Women's health/Disorders & Childbearing

A client with a history of endometriosis has abdominal surgery to remove adhesions. What should this client's postoperative plan of care include?
1. Encouraging the client to ambulate in the hallway
2. Elevating the client's legs by gatching the bed
3. He

1. Encouraging the client to ambulate in the hallway

After a mastectomy or a hysterectomy a client may feel incomplete as a woman. What statement should alert the nurse to this feeling in a client who has undergone total hysterectomy?
1. "I can't wait to see all my friends again."
2. "I feel washed out; the

2. "I feel washed out; there isn't much left.

A nurse is evaluating a client's understanding regarding postoperative concerns after mastectomy. Which development near and around the incision noted by the client should be reported to her practitioner?
1. Persistent itching
2. Decreased sensation
3. Sw

3. Swelling with erythema
**Swelling and erythema are signs of infection and should be reported to the health care provider. Itching is a sign of healing that is expected.

The nurse instructs a pregnant client in the sources of protein that can be used to meet the increased daily requirement during pregnancy. How many grams of protein should the client eat each day?
1. 65 g
2. 60 g
3. 55 g
4. 50 g

2. 60 g
**The Food and Nutrition Board of the National Academy of Sciences recommends that a pregnant woman consume 60 g of protein daily to meet the needs of pregnancy. The recommended daily intake of protein for a breastfeeding (lactating) woman is 65 g

On the first postpartum day, a client whose infant is rooming in asks the nurse to return her baby to the nursery and bring the baby to her only at feeding times. How should the nurse respond?
1. "It seems that you've changed your mind about rooming in.

1. "It seems that you've changed your mind about rooming in.

A nurse on the postpartum unit discusses breast care with a client who is formula feeding her newborn. Which statement indicates to the nurse that more teaching is needed?
1. "The discomfort will be better after a couple of days."
2. "I need to ask my hus

3. "Applying heat to my breasts will help ease the discomfort.

A nurse is discussing immunizations needed to confer active immunity with a pregnant client during her first visit to the prenatal clinic. What information should the nurse consider including that the client will understand with regard to active immunity?

2. Protein substances are formed by the body to destroy or neutralize antigens.

The school nurse is teaching a group of 16-year-old girls about the female reproductive system. One student asks how long after ovulation it is possible for conception to occur. The most accurate response by the nurse is based on the knowledge that an ovu

2. 24 hours
**The ovum is viable for about 24 hours after ovulation; if not fertilized before this time, it degenerates.

A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn?
1.

4. Gestational age and birthweight

At a client's first prenatal visit, the healthcare provider performs a pelvic examination, stating that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. The best r

4. Is caused by increased blood flow to the uterus during pregnancy"
**Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick's sign and provides a simple explanation of the cau

What instruction should a nurse include when teaching about the correct use of a female condom?
1. "Remove the condom before standing up."
2. "Insert the condom within 1 hour before intercourse."
3. "Have your partner wear a male condom at the same time.

1. "Remove the condom before standing up."
**Removing the condom before standing up keeps the semen in the female condom and prevents the inadvertent contact of semen with vaginal tissues.

A female client came to the clinic with suspected primary syphilis. What sign of primary syphilis does the nurse expect the client to exhibit?
1. Flat wartlike plaques around the vagina and anus
2. An indurated painless nodule on the vulva that is drainin

2. An indurated painless nodule on the vulva that is draining
**This is the description of a chancre, which is the initial sign of syphilis.

Although a client in labor is prepared and plans to participate in the labor and birth process, she states that she is in severe discomfort. The nurse administers the prescribed butorphanol (Stadol). Which phase of labor is the safest time for the nurse t

2. Active phase
**Respiratory depression of the newborn will not occur if the medication is given during the active phase; it should not be given when birth is expected to occur within 2 hours.

During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because of the presence of a white curdlike vaginal discharge. What other assessment supports a fungal vaginal infection?
1. A foul odor
2. An itchy perineum
3. An

2. An itchy perineum

A primigravida complains of morning sickness. What should the nurse plan to teach her?
1. Increasing her fluid intake
2. Eat three small meals a day
3. Increase the calcium in her diet
4. Avoid long periods without food

4. Avoid long periods without food

Which statements by a client with hyperemesis gravidarum would confirm that the client needs further teaching? (Select all that apply.)
1. "I'll start drinking protein shakes."
2. "I'll start drinking plenty of fluids."
3. "I'll start limiting my carbohyd

3. "I'll start limiting my carbohydrates."
4. "I'll lie down for at least 2 hours after I eat.

An estrogen-progestin oral contraceptive is prescribed for a client. Which adverse effects should the nurse teach the client to report to the health care provider? (Select all that apply.)
1. Lethargy
2 .Dizziness
3. Chest pain
4. Constipation
5. Breast s

3. Chest pain
5. Breast soreness
6. Calf tenderness

A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecological history. What condition does the client have that causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy?
1.

2. Large uterine fibroids
**Attempting to remove a uterus with large uterine fibroids vaginally can cause trauma, resulting in hemorrhage.

A client with endometriosis asks the nurse what side effects to expect from leuprolide (Lupron). What should the nurse include in the response?
1. Weight gain
2. Increased libido
3. Frequent urination
4. Heavy menstrual bleeding

1. Weight gain
**The nurse should teach the client that the side effects of leuprolide (Lupron) include edema, which causes an increase in weight.

A nurse is instructing a client to cough and deep-breathe after an emergency cesarean birth. The client says, "Get out of here. Can't you see that I'm in pain?" Which response will be the most effective?
1. "I'm sure you're in pain. I'll come back later.

2. "If you can't cough, try taking six very deep breaths."
**Having the client take deep breaths is important because deep breathing promotes full expansion of the alveoli and prevents stasis of pulmonary secretions.

A nurse is teaching a breastfeeding client about medications that are safe and unsafe for her to take. Which medication is contraindicated?
1. Heparin (Hep-Lock)
2. Propylthiouracil (PTU)
3. Gentamicin (Garamycin)
4. Diphenhydramine (Benadryl)

2. Propylthiouracil (PTU)
**The concentration of propylthiouracil (PTU) excreted in breast milk is three to 12 times higher than its level in maternal serum; this may cause agranulocytosis or goiter in the infant.

During a routine prenatal office visit at 26 weeks' gestation, a client states that she is getting fat all over and that she even needed to buy bigger shoes. What is the next nursing action?
1. Obtaining the client's weight and blood pressure
2. Reassurin

1. Obtaining the client's weight and blood pressure
**The client's weight and blood pressure helps the nurse determine whether an unusual weight gain or an increase in blood pressure has occurred; both of these findings are early signs of preeclampsia.

After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate (Clomid) is prescribed. The nurse concludes that the client understands the teaching about the correct t

1. "I'll start the pills on the fifth day of my cycle."
**The objective is to stimulate ovulation near the 14th day of the menstrual cycle, and this is achieved by taking the medication on the fifth through the ninth days; there is an increase in two pitu

A nurse teaches a pregnant woman about the need to increase her intake of complete proteins. Which foods identified by the client indicate that the teaching is effective? (Select all that apply.)
1. Nuts
2. Milk
3. Eggs
4. Bread
5. Beans
6. Cheese

2. Milk
3. Eggs
6. Cheese

After an emergency cesarean birth, the client tells the nurse that she was hoping for a "natural" childbirth but is glad that she and her baby are all right." Which postpartum phase of adjustment does this statement most closely typify?
1. Taking-in
2. Le

1. Taking-in

A client starting her second trimester asks a nurse in the prenatal clinic whether she can safely take an over-the-counter (OTC) medicine now that she is past the first 3 months of pregnancy. The nurse explains why she should consult with her health care

2. Longer gastrointestinal emptying time
**Gastrointestinal motility is reduced during pregnancy because of the high level of placental progesterone and displacement of the stomach superiorly and the intestines laterally and posteriorly; absorption of som

A 35-year-old client is scheduled for a vaginal hysterectomy. She asks the nurse about the changes she should expect after surgery. How should the nurse respond?
1. "You will stop ovulating."
2. "Surgical menopause will happen immediately."
3. "Sexual int

4. "A hysterectomy doesn't affect the chronological age when menopause usually occurs.

A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond?
1. "It covers the entrance to the cervical os."
2. "The openings to the fallopian tubes are blocked."
3. "The

4. "It produces a spermicidal intrauterine environment.

A client with cervical cancer is to undergo a course of internal radiation. The client returns to her lead-lined room on the oncology unit with an indwelling urinary catheter and a vaginal applicator in place. Once the practitioner has loaded the applicat

2. Leaving the urinary catheter undisturbed

The day after a client has a cesarean birth, the indwelling catheter is removed. The nurse concludes that urinary function has returned when the:
1. Client has 90 mL of residual urine after voiding
2. Client's daily urinary output is at least 1500 mL
3. C

4. Client voids 300 mL of urine within 4 hours of catheter removal
**Voiding 300 mL of urine within 4 hours of catheter removal indicates that urinary sphincter tone has not been affected by the catheter and that urine retention with overflow has not occu

A client who is visiting the family planning clinic is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of:
1. Cervicitis
2. Ovarian cysts
3. Fibrocystic disease
4. Breakthrough bleeding

4. Breakthrough bleeding

A client has a child with Tay-Sachs disease and wants to become pregnant again. She tells the nurse, "I'm worried it will happen again." How should the nurse respond?
1. "Did you discuss this with your physician?"
2. "Have you considered the option of gen

2. "Have you considered the option of genetic counseling?

A client who recently gave birth is transferred to the postpartum unit by the nurse. What must the nurse do first to avoid a charge of abandonment?
1. Assess the client's condition
2. Document the client's condition and the transfer
3. Orient the client t

4. Report the client's condition to the responsible staff member
**Because the nurse is responsible for the client's care until another nurse assumes that responsibility, the nurse should report directly to the client's primary nurse.

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? (Select all that apply.)
1. Focus on and repeat a rhythmic chant.

1. Focus on and repeat a rhythmic chant.
5. Eat small, frequent meals and eat dry crackers in between.

A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience?
1. Dizziness
2. Breathlessness
3. Abdominal cram

4. Increased alertness
**Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious.

The nurse is caring for a client who is in the taking-in phase of the postpartum period. The area of health teaching that the client will be most responsive to is:
1. Perineal care
2. Infant feeding
3. Infant hygiene
4. Family planning

1. Perineal care

What antidote to the side effects of terbutaline (Brethine) should a nurse have available?
1. Levodopa (l-Dopa)
2. Furosemide (Lasix)
3. Ritodrine (Yutopar)
4. Propranolol (Inderal)

4. Propranolol (Inderal)
**Propranolol (Inderal) is a beta-blocking agent that reverses the uterine inhibitory responses and cardiovascular effects of terbutaline (Brethine).

What does the nurse teach a client to do when performing breast self-examination?
1. Squeeze the nipples to examine for discharge
2. Use the right hand to examine the right breast
3. Place a pillow under the shoulder opposite the examined breast to raise

1. Squeeze the nipples to examine for discharge

During discharge teaching a client who just had a hysterectomy states, "After this surgery, I don't expect to be interested in sex anymore." What should the nurse consider before responding?
1. Many women incorrectly equate hysterectomy with loss of libid

1. Many women incorrectly equate hysterectomy with loss of libido.
**The uterus is often erroneously believed necessary for a satisfying sex life.

A client is scheduled for a vacuum aspiration abortion to terminate an unwanted pregnancy. What information should the nurse's teaching plan include?
1. It is a lengthy procedure but will cause no pain.
2. Both she and the father must sign the consent for

3. A temperature of 100.4� F (38� C) or higher should be reported immediately.

A 2-day-old infant who weighs 6 lb (2722 g) is fed formula every 4 hours. Newborns need about 73 mL of fluid per pound of body weight each day. In light of this information, approximately how much formula should the infant receive at each feeding?
1. 1 to

2. 2 to 3 oz

During a class for prepared childbirth, the nurse teacher discusses the importance of the spurt of energy that occurs before labor. Why is it important to conserve this energy?
1. Fatigue may increase the progesterone level.
2. Extra energy decreases the

4. Fatigue may influence pain medication requirements.

In childbirth classes the nurse is teaching paced breathing techniques for use during labor. In which order should the breathing techniques be used as labor progresses?
1. Slow, deep breaths
2. Pant-blow breathing
3. Modified-paced breathing
4. Slow, exha

5. Cleansing breaths
1. Slow, deep breaths
3. Modified-paced breathing
2. Pant-blow breathing
4. Slow, exhalation pushing

A nurse at a women's health clinic confirms that client teaching regarding the use of an oral contraceptive is understood when the client states, "I:
1. Can stop the pill and try to get pregnant right away"
2. May miss two periods and not worry about bein

3. Will put a baby's picture on my bathroom mirror so I'll see it every morning"
**Putting a baby's picture on the bathroom mirror serves as a reminder that the oral contraceptive must be taken every day.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? (Select all that apply.)
1. Cardiac output increases.
2. Blood pressure decreases.
3 . The he

1. Cardiac output increases.
2. Blood pressure decreases.
3 . The heart is displaced upward.

During the fourth stage of labor, the assessment of a primipara who has had a vaginal birth reveals a moderate to large amount of lochia rubra, a firm fundus that is at the umbilicus and deviated to the right, and pain that she rates as a 3 on a scale of

2. Helping the client void
**A fundus that is deviated to the right during the fourth stage of labor commonly is caused by a distended bladder ; if the bladder remains distended, involution will be inhibited, resulting in a boggy uterus that is prone to h

Which risk factors are associated with the future development of osteoporosis in women? (Select all that apply.)
1. Cigarette smoking
2. Moderate exercise
3. Use of street drugs
4. Familial predisposition
5 . Inadequate intake of dietary calcium

1. Cigarette smoking
4. Familial predisposition
5 . Inadequate intake of dietary calcium

A nurse is teaching a postpartum client the characteristics of lochia and any deviations that should be reported immediately. What client statement indicates that the teaching was effective?
1. "If I pass any clots, I'll notify the clinic."
2. "I'll call

3. "I'll notify the clinic if my lochia starts to smell bad."
**Lochia has a characteristic menstrual musky or fleshy smell. A foul-smelling discharge, along with fever and uterine tenderness, suggests an infection.

Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. Which symptoms are suggestive of a va

1. Abdominal pain
3. Rising temperature

A client who is taking an oral contraceptive calls the nurse with concerns about side effects of the medication. Which adverse effect of this medication should alert the nurse to inform the client to immediately stop the contraceptive and contact the heal

3. Visual disturbances
4. Persistent headaches

A 31-year-old client is seeking contraceptive information. Before responding to the client's questions about contraceptives, the nurse obtains a health history. What factor in the client's history indicates to the nurse that oral contraceptives are contra

4. History of borderline hypertension
**Oral contraceptives may cause or exacerbate hypertension; borderline hypertension places the client at risk for a brain attack.

What factor identified by the nurse in a client's history places the client at increased risk for breast cancer?
1. Early menopause
2. Low-income background
3. Delayed onset of menarche
4. Late beginning of childbearing

4. Late beginning of childbearing

A client is scheduled to have a contraction stress test (CST) to determine fetal well-being. Which type of fetal heart rate (FHR) decelerations constitutes a nonreassuring outcome?
1. Late
2. Early
3. Baseline
4. Variable

1. Late

A husband sits in the waiting room while his wife is getting her infertility prescription refilled by the clinic pharmacist. As the nurse sits down beside him, he blurts, "It's like there are three of us in bed�my wife, me, and the doctor." What feeling i

2. Anger

A 63-year-old woman with the diagnosis of estrogen-receptor positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen (Nolvadex) is prescribed. The client asks the nurse how long she will have to take the medication. The nurs

3. "You'll need to take it for 5 years, after which it will be discontinued.

A client comes to the fertility clinic for hysterosalpingography using radiopaque contrast material to determine whether her fallopian tubes are patent. When preparing for the test, the nurse explains to the client that she:
1. Will receive a local anesth

3. May have some persistent shoulder pain for 14 hours after the test

A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse

3. Hydatidiform mole

A pregnant client with an infection tells the nurse that she has taken tetracycline (Tetracyn) for infections on other occasions and prefers to take it now. The nurse tells the client that tetracycline is avoided in the treatment of infections in pregnant

2. Influences the fetus's teeth buds

A pregnant client at 30 weeks' gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy her cervix continues to dilate, and it is determined t

3. Dexamethasone
**Dexamethasone is a glucocorticoid that stimulates the production of fetal lung surfactants, which are needed for fetal lung maturity; administration is started 48 hours before the expected birth.

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response? (Select all that apply.)
1. Expulsion of the device
2. Occasional dyspareunia
3. Delay of return to fertili

1. Expulsion of the device
2. Occasional dyspareunia
4. Risk for perforation of the uterus

A primigravida at term is admitted to the birthing room in active labor. Later, when the client is dilated 8 cm, she tells the nurse that she has the urge to push. The nurse instructs her to pant-blow at this time because pushing can cause which of the fo

3. Cervical edema

A pregnant client has a positive group B Streptoccus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan?
1. "Go straight to the outpatient area of the maternity unit for a nonstres

4. "This information will be in your prenatal record, but please remind your labor and delivery nurse of this finding.

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. What intervention is important when the nurse discusses this finding with the client?
1. Asking her whether she has had

1. Asking her whether she has had German measles and when she had the disease

A nurse is teaching a childbirth preparation class about the discomfort of labor. What is the greatest influence on the perception of pain for a woman in labor?
1. Parity of the client
2. Duration of the labor
3. Tension of the client
4. Difficulty of the

3. Tension of the client

A 20-year-old woman is known to be heterozygous for the cystic fibrosis (CF) gene. Her husband's genotype is unknown at present and the couple is expecting their first child. What should the nurse tell the couple about the probability of their baby's havi

1. 25% or less
**Males with cystic fibrosis are usually sterile; therefore the father does not have cystic fibrosis, but he could be a carrier. If both parents are heterozygous carriers, the chance of having a child with CF is 25%. When one parent is a he

A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely?
1. Respiratory
2. Reproductive
3. Integumentary
4. Cardiovascular

4. Cardiovascular
**Syphilis is primarily a vascular disease; aortitis, valvular insufficiency, and aortic aneurysms are the most prevalent problems in tertiary syphilis.

The nurse is teaching a sex education course to high school students. What should the nurse teach them about why gonorrhea is difficult to control? (Select all that apply.)
1. Symptoms of the disease are vague.
2. Screening blood tests are expensive.
3. T

1. Symptoms of the disease are vague.
3. The incubation period is relatively short.
5 . Diagnostic tests for the causative organism are not yet available.

Which behavior indicates to a nurse that a new mother is in the taking-hold phase?
1. Calling the baby by name
2. Talking about the labor and birth
3. Touching the baby with her fingertips
4. Being involved with the infant's need to eat and sleep

1. Calling the baby by name
**The mother has moved into the taking-hold phase when she takes control and becomes actively involved with her infant and calls the infant by name

A primigravida tells the nurse that she has morning sickness. What suggestion should the nurse make to help relieve the nausea?
1. Eating three small meals a day
2. Increasing dietary calcium intake
3. Avoiding long periods without food
4. Drinking 2 quar

3. Avoiding long periods without food
**Fasting results in hypoglycemia, which can cause nausea; in addition, the developing fetus should not be deprived of nutrients for any length of time.

A client has a modified radical mastectomy because of a malignant tumor of the breast. What does the nurse plan to teach the client during the early postoperative period?
1. Keep the arm in an elevated position.
2. Observe the incision site for redness an

1. Keep the arm in an elevated position.

The clinic nurse is providing home care instructions for a client with pelvic inflammatory disease. What resting position should be recommended by the nurse?
1. Sims
2. Fowler
3. Supine with knees flexed
4. Lithotomy with head elevated

2. Fowler
**The Fowler position facilitates localization of the infection by pooling exudate in the lower pelvis.

A client's nipples become sore and tender as a result of her newborn's vigorous suckling. What should the nurse recommend that the mother do to alleviate the soreness? (Select all that apply.)
1. Apply ice packs before each feeding.
2. Formula feed the ba

4. Expose the nipples to air several times a day.
5. Apply hydrogel pads to the nipples after each feeding.
**Exposure of the nipples to air dries the nipples by way of evaporation; exposure also tends to harden the nipples, making them less tender. Hydro

A client in her 30th week of gestation is in preterm labor, and the practitioner prescribes betamethasone (Celestone). The client asks the nurse why she is being given this drug. As a basis for the response the nurse takes into consideration that it:
1. P

3. Promotes neonatal pulmonary maturity

A client's temperature is 100.4� F 12 hours after a spontaneous vaginal birth. What does the nurse suspect is the cause of the increased temperature?
1. Mastitis
2. Dehydration
3. Puerperal infection
4. Urinary tract infection

2. Dehydration

A woman has made the decision to have breast augmentation surgery, and the procedure is to be performed on an outpatient basis. As part of the preoperative protocol, the nurse provides teaching regarding the discharge instructions. Which instructions appl

1. Avoid taking aspirin or NSAIDs (e.g., ibuprofen [Advil]) for pain relief.
2. Sleep with your head and torso elevated for at least 1 week.
5 . Take your temperature daily and notify the clinic if it goes above 99.6� F

A nurse is providing dietary counseling to a client at 14 weeks' gestation. The client is a recent immigrant from Asia, and the nurse explores the foods that the client usually eats. Which foods should the nurse counsel the client to avoid during pregnanc

4. Raw shellfish
5. Herbal supplements
6. Soft-scrambled eggs

A nurse is caring for a client who is receiving internal radiation for cancer of the cervix. For which adverse reactions to the radiotherapy should the client be monitored? (Select all that apply.)
1. Nausea
2. Hemorrhage
3. Restlessness
4. Vaginal discha

2. Hemorrhage
5. Increased temperature

What nursing action best promotes parent-infant attachment behaviors?
1. Restricting visitors on the postpartum unit
2. Supporting rooming-in with parent-infant care
3. Encouraging the mother to choose breastfeeding
4. Keeping the new family together imme

4. Keeping the new family together immediately after the birth

When discussing dietary needs during pregnancy, a client tells the nurse that milk causes her to be constipated at times. What should the nurse teach the client?
1. Substitute a variety of cheeses for the milk.
2. Replace fat-free or low fat milk for whol

4. Treat constipation when it occurs and continue drinking milk.

Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching has been understood? (Select all that apply.)
1. Tailor sitting
2. Pelvic rocking
3. Forward ti

2. Pelvic rocking
3. Forward tilting
4. Sacral pressure

A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage the mother to do? (Select all that apply.)
1. Apply cool packs to her breasts to reduce the discomfort
2. Take the analgesic medication pr

1. Apply cool packs to her breasts to reduce the discomfort
2. Take the analgesic medication prescribed to limit the discomfort
5 . Assume a different position when breastfeeding to adjust the infant's sucking

A client who had a child with Tay-Sachs disease is pregnant and is to have an amniocentesis to determine whether the fetus has the disease. The nurse counsels her to plan for the procedure at the optimal time for the procedure at:
1. 6 to 8 weeks' gestati

2. 14 to 16 weeks' gestation
**An amniocentesis is done at this time because a therapeutic abortion may be legally and safely performed if desired by the parents.

A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which adverse side effect alerts the nurse to notify the health care provider?
1. Respiratory rate of 18 breaths/min
2. 2+ patellar reflex response
3. M

4. Urine output of less than 100 mL in 4 hours

A pregnant client who is scheduled for a nonstress test (NST) asks a nurse how the test can show that "my baby is all right." The nurse explains that it is a way of evaluating the condition of the fetus by comparing the fetal heart rate (FHR) with:
1. Fet

2. Fetal physical activity

A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program?
1. The need to increase high-quality protein and

4. The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

A nurse instructs a client who is taking oral contraceptives to increase her intake of dietary supplements. Which supplement should be increased?
1. Calcium
2. Vitamin C
3. Vitamin E
4. Potassium

2. Vitamin C
**Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required.

A client in preterm labor is to receive a tocolytic medication, and bedrest is prescribed. Which position should the nurse suggest that the client maintain while on bedrest?
1. Lateral
2. Supine
3. Fowler
4. Semi-Fowler

1. Lateral
**The lateral position relieves pressure on the vena cava, thereby promoting venous return and increasing placental perfusion.

Before the administration of Rho(D) immune globulin (RhoGAM) the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs test result must a pregnant woman have to receive RhoGAM after giving birth?
1. Rh-positive and Coombs pos

4. Rh-negative and Coombs negative
**Rho(D) immune globulin (RhoGAM) is given to an Rh-negative mother after birth if the infant is Rh positive and the Coombs test reveals that the mother was not previously sensitized (negative).

A nurse is planning care with a client for the recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included among the changes that the client should expect after surgery?
1. Depression
2. Weight gain
3. Ur

4. Surgical menopause

A nurse caring for a pregnant client and her partner suspects domestic violence. Which observations support this suspicion? (Select all that apply.)
1. The woman has injuries to the breasts and abdomen.
2. The partner refuses to come into the examination

1. The woman has injuries to the breasts and abdomen.
3. The partner answers questions that are asked of the woman.
4. The woman has visited the clinic several times in the last month.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do?
1. Ask her partner to withdraw before ejaculating
2. Make ce

4. Seek counseling about various contraceptive methods

e nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day?
1. Dark red
2. Deep brown
3. Pinkish brown
4. Yellowish white

3. Pinkish brown

What is the focus of the nurse's anticipatory guidance during the first trimester of pregnancy?
1. Birthing process
2. Signs of complications
3. Physical changes of pregnancy
4. Role transition into parenthood

3. Physical changes of pregnancy

A nurse is obtaining a health history from a client with newly diagnosed cervical cancer. What aspect of the client's life is most important for the nurse to explore at this time?
1. Sexual history
2. Support system
3. Obstetrical history
4. Elimination p

2. Support system

After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect?
1. An incisional nick

1. An incisional nick in the bladder
**During an abdominal hysterectomy the urinary bladder may be nicked accidentally.

A client seeking family planning information asks the nurse during which phase of the menstrual cycle an intrauterine device (IUD) should be inserted. Before responding the nurse recalls that the insertion usually is done:
1. Between the first and fourth

1. Between the first and fourth days of the cycle
**An IUD should be inserted during menstruation because the cervical os is slightly dilated at this time; also, there is little chance of the woman's being pregnant.

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the cli

4. Late-onset menarche

What is the safest and most reliable birth control method for the nurse to recommend to a client with type 1 diabetes?
1. Vaginal sponge
2. Oral contraceptive
3. Rhythm method with a condom
4. Diaphragm with a spermicidal gel

4. Diaphragm with a spermicidal gel

On a return visit to the fertility clinic a couple requests fertility drugs because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. What should the nurse expla

4. An examination of semen will be needed
**Because the client has an ovulatory cyclic pattern, the infertility may be a result of a seminal factor; the partner's semen should be examined before more extensive studies or treatments are begun.

A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have explo

4. "Have you talked to your wife about your concerns?"
**The correct response protects the wife's confidentiality while fostering open communication between the couple.

A resident practitioner in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a low-lying placenta who is in early labor. What is the priority nursing action?
1. Preparing an intravenous piggyback of oxytocin (Pitocin)

2. Explaining why a vaginal examination should not be performed

A client has just been told that she has cervical erosion. The nurse would expect to help explain that early treatment of the erosion can help prevent:
1. Cancer of the cervix
2. Pelvic inflammatory disease
3. Unexpected vaginal bleeding
4. Additional cer

1. Cancer of the cervix
**Erosion of the cervix frequently occurs at the columnosquamous junction, the most common site for carcinoma of the cervix.