Test Bank of Contemporary Maternal Newborn Nursing, 9th ed By Ladewig

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Contemporary Maternal Newborn Nursing, 9th ed By Ladewig

Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 6   Common Gynecologic Problems

 

1) The nurse is teaching a class to women who were recently diagnosed with benign breast disease (BBD), commonly known as fibrocystic breast disease. One of the participants’ reports increased swelling, pain, and pressure in her breasts just before menstruation. What is the best response by the nurse?

  1. “Consider asking your nurse practitioner about adding a mild diuretic to your regimen.”
  2. “The pain may be caused by thinning of the normal breast tissue.”
  3. “Breast swelling and pressure are expected symptoms, but pain is abnormal and should be evaluated by your physician.”
  4. “It’s best to make an appointment with an oncologist.”

Answer:  1

Explanation:  1. Treatment of BBD may include taking a mild diuretic during the week prior to the onset of menses to counteract fluid retention, relieve pressure in the breast, and help decrease pain.

  1. The pathology of BBD involves fibrosis, which is a thickening of the normal breast tissue.
  2. Common symptoms associated with BBD include cyclical breast pain, tenderness, and swelling.
  3. Cyclical breast pain, swelling, and tenderness are common symptoms associated with BBD. Generally fibrocystic changes are not a risk factor for breast cancer.

Page Ref: 94

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 6.1-Contrast the contributing factors, signs and symptoms, treatment options, and nursing care management of women with common benign breast disorders.

MNL LO:  Describe the structures and functions of the female reproductive system.

 

2) The nurse is caring for a client diagnosed with endometriosis. Which statement by the client requires immediate follow-up?

  1. “I am having many hot flashes since I had the Lupron injection.”
  2. “The pain I experience with intercourse is becoming more severe.”
  3. “My leg has become painful and swollen since I started taking birth control pills.”
  4. “I’ve noticed my voice is lower since I started taking danazol.”

Answer:  3

Explanation:  1. Leuprolide acetate (Lupron) is a GnRH agonist and causes symptoms of a hypo-estrogenic state (hot flashes, vaginal dryness, decreased libido, and bone density loss). Hot flashes are expected and not a complication.

  1. Dyspareunia is a common symptom of endometriosis and therefore is not a complication.
  2. Combination oral contraceptive pills contain estrogen. A painful, swollen lower extremity can be a sign of deep vein thrombosis, which can cause thromboembolus, which is potentially life threatening. This is a complication and must be addressed immediately.
  3. Danocrine (danazol) is a testosterone derivative that suppresses GnRH and has high-androgen and low-estrogen effects. A lowered voice is one side effect of danazol. This client is not experiencing a complication.

Page Ref: 95

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/ Health teaching and health promotion

Learning Outcome:  LO 6.2-Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

3) The nurse is creating a care plan for a client who is unable to conceive as a consequence of endometriosis. Which statement accurately reflects a nursing diagnosis that may apply to the care of this client?

  1. Acute pain related to dysuria and renal pain secondary to endometriosis
  2. Hyperandrogenism related to elevated serum androgen levels secondary to endometriosis
  3. Compromised family coping related to depression secondary to infertility
  4. Infertility related to endometrial inflammation and adhesions secondary to endometriosis

Answer:  3

Explanation:  1. Pelvic pain is a frequent symptom of endometriosis, while dysuria and renal pain are more commonly associated with conditions such as upper urinary tract infections (UTI).

  1. Hyperandrogenism is a medical diagnosis that pertains to elevated serum androgen levels. Hyperandrogenism is associated with polycystic ovarian syndrome (PCOS).
  2. Infertility may lead to depression and subsequent compromised family coping, which is a nursing diagnosis.
  3. Although associated with the medical condition of endometriosis, infertility is a medical diagnosis.

Page Ref: 95

Cognitive Level:  Analyzing

Client Need&Sub:  Safe and Effective Care Environment

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Coordination of care

Learning Outcome:  LO 6.2-Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

4) The client has been diagnosed with endometriosis. She asks the nurse if there are any long-term health risks associated with this condition. The nurse should include which statement in the client teaching about endometriosis?

  1. “There are no other health risks associated with endometriosis.”
  2. “Pain with intercourse rarely occurs as a long-term problem.”
  3. “You are at increased risk for ovarian and breast cancer.”
  4. “Most women with this condition develop fibromyalgia.”

Answer:  3

Explanation:  1. There are long-term health risks associated with endometriosis, including increased risk for cancer of the ovary and breast, melanoma, non-Hodgkin lymphoma, and an increased incidence of fibromyalgia.

  1. Dyspareunia is a common symptom of endometriosis.
  2. An increased risk for cancer of the ovary and breast is associated with endometriosis.
  3. There is a risk of increased incidence of fibromyalgia.

Page Ref: 95

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 6.2-Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

5) A patient diagnosed with polycystic ovarian disease (PCOS) asks her nurse why her treatment regimen includes spironolactone (Aldactone). How should the nurse respond?

  1. “Spironolactone may be used to decrease symptoms associated with PCOS, such as excessive hair growth and acne.”
  2. “Menstrual irregularities related to polycystic ovarian disease are treated using spironolactone.”
  3. “Spironolactone is often used to reduce complications associated with PCOS, including rectocele.”
  4. “Condylomata acuminata, which are sometimes caused by polycystic ovarian disease, are treated with spironolactone.”

Answer:  1

Explanation:  1. Spironolactone may be used to treat symptoms of hyperandrogenism that are secondary to PCOS, including excessive hair growth and acne.

