Chapter 28 Note: Thousands of additional practice questions are available on the enclosed companion CD. 1. A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information about an abortion. After verifying that the woman is at 8 weeks’ gestation, the nurse counsels her that having an abortion is controversial and that many women have long-term guilt feelings after an abortion. Legally, the: 1. nurse’s statements need not be based on current clinical research. 2. client has a right to receive correct, unbiased information. 3. nurse has a right to state feelings as long as they are identified as the nurse’s own. 4. health care provider should be notified because this is beyond the scope of nursing practice. 2. One day the family planning clinic is very busy, and the supervisor asks a nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control to work in the family planning clinic. What is the most professional response that this nurse could give to the supervisor? 1. “I will go, but it is against my beliefs.” 2. “I won’t do it because I do not believe in birth control.” 3. “I would prefer another assignment that is not contrary to my beliefs.” 4. “I will have to reinforce that the rhythm method is the method of choice.” 3. The result of an amniocentesis performed at 16 weeks’ gestation reveals a fetus with Down syndrome. The client elects to have the pregnancy terminated. What should the nurse conclude about an abortion at this stage of the pregnancy? 1. The client is exhibiting emotional instability. 2. There is a high risk for a postoperative infection. 3. Contraceptive counseling should be deferred to a later time. 4. An opportunity to express feelings about her decision should be provided. 4. Which research-based knowledge guides a nurse regarding the emotional factors of pregnancy? 1. A rejected pregnancy will result in a rejected infant. 2. Ambivalence and anxiety about mothering are common. 3. A mother’s love usually develops within the first week after birth. 4. An effective mother does not experience ambivalence and anxiety about mothering. 5. Why is it important for a nurse to support the parents’ decision to abort a fetus with a birth defect even if the nurse is morally against abortion? 1. Supporting them will eliminate feelings of guilt. 2. The parents are legally responsible for the decision. 3. It is essential for maintenance of the family equilibrium. 4. The nurse’s support will relieve the pressure caused by this decision. 6. During the postpartum period a client with heart disease and type 2 diabetes asks a nurse, “Which contraceptives will I be able to use to prevent pregnancy in the near future?” How should the nurse respond? 1. “You may use oral contraceptives because they are almost completely effective in preventing a pregnancy.” 2. “You should use foam with a condom to prevent pregnancy because this is the safest method for women with your illnesses.” 3. “You will find that the intrauterine device is best for you because it prevents a fertilized ovum from implanting in the uterus.” 4. “You do not need to worry about becoming pregnant in the near future because women with your illnesses usually become infertile.” 7. A nurse is teaching a group of women about the side effects of different types of contraceptives. What is the most frequent side effect associated with the use of an intrauterine device (IUD)? 8. A client asks a nurse about the most common problem associated with the use of an intrauterine device (IUD). What should the nurse respond? 9. 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 sperm are prevented from reaching the vagina.” 10. A nurse teaches women in the fertility clinic that after ovulation has occurred, the ovum is thought to remain viable for: 11. A nurse is teaching clients to determine the time of ovulation by taking the basal temperature. What change is expected to occur in the basal temperature during ovulation? 12. Oral contraceptives are prescribed for a client. What side effect should the nurse inform the client might occur? 13. What is important for a nurse to discuss with a client who just had a vasectomy? 1. Recanalization of the vas deferens is impossible. 2. Unprotected coitus is safe within 1 week to 10 days. 3. Some impotency is to be expected for several weeks. 4. There must be 15 ejaculations to clear the tract of sperm. 14. The school nurse is discussing issues concerning premarital sex with a group of adolescents taking a health education course. The students are asked to write an essay on what they have learned about preventing pregnancy. Which comment alerts the nurse to have a private discussion with the student? 1. “I can’t get pregnant if I have sex during my period.” 