Test Bank – Guidelines for Nurse Practitioner in Gynecologic Setting (3) – 2017

MULTIPLE CHOICE
1. A client with a history of bipolar disorder is called by the postpartum support nurse for follow- up. Which symptoms would reassure the nurse that the client is not experiencing a manic episode?
a. Psychomotor agitation and lack of sleep
b. Increased appetite and lack of interest in activities
c. Hyperactivity and distractibility
d. Pressured speech and grandiosity
ANS: B
An increased appetite and a lack of interest would reassure the nurse that the client is not experiencing an episode of mania. Clinical manifestations of a manic episode include at least three of the following: grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, psychomotor agitation, and excessive involvement in pleasurable activities. The pregnant woman exhibiting symptoms of a manic episode will likely have a decreased interest in eating and an increased level of interest in pleasurable activities without regard for negative consequences. Psychomotor agitation and a lack of sleep, hyperactivity and distractibility, and pressured speech and grandiosity are all clinical manifestations of a manic episode.
2. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurses primary concern in planning the clients care?
a. Displaying outbursts of anger
b. Neglecting her hygiene
c. Harming her infant
d. Losing interest in her husband
ANS: C
Thoughts of harm to herself or to the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. Although outbursts of anger and neglecting personal hygiene are symptoms attributable to PPD, the major concern remains the potential of

harm to herself or her infant. Although this client is likely to lose interest in her spouse, it is not the nurses primary concern.
3. During an inpatient psychiatric hospitalization, what is the most important nursing intervention?
a. Contacting the clients significant other
b. Supervising and guiding visits with her infant
c. Allowing no contact with anyone who annoys her
d. Having the infant with the mother at all times
ANS: B
In the hospital setting, the reintroduction of the infant to the mother can and should occur at the mothers own pace. A schedule is set that increases the number of hours the mother cares for her infant over several days, culminating in the infant staying overnight in the mothers room. These supervised and guided visits allow the mother to experience meeting the infants needs and giving up sleep for the infant. Reintroducing the mother to her infant while in a supervised setting is essential. Another important task for a mother under psychiatric care is to reestablish positive interactions with others.
4. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
a. Respiratory conditions
b. Intellectual impairment
c. Neural development disorder
d. Alcohol-related birth defects (ARBDs)
ANS: A
Respiratory difficulties are not attributed to exposure to alcohol in utero. Other abnormalities related to FAS include mental retardation, neurodevelopment disorders, and ARBDs.
5. As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
a. Heroin
b. Alcohol
c. Phencyclidine (1-phenylcyclohexylpiperidine; PCP)
d. Cocaine
ANS: D
Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth. Heroin is an opiate; its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. The most serious effect of alcohol use in pregnancy is FAS. The major concern regarding PCP use in pregnant women is its association with polydrug abuse and its neurobehavioral effects on the neonate.
6. According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum?

a. Prenatal depression
b. Single-mother status
c. Low socioeconomic status
d. Unplanned or unwanted pregnancy
ANS: A
Prenatal depression has been found to be a major risk factor for PPD. Single-mother status and low socioeconomic status are both small-relationship predictors for PPD. Although an unwanted pregnancy may contribute to the risk for PPD, it does not pose as great an effect as prenatal depression.
7. Which is the most accurate description of PPD without psychotic features?
a. Postpartum baby blues requiring the woman to visit with a counselor or psychologist

b. Condition that is more common among older Caucasian women because they have higher expectations
c. Distinguishable by pervasive sadness along with mood swings
d. Condition that disappears without outside help
ANS: C
PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum baby blues. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. PPD is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention.
8. While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion?
a. Phobias
b. Panic disorder
c. Posttraumatic stress disorder (PTSD)
d. Obsessive-compulsive disorder (OCD)
ANS: C
PTSD can occur as the result of a past trauma such as rape. Symptoms of PTSD include re- experiencing the event, numbing, irritability, angry outbursts, and exaggerated startle reflex. With the increased bodily touch and vaginal examinations that occur during labor, the client may have memories of the original trauma. The process of giving birth may result in her feeling out of control. The nurse should verbalize an understanding and reassure the client as necessary.
Phobias are irrational fears that may lead a person to avoid certain events or situations. Panic disorders may occur in as many as 3% to 5% of women in the postpartum period and are described as episodes of intense apprehension, fear, and terror. Symptoms of a panic disorder may include palpitations, chest pain, choking, or smothering. OCD symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly check and recheck her infant once he or she is born, although she realizes that this behavior is irrational. OCD is optimally treated with medications.

9. Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications?
a. Alcohol
b. Caffeine
c. Tobacco
d. Chocolate
ANS: C
Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low-birth-weight infants. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and worsen arrhythmias. Chocolate, particularly dark chocolate, contains caffeine that may interfere with certain medications.
10. As part of the discharge teaching, the nurse can prepare the mother for her upcoming adjustment to her new role by instructing her regarding self-care activities to help prevent PPD. Which statement regarding this condition ismost helpful for the client?
a. Stay home, and avoid outside activities to ensure adequate rest.
b. Be certain that you are the only caregiver for your baby to facilitate infant attachment.
c. Keep your feelings of sadness and adjustment to your new role to yourself.
d. Realize that PPD is a common occurrence that affects many women.
ANS: D
Should the new mother experience symptoms of the baby blues, it is important that she be aware that these symptoms are nothing to be ashamed of. As many as 10% to 15% of new mothers experience similar symptoms. Although obtaining enough rest is important for the mother, she should not distance herself from her family and friends. Her spouse or partner can communicate the best visiting times to enable the new mother to obtain adequate rest. It is also important that she not isolate herself at home by herself during this time of role adjustment. Even if breastfeeding, other family members can participate in the infants care. If depression occurs, then the symptoms will often interfere with mothering functions; therefore, family support is
essential. The new mother should share her feelings with someone else and avoid overcommitting herself or feel as though she has to besuperwoman. A telephone call to the hospital warm line may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary.
11. A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol?
a. Daily consumption of alcohol indicates a risk for alcoholism.
b. She will be at risk for abusing other substances as well.
c. The fetus is placed at risk for altered brain growth.
d. The fetus is at risk for multiple organ anomalies.
ANS: C
No period exists when consuming alcohol during pregnancy is safe. The documented effects of alcohol consumption during pregnancy include mental retardation, learning disabilities, high activity level, and short attention span. The brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use.
12. A pregnant woman who abuses cocaine admits to exchanging sex to finance her drug habit. This behavior places the client at the greatest risk for what?
a. Depression of the CNS
b. Hypotension and vasodilation
c. Sexually transmitted infections (STIs)
d. Postmature birth
ANS: C
Exchanging sex acts for drugs places the woman at increased risk for STIs because of multiple partners and the lack of protection. Cocaine is a CNS stimulant that causes hypertension and vasoconstriction. Premature delivery of the infant is one of the more common problems associated with cocaine use during pregnancy.
13. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?
a. Genetic changes and anomalies
b. Extensive CNS damage
c. Fetal addiction to the substance inhaled
d. Intrauterine growth restriction
ANS: D
The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive CNS damage. Addiction to tobacco is not a usual concern related to the neonate.
14. The use of methamphetamine (meth) has been described as a significant drug problem in the United States. The nurse who provides care to this client population should be cognizant of what regarding methamphetamine use?
a. Methamphetamines are similar to opiates.
b. Methamphetamines are stimulants with vasoconstrictive characteristics.
c. Methamphetamines should not be discontinued during pregnancy.
d. Methamphetamines are associated with a low rate of relapse.
ANS: B
Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are similarly used. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is extremely high.

15. With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimal treatment for women addicted to opioids?
a. Methadone maintenance treatment (MMT)
b. Detoxification

c. Smoking cessation
d. 4 Ps Plus
ANS: A
MMT is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for the treatment of opioid addiction that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease the rates of infections such as hepatitis B and C, human immunodeficiency virus (HIV), and other STIs. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool specifically designed to identify pregnant women who need in-depth assessment related to substance abuse.
MULTIPLE RESPONSE
1. Reports have linked third trimester use of selective serotonin uptake inhibitors (SSRIs) with a constellation of neonatal signs. The nurse is about to perform an assessment on the infant of a mother with a history of a mood disorder. Which signs and symptoms in the neonate may be the result of maternal SSRI use? (Select all that apply.)
a. Hypotonia
b. Hyperglycemia
c. Shivering
d. Fever
e. Irritability
ANS: C, D, E
Neonatal signs of maternal SSRI use include continuous crying, irritability, jitteriness, shivering, fever, hypertonia, respiratory distress, feeding difficulty, hypoglycemia, and seizures. The onset of signs and symptoms ranges from several hours to several days after birth, but the signs generally resolve within 2 weeks.
2. Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plus is a screening tool specifically designed to identify the need for a more in-depth assessment. Which are the correct components of the 4 Ps Plus? (Select all that apply.)
a. Parents
b. Partner
c. Present
d. Past
e. Pregnancy
ANS: A, B, D, E
The nurse who is screening the client using the 4 Ps Plus would use the following format: Parents: Did either of your parents have a problem with alcohol or drugs? Partner: Does your partner have a problem with alcohol or drugs? Past: Have you ever had any beer, wine, or liquor?

Pregnancy: In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink? Present: Is not a component of the 4 Ps Plus.

MULTIPLE CHOICE
1. Which statement by a school-age girl indicates the need for further teaching about the prevention of urinary tract infections (UTIs)?

Feedback

A It is desirable to wear cotton rather than nylon underwear. Nylon tends to hold in moisture and promote bacterial growth, whereas cotton absorbs moisture.

B Bubble baths should be avoided because they tend to cause urethral irritation, which leads to UTI.
C Children should be encouraged to urinate at least four times a day.
D An adequate fluid intake prevents the buildup of bacteria in the bladder.
2. The nurse assessing a child with acute poststreptococcal glomerulonephritis should be alert for which finding?
a. Increased urine output
b. Hypotension
c. Tea-colored urine
d. ANS: Weight gain
C

Feedback
A In acute poststreptococcal glomerulonephritis the urine output may be decreased.
B In acute poststreptococcal glomerulonephritis blood pressure may be increased.

C Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria.

D Edema may be noted around the eyelids and ankles in patients with acute poststreptococcal glomerulonephritis; however, weight gain is associated with nephrotic syndrome.
3. The mother of a child who was recently diagnosed with acute glomerulonephritis asks the nurse why the physician keeps talking about casts in the urine. The nurses response is based on the knowledge that the presence of casts in the urine indicates
a. Glomerular injury
b. Glomerular healing
c. Recent streptococcal infection
d. ANS: Excessive amounts of protein in the urine
A

Feedback
A The presence of red blood cell casts in the urine indicates glomerular injury.

B Casts in the urine are abnormal findings and are indicative of glomerular injury, not glomerular healing.
C A urinalysis positive for casts does not confirm a recent streptococcal infection.
D Casts in the urine are unrelated to proteinuria.
4. Which clinical finding warrants further intervention for the child with acute poststreptococcal glomerulonephritis?
a. Weight loss to within 1 lb of the preillness weight
b. Urine output of 1 mL/kg/hr
c. A positive antistreptolysin O (ASO) titer
d. ANS: Inspiratory crackles
D

Feedback
A This is an indication that the child is responding to treatment.
B This is an acceptable urine output and indicates that the child is responding to treatment.

C A positive ASO titer indicates the presence of antibodies to streptococcal bacteria; it is used to aid in diagnosis of acute poststreptococcal glomerulonephritis. This is an
expected finding if the child has this acute illness.

D
5. Whi Children with excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication.
ch diagnostic finding is present when a child has primary nephrotic syndrome?

a. Hyperalbuminemia
b. Positive ASO titer
c. Leukocytosis
d. Proteinuria

ANS: D
Feedback

A Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss.
B ASO titer is negative in a child with primary nephrotic syndrome.
C Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.
6. Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?

Feedback

A The absence of casts in the urine gives no indication about the childs response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days.

B The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days.

C Remission is achieved when the urine is negative for protein for 5 to 7 consecutive days. It is not unusual for glucose to test positive if the child is taking prednisone.

D The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.
7. Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?
a. I can give my child sweet pickles.
b. My child can put ketchup on his hotdog.
c. I can let my child have potato chips.
d. ANS: I do not put any salt in foods when I am cooking.
D

C Potato chips are a high-sodium food and should not be included in the childs diet when sodium intake is restricted.

D
8. Wha A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.
t is an appropriate intervention for a child with nephrotic syndrome who is edematous?

a. Teach the child to minimize body movements.
b. Change the childs position every 2 hours.
c. Avoid the use of skin lotions.
d. ANS: Bathe every other day.
B

Feedback

A The child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown.

B Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas.
C Applying lotion to the skin helps to increase circulation.
D Bathing daily removes irritating body secretions from the skin.
9. What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux?
a. The importance of taking prophylactic antibiotics
b. Suggestions for how to maintain fluid restrictions
c. The use of bubble baths as an incentive to increase bath time
d. The need for the child to hold urine for 6 to 8 hours
ANS: A
Feedback

A Prophylactic antibiotics are used to prevent urinary infection in a child with vesicoureteral reflux, although this treatment plan has become controversial.

B Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs.
C Bubble baths should be avoided to prevent urethral irritation and possible UTI.

D To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

10. Which intervention is appropriate when examining a male infant for cryptorchidism?
a. Cooling the examiners hands
b. Taking a rectal temperature
c. Eliciting the cremasteric reflex

d. Warming the room
ANS: D
Feedback

A Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infants testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination.
B A rectal temperature yields no information about cryptorchidism.

C Testes can retract into the inguinal canal if the infant is upset or cold or if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

D For the infants comfort, the infant should be examined in a warm room with the
examiners hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold.
11. Parents ask the nurse when should our childs hypospadias be corrected? The nurse responds based upon the knowledge that correction of hypospadias should be accomplished by the time the child is

Feedback
A Surgery to correct hypospadias is not performed when the infant is this young.

B The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training.

C It is preferable for hypospadias to be surgically corrected before the child enters school so that the child has normal toileting behaviors in the presence of his peers.
D Corrective surgery for hypospadias is done long before sexual maturity.
12. You are the nurse caring for a 4-year-old child who has developed acute renal failure as a result of hemolytic-uremic syndrome (HUS). Which bacterial infection was most likely the cause of HUS?
a. Pseudomonas aeruginosa
b. Escherichia coli
c. Streptococcus pneumoniae
d. Staphylococcus aureus
ANS: B
Feedback
A Pseudomonas aeruginosa is not associated with HUS.

B Children with HUS become infected by Escherichia coli, which is usually contracted from eating improperly cooked meat or contaminated dairy products.
C Streptococcus pneumoniae is not associated with HUS.
D Staphylococcus aureus is not associated with HUS.
13. Which dietary modification is appropriate for a child with chronic renal failure?
a. Decreased protein
b. Decreased fat
c. Increased potassium
d. ANS: Increased phosphorus
A

Feedback
A Protein intake is restricted because of the kidneys inability to remove waste products.
B A low-fat diet is not relevant to chronic renal failure.
C Potassium intake may be restricted because of the kidneys inability to remove it.
D Phosphorus is restricted to help prevent bone disease.

14. Which condition is characterized by a history of bloody diarrhea, fever, abdominal pain, and low hemoglobin and platelet counts?
a. Acute viral gastroenteritis
b. Acute glomerulonephritis
c. Hemolytic-uremic syndrome
d. Acute nephrotic syndrome
ANS: C
Feedback
A Anemia and thrombocytopenia are not associated with acute gastroenteritis.
B The symptoms described are not suggestive of acute glomerulonephritis.

C Hemolytic-uremic syndrome is an acute disorder characterized by anemia, thrombocytopenia, and acute renal failure. Most affected children have a history of gastrointestinal symptoms, including bloody diarrhea.
D The symptoms described are not suggestive of nephrotic syndrome.
15. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for which condition?
a. Hypocalciuria
b. Nephrotic syndrome
c. Glomerulonephritis
d. UTI

ANS: D
Feedback

A An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting.
B Nephrotic syndrome is not usually associated with complaints of dysuria or urgency.
C Glomerulonephritis is not a likely cause of dysuria or urgency.

D Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI.
16. A nurse is teaching a class on acute renal failure. The nurse relates that acute renal failure as a result of hemolytic-uremic syndrome (HUS) is classified as

Feedback

A Intrarenal acute renal failure is the result of damage to kidney tissue. Possible causes of intrarenal acute renal failure are HUS, glomerulonephritis, and pyelonephritis.

B Prerenal acute renal failure is the result of decreased perfusion to the kidney. Possible causes include dehydration, septic and hemorrhagic shock, and hypotension.

C Postrenal acute renal failure results from obstruction of urine outflow. Conditions causing postrenal failure include ureteropelvic obstruction, ureterovesical obstruction, or neurogenic bladder. Renal failure caused by HUS is of the acute nature.

D Chronic renal failure is an irreversible loss of kidney function, which occurs over months or years.
17. A true statement describing the differences in the pediatric genitourinary system compared with the adult genitourinary system is that
a. The young infants kidneys can more effectively concentrate urine than an adults kidneys.
b. After 6 years of age, kidney function is nearly like that of an adult.

c. Unlike adults, most children do not regain normal kidney function after acute renal failure.
d.
ANS: Young children have shorter urethras, which can predispose them to UTIs.
D

Feedback

A The young infants kidneys cannot concentrate urine as efficiently as those of older children and adults because the loops of Henle are not yet long enough to reach the inner medulla, where concentration and reabsorption occur.
B By 6 to 12 months of age, kidney function is nearly like that of an adult.

C Unlike adults, most children with acute renal failure regain normal function.
D
18. Wh Young children have shorter urethras, which can predispose them to UTIs. ich factor predisposes the urinary tract to infection?

Feedback
A This offers protective measures against UTIs.
B The short urethra in females provides a ready pathway for invasions of organisms.
C Prostatic secretions have antibacterial properties that inhibit bacteria.
D
19. Hy This offers protective measures against UTIs. pospadias refers to

Feedback
A The urethral opening is present, but not at the glans.
B Hypospadias refers to the urethral opening, not to the size of the penis.
C This is known as epispadias.

D
20. Th Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
e narrowing of preputial opening of foreskin is called

a. Chordee
b. Phimosis
c. Epispadias
d. ANS: Hypospadias
B

D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.
21. The nurse closely monitors the temperature of a child with nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication?

Feedback
A An exacerbation of the disease can occur after an infection.
B Temperature is not an indication of hypertension or edema.

C Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

D Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
22. A child is admitted with acute glomerulonephritis. The nurse expects the urinalysis during this acute phase to show
a. Bacteriuria and hematuria
b. Hematuria and proteinuria
c. Bacteriuria and increased specific gravity
d. ANS: Proteinuria and decreased specific gravity
B

Feedback

A Bacteriuria and changes in specific gravity are not usually present during the acute phase.
B Urinalysis during the acute phase characteristically shows hematuria and proteinuria.

C Bacteriuria and changes in specific gravity are not usually present during the acute phase.

D
23. Th Bacteriuria and changes in specific gravity are not usually present during the acute phase.
e most appropriate nursing diagnosis for the child with acute glomerulonephritis is

a. Risk for Injury related to malignant process and treatment
b. Deficient Fluid Volume related to excessive losses
c. Risk for Imbalanced Fluid Volume related to a decrease in plasma filtration
d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces
ANS: C

Feedback
A No malignant process is involved in acute glomerulonephritis.
B Excess fluid volume is found.

C Glomerulonephritis has a decreased filtration of plasma. The resulting decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema.
D The fluid accumulation is secondary to the decreased plasma filtration.
24. The most common cause of acute renal failure in children is
a. Pyelonephritis
b. Tubular destruction
c. Urinary tract obstruction
d. ANS: Severe dehydration
D
Feedback
A These are not common causes of acute renal failure in children.

B These are not common causes of acute renal failure in children.
C Obstructive uropathy may cause acute renal failure, but it is not the most common cause. The most common cause of acute renal failure in children is dehydration or other causes
D of poor perfusion that may respond to restoration of fluid volume.
25. The primary clinical manifestations of acute renal failure are
a. Oliguria and hypertension
b. Hematuria and pallor
c. Proteinuria and muscle cramps
d. ANS: Bacteriuria and facial edema
A

Feedback
A The principal feature of acute renal failure is oliguria.
B These are not principal features of acute renal failure.
C These are not principal features of acute renal failure.
D These are not principal features of acute renal failure.

26. A major complication in a child with chronic renal failure is
a. Hypokalemia
b. Metabolic alkalosis
c. Water and sodium retention
d. Excessive excretion of blood urea nitrogen

ANS: C
Feedback
A Hyperkalemia is a complication of chronic renal failure.
B Metabolic acidosis is a complication of chronic renal failure.

C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion.
D Retention of blood urea nitrogen is a complication of chronic renal failure.
27. The diet of a child with chronic renal failure is usually characterized as
a. High in protein
b. Low in vitamin D
c. Low in phosphorus
d. ANS: Supplemented with vitamins A, E, and K
C

Feedback
A Protein should be limited in chronic renal failure to decrease intake of phosphorus.

B Vitamin D therapy is administered in chronic renal failure to increase calcium absorption.

C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake.

D
28. Wh Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.
ich statement is descriptive of renal transplantation in children?

a. It is an acceptable means of treatment after age 10 years.
b. It is preferred means of renal replacement therapy in children.
c. Children can receive kidneys only from other children.

d. ANS: The decision for transplantation is difficult, since a relatively normal lifestyle is not possible.
B

Feedback
A It can be done in children as young as age 6 months.

B Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease.
C Both children and adults can serve as donors for renal transplant purposes.

D Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

MULTIPLE CHOICE
1. Large amounts of leukocytes in the seminal fluid suggest:
a. inadequate fructose.
b. inflammation of the testes.
c. an infection of the genital tract.
d. an obstruction in the vas deferens.
ANS: C
The presence of large amounts of leukocytes suggests an infection. Adequate fructose must be present to supply energy for the sperm. An inflammatory process would be diagnosed by abnormal consistency or chemical composition. If an obstruction is present, the total amount of the seminal fluid would be abnormal.
2. A couple who has not achieved a successful pregnancy is scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed?
a. Semen analysis
b. Testicular biopsy
c. Endometrial biopsy
d. Hysterosalpingography
ANS: A
Semen analysis is usually the first test to be performed because it is least costly and noninvasive. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. A testicular biopsy is an invasive examination using a local anesthetic. Hysterosalpingography uses a contrast medium to evaluate the structure and patency of the uterus and tubes.
3. Which situation best describes secondary infertility in a couple?
a. Never conceived
b. Had repeated spontaneous abortions
c. Not conceived after 1 year of unprotected intercourse
d. Has one child but cannot conceive a second time
ANS: D
Secondary infertility occurs in couples who have conceived before but are unable to conceive again. Primary infertility occurs when a couple has never conceived or who has not conceived after 1 year of unprotected intercourse. Repeated spontaneous abortions are considered primary infertility.
4. A woman undergoing evaluation of infertility states, At least when were through with all of these tests, we will know what is wrong. The nurses best response is:
a. I know the test will identify what is wrong.
b. Im sure that once you finish these tests, your problem will be resolved.

c. Even with diagnostic testing, infertility remains unexplained in about 20% of couples.
d. Once youve identified your problem, you may want to look at the option of adoption.
ANS: C
Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her view or opinion but should state the facts.
5. A newly married woman states, My friend told me I would never have a baby because I had pelvic inflammatory disease when I was younger. I dont understand how that can affect whether or not I get pregnant. The nurses best response is:
a. Your friend may be right. The disease may affect your ability to conceive.
b. Pelvic inflammatory disease may damage the ovaries and prevent ovulation.

c. Your friend has been misinformed. Fallopian tube damage occurs only following gonorrhea.

d. Infection may cause scarring and obstruction of the fallopian tubes, which can prevent the fertilized egg from reaching the uterus.
ANS: D
Providing the client with accurate complete information is the best response. Pelvic inflammatory disease produces scarring and obstruction of the fallopian tube if the infection is not treated. It does not occur following gonorrhea.
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6. The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the womans uterus is:
a. in vitro fertilization.
b. tubal embryo transfer.
c. therapeutic insemination.
d. gamete intrafallopian transfer.
ANS: A
In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partners sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer is when the sperm and ova are placed in the fallopian tube.

7. Chromosome analysis is a diagnostic test that should be offered to which couple?
a. Never conceived
b. Has long-standing infertility
c. Has had repeated pregnancy losses
d. Has a normal child but has not conceived again
ANS: C

Repeated failures to carry a pregnancy to term may indicate genetic defects in the fetus that are incompatible with life. A couple who has never conceived would not be offered chromosome analysis. Long-standing infertility is not an indicator for chromosome analysis. Secondary infertility with an existing normal child would not be an indicator for chromosome analysis.
8. A woman who is undergoing infertility testing states, My husband wont discuss this with me. I dont think he cares about or wants a baby. The nurses best response is:
a. You should confront him about this.
b. He probably doesnt understand your concern.
c. Men are sometimes less eager to have children.
d. It may be harder for him to express his feelings.
ANS: D
Men often internalize their feelings, which may appear to women as lack of concern or interest. Suggesting that the woman confront her husband suggests that the woman is at fault and not communicating with her husband. He probably doesnt understand your concern does not explain to the woman why her husband wont discuss the problem; it passes judgment on the husband.
Men are sometimes less eager to have children does not allow the woman to express her feelings; it offers the nurses opinion, which is not appropriate.
9. Which of the following medical conditions could possible affect a womans fertility status?

a. Past medical history of asthma during childhood that is presently under control with the use of an inhaler
b. Recently diagnosed with PCOS
c. Past surgical history of removal of external polyps on labial tissue

d. History of frequent sinus headaches that is seasonal in nature treated with over-the- counter medication
ANS: B
PCOS (polycystic ovarian syndrome) is associated with infertility issues related to syndrome presentationhormonal abnormalities, obesity, and dyslipidemia. The use of inhaler therapy for the treatment of asthma should not affect the clients fertility status. Removal of external polyps on the labia should not affect the clients fertility. A history of sinus headaches should not affect the clients fertility.
10. A client has been diagnosed with an incompetent cervix. What treatment option will be incorporated into the plan of care?
a. Bed rest throughout the pregnancy
b. Wait and see approach to determine if the client goes into preterm labor
c. Preparation for cerclage procedure at 32 weeks gestation
d. More frequent ultrasounds to assess progression of pregnancy
ANS: D
An incompetent cervix would place the client in a high-risk category, and more frequent ultrasound monitoring would be included. Although bed rest may be ordered, there is conflicting evidence about the merits of this intervention. However, it is unlikely that it would be ordered for the duration of the pregnancy. An incompetent cervix is a clinical abnormality, so the standard of

care requires appropriate surgical intervention. A cerclage procedure is typically done much earlier in the pregnancy period.
MSC: Client Needs: Physiologic Integrity/Physiologic Adaptations
MULTIPLE RESPONSE
11. Which factors would contribute to abnormalities of the fallopian tube associated with the development of infertility? (Select all that apply.)
a. History of conization of the cervix
b. History of pelvic surgical procedures
c. Incompetent cervix
d. Past treatments of STD with follow-up test of cure
e. Endometriosis
ANS: B, D, E
Surgical procedures related to the cervix, along with an incompetent cervix, would not affect the fallopian tubes in terms of infertility. It would affect fertility issues related to the cervix as a result of potential scarring (conization) and an inability to maintain the pregnancy in the presence of an incompetent cervix. A history of pelvic surgical procedures could result in the development of pelvic adhesions, which would affect the fallopian tube. Also, the presence of STDs, even with effective treatment, along with the clinical diagnosis, would affect the fallopian tube and possibly result in infertility.
12. Which adverse reactions are associated with the administration of clomiphene citrate (Clomid)?(Select all that apply.)
a. Abdominal bloating
b. Diarrhea
c. Oliguria
d. Nausea and vomiting
e. Abnormal uterine bleeding
ANS: A, D, E
Some adverse reactions associated with Clomid are abdominal distension, frequent urination, nausea and vomiting, and abnormal uterine bleeding. Diarrhea is not a common presentation.

1.A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which of the following? (Select all that apply.) ANS. A,C, E
A) Rectocele

B) Fecal incontinence C)Cystocele
D) Urinary incontinence

E) Enterocele
2. .After teaching a local womans group about incontinence, the nurse determines that the teaching was successful when the group identifies which of the following as characteristic of stress incontinence?

A) Feeling a strong need to void

B) Passing a large amount of urine

C) Most common in women after childbirth

D) Sneezing may be an initiating stimulus ANS. D
3. To assist the woman in regaining control of the urinary sphincter for urinary incontinence, the nurse should teach the client to do which of the following?

A) Perform Kegel exercises daily.

B) Void every hour while awake.

C) Limit her intake of fluid.

D) Take a laxative every night.
ANS.A The client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals.
Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.

4. Which of the following would the nurse include when teaching women about preventing pelvic support disorders?
A) Performing Kegel isometric exercises
B) Consuming low-fiber diets
C) Using hormone replacement
D) Voiding every 2 hours
ANS. A Kegel exercises are an effective preventive measure for pelvic support disorders and are generally accepted as first-line treatment for stress and urge urinary incontinence. They may limit the progression of a mild prolapse and alleviate mild prolapse symptoms. High-fiber rather than low-fiber diets are appropriate to reduce straining associated with constipation. Hormone replacement therapy must be highly individualized and is not an appropriate option for every woman. Normal voiding patterns typically are every 3 to 5 hours. Too frequent or too infrequent voiding can
lead to problems.
5. When teaching a woman how to perform Kegel exercises, the nurse explains that these exercises are designed to strengthen which muscles?

A) Gluteus

B) Lower abdominal

C) Pelvic floor

D) Diaphragmatic ANS. C.

6. When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which of the following would the nurse include?

A) Care of the indwelling catheter at home ANS. A

B) Emphasis on coughing to prevent complications

C) Return to usual activity level in a few days

D) Daily douching with dilute vinegar solution

7. Nursing measures that help prevent postpartum urinary tract infection include:

a. forcing fluids to at least 3000 mL/day.
b. promoting bed rest for 12 hours after birth.
c. encouraging the intake of orange, grapefruit, or apple juice.
d. discouraging voiding until the sensation of a full bladder is present.
ANS: A
Adequate fluid intake prevents urinary stasis, dilutes urine, and flushes out waste products. The client should be encouraged to ambulate early. Juices such as cranberry juice can discourage bacterial growth. With pain medications, trauma to the area, and anesthesia, the sensation of a full bladder may be decreased. The client needs to be encouraged to void frequently.

8. To prevent infection of the urinary tract, the nurse should instruct the client to:
a. include soft drinks in the total fluid intake.
b. drink grapefruit juice several times a day.
c. perform pericare at least twice during a shift.
d. increase fluid intake to 2500 to 3000 mL/day.
ANS: D
Drinking 2500 to 3000 mL of fluid each day will dilute the bacterial count and flush the infection from the bladder. Ingesting soft drinks and grapefruit juice increase urine alkalinity, which provides a medium for bacterial growth; pericare performed twice during a shift is not frequent enough to remove bacteria, and pericare should be done at each voiding or bowel movement.

9. Nursing measures that help prevent postpartum urinary tract infection include:
a. forcing fluids to at least 3000 mL/day.
b. promoting bed rest for 12 hours after birth.
c. encouraging the intake of orange, grapefruit, or apple juice.
d. discouraging voiding until the sensation of a full bladder is present.
ANS: A
Adequate fluid intake prevents urinary stasis, dilutes urine, and flushes out waste products. The client should be encouraged to ambulate early. Juices such as cranberry juice can discourage bacterial growth. With pain medications, trauma to the area, and anesthesia, the sensation of a full bladder may be decreased. The client needs to be encouraged to void frequently.

10. Which pelvic shape is most conducive to vaginal labor and birth?

a. Android
b. Gynecoid

c. Platypelloid
d. Anthropoid

ANS: B
The gynecoid pelvis is round and cylinder-shaped, with a wide pubic arch. The prognosis for a vaginal birth is good. Only 30% of women have an android-shaped pelvis, which has a poor prognosis for vaginal birth. The anthropoid pelvis is a long narrow oval, with a narrow pubic arch. It is more favorable than the android or platypelloid pelvic shape. The platypelloid pelvis is flat, wide, short, and oval and has a very poor prognosis for vaginal birth.
11.A labor client has been diagnosed with cephalopelvic disproportion (CPD) following attempts at pushing for 2 hours with no progress. Based on this information, what birth method is available?

a. Vaginal birth with vacuum extraction

b. Augmentation of labor with oxytocin (Pitocin) to improve contraction pattern and strengthen contractions
c. Cesarean section
d. Insertion of Foley catheter into empty bladder to provide more room for fetal descent

ANS: C
The presence of CPD is a contraindication for vaginal birth. To prevent further complications, the client should be prepped for a cesarean section.
12.A nurse is teaching a client how to perform Kegel exercises. Which of the following would the nurse include? (Select all that apply.)

A) Squeeze your rectal muscles as if you are trying to avoid passing flatus.

B) Tighten your pubococcygeal muscles for a count of 10.

C) Contract and relax your pubococcygeal muscles rapidly 10 times.

D) Try bearing down for about 10 seconds for no more than 5 times.

ANS.C

MULTIPLE CHOICE
1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process?
a. Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months.
b. Determine the clients weight gain and loss pattern for the previous year.
c. Examine skin pigmentation and hair texture for hormonal changes.
d. Explore the clients previous experiences with conception control.
ANS: 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. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method.
Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate?
a. Theyre not very effective, and it is very likely that youll get pregnant.
b. FAMs can be effective for many couples; however, 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
FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part.
3. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response?
a. Oral contraceptives are a highly effective method, but they have some side effects.
b. Your current medications will reduce the effectiveness of the pill.
c. Oral contraceptives will reduce the effectiveness of your seizure medication.
d. The pill is a good choice for a woman of your age and with your personal history.
ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill

is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what?
a. Avoid sexual contact for at least 10 days after starting the pill.
b. Use condoms and foam for the first few weeks as a backup.
c. Use another method of contraception for 1 week after starting the pill.
d. Begin sexual relations once vaginal bleeding has ended.
ANS: C
If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.
5. Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice?
a. The ideal candidate for DMPA wants menstrual regularity and predictability.
b. The client has a history of thrombotic problems or breast cancer.
c. The ideal candidate has difficulty remembering to take oral contraceptives daily.
d. The client is homeless or mobile and rarely receives health care.
ANS: C
Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.
6. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is
the most appropriate response by the nurse?
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 be safely used for repeated acts of intercourse without adding more spermicide later.
ANS: D
The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

7. Which statement regarding emergency contraception is correct?

a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse.
b. Emergency contraception may be taken right after ovulation.

c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%.
d. Emergency contraception is commonly associated with the side effect of menorrhagia.
ANS: A
Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.
8. 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). Which information is most important for the nurse to share?
a. The IUD does not interfere with sex.
b. The risk of pelvic inflammatory disease will be higher with the IUD.
c. The IUD will protect you from sexually transmitted infections.
d. Pregnancy rates are high with the IUD.
ANS: B
Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.
9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is
the mostcommon technique used for the termination of a pregnancy in the second trimester?
a. Dilation and evacuation (D&E)
b. Methotrexate administration
c. Prostaglandin administration
d. Vacuum aspiration
ANS: A
D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.
10. A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy?
a. Limit sexual contact for one cycle after starting the pill.

b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic.
c. Take one pill at the same time every day.

d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.
ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then 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. No strong pharmacokinetic evidence indicates a link between the use of broad- spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.
11. The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception?
a. LAM is effective until the infant is 9 months of age.

b. This popular method of birth control works best if the mother is exclusively breastfeeding.
c. Its typical failure rate is 5%.
d. Feeding intervals should be 6 hours during the day.
ANS: B
The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%.
Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.
12. Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would
be most helpful in achieving this goal?

a. You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset
of fever over 38.4 C, hypotension, and a rash.
b. You should remove your diaphragm right after intercourse to prevent TSS.

c. Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS.

d. Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get TSS.
ANS: A

The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.
13. Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse?
a. Family planning
b. Birth control
c. Contraception
d. Assisted reproductive therapy
ANS: A
Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive
therapy is one of several possible treatments for infertility.
14. In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document?
a. B stands for birth control.
b. R stands for reproduction.
c. A stands for alternatives.
d. I stands for ineffective.
ANS: C
In the acronym BRAIDED, A stands for alternatives and information about other viable methods. Bstands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a
particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.
15. Which benefit regarding FAMs makes it an appealing choice for some women?
a. Adherence to strict recordkeeping
b. Absence of chemicals and hormones
c. Decreased involvement and intimacy of partner
d. Increased spontaneity of coitus
ANS: B
The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.
16. The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method?
a. The natural family planning method is the same as coitus interruptus or pulling out.

b. This contraception method uses the calendar method to align the womans cycle with the natural phases of the moon.
c. This practice is the only contraceptive method acceptable to the Roman Catholic Church.
d. The natural family planning method relies on barrier methods during the fertility phases.
ANS: C
Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. 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.
17. Which nonpharmacologic contraceptive method has a failure rate of less than 25%?
a. Standard days variation
b. Periodic abstinence
c. Postovulation
d. Coitus interruptus
ANS: A
The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.
18. Which contraceptive method best protects against STIs and the HIV?
a. Periodic abstinence
b. Barrier methods
c. Hormonal methods
d. Same protection with all methods
ANS: B
Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV.
19. Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)?
a. COCs can cause TSS if the prescription is wrong.

b. Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs.
c. COCs increase the risk of endometrial and ovarian cancers.

d. Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.
ANS: D
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of

taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.
20. Importantly, the nurse must be aware of which information related to the use of IUDs?
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 STIs as the diaphragm.
d. Consent forms are not needed for IUD insertion.
ANS: B
The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.
21. Which statement is the most complete and accurate description of medical abortions?
a. Medical abortions are performed only for maternal health.
b. They can be achieved through surgical procedures or with drugs.
c. Medical abortions are mostly performed in the second trimester.
d. They can be either elective or therapeutic.
ANS: D
Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.
22. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. What is the nurses mostappropriate response?
a. This probably means that youre pregnant.
b. Dont worry; its probably nothing.
c. Have you been sick this month?
d. You probably didnt ovulate during this cycle.
ANS: D
The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely the cause of an increase in BBT.
23. A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate?
a. The lubricant prevents vaginal irritation.

b. Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions.
c. The additional lubrication improves sex.

d. Nonoxynol-9 improves penile sensitivity.
ANS: B
Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.
24. Which statement regarding the term contraceptive failure rate is the most accurate?

a. The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span.
b. It refers to the minimum rate that must be achieved to receive a government license.
c. The contraceptive failure rate increases over time as couples become more careless.
d. It varies from couple to couple, depending on the method and the users.
ANS: D
Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

25. Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception?
a. Obtain data about the frequency of coitus.

b. Determine the womans level of knowledge concerning contraception and her commitment to any particular method.
c. Assess the womans willingness to touch her genitals and cervical mucus.
d. Evaluate the womans contraceptive life plan.
ANS: B
Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive.
26. What is the importance of obtaining informed consent for a number of contraceptive methods?

a. Contraception is an invasive procedure that requires hospitalization.
b. The method may require a surgical procedure to insert a device.
c. The contraception method chosen may be unreliable.
d. The method chosen has potentially dangerous side effects.
ANS: D
Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.
27. If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate?
a. Spermicides
b. Female condoms
c. Male condoms
d. Diaphragms
ANS: C
For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%.
MULTIPLE RESPONSE
1. The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.)
a. It is highly unlikely that you will become pregnant after the procedure.

b. Tubal ligation is an effective form of 100% permanent sterilization. You wont be able to get pregnant.
c. Sterilization offers some form of protection against STIs.
d. Sterilization offers no protection against STIs.
e. Your menstrual cycle will greatly increase after your sterilization.
ANS: A, D
A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.
2. Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.)
a. Fever higher than 39 C
b. Chills
c. Foul-smelling vaginal discharge
d. Bleeding greater than four pads in 2 hours

e. Severe abdominal pain
ANS: B, C, E
The client should report to a health care facility for any of the following symptoms: fever higher than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.
3. The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.)
a. Gallbladder disease
b. Myocardial infarction and stroke
c. Hypotension
d. Breast tenderness and fluid retention
e. Dry skin and scalp
ANS: A, B, D
Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.
4. The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.)
a. Sterilization should be performed under general anesthesia.
b. Pain, bleeding, and infection are possible complications.
c. Pregnancy may still be possible.
d. Vasectomy may affect potency.
e. Secondary sex characteristics are unaffected.
ANS: B, C, E
Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.
COMPLETION
1. The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, then her fertile period would be day through day .
ANS: 6; 19To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).