Maternity Nursing Revised Reprint 8th Edition by Deitra Leonard -Test Bank

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Maternity Nursing Revised Reprint 8th Edition by Deitra Leonard -Test Bank

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WITH ANSWERS

Maternity Nursing Revised Reprint 8th Edition by Deitra Leonard -Test Bank

Lowdermilk: Maternity Nursing, 8th Edition

 

Chapter 04: Contraception, Abortion, and Infertility

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is:
a. Theyre not very effective, and its very likely youll get pregnant.
b. They can be effective for many couples, but they require motivation.
c. These methods have a few advantages and several health risks.
d. You would be much safer going on the pill and not having to worry.

 

ANS: B

 

  Feedback
A FAMs are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% during the first year of use.
B FAMs are effective with proper vigilance of ovulatory changes in the body and adherence to coitus intervals.
C FAMs have no associated health risks.
D The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the patients part.

 

DIF:   Cognitive Level: Application        REF:  98, 99

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level

 

ANS: B

 

  Feedback
A A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity.
B Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle.
C Laparoscopy usually is scheduled early in the menstrual cycle.
D Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

 

DIF:   Cognitive Level: Knowledge        REF:  125

OBJ:  Client Needs: Physiologic Integrity                                          TOP:   Nursing Process: Planning

 

  1. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurses most appropriate response is:
a. Your sperm count seems to be okay based on the first semen analysis.
b. Only marijuana cigarettes affect sperm count.
c. Smoking can give you lung cancer, even though it has no effect on sperm.
d. Smoking can reduce the quality of your sperm.

 

ANS: D

 

  Feedback
A This statement is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. Therefore a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility.
B The use of alcohol and marijuana may affect sperm counts.
C The use of tobacco may affect sperm counts.
D The use of tobacco may reduce the quality of the sperm.

 

DIF:   Cognitive Level: Application        REF:  123

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

  1. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurses most appropriate response is:
a. Tell your friends and family so they can help you.
b. Talk only to other friends who are infertile because only they can help.
c. Get involved with a support group. Ill give you some names.
d. Start adoption proceedings immediately because it is very difficult to obtain an infant.

 

ANS: C

 

  Feedback
A Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends.
B Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs, but depending on where the other couple is in their own recovery process, this may or may not help them.
C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences.
D This statement is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

 

DIF:   Cognitive Level: Application        REF:  124

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

 

  1. Which contraceptive method has a failure rate of less than 25%?
a. Standard days
b. Periodic abstinence
c. Ovulation method
d. Coitus interruptus

 

ANS: A

 

  Feedback
A The standard days variation on the calendar method has a failure rate of 14%.
B The periodic abstinence method has a failure rate of 25% or higher. The standard days variation on the calendar method has a failure rate of 14%.
C The postovulation method has a failure rate of 25% or higher.
D The coitus interruptus method has a failure rate of 27% or higher.

 

DIF:   Cognitive Level: Knowledge        REF:  99, 100

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

  1. The nurse working with a patient who has infertility concerns should be aware that Lupron (Leuprolide acetate, a gonadotropin-releasing hormone [GnRH] agonist) may be prescribed for an infertile woman to treat:
a. Anovulatory cycles.
b. Uterine fibroids.
c. Polycystic ovarian disease (POD).
d. Luteal phase inadequacy.

 

ANS: B

 

  Feedback
A Anovulatory cycles would be treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction.
B Lupron (Leuprolide acetate) is used to treat endometriosis and uterine fibroids.
C Metrodin is used to treat POD.
D Progesterone is used to treat luteal phase inadequacy.

 

DIF:   Cognitive Level: Knowledge        REF:  128, 129

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

 

  1. In vitro fertilizationembryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is:
a. IVF is a type of assisted reproductive therapy that involves collecting eggs from your wifes ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.
b. A donor embryo will be transferred into your wifes uterus.
c. Donor sperm will be used to inseminate your wife.
d. Dont worry about the technical stuff; thats what we are here for.

 

ANS: A

 

  Feedback
A A womans eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred.
B This statement describes therapeutic donor insemination.
C This statement describes the procedure for a donor embryo.
D This statement discredits the patients need for teaching and is not the most appropriate response.

