- The reproductive health nurse counsels a 17-year-old woman who is interested in initiating contraception. Which of the following would be a short-term positive outcome of the visit?
| A. | Able to describe how to obtain and use the contraceptive chosen |
| B. | Continued use and pregnancy prevention for 6 months |
| C. | Lack of side effects and complaints about the method after 3 months |
| D. | Voiced satisfaction with this method over 6 months |
ANS: A
Short-term outcomes include the patient’s ability to voice an understanding about the selected contraceptive method, voice an understanding of all information necessary to provide informed consent, and voice a comfort level with the use of the contraceptive method selected. Intermediate and long-term goals include the patient’s correct and consistent use of the selected contraceptive method, denial of adverse side effects, continued satisfaction with the selected contraceptive method, and consistent use of the contraceptive method and avoidance of pregnancy for the following year.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The clinic nurse is counseling a woman who had a Nexplanon rod implanted. The nurse reminds her that she will need an appointment to replace this birth control method in what time frame?
| A. | 12 months |
| B. | 24 months |
| C. | 36 months |
| D. | 48 months |
ANS: C
Nexplanon is a subdermal contraceptive that must be removed and replaced every 3 years if continued contraception is desired. The single-rod implant, which is inserted on the inner side of the woman’s upper arm, contains etonogestrel, which is a progestin.
Objective: 6-3
Reference:
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nurse recommends an oral contraceptive formulated with which ingredients?
| A. | Biphasic formulation |
| B. | Estrogen-progestin |
| C. | Progestin only |
| D. | Triphasic formulation |
ANS: C
Low-dose progestin-only contraceptive pills are often referred to as the “mini-pill” because they contain no estrogen. The mini-pill may be used during breastfeeding because it does not interfere with milk production.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is interested in the transdermal contraceptive patch. She is 5’5” tall and weighs 200 lb (90.9 kg). What information should the nurse provide this patient as a priority?
| A. | It may cause skin irritation. |
| B. | She can’t use the patch at her weight. |
| C. | The patch is about 95% effective. |
| D. | Withdrawal bleeding occurs monthly. |
ANS: B
All answers are correct; however, because this woman is obese, the nurse needs to tell her that women weighing over 198 lb should not use the patch. This is because of concerns that excessive adipose tissue may be associated with inconsistent levels of hormonal absorption.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse works with many women who self-identify as lesbian or bisexual. What action by the nurse would best address this population’s needs?
| A. | Aggressive screening for sexually transmitted infections |
| B. | Assisting with procedures related to conception |
| C. | Providing information on increased cancer risks |
| D. | Using questions that do not assume sexual orientation |
ANS: D
Lesbians and bisexuals are more likely to report poor physical or mental health compared with heterosexual women. Although the origins of this are not totally clear, one factor may relate to the homosexual/bisexual woman’s hesitancy in seeking health care. Nurses can greatly assist with this by being nonjudgmental and by using language and questions that do not assume sexual orientation. Sexually transmitted infections do occur in this population, although woman-to-woman transmission is lower than man-to-woman transmission. Some lesbian women do seek to become pregnant and bear children; they should be apprised of all available options. Lesbian women have increased risks for breast, endometrial, and ovarian cancer. Although all options are feasible, the option that has the potential to have the greatest impact is the one related to neutral language, which can be perceived as welcoming and accepting.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- The nurse working in a family practice clinic assesses women for sexual dysfunction. Which woman would the nurse assess as having a sexual dysfunction?
| A. | Complains about lack of arousal but still has intercourse |
| B. | Enjoys a platonic relationship with her “gentleman friend” |
| C. | Needs increased foreplay in order to reach an orgasm |
| D. | No desire for intimacy and is comfortable with the situation |
ANS: A
Sexual dysfunction is defined as any sexual situation that causes personal distress for the woman herself. If the woman is comfortable with the situation, there is no dysfunction. Dysfunction can occur in the physical, emotional, or relationship aspect of sexuality. The woman who complains of lack of arousal has a dysfunction even though she still is sexually active. The other women do not manifest complaints or personal distress about their situations.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A nurse is working with a patient who has the nursing diagnosis of altered sexuality patterns. What action by the nurse takes priority?
| A. | Assists with the physical exam |
| B. | Establishes a trusting relationship |
| C. | Reviews the past medical history |
| D. | Takes a comprehensive sexual history |
ANS: B
All options are important nursing actions, but without a trusting relationship, women (and men!) may be hesitant to share information.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Easy
PTS: 1
- A nurse is assessing a patient who complains of an inability to achieve orgasm. The patient was recently started on several new medications. Which one would the nurse evaluate as possibly contributing to this problem?
| A. | Atenolol (Tenormen) |
| B. | Clonidine (Catapres) |
| C. | Levothyroxine (Synthroid) |
| D. | Sertraline (Zoloft) |
ANS: D
Selective serotonin reuptake inhibitors such as sertraline can cause anorgasmia. Beta blockers (atenolol) can cause decreased libido. Clonidine can lead to decreased libido. Thyroid replacement hormones can cause menstrual irregularities with excessive doses.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- The nurse is assessing a sexually active heterosexual woman who does not use birth control. The nurse explains that the chance of becoming pregnant with each act of unprotected intercourse is what percentage?
| A. | 5–10% |
| B. | 10–15% |
| C. | 15–20% |
| D. | 20–25% |
ANS: C
The probability of becoming pregnant with each act of unprotected intercourse is approximately 15–20%.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse is working with a young woman planning to become sexually active. She has the nursing diagnosis of knowledge deficit related to contraceptive choices. Which action by the patient would indicate that a priority goal has been met?
| A. | Can describe how to use method chosen and its side effects |
| B. | Is able to choose the “best fit” from contraceptive choices |
| C. | Obtains the contraceptive method previously desired |
| D. | Willing and able to explain contraceptive method to partner |
ANS: B
A woman often seeks contraception with a predetermined method in mind, which may or may not be the best “fit” for her lifestyle. Nurses should be able to explain the entire range of choices and help the woman find the method that will work best for her. Once the method is chosen, it is important to know how to use it properly and what the potential side effects are; however, this is not directly correlated to a knowledge deficit related to choices. The woman should be willing and able to explain the method to her partner once one is chosen.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult
PTS: 1
- A teenage girl wishes to obtain birth control and is interested in a diaphragm. What advice does the nurse provide?
| A. | Good choice because it is cheap |
| B. | Good choice because it is easy to use |
| C. | Poor choice because it is not effective |
| D. | Poor choice because it requires planning |
ANS: D
Because the diaphragm requires planning ahead, it may not be the best choice for adolescents because of their frequent “forgetfulness” and because it interferes with spontaneity and requires correct use with every act of intercourse. All barrier methods are fairly inexpensive. A diaphragm is easy to use for many women, after they learn to use it correctly. The effectiveness of a properly used diaphragm is about 84%, making it not the best choice for someone who would consider an unplanned pregnancy a disaster. This also makes it less appealing for teens.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman who was recently fitted for a diaphragm is in the clinic for a follow-up visit. Which statement by the patient indicates that teaching was effective?
| A. | “An added benefit is that it contains my menstrual flow.” |
| B. | “Baby oil is a cheap and effective lubricant for the diaphragm.” |
| C. | “I leave the diaphragm in place for 6 hours after intercourse.” |
| D. | “This diaphragm will have to be replaced within 3 years.” |
ANS: C
The diaphragm should be left in place for 6 hours after intercourse. If intercourse occurs again before 6 hours have passed, the diaphragm must be left in place for 6 hours after the last act of intercourse. Diaphragms should not be used during a woman’s menstrual period. Oil-based lubricants such as baby oil can deteriorate the latex. The diaphragm should be replaced every 2 years.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
- A nurse is working with a young couple whose contraceptive choice is latex condoms. What statement by either partner indicates the need for more teaching?
| A. | Man: “I don’t carry these in my wallet in my pants pockets.” |
| B. | Man: “I make sure I am using the correct size of condom.” |
| C. | Woman: “I ask him to check the expiration dates each time.” |
| D. | Woman: “I buy nonoxynol-9 spermicide to use with condoms.” |
ANS: D
Nonoxynol-9 (N-9) spermicide is no longer recommended for use with condoms because of higher costs, shorter shelf life, and lack of additive benefit when compared to other spermicides. Also, N-9 can cause genital lesions and increases the woman’s risk of acquiring HIV and other sexually transmitted infections, especially when the condoms are used often. The other statements are correct. Condoms should be stored in a cool place, which makes placing them in wallets or pants pockets an incorrect action. Men should be sure to use the correct size. Condoms should be discarded if they are past their expiration date.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
- Which of the following women would the nurse advise to use a back-up contraceptive in addition to their birth control pills?
| A. | Being treated for tuberculosis |
| B. | Is a diabetic taking insulin |
| C. | On antibiotics for bronchitis |
| D. | Takes inhalers for asthma |
ANS: A
The effectiveness of oral contraceptive pills (birth control pills [BCPs]) can be decreased by several medications, including rifampin (Rifadin), isoniazid (Tubizid), barbiturates, and griseofulvin (Fulvicin-U/F). Other drugs that can decrease BCP effectiveness include acetaminophen (Tylenol), anticoagulants, and some anticonvulsants. The patient being treated for tuberculosis would most likely be taking either (or both) rifampin and isoniazid. The other patients would not have a decreased effectiveness of their BCPs due to medications, unless the diabetic patient had the disease for more than 20 years or has vascular complications.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- A woman is being started on oral contraceptive pills. Which screening assessments should the nurse perform or assist with?
