known asC a. <adins sign c. 0oodells sign

!. Hegars sign

d. ,hadwicks sign

6?. Bhysiologic anemia during pregnancy is a result of a. ecrease dietary intake of iron !. 1ncreased plasma $olume of the mother c. ecreased erythropoiesus after the first trimester d. increased detoxification demands on the mothers li$er

6?. Answer 2. There is a '?J or 3?J increase in maternal plasma $olume at the end of the first trimester, leading to a decrease in the concentration of hemoglo!in and erythrocytes A. ietary intake of iron is unrelated to the de$elopment of physiologic anemia of pregnancy ,.@rythropoiesis is increased after the first trimester . etoxification demands

61. 9n a first prenatal $isit, a client asks the nurse,E 1s it true the doctor will do an internal examination today?E The nurse should respondC a. DKes, an internal is done on all mothers on the first $isit.E !. DAre you fearful of ha$ing an internal examination done?E c. DKes. Ha$e you e$er, had an internal examination done !efore?E d. DKes, an internal is done on all mothers, !ut it is only slightly uncomforta!le.E

61. Answer ,. 2efore health teaching is instituted, the nurse should ascertain the clients past experiences, they will influence the teaching plan A. This answer does not gi$e the client a chance to discuss her feelings a!out the examination 2. This response presupposes a DyesE or DnoE answer and does not really gi$e the client an opportunity to discuss it further .This answer does not gi$e the client a chance to discuss her feelings a!out the examinationG the nurse can only assume that the clients concerns are related to discomfort

62.

62. A normal cardiopulmonary symptom experienced !y most pregnant women isC a. tachycardia !. dyspnea at rest c. progressi$e dependent edema d. shortness of !reath on exertion

Answer . A normal cardiopulmonary symptom in pregnancyG caused !y increased $entricular rate are ele$ated diaphragm. A. This is pathologic a sign of impending cardiac decompensation 2. 7ame as answer A ,. 7ame as answer A

35. Answer ,. The !lood $olume increase !y approximately 3?J during pregnancy. Beak food $olume occurs !etween '? and "? weeks of gestation A. (hite !lood cell $alues remain sta!le during the antepartum period 2. The hemnatocrit decreases as a result of hemodilution .The sedimentation rate increases !ecause of a decrease in plasma proteins 3;. Answer . A purplish color results from the increased $ascularity and !lood $essel engorgement of the $agina A. This is increased $ascularity and cer$ical softening 2. This is softening of the lower uterine segments ,. This is softening of the cer$ix

6'. A client asks the nurse why menstruation ceases once pregnancy occurs. The nurses !est response would !e that this occurs !ecause of theC a. DAeduction in the secretion of hormones !y the o$aries.E !. DBroduction of estrogen and progesterone !y the o$aries.E c. D7ecretion of luteini/ing hormone produced !y the pituitary.E d. DE7ecretion of follicle#stimulating hormone produced !y the pituitary.E 6". The nurse is aware that the nausea and $omiting commonly experienced !y many women during the first trimester of pregnancy is an adaptation to the increased le$el ofC a. estrogen !. progesterone

c. luteini/ing hormone d. chorionic gonadotropin 63. The nurse in the prenatal clinic should pro$ide nutritional counseling to all newly pregnant women !ecauseC a. :ost weight gain during pregnancy is fluid retention !. ietary allowances should increase during pregnancy c. Bregnant women must adhere to a specific pregnancy diet d. ifferent sources of essential nutrients are fa$ored !y different cultural group 66. A client in her eighth week of pregnancy complains of ha$ing to go to the !athroom often to urinate. The nurse explains to the client that urinary fre-uency often occurs !ecause the capacity of the !ladder during pregnancy is diminished !yC a. Atony of the detrusor muscle !. ,ompression !y the enlarging uterus c. ,ompromise of autonomic reflexes d. ,onstriction of the ureteral entrance at the trigone 68. The nurse can try to help a pregnant client o$ercome firs#trimester morning sickness !y suggesting that the client a. @at protein !efore sleep !. Take an antacid !efore !edtime c. @at nothing until the nausea su!side d. Ae-uest her care pro$ider to prescri!e an antiemetic

