It's a healthy way to read 20 questions a day..
ANTEPARTUM CARE
1. After the nurse instructs a 20-year old nulligravid client on how to perform a breast self-examination, which of the following client statements indicates that the teaching has been successful?
a. "I should perform breast self-examination on the day my menstrual flow begins."
b. "It's important that I perform self-breast examination on the same day each month."
c. 'If I notice that one of my breast is much smaller than the other one, I shouldn't worry."
d. "If there is some discharge from my nipples, I shhould avoid squeezing them."
2. Assessment of a 16-year old nulligravid client who visits the clinic and asks for i nformation on contraceptives reveals a mentrual cycle of 28 days. The nurse formulates a nursing diagnosis of Deficient Knowledge related to ovulation and fertility management. Which of the following would be important to include in the teaching plan for the client?
a. The ovum survives for 96 hours after the ovulation, making conception possible during this time.
b. The basal body temperature falls at least 0.2 F after ovulation has occurred.
c. Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual
cylce.
d. Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.
3. Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate?
a. Take a mild analgesic for the menstrual pain.
b. Avoid cold foods if menstrual pain persists.
c. Stop exercise while menstruating.
d. Avoid sexual intercourse during menstruation.
4. After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective?
a. "Under ideal conditions, sperm can reach the ovum in 15-30 minutes, resulting in pregnancy."
b. "I won't become pregnant if I abstain from intercourse during the last 14 days of my menstruation cycle."
c. "Sperm from a healthy male usually remain viable in the female reproductive tract for 96 hours."
d. "After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes."
5. A 20-year old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan?
a. This method has a 50% failure rate during the first year of use.
b. Couples must abstain from coitus for 5 days after the menses.
c. Cervical musus is carefully monitored for changes.
d. The male partner uses condoms for significant effectiveness.
6. Before advising a 24-year old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following?
a. Anemia
b. Hypertension
c. Dysmenorrhea
d. Acne vulgaris
7. After instructing a 20-year old nulligravid client about side effects of oral contraceptives, the nurse determines that she needs further instruction when the client states which of tthe following as a side effect/
a. Weight gain
b. Nausea
c. Headache
d. Ovarian cancer
8. While discussing reproductive health with a group of female adolescents, one of the adolescents asks the nurse, "Where is the ovum fertilized?" The nurse responds by stating that fertilization normally occurs at which of the following sites?
a. Uterus
b. Vagina
c. Fallopian tube
d. Cervix
9. A 22-year old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions would the nurse include about the use of condoms as a method for family planning?
a. Using a spermicide with the condom offers added protection against pregnancy.
b. Natural skin condoms protect against sexually transmitted diseases.
c. The typical failure rate for souples using condoms is about 25%.
d. Condom users frequently report penile gland sensitivity.
10. Which of the following would the nurse include in the teaching plan for a 32-year old female client requesting information about using a diaphragm for family planning?
a. Douching with an acidic solution after intercourse os recommended.
b. Diaphragms should not be used if the client develops acute cervicitis.
c. The diaphragm should be washed in a weak solution of bleach and water.
d. The diaphragm should be left in place for 2 hours after intercourse.
11. After being examines and fitted for a diaphragm, a 24-year old client receives instructions about its use. Which of the following client statements indicates a need for further teaching?
a. "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case."
b. "If I get pregnant, I will have to be refitted for another diaphragm after the delivery."
c. "Before inserting the diaphragm I should coat the rim with contraceptive jelly."
d. "if I gain or lose 20 pounds,, I can still use the same diaphragm."
12. A 22-year old client tells the nurse that she and her husband are trying to concieve a baby. When teaching the client about reducing the incidence of neural tube defects in newborns, the nurse would emphasize the need for intake of which of the following nutrients?
a. Iron
b. Folic acid
c. Calcium
d. Magnesium
13. When desciribing a vasectomy to a couple inquiring about this procedure, the nurse would explain that which of the following is clamped or excised?
a. Ejaculatory duct
b. Seminiferous tubules
c. Seminal vesicles
d. Vas deferens
14. A 39-year old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching?
a. "My fallopian tube will be tied off through a small abdominal incision."
b. "Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%."
c. "After this procedure, I must abstain from inertcourse for at least 3 weeks."
d. "Both of my ovaries will be removed during the tubal ligation procedure."
15. When discussing sexual arousal and orgasm with a 25-year old nulliparous client, which of the follwing would the nurse include as the primary anatomic female structure involved?
a. Vaginal wall
b. Clitoris
c. MOns Pubis
d. Vulvovaginal glands
16. A 20-year old woman desiring to use a cervical cap for family planning is instructed on its use. Which of the following client statements would indicate to the nurse that the client needs further instruction?
a. "Cervical caps can be left in place longer than a diaphragm."
b. "Using a cervical cap may increase the risk of irritation."
c. "Cervical caps usually fit better than a diaphragm."
d. "Many women are unable to use cervical caps."
17. A 23-year old nullipara visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to which of the following?
a. Check the cervical mucus to see if it is thick and sparse.
b. Take her temperature the same time every morning.
c. Document ovulation when the temperature decreases at least 1 F.
d. Avoid coitus for ten days after a slight rise in temperature.
18. A couple visiting the infertility clinic for the first time ask the nurse, "What causes infertility in a woman?" Which of the following would the nurse include in the response as one of the most common factors?
a. Absence of an ovary
b. Overproduction of prolactin
c. Anovulation
d. Immunologic factors
19. A couple visiting the infertility clinic for the first time state that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines than an appropriate goal of the couple would be to accomplish which of the following by the end of the visit?
a. Choose an appropriate infertility treatment method.
b. Acknowledge that only 50% of infertile couples achieve pregnancy.
c. Discuss alternative methods of having a family, such as adoption.
d. Describe each of the potential causes and possible treatment modalities.
20. A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following clent statements about IVF indicates that the client understands the procedure?
a. "IVF requires supplemental estrogen to enhance the implantation process."
b. "The pregnancy rate with IVF is higher than with gamete intrafallopian transfer (GIFT)."
c. "IVF involves bypassing the blocked or absent fallopian tubes."
d. "Both ova and sperm are instilled into the open end of a fallopian tube."
CORRECT ANSWERS AND RATIONALE
1. D. The nurse determines that the client has understood the instructions when the client says that she should not squeeze her nipples if there is a discharge present. If the client notices a discharge or bleeding, she should notify her physician or health care provider, because this may be symptomatic of underlying disease. Ideally, breast self-examination should be perfomraed about 1 week after the onset of menses because hormonal influences on breast tissue are at low ebb at this time. The client should perform breast self-examination on the same day each month only if she has stopped menstruating (eg, menopause). The client's breast should mirror each other. If one breast is significantly larger than the other, or if there is "pitting" disease, a tumor may be present.
2. C. For a client with a menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstural cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occure during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which conception is possible. The basal body temperature rises 0.5 to 1.0 degrees F when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelsmcherz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.
3. A. The nurse should instruct the client to take a mild analgesic such as ibuprofen, if menstrual pain or "cramps" are present. The client should also eat foods rich in iron and should continue to moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dymenorrhea. Sexual intercourse is not prohibited during menstruation, but the male partner should wear condom to prevent exposure to blood.
4. A. Under ideal conditions, sperm can reach the ovum in 15 to 30 minuts. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait to take steps to prevent conception until after the intercourse. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 though 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility taht fertilization can occur. Before fertilization, the ovum and sperm each contains 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality.
5. C. The symptothermal method is a natural method of fertility management that depends on knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 to 2 days in either direction, the sympothermal method requires daily basal body temperature assessment plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approximately 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1 through 10). Typically, the failure rate for this method is between 10% and 20%. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning.
6. B. Before advising a client about oral contraceptives, the nurse needs to assess for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity or family history of cerebral or cardiovascular accident are poor candidate for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing tthe severity of dysmenorrhea. Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives often improves facial acne.
7. D. The nurse determines that tthe client needs further instruction when the client says that one of the side effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancer are reduced in women using oral contraceptives. Other side effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious side effect is thrombophlebitis.
8. C. fertilization normallu occurs in the outer third of the fallopian tube. Although there have been reports of fertilization outside the fallopian tube, this is not a normal occurrence.
9. A. The typical failure rate of a condom is appoximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by the viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as rash) to latex, necessitating the use of another method of family planning or switch to a natural skin condom.
10. B. The teaching plan shhould include a caution that diaphragms should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.
11. D. A client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 pounds. Gaining or losing more than 15 pounds can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against preganancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and dellivery of a newborn because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness spermicidal jelly or cream before inserting the diaphragm.
12. B. Folic acid can reduce the incidence of neural tube defects in newborns. Adequate intake of folic acid is especially important just before conception. Folic acid supplements may be prescribed, especially after conception occurs. Foods that are rich in folic acod include fruits and green leafy vegetables. Iron, calcium, and magnesium are not associated with reducing the risk for neural tube defects. Iron is necessary to maintain iron stores during pregnancy and postpartum. Calcium is important for bone density of the mother and bone formation in the developing fetus. Magnesium aids in the synthesis of proteins and fats in the mother. It also is important in promoting cell growth in the fetus. Magnesium can be found in dark green leafy vegetables.
13. D. In vasectomy, a common procedure for male sterilization, the vas deferens is cut and tied. Coagulation may also be used to create an obstruction in the vas deferens and block the passage of sperm.
14. A. Tubal ligation, a female sterilization procedure, involves ligation or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure. The ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.
15. B. Although the vaginal wall and cervix may be sensitive structures, the primary anatomic female structure involved in sexual arousal is the clitoris. Composed of erectile tissue with a plentiful arterial blood supply, the clitoris is especially sensitive to foreplay, temperature, and movements of the shaft of the penis against its surface. The mons pubis - the round, fleshy prominence over the symphysis pubis - forms the anterior border of the external reproductive organs. Covered with varying amounts of pubic hair, the mons pubis is not asssociated with sexual arousal. The vulvovaginal glands include the Skene and Bartholin glands with ducts that lie within the vestibule. These glands provide lubrication for the urethra and vaginal introitus. They are not the primary anatomic organ associated with sexual arousal because they do not contain the highly sensitive erectile tissues of the clitoris.
16. C. The client needs further instruction when she says that cervical caps fit better than the diaphragm. Many women are unable to use cervical caps because their cervix is too short for the cap to fit the cervix properly. A cervical cap may remain in place for up to 48 hours after intercourse, whereas it is recommended that a diaphragm be left in place for only 24 hours. The cervical cap is associated with cervical irritation.
17. B. The basal body temperature method requires that the client take her temperature each morning before arising, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5 degrees F. At the time of ovulation, the temperature rises 0.4 degrees to 0.8 degrees F because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the menstrual cycle. The client should keep a diary of about 6 months of menstrual cycles to calculate "safe" days. There is no mucus for the first 3 or 4 days after the menses, and then thick, sticky mucus begins to appear. As estrogen increases, the mucus changes to clear, slippery, ans stretchy. This condition is termed Spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid pregnancy.
18. C. The most common factor in female infertility is ovarian dysfunction, particularly anovulation. Other common factors include blocked fallopian tubes and cervical factors such as an infection and inflammation. The causes of infertility can be determined in about 80% to 90% of couples investigated, but in about 10% to 20% of tthe cases no cause can be found. Less frequent causes include endometriosis, vaginitis, polycystic ovaries, overproduction of prolaction, immunologic factors, inadequate secretion of progesterone, and stenosis of the cervical os (possibly preventing sperm transport). Immunologic factors do play a role in female infertility; however, they are less common than anovulation. Overproduction of prolactin is also less frequent cause if infertility in women. Absence of an ovary is an extremely rare cause of infertility.
19. D. By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple need time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couple may be in a hurry for defenitive therapy, a thorough assessment for both partners is necessary before a treatment plan is initiated. The success rate for acheiving pregnancy depends on both the cause and effectiveness of the treatment and in some cases it may be only as high as 30%. The couple may desire information about alternatives treatment, but insuffecient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a pregnancy, the couple should have time to consider these options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.
20. C. The client's understanding of the procedure is demonstrated by the satement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The physician removes the ova by laparoscope - or ultrasound-guided transvaginal retrieval and mixes them with prepared sperm from the woman's partner or a donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen, is given to enhance the impantation process. Both GIFT and tubal embryo transfer have higher pregnancy rate than IVF. However, these procedures cannot be used for clients who have blocked or absent fallopian tubes because the fertilized ova are placed into tthe fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF, fertilization of the ova bythe sperm occurs outside the client's body. In GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman's body.
