Maternity And Women’s Health Care,11th Edition by Deitra Leonard Lowdermilk -Test Bank

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Maternity And Women’s Health Care,11th Edition by Deitra Leonard Lowdermilk -Test Bank

 

Sample  Questions

 

Chapter 06: Reproductive System Concerns

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

 

MULTIPLE CHOICE

 

  1. Which condition is the least likely cause of amenorrhea in a 17-year-old client?
a. Anatomic abnormalities
b. Type 1 diabetes mellitus
c. Obesity
d. Pregnancy

 

 

ANS:  C

A moderately obese adolescent (20% to 30% above ideal weight) may have early onset menstruation. Girls who regularly exercise before menarche can have delayed onset of menstruation to age 18 years. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Pregnancy is the most common cause of amenorrhea.

 

DIF:    Cognitive Level: Remember           REF:   p. 121

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat to replace blood loss
b. Reducing the intake of diuretic foods, such as peaches and asparagus
c. Temporarily substituting physical activity for a sedentary lifestyle
d. Using a heating pad on the abdomen to relieve cramping

 

 

ANS:  D

Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as a low-fat vegetarian diet may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.

 

DIF:    Cognitive Level: Analyze               REF:   pp. 122-123   TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Nafarelin (Synarel) is used to treat mild-to-severe endometriosis. What instruction or information should the nurse provide to a client regarding nafarelin administration?
a. Nafarelin stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.
b. It should be administered by intramuscular (IM) injection.
c. Nafarelin should be administered by a subcutaneous implant.
d. It can cause the client to experience some hot flashes and vaginal dryness.

 

 

ANS:  D

Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH. Nafarelin is administered twice daily by nasal spray and can be intranasally administered. Leuprolide is given once per month by IM injection. Goserelin is administered by subcutaneous implant.

 

DIF:    Cognitive Level: Apply                  REF:   p. 127            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. Which statement by the client should prompt the nurse to collect further information?
a. “My menstrual flow lasts 5 to 6 days.”
b. “My flow is very heavy.”
c. “I have had a small amount of spotting midway between my periods for the past 2 months.”
d. “The length of my menstrual cycles varies from 26 to 29 days.”

 

 

ANS:  B

Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before the onset of the next menses), is considered normal. During her reproductive years, a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.

 

DIF:    Cognitive Level: Understand          REF:   p. 131

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A 21-year-old client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this client’s presenting complaint?
a. Primary dysmenorrhea
b. Secondary dysmenorrhea
c. Dyspareunia
d. Endometriosis

 

 

ANS:  A

Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops after the age of 25 years and is usually associated with a pelvic pathologic condition. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is characterized by endometrial glands and stoma outside of the uterus.

 

DIF:    Cognitive Level: Remember           REF:   p. 122

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which symptom described by a client is characteristic of premenstrual syndrome (PMS)?
a. “I feel irritable and moody a week before my period is supposed to start.”
b. “I have lower abdominal pain beginning on the third day of my menstrual period.”
c. “I have nausea and headaches after my period starts, and they last 2 to 3 days.”
d. “I have abdominal bloating and breast pain after a couple days of my period.”

 

 

ANS:  A

PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS; however, the timing reflected is inaccurate.

 

DIF:    Cognitive Level: Apply                  REF:   p. 125

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. A client complains of severe abdominal and pelvic pain around the time of menstruation. This pain has become progressively worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to become pregnant for the past 18 months. To which condition are these symptoms most likely related?
a. Endometriosis
b. PMS
c. Primary dysmenorrhea
d. Secondary dysmenorrhea

 

 

ANS:  A

Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.

 

DIF:    Cognitive Level: Understand          REF:   pp. 126-127

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs and symptoms of the climacteric?
a. Headaches
b. Hot flashes
c. Mood swings
d. Vaginal dryness with dyspareunia

 

 

ANS:  B

Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches may be associated with a decline in hormonal levels; however, headaches are not the most frequently reported discomfort for menopausal women. Mood swings may also be associated with a decline in hormonal levels; however, mood swings are not the most frequently reported discomfort for menopausal women. Vaginal dryness and dyspareunia may be associated with a decline in hormonal levels; however, both are not the most frequently reported discomforts for menopausal women.

 

DIF:    Cognitive Level: Understand          REF:   p. 133

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which risk factor would the nurse recognize as being frequently associated with osteoporosis?
a. African-American race
b. Low-protein intake
c. Obesity
d. Cigarette smoking

 

 

ANS:  D

Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.

 

DIF:    Cognitive Level: Remember           REF:   p. 135

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A perimenopausal client has arrived for her annual gynecologic examination. Which preexisting condition would be extremely important for the nurse to identify during a discussion regarding the risks and benefits of hormone therapy?
a. Breast cancer
b. Vaginal and urinary tract atrophy
c. Osteoporosis
d. Arteriosclerosis

 

 

ANS:  A

Women with a high risk for breast cancer should be counseled against using estrogen replacement therapy (ERT). Estrogen prevents the atrophy of vaginal and urinary tract tissue and protects against the development of osteoporosis. Estrogen also has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol levels and increasing high-density lipoprotein (HDL) levels. It also has a direct antiatherosclerotic effect on the arteries.

 

DIF:    Cognitive Level: Apply                  REF:   p. 136            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding without a demonstrable cause. Which statement regarding this condition is most accurate?
a. DUB is most commonly caused by anovulation.
b. DUB most often occurs in middle age.
c. The diagnosis of DUB should be the first consideration for abnormal menstrual bleeding.
d. Steroids are the most effective medical treatment for DUB.

 

 

ANS:  A

Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

 

DIF:    Cognitive Level: Remember           REF:   p. 131            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The female athlete triad includes which common menstrual disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Menorrhagia
d. Metrorrhagia

 

 

ANS:  A

The interrelatedness of disordered eating, amenorrhea, and altered bone mineral density have been described as the female athlete triad. Dysmenorrhea is painful menstruation that begins 2 to 6 months after menarche. Menorrhagia is abnormally profuse or excessive bleeding from the uterus. Metrorrhagia is bleeding between periods and can be caused by progestin injections and implants.