disappear after the first trimester ,. The luteini/ing hormone is present only during 63. Answer . The nurse should !ecome informed a!out the cultural eating patterns of clients so that foods containing the essential nutrients, which part of these dietary patterns, will !e included in the diet. A. )luid retention is only one component of weight gainG growth of the !a!y, placenta, !reasts, etc. also contri!ute to weigh gain. 2. ,alories and nutrients are increased during pregnancy ,. Bregnancy diets are not specificG they are merely composed of the essential nutrients 66. Answer 2. The uterus and !ladder occupy the pel$ic ca$ity and lie $ery closely togetherG as the uterus enlarges with the growing fetus, it impinges on the space normally occupied !y the !ladder and there!y diminishes !ladder capacity. A. Atony would not cause fre-uencyG more likely it would lead to retention ,. This would lead to incontinence rather than fre-uency . This is an unlikely occurrenceG the uterus would not impinge on that area. 68. Answer A. *ausea and $omiting of pregnancy can !e relie$ed with small snacks of protein !efore !edtime to slow, digestionG presently 7ea2ands =used for seasickness> are !eing used successfully on some women 2. An antacid may effect electrolyte !alanceG also this will not help morning sickness ,. This is unsound ad$ice, !ecause !oth fetus and mother need nourishment. . :edications in the first trimester are contraindicatedG this is the period of organogenesis, and congenital anomalies could resul

6'. Answer A. :enstruation during pregnancy is interrupted !ecause secretion of the o$arian hormones ceases. This response answers the clients -uestion in understanda!le terms. 2. These hormones are needed to re!uild the layers of cells lining the uterus that are sloughed off during menstruation ,. <H stimulates the maturation of a primiti$e follicle into a $esicular graafian follicleG also promotes secretion of estrogen !y the o$ary . This !rings a!out the de$elopment of the o$a 6". Answer . choionic gonadotropin, secreted in large amounts !y the placenta during gestation and the meta!olic changes associated with pregnancy can precipitate nausea and $omiting in early pregnancy . A. @strogen is ele$ated throughout pregnancyG symptoms of morning sickness disappear after the first trimester 2. Brogesterone is ele$ated throughout pregnancyG symptoms of morning sickness

65. A client is concerned a!out gaining weight during pregnancy. The nurse explains that the largest part of weight gain during pregnancy is !ecause ofC a. The fetus !. )luid retention c. :eta!olic alterations d. 1ncreased !lood $olume 6;. A client who is pregnant is !eing prepared for a pel$ic examination. The client complains of feeling $ery tired and sick her to stomach, especially in the morning. The !est response for the nurse to make isC a. DThis is common. There is no need to worry.E !. D,an you tell me how you feel in the morning?E c. DBerhaps you might ask the nurse midwife a!out it.E

d. D<ets discuss some ways to deal with these common pro!lems.E 8?. The !est ad$ice the nurse can gi$e to a pregnant woman in her first trimester is toC a. ,ut down on drugs, alcohol and cigarettes !. A$oid all drugs and refrain from smoking and ingesting alcohol c. A$oid smoking, limit alcohol consumption and do not take any aspirin d. Take only prescription drugs, especially in the second and third trimesters 81. A client who is pregnant asks the nurse if she can continue to ha$e sexual relations. The nurses response is !ased on the knowledge that coitus during pregnancy would !e contraindicated in the presence ofC a. leukorrhea !. increased )HA c. 0estation of '? weeks or more d. Bremature rupture of mem!ranes 82. (hen in$ol$ed in prenatal teaching, the nurse should inform clients that an increase in $aginal secretions during pregnancy is called leukorrhea caused !y increasedC a. meta!olic rates !. production of estrogen c. functioning of 2artholin glands d. 7upply of sodium chloride to the cells of $agina

