Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig - Test Bank

Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig – Test Bank

 

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Sample Questions Are Posted Below

 

Chapter 05_LO 01_Q01

The clinic nurse is returning phone calls. Which call should the nurse return first?

1. 22-year-old reporting that she has menstrual cramps and vomiting every month
2. 17-year-old asking if there is a problem with using one tampon for a whole day
3. 46-year-old mother of a teen wondering if her daughter should be on birth control
4. 34-year-old requesting information on douching after intercourse

Correct Answer: 2

Rationale:

1. Because vomiting can lead to dehydration, this client is not completely normal or stable, but is not the top priority.
2. Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially life-threatening condition. This client needs education on the danger of using one tampon more than 3–6 hours.
3. A sexually active teen could be at risk for unintended pregnancy, as well as sexually transmitted infections. However, it is unclear whether the daughter is sexually active. This call is a low priority.
4. Douching is not recommended, because the practice causes a change in the pH of the vagina and impacts the normal flora, predisposing clients to candidiasis and bacterial vaginosis. This client requires education, but is not a top priority.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 5.1 Identify appropriate nursing care based on the results of the client’s sexual history.

 

Chapter 05_LO 01_Q02

 

When taking a sexual history from a client, the nurse should:

1. Ask questions that the client can answer with a “yes” or “no.”
2. Ask mostly open-ended questions.
3. Have the client fill out a comprehensive questionnaire, and review it after the client leaves.
4. Try not to make much direct eye contact.

 

Correct Answer:  2

 

Rationale:

1. “Yes-or-no” answers indicate closed-ended questions that will not encourage the client to share the necessary information.
2. Open-ended questions are often useful in eliciting information because they encourage more than a one-word answer.
3. Filling out a questionnaire and reviewing it after the client leaves is not appropriate. It should be reviewed in the presence of the client, encouraging conversation regarding the results.
4. It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Eye contact encourages a connection between the involved parties, and shows care and concern.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.1 Identify appropriate nursing care based on the results of the client’s sexual history.

 

 

Chapter 05_LO2 _Q03

Which patient would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea?

1. 17-year-old, has never had a menstrual cycle
2. 16-year-old, had regular menses for four years, but has had no menses in four months
3. 19-year-old, regular menses for five years that have suddenly become painful
4. 14-year-old, irregular menses for one year, experiences cramping every cycle

Correct Answer:  4

Rationale:

1. This is primary amenorrhea, or the lack of menses.
2. Secondary amenorrhea is the term used when a client has had regular cycles that cease.
3. Secondary dysmenorrheal is the sudden onset of pain and discomfort with menses.
4. Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle, and consistently continues to be painful each month.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Diagnosis

Learning Outcome: 5.2 Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

 

Chapter 05_LO2 _Q04

 

A client asks her nurse, “Is it okay for me to take a tub bath during the heavy part of my menstrual cycle?” The correct response by the nurse is:

1. “Tub baths are contraindicated during menstruation.”
2. “You should shower and douche daily instead.”
3. “Either a bath or a shower is fine at that time.”
4. “You should limit bathing and use a feminine deodorant spray during menstruation.”

Correct Answer: 3

Rationale:

1. Bathing, whether it is a tub bath or shower, is as important during menses as at any other time, to reduce any odor associated with menstruation.
2. Douching should be avoided during menstruation to prevent the risk of forcing blood into the pelvic cavity, which can contribute to endometriosis.
3. Bathing, whether it is a tub bath or shower, is as important during menses as at any other time, to reduce any odor associated with menstruation.
4. Feminine deodorant sprays are unnecessary. Bathing is sufficient hygiene.

Cognitive Level: Application

Category of Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 5.2 Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

 

Chapter 05_LO03 _Q05

What should the gynecology clinic nurse recommend for the client experiencing premenstrual syndrome?

1. “Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding should begin.”
2. “Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin.”
3. “Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of bleeding.”
4. “Increase your consumption of red meat when you feel symptoms, and eat three large meals per day.”

Correct Answer:  2

Rationale:

1. Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and colas should be limited throughout the month.
2. Regular aerobic activity helps to decrease PMS symptoms.
3. 1,200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come from supplements or be obtained through dietary intake of dairy and soy products.
4. Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating several small meals per day rather than three large meals.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 5.3 Discriminate between the signs, symptoms, and nursing management of women with dysmenorrheal and premenstrual syndrome.