 

DIF:    Cognitive Level: Understand          REF:   p. 121            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which system responses would the nurse recognize as being unrelated to prostaglandin (PGF2) release?
a. Systemic responses
b. Gastrointestinal system
c. Central nervous system
d. Genitourinary system

 

 

ANS:  D

Systemic responses to PGF2 include backache, weakness, and sweating. Gastrointestinal system changes include nausea, vomiting, anorexia, and diarrhea. Central nervous system changes manifest themselves as dizziness, syncope, headache, and poor concentration; they usually begin at the onset of menstruation and last 8 to 48 hours.

 

DIF:    Cognitive Level: Understand          REF:   p. 122

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?
a. Premenstrual dysphoric disorder (PMDD) is a milder form of PMS and more common in young women.
b. Secondary dysmenorrhea is more intense and more medically significant than primary dysmenorrhea.
c. PMS is a complex, poorly understood condition that may include any of a hundred symptoms.
d. The causes of PMS have been well established.

 

 

ANS:  C

PMS may manifest itself with one or more of a hundred physical and psychologic symptoms. PDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than the pain reported in primary dysmenorrhea; however, the medical treatment is close to the same. The cause of PMS is unknown and may be, in fact, a collection of different problems.

 

DIF:    Cognitive Level: Understand          REF:   p. 125            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. To assist a client in managing the symptoms of PMS, what should the nurse recommend based on current evidence?
a. Diet with more body-building and energy foods, such as carbohydrates
b. Herbal therapies, yoga, and massage
c. Antidepressants for symptom control
d. Discouraging the use of diuretics

 

 

ANS:  B

Herbal therapies, yoga, and massage have been reported to have a beneficial effect on the symptoms of PMS. Limiting red meat, simple carbohydrates, caffeinated beverages, and alcohol improves the diet and may mitigate symptoms. Medication is usually begun only if lifestyle changes fail to provide significant relief. Natural diuretics may help reduce fluid retention.

 

DIF:    Cognitive Level: Apply                  REF:   pp. 125-126   TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement related to the condition of endometriosis is most accurate?
a. Endometriosis is characterized by the presence and growth of endometrial tissue inside the uterus.
b. It is found more often in African-American women than in Caucasian or Asian women.
c. Endometriosis may worsen with repeated cycles or remain asymptomatic and disappear after menopause.
d. It is unlikely to affect sexual intercourse or fertility.

 

 

ANS:  C

With endometriosis, the endometrial tissue is outside the uterus. Endometriosis is found equally in Caucasian and African-American women and is slightly more prevalent in Asian women. Symptoms vary among women, ranging from nonexistent to incapacitating. The condition is seven times more prevalent in women who have a first-degree relative with endometriosis. Women can experience painful intercourse and impaired fertility with endometriosis.

 

DIF:    Cognitive Level: Understand          REF:   pp. 126-127

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which alteration in cyclic bleeding best describes bleeding that occurs at any time other than menses?
a. Oligomenorrhea
b. Menorrhagia
c. Leiomyoma
d. Metrorrhagia

 

 

ANS:  D

Metrorrhagia (intermenstrual bleeding) refers to any episode or degree of bleeding that occurs between periods. It may be caused by contraceptives that contain progesterone or by intrauterine devices (IUDs). Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding.

 

DIF:    Cognitive Level: Remember           REF:   p. 129            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Physiologic Integrity

 

  1. Management of primary dysmenorrhea often requires a multifaceted approach. Which pharmacologic therapy provides optimal pain relief for this condition?
a. Acetaminophen
b. Oral contraceptive pills (OCPs)
c. Nonsteroidal antiinflammatory drugs (NSAIDs)
d. Aspirin

 

 

ANS:  C

NSAIDs have the strongest research results for pain relief. If one NSAID is not effective, then another one may provide relief. Approximately 80% of women find relief from these prostaglandin inhibitors. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have a number of potential side effects. NSAIDs are the drug of choice. However, if a woman is taking an NSAID, she should avoid taking aspirin as well.

 

DIF:    Cognitive Level: Apply                  REF:   p. 123            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. A client has requested information regarding alternatives to hormonal therapy for menopausal symptoms. Which current information should the nurse provide to the client? (Select all that apply.)
a. Soy
b. Vitamin C
c. Vitamin K
d. Vitamin E
e. Vitamin A

 

 

ANS:  A, D

Both soy and vitamin E have been reported to help alleviate menopausal symptoms, and both are readily available in food sources. Vitamin E can be also be taken as a supplement. Vitamins C, K, and A have no apparent effect on menopausal symptoms.

 

DIF:    Cognitive Level: Understand          REF:   p. 139            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which suggestions are appropriate for a client who complains of hot flashes? (Select all that apply.)
a. Avoid caffeine.
b. Drink a glass of wine to relax.
c. Wear layered clothing.
d. Drink ice water.
e. Drink warm beverages for their calming effect.

 

 

ANS:  A, C

Layered clothing allows the client to remove layers if a hot flash occurs. Ice water may help alleviate the hot flashes. Slow, deep breathing is also beneficial. Avoid triggers such as exercising on hot days, spicy foods, hot beverages, and alcohol.

 

DIF:    Cognitive Level: Understand          REF:   p. 139            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? (Select all that apply.)
a. Calcium
b. NSAIDs
c. Fosamax
d. Actonel
e. Calcitonin

 

 

ANS:  A, C, D, E

Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to treat or prevent osteoporosis. Parathyroid hormone and estrogen may also be of value. NSAIDs may provide pain relief; however, these medications neither prevent nor treat osteoporosis.

 

DIF:    Cognitive Level: Apply                  REF:   pp. 140-142

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement(s) might the nurse appropriately include when teaching a client about calcium intake for osteoporosis? (Select all that apply.)
a. “You should try to increase your protein intake when you are taking calcium.”
b. “It is best to take calcium in one large dose.”
c. “Tums are the most soluble form of calcium.”
d. “You should take calcium with vitamin D because the vitamin D helps your body better absorb calcium.”
e. “It’s okay to take calcium if you have had a history of kidney stones.”