8?. Answer 2. The grist trimester is the period when all ma.or organs are !eing laid downG drugs, alcohol and to!acco may cause ma.or defects A. ,utting down is insufficient these teratogens should !e eliminated ,.@$en 1 o/ of alcohol is considered harmfulG !ay aspirin is now gi$en to some women who are considered at risk for pregnancy induced hypertension . rugs unless a!solutely necessary, should !e a$oided throughout pregnancyG !ut the first trimester is most significant 81. Answer d. 1ntact mem!ranes act as a !arrier against organisms that may cause an intrauterine infection A. This is common !ecause of increased production of mucus containing exfoliated $aginal epithelial cellsG intercourse is not contraindicated 2. This may occur during sex !ut there is no literature indicating that it is harmful for the fetus ,. 1ntercourse is not contraindicated if mem!ranes are intactG modification of sexual positions may !e needed !ecause of an enlarged a!domen after the 1'th week. 82. Answer 2. The increase of estrogen during pregnancy cause hyperplasia of the $aginal mucosa, which leads to increased production of mucus !y the endocer$ical glands. The mucus contains exfoliated epithelial cells. A. 1ncreased meta!olism leads to many systemic changes !ut does not increase $aginal discharge. ,. *ormal functioning of the glands, which lu!ricate the $agina during intercourse, remains unchanged during pregnancy . There is no additional supply of sodium chloride to the cells during pregnancy

65. Answer A. The a$erage weight gain during pregnancy is 23 to '3 l!s =11.; to 13.5 kg>Gof this, the fetus accounts for 8 to 5 l!s ='.15 to '.6 kg>, or approximately '?J of weight gain. !. )luid retention accounts for a!out 2?J to 23J of weight gain c. meta!olic alterations do not cause weight gain d. increased !lood $olume accounts for a!out 12J to 16J of weight gain 6;. Answer . This allows the client to discuss her feelings and participate in her care. A. This cuts off communicationG this also may cause the client to worry that something is seriously wrong 2. The client has already told the nurse how she feels ,. This statement cuts off communication and does not address the totality of the clients concern

8'. At a prenatal $isit at '6 weeks gestation, a client complains of discomfort with 2raxton Hicks contractions. The nurse instructs the client to a. <ie down until they stop !. (alk around until they su!side c. Time the contractions for L hour d. Take 1? grains of aspirin for the discomfort 8". (hen teaching a young primigra$ida a!out la!or, the nurse should tell her to come to the hospital whenC a. ,ontractions are 1? to 13 minutes apart !. 7he ahs a !loody show and !ack pressure c. :em!ranes rupture or contractions are 3 to 5 minutes apart

d. ,ontractions are 2 to ' minutes apart and she cannot walk a!out

83. True la!or can !e differentiated from false la!or !ecause in true la!or contractions willC a. 2ring a!out progressi$e cer$ical dilation !. 9ccur immediately after mem!rane rupture c. 7top when the client is encouraged to walk around d. 2e less uncomforta!le if client is in a side lying position

family and mo$ing a!out at home 2. These may !e early signs of la!or or signs of posterior fetal position .This is indicati$e of ad$anced la!or, and the client may ha$e difficulty getting to the hospital at this time 83. Answer A. Brogressi$e dilation of the cer$ix is the most accurate indication of true la!or. 2.,ontractions may not !egin until 2" to "5 hours later ,. (ith true la!or contractions will increase with acti$ity . ,ontractions of true la!or persist in any position

86. The nurse teaches a pregnant woman to a$oid lying on her !ack during la!or. The nurse has !ased this statement on the knowledge that the supine position canC a. Hnduly prolong la!or !. ,ause decreased placental perfusion c. 1nterfere with free mo$ement of the coccyx d. <ead to transient episodes of hypertension 88. A client is admitted to the la!or room in early acti$e la!or. The priority nursing inter$ention on admission of this la!oring client would !eC a. Auscultating the fetal heart rate !. Taking an o!stetric history c. Asking the client when she ate last d. Ascertaining if the mem!ranes are ruptured