  1. Combined oral contraceptive (COC) or cyclic progesterone are used to treat menstrual irregularities associated with PCOS.
  2. A rectocele, which may develop when the posterior vaginal wall is weakened, is associated with pelvic relaxation.
  3. Condylomata acuminata, also called genital or venereal warts, is a sexually transmitted condition unrelated to PCOS.

Page Ref: 96, 97

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  LO 6.4-Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome (PCOS).

MNL LO:  Women’s health

 

6) Which client in the gynecology clinic should the nurse see first?

  1. 22-year-old, using tampons, T = 102°F, P = 122, BP = 70/55
  2. 15-year-old, no menses for past 4 months
  3. 18-year-old, requests information on contraception methods
  4. 31-year-old, reports increasing dyspareunia

Answer:  1

Explanation:  1. A client using tampons who is febrile, tachycardic, and hypotensive might have toxic shock syndrome. Hypotension is life-threatening; this client should be seen immediately.

  1. Secondary amenorrhea can be caused by pregnancy. Teen pregnancy is a high risk, but no indication is given that the patient is exhibiting a life-threatening condition.
  2. Unplanned pregnancy and sexually transmitted infections can be problematic in the future, but this client exhibits no signs or symptoms of a life-threatening condition at this time.
  3. Although this client might have endometriosis, dyspareunia is not a life-threatening condition.

Page Ref: 97, 98

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 6.3-Identify the risk factors, treatment options, and nursing interventions for a woman with toxic shock syndrome.

MNL LO:  Utilize the nursing process in caring for women at risk for or with a gynecological infection.

 

 

7) Which statement indicates that client teaching has been effective?

  1. “I should douche weekly to prevent a recurrence of my bacterial vaginosis.”
  2. “I can use this antiyeast medication weekly to prevent another infection.”
  3. “My diabetes is unrelated to the frequency of my vaginal yeast infections.”
  4. “The fishy vaginal odor I have is caused by a bacterial infection.”

Answer:  4

Explanation:  1. Douching disrupts normal flora by washing out desirable bacteria; douching is not recommended.

  1. Medication for vaginal yeast infections should be used as treatment, not prophylaxis. Using medication as prescribed is important client education. Medication should not be saved for future use.
  2. Yeast vaginitis is more common in diabetic and prediabetic women. Four episodes or more per year of yeast vaginitis are an indication to screen a woman for diabetes.
  3. Bacterial vaginosis is characterized by a fishy vaginal odor and greenish discharge with a vaginal pH greater than 4.5.

Page Ref: 98

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 6.5-Compare the causes, signs and symptoms, treatment options, and nursing care for women with vulvovaginal candidiasis versus bacterial vaginosis.

MNL LO:  Utilize the nursing process in caring for women at risk for or with a gynecological infection.

 

8) Which client is at greatest risk for developing Chlamydia trachomatis infection?

  1. 16-year-old female, sexually active, using no contraceptive
  2. 22-year-old mother of two, developed dyspareunia
  3. 35-year-old woman on oral contraceptives
  4. 48-year-old woman with hot flashes and night sweats

Answer:  1

Explanation:  1. Teens have the highest incidence of sexually transmitted infections, especially Chlamydia. A client not using contraceptives is not using condoms, which decrease the risk of contracting a STI.

  1. Dyspareunia sometimes develops with Chlamydia infection, but dyspareunia is not a symptom specific to Chlamydia.
  2. There is no correlation between oral contraceptive use and an increased rate of Chlamydia infection. Additionally, Chlamydia is more commonly seen in young women
  3. This client is experiencing signs of menopause, not Chlamydia infection.

Page Ref: 101

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice

Learning Outcome:  LO 6.6-Compare the common sexually transmitted infections with regard to their etiology, signs and symptoms, treatment options, nursing care, and methods of prevention.

MNL LO:  Recognize client behaviors associated with the acquisition of sexually transmitted infections.

 

9) The physician has prescribed metronidazole (Flagyl) for a woman diagnosed with trichomoniasis. The nurse’s instructions to the woman should include:

  1. “Both partners must be treated with the medication.”
  2. “Alcohol does not need to be avoided while taking this medication.”
  3. “It will turn your urine orange.”
  4. “This medication could produce drowsiness.”

Answer:  1

Explanation:  1. Both partners should be treated with the medication.

  1. Alcohol should be avoided.
  2. Metronidazole does not turn the urine orange.
  3. Metronidazole does not cause drowsiness.

Page Ref: 100

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 6.6-Compare the common sexually transmitted infections with regard to their etiology, signs and symptoms, treatment options, nursing care, and methods of prevention.

MNL LO:  Utilize the nursing process in caring for women at risk for or with a gynecological infection.

10) The couple demonstrates understanding of the consequences of not treating Chlamydia when they state (select all that apply):

  1. “She could become pregnant.”
  2. “She could have severe vaginal itching.”
  3. “He could get an infection in the tube that carries the urine out.”
  4. “It could cause us to develop rashes.”
  5. “She could develop a worse infection of the uterus and tubes.”

Answer:  3, 5

Explanation:  1. Chlamydia does not cause a woman to become pregnant.

  1. Chlamydia does not cause vaginal itching.
  2. Chlamydia is a major cause of non-gonococcal urethritis (NGU) in men.
  3. Chlamydia does not cause a rash.
  4. Chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the uterus, fallopian tubes, and sometimes ovaries.

Page Ref: 101

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 6.6-Compare the common sexually transmitted infections with regard to their etiology, signs and symptoms, treatment options, nursing care, and methods of prevention.

MNL LO:  Utilize the nursing process in caring for women at risk for or with a gynecological infection.

 

 

11) Which of the following clients should be treated with ceftriaxone (Rocephin) IM and doxycycline (Vibramycin) orally?

  1. A pregnant client with gonorrhea and a yeast infection
  2. A non-pregnant client with gonorrhea and Chlamydia
  3. A pregnant client with syphilis
  4. A non-pregnant client with Chlamydia and trichomoniasis

Answer:  2

Explanation:  1. Doxycycline is contraindicated during pregnancy.

  1. This combined treatment provides dual treatment for gonorrhea and Chlamydia because the two infections frequently occur together.
  2. Syphilis is treated with penicillin.
  3. Trichomoniasis is treated with metronidazole.

Page Ref: 99-100

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 6.6-Compare the common sexually transmitted infections with regard to their etiology, signs and symptoms, treatment options, nursing care, and methods of prevention.

MNL LO:  Utilize the nursing process in caring for women at risk for or with a gynecological infection.

 

12) The nurse is preparing a brochure that compares and contrasts cystitis and pyelonephritis. Which information should be included in the brochure?

  1. Both conditions usually present with sudden onset of chills, high temperature, and flank pain.
  2. Dysuria, especially at the end of urination, is often the initial symptom of both conditions.
  3. Both conditions are associated with pregnancy complications including increased risk of preterm birth and of intrauterine growth restriction.
  4. Urine culture is included in the evaluation of both cystitis and pyelonephritis.

Answer:  4

Explanation:  1. Acute pyelonephritis has a sudden onset, with chills, high temperature, and flank pain (either unilateral or bilateral).

  1. The initial symptom of cystitis is often dysuria, specifically at the end of urination.
  2. Pyelonephritis during pregnancy is associated with an increased risk of preterm birth and intrauterine growth restriction.
  3. Diagnosis of cystitis is made with a urine culture. Women with acute pyelonephritis should have a urine culture and sensitivity done to determine the appropriate antibiotic.

Page Ref: 107, 108

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 6.9-Contrast the causes, signs and symptoms, treatment options, and nursing care for women with cystitis versus pyelonephritis.

MNL LO:  Differentiate the causes, risks, and treatment of upper and lower urinary tract infections.

 

13) The nurse is discharging a client after hospitalization for pelvic inflammatory disease (PID). Which statements indicate that teaching was effective? Select all that apply.

  1. “I might have infertility because of this infection.”
  2. “It is important for me to finish my antibiotics.”
  3. “Tubal pregnancy could occur after PID.”
  4. “My PID was caused by a yeast infection.”
  5. “I am going to have an IUD placed for contraception.”

Answer:  1, 2, 3

Explanation:  1. Women sometimes become infertile because of scarring in the fallopian tubes as a result of the inflammation of PID.

  1. Antibiotic therapy should always be completed when a patient is diagnosed with any infection.
  2. The tubal scarring that occurs from tubal inflammation during PID can prevent a fertilized ovum from passing through the tube into the uterus, causing an ectopic or tubal pregnancy.
  3. PID is caused by bacteria, most commonly Chlamydia trachomatis or Neisseria gonorrhoeae. Yeast infections do not ascend and become upper reproductive tract infections.
  4. An intrauterine device (IUD) in place increases the risk of developing PID; a patient who has a history of PID is not a good candidate for an IUD.

Page Ref: 104

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 6.7-Summarize the pathology, signs and symptoms, treatment, nursing care, and implications for future fertility of pelvic inflammatory disease (PID).

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

 

14) Which of the following diagnostic tests would the nurse question when ordered for a patient diagnosed with pelvic inflammatory disease (PID)?

  1. CBC (complete blood count) with differential
  2. Vaginal culture for Neisseria gonorrhoeae
  3. Throat culture for Streptococcus A
  4. RPR (rapid plasma reagin)

Answer:  3

Explanation:  1. CBC with differential will give an indication of the severity of the infection.

  1. Gonorrhea is a common cause of PID, and the patient should be tested for this.
  2. Streptococcus of the throat is not associated with PID.
  3. RPR is a test for syphilis, another cause of PID.

Page Ref: 104

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Quality of care

Learning Outcome:  LO 6.7-Summarize the pathology, signs and symptoms, treatment, nursing care, and implications for future fertility of pelvic inflammatory disease (PID).

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

15) The nurse is to tell a client that her Pap smear result was abnormal. Which statement should the nurse include?

  1. “The Pap smear is used to diagnose cervical cancer.”
  2. “A loop electrosurgical excision procedure (LEEP) is needed.”
  3. “Colposcopy to further examine your cervix is the next step.”
  4. “Your cervix needs to be treated with cryotherapy.”

Answer:  3

Explanation:  1. The Pap smear is a screening tool for cervical abnormalities; it is not diagnostic.

  1. Although LEEP (the removal of the surface tissue of the cervix) might be performed to treat cervical dysplasia or carcinoma in situ, this client has not had a diagnostic examination yet.
  2. Colposcopy is an examination of the cervix through a magnifying device. Solutions are often painted onto the cervix and surrounding tissue and observed for changes secondary to the application of the solution. Biopsy samples are taken of suspected abnormal tissue and sent for pathologic examination and diagnosis. Endocervical canal biopsy is often undertaken with colposcopy.
  3. Cryotherapy, or freezing of the cervix, is one treatment option for precancerous cervical lesions. However, this client does not yet have a diagnosis; she has only had an abnormal screening test.