 

 

ANS:  C, D

Teaching the client to take calcium with vitamin D is accurate. Excessive protein should be avoided. Calcium is best taken in divided doses to increase absorption. Calcium should be taken with vitamin D to increase absorption. Calcium is contraindicated in women with a history of kidney stones.

 

DIF:    Cognitive Level: Apply                  REF:   pp. 140-141   TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Nurses are in an ideal position to educate clients who experience PMDD. What self-help activities have been documented as helpful in alleviating the symptoms of PMDD? (Select all that apply.)
a. Regular exercise
b. Improved nutrition
c. Daily glass of wine
d. Smoking cessation
e. Oil of evening primrose

 

 

ANS:  A, B, D, E

Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are accurate modalities that may provide significant symptom relief in 1 to 2 months. If no improvement is realized after these changes have been made, then the client may need to begin pharmacologic therapy. Women should decrease their alcohol and caffeinated beverage consumption if they suffer from PMDD.

 

DIF:    Cognitive Level: Analyze               REF:   p. 125            TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Physiologic Integrity

 

MATCHING

 

Herbal preparations have long been used for the management of menstrual problems, including dysmenorrhea, cramping and discomfort, and breast pain. For the nurse to counsel adequately the client who elects to use this alternative modality, understanding the action of these herbal preparations is important. Match the herbal medicine with the appropriate action.

a. Uterine antispasmodic
b. Uterotonic
c. Antiinflammatory
d. Estrogen-like luteinizing hormone suppressant
e. Decreases prolactin levels

 

 

  1. Fennel, dong quai

 

  1. Chaste tree fruit

 

  1. Black cohosh root

 

  1. Valerian, wild yam

 

  1. Ginger

 

  1. ANS:  B                    DIF:    Cognitive Level: Apply                  REF:   p. 124

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions.

 

  1. ANS:  E                    DIF:    Cognitive Level: Apply                  REF:   p. 124

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions.

 

  1. ANS:  D                    DIF:    Cognitive Level: Apply                  REF:   p. 124

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions.

 

  1. ANS:  A                    DIF:    Cognitive Level: Apply                  REF:   p. 124

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions.

 

  1. ANS:  C                    DIF:    Cognitive Level: Apply                  REF:   p. 124

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women to understand that these therapies are not without potential toxicity and may cause drug interactions.

Chapter 07: Sexually Transmitted and Other Infections

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

 

MULTIPLE CHOICE

 

  1. Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis?
a. Fever, headache, and malaise
b. Widespread rash
c. Identified by serologic testing
d. Appearance of a chancre 2 months after infection

 

 

ANS:  D

Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

 

DIF:    Cognitive Level: Understand          REF:   p. 151

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate?
a. Only one vaccine for the HPV is available.
b. The vaccine is given in three doses over a 6-month period.
c. The vaccine is recommended for both boys and girls.
d. Ideally, the vaccine is administered before the first sexual contact.

 

 

ANS:  A

Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

 

DIF:    Cognitive Level: Remember           REF:   p. 154

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which sexually transmitted infection (STI) is the most commonly reported in American women?
a. Gonorrhea
b. Syphilis
c. Chlamydia
d. Candidiasis

 

 

ANS:  C

Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

 

DIF:    Cognitive Level: Remember           REF:   p. 149

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV?
a. Miconazole ointment
b. Topical podofilox 0.5% solution or gel
c. Two doses of penicillin administered intramuscularly (IM)
d. Metronidazole by mouth

 

 

ANS:  B

Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete’s foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

 

DIF:    Cognitive Level: Remember           REF:   p. 148

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

  1. A client exhibits a thick, white, lumpy, cottage cheese–like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition?
a. Fluconazole
b. Tetracycline
c. Clindamycin
d. Acyclovir

 

 

ANS:  A

The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

 

DIF:    Cognitive Level: Apply                  REF:   p. 163

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

  1. Which laboratory testing is used to detect the human immunodeficiency virus (HIV)?
a. HIV screening
b. HIV antibody testing
c. Cluster of differentiation 4 (CD4) counts
d. Cluster of differentiation 8 (CD8) counts

 

 

ANS:  B

The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

 

DIF:    Cognitive Level: Understand          REF:   p. 160            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which condition is the most life-threatening virus to the fetus and neonate?
a. Hepatitis A virus (HAV)
b. Herpes simplex virus (HSV)
c. Hepatitis B virus (HBV)
d. Cytomegalovirus (CMV)

 

 

ANS:  C

HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

 

DIF:    Cognitive Level: Remember           REF:   p. 158            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)?
a. Oral antiviral therapy
b. Bed rest in a semi-Fowler position
c. Antibiotic regimen continued until symptoms subside
d. Frequent pelvic examination to monitor the healing progress

 

 

ANS:  B

The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

 

DIF:    Cognitive Level: Apply                  REF:   p. 153            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a “fishy” odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect?
a. Bacterial vaginosis
b. Candidiasis
c. Trichomoniasis
d. Gonorrhea

 

 

ANS:  A

Most women with bacterial vaginosis complain of a characteristic “fishy” odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

 

DIF:    Cognitive Level: Understand          REF:   p. 162

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?
a. Herpes simplex virus 2 (HSV-2)
b. HPV
c. HIV
d. CMV

 

 

ANS:  A

The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

 

DIF:    Cognitive Level: Understand          REF:   p. 156

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity?
a. 6 to 10 days
b. 2 to 4 weeks
c. 6 to 12 weeks
d. 6 months

 

 

ANS:  C

Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

 

DIF:    Cognitive Level: Understand          REF:   p. 159

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. A 25-year-old single woman comes to the gynecologist’s office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, “What is that? Can you get rid of it?” Which is the best response for the nurse to provide?
a. “It’s just a little lump on your cervix. We can just freeze it off.”
b. “HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection that may lead to cervical cancer.”
c. “HPV is a type of early human immunodeficiency virus. You will die from this.”
d. “You probably caught this from your current boyfriend. He should get tested for this.”