| A. | Blood pressure |
| B. | Breast exam |
| C. | Pelvic exam |
| D. | Weight |
ANS: A
The only routine screening needed before initiating oral contraceptive pills is blood pressure, unless the woman has other symptoms that need investigation.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
- A patient has been taught about the vaginal contraceptive ring. Which statement by the patient indicates that further teaching is needed?
| A. | “If it comes out at all, I need back-up contraception for a week.” |
| B. | “The exact position of the ring is not vital for its function.” |
| C. | “Using tampons is allowed with the vaginal contraceptive ring.” |
| D. | “Vaginal contraceptive rings are about 96% effective.” |
ANS: A
If the vaginal ring comes out, it can be washed with lukewarm water and reinserted. If it is out of the vagina for more than 3 hours, the woman will need a back-up method of contraception for the next 7 days. Her incorrect statement indicates she needs more teaching. The other statements about the vaginal contraceptive ring are correct.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
- The nurse is teaching a group of women about hormonal emergency contraception. Which of the following is not a benefit of this type of contraception?
| A. | Available in some forms over the counter |
| B. | Can be taken up to 120 hours after intercourse |
| C. | Over-the-counter version has only two pills |
| D. | Typically has no side effects |
ANS: D
Emergency contraception pills have side effects that include nausea and vomiting, abdominal pain, breast tenderness, headache, and fatigue. The other statements about the “morning-after pill” are correct and are benefits of emergency contraception.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse in an emergency pregnancy clinic is evaluating women for the IUD method of emergency contraception. Which woman would not be considered a good candidate for this method of emergency contraception?
| A. | Does not wish to have an abortion |
| B. | Had sexual intercourse 4 days ago |
| C. | Took over-the-counter “morning-after pill” today |
| D. | Was raped by a stranger |
ANS: D
Women who are at high risk of sexually transmitted infections or pelvic infections should not use this form of emergency contraception. This includes women who have been raped. The other women would be appropriate candidates for emergency IUD contraception.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A student nurse is giving a patient an intramuscular Depo-Provera injection. Which action by the student would cause the instructor to intervene?
| A. | Assesses that the patient’s last period started 5–7 days ago |
| B. | Injects the medication deeply into the gluteus maximus |
| C. | Instructs the woman to return in 3 months for another shot |
| D. | Massages the site when the patient complains of pain |
ANS: D
The injection site should not be massaged, as this action can decrease the effectiveness of the medication. The other actions are correct.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- A patient has been taught about her Depo-Provera contraceptive injection. Which statement by the patient indicates that education has not been effective?
| A. | “Daily weight-bearing exercise will be important.” |
| B. | “I can become pregnant right after stopping the shots.” |
| C. | “I should add a calcium supplement to my diet.” |
| D. | “Hopefully I won’t have any periods while on this medication.” |
ANS: B
On average, ovulation begins within 10 months of discontinuing this medication, so women who are planning a pregnancy within the next year should probably use a different method of contraception. The other statements are correct. Due to possible decrease in bone density, weight-bearing exercise and calcium supplementation are important. Exercise will offset the possible weight gain also associated with this medication. Depo-Provera usually causes light or absent menstrual periods.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
- An adolescent is in the family practice clinic to obtain birth control. She began menstruating 4 days ago and wants the Depo-Provera injection because of the convenience associated with the method. What action by the nurse is best?
| A. | Administer the injection as prescribed. |
| B. | Assist the teen in choosing another method. |
| C. | Document that education was completed. |
| D. | Obtain a urine sample for a pregnancy test. |
ANS: A
There is recent evidence that Depo-Provera causes bone density loss. The teenager should be educated about the range of appropriate birth control options and side effects and assisted to make a choice that is appropriate for her. The bone density loss often is reversed once the patient has stopped the medication. If the benefits (i.e., convenience; teen will not be consistent with other methods) outweigh the risks, the nurse should administer the injection as requested. If the benefits do not outweigh the risks, then the nurse can assist the teen to make another choice. Documentation should always be complete, and because this patient is within 5 to 7 days of menstruation, a pregnancy test is not required.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity :Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- Prior to a sterilization procedure, which action by the nurse takes priority?
| A. | Obtaining informed consent from the partner |
| B. | Obtaining pre-approval for Medicaid patients |
| C. | Obtaining pre-approval from the insurer |
| D. | Obtaining the woman’s informed consent |
ANS: D
Because this is an invasive, permanent procedure, the nurse must obtain fully informed consent from the woman. Partner consent is not legally required. Pre-approval may or may not be required, but the priority is the patient’s informed consent.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Easy
PTS: 1
- A woman who is 10 weeks pregnant is being counseled by the nurse regarding her upcoming elective abortion. What information should the nurse provide?
| A. | “A local anesthetic will be injected into your vagina.” |
| B. | “The exact name of the procedure is dilation and extraction.” |
| C. | “They may use a seaweed product to dilate your cervix.” |
| D. | “You won’t need to have any cervical dilation at all.” |
ANS: C
Vacuum aspiration is the most common method for surgical abortion for pregnancies up to 12 weeks’ gestation. After 7 weeks, cervical dilation is often accomplished with laminaria, a dried seaweed product. For a pregnancy that is 5–7 weeks’ gestation, no dilation is needed. A local anesthetic is injected into the cervix in women who are between 8 and 12 weeks’ gestation because of the need for mechanical dilation. A dilation and extraction is the term for abortions performed during the second trimester.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman had an elective surgical abortion 7 weeks ago and calls the clinic to ask when her menstrual periods should return. What response by the nurse is most appropriate?
| A. | “I will ask the physician to prescribe misoprostol (Cytotec).” |
| B. | “It usually takes 1 to 3 months for your menstrual periods to return.” |
| C. | “Please come in to the clinic today for a checkup.” |
| D. | “You should be seen in the emergency department.” |
ANS: C
Short-term complications from surgical abortions include fever, abdominal pain, prolonged or heavy bleeding with large clots, foul-smelling vaginal discharge, and no menstrual period within 6 weeks. The woman should be advised to come in for a checkup. Cytotec is used to help dilate the cervix and is inappropriate here. The woman does not need to go to the emergency department.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A woman is in the clinic for a checkup 4 weeks after elective surgical abortion and has the nursing diagnosis of spiritual distress related to discrepancy between religious beliefs and reproductive choices. Which statement by the patient indicates that goals for this diagnosis have been met?
| A. | “I don’t ever want to go through anything like that again.” |
| B. | “I found out that my religion doesn’t forbid birth control.” |
| C. | “I talked to my minister and feel better about my choice.” |
| D. | “I will be much more careful about contraception now.” |
ANS: C
Abortion is an emotional decision and often brings about distress from a religious perspective. When the patient can state that she feels better about her choice, goals for resolving this diagnosis are being met or have been met. The other statements do not indicate this level of resolution.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy
PTS: 1
- A woman who desires a second-trimester medical abortion has been educated about the procedure, side effects, and follow-up. What statement by the patient indicates that additional teaching is needed?
| A. | “I understand that I might need several doses of the prostaglandins.” |
| B. | “I will get over-the-counter medication to treat any headache that I get.” |
| C. | “I will watch for dizziness when standing if I have vomiting or diarrhea.” |
| D. | “If I get a fever with chills, I should go to the emergency department.” |
ANS: D
Second-trimester medical abortions are associated with several side effects and may require multiple doses of prostaglandins to achieve the desired results. Side effects include headache, nausea, vomiting, diarrhea, fever, chills, dizziness, and cramping. Because fever and chills are a possible expected side effect, the woman would not need to go to the emergency department. The other statements are correct and indicate good understanding.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse reads on a woman’s chart that she has a past history of Asherman syndrome. What does the nurse conclude about this patient?
| A. | Has had an abortion |
| B. | Has had multiple miscarriages |
| C. | Has never been pregnant |
| D. | Has a uterine abnormality |
ANS: A
Asherman syndrome is a complication of abortion and is characterized by the presence of endometrial adhesions or scar tissue. The other options are not related.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate
PTS: 1
- After an abortion, when should the nurse advise the patient to return for a follow-up visit?
| A. | 2 weeks |
| B. | 4 weeks |
| C. | 6 weeks |
| D. | 8 weeks |
ANS: A
After all types of abortion the patient is instructed to return for a follow-up visit at 2 weeks.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse is reviewing a 36-year-old woman’s chart. The woman has the diagnosis of infertility. What does the nurse conclude about this woman?
| A. | Has a medical condition that prevents pregnancy |
| B. | Has been attempting to get pregnant for 12 months |
| C. | Has delayed pregnancy and childbirth for too long |
| D. | Has not conceived in 6 months of actively trying |
ANS: D
Infertility is diagnosed if a woman age 34 or younger has not conceived within 12 months of actively trying. For women 35 and older, the timeframe decreases to 6 months. The other statements are not valid conclusions about this patient.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
- During the initial visit with a couple in the infertility clinic, what action by the nurse is best to promote a trusting relationship?
| A. | Explain the process of a workup and its sensitive nature. |
| B. | Give written information with a timeline of testing. |
| C. | Go over the cost of a workup and insurance coverage. |
| D. | Ask the couple if they have considered adoption as an alternative option. |
ANS: A
Providing an overview of the infertility workup process gives couples the information they need to make an informed decision. Because of the sensitive nature of this condition, some people may not be willing to commit to the time, expense, and involvement needed for a successful workup. To best facilitate a trusting relationship, the nurse should give the couple this information in the initial visit so there will be no surprises and so the couple can make an informed choice after considering their comfort level with the process. Written information is important after verbal explanations are given and after the nurse assesses the couple’s ability to read and understand the information. Cost is an important factor but not the priority. Although a discussion about adoption may be appropriate at a later point during the infertility evaluation process, this is not the best initial strategy to promote a trusting relationship with the couple.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A nurse is explaining that a woman will undergo follicular monitoring to evaluate her response to ovulation induction. For what test does the nurse prepare her?
