Maternal Child Nursing Care with Women Health Companion Optimizing Outcomes for Mothers Children and Families 2nd Edition by Susan L. Ward, Shelton M. Hisley Test Bank

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Maternal Child Nursing Care with Women Health Companion Optimizing Outcomes for Mothers Children and Families 2nd Edition by Susan L. Ward, Shelton M. Hisley Test Bank

Description

Chapter 5: Reproductive Anatomy and Physiology

MULTIPLE CHOICE

1. The perinatal nurse reads in a chart that a woman has a lesion on her perineum. Where would the nurse assess this lesion?
A. Greater vestibular or vulvovaginal glands
B. Skin-covered region between the vagina and the anus
C. Small portion of tissue around the anus
D. Small portion of tissue surrounding the vaginal opening

ANS: B
The perineum, an anatomical landmark, is the skin-covered region between the vagina and the anus.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

2. The perinatal nurse knows that the lowest portion of the true pelvis is which of the following anatomical landmarks ?
A. Pelvic outlet
B. Linea terminalis
C. Sacral promontory
D. Sacrum

ANS: A
Inferiorly, the lowest portion of the true pelvis is termed the pelvic outlet. Superiorly, the true pelvis is bounded by the sacral promontory (anterior projecting portion of the base of the sacrum) and the sacral alae (broad bilateral projections from the base of the sacrum), the linea terminalis, and the upper margins of the pubic bones. The false pelvis and the true pelvis are divided by the linea terminalis, or pelvic brim.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

3. The clinic nurse knows that the part of the uterine cycle that occurs during the period of time between ovulation and the onset of menses is known as which of the following?
A. Ischemic phase
B. Menstrual phase
C. Proliferative phase
D. Secretory phase

ANS: D
The secretory phase occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6. The proliferative phase is the end of menses through ovulation, approximately days 7 to 14. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation, approximately days 27 to 28.

Cognitive Level: Knowledge/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

4. The perinatal nurse explains to the new nurse that the maternal pelvic shape can determine the fetal presentation. A fetus in a transverse presentation may be due to which maternal pelvic type?
A. Android
B. Anthropoid
C. Gynecoid
D. Platypelloid

ANS: D
The gynecoid pelvic type is the typical, traditional female pelvis (present in 50% of women) that is best suited for childbirth. Fetal descent through a platypelloid pelvis is usually in a transverse presentation and will not allow for a vaginal birth. Fetal descent through an anthropoid pelvis is more likely to be in a posterior (facing the womans front) rather than anterior (facing the womans back) presentation. The android pelvis resembles a typical male pelvis, and this pelvic shape can also cause difficulty during fetal descent.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

5. The clinic nurse explains to a student that the hormone responsible for limiting the maternal immune response to pregnancy is which of the following?
A. Human chorionic gonadotropin
B. Progesterone
C. Prostaglandin
D. Relaxin
.

ANS: A
Human chorionic gonadotropin may play a role in limiting the maternal immune response to the pregnancy. Prostaglandins modulate hormonal activity and have an effect on ovulation, fertility, and cervical mucus viscosity. Relaxin aids in the softening and lengthening of the uterine cervix and works on the myometrial smooth muscle to promote uterine relaxation.
Progesterone functions to create a highly vascular secretory endometrium that will be suitable for implantation of a fertilized ovum.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

6. A woman who might be pregnant is excited to learn when she will know the gender of the baby. What is the best response by the nurse?
A. 5 weeks
B. 6 weeks
C. 8 weeks
D. 12 weeks

ANS: D
It takes about 8 weeks of development before the reproductive system becomes differentiated as male or female, but external genitalia are not visible until after 12 weeks.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

7. The pediatric nurse explains to the student that production of testosterone by the male embryo causes what to occur?
A. Creation of a gonad
B. Formation of the male genital tract
C. Production of spermatozoa
D. Stimulation of external genitalia growth

ANS: B
The mesonephric ducts evolve into the male genital tract due to the influence of testosterone in the 7th or 8th week of gestation. A gonad is the first reproductive structure formed. Production of spermatozoa doesnt occur until puberty. The growth of external genitalia does not begin until the 12th week of gestation.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

8. The nursing instructor explains to the students that external female genitalia develop under what influence?
A. Absence of androgens
B. Ductal pair dominance
C. Ovary production
D. Process of oogonia