 

 

ANS:  B

Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

 

DIF:    Cognitive Level: Analyze               REF:   p. 154            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which STI does not respond well to antibiotic therapy?
a. Chlamydia
b. Gonorrhea
c. Genital herpes
d. Syphilis

 

 

ANS:  C

Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

 

DIF:    Cognitive Level: Understand          REF:   p. 156            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate?
a. Vaccine exists for hepatitis C virus (HCV) but not for HBV.
b. HAV is acquired by eating contaminated food or drinking polluted water.
c. HBV is less contagious than HIV.
d. Incidence of HCV is decreasing.

 

 

ANS:  B

Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

 

DIF:    Cognitive Level: Understand          REF:   p. 158

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing?
a. Bacterial vaginosis
b. Candidiasis
c. Yeast infection
d. Trichomoniasis

 

 

ANS:  D

Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

 

DIF:    Cognitive Level: Understand          REF:   p. 164            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important?
a. Strategies to enhance condom use
b. Choice of colors and special features
c. Leaving the decision up to the male partner
d. Places to carry condoms safely

 

 

ANS:  A

When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

 

DIF:    Cognitive Level: Analyze               REF:   pp. 147-148   TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection?
a. Positive prenatal culture
b. Preterm birth at 37 weeks or less of gestation
c. Maternal temperature of 38° C or higher
d. Premature rupture of membranes (PROM) 24 hours or longer before the birth

 

 

ANS:  D

PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

 

DIF:    Cognitive Level: Understand          REF:   p. 164

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction?
a. Vomiting and diarrhea
b. Headache, myalgias, and arthralgia
c. Preterm labor
d. Jarisch-Herxheimer in the first 24 hours after treatment

 

 

ANS:  A

The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

 

DIF:    Cognitive Level: Remember           REF:   p. 152

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn?
a. Wear gloves.
b. Wear mouth, nose, and eye protection.
c. Wear a mask.
d. Wash the hands after medication administration.

 

 

ANS:  A

Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

 

DIF:    Cognitive Level: Apply                  REF:   p. 168            TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The nurse providing care in a women’s health care setting must be knowledgeable about STIs. Which STIs can be successfully treated?
a. HSV
b. AIDS
c. Venereal warts
d. Chlamydia

 

 

ANS:  D

The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

 

DIF:    Cognitive Level: Remember           REF:   p. 150

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. What is the drug of choice for the treatment of gonorrhea?
a. Penicillin G
b. Tetracycline
c. Ceftriaxone
d. Acyclovir

 

 

ANS:  C

Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

 

DIF:    Cognitive Level: Remember           REF:   p. 151            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. Which sexual behaviors are associated with exposure to an STI? (Select all that apply.)
a. Fellatio
b. Unprotected anal intercourse
c. Multiple sex partners
d. Dry kissing
e. Abstinence

 

 

ANS:  A, B, C

Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

 

DIF:    Cognitive Level: Understand          REF:   p. 147

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which statements regarding the HPV are accurate? (Select all that apply.)

HPV infections:

a. are thought to be less common in pregnant women than in women who are not pregnant.
b. are thought to be more common in pregnant women than in women who are not pregnant.
c. were previously called genital warts.
d. were previously called herpes.
e. may cause cancer.

 

 

ANS:  B, C, E

HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

 

DIF:    Cognitive Level: Understand          REF:   p. 154            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital’s maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care?
a. Intrapartum treatment with antiviral medications
b. Cesarean birth
c. Postpartum treatment with antiviral medications
d. Avoidance of breastfeeding
e. Pneumococcal, HBV, and Haemophilus influenzae vaccine

 

 

ANS:  A, B, D

The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

 

DIF:    Cognitive Level: Apply                  REF:   p. 161            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.)
a. Toxoplasmosis
b. Other infections
c. Roseola
d. Clostridium
e. Herpes simplex

 

 

ANS:  A, B, E

Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

 

DIF:    Cognitive Level: Remember           REF:   p. 165

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.)
a. Number of partners
b. Level of physical activity
c. Prevention of pregnancy
d. Protection from STIs
e. Past history

 

 

ANS:  A, C, D, E

Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

 

DIF:    Cognitive Level: Apply                  REF:   p. 145

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.)
a. Menstruation
b. Trauma
c. Febrile illness
d. Soap
e. Ultraviolet light

 

 

ANS:  A, B, C, E

Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

 

DIF:    Cognitive Level: Apply                  REF:   p. 157

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

Chapter 09: Infertility

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

 

MULTIPLE CHOICE

 

  1. Which test is performed around the time of ovulation to diagnose the basis of infertility?
a. Hysterosalpingogram
b. Ultrasonography
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level

 

 

ANS:  B

Ultrasonography is performed around the time of ovulation to assess pelvic structures for abnormalities, to verify follicular development, and to assess the thickness of the endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

 

DIF:    Cognitive Level: Understand          REF:   p. 201            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurse’s most appropriate response?
a. “This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins?”
b. “No one has ever had more than triplets with Clomid.”
c. “Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen.”
d. “Ten percent is a very low risk, so you don’t need to worry too much.”

 

 

ANS:  A

The incidence of multiple pregnancies with the use of these medications is higher than 25%. The client’s concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the client’s concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is inaccurate. Furthermore, the client’s concern is discredited with a statement such as, “…don’t worry.”

 

DIF:    Cognitive Level: Apply                  REF:   p. 208            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. Which guidance should the nurse provide?
a. “Your sperm count seems to be okay in the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Although smoking has no effect on sperm count, it can give you lung cancer.”
d. “Smoking can reduce the quality of your sperm.”

 

 

ANS:  D

Cigarette smoking has detrimental effects on sperm and has been associated with abnormal sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a smoking cessation program to increase the fertility of the male partner. Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. Marijuana use may depress the number and motility of sperm. Smoking is indeed a causative agent for lung cancer.

 

DIF:    Cognitive Level: Apply                  REF:   p. 199            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional testing is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. FSH level
d. Examination for testicular infection

 

 

ANS:  C

This scenario does not indicate that the woman has had any testing related to her irregular menstrual cycles. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of the woman’s irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the case because the husband has already produced children, antisperm antibodies may be produced by the man against his own sperm. Examination for testicular infection would be performed before semen analysis. Furthermore, infection would affect spermatogenesis.