2. “The pill may prevent me from getting pregnant, but I can still get an STI.” 3. “I won’t get pregnant if I swim in a pool where a boy has just masturbated.” 4. “A condom will not always protect me from getting pregnant, but it can protect me from getting an STI.” 16. A nurse explains that the efficiency of the basal body temperature method of contraception depends on fluctuation of the basal body temperature. What factor will alter its effectiveness? 17. A biphasic antiovulatory medication of combined progestin and estrogen is prescribed for a female client. What should a nurse include when teaching about this oral contraceptive? 1. Report irregular vaginal bleeding. 2. Restrict sexual activity temporarily. 3. Have regular bimonthly Pap smears. 18. A nurse is giving discharge instructions to a client who had an aspiration abortion by suction curettage. What should the client be told? 1. Avoid showering for 2 days. 2. Tampons may be used after 1 day. 3. Sexual intercourse should be delayed for 3 weeks. 4. Report bleeding that requires a pad change every 2 hours. 19. A client at 10 weeks’ gestation elects to have an induced abortion. After receiving oral mifepristone (Mifeprex), she returns to the clinic 2 days later to have misoprostol (Cytotec) inserted vaginally. For when should the nurse schedule a follow-up visit? 20. A couple indicate that they do not want any more children. The woman is scheduled for a laparoscopic bilateral tubal ligation. What should the nurse include in preoperative teaching? 1. “Menstruation will stop after the surgery.” 2. “Birth control will be needed until your follow-up visit.” 3. “You will be admitted as an outpatient for same-day surgery.” 4. “You can have the operation reversed if you decide to have more children.” 21. One of the responsibilities of a nurse in a fertility specialist’s office is to provide health teaching to the client in relation to timing of intercourse. Which instruction addresses the best time to achieve a pregnancy? 22. A nurse teaches a client that a postcoital test to evaluate fertility should be performed: 23. A histogram (hysterosalpingography [HSG]) is performed to determine whether there is a tubal obstruction. The nurse concludes that infertility caused by a defect in the tube is most often related to a: 24. A nurse is counseling a couple in the fertility clinic. Which aspect of the protocol is the most stressful for the couple? 1. Planning when to have intercourse 2. Obtaining the necessary specimens 3. Visiting the fertility clinic frequently 25. Genetic testing is being discussed with a couple at the fertility clinic. What is the nurse’s best response when they express concerns? 1. “You should be tested because it will be to your benefit.” 2. “Environmental factors can have an impact on genetic factors.” 3. “This type of testing will determine if you’ll need in vitro fertilization.” 4. “If you have a gene for a disease there is a probability that your children will inherit it.” 26. A client is admitted with a diagnosis of torsion of the testes. How should the nurse respond when the client asks, “Why must I have surgery immediately?”? 1. “There is no other way to control the pain.” 2. “Irreversible damage occurs after a few hours.” 3. “Swelling is excessive, which may cause the testicle to rupture.” 4. “There is a reduction in testicular blood flow, which leads to rapid death of sperm.” 27. A nurse at the fertility clinic is counseling a couple about the tests that will be needed to determine the cause of their infertility. Which test should the nurse describe that will evaluate the woman’s organs of reproduction? 28. While preparing a client for her first routine Papanicolaou (Pap) smear, a nurse determines that she appears anxious. What should the nurse include as part of the teaching plan? 1. Current statistics on the incidence of cervical cancer 2. Description of the early symptoms of cervical cancer 3. Explanation of why there is a small risk for cervical cancer 4. Written instructions about the purpose of the Papanicolaou smear 29. A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Her last menses started on January 1st. On what day in January should the nurse respond? 30. A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect? 31. At 6 weeks’ gestation a client is diagnosed with gonorrhea. What medication does a nurse expect the health care provider to prescribe? 32. A 15-year-old adolescent tells a school nurse, “I have persistent pain during my periods.” What should the nurse encourage her to do? 34. What does a nurse expect to be the priority concern of a 28-year-old woman who is to undergo a laparoscopic bilateral salpingo-oophorectomy? 36. When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurrence of: 1. white vaginal discharge and itching. 