Mosby's Question & Answer Practice PDF

Mosby's Question & Answer Practice ✨Rule For Success 👉 Don't wast time G 👉 Maintain continuity N SI R...

Mosby's Question & Answer Practice ✨Rule For Success 👉 Don't wast time G 👉 Maintain continuity N SI R U N AL IC N FOR PDF of This Book 📚 इस Book की PDF 👇 LI DOWNLOAD करने के लिए इस LINK पर CLICK करें । 👉https://t.me/Clinical_Nursing C SHARE YOUR FEEDBACK AND DOUBT👇 👉https://t.me/Clinical_Nursing1 THIS PDF PROVIDE ALL MOSBY'S SUBJECT QUESTION & ANSWER IN SINGLE PDF  Review Questions 579 Childbearing and Women’s Health Nursing Review Questions with Answers 28 CHAPTER and Rationales QUESTIONS Note: Thousands of additional practice questions are available on the enclosed companion CD. Nursing Care to Promote Childbearing 4. An effective mother does not experience ambivalence and and Women’s Health anxiety about mothering. 5. Why is it important for a nurse to support the parents’ deci- 1. A woman arrives at the prenatal clinic stating that her preg- sion to abort a fetus with a birth defect even if the nurse is nancy test is positive. She asks the nurse for information morally against abortion? about an abortion. After verifying that the woman is at 8 1. Supporting them will eliminate feelings of guilt. weeks’ gestation, the nurse counsels her that having an abor- 2. The parents are legally responsible for the decision. tion is controversial and that many women have long-term 3. It is essential for maintenance of the family equilibrium. guilt feelings after an abortion. Legally, the: 4. The nurse’s support will relieve the pressure caused by 1. nurse’s statements need not be based on current clinical this decision. research. 6. During the postpartum period a client with heart disease 2. client has a right to receive correct, unbiased and type 2 diabetes asks a nurse, “Which contraceptives will information. I be able to use to prevent pregnancy in the near future?” 3. nurse has a right to state feelings as long as they are How should the nurse respond? identified as the nurse’s own. 1. “You may use oral contraceptives because they are almost 4. health care provider should be notified because this is completely effective in preventing a pregnancy.” beyond the scope of nursing practice. 2. “You should use foam with a condom to prevent preg- 2. One day the family planning clinic is very busy, and the nancy because this is the safest method for women with supervisor asks a nurse from the pediatric clinic who is your illnesses.” strongly opposed to any chemical or mechanical method of 3. “You will find that the intrauterine device is best for birth control to work in the family planning clinic. What is you because it prevents a fertilized ovum from implant- the most professional response that this nurse could give to ing in the uterus.” the supervisor? 4. “You do not need to worry about becoming pregnant 1. “I will go, but it is against my beliefs.” in the near future because women with your illnesses 2. “I won’t do it because I do not believe in birth control.” usually become infertile.” 3. “I would prefer another assignment that is not contrary 7. A nurse is teaching a group of women about the side effects to my beliefs.” of different types of contraceptives.What is the most fre- 4. “I will have to reinforce that the rhythm method is the quent side effect associated with the use of an intrauterine method of choice.” device (IUD)? 3. The result of an amniocentesis performed at 16 weeks’ gesta- 1. A tubal pregnancy tion reveals a fetus with Down syndrome. The client elects 2. A rupture of the uterus to have the pregnancy terminated. What should the nurse 3. An expulsion of the device conclude about an abortion at this stage of the pregnancy? 4. An excessive menstrual flow 1. The client is exhibiting emotional instability. 8. A client asks a nurse about the most common problem 2. There is a high risk for a postoperative infection. associated with the use of an intrauterine device (IUD). 3. Contraceptive counseling should be deferred to a later What should the nurse respond? time. 1. Perforation of the uterus 4. An opportunity to express feelings about her decision 2. Spontaneous device expulsion should be provided. 3. Discomfort associated with coitus 4. Which research-based knowledge guides a nurse regarding 4. Development of vaginal infections the emotional factors of pregnancy? 9. A client seeking advice about contraception asks a nurse 1. A rejected pregnancy will result in a rejected infant. about how an intrauterine device (IUD) prevents pregnancy. 2. Ambivalence and anxiety about mothering are common. How should the nurse respond? 3. A mother’s love usually develops within the first week 1. “It covers the entrance to the cervical os.” after birth. 2. “The openings to the fallopian tubes are blocked.” u Denotes alternate format question. 579 580 CHAPTER 28 Childbearing and Women’s Health Nursing 3. “The sperm are prevented from reaching the vagina.” 17. A biphasic antiovulatory medication of combined progestin 4. “It produces a spermicidal intrauterine environment.” and estrogen is prescribed for a female client. What should 10. A nurse teaches women in the fertility clinic that after ovula- a nurse include when teaching about this oral tion has occurred, the ovum is thought to remain viable for: contraceptive? 1. 1 to 6 hours. 1. Report irregular vaginal bleeding. 2. 12 to 18 hours. 2. Restrict sexual activity temporarily. 3. 24 to 36 hours. 3. Have regular bimonthly Pap smears. 4. 48 to 72 hours. 4. Increase the dietary intake of calcium. 11. A nurse is teaching clients to determine the time of 18. A nurse is giving discharge instructions to a client who had ovulation by taking the basal temperature. What change an aspiration abortion by suction curettage. What should is expected to occur in the basal temperature during the client be told? ovulation? 1. Avoid showering for 2 days. 1. Slight drop and then rises 2. Tampons may be used after 1 day. 2. Sudden rise and then drops 3. Sexual intercourse should be delayed for 3 weeks. 3. Marked rise and remains high 4. Report bleeding that requires a pad change every 2 hours. 4. Marked drop and remains lower 19. A client at 10 weeks’ gestation elects to have an induced 12. Oral contraceptives are prescribed for a client. What side abortion. After receiving oral mifepristone (Mifeprex), she effect should the nurse inform the client might occur? returns to the clinic 2 days later to have misoprostol (Cytotec) 1. Cervicitis inserted vaginally. For when should the nurse schedule a 2. Ovarian cysts follow-up visit? 3. Breakthrough bleeding 1. 4 hours after the procedure 4. Fibrocystic breast disease 2. 2 weeks after the procedure 13. What is important for a nurse to discuss with a client who 3. 4 to 8 days after the procedure just had a vasectomy? 4. 8 to 24 hours after the procedure 1. Recanalization of the vas deferens is impossible. 20. A couple indicate that they do not want any more children. 2. Unprotected coitus is safe within 1 week to 10 days. The woman is scheduled for a laparoscopic bilateral tubal 3. Some impotency is to be expected for several weeks. ligation. What should the nurse include in preoperative 4. There must be 15 ejaculations to clear the tract of sperm. teaching? 14. The school nurse is discussing issues concerning premarital 1. “Menstruation will stop after the surgery.” sex with a group of adolescents taking a health education 2. “Birth control will be needed until your follow-up visit.” course. The students are asked to write an essay on what they 3. “You will be admitted as an outpatient for same-day have learned about preventing pregnancy. Which comment surgery.” alerts the nurse to have a private discussion with the student? 4. “You can have the operation reversed if you decide to 1. “I can’t get pregnant if I have sex during my period.” have more children.” 2. “The pill may prevent me from getting pregnant, but I 21. One of the responsibilities of a nurse in a fertility specialist’s can still get an STI.” office is to provide health teaching to the client in relation 3. “I won’t get pregnant if I swim in a pool where a boy to timing of intercourse. Which instruction addresses the has just masturbated.” best time to achieve a pregnancy? 