 

DIF:    Cognitive Level: Analyze               REF:   p. 201            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurse’s most appropriate response?
a. “Tell your friends and family so that they can help you.”
b. “Talk only to other friends who are infertile, because only they can help.”
c. “Get involved with a support group. I’ll give you some names.”
d. “Start adoption proceedings immediately, because adopting an infant can be very difficult.”

 

 

ANS:  C

Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others’ experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couple’s relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs. However, depending on where the other couple is in their own recovery process, limiting their interactions may not be of assistance to them. Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

 

DIF:    Cognitive Level: Apply                  REF:   p. 204

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed?
a. Anovulatory cycles
b. Uterine fibroids
c. Polycystic ovary disease (PCOD)
d. Luteal phase inadequacy

 

 

ANS:  B

Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy.

 

DIF:    Cognitive Level: Remember           REF:   p. 206

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)?
a. Thyroid dysfunction
b. Recent miscarriage
c. PCOD
d. Oocyte retrieval

 

 

ANS:  A

Synthroid is administered for anovulation associated with hypothyroidism. For women with polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have insufficient progesterone and require exogenous progesterone until placental production is sufficient.

 

DIF:    Cognitive Level: Remember           REF:   p. 205            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Physiologic Integrity

 

  1. In vitro fertilization–embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. Which explanation regarding the procedure is most accurate?
a. “The procedure begins with collecting eggs from your wife’s ovaries.”
b. “A donor embryo will be transferred into your wife’s uterus.”
c. “Donor sperm will be used to inseminate your wife.”
d. “Don’t worry about the technical stuff; that’s what we are here for.”

 

 

ANS:  A

A woman’s eggs are collected from her ovaries, fertilized in the laboratory with the partner’s sperm, and transferred to her uterus after normal embryonic development has occurred. Transferring a donor embryo to the woman’s uterus describes the procedure for a donor embryo. Inseminating the woman with donor sperm describes therapeutic donor insemination. Telling the client not to worry discredits the client’s need for teaching and is not the most appropriate response.

 

DIF:    Cognitive Level: Apply                  REF:   p. 207            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information?
a. The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis.
b. The investigation will take several months and can be very costly.
c. The woman is assessed first; if she is not the problem, then the male partner is analyzed.
d. Semen analysis is for men; the postcoital test is for women.

 

 

ANS:  B

Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment. Both partners are systematically and simultaneously assessed, first as individuals and then as a couple. Semen analysis is for men; however, the postcoital test is for the couple.

 

DIF:    Cognitive Level: Apply                  REF:   p. 199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, “Deficient knowledge, related to lack of understanding of the reproductive process with regard to conception.” Which nursing intervention does not apply to this diagnosis?
a. Assess the current level of factors promoting conception.
b. Provide information regarding conception in a supportive manner.
c. Evaluate the couple’s support system.
d. Identify and describe the basic infertility tests.

 

 

ANS:  C

Evaluating the couple’s support system would be a nursing action more suitable to the diagnosis, “Ineffective individual coping, related to the ability to conceive.”

 

DIF:    Cognitive Level: Analyze               REF:   p. 203            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Male fertility declines slowly after age 40 years; however, no cessation of sperm production analogous to menopause in women occurs in men. What condition is not associated with advanced paternal age?
a. Autosomal dominant disorder
b. Schizophrenia
c. Autism spectrum disorder
d. Down syndrome

 

 

ANS:  D

Paternal age older than 40 years is associated with an increased risk for autosomal dominant disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down syndrome can occur in any pregnancy, it is often associated with advanced maternal age.

 

DIF:    Cognitive Level: Understand          REF:   p. 199

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when informing the client on which herbal preparations may improve ovulation induction therapy?
a. “You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant.”
b. “You may want to try black cohosh or phytoestrogens.”
c. “You should take vitamins E and C, selenium, and zinc.”
d. “Herbs have no bearing on fertility.”

 

 

ANS:  B

Ovulation therapy may have better outcomes when supplemented by black cohosh, progesterone, or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10, and ginseng have been shown to improve male fertility. Although most herbal remedies have not been clinically proven, many women find them helpful. They should be prescribed by a health care provider who has knowledge of herbalism.

 

DIF:    Cognitive Level: Apply                  REF:   p. 205            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. To provide adequate care, the nurse should be cognitive of which important information regarding infertility?
a. Is perceived differently by women and men.
b. Has a relatively stable prevalence among the overall population and throughout a woman’s potential reproductive years.
c. Is more likely the result of a physical flaw in the woman than in her male partner.
d. Is the same thing as sterility.

 

 

ANS:  A

Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a woman’s age, especially after age 40 years. Of cases with an identifiable cause, approximately 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a prolonged time to conceive.

 

DIF:    Cognitive Level: Understand          REF:   p. 204

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives to enable couples to make informed decisions about their choice of treatment. Which concern is unnecessary for the nurse to address before treatment?
a. Risks of multiple gestation
b. Whether or how to disclose the facts of conception to offspring
c. Freezing embryos for later use
d. Financial ability to cover the cost of treatment

 

 

ANS:  D

Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that multifetal reduction may be needed. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, donor oocytes, sperm, embryos, or a surrogate mother may be needed. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

 

DIF:    Cognitive Level: Apply                  REF:   p. 208

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate?
a. Semen is collected after laparoscopy.
b. Women must have two normal fallopian tubes.
c. Ovulation spontaneously occurs.
d. Ova and sperm are transferred to one tube.

 

 

ANS:  D

Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal tube. Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is collected before laparoscopy. The ova and sperm are then transferred to one uterine tube, permitting natural fertilization and cleavage.

 

DIF:    Cognitive Level: Remember           REF:   p. 207

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Significant advances have been made with most reproductive technologies. Which improvement has resulted in increased success related to preimplantation genetic diagnosis?
a. Embryos are transferred at the cleavage stage.
b. Embryos are transferred at the blastocyst stage.
c. More than two embryos can be transferred at a time.
d. Two cells are removed from each embryo.

 

 

ANS:  B

Preimplantation genetic diagnosis can be performed on a single cell removed from each embryo after 3 to 4 days. With the availability of extended culture mediums, embryos are transferred at the blastocyst stage (day 5), which increases the chance of a live birth, compared with the older practice of transferring embryos at the cleavage stage (day 3). No more than two embryos should be transferred at a time.