ANS: A
The external female genitalia develop in the absence of androgens. The paramesonephric ducts are dominant in females, but this does not lead directly to the development of external genitalia. Ovaries are created when the medulla of the first primitive gonad regresses as the outer cortex becomes the ovary at around 10 weeks of gestation. Oogonia are underdeveloped fetal egg cells; it is not a process.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

9. A woman sustained a moderate blow to the lower pelvic region in an occupational accident. She is surprised to find out that no bones were broken. What explanation by the nurse is best?
A. Blunt force trauma doesnt cause fractures.
B. Pelvic bones are very hard to fracture.
C. Some fractures dont show up right away.
D. You have a fat pad in front of your pelvis.

ANS: D
The mons pubis is a layer of subcutaneous tissue anterior to the genitalia in front of the symphysis pubis. It is essentially a protective fat pad, and although it will not prevent fracture of the pelvis in a serious trauma, the mons pubis does offer some protection to these tissues. Blunt force is the usual cause of fractures. The pelvis is often fractured, especially in motor vehicle crashes. Some fractures do not show up immediately, but this is not the best answer because most do.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

10. A new nurse is attempting to catheterize a female patient. The nurse has a difficult time and after three attempts, finally inserts the catheter into the bladder and has urine output. What suggestion by the more experienced nurse is best?
A. Leave the incorrectly placed catheters where they are while inserting a fresh one.
B. Place the patient in a high Fowlers position and have another nurse adduct the legs.
C. Position the patient prone with another nurse abducting the patients legs.
D. To save the patient some charges, use the same catheter for two attempts.

ANS: A
Because the clitoris often resembles the urinary meatus, nurses sometimes try to insert a catheter in it instead of the real meatus. Leaving the incorrectly placed catheter while attempting another insertion shows the nurse where not to insert it. The patient should be in a low semi-Fowlers or supine position with the legs abducted (or frog-legged). To maintain infection control, never use a catheter for more than one catheterization attempt.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. A nurse is examining a patients Skenes glands. What action is best to visualize these structures?
A. Place a gloved finger in the rectum.
B. Place a gloved finger in the vagina.
C. Pull the urethral margins apart.
D. Use a speculum and a bright light.

ANS: C
The Skenes glands are located on each side of the urethra. To examine them, the nurse should gently pull the margins of the urethra apart and evert the mucous membranes.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

12. A nursing instructor is planning to teach students about the process of oogenesis. Which information does the nurse plan to include?
A. All polar bodies in the ovary become ova.
B. It is regulated by follicle-stimulating hormone (FSH).
C. The graafian follicle eventually secretes prolactin.
D. It usually occurs in a twice-monthly cycle.

ANS: B
Oogenesis begins in the ovaries and is regulated by follicle-stimulating hormone (FSH). For each primary oocyte that undergoes meiosis, only one functional egg is produced; the other cells (termed polar bodies) deteriorate. The graafian follicle is a mature ovarian follicle and does not secrete prolactin. Oogenesis occurs in utero.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

13. A woman is having an infertility workup and has been told she has scarring of her fallopian tubes. What action by the nurse is best?
A. Ask the woman how many sexually transmitted infections she has had.
B. Assess the woman for previous vaginal infections and their treatment.
C. Gently tell the woman that nothing can be done about scarring of the tubes.
D. Question the woman about genetic defects or family history of infertility.

ANS: B
Anatomically, there is a continuous passage from the vagina into the uterus and on into the fallopian tubes and ovaries. A vaginal infection can lead to residual scarring of the tubes from the inflammatory process. This puts the woman at increased risk for ectopic pregnancies and infertility. Not all vaginal infections are sexually transmitted infections (STIs), and to specifically ask about STIs sounds judgmental in addition to not providing adequate information. There are several treatment options for this woman. Genetic defects may play a role in this womans problem, but the higher likelihood is that her scarred tubes are due to a vaginal infection.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

14. The nurse manager on the high-risk OB unit has been told by an OB office nurse to prepare for a woman with a spinal cord injury (SCI) to deliver there. The woman wants to try a vaginal birth. What response by the nurse manager is best?
A. Assess the level of the womans spinal cord injury.
B. Assure the office nurse that vaginal birth is possible.
C. Explain that women with SCI do well with a water birth.
D. Tell the office nurse that vaginal birth is impossible.