4. “A condom will not always protect me from getting 1. Midway between periods pregnant, but it can protect me from getting an STI.” 2. Immediately after menses end 15. Contraceptives that have estrogen-like and/or progesterone- 3. 14 days before the next period is expected u like compounds are prepared in a variety of forms. Which 4. 14 days after the beginning of the last period contraceptives should a nurse identify as having a hormonal 22. A nurse teaches a client that a postcoital test to evaluate component? Select all that apply. fertility should be performed: 1. Oral agents 1. 1 week after ovulation. 2. Diaphragms 2. immediately after menses. 3. Cervical caps 3. just before the next menstrual period. 4. Female condoms 4. within 1 to 2 days of presumed ovulation. 5. Foam spermicides 23. A histogram (hysterosalpingography [HSG]) is performed 6. Transdermal agents to determine whether there is a tubal obstruction. The nurse 16. A nurse explains that the efficiency of the basal body concludes that infertility caused by a defect in the tube is temperature method of contraception depends on fluctua- most often related to a: tion of the basal body temperature. What factor will alter 1. tubal injury. its effectiveness? 2. past infection. 1. Presence of stress 3. fibroid tumor. 2. Length of abstinence 4. congenital anomaly. 3. Age of those involved 24. A nurse is counseling a couple in the fertility clinic. Which 4. Frequency of intercourse aspect of the protocol is the most stressful for the couple?  Review Questions 581 1. Planning when to have intercourse 1. Estrogen (Premarin) 2. Obtaining the necessary specimens 2. Leuprolide (Lupron) 3. Visiting the fertility clinic frequently 3. Diclofenac (Voltaren) 4. Taking daily basal body temperatures 4. Ergonovine (Ergotrate) 25. Genetic testing is being discussed with a couple at the fer­ 31. At 6 weeks’ gestation a client is diagnosed with gonorrhea. tility clinic. What is the nurse’s best response when they What medication does a nurse expect the health care pro- express concerns? vider to prescribe? 1. “You should be tested because it will be to your benefit.” 1. Ceftriaxone (Rocephin) 2. “Environmental factors can have an impact on genetic 2. Levofloxacin (Levaquin) factors.” 3. Sulfasalazine (Azulfidine) 3. “This type of testing will determine if you’ll need in vitro 4. Trimethoprim/sulfamethoxazole (Bactrim) fertilization.” 32. A 15-year-old adolescent tells a school nurse, “I have persis- 4. “If you have a gene for a disease there is a probability tent pain during my periods.” What should the nurse that your children will inherit it.” encourage her to do? 26. A client is admitted with a diagnosis of torsion of the testes. 1. Continue daily activities. How should the nurse respond when the client asks, “Why 2. Have a gynecologic examination. must I have surgery immediately?”? 3. Eat a nutritious diet containing iron. 1. “There is no other way to control the pain.” 4. Practice relaxation of abdominal muscles. 2. “Irreversible damage occurs after a few hours.” 33. A client at the women’s health clinic tells the nurse she has 3. “Swelling is excessive, which may cause the testicle to u endometriosis. What factors associated with endometriosis rupture.” does the nurse anticipate the client will report? Select all 4. “There is a reduction in testicular blood flow, which leads that apply. to rapid death of sperm.” 1. Insomnia 27. A nurse at the fertility clinic is counseling a couple about 2. Ecchymoses the tests that will be needed to determine the cause of their 3. Rectal pressure infertility. Which test should the nurse describe that will 4. Abdominal pain evaluate the woman’s organs of reproduction? 5. Skipped periods 1. Biopsy 6. Pelvic infections 2. Cystogram 34. What does a nurse expect to be the priority concern of a 3. Culdoscopy 28-year-old woman who is to undergo a laparoscopic bilat- 4. Hysterosalpingogram eral salpingo-oophorectomy? 28. While preparing a client for her first routine Papanicolaou 1. Acute pain (Pap) smear, a nurse determines that she appears anxious. 2. Risk for hemorrhage What should the nurse include as part of the teaching plan? 3. Fear of chronic illness 1. Current statistics on the incidence of cervical cancer 4. Loss of childbearing potential 2. Description of the early symptoms of cervical cancer 35. A nurse is assessing a client who is being admitted for surgi- 3. Explanation of why there is a small risk for cervical u cal repair of a rectocele. What signs or symptoms does the cancer nurse expect the client to report? Select all that apply. 4. Written instructions about the purpose of the Papanico- 1. Painful intercourse laou smear 2. Crampy abdominal pain 29. A client who menstruates regularly every 30 days asks a 3. Bearing-down sensations nurse on what day she is most likely to ovulate. Her last 4. Urinary stress incontinence menses started on January 1st. On what day in January 5. Recurrent urinary tract infections should the nurse respond? 36. When taking the health history of a client who is admitted 1. 7th for repair of a cystocele and rectocele, the nurse should 2. 16th expect the client to report the occurrence of: 3. 24th 1. white vaginal discharge and itching. 4. 29th 2. sporadic bleeding and abdominal pain. 3. elevated temperature and intractable diarrhea. 4. stress incontinence and low abdominal pressure. Nursing Care Related to Major Disorders 37. A client has an anterior and posterior surgical repair of a Affecting Women’s Health u cystocele and rectocele and returns from the postanesthesia care unit (PACU) with an indwelling catheter in place. 30. A client who has a diagnosis of endometriosis is concerned What should the nurse tell the client about the primary about the side effect of hot flashes from her prescribed reasons for the catheter? Select all that apply. medication. She tells the nurse that her mother found them 1. Discomfort is minimized. very uncomfortable during her menopause. Which medica- 2. Bladder tone is maintained. tion causes this side effect? 3. Urinary retention is prevented. 582 CHAPTER 28 Childbearing and Women’s Health Nursing 4. Pressure on the suture line is relieved. 46. A nurse in the women’s health clinic is obtaining a client’s 5. Hourly urine outputs can be easily measured health history. What question will elicit information about 38. A client past menopause undergoes an anterior-posterior the client’s risk for exposure to diethylstilbestrol (DES)? colporrhaphy. What should the discharge teaching include? 1. “Were you born before 1971?” 1. Eating a high-fiber diet 2. “Have you ever taken oral contraceptives?” 2. Limiting daily activities 3. “Have you noticed any lesions in your perineal area?” 3. Reporting signs of urinary retention 4. “Did your mother take hormones during her 4. Observing for signs of a rectovaginal fistula pregnancy?” 39. What potential complication does a nurse anticipate when 47. A 35-year-old client is scheduled for a conization of the admitting a client with the diagnosis of severe procidentia cervix to remove dysplastic cervical cells and to determine (prolapse of the uterus)? the extent of involvement. What behavior indicates to a 1. Edema nurse that the client understands the postoperative 2. Fistulas instructions? 3. Exudate 1. States she will not resume sexual intercourse for 48 hours 4. Ulcerations 2. Verbalizes expectations of a vaginal discharge for 3 to 5 40. A client with a third-degree uterine prolapse is scheduled for days a vaginoplasty. What should the nurse anticipate the surgeon 3. Demonstrates the ability to change sterile surgical will order? dressings 1. Encourage ambulation. 4. Affirms that because she has children she does not mind 2. Elevate the foot of the bed. being sterile 3. Apply moist compresses to the uterus. 48. A client with cancer of the cervix has an intracavity radio­ 4. Support the prolapsed uterus with a sanitary pad. active sealed implant in place. What precaution should 41. What resting position should a nurse encourage for a client the nurse take to protect against excessive exposure to with pelvic inflammatory disease (PID)? radiation? 1. Sims 1. Dispose of body fluids in special marked containers. 2. Fowler 2. Cohort two clients who have implanted radiation therapy. 