 

DIF:    Cognitive Level: Understand          REF:   p. 207

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified FSH (Metrodin). The nurse instructs her that this medication is administered in the form of what?
a. Intranasal spray
b. Vaginal suppository
c. Intramuscular (IM) injection
d. Tablet

 

 

ANS:  C

Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or a vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by mouth in tablet form.

 

DIF:    Cognitive Level: Comprehend        REF:   p. 206

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

  1. A couple arrives for their first appointment at an infertility center. Which of the following is a noninvasive test performed during the initial diagnostic phase of testing?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Sperm analysis
d. Laparoscopy

 

 

ANS:  C

Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of testing for male infertility. Radiographic film examination allows visualization of the uterine cavity after the instillation of a radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure, during which a small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful to view the pelvic structures intraperitoneally and is an invasive procedure.

 

DIF:    Cognitive Level: Comprehend        REF:   pp. 202-203   TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. Which factors are possible causes for female infertility? (Select all that apply.)
a. Congenital or developmental
b. Hormonal or ovulatory
c. Tubal or peritoneal
d. Uterine
e. Emotional or psychologic

 

 

ANS:  A, B, C, D

Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors. Although the diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress, these are not considered factors associated with infertility. Feelings connected with infertility are many and complex. Resolve is an organization that provides support, advocacy, and education for both clients and health care providers.

 

DIF:    Cognitive Level: Remember           REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. A probable cause for increasing infertility is the societal delay in pregnancy until later in life. What are the natural reasons for the decrease in female fertility? (Select all that apply.)
a. Ovulation dysfunction
b. Endocrine dysfunction
c. Organ damage from toxins
d. Endometriosis
e. Tubal infections

 

 

ANS:  A, C, D, E

All of these factors may result in a cumulative effect, decreasing fertility in women. Male infertility is more often caused by unfavorable sperm production attributable to endocrine dysfunction or cumulative metabolic disease.

 

DIF:    Cognitive Level: Comprehend        REF:   p. 197

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are accurate? (Select all that apply.)
a. Donor is inseminated with semen from the parent.
b. Donor eggs are fertilized with the male partner’s sperm.
c. Donors are under 35 years of age.
d. Recipient undergoes hormonal stimulation.
e. Ovum is placed into a surrogate.

 

 

ANS:  B, C, D

Oocyte donation is usually provided by healthy women under the age of 35 years, who are recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are fertilized in a laboratory with the male partner’s sperm. The woman undergoes hormonal stimulation to allow the development of the uterine lining. Embryos are then transferred. A donor that is inseminated with the male partner’s semen or receives the fertilized ovum and then carries it to gestation is known as a surrogate mother.

 

DIF:    Cognitive Level: Understand          REF:   p. 207

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which procedure falls into the category of micromanipulation techniques of the follicle? (Select all that apply.)
a. Intrauterine insemination
b. Preimplantation genetic diagnosis
c. Intracytoplasmic sperm injection (ISCI)
d. Assisted hatching
e. IVF-ET

 

 

ANS:  C, D

ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by introducing sperm beneath the zone pellucid into the egg. Another micromanipulation technique is assisted hatching. An infrared laser breaks through the thick or tough zone pellucid, enabling the blastocyst to hatch.

 

DIF:    Cognitive Level: Understand          REF:   p. 207

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

MATCHING

 

Evaluation for infertility should be offered to couples who have failed to become pregnant after 1 year of regular intercourse or after 6 months if the woman is older than 35 years. Impaired fertility in women may be the result of numerous factors. Careful identification of the cause of infertility assists in determining the correct treatment plan. The nurse who chooses to work in the specialty of infertility must have an excellent understanding of these factors and causes. Match each factor affecting female infertility with the likely cause.

a. Ovarian
b. Tubal or peritoneal factors
c. Uterine
d. Vaginal-cervical factors
e. Other factors

 

 

  1. Endometrial or myometrial tumors

 

  1. Anorexia

 

  1. Isoimmunization

 

  1. Thyroid dysfunction or obesity

 

  1. Endometriosis

 

  1. ANS:  C                    DIF:    Cognitive Level: Understand          REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

 

  1. ANS:  A                    DIF:    Cognitive Level: Understand          REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

 

  1. ANS:  D                    DIF:    Cognitive Level: Understand          REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

 

  1. ANS:  E                    DIF:    Cognitive Level: Understand          REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

 

  1. ANS:  B                    DIF:    Cognitive Level: Understand          REF:   pp. 197-199

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

NOT:  Ovarian factors include congenital anomalies, primary or secondary anovulation (anorexia), and medications. Tubal or peritoneal factors include congenital anomalies of the tubes, reduced tubal motility, inflammation, adhesions, and disruption owing to tubal pregnancy and endometriosis. Uterine factors include developmental anomalies of the uterus, endometrial and fibroid tumors, and Asherman syndrome. Vaginal-cervical factors include vaginal-cervical infections, inadequate cervical mucus, and isoimmunization (development of sperm antibodies). Other factors may include nutritional deficiencies, obesity, thyroid dysfunction, and idiopathic conditions.

Chapter 13: Anatomy and Physiology of Pregnancy

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

 

MULTIPLE CHOICE

 

  1. A woman’s obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
a. 3-1-1-1-3
b. 4-1-2-0-4
c. 3-0-3-0-3
d. 4-2-1-0-3

 

 

ANS:  B

Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this woman’s gravidity and parity. The numbers reflect the woman’s gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L signifies the number of children born who are currently living; the woman has four children. 3-1-1-1-3 is an incorrect calculation of this woman’s gravidity and parity; 3-0-3-0-3 is an incorrect calculation of this woman’s gravidity and parity; and 4-2-1-0-3 is an incorrect calculation of this woman’s gravidity and parity.