ANS: A
Women with SCI above the level of T6 may be able to deliver vaginally because the uterus may retain enough intrinsic motility to create effective contractions. The nurse manager should ask about the level of the SCI. The nurse should not assure the office nurse that vaginal delivery is possible without this information. A woman with an SCI probably would not do well in a water birth due to impaired mobility. The nurse should also not tell the office nurse that vaginal birth is impossible without further information.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity/Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

15. A pregnant woman calls the OB clinic nurse to complain of sharp abdominal pain with coughing or sneezing. What action by the nurse is best?
A. Explain that the pain is from stretching of the ligaments.
B. Have the woman count her contractions each hour while awake.
C. Place the woman on bedrest until her next clinic visit.
D. Tell the woman to come to the clinic today.

ANS: A
The uterus is supported by several ligaments. The round ligaments expand in diameter and length during pregnancy and may be associated with sharp pain if they are stretched tight during sudden movement, such as with sneezing, coughing, or position changes. The nurse should reassure the woman that this is not concerning and explain the phenomenon. There is no need for the woman to count contractions, be placed on bedrest, or come in to the clinic that day.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

16. A pregnant woman has a midpelvis pelvimetry measurement of 3.8 inches (9.65 cm). What action by the labor and delivery nurse is most important?
A. Encourage attendance at childbirth classes.
B. Explain that vaginal birth will be possible.
C. Instruct her to drink 10 glasses of water daily.
D. Obtain consent for possible cesarean delivery.

ANS: D
Pelvimetry measurements demonstrate the feasibility of a vaginal birth. The minimum measurement for the midpelvis (which is the narrowest lateral portion of the female pelvis) is 4.7 inches (12 cm). Pelvimetry measurements may not be accurate for several reasons, and despite findings, in most situations, the woman is allowed a trial of labor. As the joints of the pelvis soften and become more mobile, a vaginal delivery might still be possible. The nurse should obtain consent for a possible cesarean delivery. All pregnant women should attend childbirth preparation classes. The nurse should not guarantee that a vaginal birth can occur. Drinking water is not related.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Difficult

PTS: 1

17. The nurse explains to the student that the development of the lining of the uterus is mediated by which hormone?
A. Follicle-stimulating hormone
B. Luteinizing hormone
C. Progesterone
D. Prostaglandin

ANS: C
Estrogen and progesterone are responsible for mediating the development of the uterine lining. Follicle-stimulating hormone stimulates growth of the graafian follicle. Luteinizing hormone stimulates the development of the corpus luteum. Prostaglandins modulate hormonal activity and affect ovulation, fertility, and cervical mucus viscosity.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

18. A 17-year-old female is brought to the family practice clinic by her mother, who is worried that her daughter has not yet developed secondary sex characteristics. Which action by the nurse is best?
A. Assess a family pedigree for genetic influences.
B. Explain that some girls dont develop until their 20s.
C. Inform them that the daughter will be tested for estrogen deficiency.
D. Obtain a urine sample for a pregnancy test.

ANS: C
Estrogen is the primary female hormone and is responsible for the development of secondary sex characteristics. Physical changes associated with puberty usually begin between ages 11 and 13. A 17-year-old female who has not yet developed these features may have an estrogen deficiency. A family pedigree may be beneficial, but not as the first step. A pregnancy test would not illustrate the cause of the problem.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Easy

PTS: 1

19. A patient in the emergency department has a positive serum hCG. What can the nurse surmise about this patient?
A. Lactating
B. Menopausal
C. Menstruating
D. Pregnant

ANS: D
Human chorionic gonadotropin (hCG) is measured to diagnose pregnancy; it does not signify any of the other conditions.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

20. A patient inquires why ibuprofen (Motrin) and not acetaminophen (Tylenol) is usually prescribed for menstrual discomfort. Which response by the nurse is best?
A. Cheaper than Tylenol
B. Fewer side effects
C. Inhibits prostaglandins
D. Works more quickly

ANS: C
Prostaglandin release causes vasoconstriction and muscle contractions that lead to the tissue ischemia and pain felt with dysmenorrhea. Tylenols mechanism of action is not fully understood, but it is thought to raise the pain threshold. Ibuprofen is a prostaglandin inhibitor. Both drugs can be found in generic form for little money. All drugs have side effects. Oral medications take 3045 minutes to start working.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

21. In providing anticipatory guidance to a 12-year-old female who has developed breast buds, what information should the nurse provide?
A. Breast self-exam is now important.
B. First period will occur in 6 months.
C. Growth of pubic hair will occur next.
D. Maximum height has been obtained.