86. Answer 2. This is !ecause of impedance of $enous return !y the gra$id uterus, which causes hypotension and decreased systemic perfusion A. Thus may !e partially true, !ut more significantly it is the least comforta!le position and may cause hypotension ,.@$en if true this is not significant as a factor of la!or . This is falseG it can lead to supine position

88. Answer A. etermining fetal well#!eing supercedes all other measuresG if the fetal heart rate =)HA> si a!sent or persistently decelerating, immediate inter$ention is re-uired 2. 1mportant, !ut the determination of fetal well !eing is the priority ,. 7ame as answer 2 . 7ame as answer 2.

8'. Answer 2. Am!ulation relie$es 2raxton Hicks contractions A .2raxton Hicks contractions increase when the client is resting ,.These contractions are not indicati$e of true la!or and need not !e timed . Aspirin may !e harmful to the fetus !ecause it can hemoly/e red !lood cells 8". Answer ,. (hen the mem!ranes rupture, the potential for infection is increased, and when the contractions are 3 to 5 minutes apart, they are usually insufficient force to warrant medical super$ision. Therefore, the safety of the mother and fetus, the mother should go to the hospital. A. This is too earlyG the client still had a great deal of time and would !e !etter off wither

85. After doing <eopolds maneu$ers on a la!oring client, the nurse determines that the fetus is in the A9B position. To !est auscultate the fetal heart tones, the oppler is placedC a. A!o$e the um!ilicus in the midline !. A!o$e the um!ilicus on the left side c. 2elow the um!ilicus on the right side d. 2elow the um!ilicus near the left groin

8;. The nurse teaches that the most fre-uent side effect associated with the use of 1H s isC a. @ctopic pregnancy !. @xpulsion of the 1H c. Aupture of the uterus d. @xcessi$e menstrual flow

side effect ,. This may occur upon insertion !ut is fairly uncommon

5?. The nurse should explain that a common pro!lem that has !een associated with 1H s when they are used isC a. Berforation of the uterus !. iscomfort associated with coitus c. e$elopment $aginal infections d. 7pontaneous expulsion of the de$ice

5?. Answer . The 1H may cause irrita!ility of the myometrium, inducing contraction of the uterus and expulsion of the de$ice A. This is rare rather than a common occurrence 2. ,lients do not complain of discomfort during coitus when an 1H is in place ,. 1ncreased $aginal infections are not reported with the use of an 1H

51. A client seeking ad$ice a!out contraception asks the nurse a!out an 1H . The nurse explains that the 1H pro$ides contraception !yC a. 2locking the cer$ical os !. 1ncreasing the mo!ility of the uterus c. Bre$enting the sperm from reaching the $agina d. 1H s interfere with either fertili/ation or implantation, promoting contraception

51. Answer . 7perm are damaged !y copper 1H s, while progesterone 1H s interfere with endometrial maturation. A. iaphragm !locks the cer$ical os 2. :o!ility of the uterus is not related to contraception ,. This is the function of a condom

52. 1n a lecture on sexual functioning, the nurse plans to include the fact that o$ulation occurs when theC a. 9xytocin le$el is high !. 2lood le$el of <H is high c. Brogesterone le$el 1 shih d. @ndometrial wall is sloughed off

52. Answer 2. 1t is the surge of <H secretion in midcycle that is responsi!le for o$ulation A. This is not relatedG this stimulates e.ection of milk into the mammary ducts ,.This occurs when the progesterone le$el is low . This occurs when the endometrial wall is !uilt up

85. Answer ,. )etal heart tones are !est auscultated through the fetal !ackG !ecause the position is A9B =right occiput presenting>, teh!ack would !e !elow the um!ilicus and on the right side. A. This could !e used when the fetus is lying in the midline in a !reech position 2. This would !e appropriate for an <7A position . This would !e appropriate