2. sporadic bleeding and abdominal pain. 3. elevated temperature and intractable diarrhea. 37. 2. Bladder tone is maintained. 3. Urinary retention is prevented. 4. Pressure on the suture line is relieved. 38. A client past menopause undergoes an anterior-posterior colporrhaphy. What should the discharge teaching include? 39. What potential complication does a nurse anticipate when admitting a client with the diagnosis of severe procidentia (prolapse of the uterus)? 40. A client with a third-degree uterine prolapse is scheduled for a vaginoplasty. What should the nurse anticipate the surgeon will order? 41. What resting position should a nurse encourage for a client with pelvic inflammatory disease (PID)? 42. A nurse explains to a client with cervical erosion that early treatment of the erosion can help prevent: 43. A client asks a nurse why she developed cervical polyps. How should the nurse respond? 1. “They are often malignant and must be removed.” 2. “Cervical polyps usually are precursors of uterine cancer.” 3. “They are usually benign and a biopsy rules out a malignancy.” 4. “Cervical polyps do not cause bleeding unless they are malignant.” 44. A nurse in the women’s health clinic is counseling clients about the signs of gynecological problems. What early manifestation of cervical cancer should prompt a client to seek professional care? 45. After a client has a biopsy for suspected cervical cancer, the laboratory report reveals a stage 0 lesion. What does a nurse conclude about this client’s stage of cancer? 1. The lesion is carcinoma in situ. 2. There is early stromal invasion. 3. There is parametrial involvement. 46. A nurse in the women’s health clinic is obtaining a client’s health history. What question will elicit information about the client’s risk for exposure to diethylstilbestrol (DES)? 1. “Were you born before 1971?” 2. “Have you ever taken oral contraceptives?” 3. “Have you noticed any lesions in your perineal area?” 47. A 35-year-old client is scheduled for a conization of the cervix to remove dysplastic cervical cells and to determine the extent of involvement. What behavior indicates to a nurse that the client understands the postoperative instructions? 1. States she will not resume sexual intercourse for 48 hours 2. Verbalizes expectations of a vaginal discharge for 3 to 5 days 3. Demonstrates the ability to change sterile surgical dressings 4. Affirms that because she has children she does not mind being sterile 48. A client with cancer of the cervix has an intracavity radioactive sealed implant in place. What precaution should the nurse take to protect against excessive exposure to radiation? 1. Dispose of body fluids in special marked containers. 2. Cohort two clients who have implanted radiation therapy. 3. Exit the room walking backward while wearing a lead apron. 4. Limit visitors to individuals who are 13 years of age and older. 49. A client who is scheduled to have an abdominal panhysterectomy asks how the surgery will affect her periods. How should the nurse respond? 1. “You will not have any more periods.” 2. “Your periods will become more regular.” 3. “Your periods will become lighter until they disappear.” 4. “You will notice that the time between periods will be longer.” 50. A client is diagnosed with uterine fibroids, and the health care provider advises a hysterectomy. The client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo severe symptoms of menopause after surgery. What is the nurse’s most appropriate response? 1. “You are correct, but there are medicines you can take that will ease the symptoms.” 2. “This sometimes occurs in women of your age, but you needn’t worry about it at this time.” 3. “Perhaps you should talk to your surgeon because I am not allowed to discuss this with you.” 4. “Some women may experience symptoms of menopause if their ovaries are removed with their uterus.” 51. After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. What is the nurse’s most appropriate response? 1. “It is best to wait because you may not have any symptoms.” 2. “It is comforting to know that hormones are available if you should ever need them.” 3. “You have to wait until symptoms are severe; otherwise, hormones will have no effect.” 4. “Discuss this with your health care provider, because it is important to know your concerns.” 52. After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse identifies that the urine in the client’s collection bag has become increasingly sanguineous. What complication does a nurse suspect? 1. An incisional nick in the bladder 2. A urinary infection from the catheter 3. Disseminated intravascular coagulopathy 53. A client who had a mastectomy asks about the term ERP-positive. The nurse explains that tumor cells are evaluated for estrogen receptor protein to determine the: 1. need for supplemental estrogen. 