| A. | 3-D ultrasound and color flow Doppler |
| B. | Endometrial biopsy |
| C. | Hysterosalpingography |
| D. | Laparoscopy |
ANS: A
A 3-D ultrasound and color flow Doppler provides visualization of the pelvic structures and provides a means of follicular monitoring if a woman is undergoing ovulation induction. An endometrial biopsy is used to assess the endometrial response to progestin. A hysterosalpingogram provides visualization of the interior dimensions of the uterine cavity and fallopian tubes. A laparoscopy allows direct visualization of the internal pelvic structures.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is having hysterosalpingography and begins complaining of severe left shoulder pain. What action by the nurse is best?
| A. | Administer morphine sulfate, 1–2 mg intravenously. |
| B. | Ask the patient if she took a nonsteroidal anti-inflammatory drug (NSAID) prior to the procedure. |
| C. | Determine exactly where the woman is in her monthly cycle. |
| D. | Inform the physician so the procedure can be stopped. |
ANS: B
During this procedure, women should be told that they may experience moderate to severe cramping and shoulder pain from subdiaphragmatic gas collection. This symptom is usually prevented by administering an NSAID, such as ibuprofen (Motrin), 30 minutes to 1 hour before the procedure. The nurse should assess if the woman has taken an NSAID prior to the procedure. Morphine sulfate is not warranted, nor is stopping the procedure. Although the test is performed during a specific part of the woman’s monthly cycle (during the follicular phase to prevent possible termination of an early pregnancy), the side effects will not be different in other phases.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- A woman is being treated for infrequent ovulation. The nurse should educate her about what medication?
| A. | Clomiphene citrate (Clomid) |
| B. | Chlorambucil (Leukeran) |
| C. | Estradiol (Estrace) |
| D. | Follicle-stimulating hormone (FSH) |
ANS: A
Clomid is used to stimulate follicle development in women who are anovulatory or who ovulate infrequently. Leukeran is used to treat leukemias and lymphomas. Estrace is often prescribed to treat the symptoms of menopause. FSH is a hormone, often used to supplement the woman’s levels of this hormone.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is receiving clomiphene citrate (Clomid). What assessment finding warrants immediate intervention by the nurse?
| A. | Chest pain worse with inspiration |
| B. | Complaints of anxiety and depression |
| C. | Headache and bilateral eye pain |
| D. | Increase in blood pressure of 10% |
ANS: A
Ovarian hyperstimulation is a serious complication that can occur with ovulation induction (the purpose of giving Clomid). The signs and symptoms include marked ovarian enlargement, ascites with or without pain, and pleural effusion. A common manifestation of pleural effusion is pleuritic chest pain such as described by the patient. The other complaints are not related to Clomid use and, in fact, anxiety, depression, and emotional instability are common to the dramatic hormonal alterations that occur in patients undergoing treatment.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult
PTS: 1
- A woman in the infertility clinic is concerned that her religion may object to assisted reproductive technologies. Which process should the nurse explore with the woman as possibly acceptable?
| A. | FET (frozen embryo transfer) |
| B. | GIFT (gamete intrafallopian transfer) |
| C. | IVF-ET (in vitro fertilization-embryo transfer) |
| D. | ZIFT (zygote intrafallopian transfer) |
ANS: B
During the GIFT procedure, oocytes are harvested from the ovary and placed into a catheter along with washed, motile donor or partner sperm. The oocytes and sperm are then injected into the fallopian tubes through a laparoscope. Fertilization takes place in the fallopian tube. Because fertilization occurs inside the woman’s body, this procedure may be more acceptable to adherents of certain religious groups.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- A nurse is counseling a couple about fertility prior to the husband beginning chemotherapy for cancer. The couple wish to delay childbirth until the husband is in remission. What information from the nurse is most accurate?
| A. | “Donor sperm are usually used in cases such as yours.” |
| B. | “Have you considered cryopreservation of your sperm?” |
| C. | “Most chemotherapeutic drugs don’t affect fertility.” |
| D. | “You shouldn’t wait, because remission may not occur.” |
ANS: B
Many chemotherapeutic drugs affect fertility. Cryopreservation, or freezing, is used to store sperm (or ovarian tissue) for use later. This might be a viable option for this couple, and the nurse should investigate it with them. The other statements are misleading, and in the case of telling the couple that remission may not occur, will not help establish a trusting relationship.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A woman asks the nurse about taking chasteberry tree supplements. What response by the nurse is best?
| A. | “Herbal supplements have no side effects.” |
| B. | “There are no scientific data supporting the use of this supplement.” |
| C. | “This herb is known to promote ovulation.” |
| D. | “Try it first, as herbs are inexpensive.” |
ANS: B
Chasteberry tree has been used for fertility, as it is believed to promote ovulation. However, there are no scientific data to support its use. All herbal supplements have side effects. Herbs are certainly less expensive than medications and assistive reproductive technology, but this is not the best answer because the patient needs to know about the lack of scientific evidence in order to make an informed choice.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is tracking her basal body temperature and is having inconsistent results. When assessing the patient, the nurse discovers that the patient has seasonal allergies. The nurse needs to assess for what further information?
| A. | Any over-the-counter allergy medications taken |
| B. | How long the patient has suffered from allergies |
| C. | Signs and symptoms the patient has with her allergies |
| D. | What grasses, trees, molds, and pollens affect her |
ANS: A
Many over-the-counter sinus and allergy medications contain antipyretics, which would affect the woman’s temperature readings. The other options are not relevant.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- A woman with hypertension is experiencing infertility. After reviewing her medication list, which medication does the nurse advise the woman to discuss with her primary care provider?
| A. | Atenolol (Tenormin) |
| B. | Enalapril (Vasotec) |
| C. | Isosorbide dinitrate (Isordil) |
| D. | Methyldopa (Aldomet) |
ANS: D
Methyldopa can cause amenorrhea and possibly interfere with fertility. Beta blockers (atenolol) can cause decreased libido, but that would not physically interfere with fertility. Isordil and enalapril do not affect fertility.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- The nurse has educated a woman about bromocriptine mesylate (Parlodel). Which statement by the patient indicates that she needs more teaching about this drug?
| A. | “I may get a metallic taste in my mouth when using this drug.” |
| B. | “My endometriosis will regress with this medication.” |
| C. | “Some side effects include vomiting, headache, and dizziness.” |
| D. | “This medication normalizes follicle-stimulating hormone.” |
ANS: B
Parlodel improves the release of follicle-stimulating hormone and luteinizing hormone, both of which help restore ovulation. Increased progesterone released by the corpus luteum supports early pregnancy. Side effects include vomiting, headache, dizziness, and a metallic taste in the mouth, among others. GnRh antagonists such as cetrorelix acetate (Cetrotide) reduce the extent of endometriosis.
Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Evaluation
Difficulty: Difficult
PTS: 1
- A woman has been taking progesterone via intramuscular injection. She calls the clinic to complain of swollen ankles. What response by the nurse is best?
| A. | Advise her to come to the clinic for an EKG. |
| B. | Assess how much sodium is in her daily diet. |
| C. | Have her go to the nearest emergency department. |
| D. | Reassure her that this is a common side effect. |
ANS: D
Common side effects of progesterone include nausea, weight gain, and fluid retention. The nurse should reassure the patient. There is no need for the patient to have an EKG or go to the emergency department. Assessing sodium intake may be helpful, but first the nurse should reassure the woman.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is in the clinic complaining of frequent constipation. During the assessment, the patient states that she has been trying to conceive for many months. Which of the following should the nurse ask this patient about using?
| A. | Bisocodyl (Dulcolax) suppositories |
| B. | Fleet enemas |
| C. | Psyllium (Metamucil) |
| D. | Senna (Senekot) |
ANS: D
Senna is in a group of herbs called anthraquinone laxatives, which should be avoided when trying to conceive. The other items do not appear to have an effect on conception.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
MULTIPLE RESPONSE
- Masters and Johnson described the four phases of human sexual response. Which phases did they include? (Select all that apply.)
| A. | Excitement |
| B. | Orgasm |
| C. | Plateau |
| D. | Resolution |
| E. | Response |
ANS: A, B, C, D
The four phases of human sexual response described by Masters and Johnson are excitement, plateau, orgasm, and resolution. Response is not a phase.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse is working with women and issues of reproductive health practices to help meet the National Health Goals related to reproductive life planning. Which goals are included in this document? (Select all that apply.)
| A. | Increase the number of private pharmacies that supply emergency contraception. |
| B. | Increase the proportion of subsequent births to 18 months from 12 months. |
| C. | Increase the proportion of young males who receive reproductive health care. |
| D. | Reduce the number of publicly funded family planning clinics that offer abortion. |
| E. | Reduce the proportion of women with unplanned pregnancy despite contraception. |
ANS: C, E
Several of the National Health Goals are related to reproductive life planning. Two of them include increasing the proportion of young males who receive reproductive health services and reducing the proportion of women experiencing unplanned pregnancies despite using contraception. Another goal is to increase the number of publicly funded family planning clinics (not private pharmacies) that offer the full range of FDA-approved methods of contraception, including emergency contraception, on site. Another goal is to decrease the proportion of pregnancies conceived within 18 months of a previous birth.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Planning
Difficulty: Difficult
PTS: 1
- A couple is interested in fertility-awareness-based (FAB) family planning. The nurse should advise them about what drawbacks that accompany this method? (Select all that apply.)