5'. After o$ulation has occurred, the o$um is !elie$ed to remain $ia!le forC a. 1 to 6 hours c. 2" to '6 hours !. 12 to 15 hours d. "5 to 82 hours

8;. Answer . 7u!se-uent to 1H insertion, there may !e an excessi$e menstrual flow for se$eral cyclesG this is !ecause of an increase in the !lood supply resulting from the inflammatory process !ecause the 1H is really a foreign !ody A. There is no documentation of this 2. This may occur !ut is not classified as a

5". The time of o$ulation can !e determined !y taking the !asal temperature. uring o$ulation the !asal temperatureC a. rops markedly !. rops slightly and then rises c. Aises suddenly and then falls d. Aises markedly and remains high

53. (hen oral contracepti$es are prescri!ed for a client the nurse should teach the client a!out the potential of de$eloping

a. !. c. d.

,er$icitis o$arian cysts )i!rocystic disease !reakthrough !leeding

56. The nurse explains that the efficiency of the !asal !ody temperature =22T> method of contraception depends on fluctuation of the !asal !ody temperature. A factor that will alter its effecti$eness isC a. Bresence of stress !. <ength of a!stinence c. Age of those in$ol$ed d. )re-uency of intercourse 58. A factor in infertility may !e related to the pH of the $aginal canal. A medication that is ordered to alter the $aginal pH isC a. @strogen therapy !. 7ulfur insufflations c. <actic acid douches d. 7odium !icar!onate douches 55. A diagnostic test used is done to determine whether there is a tu!al o!struction. 1nfertility caused !y a defect in the tu!e is most often related to aC a. 1 week after o$ulation !. immediately after menses c. .ust !efore the next menstrual period d. within 1#2 days of presumed o$ulation
5'. Answer ,. The o$um is capa!le of !eing fertili/ed for only 2" to '6 hours following o$ulationG after this time it tra$els a $aria!le distance !etween the fallopian tu!e and uterus, disintegrate and phagocyti/ed !yluekocytes A. The o$um is $ia!le for 2" to '6 hours 2. The o$um is $ia!le a longer time a longer time .The o$um is not fertili/a!le after '6 hours 5". Answer 2. The o$ulation approaches there may !e a drop in the !asal temperature !ecause of an increased production of estrogenG when o$ulation occurs, there will !e rise in the !asal temperature !ecause of an increase production of progesterone A. At o$ulation the temperature drop is slight not marked ,.At o$ulation the temperature rises after a slight drop . At o$ulation the temperature drops slightly and then rises 53. Answer . This commonly occurs when clients first start an oral contracepti$es it is midcycle

!leeding and if it persists, pill dosage is changeg. A.,er$icitis is unrelated drop is slight not marked. 2. At this time there is no e$idence that o$arian cysts are related to pill use ,. )ir!rocystic !reast disease is unrelated to pill use. 56. Answer A. 7tress or infection alters the !odys meta!olism, causing an ele$ation in temperatureG a rise in temperature from these causes may !e misinterpreted as o$ulation. 2. This may increase sperm $olume !ut does not affect the females !asal temperature ,. Age is not a factor concerning efficiency of the rhythm method . )re-uency of intercourse may affect the $olume of sperm !ut does not alter the females !asal temperature. 58. Answer . 7perm motility is increased at pH $alues near neutral or slightly alkalineG a sodium !icar!onate douche will reduce the acidity of fluids in the $agina and help optimi/e the pH A. @strogen does not alter the pH 2. 7ulfur does not change the pH in any way ,. This would increase the acid content and kill the sperm 55. Answer . At this time. !ecause of increased estrogen le$els, the cer$ical mucus is a!undant and its -uality changes in such a way as to optimi/e sperm sur$i$al time A. ,er$ical mucus at this time is still thick and not yet recepti$e to spermato/oa 2. The cer$ical mucus at this time is not recepti$e to spermato/oa ,. ,er$ical mucus is destructi$e to spermato/oa at this time, and sperm penetration cannot occur.