 

DIF:    Cognitive Level: Understand          REF:   p. 284            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?
a. Amenorrhea
b. Positive pregnancy test
c. Chadwick sign
d. Hegar sign

 

 

ANS:  A

Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

 

DIF:    Cognitive Level: Understand          REF:   p. 285

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?
a. Nonpalpable above the symphysis at 14 weeks of gestation
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus

 

 

ANS:  B

In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

 

DIF:    Cognitive Level: Apply                  REF:   p. 286

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints.

 

 

ANS:  B

An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

 

DIF:    Cognitive Level: Understand          REF:   p. 296            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
a. The pregnancy test was taken too early.
b. Anticonvulsant medications may cause the false-positive test result.
c. The woman has a fibroid tumor.
d. She has been under considerable stress and has a hormone imbalance.

 

 

ANS:  B

Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

 

DIF:    Cognitive Level: Apply                  REF:   p. 285

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?
a. This respiratory change is normal in pregnancy and caused by an elevated level of estrogen.
b. This cardiovascular change is abnormal, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been intranasally using cocaine.

 

 

ANS:  A

Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

 

DIF:    Cognitive Level: Apply                  REF:   p. 294

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?
a. The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an infection of the tubercles.
b. The mammary glands do not develop until 2 weeks before labor.
c. Lactation is inhibited until the estrogen level declines after birth.
d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

 

 

ANS:  C

Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

 

DIF:    Cognitive Level: Understand          REF:   p. 290            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which hormone is essential for maintaining pregnancy?
a. Estrogen
b. hCG
c. Oxytocin
d. Progesterone

 

 

ANS:  D

Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

 

DIF:    Cognitive Level: Remember           REF:   p. 299

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?
a. Ptyalism
b. Pyrosis
c. Pica
d. Decreased peristalsis

 

 

ANS:  C

Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

 

DIF:    Cognitive Level: Analyze               REF:   p. 298

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Why might it be more difficult to diagnose appendicitis during pregnancy?
a. The appendix is displaced upward and laterally, high and to the right.
b. The appendix is displaced upward and laterally, high and to the left.
c. The appendix is deep at the McBurney’s point.
d. The appendix is displaced downward and laterally, low and to the right.

 

 

ANS:  A

The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurney’s point and is not displaced in a downward direction.

 

DIF:    Cognitive Level: Understand          REF:   p. 298            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Physiologic Integrity

 

  1. The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?
a. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia, requires close medical and obstetric observation no matter how healthy she may appear otherwise.
b. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term.
c. Palpitations are twice as likely to occur in twin gestations.
d. All of the above changes will likely occur.

 

 

ANS:  B

These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

 

DIF:    Cognitive Level: Understand          REF:   p. 290            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement regarding the probable signs of pregnancy is most accurate?
a. Determined by ultrasound
b. Observed by the health care provider
c. Reported by the client
d. Confirmed by diagnostic tests

 

 

ANS:  B

Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

 

DIF:    Cognitive Level: Understand          REF:   p. 285

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which time-based description of a stage of development in pregnancy is correct?
a. Viability—22 to 37 weeks of gestation since the last menstrual period (assuming a fetal weight greater than 500 g)
b. Term—pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation
c. Preterm—pregnancy from 20 to 28 weeks of gestation
d. Postdate—pregnancy that extends beyond 38 weeks of gestation

 

 

ANS:  B

Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

 

DIF:    Cognitive Level: Remember           REF:   p. 283            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?
a. hCG can be detected as early as  weeks after conception.
b. hCG levels gradually and uniformly increase throughout pregnancy.
c. Significantly lower-than-normal increases in the levels of hCG may indicate a postdate pregnancy.
d. Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.

 

 

ANS:  D

Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

 

DIF:    Cognitive Level: Understand          REF:   p. 284            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?
a. Lightening occurs near the end of the second trimester as the uterus rises into a different position.
b. Woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise.
d. Uterine souffle is the movement of the fetus.

 

 

ANS:  B

The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

 

DIF:    Cognitive Level: Understand          REF:   p. 287            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What is the correct term used to describe the mucous plug that forms in the endocervical canal?
a. Operculum
b. Leukorrhea
c. Funic souffle
d. Ballottement

 

 

ANS:  A

The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

 

DIF:    Cognitive Level: Remember           REF:   p. 289

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?
a. Voice changes are caused by decreased estrogen levels.
b. Displacement of the diaphragm results in thoracic breathing.
c. Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract.
d. Increased blood volume causes changes in the voice.

 

 

ANS:  C

Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

 

DIF:    Cognitive Level: Understand          REF:   p. 294            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which renal system adaptation is an anticipated anatomic change of pregnancy?
a. Increased urinary output makes pregnant women less susceptible to urinary infections.
b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.
c. Renal (kidney) function is more efficient when the woman assumes a supine position.
d. Using diuretic agents during pregnancy can help keep kidney function regular.

 

 

ANS:  B

Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

 

DIF:    Cognitive Level: Understand          REF:   pp. 294-295   TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?
a. Melasma
b. Linea nigra
c. Striae gravidarum
d. Palmar erythema

 

 

ANS:  A

Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more common in women with a dark complexion. Melasma appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

 

DIF:    Cognitive Level: Remember           REF:   p. 295            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Which gastrointestinal alteration of pregnancy is a normal finding?
a. Insufficient salivation (ptyalism) is caused by increases in estrogen.
b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy.
c. Hyperthyroidism often develops (temporarily) because hormone production increases.
d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

 

 

ANS:  D

Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation that may be caused by a decrease in unconscious swallowing or by stimulation of the salivary glands. Pyrosis begins as early as the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.

 

DIF:    Cognitive Level: Apply                  REF:   p. 298

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share?
a. Braxton Hicks contractions should be painless.
b. They may increase in frequency with walking.
c. These contractions might cause cervical dilation.
d. Braxton Hicks contractions will impede oxygen flow to the fetus.

 

 

ANS:  A

Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. This type of contraction usually ceases with walking or exercise. Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation. These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

 

DIF:    Cognitive Level: Understand          REF:   p. 287            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?
a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are easier to evaluate.
b. Quickening is a technique of palpating the fetus to engage it in passive movement.
c. The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor.
d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

 

 

ANS:  D

Increased sensitivity and an increased interest in sex sometimes go together and frequently occur during the second trimester. These cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of gestation.