| A. | Depends on tracking cycles on a calendar |
| B. | Less than 50% effective in family planning |
| C. | May interfere with sexual spontaneity |
| D. | Requires months of charting cycles before use |
| E. | Requires a lot of motivation and education |
ANS: C, D, E
The FAB method of family planning is based on identifying the woman’s fertile periods and abstaining or using other methods of contraception when she is fertile. This method requires motivation, extensive education, and commitment to be used successfully. The couple may need to chart cycles and symptoms of fertility for months before initiating this method. There are several ways to track fertility, including using a calendar or rhythm method, the standard days method, the cervical mucus method, the basal body temperature method, and the symptothermal method that combines basal body temperature with other physical signs. When used correctly and consistently, this method is about 75% effective.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The clinic nurse obtains a history from women who wish to use a cervical cap as their method of contraception. The nurse assesses for relative or absolute contraindications to this contraceptive device, including which of the following? (Select all that apply.)
| A. | Patient is a commercial sex worker. |
| B. | Patient has history of an abnormal Pap test. |
| C. | Patient has human papillomavirus infection. |
| D. | Patient has silicone allergy. |
| E. | Patient is nulliparous. |
ANS: A, B, C, D
Certain women are not suitable candidates for the cervical cap. Patients who have a history of toxic shock syndrome, pelvic inflammatory disease, cervicitis, papillomavirus infection, a previous abnormal Pap test or cervical cancer, undiagnosed vaginal bleeding, or a silicone allergy should choose another contraceptive method. In addition, women who have an abnormally short or long cervix may not be able to use a cervical cap satisfactorily. Because the cervical cap can cause irritation, it is not advisable for women who are at high risk for HIV, such as commercial sex workers. Parity has no bearing on suitability for using this device.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Easy
PTS: 1
- The family planning clinic nurse reviews the signs and symptoms of toxic shock syndrome (TSS) with a patient who is being fitted for a diaphragm. The nurse explains that the patient should promptly seek medical attention if she develops which of the following manifestations? (Select all that apply.)
| A. | Develops a generalized red rash |
| B. | Develops a fever over 101.1°F (38.4°C) |
| C. | Experiences difficulty breathing |
| D. | Feels lightheaded, is dizzy, or has chills |
| E. | Has swelling of the face or neck |
ANS: A, B, D
The diaphragm should not be used during menses due to the risk of toxic shock syndrome (TSS), a rare, sometimes fatal disease caused by toxins produced by certain strains of the bacterium Staphylococcus aureus. Common signs of TSS include fever of sudden onset greater than 38.4°C (101.1°F), rash, and hypotension with a systolic blood pressure less than 90 mm Hg, leading to dizziness or lightheadedness. Shortness of breath and facial swelling do require medical attention but are not related to TSS.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nurse teaches a patient the acronym “ACHES” for the serious symptoms that must be reported immediately when taking oral contraceptive pills. Which manifestations does this include? (Select all that apply.)
| A. | Abdominal pain |
| B. | Chest pain |
| C. | Headaches |
| D. | Eye pain |
| E. | Sore muscles |
ANS: A, B, C, D
ACHES stands for abdominal pain, chest pain (or shortness of breath), headaches, eye problems, and severe leg pain. Muscle soreness is not part of the acronym.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The clinic nurse uses the acronym “PAINS” when teaching a woman about warning signs associated with her intrauterine device (IUD). Warning signs include which of the following? (Select all that apply.)
| A. | Breast tenderness |
| B. | Fever and/or chills |
| C. | Inability to feel the strings |
| D. | Spotting |
| E. | Vaginal discharge |
ANS: B, C, E
All IUD patients must understand warning signs (“PAINS”) that may indicate infection or ectopic pregnancy: Period late (pregnancy); Abdominal pain; pain with intercourse (infection); Infection exposure or vaginal discharge; Not feeling well, fever, or chills (infection); String missing, shorter, or longer (IUD expelled).
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse is explaining contraceptive options to a young woman. What benefits of an IUD does the nurse describe? (Select all that apply.)
| A. | Appropriate with dysmenorrhea |
| B. | No interference with spontaneity |
| C. | No daily attention required |
| D. | No hormonal side effects associated with the Copper T 380A |
| E. | One-time expense |
ANS: B, C, D, E
Benefits of the IUD include no continued expense, no daily attention required, no interference with sexual pleasure or spontaneity, possible decrease in risk of endometrial cancer and ectopic pregnancy, and no hormonal side effects associated with the copper-bearing IUD. The IUD is not appropriate for women who have severe dysmenorrhea or menorrhagia.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse is counseling women about the lactational amenorrhea method of contraception. Which of the following women would the nurse advise to use another method of contraception if pregnancy is not desired? (Select all that apply.)
| A. | Baby is 5 months old and started on cereals. |
| B. | Baby is 8 months old; menses have not resumed. |
| C. | Baby is 4 months old; breastfed exclusively. |
| D. | Dad feeds 5-month-old baby the mother’s stored breast milk. |
| E. | Mother uses breast pump while at work. |
ANS: A, B
Women who wish to avoid a subsequent pregnancy should be counseled to use another form of birth control in the following situations: menstruation resumes, the frequency or duration of breastfeeding is reduced, bottle feeding or solid foods are introduced, and the baby reaches 6 months of age. Therefore, the mothers of the 5-month-old baby who has started solid food and the baby who is 8 months old should be advised to use another form of birth control. The mother of the 4-month-old who is exclusively breastfed can expect an effectiveness rate of approximately 98%. The nurse needs to assess the other two situations more carefully prior to determining if the mother needs another form of birth control.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman has decided to have an elective abortion. What information can the nurse provide to make the experience less stressful and to better prepare her? (Select all that apply.)
| A. | Average waiting time to be seen |
| B. | Cost and range of services provided |
| C. | How many patients the clinic sees |
| D. | How to access social services |
| E. | Potential for protesters to be present |
ANS: A, B, E
When a woman decides to seek an abortion, an important role for the nurse is to establish a relationship with the patient and to provide information about the services offered at abortion providers. Some of this information includes what methods the provider uses, the cost, the average wait time, languages spoken, the potential for protesters to be present, and the general quality of the care provided.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse is counseling a woman who wishes to undergo an elective medication abortion. The nurse should assess the woman for what psychosocial considerations? (Select all that apply.)
| A. | Availability of a close friend who can stay with the woman |
| B. | Feeling that medication pregnancy termination is a natural, less stressful process |
| C. | Potential for trauma at seeing or handling the products of conception |
| D. | Previous use of alcohol or other substances for coping |
| E. | Type of birth control the woman plans to use after the abortion |
ANS: A, B, C
Patients should be assessed thoroughly and educated about what to expect prior to a medication abortion. The nurse should advise the patient to call upon a trusted friend or relative to stay with her and provide emotional support during the process. Some women are more accepting of a medication termination of pregnancy, finding it more natural than a surgical procedure. The woman should be told to expect uterine cramping beginning several days after medication administration, and then painless, heavy bleeding with the expulsion of the products of conception. The nurse should assess the patient’s potential for being traumatized by that experience. Coping mechanisms should be assessed, but specifically focusing on substance abuse as a coping method is judgmental. The priority education is focused on preparing the woman for the abortion; discussing birth control options can be handled at the follow-up visit.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A nurse is assessing a couple who are in the clinic complaining of an inability to get pregnant. Which questions are most important at this time? (Select all that apply.)
| A. | “Do you get up right after intercourse?” |
| B. | “Do you know how to track your cycle?” |
| C. | “How do you know when you ovulate?” |
| D. | “How often do you have intercourse?” |
| E. | “What sexual positions do you use?” |
ANS: A, B, C, E
Before beginning an intensive infertility workup, the nurse should assess the couple for basic knowledge related to their ability to conceive. Questions about their understanding of the woman’s most fertile times (48 hours around ovulation), signs and symptoms of ovulation, and positions to enhance sperm retention are important areas to explore. Frequency of intercourse is not as important as timing.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A nurse is instructing a man on the correct procedure for semen analysis. Which instructions should the nurse include? (Select all that apply.)
| A. | Abstain for 2–3 days before collecting the sample. |
| B. | Collect the sperm sample through masturbation. |
| C. | Have the sample in the laboratory within 3 hours of collection. |
| D. | Store the sample on ice while bringing it to the lab. |
| E. | Store the sample on your body during transport. |
ANS: A, B, E
The man should be instructed to abstain for 2–3 days, then collect the semen sample through masturbation. The specimen needs to be kept warm, so during transport it should be stored near the body. The sample should arrive in the laboratory within 1 hour after collection.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- An infertility clinic nurse explains to the student that the process of sperm washing has several benefits. Which benefits should the nurse explain to the student? (Select all that apply.)
| A. | Improves chances of fertilization |
| B. | Increases sperm motility |
| C. | Makes the sperm denser |
| D. | May correct sperm clumping |
| E. | Removes sperm impurities |
ANS: A, B, D
Before intrauterine insemination by mechanical means, sperm are “washed” by placing them in a special solution that enhances motility and improves the chances of fertilization. Another benefit is decreased sperm clumping, which can be caused by the woman’s antibodies. The washing process does not make the sperm denser nor does it remove impurities.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nurse is concerned about a woman who is undergoing her second in vitro fertilization (IVF) cycle. The patient is anxious, sad, and worried that her partner does not feel as motivated as she does to try to achieve a pregnancy. Which actions by the nurse are most appropriate? (Select all that apply.)
| A. | Ask the woman to consider herbal supplements like blue cohosh. |
| B. | Encourage the woman to talk honestly with her partner. |
| C. | Explain that it takes an average of five attempts to become pregnant with IVF. |
| D. | Instruct the woman to engage in relaxation techniques. |
| E. | Encourage the woman and her partner to contact a support group such as RESOLVE. |
ANS: B, D, E
Open, honest conversation with the partner and relaxation techniques are helpful interventions for couples undergoing treatment for infertility. On average, women who undergo three IVF cycles have a good chance of achieving pregnancy. Community support groups and RESOLVE (a national education and support organization) are very beneficial for couples experiencing the stress of assisted reproduction. Certain herbs, including blue or black cohosh, goldenseal, poke root, pennyroyal, and aloe, can be detrimental to a pregnancy and should be avoided by couples who are attempting to conceive.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse is teaching a couple about the postcoital test. What information should the nurse provide about the test? (Select all that apply.)
| A. | It assesses the quality and quantity of cervical mucus at ovulation. |
| B. | It assesses the quality of sperm function at the time of ovulation. |
| C. | It may cause cramping and discomfort when samples are obtained. |
| D. | The woman should have nothing by mouth for 6 hours before the test. |
| E. | The woman should return to the clinic 6 to 12 hours after intercourse. |
ANS: A, B, E
The postcoital test (Huhner test) assesses the quality and quantity of cervical mucus and sperm function at the time of ovulation. The woman should return to the clinic 6 to 12 hours after intercourse. There is no reason for her to be NPO or to expect cramping and discomfort.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
OTHER
- Place the following methods of birth control in order of their effectiveness, starting with the most effective.