2. feasibility of breast reconstruction. 3. degree of metastasis that has occurred. 54. A nurse is caring for a client who just had a mastectomy. How should the nurse position the client’s arm on the affected side? 1. In adduction supported by sandbags 2. In abduction surrounded by sandbags 3. On pillows with the hand higher than the arm 55. When encouraging a client to cough and deep breathe after a bilateral mastectomy, the client says, “Leave me alone! Don’t you know I’m in pain?” What is the nurse’s most therapeutic response? 1. “I know it hurts to cough, but try to use the incentive spirometer.” 2. “We’ll start this tomorrow; I will give you something for your pain.” 3. “I understand that you are in pain; rest now, and I’ll come back later.” 4. “Your pain is to be expected, but you must attempt to expand your lungs.” 56. A nurse is writing a teaching plan about osteoporosis. The nurse should include in language that most clients would understand that osteoporosis is best described as: 57. The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. How does a nurse determine that the desired effect of therapy is attained? 58. A nurse is assessing a client for the potential for developing osteoporosis. Which factor in the client’s history increases the risk for this disorder? 59. Which food selected by a client with osteoporosis indicates that the nurse’s dietary instruction was effective? 60. A thin older adult client is diagnosed with osteoporosis. What should the nurse include in the discharge plan for this client? 1. Encouragement of gradual weight gain 2. Monitoring for decreased urine calcium 3. Instructions relative to diet and exercise 4. Safety factors when using opioids and nonsteroidal antiinflammatory drugs 1. “I must go on a strict diet.” 2. “I will take 400 mg of vitamin D daily.” 3. “I should take 1200 mg of calcium daily.” 4. “Swimming or bike riding 5 times a week is good for me.” 5. “Joining an aerobics class 3 times a week will help my bones.” 62. A health care provider prescribes teriparatide (Forteo), a parathyroid hormone (PTH) agonist, for a client with osteoporosis. What should the nurse consider before administering this medication? 1. It requires an increased intake of vitamin A. 2. It prevents existing bone from being destroyed. 3. Sunscreen should be used to prevent vitamin D absorption. 4. Osteoblastic activity is stimulated more than osteoclastic activity. 63. A female client who has been sexually active for 5 years is diagnosed with gonorrhea. The client is upset and asks the nurse, “What can I do to prevent getting another infection in the future?” The nurse provides health teaching. Which client statement indicates that the teaching was effective? 1. “I will douche after each time I have sex.” 2. “Having sex is a thing of the past for me.” 3. “My partner must use a condom all the time.” 64. A nurse is caring for a client who contracted a trichomonal infection. Which oral drug should the nurse anticipate the health care provider most likely will prescribe? 65. A nurse is teaching a client how to self-administer a medicated douche. In which direction should the nurse instruct the client to direct the douche nozzle? 66. At her first visit to the prenatal clinic, a client tells the nurse she is ambivalent about continuing the pregnancy. Why does the nurse conclude that the client is experiencing a crisis? 1. Mood changes occur during pregnancy. 2. Pregnancy is a period of change and adjustment to change. 3. Hormonal and physiologic changes occur during pregnancy. 4. Pregnancy changes the future parents’ relationship with each other. 67. A pregnant woman who is at term is admitted to the birthing unit in active labor. She is excited about the anticipated birth because she has three sons and the amniocentesis indicated that she will have a girl. Which factor in the client’s history alerts the nurse that the newborn will be at risk for a complication? 1. Her membranes ruptured two hours ago. 2. Her first child was diagnosed with hemophilia. 3. She used NSAIDs for frequent sinus headaches. 68. A couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic blood test should the nurse recommend to determine the possibility of their child inheriting the disease? 69. A nurse is teaching a childbirth class to a group of pregnant women. One of the women asks the nurse at what point during the pregnancy does the embryo become a fetus. How should the nurse respond? 1. During the eighth week of the pregnancy 2. At the end of the second week of pregnancy 3. When the fertilized ovum becomes implanted 4. When the products of conception are visualized on the sonogram 70. A client at 35 weeks’ gestation asks a nurse why her breathing has become more difficult. How should the nurse respond? 