ANS: C
Thelarche (breast budding) is followed by the growth of pubic hair. Breast self-exam is not vital until the breasts have developed, and then self-exam is taught as a component of breast awareness. Menarche, the first period, usually occurs 1 year after peak height velocity. It is not possible to state if maximum height has been obtained. Thelarche starts on average at age 9.8 years and is complete on average at age 14.6 years. The growth spurt starts on average at age 10 years and is complete on average by age 11.8.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

22. A family practice nurse is providing anticipatory guidance to an 11-year-old boy. What information about puberty should the nurse plan to include?
A. Boys start puberty about 2 years earlier than girls.
B. Circulating estrogen may cause breast enlargement.
C. Testosterone production is the last stage of puberty.
D. The first sign of puberty is testicular enlargement.

ANS: D
Testosterone secretion causes testicular enlargement, which is the first sign of pubertal changes in males. Girls start puberty about 2 years earlier than boys. Testosterone production causes the first signs of puberty, so saying that this is a late occurrence is incorrect. Breast enlargement usually does not occur in males despite the presence of circulating estrogen.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

23. A 14-year-old girl asks the school nurse why her periods are so irregular. What is the best response by the nurse?
A. All young girls have irregular periods.
B. Dont worry; this is totally normal.
C. Estrogen levels are still pretty low.
D. You should be seen by your physician.

ANS: C
As a girl begins menstruating, estrogen levels are usually insufficient to stimulate ovulation, and the menstrual periods are generally unpredictable and irregular. As the ovaries mature, regular ovulation and menses are established. Telling the student that all young girls have irregular periods and that her complaint is normal are both poor choices, because they do not give the girl adequate information. She does not need to be seen by her physician for this complaint.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

24. A nurse reads in a female patients chart that she is Tanner stage V. What can the nurse conclude about this patient?
A. Beginning puberty
B. Midpoint of puberty
C. Sexually immature
D. Sexually mature

ANS: D
Guidelines of secondary sexual characteristic development, termed Tanner stages, measure the predictable stages of pubertal body changes in both genders. A female in stage V (the last stage) would be sexually mature.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Development
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

25. The nursing instructor explains to a class that important effects of estrogen in the proliferative phase of the uterine cycle include which of the following?
A. Causes uterine spiral arteries to constrict, limiting blood flow
B. Causes changes in cervical mucus to facilitate sperm penetration
C. Leads to changes causing the uterus to be receptive to a fertilized ovum
D. Results in rupture of endometrial blood vessels and the onset of menses

ANS: B
During the proliferative phase of the uterine, or endometrial, cycle, increasing amounts of estrogen lead to changes in cervical mucus that facilitate sperm penetration at midcycle. During the ischemic phase, both estrogen and progesterone levels are low, and the uterine spiral arteries constrict, limiting blood flow to the endometrium. Eventually, the endometrial blood vessels rupture and menses begin. In the secretory phase, progesterone functions to create a highly vascular secretory endometrium that is suitable for implantation of a fertilized ovum.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

26. A nurse is teaching a patient how to track her menstrual cycle. What day does the nurse tell the patient to label as day 1?
A. First day after the menstrual cycle
B. First day of the menstrual cycle
C. Last day before the menstrual cycle
D. Last day of the menstrual cycle

ANS: B
Day 1 of the menstrual cycle begins with the onset of bleeding.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

27. A woman is in the family planning clinic to learn about her cycle and the best times to get pregnant. What information should the nurse plan to teach her?
A. An ovum can be fertilized for 12 to 24 hours after ovulation.
B. Pregnancy can only occur during the follicular phase.
C. There are no physiological signs that demonstrate ovulation.
D. You cant easily get pregnant if your cycles are irregular.

ANS: A
An ovum is capable of being fertilized by a sperm cell for approximately 12 to 24 hours after ovulation. Pregnancy occurs during ovulation, which marks the end of the follicular phase and the beginning of the luteal phase. There are physiological signs of ovulation, such as changes in cervical mucus and body temperature. Women with irregular cycles can get pregnant.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

28. A nurse has taught a woman about the physical signs that accompany ovulation. Which statement by the patient indicates that teaching has been effective?
A. I can still conceive for up to 48 hours after ovulation.
B. My temperature will go down after ovulation.
C. Thin, watery cervical mucus means I am no longer fertile.
D. Sticky cervical mucus helps hold the sperm in place on the egg.

ANS: A
The womans basal body temperature increases 24 to 48 hours after ovulation, and it is still possible to become pregnant at this point. Thin, watery cervical mucus creates a pathway for sperm to readily swim through the cervix. Sticky cervical mucus does not aid in fertilization.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Easy

PTS: 1

29. A woman complains of irregular menstrual periods and wonders if she is in perimenopause or menopause. Her laboratory work shows high levels of follicle-stimulating hormone (FSH) and low levels of estradiol. What response by the nurse is best?
A. No, in menopause the FSH is low and the estradiol is high.
B. No, those two laboratory findings are not related to the climacteric phase.
C. These laboratory findings usually indicate menopause or perimenopause.
D. Yes you are definitely in menopause right now.

ANS: C
Elevated levels of FSH combined with low levels of estradiol usually indicate perimenopause or menopause.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

30. A woman who is postmenopausal is in the clinic complaining of urinary incontinence and wants to know why this is occurring. Otherwise she has no other complaints. What response by the nurse is best?
A. Im not sure; lets ask the physician why this could occur.
B. Low estrogen levels after menopause causes the urinary tissues to atrophy.
C. Most older women experience some incontinence.
D. You may have a urinary tract infection or other medical problem.

ANS: B
During the perimenopausal and postmenopausal stages, lowered levels of estrogen can lead to atrophy of urinary tissues and incontinence. This is knowledge all nurses should have, so needing to ask the physician is not appropriate. Telling the woman that most older women have this problem does not give the patient any information about why this occurs, which was her question. Because she has no other complaints, a urinary tract infection is less likely.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

31. A healthy-appearing 68-year-old woman is in the clinic for a physical exam. Her laboratory work shows decreased levels of high-density lipoprotein (HDL) cholesterol and increased levels of low-density lipoprotein (LDL) cholesterol. What conclusion can the nurse make about this patient?
A. Eats an unhealthy diet
B. At risk for long-bone fractures
C. Increased cardiovascular risk
D. Probably does not exercise

ANS: C
Decreased estrogen in a womans later years accompanied by low HDL and high LDL cholesterol levels increases the risk of cardiovascular disease. The nurse cannot conclude anything about the patients exercise or eating habits without further assessment. Older women are at risk of fractures due to osteoporosis, but that is not related to these laboratory values.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

32. A woman in the clinic complains of severe hot flashes associated with perimenopause. Her past medical history includes deep vein thrombosis (DVT) 10 years ago. The nurse can anticipate teaching the woman about what treatment?
A. A trial of a selective serotonin reuptake inhibitor
B. A trial of the anticonvulsant phenytoin (Dilantin)
C. Hormone replacement with estrogen only
D. Hormone replacement with estrogen-progestin

ANS: A
Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft), have been used to reduce vasomotor symptoms such as hot flashes. The anticonvulsant gabapentin (Neurontin) has also been used. This woman is not a candidate for estrogen-only hormone replacement therapy for two reasons: she has not had a hysterectomy and she has a history of DVT. She is not a candidate for estrogen-progestin therapy because of her previous history of DVT.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Planning
Difficulty: Difficult

PTS: 1

33. A nurse is teaching a group of middle school students about the functions of the male reproductive tract. Which information should the nurse include?
A. Maturing sperm are stored in the epididymis.
B. Seminal fluid is secreted by the ductus deferens.
C. Spermatogenesis occurs in the bulbourethral glands.
D. The prostate, found only in men, has no known function.