 

Chapter 05_LO03 _Q06

 

A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for two years. The most likely cause for the client’s complaint is:

1. Primary dysmenorrhea.
2. Secondary dysmenorrhea.
3. Menorrhagia.
4. Hypermenorrhea.

Correct Answer: 2

Rationale:

1. Primary dysmenorrhea is defined as cramps without underlying disease.
2. Secondary dysmenorrhea is associated with pathology of the reproductive tract, and usually appears after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device.
3. Menorrhagia is excessive, profuse flow.
4. Hypermenorrhea is an abnormally long menstrual flow.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Diagnosis

Learning Outcome: 5.3 Discriminate between the signs, symptoms, and nursing management of women with dysmenorrheal and premenstrual syndrome.

 

 

Chapter 05_LO 04_Q07

Which issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply.

1. Cultural perspectives on menstruation and pregnancy
2. Efficacy of the method
3. Future childbearing plans
4. Whether the client is a vegetarian
5. Age at menarche

Correct Answers:  1, 2, 3

Rationale:

1. Cultural and religious beliefs, practices, and sanctions must be considered when discussing contraception with clients in order to avoid insulting a client for whom a particular type of contraceptive method is prohibited by her background.
2. Efficacy of contraceptive methods vary, and must be considered when discussing contraception with clients. When pregnancy is medically contraindicated, high-efficacy methods (such as an IUD, hormonal methods, or sterilization) should be discussed with the client. When the client would like to avoid pregnancy at this time, but pregnancy is not medically contraindicated, lower-efficacy methods (such as diaphragm, cervical cap, or Today sponge) could be discussed.
3. If a client desires children in the future, sterilization methods would be inappropriate to discuss.
4. Vegetarianism has no impact on contraceptive method use.
5. Age at menarche has no impact on contraceptive method use.

Cognitive level:  Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 04_Q08

 

A client wants to use the vaginal sponge as a method of contraception. Which of the following statements indicate that she will need further instruction? Select all that apply.

1. “I need to use a lubricant prior to insertion.”
2. “I need to add spermicidal cream prior to intercourse.”
3. “I need to moisten it with water prior to use.”
4. “I need to leave it in no longer than 6 hours.”

 

Answer: 1, 2, 4

 

Rationale:

1. A lubricant is not needed, as the sponge is moistened with water prior to insertion.
2. Spermicidal cream is not needed, because it is already in the sponge.
3. To activate the spermicide in the vaginal sponge, it must be moistened thoroughly with water.
4. The sponge can remain in place for 24 hours.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 04_Q09

 

Which client is not a good candidate for Depo-Provera (DMPA)?

1. One who wishes to get pregnant within three months
2. One who wishes to breastfeed
3. One with a vaginal prolapse
4. One who weighs 200 pounds

Correct Answer: 1

Rationale:

1. Return of fertility after the use of Depo-Provera takes an average of nine months.
2. Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera.
3. There is no correlation between a vaginal prolapse and use of Depo-Provera.
4. There is no correlation between one’s weight and use of Depo-Provera.

Cognitive Level: Analysis

Category of Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 5.4 Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

 

Chapter 05_LO 05_Q10

The home care nurse is working with a 40-year-old developmentally delayed adult who has had no gynecologic well-woman care since her teens. What screenings are recommended for this client?

1. STI screening and Pap smear
2. Clinical breast exam, Pap smear, and serum calcium levels
3. Clinical breast exam, Pap smear, and mammogram
4. Pap smear and vaccination update

Correct Answer:  3

Rationale:

1. A Pap smear is recommended, but STI screening might or might not be indicated, based on whether the client is sexually active and using contraception or not. Sexually transmitted infections are more common in teens and those in their early 20s.
2. A clinical breast exam and Pap smear are recommended gynecologic examinations for women, but a serum calcium level is not part of a routine gynecologic routine physical exam. When any part of an answer is incorrect, the entire answer is incorrect.
3. A clinical breast exam, Pap smear, and mammogram are recommended gynecologic screenings for 40-year-old women.
4. A Pap smear is a recommended gynecologic screening for an adult woman, but a vaccination update is not considered part of gynecologic care.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.5 Support clients in following and partaking in basic gynecologic screening procedures indicated for well women.

 

Chapter 05_LO 05_Q11

 

A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate the likelihood that she understands how to detect changes such as lumps in her breast? Select all that apply.