 

DIF:   Cognitive Level: Application        REF:  131

OBJ:  Client Needs: Physiologic Integrity                                          TOP:   Nursing Process: Planning

 

  1. A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:
a. Obtain a history of menstrual cycle lengths for the past 6 months.
b. Determine the womans weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the womans previous experiences with conception control.

 

ANS: A

 

  Feedback
A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months.
B Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method.
C Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method.
D Exploring previous experiences with conception control may demonstrate patient understanding and compliance, but it is not the most important aspect to assess for discussion of the calendar method.

 

DIF:   Cognitive Level: Analysis             REF:  99

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

 

  1. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurses most appropriate response would be:
a. This is a highly effective method, but it has some side effects.
b. Your current medications will reduce the effectiveness of the pill.
c. The pill will reduce the effectiveness of your seizure medication.
d. This is a good choice for a woman of your age and personal history.

 

ANS: B

 

  Feedback
A This is a true statement, but it is not the most appropriate response.
B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants.
C The anticonvulsant will reduce the effectiveness of the pill, not the other way around.
D This statement does not teach the woman that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

 

DIF:   Cognitive Level: Application        REF:  110

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurses most appropriate response is:
a. No spermicide is used with the cervical cap, so its less messy.
b. The diaphragm can be left in place longer after intercourse.
c. Repeated intercourse with the diaphragm is more convenient.
d. The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later.

 

ANS: D

 

  Feedback
A Spermicide should be used inside the cap as an additional chemical barrier.
B The cervical cap should remain in place for 6 hours after the last act of intercourse.
C Repeated intercourse with the cervical cap is more convenient, because no additional spermicide is needed.
D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse.

 

DIF:   Cognitive Level: Application        REF:  106

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurses most appropriate response is:
a. The IUD does not interfere with sex.
b. The risk of pelvic inflammatory disease (PID) will be higher for you.
c. The IUD will protect you from sexually transmitted infections (STIs).
d. Pregnancy rates are high with the IUD.

 

ANS: B

 

  Feedback
A Although this statement may be correct, it is not the most appropriate response.
B Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or the human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing an STI. The IUD does not protect against infection as does a barrier method.
C The IUD offers no protection from STIs.
D The typical failure rate of the IUD ranges from 0.8% to 2%.

 

DIF:   Cognitive Level: Application        REF:  114

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:
a. Dilation and evacuation (D&E).
b. Instillation of hypertonic saline into the uterine cavity.
c. Intravenous administration of Pitocin.
d. Vacuum aspiration.

 

ANS: A

 

  Feedback
A The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks.
B Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use.
C Intravenous administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise.
D Vacuum aspiration is used for abortions in the first trimester.

 

DIF:   Cognitive Level: Comprehension  REF:  120

OBJ:  Client Needs: Physiologic Integrity

TOP:  Nursing Process: Implementation

 

  1. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by:
a. Limiting sexual contact for one cycle after starting the pill.
b. Using condoms and foam instead of the pill for as long as she takes an antibiotic.
c. Taking one pill at the same time every day.
d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle.

 

ANS: C

 

  Feedback
A If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur.
B No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users.
C To maintain adequate hormone levels for contraception and to enhance compliance, patients should take oral contraceptives at the same time each day.
D If the patient misses two pills during week 1, she should take two pills a day for 2 days, finish the package, and use a backup method the next 7 consecutive days.

 

DIF:   Cognitive Level: Application        REF:  110

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her fertile time. She asks the nurse about emergency contraception. The nurse tells her that:
a. It is too late; she needed to begin treatment within 24 hours after intercourse.
b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy.
c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting.
d. The most effective approach is to use a progestin-only preparation.

 

ANS: C

 

  Feedback
A Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy.
B Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy.
C To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose.
D Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. Women with contraindications to estrogen use should use progestin-only pills.

 

DIF:   Cognitive Level: Analysis             REF:  113

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

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

 

ANS: C

 

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

 

DIF:   Cognitive Level: Analysis             REF:  125

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

  1. While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning:
a. Is the same as coitus interruptus, or pulling out.
b. Uses the calendar method to align the womans cycle with the natural phases of the moon.
c. Is the only contraceptive practice acceptable to the Roman Catholic church.
d. Relies on barrier methods during fertility phases.

 

ANS: C

 

  Feedback
A Pulling out is not the same as periodic abstinence, another name for natural family planning.
B The phases of the moon are not part of the calendar method or any method.
C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic church.
D Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

 

DIF:   Cognitive Level: Comprehension  REF:  99

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)?
a. Periodic abstinence
b. Barrier methods
c. Hormonal methods
d. They all offer about the same protection.