3. Supine with knees flexed 3. Exit the room walking backward while wearing a lead 4. Lithotomy with head elevated apron. 42. A nurse explains to a client with cervical erosion that early 4. Limit visitors to individuals who are 13 years of age treatment of the erosion can help prevent: and older. 1. cancer of the cervix. 49. A client who is scheduled to have an abdominal panhyster- 2. pelvic inflammatory disease. ectomy asks how the surgery will affect her periods. How 3. unexpected vaginal bleeding. should the nurse respond? 4. more erosions from occurring. 1. “You will not have any more periods.” 43. A client asks a nurse why she developed cervical polyps. 2. “Your periods will become more regular.” How should the nurse respond? 3. “Your periods will become lighter until they disappear.” 1. “They are often malignant and must be removed.” 4. “You will notice that the time between periods will be 2. “Cervical polyps usually are precursors of uterine longer.” cancer.” 50. A client is diagnosed with uterine fibroids, and the health 3. “They are usually benign and a biopsy rules out a care provider advises a hysterectomy. The client expresses malignancy.” concern about having a hysterectomy at age 45 because she 4. “Cervical polyps do not cause bleeding unless they has heard from friends that she will undergo severe symp- are malignant.” toms of menopause after surgery. What is the nurse’s most 44. A nurse in the women’s health clinic is counseling clients appropriate response? about the signs of gynecological problems. What early mani- 1. “You are correct, but there are medicines you can take festation of cervical cancer should prompt a client to seek that will ease the symptoms.” professional care? 2. “This sometimes occurs in women of your age, but you 1. Abdominal heaviness needn’t worry about it at this time.” 2. Pressure on the bladder 3. “Perhaps you should talk to your surgeon because I am 3. Foul-smelling discharge not allowed to discuss this with you.” 4. Bloody spotting after intercourse 4. “Some women may experience symptoms of menopause 45. After a client has a biopsy for suspected cervical cancer, the if their ovaries are removed with their uterus.” laboratory report reveals a stage 0 lesion. What does a nurse 51. After a hysterosalpingo-oophorectomy, a client wants to conclude about this client’s stage of cancer? know whether it would be wise for her to take hormones 1. The lesion is carcinoma in situ. right away to prevent symptoms of menopause. What is the 2. There is early stromal invasion. nurse’s most appropriate response? 3. There is parametrial involvement. 1. “It is best to wait because you may not have any 4. The cancer is confined to the cervix. symptoms.”  Review Questions 583 2. “It is comforting to know that hormones are available if 1. Estrogen therapy you should ever need them.” 2. Hypoparathyroidism 3. “You have to wait until symptoms are severe; otherwise, 3. Prolonged immobility hormones will have no effect.” 4. Excessive calcium intake 4. “Discuss this with your health care provider, because it 59. Which food selected by a client with osteoporosis indicates is important to know your concerns.” that the nurse’s dietary instruction was effective? 52. After an abdominal hysterectomy the client returns to the 1. Red meat unit with an indwelling catheter. The nurse identifies that 2. Soft drinks the urine in the client’s collection bag has become increas- 3. Turnip greens ingly sanguineous. What complication does a nurse suspect? 4. Enriched grains 1. An incisional nick in the bladder 60. A thin older adult client is diagnosed with osteoporosis. 2. A urinary infection from the catheter What should the nurse include in the discharge plan for this 3. Disseminated intravascular coagulopathy client? 4. Uterine relaxation with increased bleeding 1. Encouragement of gradual weight gain 53. A client who had a mastectomy asks about the term ERP- 2. Monitoring for decreased urine calcium positive. The nurse explains that tumor cells are evaluated for 3. Instructions relative to diet and exercise estrogen receptor protein to determine the: 4. Safety factors when using opioids and nonsteroidal anti- 1. need for supplemental estrogen. inflammatory drugs 2. feasibility of breast reconstruction. 61. A nurse is counseling a postmenopausal obese client how to 3. degree of metastasis that has occurred. u prevent bone loss. Which statements indicate understanding 4. potential response to hormone therapy. of the strategies to prevent bone loss? Select all that apply. 54. A nurse is caring for a client who just had a mastectomy. 1. “I must go on a strict diet.” How should the nurse position the client’s arm on the 2. “I will take 400 mg of vitamin D daily.” affected side? 3. “I should take 1200 mg of calcium daily.” 1. In adduction supported by sandbags 4. “Swimming or bike riding 5 times a week is good for me.” 2. In abduction surrounded by sandbags 5. “Joining an aerobics class 3 times a week will help my 3. On pillows with the hand higher than the arm bones.” 4. With the arm lower than the level of the heart 62. A health care provider prescribes teriparatide (Forteo), a 55. When encouraging a client to cough and deep breathe after parathyroid hormone (PTH) agonist, for a client with osteo- a bilateral mastectomy, the client says, “Leave me alone! porosis. What should the nurse consider before administer- Don’t you know I’m in pain?” What is the nurse’s most ing this medication? therapeutic response? 1. It requires an increased intake of vitamin A. 1. “I know it hurts to cough, but try to use the incentive 2. It prevents existing bone from being destroyed. spirometer.” 3. Sunscreen should be used to prevent vitamin D 2. “We’ll start this tomorrow; I will give you something absorption. for your pain.” 4. Osteoblastic activity is stimulated more than osteo- 3. “I understand that you are in pain; rest now, and I’ll clastic activity. come back later.” 63. A female client who has been sexually active for 5 years is 4. “Your pain is to be expected, but you must attempt to diagnosed with gonorrhea. The client is upset and asks the expand your lungs.” nurse, “What can I do to prevent getting another infection 56. A nurse is writing a teaching plan about osteoporosis. The in the future?” The nurse provides health teaching. Which nurse should include in language that most clients would client statement indicates that the teaching was effective? understand that osteoporosis is best described as: 1. “I will douche after each time I have sex.” 1. avascular necrosis. 2. “Having sex is a thing of the past for me.” 2. pathologic fractures. 3. “My partner must use a condom all the time.” 3. hyperplasia of osteoblasts. 4. “I will use a spermicidal cream from now on.” 4. decrease in bone substance. 64. A nurse is caring for a client who contracted a trichomonal 57. The plan of care for a client with osteoporosis includes active infection. Which oral drug should the nurse anticipate the and passive exercises, calcium supplements, and daily vita- health care provider most likely will prescribe? mins. How does a nurse determine that the desired effect of 1. Penicillin G therapy is attained? 2. Gentian violet 1. Mobility increases. 3. Nystatin (Mycostatin) 2. Fewer muscle spasms occur. 4. Metronidazole (Flagyl) 3. There is a more regular heartbeat. 65. A nurse is teaching a client how to self-administer a medi- 4. There are fewer bruises than before therapy. cated douche. In which direction should the nurse instruct 58. A nurse is assessing a client for the potential for developing the client to direct the douche nozzle? osteoporosis. Which factor in the client’s history increases 1. To the left the risk for this disorder? 2. To the right 584 CHAPTER 28 Childbearing and Women’s Health Nursing 3. Toward the sacrum 1. 8th week of pregnancy 4. Toward the umbilicus 2. 10th week of pregnancy 3. 12th week of pregnancy 4. 