Condoms
Depo-Provera
Diaphragm
Natural family planning
Oral contraceptive pills
Withdrawal
ANS:
Depo-Provera (>99%), oral contraceptive pills (95%), condoms (85%), diaphragm (84%), natural family planning (73%), withdrawal (71%)
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
Chapter 7: Conception and Development of the Embryo and Fetus
MULTIPLE CHOICE
- A faculty member explains the Human Genome Project to a class of nursing students. Which information about this project is correct?
| A. | It began in the 1980s to find the basic building blocks of human proteins. |
| B. | The findings will be used to create better matches for animal-to-human transplants. |
| C. | The goal is to identify exact DNA sequences and genes occurring in humans. |
| D. | Information from the project is being used to find preventative measures for diseases. |
ANS: C
The Human Genome Project began in 1990 with an overarching goal to identify the exact DNA sequences and genes that occur in humans. It is hoped that the findings will lead to new methods of diagnosing, treating, and perhaps preventing human disease and disorders.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nurse is interested in studying the functions and interactions of the genes in the human genome. What branch of science should this nurse pursue?
| A. | Biology |
| B. | Genetics |
| C. | Genomics |
| D. | Inheritance |
ANS: C
Genomics is the study of the functions and interactions of all the genes in the genome. Genetics is the study of single genes and their effects. Both are subsets of biology, which is the study of life and living matter. Inheritance is the way in which genetic material is passed on to subsequent generations.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nursing instructor is explaining genetic concepts to a class of students. Where in the cell does the instructor tell the students that each person’s genes can be found?
| A. | Golgi body |
| B. | Lysosome |
| C. | Mitochondria |
| D. | Nucleus |
ANS: D
Most genes are located on chromosomes found in the nucleus of cells. Golgi bodies process cellular proteins. Lysosomes break down waste and cellular debris. Mitochondria are responsible for cellular energy production.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A couple wishes to determine the chances of having a blue-eyed baby. Both parents have brown eyes, but have heterozygous gene pairs for eye color. Calculate the odds of their having a child with blue eyes.
ANS: C
Each parent has a heterozygous gene pair for brown eyes, which means that each parent has one blue gene and one brown gene. Using a Punnett square, one can calculate the odds of their having a blue-eyed baby to be 25%.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A nurse reads in a patient’s chart that the patient has a condition caused by monosomy X. What can the nurse conclude about this patient?
| A. | Female with one missing X chromosome |
| B. | Female with very feminine features |
| C. | Male with one extra X chromosome |
| D. | Male with very feminine features |
ANS: A
A monosomy condition is one in which only one of the paired chromosomes is present. In this case, the patient would have one or more cells with one X chromosome and nothing else. Turner’s syndrome is the most common example of this defect; children born with this syndrome are female and exhibit juvenile external genitalia, underdeveloped ovaries, short stature, webbing of the neck, and possible intellectual deficits and cardiac disorders.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A nurse has completed a family pedigree on a patient with a known autosomal dominant inheritance disorder. No one else in the family has been affected by this disorder. How does the nurse explain this finding to the patient?
| A. | Genetic variation occurred via a mutation. |
| B. | Information about the family is incorrect. |
| C. | The patient is not biologically related to the family. |
| D. | The patient’s diagnosis must be incorrect. |
ANS: A
Most autosomal dominant inheritance disorders are seen in families in which multiple members in different generations have been affected by the disorder. However, the variant allele may arise from a mutation, in which case the affected person will be the first known person in the family to be affected. The other options are incorrect.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease, but don’t know how the child got it, as neither of them is affected. What response by the nurse is best?
| A. | “Are you certain that you (points to man) are the biological father?” |
| B. | “Maybe each of you has a mild case that hasn’t been diagnosed yet.” |
| C. | “Something in your environment must have altered one of the genes.” |
| D. | “This is a recessive disorder, meaning that each of you is just a carrier.” |
ANS: D
Cystic fibrosis is an example of an autosomal recessive inheritance problem. Both parents carry an altered gene for this condition (carriers), but both parents must pass this altered version on to their child in order for it to be expressed. Asking if the man is the father is accusatory and unhelpful. Each parent has the gene, but not the disease, so they don’t have a mild form. An environmental factor can cause genetic mutations, but this is not the case in this type of inheritance.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A couple wishes to know the chances of passing on an X-linked dominant heritable disorder to their four sons. The father’s family has the disorder. The sons appear healthy, but the couple wants to be prepared for possible future events related to the disease. What information does the nurse give them?
| A. | “All of them will be affected.” |
| B. | “Half of them will be affected.” |
| C. | “None of your sons will be affected.” |
| D. | “One of the four will be affected.” |
ANS: C
An X-linked dominant inheritance disorder is the result of an alteration in a gene located on an X chromosome. None of this couple’s sons can be affected because boys get a Y chromosome from the father, whereas all of a man’s daughters will have it.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nursing faculty member is explaining the process of fertilization to a class of students. One student asks the instructor to clarify the term “secondary oocyte.” What description is best?
| A. | An oocyte in the secondary position during transportation |
| B. | An oocyte in which the first meiotic division has occurred |
| C. | The second egg released by the ovary during ovulation |
| D. | The second egg to reach its place in the fallopian tube |
ANS: B
The secondary oocyte is one in which the first meiotic division has occurred. This is the egg that is expelled from the ovary during ovulation. The other statements are incorrect.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- The perinatal nurse understands that 4 days after fertilization, the morula now contains how many cells?
ANS: D
By 3–4 days after fertilization, there are approximately 16 cells in the zygote, which is now termed a morula.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nursing faculty member explains to a class that embryonic stem cells have a special feature. Which feature is the instructor describing?
| A. | Ability to develop into any type of human cell |
| B. | Able to nourish the blastocyst as it develops |
| C. | Gives rise to the embryo and placenta |
| D. | Secretes a mixture of lipids and other liquids |
ANS: A
Embryonic stem cells have the ability to differentiate into any one of the 200 kinds of human cells that will be present at birth. The uterus secretes a mix of lipids, mucopolysaccharides, and glycogen that nourishes the blastocyst. The embryo develops from the blastocyst, and the placenta develops from the trophoblast.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A student asks the faculty member to explain the term “nidation.” Which explanation is best?
| A. | Blood vessel development |
| B. | Degradation of the zona pellucida |
| C. | Implantation of the fertilized ovum |
| D. | Sperm washing |
ANS: C
Nidation is the process whereby the fertilized ovum is implanted into the endometrium. This usually occurs by the 10th day.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The experienced perinatal nurse explains hormone function to a new graduate. Which hormone does the nurse describe as being responsible for regulating glucose availability for the fetus?
| A. | Estrogen |
| B. | Human chorionic gonadotropin |
| C. | Human placental lactogen |
| D. | Progesterone |
ANS: C
Human placental lactogen is responsible for glucose availability for the fetus and promotes fetal growth by altering maternal protein, carbohydrate, and fat metabolism. Estrogen has multiple functions, but these do not include regulating glucose availability. Human chorionic gonadotropin maintains the corpus luteum until the placenta has developed enough to produce adequate progesterone. Among other functions, progesterone helps suppress maternal immunological responses to fetal antigens.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- The perinatal nurse understands that maternal antibodies pass through the placenta by which mechanism?
| A. | Active transport |
| B. | Facilitated diffusion |
| C. | Osmosis |
| D. | Pinocytosis |
ANS: D
Maternal antibodies pass through the placenta via pinocytosis, not by active transport, facilitated diffusion, or osmosis.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- A student has read that hematopoiesis occurring in the wall of the yolk sac declines after the eighth week of gestation and asks the instructor for clarification. What statement by the faculty member is most accurate?
| A. | “All of the blood needed is transported across the placenta.” |
| B. | “Bone marrow production of blood begins in week 8.” |
| C. | “The fetal liver takes over that function then.” |
| D. | “You must have misread that information.” |
ANS: C
Formation and development of red blood cells (hematopoiesis) occurs in the wall of the yolk sac beginning in the third week. The function gradually declines after the eighth gestational week when the fetal liver begins to take over this process.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nurse assessing a newborn’s umbilical cord stump would document which finding as normal anatomy?