1. “Your lower rib cage is more restricted.” 2. “Your diaphragm has been displaced upward.” 3. “There is an increase in the size of your lungs.” 71. A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation does this occur? 2. _____ Sickle cell screening 3. _____ Group B streptococcus culture 4. _____ Serum glucose for gestational diabetes 5. _____ Alpha-fetoprotein (AFP) testing for neural tube defects 1. Risks of passing the virus to the fetus 2. Meaning of positive or negative test results 3. Disclosure of risk factors for contracting HIV 4. Requirement that pregnant women are tested for HIV 5. Emotional, legal, and medical implications of test results 74. At what time during prenatal development should the nurse expect the greatest fetal weight gain? 75. A client tells the nurse that the first day of her last menstrual period was July 22, 2010. What is the estimated date of birth? 76. What information concerning the childbearing process should the nurse teach a client during the first trimester of pregnancy? 77. A nurse is caring for a client during an ultrasonogram. What parameters does the nurse expect to be used when determining pregnancy dates? 1. Occipital frontal diameter at term 2. Crown to rump measurement until 11 weeks 3. Biparietal diameter of 12 cm or more at term 78. What change does a nurse expect in a client’s hematologic system during the second trimester of pregnancy? 79. During a physical in the prenatal clinic the client’s vaginal mucosa is observed to have a purplish discoloration. What sign should the nurse document in the client’s clinical record? 80. What does a nurse explain to a pregnant client about the cause of her physiologic anemia? 81. The nurse reviews the blood test results of a client who is at 24 weeks’ gestation. Which finding should be reported to the health care provider? 82. At her first prenatal visit, a client says to the nurse, “I guess I’ll be having an internal examination today.” What is the nurse’s best response? 1. “Yes, an internal exam is done at the mother’s first visit.” 2. “Are you fearful of having an internal examination done?” 3. “Have you ever had an internal examination done before?” 4. “Yes, a slightly uncomfortable internal exam must be done.” 83. A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, what does the nurse document about the client’s obstetric history? 84. A nurse is assessing a pregnant client during the third trimester. What clinical finding is an expected response to the pregnancy? 85. A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. An increase in which hormone should the nurse explain is the precipitating cause of the nausea and vomiting? 86. During a client’s first visit to the prenatal clinic, a nurse discusses a pregnancy diet. The client states that her mother told her she should restrict her salt intake. What is the nurse’s best response? 1. “Your mother is correct. You should use less salt to prevent swelling.” 2. “Because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet.” 3. “Salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet.” 4. “We no longer recommend that salt intake be as restricted as much as in the past. However, you shouldn’t add salt to your food.”
Childbearing and Women’s Health Nursing
Review Questions with Answers and Rationales
Denotes alternate format question.
Nursing Care to Promote Childbearing and Women’s Health
15. Contraceptives that have estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should a nurse identify as having a hormonal component? Select all that apply.
Nursing Care Related to Major Disorders Affecting Women’s Health
33. A client at the women’s health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply.
35. A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs or symptoms does the nurse expect the client to report? Select all that apply.
A client has an anterior and posterior surgical repair of a cystocele and rectocele and returns from the postanesthesia care unit (PACU) with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter? Select all that apply.
61. A nurse is counseling a postmenopausal obese client how to prevent bone loss. Which statements indicate understanding of the strategies to prevent bone loss? Select all that apply.
Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period
72. A client has several tests during pregnancy. Place the tests in the order they should be performed during pregnancy.
73. What information should a nurse include when counseling a pregnant client about human immunodeficiency virus (HIV) testing? Select all that apply.
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