18th week of pregnancy Nursing Care of Women during Uncomplicated 72. A client has several tests during pregnancy. Place the tests in Pregnancy, Labor, Childbirth, and the u the order they should be performed during pregnancy. Postpartum Period 1. _____ Fetal movement test 2. _____ Sickle cell screening 66. At her first visit to the prenatal clinic, a client tells the nurse 3. _____ Group B streptococcus culture she is ambivalent about continuing the pregnancy. Why 4. _____ Serum glucose for gestational diabetes does the nurse conclude that the client is experiencing a 5. _____ Alpha-fetoprotein (AFP) testing for neural tube crisis? defects 1. Mood changes occur during pregnancy. 73. What information should a nurse include when counseling 2. Pregnancy is a period of change and adjustment to u a pregnant client about human immunodeficiency virus change. (HIV) testing? Select all that apply. 3. Hormonal and physiologic changes occur during 1. Risks of passing the virus to the fetus pregnancy. 2. Meaning of positive or negative test results 4. Pregnancy changes the future parents’ relationship with 3. Disclosure of risk factors for contracting HIV each other. 4. Requirement that pregnant women are tested for HIV 67. A pregnant woman who is at term is admitted to the birth- 5. Emotional, legal, and medical implications of test results ing unit in active labor. She is excited about the anticipated 74. At what time during prenatal development should the nurse birth because she has three sons and the amniocentesis indi- expect the greatest fetal weight gain? cated that she will have a girl. Which factor in the client’s 1. Third trimester history alerts the nurse that the newborn will be at risk for 2. Second trimester a complication? 3. First eight weeks 1. Her membranes ruptured two hours ago. 4. Implantation period 2. Her first child was diagnosed with hemophilia. 75. A client tells the nurse that the first day of her last menstrual 3. She used NSAIDs for frequent sinus headaches. period was July 22, 2010. What is the estimated date of 4. She had a placenta previa in a previous pregnancy. birth? 68. A couple who recently emigrated from Israel tells a nurse in 1. May 7, 2011 the prenatal clinic that they are concerned about a genetic 2. April 29 2011 disease that is prevalent among Jewish people. Which genetic 3. April 22, 2011 blood test should the nurse recommend to determine the 4. March 6, 2011 possibility of their child inheriting the disease? 76. What information concerning the childbearing process 1. Cystic fibrosis should the nurse teach a client during the first trimester of 2. Phenylketonuria pregnancy? 3. Turner syndrome 1. Labor and birth 4. Tay-Sachs disease 2. Signs and symptoms of complications 69. A nurse is teaching a childbirth class to a group of pregnant 3. Role transition into parenthood and its acceptance women. One of the women asks the nurse at what point 4. Physical and emotional changes resulting from preg­ during the pregnancy does the embryo become a fetus. How nancy should the nurse respond? 77. A nurse is caring for a client during an ultrasonogram. What 1. During the eighth week of the pregnancy parameters does the nurse expect to be used when determin- 2. At the end of the second week of pregnancy ing pregnancy dates? 3. When the fertilized ovum becomes implanted 1. Occipital frontal diameter at term 4. When the products of conception are visualized on the 2. Crown to rump measurement until 11 weeks sonogram 3. Biparietal diameter of 12 cm or more at term 70. A client at 35 weeks’ gestation asks a nurse why her breath- 4. Diagonal conjugate is between 26 and 37 weeks ing has become more difficult. How should the nurse 78. What change does a nurse expect in a client’s hematologic respond? system during the second trimester of pregnancy? 1. “Your lower rib cage is more restricted.” 1. An increase in hematocrit 2. “Your diaphragm has been displaced upward.” 2. An increase in blood volume 3. “There is an increase in the size of your lungs.” 3. A decrease in sedimentation rate 4. “There is an increase in the height of your rib cage.” 4. A decrease in white blood cells 71. A nurse at the prenatal clinic examines a client and deter- 79. During a physical in the prenatal clinic the client’s vaginal mines that her uterus has risen out of the pelvis and is now mucosa is observed to have a purplish discoloration. What an abdominal organ. At what week of gestation does this sign should the nurse document in the client’s clinical occur? record?  Review Questions 585 1. Hegar 2. “Because you need salt to maintain body water balance, 2. Goodell it is not restricted. Just eat a well-balanced diet.” 3. Chadwick 3. “Salt is an essential nutrient that is naturally reduced by 4. Braxton Hicks the body’s estrogen. There is no reason to restrict salt in 80. What does a nurse explain to a pregnant client about the your diet.” cause of her physiologic anemia? 4. “We no longer recommend that salt intake be as restricted 1. Erythropoiesis decreases. as much as in the past. However, you shouldn’t add salt 2. Plasma volume increases. to your food.” 3. Utilization of iron decreases. 87. A pregnant client uses a computer continuously during her 4. Detoxification by the liver increases. working hours. This has implications for her plan of care 81. The nurse reviews the blood test results of a client who is at during pregnancy. What should a nurse recommend? 24 weeks’ gestation. Which finding should be reported to 1. “Try to walk around every few hours during the workday.” the health care provider? 2. “Ask for time in the morning and afternoon to elevate 1. Platelets: 230,000 mm3 your legs.” 2. Hemoglobin: 10.8 g/dL 3. “Tell your boss that you cannot work beyond the second 3. Fasting blood glucose: 90 mg/dL trimester.” 4. White blood cell count: 10,000 mm3 4. “Ask for time in the morning and afternoon to get some- 82. At her first prenatal visit, a client says to the nurse, “I guess thing to eat.” I’ll be having an internal examination today.” What is the 88. A client at her first prenatal clinic visit is at 6 weeks’ gesta- nurse’s best response? tion. She asks how long she may continue to work and when 1. “Yes, an internal exam is done at the mother’s first visit.” she should plan to quit. How should the nurse respond? 2. “Are you fearful of having an internal examination 1. “What activities does your job entail?” done?” 2. “How do you feel about continuing to work?” 3. “Have you ever had an internal examination done 3. “Most women work throughout their pregnancy.” before?” 4. “Usually women quit work at the start of their third 4. “Yes, a slightly uncomfortable internal exam must trimester.” be done.” 89. Why is it important for a nurse in the prenatal clinic 83. A pregnant client is making her first antepartum visit. She to provide nutritional counseling to all newly pregnant has a 2-year-old son born at 40 weeks, a 5-year-old daughter women? born at 38 weeks, and 7-year-old twin daughters born at 35 1. Most weight gain is caused by fluid retention. weeks. She had a spontaneous abortion 3 years ago at 10 2. Different cultural groups favor different essential weeks. Using the GTPAL format, what does the nurse docu- nutrients. ment about the client’s obstetric history? 3. Dietary allowances should not increase throughout 1. G4 T3 P2 A1 L4 pregnancy. 2. G5 T2 P2 A1 L4 4. Pregnant women must adhere to a specific pregnancy 3. G5 T2 P1 A1 L4 dietary regimen. 4. G4 T3 P1 A1 L4 90. A primigravida in her 10th week of gestation is concerned 84. A nurse is assessing a pregnant client during the third tri- because she has read that nutrition during pregnancy is mester. What clinical finding is an expected response to the important for the growth and development of the fetus. She pregnancy? wants to know something about the foods she should eat. 1. Tachycardia What should be the nurse’s initial response? 2. Dyspnea at rest 1. Instruct her to continue eating her regular diet. 3. Progressive dependent edema 2. Ask her what she has eaten over the last three days. 4. Shortness of breath on exertion 3. Give her a list of foods to help her plan her meals more 85. A pregnant woman reports nausea and vomiting during the efficiently. first trimester of pregnancy. An increase in which hormone 4. Emphasize to her the importance of limiting highly sea- should the nurse explain is the precipitating cause of the soned foods. nausea and vomiting? 91. A pregnant woman tells a nurse in the prenatal clinic that 1. Estrogen u she knows that folic acid is very important during pregnancy 2. Progesterone and she is taking a prescribed supplement. She asks the nurse 3. Luteinizing hormone what foods contain folic acid (folate) so she can add them 4. Chorionic gonadotropin to her diet in its natural form. Which foods should the nurse 86. During a client’s first visit to the prenatal clinic, a nurse recommend? Select all that apply. discusses a pregnancy diet. The client states that her mother 1. Beef and fish told her she should restrict her salt intake. What is the 2. Milk and cheese nurse’s best response? 3. Chicken and turkey 1. “Your mother is correct. You should use less salt to 4. Black and pinto beans prevent swelling.” 5. Enriched bread and pasta 586 CHAPTER 28 Childbearing and Women’s Health Nursing 92. A client at 8 weeks’ gestation reports having to urinate more 3. An increase of 300 calories per day often. The nurse explains that urinary frequency often 4. An increase of 500 calories per day occurs because bladder capacity during pregnancy is dimin- 98. A client is concerned about gaining weight during preg- ished by: nancy. What should the nurse explain is the cause of the 1. atony of the detrusor muscle. largest amount of weight gain during pregnancy? 2. compression by the enlarging uterus. 1. Fetal growth 3. compromise of the autonomic reflexes. 2. Fluid retention 4. narrowing of the ureteral entrance at the trigone. 3. Metabolic alterations 93. While caring for a pregnant client and her partner, a nurse 4. Increased blood volume u suspects domestic violence. Which assessments support this 99. A client at 7 weeks’ gestation tells a nurse in the prenatal suspicion? Select all that apply. clinic that she is sick every morning with nausea and vomit- 1. Woman has injuries to the breasts and abdomen. ing and adds that she does not think she can tolerate it 2. Partner refuses to come into the examination room. throughout her pregnancy. The nurse assures her that this is 3. Partner answers questions that are asked of the woman. a common occurrence in early pregnancy and will probably 4. Woman has visited the clinic several times in the last disappear by the end of the: month. 1. fifth month. 5. Partner is excessively attentive while the health history is 2. third month. being taken. 3. fourth month. 94. A nurse who is caring for a mother and her newborn infant 4. second month. u reviews their record. Using the data below, which nursing 100. A pregnant client is being prepared for a pelvic examination. intervention is required? She states that she is always tired and feels sick to her stomach, especially in the morning. What is the nurse’s best response? MATERNAL: Prenatal Laboratory Tests 1. “Tell me about how you feel the rest of the day.” 2. “Let’s discuss ways to resolve these common problems.” Type: Rubella Sickle 3. “Perhaps you should ask your health care provider RPR/VDRL HB Sag HIV Hgb/Hct RH: Titer Prep about it.” 4. “There is no need to worry about these expected A Neg 1:2 Neg Neg Neg 11/33 Neg problems.” 101. During a prenatal examination, a nurse draws blood from INFANT: Day 2 of Life Laboratory Tests an Rh-negative client. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus Blood Glucose Total Bilirubin Blood type Hct is at risk for developing: 1. acute hemolytic anemia. 46 10 mg O Neg 55 2. respiratory distress syndrome. 3. protein metabolism deficiency. 1. Neonatal blood transfusion 4. physiologic hyperbilirubinemia. 2. Maternal rubella vaccination 102. What is the best advice a nurse can give to a pregnant 3. Maternal RhoGAM injection woman in her first trimester? 4. Neonatal 50% glucose infusion 1. “Cut down on drugs, alcohol, and cigarettes.” 95. A client at 10 weeks’ gestation calls the clinic and tells a 2. “Avoid drugs, and refrain from smoking and ingesting nurse that she has morning sickness and cannot control it. alcohol.” What should the nurse suggest to promote relief? 3. “Avoid smoking, limit alcohol consumption, and do not 1. “Eat dry crackers before arising.” take aspirin.” 2. “Increase fat intake before bedtime.” 4. “Take only prescription drugs, especially in the second 3. “Drink high-carbohydrate fluids with meals.” and third trimesters.” 4. “Have two small meals a day with a snack at noon.” 103. During a routine visit to the prenatal clinic, a client listens 96. What should a nurse suggest to a pregnant client that might to the fetal heartbeat for the first time. The client, com­ help overcome first-trimester morning sickness? menting on how rapid it is, appears frightened and asks 1. “Eat protein before bedtime.” whether this is normal. The nurse should respond, “The 2. “Take an antacid before breakfast.” heart rate is: 3. “Drink water until the nausea subsides.” 1. usually rapid and is in the expected range.” 4. “Request a prescription for an antiemetic.” 2. usually rapid and twice the mother’s pulse rate.” 97. What should a nurse include in nutritional planning for a 3. rapid, but I’d be more concerned if it were slow.” newly pregnant woman of average height weighing 145 4. rapid, but it accommodates the fetus’s nutritional needs.” pounds? 104. When involved in prenatal teaching, a nurse should inform 1. A decrease of 100 calories per day clients that there is an increase in vaginal secretions during 2. A decrease of 200 calories per day pregnancy called leukorrhea. What causes this increase?  Review Questions 587 1. Metabolic rate 1. Labor may take longer. 2. Production of estrogen 2. Placental perfusion is decreased. 3. Secretion from the Bartholin glands 3. Movement of the coccyx is obstructed. 4. Supply of sodium chloride to the vaginal cell 4. Transient episodes of hypertension may occur. 105. A client who is 28 weeks into her second pregnancy is expe- 112. A 42-year-old client has an amniocentesis during the 16th riencing increasing edema in the lower extremities. The week of gestation because of concern about Down syn- nurse advises rest with the legs elevated and provides dietary drome. What additional information about the fetus will instructions. What else should the nurse suggest? examination of the amniotic fluid reveal at this time? 1. A preferred diet will include favorite foods 1. Lung maturity 2. A nutritionist should be involved in planning a diet. 2. Type 1 diabetes 3. The foods selected do not need to have a low salt content. 3. Cardiac anomaly 4. The client should be referred to the health care provider 4. Neural tube defect at the prenatal clinic. 113. During the postpartum period, a client tells a nurse she is 106. What recommendation should a nurse give to clients who having leg cramps. Which foods should the nurse encourage have fluid retention during pregnancy? the client to eat? 1. Decrease fluid intake. 1. Liver and raisins 2. Maintain a low-sodium diet. 2. Cheese and broccoli 3. Elevate the lower extremities. 3. Eggs and lean meats 4. Ask the health care provider for a diuretic. 4. Whole wheat breads and cereals 107. A 36-year-old multigravida who is at 14 weeks’ gestation 114. When is it most important for a female client to know that is scheduled for an alpha-fetoprotein test. She asks the a fetus may be structurally damaged by the ingestion of nurse, “What does the alpha-fetoprotein test indicate?” The drugs? nurse bases a response on the knowledge that this test can 1. During early adolescence detect: 2. Throughout the entire pregnancy 1. kidney defects. 3. When planning to become pregnant 2. cardiac anomalies. 4. At the beginning of the first trimester 3. neural tube defects. 115. A pregnant client asks the clinic nurse how smoking will 4. urinary tract anomalies. affect her baby. What information about cigarette smoking 108. A client is scheduled for a nonstress test in the 37th will influence the nurse’s response? week of gestation. A nurse explains the procedure. Which 1. It relieves tension and the fetus responds accordingly. statement demonstrates that the client understands the 2. The resulting vasoconstriction affects both fetal and teaching? maternal blood vessels. 1. “An IV will be needed to inject the medication.” 3. Substances contained in smoke diffuse through the pla- 2. “My baby may get very restless after this procedure.” centa and compromise the fetus’s well-being. 3. “I hope this test does not cause my labor to begin early.” 4. Effects are limited because fetal circulation and maternal 4. “If the heart reacts well, my baby should do okay when circulation are separated by the placental barrier. I give birth.” 116. A client who is at 12 weeks’ gestation tells a nurse at the 109. A client in the 18th week of pregnancy is scheduled for prenatal clinic that she has severe nausea and frequent vomit- ultrasonography. What instruction should the nurse give the ing. The nurse suspects that the client has hyperemesis gravi- client? darum. With what disorder is this frequently associated? 1. “Don’t eat for 4 hours after the test.” 1. History of cholecystitis 2. “Give yourself an enema the night before.” 2. Large amount of amniotic fluid 3. “Don’t urinate for at least 3 hours before the test.” 3. High levels of chorionic gonadotropin 4. “You will be monitored closely afterward for signs of 4. Decreased secretion of hydrochloric acid labor.” 117. A nurse is planning a prenatal class about the changes that 110. A nurse is teaching a primigravida about how she can iden- u occur during pregnancy and the necessity of routine health tify the onset of labor. What clinical indicator of labor would care supervision throughout pregnancy. Which cardiovascu- necessitate the client to call her health care provider? lar compensatory mechanisms should the nurse explain will 1. Bloody show and back pressure occur. occur? Select all that apply. 2. Contractions become regular or get stronger. 1. Systemic vasodilation 3. Membranes rupture or contractions are 5 to 8 minutes 2. Increased blood volume apart. 3. Elevated blood pressure 4. Contractions are 10 to 12 minutes apart and last about 4. Increased cardiac output 30 seconds. 5. Enlargement of the heart 111. A nurse teaches a pregnant woman to avoid lying on her 6. Decreased erythrocyte production back during labor. What information about the result of 118. The husband of a client who is in the transition phase of the lying in the supine position is the basis for the nurse’s first stage of labor becomes very tense and anxious during teaching? this period and asks a nurse, “Do you think it is best for me 588 CHAPTER 28 Childbearing and Women’s Health Nursing to leave, since I don’t seem to be doing my wife much good?” 4. Contractions occur immediately after the membranes What is the nurse’s best response? rupture. 1. “This is the time your wife needs you. Don’t run out on 125. Why should a nurse teach pregnant women the importance her now.” of conserving the “spurt of energy” before labor? 2. “This is hard for you. Let me try to help you coach her 1. Energy helps to increase the progesterone level. during this difficult phase.” 2. Fatigue may influence the need for pain medication. 3. “I know this is hard for you. You should go have a cup 3. Energy is needed to push during the first stage of labor. of coffee to help you relax and then come back in a little 4. Fatigue will increase the intensity of the uterine while.” contractions. 4. “If you feel that way, you’d best go out and sit in the 126. A client is admitted to the birthing suite in early active labor. father’s waiting room for a while. You may transmit your Which nursing action takes priority during the admission anxiety to your wife.” process? 119. A nurse is caring for an obese client in early labor. The 1. Auscultating the fetal heart anesthesiologist discussed several types of analgesia/ 2. Obtaining an obstetric history anesthesia with the client and recommended one. The client 3. Determining when the last meal was eaten requests clarification before signing the consent form. Which 4. Ascertaining whether the membranes have ruptured type did the anesthesiologist recommend? 127. A primigravida is admitted to the birthing unit in early 1. Epidural anesthesia labor. A pelvic examination reveals that her cervix is 100% 2. Oral opioid analgesia effaced and 3 cm dilated. The fetal head is at +1 station. In 3. Pudendal nerve anesthesia what area of the client’s pelvis is the fetal occiput? 4. IV infusion of opioid analgesia 1. Not yet engaged 120. During labor a client who has been receiving epidural anes- 2. Below the ischial spines thesia has a sudden episode of severe nausea, and her skin 3. Entering the pelvic inlet becomes pale and clammy. What is the nurse’s immediate 4. Visible at the vaginal opening reaction? 128. After performing Leopold maneuvers on a laboring client, 1. Turn the client on her side. a nurse determines that the fetus is in the right occiput 2. Notify the health care provider. posterior (ROP) position. Where should the Doppler be 3. Check the vaginal area for bleeding. placed to best auscultate fetal heart tones? 4. Monitor the fetal heart rate every three minutes. 1. Above the umbilicus in the midline 121. A nurse is caring for a primigravida during labor. At 7 cm 2. Above the umbilicus on the left side dilation a prescribed pain medication is administered. 3. Below the umbilicus on the right side Which medication requires monitoring of the newborn for 4. Below the umbilicus near the left groin the side effect of respiratory depression? 129. A client in the active phase of the first stage of labor begins 1. Butorphanol (Stadol) to tremble, becomes very tense during contractions, and is 2. Hydroxyzine (Vistaril) quite irritable. She frequently states, “I cannot stand this a 3. Promethazine (Phenergan) minute longer.” What does this behavior indicate to the 4. Diphenhydramine (Benadryl) nurse caring for her? 122. A client in active labor becomes very uncomfortable and 1. There was no preparation for labor. asks a nurse for pain medication. Nalbuphine (Nubain) is 2. She should receive an analgesic for pain. prescribed. How does this medication relieve pain? 3. She is entering the transition phase of labor. 1. Produces amnesia 4. Hypertonic uterine contractions are developing. 2. Acts as a preliminary anesthetic 130. A nurse assesses the frequency of a client’s contractions by 3. Induces sleep until the time of birth timing them from the beginning of a contraction: 4. Acts on opioid receptors to reduce pain 1. until the uterus starts to relax. 123. At a prenatal visit a client who is at 36 weeks’ gestation states 2. to the end of a second contraction. that she is having uncomfortable irregular contractions. 3. until the uterus completely relaxes. What should the nurse recommend? 4. to the beginning of the next contraction. 1. “Lie down until they stop.” 131. A nurse observes a laboring client’s amniotic fluid and 2. “Walk around until they subside.” decides that it is the expected color. What description of 3. “Time the contractions for 30 minutes.” amniotic fluid supports this conclusion? 4. “Take 2 extra-strength aspirins if the discomfort 1. Clear, dark amber, and contains shreds of mucus persists.” 2. Straw-colored, clear, and contains little white specks 124. How does the nurse identify true labor as opposed to false 3. Milky, greenish yellow, and contains shreds of mucus labor? 4. Greenish yellow, cloudy, and contains little white 1. Cervical dilation is progressive. specks 2. Contractions stop when the client walks around. 132. A client in active labor has an external fetal monitor in 3. Clients’ contractions progress only in a side-lying u place. Using the monitor strip on the next page, identify the position. correct assessment.  Review Questions 589 FHR 240 bpm FHR 240 bpm 210 210 100 100 150 150 120 120 90 90 60 60 30 30 100 100 100 12 12 12 75 10 75 10 75 10 8 8 8 50 50 50 6 6 6 4 4 4 25 25 25 2 2 2 UA 0 mm Hg 0 kPa UA 0 mm Hg 0 kPa UA 0 mm Hg 0 kPa 1. Tetanic contractions and 75% effaced, and the fetal heart rate is 136 beats/min. 2. Marked FHR variability She and her partner are admitted to the birthing unit. What 3. FHR baseline at 150 beats/min should the nurse do upon their arrival? 4. Contractions lasting 130 seconds 1. Place the client in bed and attach an external fetal 133. What is a common problem that confronts the client in monitor. labor when an external fetal monitor has been applied to her 2. Have the client undress while taking her history from abdomen? her partner. 1. Intrusion on movement 3. Introduce the staff nurses to the couple and try to make 2. Inability to take sedatives them feel welcome. 3. Interference with breathing techniques 4. Ask the couple to wait in the examining room while 4. Increased frequency of vaginal examinations notifying the health care provider. 134. A client’s membranes rupture while her labor is being aug- 138. A pregnant woman at 39 weeks’ gestation arrives in the mented with an oxytocin (Pitocin) infusion. A nurse observes triage area of the birthing unit, stating she thinks her “water variable decelerations in the fetal heart rate on the fetal broke.” What should the nurse do first? monitor strip. What action should the nurse take next? 1. Auscultate the fetal heart to determine fetal well-being. 1. Change the client’s position. 2. Perform Leopold’s maneuvers to rule out a breech 2. Take the client’s blood pressure. presentation. 3. Stop the client’s oxytocin infusion. 3. Check the vaginal introitus for the presence of the 4. Prepare the client for an immediate birth. umbilical cord. 135. Epidural anesthesia was initiated 30 minutes ago for a client 4. Do a nitrazine test on the vaginal fluid for verification u in labor. The nurse identifies that the fetus is experiencing of ruptured membranes. late decelerations. List the following nursing actions in order 139. A client is admitted to the birthing unit in active labor. of priority. What should the nurse expect after an amniotomy is 1. _____ Increase IV fluids. performed? 2. _____ Reposition client on her side. 1. Diminished bloody show 3. _____ Reassess fetal heart rate pattern. 2. Increased and more variable FHR 4. _____ If late decelerations persist notify the health care 3. Less discomfort with contractions provider. 4. Progressive dilation and effacement 5. _____ Document interventions with related maternal/ 140. A primigravida who is at 40 weeks’ gestation arrives at the fetal responses. birthing center with abdominal cramping and a bloody 136. A client’s membranes spontaneously rupture during active show. Her membranes ruptured 30 minutes before arrival. labor. The nurse inspects the perineum and determines that A vaginal examination reveals 1 cm dilation and the present- the umbilical cord is not visible. What is the next nursing ing part at −1 station. After obtaining the fetal heart rate action? and maternal vital signs, what should the nurse do next? 1. Auscultate the FHR. 1. Teach the client how to push with each contraction. 2. Time the contractions. 2. Encourage the client to perform pattern-paced 3. Call the health care provider. breathing. 4. Obtain the maternal vital signs. 3. Provide the client with comfort measures used for 137. The membranes of a client who is at 39 weeks’ gestation women in labor. have ruptured spontaneously. Examination in the emer- 4. Prepare to have the client’s blood typed and crossmatched gency department revealed that her cervix is 4 cm dilated for a possible transfusion. 590 CHAPTER 28 Childbearing and Women’s Health Nursing 141. A client is receiving an IV piggyback infusion of oxytocin 148. A nurse is caring for a primigravida during labor. What u (Pitocin) to augment labor. The nurse identifies that there does the nurse observe that indicates birth is about to take have been three contractions lasting 80 to 90 seconds that place? are less than 2 minutes apart. There is a specific protocol 1. Bloody discharge from the vagina increases. that is followed in response to this observation. List in order 2. Perineum begins to bulge with each contraction. of priority the nursing actions that should be taken. 3. Client becomes irritable and stops following 1. _____ Check the fetal heart rate. instructions. 2. _____ Stop the piggyback infusion. 4. Contractions occur more frequently, are stronger, 3. _____ Notify the health care provider. and last longer. 4. _____ Administer oxygen via face mask. 149. For what complication should a nurse monitor a client when 5. _____ Document maternal/fetal responses. an oxytocin (Pitocin) infusion is used to induce labor? 6. _____ Determine if the contractions have diminished. 1. Intense pain 142. When monitoring the FHR of a client in labor, the nurse 2. Uterine tetany identifies an elevation of 15 beats more than the baseline 3. Hypoglycemia rate of 135 beats/min lasting for 15 seconds. How should 4. Umbilical cord prolapse the nurse document this event? 150. The cervix of a client in labor is fully dilated and effaced. 1. An acceleration The head of the fetus is at +2 station. What should the nurse 2. An early elevation encourage the client to do during contractions? 3. A sonographic motion 1. Relax by closing her eyes. 4. A tachycardic heart rate 2. Push with her glottis open. 143. A client and her partner are working together during the 3. Blow to slow the birth process. woman’s labor. The client’s cervix is now dilated 7 cm, and 4. Pant to prevent cervical edema. the presenting part is low in the midpelvis. What should the 151. A laboring client is to have a pudendal block. What should nurse instruct the partner to do that would alleviate the a nurse teach the client about the effects of the pudendal client’s discomfort during contractions? block? 1. Deep breathe slowly. 1. Bladder sensation may be lost. 2. Perform pelvic rocking. 2. She will not feel an episiotomy. 3. Use the panting technique. 3. She may lose the ability to push. 4. Begin pattern-paced breathing. 4. Contractions will no longer be felt. 144. Why should a nurse withhold food and oral fluids as a labor- 152. A nurse is caring for a client during the early postpartum ing client approaches the second stage of labor? u period. The client alerts the nurse that she is having pain. 1. The mechanical and chemical digestive processes require The nurse interviews the client, obtains her vital signs, and energy that is needed for labor. performs a physical assessment. What does this assessment 2. Undigested food and fluid may cause nausea and vomit- most likely indicate? ing and limit the choice of anesthesia. 3. The gastric phase of digestion stimulates the release of Vital Signs hydrochloric acid and may cause dyspepsia. T: 99° F 4. Food and fluid will further aggravate gastric peristalsis, P: 108 beats/min which is already increased because of the stress of labor. R: 20 breaths/min 145. How should a nurse direct care for a client in the transition BP: 105/60 mm Hg phase of the first stage of labor? Physical Assessment 1. Decrease IV fluid intake. Episiotomy surrounded by edema and ecchymosis 2. Help the client to maintain control. Fundus is firm 3. Reduce the client’s discomfort with medications. No lochia present 4. Institute simple breathing patterns during contractions. Client Interview Reports severe perineal and rectal pressure 146. Which breathing technique should the nurse instruct the client to use as the head of the fetus is crowning? 1. Shallow 1. Uterine infection 2. Blowing 2. Urinary infection 3. Slow chest 3. Vaginal hematoma 4. Modified paced 4. Postpartum hemorrhage 147. When a client’s legs are placed in stirrups for birth, the nurse 153. After a client gives birth, what physiologic occurrence indi- confirms that both legs are positioned simultaneously to cates to the nurse that the placenta is beginning to separate prevent: from the uterus and is ready to be expelled? 1. venous stasis in the legs. 1. Relaxation of the uterus 2. pressure on the perineum. 2. Descent of the uterus in the abdomen 3. excessive pull on the fascia. 3. Appearance of a sudden gush of blood 4. trauma to the uterine ligaments. 4. Retraction of the umbilical cord into the vagina  Review Questions 591 154. A multigravida has a spontaneous vaginal birth. Five minutes 4. “It is not safe to prop a bottle. The baby could aspirate later the placenta is expelled. Where does a nurse expect to the fluid.” locate the uterine fundus at this time? 160. A primipara has just given birth at 37 weeks’ gestation. 1. In the pelvic cavity What should the nurse do to help promote the attachment 2. Just below the xiphoid process process between the mother and her newborn? 3. At the umbilicus and in the right quadrant 1. Teach how to breastfeed the baby. 4. Halfway between the symphysis pubis and the 2. Encourage continuous rooming-in. umbilicus 3. Assign one nurse to care for both of them. 155. A client in labor begins to experience contractions 2 to 3 4. Allow extra visiting privileges in the nursery. minutes apart that last about 45 seconds. Between contrac- 161. A multigravida of Asian descent weighs 104 pounds, having tions the nurse identifies a fetal heart rate of 100 beats/min gained 14 pounds during the pregnancy. On her second on the internal fetal monitor. What is the next nursing postpartum day, the client’s temperature is 100.2° F. She is action? anorectic and rarely gets out of bed. What should the nurse 1. Notify the health care provider. do? 2. Resume continuous fetal heart monitoring. 1. Ask the nursing supervisor to discuss this with the health 3. Continue to monitor the maternal vital signs. care provider. 4. Document the fetal heart rate as an expected response to 2. Encourage the family to bring in special foods preferred contractions. in their culture. 156. A client is bleeding excessively after the birth of a neonate. 3. Order a high-protein milkshake as a between-meal snack The health care provider orders fundal massage and pre- to stimulate her appetite. scribes an IV infusion containing 10 units of oxytocin 4. Explain to the family that the dietician plans nutritious (Pitocin) at 100 mL/hr. A nurse’s evaluation of the client’s meals that the client should eat. responses to these interventions is BP: 135/90 mm Hg; 162. At 9 PM visiting hours are officially over, but the sister of a uterus: boggy at 3 cm above the umbilicus and displaced to newly admitted postpartum client remains at the bedside. the right; perineal pad: saturated with bright red lochia. What is the most appropriate nursing intervention? What is the nurse’s next action? 1. Remind the client’s sister that visiting hours are over. 1. Increase the infusion rate. 2. Get written permission from the client for her sister to 2. Assess for a distended bladder. remain. 3. Continue to perform fundal massage. 3. Call the evening nursing supervisor to tactfully handle 4. Continue to assess the blood pressure. the situation. 157. A nurse is evaluating the effectiveness of fundal massage 4. Encourage the sister to participate in care as much as the on a postpartum client 3 hours after giving birth. An IV client wishes. infusion of 10 units of oxytocin (Pitocin) is infusing at 163. Three weeks after giving birth, a client develops a deep vein 100 mL/hr. Her blood pressure is 135/90, the uterus is thrombophlebitis of the left leg and is admitted to the hos- boggy at 3 cm above the umbilicus and displaced to the pital for bed rest and anticoagulant therapy. Which anti­ right, and her perineal pad is saturated with lochia rubra. coagulant does the nurse expect to administer? What should the nurse do next? 1. Clopidogrel (Plavix) 1. Massage the fundus again. 2. Warfarin (Coumadin) 2. Notify the health care provider. 3. Continuous infusion of heparin 3. Assist the client to the bathroom. 4. Intermittent doses of a low molecular weight heparin 4. Increase the IV infusion rate as prescribed. 164. A nurse teaches a postpartum client how to care for her 158. A primigravida who is at 35 weeks’ gestation is diagnosed episiotomy to prevent infection. Which behavior indicates with hydramnios. For what should the nurse assess the that the teaching was effective? newborn? 1. The perineal pad is changed twice daily. 1. Cardiac defect 2. She washes her hands whenever a perineal pad is changed. 2. Kidney disorder 3. She rinses her perineum with water after using an anal- 3. Diabetes mellitus gesic spray. 4. Esophageal atresia 4. The perineum is cleansed from the anus toward the sym- 159. A client who just gave birth has three young children at home. physis pubis. She comments to the nursery nurse that she must prop the 165. A nurse observes that a client is voiding frequently in small baby during feedings when she returns home because she has amounts 8 hours after giving birth. What should the nurse too much to do, and anyway holding babies during feedings conclude about this small output of urine during the early spoils them. What is the nurse’s best response? postpartum period? 1. “You seem concerned about time. Let’s talk about it.” 1. It may indicate retention of urine with overflow. 2. “That’s up to you, since you have to do what works for 2. It may be indicative of beginning glomerulonephritis. you.” 3. This is common because less fluid is excreted after birth. 3. “Holding the baby when feeding is important for 4. This is common because fluid intake diminishes after development.” birth. 592 CHAPTER 28 Childbearing and Women’s Health Nursing 166. When palpating a client’s fundus on the second postpartum 1. _____ Obtain a chest x-ray study. day, a nurse identifies that it is above the umbilicus and 2. _____ Send a lochia specimen for culture. displaced to the right. What does the nurse conclude? 3. _____ Administer the prescribed IV antibiotic. 1. There is a slow rate of involution. 4. _____ Offer the prn acetaminophen (Tylenol) for a fever 2. There are retained placental fragments. more than 100° F. 3. The bladder has become overdistended. 5. _____ Document the client’s temperature 30 minutes 4. The uterine ligaments are overstretched. after administering the medications. 167. A nurse examines a client who had a cesarean birth. It is 3 days since the birth and the client is about to be discharged. Where does the nurse expect the fundus to be located? Nursing Care of Women at Risk during 1. 1 fingerbreadth below the umbilicus Pregnancy, Labor, Childbirth, and 2. 2 fingerbreadths below the umbilicus the Postpartum Period 3. 3 fingerbreadths below the umbilicus 4. 4 fingerbreadths below the umbilicus 174. A 16-year-old adolescent visits the prenatal clinic because 168. A client on the postpartum unit asks the nurse why the she has missed three menstrual periods. Before her physical nurses are always encouraging her to walk. What should the examination she says, “I don’t know what the problem is, nurse consider when forming a response in language the but I can’t be pregnant.” What is the nurse’s most therapeu- client will understand? tic response? 1. Respirations are enhanced. 1. “Many young women are irregular at your age.” 2. Bladder tonicity is increased. 2. “You probably are pregnant if you had intercourse.” 3. Abdominal muscles are strengthened. 3. “Why did you decide to come to the prenatal clinic?” 4. Peripheral vasomotor activity is promoted. 4. “Should I ask the health care provider to talk to you?” 169. What should a nurse include in the discharge teaching of a 175. A teenager at 32 weeks’ gestation is hospitalized with pre- postpartum client? eclampsia. She is anorexic and appears depressed. Which 1. The prenatal perineal tightening exercises should be comment indicates to the nurse that further exploration of continued. the client’s emotional status is indicated? 2. The episiotomy sutures will be removed at the first post- 1. “I’m tired of feeling so clumsy.” partum visit. 2. “I’ll be glad when I can sleep all night.” 3. She may not have a bowel movement for up to a week 3. “I dreamed my baby had only one arm.” after the birth. 4. “I was really happy before I got pregnant.” 4. She should schedule a postpartum checkup as soon as 176. A client visiting the prenatal clinic for the first time asks a her menses return. nurse about the probability of having twins because her 170. A nurse is caring for a postpartum client who is formula husband is one of a pair of fraternal twins. What is the feeding. What should the nurse teach her about minimizing appropriate response by the nurse? breast discomfort? 1. “A sonogram will confirm if there is a twin pregnancy.” 1. Apply covered ice packs to her breasts. 2. “There is a twenty-five percent probability of having 2. Gently apply cocoa butter to her nipples. twins.” 3. Place warm, wet washcloths on her nipples. 3. “The husband’s history of being a twin increases the 4. Manually express colostrum from her breasts. chance of having twins.” 171. Two days after having had a cesarean birth, a client tells a 4. “There is no greater probability of having twins than nurse that she has pain in her right leg, and after an assess- in the general population.” ment the nurse suspects that the client may have a throm- 177. What assessment finding of a pregnant client should alert bus. What is the nurse’s initial response? the nurse to notify the health care provider? 1. Maintain bed rest.