| A. | One artery, one vein |
| B. | One artery, two veins |
| C. | Two veins, two arteries |
| D. | One vein, two arteries |
ANS: D
The vessels in the umbilical cord are comprised of two arteries and one vein.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Easy
PTS: 1
- The perinatal nurse explains the function of Wharton’s jelly to a class of expectant parents. What description is most accurate?
| A. | Collection of blood from the maternal circulation |
| B. | Gooey uterine substance that cushions the fetus |
| C. | Precursor cells from which blood cells originate |
| D. | Protects the umbilical cord from compression |
ANS: D
Wharton’s jelly is a specialized type of connective tissue surrounding the vessels within the umbilical cord that protects the cord from compression.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The perinatal nurse is explaining blood transport though fetal circulation to the new nurse. How does the perinatal nurse describe the foramen ovale?
| A. | Opening in the heart’s septum between the right and left atria |
| B. | Vascular channel between the pulmonary artery and the descending aorta |
| C. | Vascular channel connecting the umbilical vein to the inferior vena cava |
| D. | Vascular route connecting the heart to the extremities |
ANS: A
The foramen ovale is an opening in the heart’s septum between the right and left atria. The vascular channel between the pulmonary artery and descending aorta is the ductus arteriosus. The channel connecting the umbilical vein to the inferior vena cava is the ductus venosus. The closest thing to a route connecting the heart to the extremities would be the aorta, which then leads to peripheral and cerebral circulation.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A couple has been told that there is a problem with their pregnancy. They only remember the term “ductus venosus.” The nurse explains that there is a problem in the circulation between which two structures?
| A. | Pulmonary artery and descending aorta |
| B. | Pulmonary vein and pulmonary artery |
| C. | Right and left atria in the heart |
| D. | Umbilical cord and inferior vena cava |
ANS: D
The ductus venosus is a vascular channel connecting the umbilical vein to the inferior vena cava. The ductus arteriosus connects the pulmonary artery and descending aorta. The foramen ovale is an opening in the septum between the right and left atria of the heart.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A student reviewing the anatomy and physiology of fetal circulation learns that fetal blood enters the aorta through which structure?
| A. | Ductus arteriosus |
| B. | Ductus venosus |
| C. | Foramen ovale |
| D. | Portal circulation |
ANS: A
Most blood enters the aorta through the ductus arteriosus, which is a channel between the pulmonary artery and the descending aorta. The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is an opening between the atria of the heart. Most blood bypasses the liver (portal circulation).
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A student reviewing the anatomy and physiology of the fetal circulatory system learns that the highest concentration of oxygen in fetal blood is measured at what level?
| A. | 10–20 mm Hg |
| B. | 20–25 mm Hg |
| C. | 30–35 mm Hg |
| D. | 40–50 mm Hg |
ANS: C
The highest concentration of oxygen (PO2) in fetal circulation is found in the blood returning from the placenta via the umbilical vein and is measured at 30–35 mm Hg.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A student asks the faculty member to explain why the fetus has such a low PO2. What explanation by the faculty member is most accurate?
| A. | Blood from the mother is deoxygenated. |
| B. | It keeps the ductus arteriosus open. |
| C. | It maintains the maternal circulation. |
| D. | It supports the foramen ovale. |
ANS: B
The low fetal PO2 helps to maintain fetal (not maternal) circulation and keeps the ductus arteriosus open. It also helps keep the pulmonary vascular bed constricted. Blood from the mother is oxygenated. It does not support the foramen ovale.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- The nurse discussing fetal development describes the hormone responsible for suppressing the maternal immunological response to the fetus, thereby facilitating physiological acceptance of the pregnancy. Which hormone is the nurse describing?
| A. | Estrogen |
| B. | Human chorionic gonadotropin |
| C. | Human placental lactogen |
| D. | Progesterone |
ANS: D
Progesterone helps to suppress maternal immunological responses to fetal antigens, thereby preventing maternal rejection of the fetus. Estrogen enhances myometrial activity, promotes myometrial vasodilation, increases maternal respiratory center sensitivity to carbon dioxide, softens fibers in the cervical collagen tissue, increases the pituitary secretion of prolactin, increases serum-binding proteins and fibrinogen, decreases plasma proteins, and increases sensitivity of the uterus to progesterone in late pregnancy. Human placental lactogen regulates glucose availability for the fetus and promotes fetal growth by altering maternal protein, carbohydrate, and fat metabolism. Human chorionic gonadotropin maintains the corpus luteum during early pregnancy until the placenta has sufficiently developed to produce adequate amounts of progesterone.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A clinic nurse explains to a pregnant woman that the amount of amniotic fluid present at 7 or 8 months’ gestation is approximately what volume?
| A. | 500 mL |
| B. | 750 mL |
| C. | 800 mL |
| D. | 1,000 mL |
ANS: C
Amniotic fluid first appears at about 3 weeks. There is approximately 30 mL of amniotic fluid present at 10 weeks of gestation, and this amount increases to approximately 800 mL at 24 weeks of gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A pregnant woman is confused about the terms “embryo” and “fetus.” How does the nurse explain the difference?
| A. | “The baby can’t be called a fetus until the limbs and organs have formed.” |
| B. | “The baby is an embryo until 8 weeks’ gestation; then it is called a fetus.” |
| C. | “There really isn’t any difference between the terms; they are interchangeable.” |
| D. | “Your baby is a fetus until the kidneys are matured and he makes urine.” |
ANS: B
During the first 8 weeks of gestation, the baby is called an embryo. By the end of the eighth week, the embryo has developed enough to be called a fetus. The other statements are inaccurate.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A nurse teaching a prenatal class instructs the participants that early organ system development occurs during which period of time?
| A. | Embryonic period |
| B. | Fetal period |
| C. | Pre-embryonic period |
| D. | Post-embryonic period |
ANS: A
The early development of the nervous system, cardiovascular system, and all major internal and external structures occurs during the embryonic period, which is the first 2 weeks beginning at fertilization.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is starting on birth control, but tells the nurse she wants to become pregnant next year. What action by the nurse is most important?
| A. | Ask the woman to describe how her life will be different in the next year. |
| B. | Educate the woman about the need for folic acid supplementation before conceiving. |
| C. | Have the woman make a pre-pregnancy appointment for next year before she leaves. |
| D. | Tell the woman that it is difficult to get pregnant right after stopping birth control. |
ANS: B
Neural tube defects occur during the fourth week of pregnancy, which is often before women know they are pregnant. Any woman considering pregnancy should take folic acid supplements well in advance of trying to conceive. The other options are not helpful interventions.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- A newborn has rachischisis. What action by the nurse takes priority?
| A. | Contact the palliative care team for interventions. |
| B. | Discourage the family from seeing the infant. |
| C. | Obtain informed consent for immediate surgery. |
| D. | Prepare to provide the baby total parenteral nutrition. |
ANS: C
Rachischisis is spina bifida, a type of neural tube defect that often requires immediate surgery. The priority of the nurse is to obtain signatures on the informed consent form and place it on the chart. There is no need for palliative care or parenteral nutrition. The nurse would not discourage the family from seeing the baby.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A woman in her 26th week of pregnancy is in preterm labor. What can the nurse conclude about this baby’s ability to survive?
| A. | Cannot survive, as all organ systems are too immature |
| B. | Might survive, as lungs can breathe air with rhythmic breathing |
| C. | Probably will not survive, as all organ systems have not formed |
| D. | Will survive, because all body systems are completely mature |
ANS: B
A baby born at this gestation can survive because the lungs are capable of breathing air, they produce surfactant, and the central nervous system can regulate body temperature and direct rhythmic breathing. Many obstacles remain for a baby born this early, and survival is not guaranteed. The other statements are inaccurate.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A baby is born with several congenital anomalies. The parents are distraught and begin questioning each other about what they did wrong during the pregnancy. What response by the nurse is best?
| A. | “Chances are you did everything right; we may never know why this happened.” |
| B. | “Usually these types of issues result from toxic environmental exposures.” |
| C. | “You are lucky you did not have a miscarriage and instead have a wonderful baby.” |
| D. | “You can’t worry about that now; you have a baby who needs you.” |
ANS: A
Damage to a developing embryo/fetus can occur from genetic or environmental causes or a combination of both. However, in 50 to 60% of cases, the exact cause may never be known. The nurse should reassure the parents gently. It is incorrect to state that anomalies are usually caused by environmental factors. Telling the family they are lucky and they shouldn’t worry is disrespectful and dismissive to the parents.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy
PTS: 1
- A nurse is assessing a pregnant woman who says she drinks 5 to 7 alcoholic drinks per week. What action by the nurse is best?
| A. | Advise the woman to decrease her drinking to 3 to 4 drinks per week. |
| B. | Explain that during pregnancy, alcohol in any amount can harm the fetus. |
| C. | Teach her that for women, the safe alcohol limit is 1 drink in an hour. |
| D. | Tell the woman to substitute caffeinated beverages for the alcohol. |
ANS: B
Alcohol is one of the most potent teratogens known, and a safe level of alcohol during pregnancy has not been established. Therefore, the nurse should advise the woman to stop drinking alcohol altogether while she is pregnant. Caffeine is also considered a teratogen, so this is not a good substitute.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A preterm infant is jittery and has an oxygen saturation of 88%. After stabilizing the newborn, what action by the nurse is most important?
| A. | Assess the mother for caffeine use during pregnancy. |
| B. | Assess the mother for opioid use during pregnancy. |
| C. | Call Child Protective Services (CPS) to take the child away. |
| D. | Question the father about maternal drug abuse. |
ANS: B
Maternal opioid use can lead to neonatal withdrawal syndrome, characterized by hyperirritability, gastrointestinal dysfunction, respiratory distress, and autonomic disturbances. After stabilizing the baby, the nurse should first assess the mother for opioid abuse during pregnancy. Caffeine use would not cause these effects. Calling CPS is premature at this point. Questioning the father is not the best way to determine if the mother has abused drugs.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A neonate whose mother is a drug addict is listless and sweating. What action by the nurse takes priority?