 

ANS: B

 

  Feedback
A Periodic abstinence offers no protection against STIs or HIV.
B Barrier methods such as condoms best protect against STIs and HIV.
C Hormonal methods such as birth control pills offer no protection against STIs or HIV.
D Periodic abstinence and hormonal methods (the pill) offer no protection against STIs or HIV.

 

DIF:   Cognitive Level: Application        REF:  102

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that:
a. COCs can cause toxic shock syndrome if the prescription is wrong.
b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week.
c. COCs increase the risk of endometrial and ovarian cancer.
d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

 

ANS: D

 

  Feedback
A Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills.
B Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days.
C Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.
D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

 

DIF:   Cognitive Level: Comprehension  REF:  110

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. With regard to the use of intrauterine devices (IUDs), nurses should be aware that:
a. Return to fertility can take several weeks after the device is removed.
b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse.
c. IUDs offer the same protection against sexually transmitted infections as the diaphragm.
d. Consent forms are not needed for IUD insertion.

 

ANS: B

 

 

  Feedback
A Return to fertility is immediate after removal of the IUD.
B The woman has up to 8 days to insert the IUD after unprotected sex.
C IUDs offer no protection for sexually transmitted infections.
D A consent form is required for insertion, as is a negative pregnancy test.

 

DIF:   Cognitive Level: Comprehension  REF:  113

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

 

  1. Which statement is the most complete and accurate description of medical abortions?
a. They are performed only for maternal health.
b. They can be achieved through surgical procedures or with drugs.
c. They are mostly performed in the second trimester.
d. They can be either elective or therapeutic.

 

ANS: D

 

  Feedback
A Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health).
B Medical abortions are performed through the use of medications rather than surgical procedures.
C Medical abortions are usually done in the first trimester.
D Medical abortions are performed through the use of medications rather than surgical procedures. They are mostly done in the first trimester, and they can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health).

 

DIF:   Cognitive Level: Comprehension  REF:  120

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

 

MULTIPLE RESPONSE

 

  1. You (the nurse) are reviewing the educational packet provided to a patient about tubal ligation. What is an important fact you should point out? Choose all that apply.
a. It is highly unlikely that you will become pregnant after the procedure.
b. This is an effective form of 100% permanent sterilization. You wont be able to get pregnant.
c. Sterilization offers some form of protection against sexually transmitted infections (STIs).
d. Sterilization offers no protection against STIs.
e. Your menstrual cycle will greatly increase after your sterilization.

 

ANS: A, D

 

  Feedback
Correct A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against STIs.
Incorrect Tubal ligation is not 100% effective. It does not offer any protection against STIs. Typically the menstrual cycle remains the same after a tubal ligation.

 

DIF:   Cognitive Level: Application        REF:  114

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

Lowdermilk: Maternity Nursing, 8th Edition

 

Chapter 06: Anatomy and Physiology of Pregnancy

 

Test Bank

 

MULTIPLE CHOICE

 

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

 

ANS: B

 

  Feedback
A The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as:

G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.

T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.

P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.

A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.

L: This number signifies the number of children born that currently are living; the woman has four children.

B This is the correct calculation of this womans gravidity and parity.
C The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as:

G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.

T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.

P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.

A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.

L: This number signifies the number of children born that currently are living; the woman has four children.

D The numbers do not accurately reflect the womans gravidity and parity information. Using the GTPAL system, her information would be calculated as:

G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.

T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.

P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.

A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.

L: This number signifies the number of children born that currently are living; the woman has four children.

 

DIF:   Cognitive Level: Comprehension  REF:  169, 170

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

  1. A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
a. 2-0-0-1-1
b. 2-1-0-1-0
c. 3-1-0-1-0
d. 3-0-1-1-0

 

ANS: C

 

  Feedback
A Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows:

G: Total number of times the woman has been pregnant (she is pregnant for the third time).

T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).

P: Number of pregnancies that resulted in a preterm birth (none).

A: Abortions or miscarriages before the period of viability (she has had one).

L: Number of children born who are currently living (she has no living children).

B Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows:

G: Total number of times the woman has been pregnant (she is pregnant for the third time).

T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).

P: Number of pregnancies that resulted in a preterm birth (none).

A: Abortions or miscarriages before the period of viability (she has had one).

L: Number of children born who are currently living (she has no living children).

C This is the correct calculation of this womans gravidity and parity.
D Using the GTPAL system explained in question 1, this patients gravidity and parity information would be calculated as follows:

G: Total number of times the woman has been pregnant (she is pregnant for the third time).

T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).

P: Number of pregnancies that resulted in a preterm birth (none).

A: Abortions or miscarriages before the period of viability (she has had one).

L: Number of children born who are currently living (she has no living children).

 

DIF:   Cognitive Level: Comprehension  REF:  169, 170

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Diagnosis

 

  1. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?
a. Radioimmunoassay
b. Radioreceptor assay
c. Latex agglutination test
d. Enzyme-linked immunosorbent assay (ELISA)

 

ANS: D

 

  Feedback
A The radioimmunoassay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
B The radioreceptor assay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
C The latex agglutination test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
D ELISA technology is used in OTC pregnancy tests.

 

DIF:   Cognitive Level: Knowledge        REF:  171

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

 

  1. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:
a. Amenorrhea.
b. Positive pregnancy test.
c. Chadwicks sign.
d. Hegars sign.

 

ANS: A

 

  Feedback
A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman.
B A positive pregnancy test would be a probable sign of pregnancy.
C The presence of Chadwicks sign would be a probable sign of pregnancy.
D The presence of Hegars sign would be a probable sign of pregnancy.

 

DIF:   Cognitive Level: Comprehension  REF:  172

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

 

  1. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurses instructions if she states that a positive sign of pregnancy is:
a. A positive pregnancy test.
b. Fetal movement palpated by the nurse-midwife.
c. Braxton Hicks contractions.
d. Quickening.

 

ANS: B

 

  Feedback
A A positive pregnancy test would be a probable sign of pregnancy.
B Positive signs of pregnancy are those that are attributed to the presence of a fetus such as hearing the fetal heartbeat or palpating fetal movement.
C Braxton Hicks contractions would be a probable sign of pregnancy.
D Quickening would be a presumptive sign of pregnancy.

 

DIF:   Cognitive Level: Comprehension  REF:  172

OBJ:  Client Needs: Health Promotion and Maintenance        TOP:  Nursing Process: Planning

 

  1. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
a. Not palpable above the symphysis at this time
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus

 

ANS: B

 

  Feedback
A As the uterus grows, it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy.
B  In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy.
C The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.
D The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

 

DIF:   Cognitive Level: Comprehension  REF:  173

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

 

  1. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
a. Less audible heart sounds (S1, S2)
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production

 

ANS: B

 

  Feedback
A Splitting of S1 and S2 is more audible.
B Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term.
C In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg.
D Production of RBCs accelerates during pregnancy.

 

DIF:   Cognitive Level: Comprehension  REF:  177

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

 

  1. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints.

 

ANS: B

 

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

 

DIF:   Cognitive Level: Comprehension  REF:  185

OBJ:  Client Needs: Physiologic Integrity                                          TOP:   Nursing Process: Planning

 

  1. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.
b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been using cocaine intranasally.

 

ANS: A

 

  Feedback
A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis.
B Cardiovascular changes in pregnancy may cause edema in lower extremities.
C This determination cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings.
D This determination cannot be made on the basis of the sparse facts provided.

 

DIF:   Cognitive Level: Application        REF:  181

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

 

  1. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:
a. Estrogen.
b. Human chorionic gonadotropin (hCG).
c. Oxytocin.
d. Progesterone.

 

ANS: D

 

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

 

DIF:   Cognitive Level: Comprehension  REF:  187

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

 

  1. The nurse providing care to the pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:
a. Ptyalism.
b. Pyrosis.
c. Pica.
d. Decreased peristalsis.

 

ANS: C

 

  Feedback
A Ptyalism (excessive salivation) is a normal finding.
B Pyrosis (heartburn) is a normal finding.
C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated.
D Decreased peristalsis is a normal finding.

 

DIF:   Cognitive Level: Analysis             REF:  186

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

 

  1. Appendicitis may be difficult to diagnose in pregnancy because the appendix is:
a. Displaced upward and laterally, high and to the right.
b. Displaced upward and laterally, high and to the left.
c. Deep at McBurney point.
d. Displaced do

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