5;. A tu!al insufflations test is done to determine whether there is a tu!al o!struction. 1nfertility caused !y a defect in the tu!e is most often related to a C a. past infection !. fi!roid tumor c. congenital anomaly d. pre$ious in.ury to a tu!e

;?. A test commonly used to determine the num!er, motility and acti$ity of sperm is theC a. Au!in test c. )riedman test !. Bostcoidal test d. Bapanicolaou test

;1. 1n the female e$aluation of the pel$ic organs of reproduction is accomplished !yC a. !iopsy c. culdoscopy !. cystoscopy d. hysterosalpingogram

;2. (hen assessing a client with a tentati$e diagnosis of hydatidiform mole, the nurse should !e alert for a. hypotension !. decreased )HA c. Hnusual uterine enlargement d. Bainless, hea$y $aginal !leeding

;'. The nurse would suspect an ectopic pregnancy if the client complained ofC a. An adherent painful o$arian mass !. <ower a!dominal cramping for a long period of time c. <eukorreha and dysuria a few days after the first missed period d. 7harp lower right or left a!dominal pain radiating to the shoulder ;". The most common type of ectopic pregnancy us tu!al. (ithin a few weeks after conception the tu!e may rupture suddenly, causingC a. Bainless $aginal !leeding !. 1ntermittent a!dominal contractions c. ,ontinuous dull, upper#-uadrant a!dominal pain d. 7udden knifelike, lower -uadrant a!dominal pain
5;. Answer A. Bast infections may cause tu!al occlusion, most of which are caused !y post infection adhesions. 2. This is a tumor of the uterus and does not affect the tu!e ,. This is rareG anomalies of the uterus are more common than those of a tu!e . This is possi!le !ut infection is the tu!e are more common ;?. Answer 2. This test determines the num!er and condition of sperm aspirated form the cer$ix within 2 hours after coitus A. The Au!in test determines the patency of the fallopian tu!es ,.)riedman test was a test done to esta!lish the diagnosis of pregnancyG it has !een replaced !y more sophisticated tests . The papanicolaou test is used for the early diagnosis of cer$ical cancer ;1. Answer . This test ena!les the examiner to $isuali/e the uterus and fallopian tu!es and

the pel$ic organs for reproduction. A. A !iopsy is the surgical excision of tissue for diagnostic purposes 2. A csytoscopy is used to e$aluate the urinary !ladder ,. A culdoscopy is the direct examination of female pel$ic $iscera using an endoscope introduced through a perforation in the $agina ;2. Answer ,. The proliferation of tropho!lastic tissue filled with fluid causes the uterus to enlarge more -uickly than it would with a normally growing fetus A. Hypertension not hypotension, often occurs with molar pregnancy 2. There is generally no li$ing fetus with a hydatidiform ,. There may !e slight $aginal !leeding without pain ;'. Answer . A fallopian tu!e is una!le to contain and sustain a pregnancy to termG as the fertili/ed o$um grows, there is excessi$e stretching or rupture of the fallopian tu!e, causing pain A. This would !e difficult for the client to identify correctly 2. The pain is sudden, intense, knifelike and usually located on one side ,. <eukorrhea an dysuria may !e indicati$e of a $aginal or !ladder infection ;". Answer . A symptom of sudden rupture of a fallopian tu!e is pain on the affected side, usually sudden, excruciating and radiating o$er the lower a!domen and to shoulderG sometimes the pain is associated with nausea, $omiting and diarrhea A. There may !e some $aginal !leeding with a ruptured tu!al pregnancyG usually se$ere pain is present 2. There are no contractions since the pregnancy is not uterine ,. The pain is ex-uisite, sharp and sudden in the lower a!domen

;3. A client who has missed two menstrual periods comes to the prenatal clinic complaining of $aginal !leeding and one# sided lower -uadrant pain. The nurse suspects that this client hasC a. A!ruptio placentae !. An ectopic pregnancy c. An incomplete a!ortion d. A rupture of a graafian follicle