ANS: A
Maturing sperm are stored in both epididymi, which also convey the sperm to the vas deferens and secrete seminal fluid. Spermatogenesis occurs in the testicles. The prostate has several functions, one of which is to secrete an alkaline fluid that protects sperm from the acidic environment of the vagina and the male urethra.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

34. The nurse knows that in any volume of ejaculate, what percentage of sperm is motile?
A. 25%
B. 35%
C. 40%
D. 50%

ANS: C
In each millimeter of ejaculate, there are approximately 120 million sperm, 40% of which are motile.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

35. A nurse working in the infertility clinic counsels a couple about male fertility. What assessment question to a male by the nurse would yield the most important information?
A. Do you get plenty of exercise?
B. Do you wear boxer shorts or briefs?
C. How much alcohol do you drink?
D. Have you been circumcised yet?

ANS: B
Factors that influence male fertility include participation in active contact sports; smoking; and wearing tight, constrictive clothing. Brief-style underwear are tighter than boxer shorts, and this is one question the nurse could ask about clothing that might yield some useful information. Exercise does not specifically address active contact sports. Alcohol use and circumcision are not related.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

36. A nurse working with a couple in the infertility clinic notes the diagnosis of cryptorchidism on the mans chart. What assessment question by the nurse is most important?
A. Did you have surgery for your undescended testes?
B. Do you have a family history of testicular cancer?
C. Do you use lead shielding when you get x-rays?
D. For how long did you undergo chemotherapy?

ANS: A
Cryptorchidism is a condition in which the testes fail to descend, and if they are not surgically placed into the scrotum, infertility can result. The other questions are not related to this condition.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

37. A nurse is teaching a class about gender maturation. What information is most accurate?
A. Gender is determined by 8 weeks of gestation, when sex organs are visible.
B. Gender maturity is not fully complete until old age.
C. It is a lengthy process that spans from the embryonic stage through puberty.
D. The process begins and ends during fetal development.

ANS: C
Gender maturation is a lengthy process that begins during embryonic development and is completed during late adolescence, at which time full maturity is achieved. The other statements are not correct.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

38. A mother brings her 9-year-old daughter to the family practice clinic. She is worried because the daughter already has definite breast buds and is asking to wear a bra. What response by the nurse is best?
A. At what age did you develop breast buds or start menstruating?
B. Does anyone in your family have a history of precocious development?
C. The average age for breast budding is 9.8 years, so she is normal.
D. This is too early for breast buds; she may need endocrine studies.

ANS: C
The average age that breast budding begins is 9.8 years, so this child is normal. The other responses are not relevant for this situation.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

39. The nurse teaching a course in human reproduction informs the class that which reproductive structure is the first to form in the embryo?
A. Gonad
B. Mesoderm
C. Mesonephric duct
D. Oocyte

ANS: A
The first reproductive structure formed in the embryo is a gonad. This early reproductive tissue arises from the mesoderm, which is the embryos middle layer. The mesonephric ducts are a set of primitive reproductive ducts. Oocytes are eggs.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

40. The nurse teaches a class that which of the following is the first gender change to occur in the embryo?
A. Destruction of the Y chromosome in the female embryo
B. Development of dominance in the primitive duct structure
C. Formation of primitive external genitalia that are visible on ultrasound
D. Spermatogenesis and oogenesis in male and female embryos, respectively

ANS: B
Differing male/female developmental changes in the mesonephric and paramesonephric ducts include the development of dominance in one set of the ducts. Mesonephric ducts become dominant in males; paramesonephric ducts become dominant in females. This is the first gender change that occurs. Gender is determined by the presence of an XX or XY pair of chromosomes; none are destroyed. External genitalia are usually not visible before 12 weeks of gestation, when androgens begin to stimulate their growth. Spermatogenesis occurs in puberty in boys; oogenesis begins sometime after 10 weeks of gestation when the ovaries begin to develop.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

41. A nurse is providing anticipatory guidance to a group of elementary school girls and their parents. What information is most accurate?
A. Around age 10, girls will get interested in shaving their underarms.
B. By age 12, both boys and girls are at their maximal height.
C. Moms, you should buy feminine supplies for your daughter before she is 14.
D. You wont need to worry about bras until at least age 14.