Page Ref: 105

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 6.8-Identify the implications of an abnormal finding during a pelvic examination in the provision of nursing care.

MNL LO:  Women’s health

 

16) The nurse is preparing an education session for women on prevention of urinary tract infections (UTIs). Which statement should be included?

  1. Lower urinary tract infections rarely occur in women.
  2. The most common causative organism of cystitis is E. coli.
  3. Wiping from back to front after a BM will help prevent a UTI.
  4. Back pain often develops with a lower urinary tract infection.

Answer:  2

Explanation:  1. About 60 percent of women will experience an episode of cystitis during their lifetime.

  1. Because E. coli is a common bacterium in the bowel and the female urethra is short and close to the anus, cross-contamination of bowel bacteria into the female urinary tract is common.
  2. Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being drawn towards the urethra. Women should be instructed always to wipe from front to back.
  3. Low back or flank pain is a sign of pylonephritis, which is an upper urinary tract infection. Signs of a lower UTI include dysuria, urinary frequency, and urinary urgency.

Page Ref: 107, 108

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 6.9-Contrast the causes, signs and symptoms, treatment options, and nursing care for women with cystitis versus pyelonephritis.

MNL LO:  Differentiate the causes, risks, and treatment of upper and lower urinary tract infections.

 

17) The nurse is caring for a client who underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy several hours ago. The highest priority for the nurse is to:

  1. Monitor blood pressure and pulse.
  2. Assess the client’s acceptance of not being able to have children.
  3. Teach the client how to splint her abdomen while taking deep breaths.
  4. Verify that the IV pump is working correctly.

Answer:  1

Explanation:  1. A post-surgical client is at risk for internal bleeding at the site of the surgery. Monitoring blood pressure and pulse is necessary to verify that the client is hemodynamically stable.

  1. Although this client will not be able to become pregnant because of the surgery, acceptance is a psychosocial issue and a lower priority than is physiologic stability.
  2. Splinting while deep-breathing is a comfort measure to facilitate oxygenation and prevent atelectasis. But hemodynamic stability is a higher priority.
  3. The client needs IV fluids to replace blood loss during surgery and until oral intake is adequate. But hemodynamic stability is a higher priority.

Page Ref: 109

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 6.11-Contrast laparoscopic-assisted vaginal hysterectomy and abdominal hysterectomy with regard to indications for use and the advantages and disadvantages of each procedure.

MNL LO:  Implement the nursing process to post-operative care after a gynecological surgery procedure.

 

 

18) The nurse is creating a care plan for a client diagnosed with dyspareunia. Which nursing diagnostic statements accurately reflects a nursing diagnosis that applies to the care of the client? Select all that apply.

  1. Pain, chronic related to menopause
  2. Coping, Family Compromised related to depression secondary to infertility
  3. Anxiety related to threat to body image
  4. Pain, acute related to fixed, tender, retroverted uterus
  5. Hyperandrogenism related to elevated insulin levels

Answer:  2, 4

Explanation:  1. Dyspareunia is painful intercourse, and is often diagnosed when a woman seeks evaluation for infertility. Bimanual examination may reveal a fixed, tender, retroverted uterus and palpable nodules in the cul-de-sac. Because this pain is usually related to menstruation, the woman typically assumes it is dysmenorrhea.

  1. Dyspareunia is painful intercourse, and is often diagnosed when a woman seeks evaluation for infertility. Bimanual examination may reveal a fixed, tender, retroverted uterus and palpable nodules in the cul-de-sac. Because this pain is usually related to menstruation, the woman typically assumes it is dysmenorrhea.
  2. Dyspareunia is painful intercourse, and is often diagnosed when a woman seeks evaluation for infertility. Bimanual examination may reveal a fixed, tender, retroverted uterus and palpable nodules in the cul-de-sac. Because this pain is usually related to menstruation, the woman typically assumes it is dysmenorrhea.
  3. Dyspareunia is painful intercourse, and is often diagnosed when a woman seeks evaluation for infertility. Bimanual examination may reveal a fixed, tender, retroverted uterus and palpable nodules in the cul-de-sac. Because this pain is usually related to menstruation, the woman typically assumes it is dysmenorrhea.
  4. Dyspareunia is painful intercourse, and is often diagnosed when a woman seeks evaluation for infertility. Bimanual examination may reveal a fixed, tender, retroverted uterus and palpable nodules in the cul-de-sac. Because this pain is usually related to menstruation, the woman typically assumes it is dysmenorrhea.

Page Ref: 95, 96

Cognitive Level:  Analyzing

Client Need&Sub:  Safe and Effective Care Environment

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Coordination of care

Learning Outcome:  LO 6.2-Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

 

19) A woman having the diagnosis of Polycystic ovarian syndrome (PCOS) consistently has elevated serum androgen levels. The nurse should assess the client for what clinical manifestations? Select all that apply.

  1. Hirsutism
  2. Acne
  3. Hypotension
  4. Deepening voice
  5. Fever

Answer:  1, 2, 4

Explanation:  1. Polycystic ovarian syndrome is the most common endocrine disorder affecting women of reproductive age, marked by menstrual dysfunction, androgen excess, obesity, hyperinsulinemia, and infertility.