 

DIF:    Cognitive Level: Understand          REF:   p. 289            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?
a. Epulis
b. Chloasma
c. Telangiectasia
d. Striae gravidarum

 

 

ANS:  D

Striae gravidarum, or stretch marks, reflect a separation within the underlying connective tissue of the skin. They usually fade after birth, although they never completely disappear. An epulis is a red, raised nodule on the gums that easily bleeds; it disappears or shrinks after giving birth. Chloasma, or the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen and usually disappear after birth.

 

DIF:    Cognitive Level: Understand          REF:   p. 290            TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. What is the correct term for a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability?
a. Primipara
b. Primigravida
c. Multipara
d. Nulligravida

 

 

ANS:  A

A primipara is a woman who has completed one pregnancy with a viable fetus. To help remember the terms: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. Therefore, a primigravida is a woman pregnant for the first time; a multipara is a woman who has completed two or more pregnancies with a viable fetus; and a nulligravida is a woman who has never been pregnant.

 

DIF:    Cognitive Level: Understand          REF:   p. 283            TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?
a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.
b. Shifting the client’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.
c. Systolic blood pressure slightly increases as the pregnancy advances; diastolic pressure remains constant.
d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy.

 

 

ANS:  D

Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and vulva. The tightness of a blood pressure cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as the pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

 

DIF:    Cognitive Level: Understand          REF:   p. 292

TOP:   Nursing Process: Planning | Nursing Process: Implementation

MSC:  Client Needs: Physiologic Integrity

 

  1. Which finding in the urinalysis of a pregnant woman is considered a variation of normal?
a. Proteinuria
b. Glycosuria
c. Bacteria in the urine
d. Ketones in the urine

 

 

ANS:  B

Small amounts of glucose may indicate physiologic spilling. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

 

DIF:    Cognitive Level: Analyze               REF:   p. 295

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the rationale for this change?
a. To compensate for the decreased renal plasma flow
b. To provide adequate perfusion of the placenta
c. To eliminate metabolic wastes of the mother
d. To prevent maternal and fetal dehydration

 

 

ANS:  B

The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

 

DIF:    Cognitive Level: Understand          REF:   p. 287

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy?
a. Physiologic anemia involves an inadequate intake of iron.
b. Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia.
c. Fetus establishes the iron stores.
d. Decreased production of erythrocytes occur.

 

 

ANS:  B

When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of the dilution of hemoglobin concentration rather than inadequate hemoglobin. An inadequate intake of iron may lead to true anemia. The production of erythrocytes increases during pregnancy.

 

DIF:    Cognitive Level: Remember           REF:   p. 292

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. A patient in her first trimester complains of nausea and vomiting. She asks, “Why does this happen?” What is the nurse’s best response?
a. “Nausea and vomiting are due to an increase in gastric motility.”
b. “Nausea and vomiting may be due to changes in hormones.”
c. “Nausea and vomiting are related to an increase in glucose levels.”
d. “Nausea and vomiting are caused by a decrease in gastric secretions.”

 

 

ANS:  B

Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

 

DIF:    Cognitive Level: Understand          REF:   p. 297

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.)
a. Identification of fetal heartbeat
b. Palpation of fetal outline
c. Visualization of the fetus
d. Verification of fetal movement
e. Positive hCG test

 

 

ANS:  A, C, D

Identification of a fetal heartbeat, the visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

 

DIF:    Cognitive Level: Analyze               REF:   p. 285

TOP:   Nursing Process: Assessment | Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A woman is in for a routine prenatal checkup. The nurse is assessing her urine for glycosuria and proteinuria. Which findings are considered normal? (Select all that apply.)
a. Dipstick assessment of trace to +1
b. <300 mg/24 hours
c. Dipstick assessment of +2 glucose
d. >300 mg/24 hours
e. Albumin < 30 mg/24 hours

 

 

ANS:  A, B, E

Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein in greater amounts may indicate renal problems. A dipstick assessment of +2 and proteinuria >300 mg/24 hours, and albuminuria greater than 30 mg/24 hours are excessive and should be further evaluated.

 

DIF:    Cognitive Level: Apply                  REF:   p. 295

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.)
a. Leukorrhea
b. Development of the operculum
c. Quickening
d. Ballottement
e. Lightening

 

 

ANS:  C, D, E

Quickening is the first recognition of fetal movements or “feeling life.” Quickening is often described as a flutter and is felt earlier in the multiparous woman than in the primiparous woman. Passive movement of the unengaged fetus is referred to as ballottement. Lightening occurs when the fetus begins to descend into the pelvis and occurs 2 weeks before labor in the nulliparous woman and at the start of labor in the multiparous woman. Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy.

 

DIF:    Cognitive Level: Understand          REF:   p. 286 | pp. 287-288

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable to an increase in various clotting factors. Which of these come into play during pregnancy? (Select all that apply.)
a. Factor VII
b. Factor VIII
c. Factor IX
d. Factor XIII
e. Fibrinogen

 

 

ANS:  A, B, C, E

Factors VII, VIII, IX, X, and fibrinogen increase in pregnancy. Factors that inhibit coagulation decrease. Fibrinolytic activity (dissolving of a clot) is depressed during pregnancy and the early postpartum period to protect the women from postpartum hemorrhage.

 

DIF:    Cognitive Level: Understand          REF:   p. 293

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

COMPLETION

 

  1. To provide optimal prenatal care, a blood pressure reading should be obtained at every prenatal visit. Calculating the mean arterial pressure (MAP) can increase the value of this diagnostic finding. MAP readings for a pregnant woman at term are 90+ = 5.8 mm Hg. The nurse has just obtained a BP of 106/70 mm Hg on a 37-week primiparous client. The formula for the MAP reading is (systolic + [2 ´ diastolic]) ¸ 3. The MAP reading for this client is _____ mm Hg.

 

ANS:

82

(106 + [2 ´ 70]) ¸ 3

(106 + 140) ¸ 3

246 ¸ 3 = 82 mm Hg

 

The MAP can also be thought of as the mean of the blood pressure present in arterial circulation.

 

DIF:    Cognitive Level: Apply                  REF:   p. 291

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity