A nurse is providing discharge teaching to a client following tubal ligation
(occlusion). Which of the following statement by the client indicates
... [Show More] an
understanding of the teaching?
A. "premenstrual tension will no longer be present."
B. "Ovulation will remain the same."
C. "Hormone replacements will be needed following this procedure."
D. "My monthly menstrual period will be shorter."
- B. "Ovulation will remain the same."
Ovulation (egg release from the ovaries) will remain the same. Tubal ligation also
known as having your tubes tied or tubal sterilization is a type of permanent birth
control. During tubal ligation, the fallopian tubes are cut, tied or blocked to
permanently prevent pregnancy. Tubal ligation prevents an egg from traveling
from the ovaries through the fallopian tubes and blocks sperm from traveling up
the fallopian tubes to the egg. The procedure doesn't affect your menstrual cycle it
just prevents fertilization.
A nurse is assessing a newborn following forceps-assisted birth. Which of the
following clinical manifestations should the nurse identify as a complication of the
birth method?
A. Hypoglycemia
B. Polycythemia
C. Facial Palsy
D. Bronchopulmonary dysplasia
- C. Facial Palsy
Difficult delivery, with or without the use of an instrument called forceps, may
lead to facial palsy. Facial paralysis 15 minutes after forceps birth or absence of
movement on affected side is especially noticeable when infant cries.
A nurse is providing teaching about terbutaline to a client who is experiencing
preterm labor. Which of the following statements by the client indicates
understanding of the
teaching?A. "This medication could cause me to experience heart palpitations."
B. "This medication could cause me to experience blurred vision."
C. "This medication could cause me to experience ringing in my ears."
D. "This medication could cause me to experience frequent urination."
- A. "This medication could cause me to experience heart palpitations."
Beta-adrenergic agents such as terbutaline (Brethine) are associated with various
side effects, including tachycardia, irregular pulse, myocardial ischemia, and
pulmonary edema. Therefore, these medications should not be used in women with
known or suspected heart disease
A nurse is caring for a client who is in labor and requests nonpharmacological pain
management. Which of the following nursing actions promotes client comfort?
A. Assisting the client into squatting position
B. Having the client lie in a supine position
C. Applying fundal pressure during contractions
D. Encouraging the client to void every 6 hrs.
- C. Applying fundal pressure during contractions
Applying fundal pressure by pushing on the mother's abdomen in the direction of
the birth canal is often used to assist spontaneous vaginal birth, shorten the length
of the second stage and reduce the need for instrumental birth (forceps- or vacuumassisted) or caesarean section.
A nurse caring for a client who is at 20 weeks of gestation and has trichomoniasis.
Which of the following findings should the nurse expect?
A. Thick, White Vaginal Discharge
B. Urinary Frequency
C. Vulva Lesions
D. Malodorous Discharge
- D. Malodorous Discharge
Although trichomoniasis may be asymptomatic, women commonly experience
characteristically yellowish-to-greenish, frothy, mucopurulent, copious,
malodorous discharge. Inflammation of the vulva, vagina, or both may be present;
and the woman may complain of irritation and pruritus. Dysuria and dyspareunia
are often present.A nurse is caring for a client who is at 14 weeks of gestation. At which of the
following locations should the nurse place the doppler device when assessing the
fetal heart rate?
A. Midline 2 to 3 cm (0.8 to 1.2 in) above the symphysis pubis
B. Left Upper Abdomen
C. Two fingerbreadths above the umbilicus
D. Lateral at the Xiphoid Process
- A. Midline 2 to 3 cm (0.8 to 1.2 in) above the symphysis pubis
Toward the end of the first trimester, before the uterus is an abdominal organ, the
fetal heart tones (FHTs) can be heard with an ultrasound fetoscope or an ultrasound
stethoscope (Fig. 8-8). To hear the FHTs, place the instrument in the midline just
above the symphysis pubis and apply firm pressure. The woman and her family
should be offered the opportunity to listen to the FHTs. The health status of the
fetus is assessed at each visit for the remainder of the pregnancy.
A nurse is assessing a client who is at 27 weeks of gestation and has preeclampsia.
Which of the following findings should the nurse report to the provider?
A. Urine protein concentration 200 mg/24 hr.
B. Creatinine 0.8 mg/ dL
C. Hemoglobin 14.8 g/ dL
D. Platelet Count 60,000/ mm3
- D. Platelet Count 60,000/ mm3
Platelets < 100,000/mm3 (60,000/mm3) is below the expected reference range,
which can indicate DIC. The nurse should report this result to the provider. In a 24-
hour specimen proteinuria is defined as a concentration at or > 300 mg/24 hours.
A nurse is teaching about clomiphene citrate to a client who is experiencing
infertility. Which of the following adverse effect should the nurse include?
A. Tinnitus
B. Urinary Frequency
C. Breast Tenderness
D. Chills
- C. Breast TendernessThe adverse effects of clomiphene citrate are stomach upset, bloating,
abdominal/pelvic fullness, flushing ("hot flashes"), breast tenderness, headache, or
dizziness may occur. If any of these effects last or get worse, tell your doctor or
pharmacist promptly.
A nurse is assessing a newborn upon admission to the nursery. Which of the
following should the nurse expect?
A. Bulging Fontanels
B. Nasal Flaring
C. Length from head to heel of 40 cm (15.7 in)
D. Chest circumference 2 cm (0.8 in) smaller than the head circumference
- D. Chest circumference 2 cm (0.8 in) smaller than the head circumference
Measure at nipple line 2-3 cm (0.8-1.2 in) less than head circumference; average
30-33 cm (11.8-13 in) ≤ 30 cm.
A nurse is planning care for a newborn who has neonatal abstinence syndrome.
Which of the following interventions should the nurse include in the plan of care?
A. Increase the newborn's visual stimulation
B. Weigh the newborn every other day
C. Discourage parental interaction until after a social evaluation
D. Swaddle the newborn in a flexed position
- D. Swaddle the newborn in a flexed position
Swaddling in a flexed position with hands midline against chest and legs loosely
swaddled in lumbar flexion to decrease sensory stimulation. Minimize
environmental and physical stimulation low lighting and noise level do not use TV
or mobiles. Avoidance of abrupt changes in infant's environment handle gently and
close to the body to increase sense of security. [Show Less]