  1. Polycystic ovarian syndrome is the most common endocrine disorder affecting women of reproductive age, marked by menstrual dysfunction, androgen excess, obesity, hyperinsulinemia, and infertility.
  2. Polycystic ovarian syndrome is the most common endocrine disorder affecting women of reproductive age, marked by menstrual dysfunction, androgen excess, obesity, hyperinsulinemia, and infertility.
  3. Polycystic ovarian syndrome is the most common endocrine disorder affecting women of reproductive age, marked by menstrual dysfunction, androgen excess, obesity, hyperinsulinemia, and infertility.
  4. Polycystic ovarian syndrome is the most common endocrine disorder affecting women of reproductive age, marked by menstrual dysfunction, androgen excess, obesity, hyperinsulinemia, and infertility.

Page Ref: 96

Cognitive Level:  Analyzing

Client Need&Sub:  Patient-centered Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice

Learning Outcome:  LO 6.2-Explain the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

MNL LO:  Explain the relationship between pelvic inflammatory disease (PID) and infertility.

 

Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 7   Families with Special Reproductive Concerns

 

1) A client who has been unable to conceive asks the nurse if it is her fault or her husband’s fault that they have not been able to become pregnant. The best response by the nurse is:

  1. “The male infertility factors are more common than female.”
  2. “Female infertility issues are more common than male issues.”
  3. “The testing the doctor will order will determine who is at fault.”
  4. “We will know more about what is causing your infertility after some tests are done.”

Answer:  4

Explanation:  1. This statement is not true. Because of the complexity of ovulation and maintaining a pregnancy, it is more likely that a female issue is causing the infertility. Regardless, using the term “at fault” is blaming and should be avoided.

  1. Although this statement is true because of the complexity of ovulation and maintaining a pregnancy, using the term “at fault” is blaming and should be avoided.
  2. Testing will determine what the infertility issue is, but using the term “at fault” is blaming and should be avoided.
  3. This is a factual answer that avoids using the term “at fault.” This statement is therapeutically worded and therefore is the best answer.

Page Ref: 115

Cognitive Level:  Application

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 7.1-Compare the essential components of fertility with the possible causes of infertility.

MNL LO:  Explain infertility and its associated risk factors.

 

2) The client experiencing infertility is to complete three months of documenting her basal body temperatures. Which statement by the client indicates a need for additional teaching?

  1. “I should check my temperature with this special thermometer before I get out of bed each day.”
  2. “I will track my temperatures and the consistency of my cervical mucus for the next 3 months.”
  3. “If I am ovulating, my temperature will be a smooth, even line on the graph that does not go up or down.”
  4. “The point of checking my basal body temperature is to determine whether I am ovulating regularly.”

Answer:  3

Explanation:  1. The basal body temperature is most accurate prior to arising each day. A thermometer with larger spaces between tenths of a degree is used to facilitate accurate recording.

  1. Taking the temperature each morning will help detect ovulation. Checking cervical mucus daily for changes in consistency and stretchiness is another method to detect ovulation. Combining the two methods gives better information on when ovulation is occurring than one method does alone.
  2. A flat line on the graph is a monophasic cycle indicating a lack of ovulation. An ovulating woman will have a biphasic pattern to her basal body temperature. The temperature will drop slightly prior to ovulation, and rise about .5 to 1.0°F as ovulation occurs, remaining elevated if conception occurs or dropping just prior to onset of menses.
  3. Basal body temperatures are less predictive of when ovulation occurs, but an increase in the latter half of the cycle indicates that ovulation has occurred.

Page Ref: 116, 117

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.2-Describe the elements of the preliminary investigation of infertility and the nurse’s role in supporting/teaching patients during this phase.

MNL LO:  Recognize the various strategies for managing infertility.

 

3) A 31-year-old woman with normal ovaries, a normal prolactin level, and an intact pituitary gland is undergoing initial pharmacologic treatment of anovulation. Which medication would the nurse anticipate being prescribed for this client?

  1. Clomiphene citrate (Clomid or Serophene)
  2. Glucophage (Metformin)
  3. Human menopausal gonadotropins (hMGs)
  4. Bromocriptine (Parlodel)

Answer:  1

Explanation:  1. Clomiphene citrate (Clomid or Serophene) is a common first-line therapy for inducing ovulation in women with normal ovaries, normal prolactin level, and intact pituitary gland.

  1. Oral hypoglycemic agents such as glucophage (Metformin) are used for inducing ovulation in women with polycystic ovary disease (PCOS).
  2. hMGs is a second line of therapy in women who fail to ovulate or conceive with clomiphene citrate therapy.
  3. Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation.

Page Ref: 114, 115

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Quality of practice

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Examine the assessment process for male and female infertility.

 

 

4) A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful?

  1. “I have to go buy a special type of thermometer.”
  2. “I need to wait five minutes after smoking a cigarette before I take my temperature.”
  3. “I need to take my temperature before I get out of the bed in the morning.”
  4. “I need to take my temperature for at least two minutes every day.”

Answer:  3

Explanation:  1. The temperature can be taken with a standard oral or rectal thermometer.

  1. In the basal body temperature method, the woman takes her temperature every day before starting any activity, including smoking.
  2. In the basal body temperature method, the woman takes her temperature every day before arising.
  3. In the basal body temperature method, the woman takes her temperature every day for five minutes.

Page Ref: 116. 117

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Recognize the various strategies for managing infertility.

 

5) A client calls his urologist’s office to clarify instructions about semen analysis. The nurse should instruct the client to:

  1. Remain abstinent for 3 days prior to collecting the specimen.
  2. Use a lubricant while obtaining the semen specimen.
  3. Immediately refrigerate the specimen for a maximum of 8 hours.
  4. Deliver the specimen to the laboratory within 1 hour of collection.

Answer:  1

Explanation:  1. To obtain accurate results of a semen analysis, the specimen is collected after 3 days of abstinence.

  1. Most lubricants also are spermicidal and should not be used unless approved by the andrology laboratory.
  2. If the specimen is obtained at home, it needs kept at body temperature and delivered to the lab within 1 hour so as not to impair motility.
  3. If the specimen is obtained at home, it needs to be delivered to the lab within 1 hour so as not to impair motility.

Page Ref: 118, 119

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Quality of practice

Learning Outcome:  LO 7.3-Compare the indications for the tests with the associated treatments, including assisted reproductive technologies that are done in an infertility workup.

MNL LO:  Recognize the various strategies for managing infertility.

 

6) The client undergoing infertility treatment reports to the nurse that her partner is angry all of the time since beginning treatment and is very negative in comments made about the likelihood of their achieving pregnancy. The client states, “I was angry and depressed, but now I am dedicated to following through with treatment and hoping we get pregnant.” What is the best interpretation of these comments? The partner is (select all that apply):

  1. Exhibiting signs of the anger stage of grieving the loss of their dreams of having children.
  2. In a different stage of grief than the patient.
  3. Having difficulty accepting the reality of their infertility.
  4. Showing that he will not be a good parent.
  5. Feeling guilty about not being able to father a child.

Answer:  1, 2

Explanation:  1. The client’s description of her partner correlates with the anger stage of grief. Couples often experience the stages of grief when infertility is diagnosed because childbearing is an expected outcome in marriage; the inability to become pregnant is the loss of the dream of parenthood.

  1. The client is in acceptance stage of grief, while the partner is in the anger stage. It is common and normal for families to be in different stages of the grieving process.
  2. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct.
  3. Being in the anger stage of grief is expected and normal and has no bearing on parenting ability.
  4. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger.

Page Ref: 123, 124

Cognitive Level:  Analyzing

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Quality of practice

Learning Outcome:  LO 7.4-Explain the physiologic and psychologic effects of infertility on a couple in relation to the nursing management of the couple.

MNL LO:  Implement the nurse’s role in caring for and supporting couples who experience infertility.

 

7) The nurse manager is interviewing nurses for a position in an infertility clinic. Which statement best indicates that the interviewee understands the role of the nurse when working with infertile clients?

  1. “My job will be teaching patients how to take their medications and scheduling tests.”
  2. “Much of my duties will involve forming therapeutic relationships with clients struggling with infertility.”
  3. “This position is an assistant to the physician during diagnostic testing for infertility.”
  4. “I will both teach and support families struggling with emotions as they attempt to become pregnant.”

Answer:  4

Explanation:  1. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed.

  1. Although this response addresses the emotional aspects of infertility, it does not mention providing support or teaching, which are also major components of the job.
  2. Some assisting might be a part of this position; the role of the RN in an infertility clinic involves much teaching and providing emotional support to infertile patients.
  3. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education.

Page Ref: 123, 124

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential V: Healthcare Policy, Finance, and Regulatory Environments | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Quality of practice

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Implement the nurse’s role in caring for and supporting couples who experience infertility.

 

 

8) Which client(s) should the nurse refer to a genetics practitioner prior to attempting pregnancy?

  1. A 32-year-old woman and a 29-year-old man with 3-year-old twins.
  2. A 22-year-old woman whose sister has Tay-Sachs disease.
  3. A 30-year-old woman whose husband has AIDS.
  4. A 19-year-old woman whose sister has primary infertility.

Answer:  2

Explanation:  1. This client has no indication of having a genetic problem.

  1. Tay-Sachs disease is an autosomal recessive condition; therefore, if the client’s sister has the disease, the client could be a carrier for the condition.
  2. The risk for this patient is becoming infected with HIV while attempting conception. This couple has no indication of a genetic condition.
  3. Primary infertility is not likely to be caused by a genetic defect that could be carried by a sibling. This client has no indication of a genetic condition.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 7.6-Identify couples who may benefit from pre-conceptual chromosomal analysis and prenatal testing when providing care to couples with special reproductive concerns.

MNL LO:  Recognize the various strategies for managing infertility.

 

9) The nurse has presented an in-service to nurses new to the maternal-child health care unit. Which statement indicates that teaching on genetic disorders has been successful?

  1. “Down syndrome is an autosomal recessive condition. If both parents carry the gene, there is a 1-in-4 chance that a child will be affected.”
  2. “Galactosemia is a sex-linked condition. Both parents must carry the gene, and more girls than boys will be affected by this condition.”
  3. “Sickle cell disease is a trisomy; the affected client has three copies of a gene. Trisomies are more common in pregnancies of young women than those of older women.”
  4. “Huntington’s disease is an autosomal dominant condition. Only one parent carries the gene, and males and females are equally affected by the disease.”

Answer:  4

Explanation:  1. Down syndrome is a trisomy and most likely to occur in parents older than age 35. Autosomal recessive conditions are passed along to offspring when both parents carry the affected gene and pass the affected gene to the child.

  1. Galactosemia is not a sex-linked disorder; it is an autosomal recessive disorder. Both parents must carry the gene and pass that gene on to the child. Males and females are equally affected. Sex-linked disorders are carried on the X chromosome; therefore, males are more likely to have the condition because they only have one copy of the X chromosome.
  2. Trisomies are three copies of a specific gene and occur most often in parents older than age 35. Sickle-cell disease is not a trisomy; it is an autosomal recessive condition. Both parents must carry the gene; there is a 1-in-4 chance that their child will be affected.
  3. Huntington’s disease is an autosomal dominant disease, meaning that the affected person inherited the condition from only one affected parent. A child has a 50 percent chance of inheriting an autosomal dominant condition if one parent is affected. Males and females are equally affected by autosomal dominant disorders.

Page Ref: 127

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Quality Improvement | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Contrast the various genetic inheritance patterns.

 

10) A 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease, poor muscle tone, and low-set ears on the newborn. The nurse understands that these signs most likely indicate the infant has which autosomal abnormalities?

  1. Trisomy 13
  2. Trisomy 18
  3. Trisomy 21
  4. Trisomy 26

Answer:  3

Explanation:  1. A single palmar crease and low-set ears are not characteristics of trisomy 13.

  1. A single palmar crease and low-set ears are not characteristics of trisomy 18.
  2. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).
  3. Trisomy 26 is not an autosomal abnormality.

Page Ref: 126

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Quality of practice

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Contrast the various genetic inheritance patterns.

 

 

11) A nurse counsels a couple regarding their concerns about an X-linked disorder. Both parents are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse’s best response?

  1. “If you have a daughter, she will not be a carrier.”
  2. “If you have a daughter, she will not be affected.”
  3. “If you have a son, he will be a carrier.”
  4. “If you have a son, he will not be affected.”

Answer:  2

Explanation:  1. Fathers affected with an X-linked disorder cannot pass the disorder to their sons, but all their daughters become carriers of the disorder.

  1. An X-linked disorder is manifested in a male who carries the abnormal gene on his only X chromosome.
  2. There is no male-to-male transmission of an X-linked disorder. An X-linked disorder is manifested in a male who carries the abnormal gene on his only X chromosome.
  3. There is a 50 percent chance that a carrier mother will pass the abnormal gene to each of her sons, who will thus be affected.

Page Ref: 127

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 7.7-Identify the characteristics of autosomal dominant, autosomal recessive, and X-linked (sex-linked) recessive disorders.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

12) A child with suspected Down syndrome has been born to 32-year-old parents. The parents ask the nurse how the diagnosis will be made and if there was a way that the diagnosis could have been made during the pregnancy. The best response by the nurse is:

  1. “The baby’s genes could have been tested during pregnancy by doing an amniocentesis.”
  2. “The doctor will check the baby’s genes by doing a 24-hour urine collection on your child.”
  3. “Mom’s blood could have been tested during the pregnancy to check for genetic problems with the baby.”
  4. “A swab of the baby’s cheek or a stool sample will be used to check your baby’s chromosomes.”

Answer:  1

Explanation:  1. A genetic amniocentesis is the removal of a small amount of amniotic fluid obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes.

  1. Suspected genetic conditions in newborns are diagnosed by examining the baby’s chromosomes either from a blood sample or from a swab of the inside of the cheek.
  2. Mom’s blood would contain the mother’s chromosomes, not the baby’s. Prenatal genetic testing is accomplished through genetic amniocentesis. A small amount of amniotic fluid is obtained by inserting a needle through the abdominal wall into the uterus. The amniotic fluid is then processed to examine the chromosomes.
  3. Although a cheek swab can be used for genetic testing, stool samples cannot. Because part of the answer is incorrect, the whole answer is incorrect.

Page Ref: 126

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

13) The couple has had an ultrasound at 19 weeks’ gestation, and their fetus was found to have anencephaly. The nurse is completing counseling for the couple on the ultrasound findings. Which statement indicates that additional teaching is needed?

  1. “We won’t know if something is wrong until the baby’s chromosomes are tested.”
  2. “This problem is not caused by one of us having a genetic problem.”
  3. “Our baby has an incomplete brain and might not be born alive.”
  4. “Waiting until our 30s did not cause this problem to develop.”

Answer:  1

Explanation:  1. Anencephaly is clearly visualized with an ultrasound and does not require genetic testing to verify a diagnosis.

  1. Genetic abnormalities in either parent are not related to anencephaly.
  2. Anencephaly is a condition in which the skull does not cover the brain completely, and the brain consists mostly of brainstem with little other brain development.
  3. The age of either parent is not related to anencephaly.

Page Ref: 126

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

 

14) A male infant was born 2 days ago, and the nurse assessed the infant as having single palmar crease, poor muscle tone, and low-set ears. Genetic testing of the infant has been ordered by the physician. Which statement should the nurse include when explaining this plan to the parents?

  1. “We will draw blood from both of you to check for abnormal genes.”
  2. “Your son will have his chromosomes sampled and then studied.”
  3. “When your son is 2 years old, he will need a blood test.”
  4. “After your breast milk is in, we will draw blood from your son.”

Answer:  2

Explanation:  1. The parents’ chromosomes do not need to be assessed in order to diagnose the infant.

  1. A single palmar crease, poor muscle tone, and low-set ears could indicate trisomy 18. This diagnosis is confirmed by chromosomal analysis of the infant, using either a buccal smear or a blood specimen.
  2. The chromosome studies will be undertaken as soon as possible.
  3. It is not necessary to wait until the breast milk has come in.

Page Ref: 126, 127

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 7.8-Compare prenatal and postnatal diagnostic procedures used to determine the presence of genetic disorders and the nursing considerations for each.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

15) The family of a 3-day-old child has just been informed that their child has cystic fibrosis. Which statement to the family should the nurse make?

  1. “I can see that you are adjusting well. I’ll leave you alone for a while.”
  2. “This must be difficult news for you. What questions do you have?”
  3. “Do you have family members or clergy you would like me to call?”
  4. “Why didn’t you have an amniocentesis during your pregnancy?”