;6. After a spontaneous a!ortion the nurse should o!ser$e the client forC a. Hemorrhage and infection !. ehydration and hemorrhage c. su!in$olution and dehydration d. signs of pregnancy#induced hypertension

;8. After a spontaneous are caused !yC a. physical trauma !. unresol$ed stress c. congenital defects d. germ plasma defects

;8. Answer . A!out 83J of all spontaneous a!ortions take place !etween 5 and 12 weeks of gestation and show em!ryonic defects. A. Through possi!le, physical trauma rarely causes an a!ortion 2. Hnresol$ed stress may lead to congenital defects !ut is rarely associated with a!ortion ,. ,ongenital defects are asymptomatic during pregnancy and do not usually cause an a!ortion. ;5. Answer . 7potting in the first trimester may indicate that the client may !e ha$ing a threatened a!ortionG any client with the possi!ility of hemorrhage should not !e left aloneG therefore, admitting the client for o!ser$ation is safe medical practiceG a!ortion is usually ine$ita!le if accompanied !y pain and cer$ical dilation. A. This may not cause any outward symptomsG only the signs of pregnancy disappearing 2. This can !e confirmed only if $aginal examination re$eals cer$ical dilation ,. This is usually accompanied !y se$ere pain radiating to the shoulder on the affected side ;;. Answer A. After a spontaneous a!ortion the fundus should !e checked for firmness, which would indicate effecti$e uterine toneG if the uterus is not firm or appears to !e hypotonic, hemorrhage may occurG a soft or !oggy uterus may also indicate retained placental tissue 2. The nurse would do this if necessary after checking fro fundal firmness ,. The priority action is to check fro firmness of the fundus and possi!le !leeding . This is unnecessaryG fetal and placental contents are small and expelled easily in !ed

;5. A client whose hus!and is o$erseas in the military is admitted to the hospital with $aginal staining !ut no pain. The clients history re$eals amenorrhea for the last 2 months and pregnancy confirmation !y het physician after her first missed period. 7he is admitted fro o!ser$ation room with a possi!le diagnosis ofC a. missed a!ortion !. ine$ita!le a!ortion c. ectopic pregnancy d. threatened a!ortion ;;. A few hours after !eing admitted with a diagnosis of ine$ita!le a!ortion, a client !egins to experience !earing#down sensations and suddenly expels the products of conception in !ed. To gi$e safe nursing care, the nurse should first a. check the fundus for firmness !. gi$e her the sedation ordered c. immediately notify the physician d. take her immediately to the deli$ery room
;3. Answer 2. @ctopic pregnancy is one of the leading causes of first#trimester !leeding unless an em!ryo and placenta happen to !e located in the a!dominal ca$ity, they cannot grow outside the uterus for more than 1? to 12 weeks without showing the classic signs of pressure and !leeding A. A!ruptio placentae is accompanied !y sharp a!dominal pain with or without !leeding ,.A!dominal cramping pain is present with an incomplete a!ortion . This occurs monthly during o$ulation without pain or $aginal !leeding, occasionally pain occurs when the follicle ruptures =mittelschmer/> !ut !leeding does not ;6. Answer A. Hemorrahge may result from retained placental tissue of uterine atonyG infection may !e occur from the introduction of organisms into the warm, moist en$ironment, which is fa$ora!le o micro!ial growth.

1??. After an incomplete a!ortion, a client ells the nurse that although her doctor explained what an incomplete a!ortion was, she did not understand. The nurse could !est respondC a. D1 really dont think you should focus on what happened right now.E !. DThis is when the fetus dies !ut is retained in the uterus for 5 weeks or more. c. D1 think would it !e !est if you asked your doctor for the answer to the -uestion.E d. DAn incomplete a!ortion is when the fetus is expelled !ut part of the placenta and mem!ranes are not.E

1??. Answer . A correct and simple definition answers the -uestion and fulfills the clients need to know. A. This denies the clients right to know 2. This is the definition of a missed a!ortion ,. The nurse can independency reinforce and clear misconceptions