ANS: A
Adrenarche (the time when androgen secretion leads to axillary and pubic hair) occurs at an average age of 10, so girls around that time will start noticing this change and thinking about shaving. The adolescent growth spurt is not completed for girls until an average age of 11.8, but in calculating an average, older and younger ages are included. Feminine supplies should be on hand for a girl to use earlier than age 14, because the average age of menarche is 12.8. Breast budding begins on average at 9.8 years.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

MULTIPLE RESPONSE

1. What information does the nurse understand about the labia minora? (Select all that apply.)
A. Contain the Skenes glands and Bartholins glands
B. Constitute the primary organ of sexual pleasure in women
C. Provide lubrication and protective bacteriocidal secretions
D. Resemble mucous membrane and do not have hair follicles
E. Share an extensive lymphatic network with other vulvar structures

ANS: C, D
The labia minora resemble mucus membrane and do not have hair follicles. They provide lubrication and protective bacteriocidal secretions. The Skenes and Bartholins glands are found in the vestibule of the vagina. The primary organ of sexual pleasure in women is the clitoris. The labia majora share an extensive network of lymphatics with other vulvar structures, leading to rapid spread of malignant disease.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

2. A teenager is asking questions about her hymen. Which of the following are correct responses by the nurse? (Select all that apply.)
A. An intact hymen is a positive indication of virginity.
B. Bright red bleeding is always present following hymenal tearing.
C. The hymen can widen or perforate with tampon use, vulvar injury, or intercourse.
D. It is a small portion of tissue around the vaginal opening in young girls.
E. It will widen and perforate only with intercourse.

ANS: C, D
The hymen is a small portion of tissue forming a border around the entrance of the vagina in young girls. The hymen eventually widens through vulvar injury, use of tampons, or intercourse, sometimes accompanied by bleeding. It is a myth that the hymen must be intact for a female to be considered a virgin.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

3. The perinatal nurse mentor teaches the new nurse about the functions of cervical mucus. What information should the nurse include? (Select all that apply.)
A. Provides an acidic environment for sperm
B. Acts as a bacteriostatic agent
C. Provides a barrier to sperm during nonfertile phases
D. Provides an easy-flowing pathway during fertile phases
E. Forms an operculum to protect the pregnancy

ANS: B, C, D, E
The cervix secretes mucus, which serves several functions: (1) lubricates the vaginal canal, (2) forms a barrier to sperm penetration into the uterus during nonfertile periods, (3) provides an easy-flowing pathway to facilitate sperm passage into the uterus during fertile periods, (4) provides an alkaline environment to facilitate the viability of sperm that have been deposited in the acidic vagina, (5) forms a solid plug called an operculum to protect a pregnancy from outside pathogens, and (6) functions as a bacteriostatic agent.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity/Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. The perinatal nurse understands that the functions of the vagina include which of the following? (Select all that apply.)
A. Manufactures a cervical plug during pregnancy
B. Produces lubrication for intercourse
C. Provides a receptacle for sperm
D. Serves as a lower portion of the birth canal
E. Stimulates the penis during intercourse

ANS: B, C, D, E
The vagina has five functions: (1) to provide lubrication to facilitate intercourse, (2) to stimulate the penis during intercourse, (3) to act as a receptacle for semen, (4) to transport tissue and blood during menses to the outside, and (5) to function as the lower portion of the birth canal during childbirth.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

5. The OB nurse knows the menstrual cycle is controlled by the complex interplay of hormones that are secreted by which physiological structures? (Select all that apply.)
A. Anterior pituitary
B. Cerebral cortex
C. Hypothalamus
D. Ovaries
E. Posterior pituitary

ANS: A, C, D
The menstrual cycle is controlled by complex interactions between hormones secreted by the hypothalamus, anterior pituitary, and ovaries.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

6. A nurse is planning an educational seminar focused on changes associated with perimenopause and postmenopause. Which topics should the nurse plan to include? (Select all that apply.)
A. Eating foods high in calcium
B. Getting plenty of rest and sleep
C. Keeping the room cool at night
D. Need for increased antiperspirant
E. Using vaginal lubricants

ANS: A, B, C, E
During the perimenopausal and postmenopausal periods, several physical and emotional changes occur. Long-term effects include increased risk for osteoporosis and cardiovascular disease. Appropriate teaching topics include eating foods high in calcium to help prevent osteoporosis, getting plenty of rest and sleep to combat the fatigue that often accompanies these changes, keeping the room cool at night because hot flashes often occur at night, and the use of water-based vaginal lubricants during sexual activity to combat vaginal dryness. Sweat and sebaceous glands have diminished activity, so there is usually no need for an increased use of antiperspirants.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

7. A nurse is planning an educational program for middle school boys focused on physical changes they can expect with puberty. Which topics should the nurse plan to include? (Select all that apply.)
A. Changes in patterns of hair
B. Deepening of the voice
C. Growth spurt
D. Narrowing waist
E. Thinning skin

ANS: A, B, C, D
During puberty, a boy can expect to see changes in hair patterns, deepening of the voice, a linear growth spurt, increased upper body musculature with a narrowed waist, and thickening of the skin.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

OTHER

1. Match the pelvic types with their descriptions. Pelvic types may be used more than once.

a. Gynecoid _____ Best suited for childbirth
b. Android _____ Fetal descent more likely to be in a posterior presentation
c. Anthropoid _____Fetal descent is often in a transverse presentation
d. Platypelloid _____ Triangular or heart-shaped
_____ Only found in 3% of women
_____ Traditional form found in about 50% of women
_____Oval shaped at the inlet but in the anterior-posterior plane
_____ Characteristics cause difficulty during fetal descent

ANS:
a, c, d, b, d, a, c, b
The gynecoid pelvis is the typical female pelvis best suited for vaginal delivery. The android pelvis is triangular (or heart-shaped) and the shape can cause difficulty during fetal descent. The anthropoid pelvis is more likely to result in a posterior fetal presentation due to its oval shape at the inlet that is in the anterior-posterior plane. The platypelloid pelvis usually prevents vaginal delivery owing to the fetus descending in a transverse presentation.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

2. Match the hormones and their functions.

a. Gonadotropin-releasing hormone 1. ____ Controls the development and function of the adrenal cortex
b. Somatostatin 2. _____ Stimulates the maturation of the mammary glands during pregnancy
c. Adrenocorticotropic hormone 3. _____ Regulates thyroid hormones
d. Oxytocin 4. _____ Also known as growth hormoneinhibiting hormone; inhibits the release of growth hormone
e. Prolactin 5. Among other things, it is responsible for developing muscle mass and protein synthesis
f. Corticotropin-releasing hormone 6. _____ Appears to provide a protective action by minimizing a maternal immunological rejection that could cause miscarriage
g. Thyrotropin-releasing hormone 7. _____ Stimulates the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary
h. Growth hormone 8. _____ Stimulates uterine contractions and the release of milk from milk ducts during lactation

ANS:
1:c; 2: e; 3: g; 4:b; 5:h; 6: f; 7:a; 8:d
Gonadotropin-releasing hormone stimulates the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. Somatostatin is also known as growth hormone inhibiting hormone; it inhibits the release of growth hormone. Adrenocorticotropic hormone controls the development and function of the adrenal cortex. Oxytocin stimulates uterine contractions and the release of milk from milk ducts during lactation. Prolactin stimulates the maturation of the mammary glands during pregnancy. Corticotropin-releasing hormone appears to provide a protective action by minimizing a maternal immunological rejection that could cause miscarriage. Thyrotropin-releasing hormone regulates thyroid hormones. Growth hormone is responsible for developing muscle mass and protein synthesis, among other things.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

3. The nurse understands that the genetic possibility of a woman having a male or a female child is based on the single sex chromosome provided by each parent (mother is XX, father is XY, and each contributes one chromosome). Fill in the boxes below with the possibilities based on the single chromosome that is contributed by each parent in these four possible combinations. For the purpose of this exercise, the mothers chromosomes are designated X(m1) and X(m2), and the fathers are designated X(f) and Y(f). The result of any XX chromosome pair yields a girl, and XY a boy.

1. Mothers sex chromosome _____
Fathers sex chromosome _____
Child is a _____________ 2. Mothers sex chromosome _____
Fathers sex chromosome _____
Child is a _____________
3. Mothers sex chromosome _____
Fathers sex chromosome _____
Child is a _____________ 4. Mothers sex chromosome _____
Fathers sex chromosome _____
Child is a _____________

ANS:
(Boxes can appear in any order)
Box 1:
Mothers sex chromosome X(m1)
Fathers sex chromosome X(f)
Child is a girl

Box 2:
Mothers sex chromosome X(m1)
Fathers sex chromosome Y(f)
Child is a boy

Box 3:
Mothers sex chromosome X(m2)
Fathers sex chromosome X(f)
Child is a girl

Box 4:
Mothers sex chromosome X(m2)
Fathers sex chromosome Y(f)
Child is a boy

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

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