Answer:  2

Explanation:  1. When a client is given bad news, the grieving process begins. The family is grieving the loss of a normal child. This family is most likely in the shock/disbelief stage of grief.

  1. This response uses therapeutic communication techniques and portrays a caring attitude towards the family. Asking if the family has questions further facilitates communication.
  2. Although it is good to have supportive family members or a clergy person called if the family desires, it is better for the nurse to take the initiative and establish therapeutic communication and to portray caring.
  3. It is not therapeutic to ask “why” questions. In addition, although cystic fibrosis is diagnosable prenatally, a client opposed to abortion often will not seek prenatal diagnosis, because the pregnancy would not be terminated if the child were affected by a chromosomal abnormality.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication

Learning Outcome:  LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

16) The couple at 12 weeks’ gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping?

  1. “We knew we were both carriers of sickle cell. We shouldn’t have tried to have a baby.”
  2. “If we had been healthier when we conceived, our baby wouldn’t have this disease now.”
  3. “Taking vitamins before we got pregnant would have prevented this from happening.”
  4. “The doctor told us there was a 25 percent chance that our baby would have sickle cell disease.”

Answer:  4

Explanation:  1. Self-blame and judgment do not indicate coping.

  1. Preconception health does not affect transmission of an autosomal recessive trait.
  2. Nutrition does not affect transmission of an autosomal recessive trait.
  3. A true statement indicates coping. When both the mother and father are carriers of an autosomal recessive disease like sickle cell disease, there is a 25 percent chance of a normal child, a 25 percent chance of a child with sickle-cell disease, and a 50 percent chance of a child with sickle-cell trait.

Page Ref: 128

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Professional identity | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication

Learning Outcome:  LO 7.9-Examine the emotional impact on a couple undergoing genetic testing or coping with the birth of a baby with a genetic disorder.

MNL LO:  Contrast the various genetic inheritance patterns.

 

17) The parents of a child with cystic fibrosis are attending genetic counseling. After their initial visit, they ask the nurse what will happen next. How should the nurse respond?

  1. “Your genetic counseling is a medical matter that can only be discussed with your physician.”
  2. “You will have one more appointment with your genetic counselor and that will conclude your genetic counseling.”
  3. “You will receive a letter from your primary care physician that explains the results of your genetic counseling session.”
  4. “You will have a follow-up visit with your genetic counselor and you will receive additional information at that time.”

Answer:  4

Explanation:  1. The nurse should act as a liaison between the family and genetic counselor.

  1. After a follow-up visit, the family may return to the genetic counselor to ask questions and express concerns, especially if the couple is considering having more children, or if siblings want information about their affected brother or sister.
  2. Upon completion of genetic counseling, the genetic counselor sends the parent(s) and their certified nurse-midwife or physician a letter detailing the contents of the sessions.
  3. After the initial genetic counseling session, a follow-up visit is scheduled in order for the genetic counselor to provide the parents with all available information and offer additional counseling.

Page Ref: 128

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VIII: Professionalism and professional values | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Communication

Learning Outcome:  LO 7.10-Explain the nurse’s role in supporting the family undergoing genetic counseling.

MNL LO:  Examine the role of the nurse and the process involved in genetic counseling.

 

18) The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Select all that apply.

  1. “Infertility can be stressful for a marriage.”
  2. “The doctor will be able to tell why you have not conceived.”
  3. “Your insurance will pay for the infertility treatments.”
  4. “Keep communicating with one another through this process.”
  5. “Taking a vacation usually results in pregnancy.”

Answer:  1, 4

Explanation:  1. Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and pay for treatments and the societal expectation to have children.

  1. Some infertility cannot be explained, despite extensive treatments.
  2. Insurance often does not pay for infertility treatment.
  3. Communication is important to help cope with stress. A nurse should always encourage clients to ask questions.
  4. A common myth is that taking a vacation or just relaxing will result in conception.

Page Ref: 97

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Explain infertility and its associated risk factors.

 

19) A woman has had her initial infertility work-up and labs. In the next step, the nurse teaches the woman about basal body temperature (BBT) method. The nurse should explain that certain situations can disturb body temperature, which situations should the nurse instruct the client regarding?

  1. Eating
  2. Jet lag
  3. Voiding
  4. Waterbed use
  5. Shift work

Answer:  2, 4, 5

Explanation:  1. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.

  1. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  2. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  3. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.
  4. BBT is the lowest waking temperature. Clients should be cautioned against anything that would increase temperature before taking the temperature, examples include smoking, waterbed and Jacuzzi use, jet lag, and shift work.

Page Ref: 142

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Recognize the various strategies for managing infertility.

 

20) The first-line therapy to induce ovulation in women with normal ovaries, normal prolactin level and an intact pituitary is Clomiphene citrate. The nurse also teaches about what side effects?

  1. Dryness/loss of hair
  2. Hot flashes
  3. Visual disturbances
  4. Weight gain
  5. Hair growth

Answer:  1, 2, 3

Explanation:  1. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.

  1. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  2. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  3. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.
  4. The side effects the nurse should teach about are dryness and loss of hair, hot flashes, nausea and vomiting, visual disturbances, headaches, multiple pregnancies, pain and breast discomfort.

Page Ref: 148

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 7.5-Describe the nurse’s role as counselor, educator, and advocate for couples during infertility evaluation and treatment.

MNL LO:  Recognize the various strategies for managing infertility.