| A. | Check the baby’s blood sugar. |
| B. | Have the mother hold the baby to her skin. |
| C. | Obtain an oxygen saturation. |
| D. | Place the baby on a cardiac monitor. |
ANS: A
Babies born of mothers who have used amphetamines during pregnancy may exhibit hypoglycemia, sweating, poor visual tracking, lethargy, and difficulty feeding. The nurse would conclude that the baby may be at risk for hypoglycemia because he or she has other manifestations of this syndrome and should check the blood sugar. If low, the blood glucose can be treated quickly. The other options may be valuable, but do not take priority over this assessment.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- A pregnant woman tells the perinatal nurse that she stopped abusing other drugs when she learned that she was pregnant but kept using marijuana because “it is so harmless.” What response by the nurse is best?
| A. | Agree with the patient that marijuana is less dangerous than other drugs. |
| B. | Ask the patient what other drugs she used before discovering she was pregnant. |
| C. | Inform the mother that the child may have withdrawal syndrome after birth. |
| D. | Tell the mother that marijuana use can affect language and cognitive development. |
ANS: D
Marijuana use is associated with carbon monoxide levels five times higher than those produced with cigarettes and can lead to intrauterine growth restriction and abnormal neonatal neurobehavior (hyperirritability, tremors, photosensitivity). Marijuana can also lead to cognitive and language abnormalities up to 48 months of age. The nurse should not agree that it is less dangerous than other drugs, but should also not tell the mother the child may have withdrawal syndrome, as that information is incorrect. Assessing the mother for a complete history of drug use is important, but is not directly related to the effects of marijuana, and is less important.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A male baby is born with undescended testes. After caring for the newborn, what question by the nurse is most important?
| A. | “Did your other children have this problem?” |
| B. | “Do you have cats and litter boxes at home?” |
| C. | “Have you been exposed to measles?” |
| D. | “How old is the house in which you live?” |
ANS: D
One risk factor for undescended testes is intrauterine lead exposure. In this country, the most common source of lead is from lead-based paint in older homes (built prior to 1978), lead-contaminated house dust and soil, and vinyl products. The nurse should assess for sources of lead exposure. The other questions are not relevant.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- The prenatal clinic nurse is providing information to a pregnant woman who is at 15 weeks’ gestation. The patient asks when she should expect to feel fetal movement. Which of the following is the most appropriate answer by the nurse?
| A. | 15 to 18 weeks |
| B. | 17 to 20 weeks |
| C. | 18 to 21 weeks |
| D. | 20 to 24 weeks |
ANS: B
In gestational weeks 17 to 20, fetal growth continues, and maternal awareness of fetal movements (termed “quickening”) is often first noted.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- During preconception counseling, the nurse explains that the fetus is most vulnerable to the effects of teratogens during which time period?
| A. | 2 to 8 weeks |
| B. | 4 to 12 weeks |
| C. | 5 to 10 weeks |
| D. | 6 to 15 weeks |
ANS: A
The period of organogenesis lasts from approximately the second until the eighth week of gestation, during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens, such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens, either before or during a critical period of development of an organ, can cause a malformation.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- During prenatal classes for expectant parents, the perinatal nurse explains that fetal brain development is most critical during which gestational weeks?
| A. | 2 to 8 |
| B. | 3 to 16 |
| C. | 5 to 24 |
| D. | 6 to 14 |
ANS: B
The most critical time for brain development is between 3 and 16 weeks of gestation. However, the fetal brain continues to differentiate and grow rapidly until at least the first 2 years of life.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- The birthing center nurse caring for a 21-year-old laboring woman is given a report about the patient’s cocaine use throughout pregnancy. This history prompts the labor nurse to assess for which condition?
| A. | Abruptio placentae |
| B. | Cephalopelvic disproportion |
| C. | Hypotension |
| D. | Placenta previa |
ANS: A
Cocaine and crack use during pregnancy causes vasoconstriction of the uterine vessels and adversely affects blood flow to the fetus. Cocaine use in pregnancy is associated with spontaneous abortion, abruptio placentae, stillbirth, intrauterine growth restriction (IUGR), fetal distress, meconium staining, and preterm birth.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- The birthing center nurse is assisting with pain management for a laboring woman at 18 weeks’ gestation. The fetus is born and the weight is 450 gm. The nurse would document this birth as which of the following?
| A. | Abortion |
| B. | Fetal loss |
| C. | Neonatal death |
| D. | Stillbirth |
ANS: A
The loss of a fetus before 20 to 22 weeks of gestation is referred to as an abortion because the fetus is considered too immature to survive outside the uterus. Fetal loss and neonatal death are not medical terms. Stillbirth is the intrauterine death of a fetus old enough to survive outside the womb.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate
PTS: 1
- A 26-year-old woman has come for preconception counseling and asks about caring for her cat, because she has heard that she “should not touch the cat during pregnancy.” Which of the following is the nurse’s best response?
| A. | “If someone else changes the litter box you should be okay.” |
| B. | “It is more important to avoid eating raw vegetables now.” |
| C. | “That is correct; in fact, you should give the cat away.” |
| D. | “You probably already have had toxoplasmosis from the cat.” |
ANS: A
Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with Toxoplasma gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii. The nurse should advise the woman to avoid poorly or undercooked meat and changing the cat’s litter box. The other statements are inaccurate.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A couple has undergone prenatal testing and their fetus has an identified congenital anomaly. What action by the nurse is best?
| A. | “I know how you feel; my daughter has a cleft lip.” |
| B. | “I’m sure you will come to love your baby anyway.” |
| C. | “It is normal for both of you to be afraid, sad, or angry.” |
| D. | “You are lucky you found out now and can prepare.” |
ANS: C
The nurse plays an important role in situations such as this by providing support and education. The nurse should use empathetic and therapeutic communication and be sure to include the father. The other statements are not examples of therapeutic communication and sound dismissive.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy
PTS: 1
- A baby is born with trisomy 18. What action by the nurse is most appropriate?
| A. | Allow the family members to express their grief and anger. |
| B. | Call the hospital chaplain to counsel the parents. |
| C. | Make a referral to a home health agency for home visits. |
| D. | Prepare the parents for the baby’s imminent death. |
ANS: A
Trisomy 18 (Edward syndrome) is a rare genetic disorder with a poor prognosis; approximately 70% of infants die within the first 3 months of life. The nurse should allow the family to grieve. The parents may or may not welcome a visit from a religious person and the nurse should ask them before calling a chaplain. A home health-care agency may or may not be needed; further assessment is needed. The baby may not die immediately, so preparing the parents for an imminent death is unwarranted.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy
PTS: 1
- An obstetrical nurse is taking a medication history from a pregnant woman. One of the woman’s medications is classified as category D. What action by the nurse is best?
| A. | Advise her to stop the medication right away. |
| B. | Encourage her to find herbal substitutions. |
| C. | Have her call her primary care provider immediately. |
| D. | Tell her to cut the medication dose in half until she gives birth. |
ANS: C
A category D medication is one with well-documented risks to the fetus. In some situations, this may be acceptable if the medication is prescribed for a life-threatening situation or for a disease for which safer drugs cannot be used or do not exist. The nurse should help the woman contact her primary care provider during the OB visit to discuss the continued used of the medication. The nurse should not advise the woman to just stop the medication; she needs to discuss this with the primary care provider, but that needs to be accomplished quickly. The nurse should not encourage substituting herbal preparations or cutting the medication dose in half.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- A parent wonders why his baby needs all the blood samples to test for different diseases. What response by the nurse is best?
| A. | “Many serious disorders can be found before they cause damage or death.” |
| B. | “This is a hospital policy; if you want to opt out you need to sign a waiver.” |
| C. | “We see a lot of these diseases in our community so we screen for them.” |
| D. | “Your baby doesn’t need the blood tests if you don’t want them.” |
ANS: A
Newborn screening was the first population-based screening program to test for genetic conditions. Many diseases that cause an increased risk for infection, liver damage, mental retardation, or even death can often be identified through these tests. The hospital may require an opt-out waiver, but this is not the best initial answer. Some of the diseases are uncommon but potentially devastating, so the screening is not done for diseases only seen in one community. Parents can opt out of some or all tests, depending on the state in which they live, but the nurse should first educate the parent about why the tests are so important.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A woman is admitted with rubella. What action by the nurse manager is best?
| A. | Place the woman on droplet precautions. |
| B. | Put the woman in contact isolation. |
| C. | Tell the nurses to use good hand-washing techniques. |
| D. | Use standard precautions only. |
ANS: A
Rubella (German measles) is spread through respiratory droplets. The patient should be put on droplet precautions. Nurses should use good hand-washing techniques for all patient contacts.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate
PTS: 1
- A newborn nursery nurse is arranging genetic screening for several newborns. The nurse should educate the parents of which baby about screening for Tay-Sachs disease?
| A. | African American baby |
| B. | Asian baby |
| C. | Caucasian baby |
| D. | Jewish baby |
ANS: D
Tay-Sachs disease is the most common genetic disease among people of Jewish ancestry. The nurse should educate the parents with Jewish ancestry about screening for this disease.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A pediatric nurse is reviewing the chart of a new school-age patient. The chart notes the child is on a phenylalanine-free diet. What does the nurse conclude about this patient?
| A. | Has Canavan disease |
| B. | Has familial dysautonomia |
| C. | Has phenylketonuria (PKU) |
| D. | Has Tay-Sachs disease |
ANS: C
Children with PKU are born without an enzyme to metabolize the amino acid phenylalanine. If not treated with a life-long phenylalanine-free diet, the child can have severe mental and physical retardation. The other diseases do not require this diet.
Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate
PTS: 1
- A student has read that fetal development progresses in a cephalocaudal fashion and asks the faculty member for clarification. What explanation by the faculty member is best?
| A. | From feet to head |
| B. | From head to feet |
| C. | Inward to outward |
| D. | Outward to inward |
ANS: B
Cephalocaudal development proceeds from head to feet.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- A nursing student asks the faculty member to define “lanugo.” Which description is best?
| A. | Fine, downy hair on the fetus |
| B. | Immune complexes in the amniotic fluid |
| C. | Initial scalp hair on the fetus |
| D. | Outer layer of pale, wrinkled skin |
ANS: A
Lanugo is the fine, downy hair seen on fetuses.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
MULTIPLE RESPONSE
- The perinatal nurse explains to a childbirth class that which of the following are the primary functions of the placenta? (Select all that apply.)
| A. | Creates blood vessels in the fetus |
| B. | Protects the fetus from pathogens |
| C. | Provides hormones that maintain the pregnancy |
| D. | Removes waste products from the fetus |
| E. | Transfers nutrients to the fetus |
ANS: B, C, D, E
The placenta serves several functions, including providing nutrition and oxygen to the fetus, carrying waste products away from the fetus, providing hormones that help to maintain the pregnancy, and protecting the fetus from pathogens. The placenta does not create blood vessels in the fetus.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The perinatal nurse explains to a student the different mechanisms by which substances are transported across the placenta. Which mechanisms are included? (Select all that apply.)
| A. | Active diffusion |
| B. | Bulk flow |
| C. | Endocytosis |
| D. | Osmosis |
| E. | Pinocytosis |
ANS: A, B, C, E
Several mechanisms exist to transport substances across the placenta. These include passive or simple diffusion, facilitated diffusion, active diffusion, pinocytosis, endocytosis, bulk flow, accidental capillary breaks, and independent movement.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nursing instructor is explaining mechanisms of substance transport across the placenta. Which substances require facilitated diffusion? (Select all that apply.)
| A. | Carbon dioxide |
| B. | Fatty acids |
| C. | Globulins |
| D. | Glucose |
| E. | Oxygen |
ANS: D, E
Glucose and oxygen require facilitated diffusion to cross the placenta. Carbon dioxide and fatty acids move by simple diffusion. Globulins move via pinocytosis and endocytosis.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- The nursing instructor is explaining the function of the placenta in hormone production. Which hormones does the instructor include in this discussion? (Select all that apply.)
| A. | Estrogens |
| B. | Human chorionic gonadotropin |
| C. | Human placental lactogen |
| D. | Luteinizing hormone |
| E. | Progesterone |
ANS: A, B, C, E
The placenta produces four main hormones: estrogens, human chorionic gonadotropin, human placental lactogen, and progesterone. Luteinizing hormone is produced in the anterior pituitary gland.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- During prenatal class, the nurse teaches expectant couples about the importance of the amniotic fluid and its functions. What functions does the nurse describe? (Select all that apply.)
| A. | Cushions the fetus from mechanical injury |
| B. | Facilitates symmetrical growth of fetal limbs |
| C. | Helps regulate fetal body temperature |
| D. | Provides nourishment to the fetus |
| E. | Prevents the amnion from adhering to the fetus |
ANS: A, B, C, E
Amniotic fluid allows for symmetrical fetal growth, cushions the fetus from mechanical injury, and aids in fetal musculoskeletal development. Amniotic fluid prevents adherence of the amnion to the fetus and is essential for normal fetal lung development and temperature regulation. Amniotic fluid does not provide nourishment to the fetus.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- The nurse explaining fetal growth and development to a class of expectant parents describes events that occur during weeks 9 to 12 as which of the following? (Select all that apply.)
| A. | External genitalia are distinguishable. |
| B. | Hair appears on the eyebrows and head. |
| C. | Intestines become visible in the abdomen. |
| D. | Ossification centers appear in the skeleton. |
| E. | Rapid eye movements occur and fingernails form. |
ANS: A, C, D
During gestational weeks 9 to12 several events occur: distinguishable external genitalia appear, ossification centers in the skeleton appear, and the intestines leave the umbilical cord to become an abdominal organ. Hair growth occurs during weeks 17 to 20. The baby develops rapid eye movements and fingernails during weeks 21 to 25.
Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate
PTS: 1
- A perinatal nurse is assessing a woman who is approximately 10 weeks pregnant. The woman smells like cigarette smoke. What actions by the nurse are best? (Select all that apply.)
| A. | Advise her to stop smoking now so that the baby can be of normal weight. |
| B. | Ask the woman if either she or her partner smokes. |
| C. | Determine how many cigarettes she smokes a day. |
| D. | Describe the behavior problems her child may develop. |
| E. | Explain that nicotine deprives the fetus of oxygen. |
ANS: A, B, E
If the nurse smells cigarette smoke, assessing the woman for smoking or exposure to second-hand smoke is appropriate. Exposure to nicotine causes vasoconstriction and deprives the fetus of essential oxygen and nutrients needed for growth and development. Consequences include low birth weight and small-for-gestational-age babies. If the woman stops smoking during the first trimester, the baby will have a similar birth weight to babies whose mothers did not smoke. The absolute number of cigarettes per day is not as important as determining if she does smoke and advising her to quit now. Childhood behavior problems are often attributed to cocaine use during pregnancy.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult
PTS: 1
- A nurse is assessing a woman for TORCH infections. What diseases are included in this acronym? (Select all that apply.)
| A. | Cytomegalovirus |
| B. | Hepatitis B |
| C. | Roseola |
| D. | Toxoplasmosis |
| E. | Varicella zoster |
ANS: A, B, D, E
TORCH stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus. “Other infections” include varicella zoster virus, human immunodeficiency virus, hepatitis B virus, human parvovirus B19, and syphilis. Roseola is not included.
Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
OTHER
- Match each term with its definition or description.
| a. Autosome | 1. _____ Large female chromosome |
| b. X chromosome | 2. _____ Gene pair in which the gene pairs are different |
| c. Y chromosome | 3. _____ Genetic makeup of an individual |
| d. Homozygous | 4. _____ Observable expression of a person’s genotype |
| e. Heterozygous | 5. _____ Non-sex chromosome common to both males and females |
| f. Genotype | 6. _____ Smaller male chromosome |
| g. Genome | 7. _____ Gene pair in which both genes are identical |
| h. Phenotype | 8. _____ Complete set of genes present in a person |
ANS:
1b, 2e, 3f, 4h, 5a, 6c, 7d, 8g
An autosome is a non-sex chromosome common to both males and females. The X chromosome is the larger female chromosome, whereas the Y chromosome is the smaller male chromosome. Homozygous gene pairs have identical genes, whereas heterozygous gene pairs have differing genes. A genotype is the genetic makeup of an individual. The genome is the complete set of genes present in each person. The phenotype is the observable genetic differences expressing a person’s genotype, such as hair and eye color.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy
PTS: 1
- Match each TORCH disease with its possible effects on the newborn or characteristics. Diseases may be used more than once or not at all.
| a. Toxoplasmosis | 1. _____ Without intervention, maternal transmission to the fetus is about 25% |
| b. Rubella | 2. _____ The most common viral infection in the fetus |
| c. Cytomegalovirus | 3. _____ Bullae, microcephaly, hydrencephaly, and encephalitis can occur |
| d. Herpes simplex virus | 4. _____ No known risks if infection occurs after 20 weeks’ gestation |
| e. Human immunodeficiency virus (HIV) | 5. _____ Late manifestations include keratitis, snuffles, deafness, and bowing of the shins |
| f. Varicella zoster virus | 6. _____ Symptoms in the mother seem to be “flu-like” |
| g. Syphilis | 7. _____ Maternal infection in the first trimester can lead to spontaneous abortion |
| 8._____Maternal infection during the first trimester leads to a 20% chance of fetal infection |
ANS:
1e, 2c, 3d, 4f, 5g, 6a, 7c, 8b
Toxoplasmosis has symptoms often referred to as “flu-like.” Maternal infection with rubella in the first trimester leads to a 20% chance of the fetus being infected. Cytomegalovirus is the most common viral infection in the fetus, and spontaneous abortion may result from maternal CMV infection in the first trimester. Herpes simplex infection leads to manifestations such as bullae, microcephaly, hydrencepahly, and encephalitis. Without medical intervention, vertical (maternal-to-child) transmission of HIV is about 25%. Varicella zoster virus carries no known risk to the fetus after 20 weeks’ gestation. Late syphilis symptoms include keratitis, snuffles, deafness, and bowing of the shins.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
PTS: 1
- Trace a drop of blood through the fetal circulation using the structures provided.
_____ Aorta
_____ Ductus arteriosus
_____ Ductus venosus
_____ Foramen ovale
_____ Head and extremities
_____ Left ventricle
_____ Right atrium
_____ Superior vena cava
ANS:
5, 8, 1, 3, 6, 4, 2, 7
Blood travels through the fetus in a unique pattern. Most blood enters the inferior vena cava through the ductus venosus, empties into the right atrium, and passes through the foramen ovale into the left atrium. It then travels to the left ventricle, into the aorta, and out into the rest of the systemic circulation. Blood returns to the heart from the head through the superior vena cava, goes through the right side of the heart before entering the pulmonary artery, or bypasses the lungs and enters the aorta through the ductus arteriosus.
Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult
