The reproductive health nurse counsels a 17-year-old

Multiple Choice
Identify the choice that best completes the statement or answers the question.

1.

The reproductive health nurse counsels a 17-year-old woman who is interested in initiating contraception. A short-term positive outcome of the visit would include the patient’s:
a.
ability to describe when and how to obtain and use the contraceptive chosen.
b.
lack of side effects after 3 months.
c.
voiced satisfaction with this method over the past 6 months.
d.
continued use and pregnancy prevention for 6 months.

2.

The clinic nurse schedules a yearly Pap test for the woman who is using Implanon as her contraceptive method of choice. The patient is also reminded that she will need an appointment to replace this birth control method in:
a.
12 months.
b.
24 months.
c.
36 months.
d.
48 months.

3.

A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nurse recommends an oral contraceptive formulated:
a.
with progestin only.
b.
as a monophasic.
c.
as a biphasic.
d.
as a triphasic.

4.

The clinic nurse seeks detailed information concerning the menstrual cycles of a 15-year-old athletic girl who is interested in using birth control pills. When considering the initiation of oral contraceptives in adolescents, the goal is that the young woman will have already experienced regular menstrual cycles for at least:
a.
6 months.
b.
12 months.
c.
18 months.
d.
24 months.

5.

A clinic nurse explains to a pregnant woman that the amount of amniotic fluid present at 7 or 8 months gestation is approximately:
a.
500 mL.
b.
750 mL.
c.
800 mL.
d.
1000 mL.

6.

During prenatal class, the nurse teaches expectant couples about the importance of the amniotic fluid. The amniotic fluid helps the fetus to maintain a normal body temperature and also:
a.
facilitates asymmetrical growth of the fetal limbs.
b.
cushions the fetus from mechanical injury.
c.
promotes development of muscle tone.
d.
promotes adherence of fetal lung tissue.

7.

The nurse discusses fetal development and states that the hormone responsible for suppressing the maternal immunological response to the fetus, thereby facilitating physiological acceptance of the pregnancy, is:
a.
progesterone.
b.
estrogen.
c.
human placental lactogen.
d.
human chorionic gonadotropin.

8.

The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given birth to a 2700-gram infant at 36 weeks’ gestation. The most appropriate term for this is:
a.
preterm birth.
b.
term birth.
c.
small for gestational age infant.
d.
large for gestational age infant.

9.

The prenatal clinic nurse is providing information to a pregnant woman at 15 weeks’ gestation. The patient asks when she should expect to feel fetal movement. The most appropriate gestational age that a woman will first experience fetal movement is from:
a.
15 to 18 weeks.
b.
17 to 20 weeks.
c.
18 to 21 weeks.
d.
20 to 24 weeks.

10.

During preconception counseling, the nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from:
a.
2 to 8 weeks.
b.
4 to 12 weeks.
c.
5 to 10 weeks.
d.
6 to 15 weeks.

11.

During prenatal classes for expectant parents, the perinatal nurse explains that fetal brain development is most critical during gestational weeks:
a.
2 to 8.
b.
3 to 16.
c.
5 to 24.
d.
6 to 14.

12.

The birthing center nurse caring for a 21-year-old laboring woman is given a report about the patient’s cocaine use throughout pregnancy. This history of cocaine abuse increases the patient’s risk for the following condition during labor:
a.
placenta previa.
b.
abruptio placentae.
c.
cephalopelvic disproportion.
d.
hypotension.

13.

The birthing center nurse is assisting with pain management for a laboring woman at 18 weeks’ gestation. The fetus is born and the weight is 450 grams. The most appropriate term for a birth that occurs at this gestation is:
a.
stillbirth.
b.
abortion.
c.
neonatal death.
d.
fetal loss.

14.

A woman who is experiencing her first pregnancy is in labor at 30 weeks’ gestation. She is very concerned about the health of her baby and her impending preterm birth. The woman asks the perinatal nurse about her baby’s possibilities for survival and what physiological development has occurred by this time. The nurse’s best response is:
a.
“It is best to wait for the obstetrician to come and talk with you so that he or she can provide you with exact numbers regarding your baby’s survival rate.”
b.
“At 30 weeks, your baby’s lungs are still developing and do not have the ability to sustain air exchange.”
c.
“At 30 weeks, your baby will be small and will need to be in the hospital for a long time but will survive.”
d.
“At 30 weeks, your baby has completed a great deal of growth and development. For example, the reflex in the eye that responds to light should be present by now.”

15.

A 26-year-old woman has come for preconception counseling and asks about caring for her cat because she has heard that she “should not touch the cat during pregnancy.” The nurse’s best response is:
a.
“It is best if someone other than you changes the cat’s litter pan during pregnancy so that you have no risk of exposure to toxoplasmosis during pregnancy.”
b.
“It is important to have someone else change the litter pan during pregnancy and also to avoid consuming raw vegetables.”
c.
“Have you had any ‘flu-like’ symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about.”
d.
“Toxoplasmosis is a concern during pregnancy so it is important to have someone else change the cat’s litter pan and also to avoid consuming uncooked meat.”

16.

The clinic nurse talks with a 30-year-old woman at 34 weeks’ gestation who complains of having difficulty sleeping. The patient has noticed that getting back to sleep after she has been up at night is difficult. The nurse’s best response is:
a.
“This is abnormal; it is important that you describe this problem to the doctor.”
b.
“This is normal and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon.”
c.
“This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary.”
d.
“This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day.”

17.

A 26-year-old woman at 29 weeks’ gestation experienced epigastric pain following the consumption of a large meal of fried fish, hushpuppies, and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is:
a.
cholelithiasis.
b.
influenza.
c.
urinary tract infection.
d.
intrahepatic cholelithiasis.

18.

The clinic nurse reviews the complete blood count results of a 30-year-old woman who is now 33 weeks’ gestation. The patient’s hemoglobin value is 11.2 g/dL and her hematocrit is 38%. The clinic nurse interprets these findings as:
a.
normal adult values.
b.
normal pregnancy values for the third trimester.
c.
increased adult values.
d.
increased values for 33 weeks’ gestation.

19.

The clinic nurse is aware that the pregnant woman’s blood volume increases by:
a.
20% to 25%.
b.
30% to 35%.
c.
40% to 45%.
d.
50% to 55%.

20.

The nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse’s hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the:
a.
first maneuver.
b.
second maneuver.
c.
third maneuver.
d.
fourth maneuver.

21.

The nurse includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be:
a.
“This is something that we ask everyone. Do you feel safe in your current living environment and relationships?”
b.
“This is something we ask everyone. Do you have any abuse in your life right now?”
c.
“Is your partner threatening or harming you in any way right now?”
d.
“I need to ask you, do you feel safe from abuse right now?”

22.

The clinic nurse talks with a patient about her possible pregnancy. The patient has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as:
a.
positive signs of pregnancy.
b.
presumptive signs of pregnancy.
c.
probable signs of pregnancy.
d.
possible signs of pregnancy.

23.

The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting, fatigue, and weight gain. His symptoms are best described as:
a.
influenza.
b.
Couvade syndrome.
c.
acid reflux.
d.
cholelithiasis.

24.

After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. The major concern with this amount of soda intake is excessive:
a.
sodium.
b.
potassium.
c.
calcium.
d.
creatinine.

25.

The perinatal nurse explains to the new nurse that prescription medications are classified in pregnancy according to risk. A Category D medication is one that has:
a.
no associated fetal risk and is safe to take in pregnancy.
b.
no associated fetal risk in animals, although fetal risk in humans has not been identified.
c.
evidence of adverse effects in animal fetuses, and the fetal risk in humans has not been identified.
d.
evidence of adverse effects; the fetal risk in humans and the benefits and risks must be considered before prescribing to a pregnant woman.

26.

The nurse explains to the prenatal class attendees that at full term about 10% of the maternal weight gain is attributed to the:
a.
maternal reserves.
b.
fetal tissue.
c.
placental fluid.
d.
blood, uterine, and breast tissue.

27.

The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patient’s quadruple marker screen result is positive at 17 weeks of gestation. The nurse explains that the patient needs a referral to:
a.
a genetics counselor/specialist.
b.
an obstetrician.
c.
a gynecologist.
d.
a social worker.

28.

The nurse encourages women who are pregnant to use a moderate amount of caffeine. A moderate amount is best described as:
a.
200 mg per day.
b.
300 mg per day.
c.
400 mg per day.
d.
500 mg per day.

29.

A 21-year-old pregnant woman now at 24 weeks’ gestation has gained 13 pounds and smokes 8 to 10 cigarettes per day. The patient reports that she is beginning to feel regular fetal movement. The clinic nurse is reviewing the patient’s diet with her and notes that she does not like fruits or vegetables. The patient’s daily requirement for vitamin C is:
a.
40 to 60 mg/day.
b.
60 to 80 mg/day.
c.
80 to 90 mg/day.
d.
160 to 180 mg/day.

30.

An 18-year-old woman at 20 weeks’ gestation is complaining of fatigue and listlessness. This is her first pregnancy. The patient’s vital signs are within a normal range: BP = 118/60 mm Hg, pulse = 70 beats per minute, and respiratory rate = 16 breaths per minute. The patient’s fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5’ 4”. The perinatal nurse’s best approach to care at this visit is to:
a.
ask the patient to keep a 3-day food diary to bring in with her; schedule her next prenatal visit for 1 week.
b.
explain to the patient that weight gain is not a concern in pregnancy and she should not worry.
c.
teach the patient about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks’ gestation).
d.
explain to the patient the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

31.

A 20-year-old woman who underwent an elective abortion 6 months ago comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. The patient’s fundal height is 22 cm, and she is very concerned about her changing body shape. The perinatal nurse suspects that the patient may have:
a.
anemia.
b.
anorexia nervosa.
c.
gestational diabetes.
d.
gestational hypertension.

Multiple Response
Identify one or more choices that best complete the statement or answer the question.

32.

The clinic nurse uses the acronym “PAINS” when teaching a woman about warning signs associated with her intrauterine device (IUD). Warning signs include: (Select all answers that apply.)
a.
fever and/or chills.
b.
an inability to feel the IUD strings.
c.
spotting.
d.
breast tenderness.

33.

The nurse is concerned about a 28-year-old woman who is undergoing her second in vitro fertilization (IVF) cycle. The patient is anxious, sad, and worried that her partner does not feel as motivated as she does to try to achieve a pregnancy. The nurse recommends that the patient:
(Select all answers that apply.)
a.
talk honestly with her partner.
b.
engage in relaxation techniques, such as exercise.
c.
consider using complementary preparations such as blue cohosh.
d.
recognize the fact that it takes an average of five attempts to achieve a pregnancy with IVF.

34.

A 16-year-old adolescent arrives at the health clinic for contraceptive counseling. The patient is 5’ 7” with a body mass index of 18. The clinic nurse is concerned that the patient may have an eating disorder. When presenting contraceptive options, the clinic nurse suggests that a transdermal contraceptive patch and condoms would be the patient’s best options because: (Select all answers that apply.)
a.
of the potential for weight gain with an oral contraceptive.
b.
of the potential for decreased effectiveness of an oral contraceptive if the patient has any nausea or vomiting.
c.
the transdermal contraceptive patch would require once a week application instead of daily dosage.
d.
condoms would increase protection against human immunodeficiency virus (HIV) and sexually transmitted infections.

35.

The clinic nurse obtains a history from women who wish to use a cervical cap as their method of contraception. Relative or absolute contraindications to this contraceptive device include: (Select all answers that apply.)
a.
human papilloma virus infection.
b.
history of an abnormal Pap smear.
c.
latex allergy.
d.
nulliparity.

36.

The family planning clinic nurse reviews the signs and symptoms of toxic shock syndrome (TSS) with a patient who is being fitted for a diaphragm. The nurse explains that the patient should promptly seek medical attention if she: (Select all answers that apply.)
a.
develops a temperature greater than 101.1°F (38.4°C).
b.
feels lightheaded, dizzy, or has chills.
c.
develops a generalized red rash.
d.
experiences difficulty breathing or shortness of breath.

37.

An 18-year-old woman at 23 weeks’ gestation tells the nurse that she has fainted two times. The nurse teaches the patient about the warning signs that often precede syncope so that she can sit or lie down to prevent personal injury. Warning signs include: (Select all answers that apply.)
a.
sweating.
b.
nausea.
c.
chills.
d.
yawning.

38.

The nurse encourages paternal attachment during pregnancy by including the father in: (Select all answers that apply.)
a.
prenatal visits.
b.
ultrasound appointments.
c.
prenatal class information.
d.
history taking and obtaining prenatal screening information.

39.

The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include: (Select all answers that apply.)
a.
relaxation of the smooth muscle of the urinary sphincter.
b.
relaxation of the smooth muscle of the bladder.
c.
inadequate emptying of the bladder.
d.
increased peristalsis of the ureters.

40.

The nurse discusses normal bladder function in pregnancy with a 22-year-old pregnant woman who is now in her 29th gestational week. The nurse explains that at this time in pregnancy it is normal to experience: (Select all answers that apply.)
a.
urinary frequency.
b.
urinary urgency.
c.
nocturia.
d.
bacteriuria.

41.

A 32-year-old woman now at 32 weeks of gestation is complaining of right-sided sharp abdominal pain. The patient is examined by the clinic nurse and given information about abdominal discomfort in pregnancy. The patient is also instructed to seek immediate attention if she: (Select all answers that apply.)
a.
has heartburn.
b.
has chills or a fever.
c.
feels decreased fetal movements.
d.
has increased abdominal pain.

42.

An 18-year-old woman at 28 weeks’ gestation describes blurred vision to the prenatal clinic nurse. The patient denies any other symptoms. The nurse is aware that this common visual complaint during pregnancy is most likely caused by: (Select all answers that apply.)
a.
corneal thickening.
b.
corneal thinning.
c.
increased intraocular pressure.
d.
decreased intraocular pressure.

43.

The clinic nurse talks with a pregnant woman at 9 weeks’ gestation who has just learned of her pregnancy. The patient’s nausea and vomiting are most likely caused by: (Select all answers that apply.)
a.
increased levels of estrogen.
b.
increased levels of progesterone.
c.
an altered carbohydrate metabolism.
d.
increased levels of human chorionic gonadotropin.

44.

The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day to: (Select all answers that apply.)
a.
decrease the risk of constipation.
b.
decrease the risk of bile stasis.
c.
decrease their feelings of fatigue.
d.
decrease the risk of urinary tract infections.

45.

The perinatal nurse examines the thyroid gland as part of the physical examination of a pregnant woman who is now at 16 weeks’ gestation. The perinatal nurse informs the patient that during pregnancy: (Select all answers that apply.)
a.
increased size of the thyroid gland is normal.
b.
increased function of the thyroid gland is normal.
c.
decreased function of the thyroid gland is normal.
d.
the thyroid gland will return to its normal size and function during the postpartal period.

46.

The clinic nurse describes the respiratory system changes common to pregnancy to the new nurse. These changes include: (Select all answers that apply.)
a.
an increased tidal volume.
b.
a decreased airway resistance.
c.
an increased chest circumference.
d.
an increased airway resistance.

47.

The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes. The nurse explains that a pregnant woman is at risk for venous thrombosis due to: (Select all answers that apply.)
a.
increased fibrinogen volume.
b.
increased blood factor V.
c.
increased blood factor X.
d.
venous stasis.

48.

The clinic nurse describes possible interventions for a pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests: (Select all answers that apply.)
a.
elevating the arms and wrists at night.
b.
reassessment during the postpartum period.
c.
the use of “cock splints” to prevent wrist flexion.
d.
massaging the hands and wrists with alcohol.

49.

A 21-year-old single woman comes for her first prenatal appointment at 31 weeks gestation with her first pregnancy. The nurse’s most appropriate statement is: (Select all answers that apply.)
a.
“It is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care.”
b.
“Have you had care in another clinic? I can’t believe this is your first appointment!”
c.
“By the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly.”
d.
“By your information, you are 31 weeks gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?”

50.

The nurse will ensure further testing for a woman who is potentially positive for hepatitis B to include: (Select all answers that apply.)
a.
hepatitis C.
b.
parvovirus.
c.
human immunodeficiency virus (HIV).
d.
cytomegalovirus.

51.

The nurse advocates for smoking cessation during pregnancy. Potential harmful effects of prenatal tobacco use include: (Select all answers that apply.)
a.
preterm birth.
b.
gestational hypertension.
c.
gestational diabetes.
d.
small for gestational age infant.

52.

The nurse recognizes that a pregnant adolescent must successfully complete developmental tasks to be an effective mother. These developmental tasks include: (Select all answers that apply.)
a.
accepting this pregnancy and telling her parents/friends.
b.
setting reasonable goals for herself.
c.
seeing herself as a mother.
d.
maintaining her freedom.

53.

Asking the pregnant woman about her use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drug use include: (Select all answers that apply.)
a.
miscarriage/spontaneous abortion.
b.
low birth weight.
c.
macrosomia.
d.
postterm labor/birth.

54.

The nurse recognizes that pregnant women who are in particular need of support are those who are: (Select all answers that apply.)
a.
experiencing a second pregnancy.
b.
awaiting genetic testing results.
c.
experiencing a first pregnancy.
d.
trying to conceal this pregnancy as long as possible.

55.

The nurse schedules a patient for her first prenatal appointment with the certified nurse-midwife in the clinic. The patient has appropriate questions for her potential health-care provider that include: (Select all answers that apply.)
a.
the opportunity to use complementary and alternative methods during labor and birth.
b.
an opportunity to meet other providers in the practice.
c.
the health-care provider’s beliefs and practices concerning epidural anesthesia and the routine use of an episiotomy.
d.
whether the nurse-midwife will be continually available at the bedside to provide support during labor.

56.

The nurse provides increased support to a woman who is in her second trimester. The patient’s first pregnancy ended in a miscarriage. Understandably, the patient is ambivalent about this baby due to her: (Select all answers that apply.)
a.
previous loss.
b.
needs related to a second child.
c.
potential role relationship changes.
d.
awareness that she will be taking on a new 24-hour responsibility.

57.

The nurse explains to a newly diagnosed pregnant woman at 10 weeks’ gestation that her rubella titer indicates that she is not immune. The patient should be advised to: (Select all answers that apply.)
a.
avoid contact with all children.
b.
be retested in 3 months.
c.
receive the rubella vaccine during the postpartum period.
d.
report any signs or symptoms of fever, runny nose, and generalized red rash to her health-care provider.

58.

A 24-year-old pregnant woman at 26 weeks’ gestation is experiencing her third pregnancy. The patient’s obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. The perinatal nurse identifies concerns in the patient’s history and work environment, including: (Select all answers that apply.)
a.
risk of preterm birth.
b.
presence of chemotherapeutic agents.
c.
requirement for heavy lifting.
d.
history of diabetes.

59.

The perinatal nurse discusses with the patient some options for ongoing work, including (refer to question 10): (Select all answers that apply.)
a.
negotiating for 8-hour shifts.
b.
resting when she is at home after work.
c.
ensuring that she has 20 to 30 minutes every 2 hours to put her feet up and rest.
d.
reviewing the signs and symptoms of preterm labor and the need to discontinue work if these symptoms occur.

60.

The nurse teaches the prenatal class attendees about herbal medications that may cause uterine contractions and preterm labor. Herbal preparations that should be avoided because they act as uterine stimulants include: (Select all answers that apply.)
a.
black cohosh.
b.
mugwort.
c.
ephedra.
d.
senna.

61.

The clinic nurse is assessing the complete blood count results for a 23-year-old pregnant woman. The patient’s hemoglobin is 9.8 g/dL. This laboratory finding places the patient’s pregnancy at risk for: (Select all answers that apply.)
a.
preterm birth.
b.
placental abruption.
c.
intrauterine growth restriction.
d.
thrombocytopenia.

62.

A 22-year-old woman is experiencing her third pregnancy. Her obstetrical history includes one first trimester elective abortion and one first trimester spontaneous abortion. The patient is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The perinatal nurse discusses the patient’s diet with her because she may be deficient in: (Select all answers that apply.)
a.
iron.
b.
magnesium.
c.
zinc.
d.
vitamin B12.

63.

During the initial prenatal visit, the clinic nurse asks questions about the woman’s nutritional intake. Specific questions should include information pertaining to: (Select all answers that apply.)
a.
preferred foods.
b.
the presence of cravings.
c.
the use of herbal supplements.
d.
aversions to certain foods and odors.

64.

The perinatal nurse would assess which newborn systems in more detail after the birth if a woman admitted to cocaine use during her pregnancy? (Select all answers that apply.)
a.
central nervous system
b.
cardiovascular system
c.
gastrointestinal system
d.
respiratory system

65.

The perinatal nurse talks to the prenatal class attendees about guidelines for exercise in pregnancy. Recommended guidelines include: (Select all answers that apply.)
a.
stopping if the woman is tired.
b.
bouncing and slowly arching the back.
c.
increasing fluid intake throughout the physical activity.
d.
maintaining the ability to walk and talk during exercise.

66.

The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include: (Select all answers that apply.)
a.
adolescence.
b.
low educational level.
c.
history of depression.
d.
a strong support system for the pregnancy.

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