1. “I should perform BSE one week prior to the start of my period.”
2. “When I reach menopause, I will perform BSE every two months.”
3. “Knowing the texture and feel of my breasts is important.”
4. “I should inspect my breasts in a circular manner.”
5. “I should inspect my breasts while in a supine position, with my arms at my sides.”

Correct Answers: 3, 4

Rationale:

1. BSE should be performed one week after the start of each menstrual period, because hormonal levels are lowest, and allow closer exam of softer breast tissue.
2. BSE should be performed monthly, on the same day each month, during menopause.
3. A woman who knows the texture and feel of her own breasts is far more likely to detect changes that develop.
4. Checking breasts in a circular manner, feeling all parts of the breast, provides adequate palpation and possible detection of lumps.
5. The breasts should be inspected while standing with arms at sides.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 5.5 Support clients in following and partaking in basic gynecologic screening procedures indicated for well women.

 

Chapter 05_LO 06_Q12

What is the best indicator that the client is experiencing menopause?

1. No menses for eight consecutive months
2. Hot flashes and night sweats
3. High serum FSH with low serum estrogen
4. Diagnosed with osteoporosis four months ago

Correct Answer:  3

Rationale:

1. Menopause is defined as twelve months of amenorrhea.
2. Although hot flashes and night sweats are common in menopause, lab values or twelve months of amenorrhea are better indicators.
3. Examining serum levels of the hormones FSH and estrogen is a very accurate indication of menopause.
4. Menopause is not the only cause of osteoporosis, therefore the diagnosis of osteoporosis four months ago is not an indicator of menopause.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 5.6 Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

 

Chapter 05_LO 06_Q13

 

A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during sexual intercourse, and asks, “What should I use as a lubricant?” The nurse should recommend:

1. Petroleum jelly.
2. A water-soluble lubricant.
3. Body cream or body lotion.
4. Less-frequent intercourse.

Correct Answer: 2

Rationale:

1. Petroleum jelly is not water-soluble, and not recommended as a lubricant.
2. A water-soluble lubricant should be used so it does not cause irritation.
3. Body creams and body lotions are not water-soluble.
4. Less-frequent intercourse does not increase vaginal lubrication.

Cognitive Level: Application

Category of Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 5.6 Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

 

Chapter 05_LO 07_Q14

The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further education?

1. “My daughter is not to blame for the violence in her marriage.”
2. “Everyone experiences anger and hitting in a relationship.”
3. “Abusers can be either husbands or boyfriends or girlfriends.”
4. “The ‘honeymoon period’ follows an episode of violence.”

Correct Answer:  2

Rationale:

1. The victims of violence are not the cause of the violence. Abusers are responsible for their violent behavior. Avoiding blaming and shaming of victims of domestic violence is important to establish a therapeutic relationship.
2. Violence is not a normal part of intimate relationships. This statement indicates that the client has likely been a victim of domestic violence.
3. Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be experienced in any intimate relationship, regardless of whether the couple is straight, gay, or lesbian, and both within marriage and outside of marriage.
4. An acute episode of battering is followed by the tranquil phase, or honeymoon period, when the abuser is often repentant and promising never to abuse the victim again. In some cases, the honeymoon period is the only time there is a lack of building tension.

Cognitive level: Analysis

Category of Client Need: Psychosocial Integrity

Nursing Process: Evaluation

Learning Outcome: 5.7 Examine the nurse’s role in screening and caring for women who have experienced domestic violence or rape.

 

Chapter 05_LO 07_Q15

 

When a woman who has been raped is admitted to the Emergency Department, which nursing intervention has priority?

1. Explain exactly what will need to be done to preserve legal evidence.
2. Assure the woman that everything will be all right.
3. Create a safe, secure atmosphere for the woman.
4. Contact family members.

Correct Answer: 3

Rationale:

1. Explaining exactly what will need to be done to preserve legal evidence is not the top priority.
2. Assuring the woman that everything will be all right is not the top priority, and is giving false promise.
3. The first priority in caring for a survivor of a sexual assault is to create a safe, secure atmosphere that will allow the woman to process what has happened.
4. Contacting family members is not the top priority, and can wait until a safe environment is established.

Cognitive Level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 5.7 Examine the nurse’s role in screening and caring for women who have experienced domestic violence or rape.