1. A woman is to have a routine gynecological examination to

1. A woman is to have a routine gynecological examination tomorrow….  1.         A woman is to have a routine gynecological examination tomorrow. What instructions should the nurse give this client?            1.         “Bring a urine sample with you     2.         ” Be sure to drink plenty of fluids in the morning before you come so your bladder will be full.”            3.         “Be sure not to douche today or tomorrow.”            4.         “Don’t eat breakfast.  You will be able to eat right after the exam.” 2.         A 45-year-old woman has been having menorrhagia and metrorrhagia for several months.  She is also feeling very tired and run down. She asks why she is so tired.  The nurse understands that her fatigue is most likely related to                     1.         Emotional changes associated with menopause.            2.         Psychological exhaustion produced by continuous worry about the cause of her illness.            3.         Interference with normal digestion due to pressure on the small bowel.            4.         Decreased oxygen carrying capacity of the blood due to chronic loss of iron stores. 3.         A client in the women’s clinic tells the nurse she thinks she wants to go on the pill. Which information is most accurate about this type of contraception?            1.         The pill is an irreversible form of contraception.            2.         The pill inhibits ovulation.            3.         The pill helps to protect against sexually transmitted diseases.            4.         The pill causes periods to stop. 4.         A 46-year-old woman visits her gynecologist because she has been spotting.  She is to be evaluated for carcinoma of the cervix. If she has cancer of the cervix she is most likely to report that vaginal spotting occurred            1.         on arising.            2.         while sitting.            3.         after intercourse.            4.         when climbing stairs.    5.         The nurse is assessing a woman who thinks she is pregnant. Which information from the client is most significant in confirming the diagnosis of pregnancy?              1.         She is experiencing nausea before bedtime and after meals.            2.         She says she has gained six pounds and her slacks are tight.            3.         She has noticed it is difficult to sleep on her “stomach” because her breasts are tender.            4.         She has a history of regular menstrual periods since age 13 and she has missed her second period. 6.         After examination by the physician, the client tells the nurse the physician said she had positive Chadwick’s and Goodell’s signs. She asks the nurse what this means. What is the best response for the nurse to make?              1.         “Chadwick’s sign is a dark blue coloring of the vagina and cervix.  Goodell’s sign is softening of the cervix of the uterus.”            2.         “These help to confirm pregnancy.  They refer to color changes and changes in the uterus caused by increased hormones of pregnancy.”            3.         “Those are medical terms.  You don’t need to be concerned about them.”            4.         “It refers to changes that occasionally happen in pregnancy but are unlikely to cause problems.” 7.         A woman whose pregnancy has just been confirmed asks when her baby is due.   Her last menstrual period started May 28.  The nurse uses Nagele’s rule to calculate the EDC (estimated date of confinement).                    1.         Feb. 21            2.         Feb. 28            3.         Mar. 7            4.         Mar. 28  8.         In establishing a teaching plan for a client who is in the first trimester of pregnancy, the nurse identifies a long list of topics to discuss. Which is most appropriate for the first visit?                1.         Preparation for labor and delivery.            2.         Asking the woman what s and concerns she has about parenting.            3.         Nutrition and activity during pregnancy.            4.         Dealing with heartburn and abdominal discomfort.  9.         When a woman in early pregnancy is leaving the clinic, she blushes and asks the nurse if it is true that sex during pregnancy is bad for the baby. The nurse’s best response is to say            1.         “The baby is protected by his sac.  Sex is perfectly all right.”            2.         “It is unlikely to harm the baby.  What you do with your personal life is your concern.”            3.         “In a normal pregnancy, intercourse will not harm the baby.  However, many women experience a change in desire.  How are you feeling?”            4.         “Intercourse during pregnancy is usually all right, but you need to ask the doctor if it is acceptable for you.” 10.      The nurse is teaching a prenatal class. A woman in the class who is 8 months pregnant asks why her feet swell.  The nurse includes which of the following information in the answer?                  1.         Swollen feet during pregnancy can indicate a serious problem.            2.         The enlarging baby reduces venous return causing retention of fluid in the feet and ankles.            3.         Swelling of the feet during pregnancy is usually related to pregnancy induced hypertension.      4.         Swelling of the feet during pregnancy is due to the increased blood volume and will disappear after delivery. 11.      A 25-year-old is pregnant for the third time.  She is two months pregnant.  She had rheumatic fever at age 15 and developed a systolic murmur.  She has been maintained on prophylactic penicillin. She reports exertional dyspnea.  What is the most appropriate instruction for the nurse to give her?                       1.         “Try to keep as active as possible, but eliminate any activity which you find tiring.”            2.         “Carry on all your usual activities but learn to work at a slower pace.”            3.         “Avoid heavy housework, shopping, stair climbing, and all unnecessary physical effort.”            4.         “Get someone to do your housework and stay in bed or in a wheelchair.”       12.      A pregnant woman who had rheumatic heart disease asks the nurse why she developed symptoms of heart failure during her previous pregnancies when she had not had such symptoms before becoming pregnant. The nurse’s response should be based on which concept?         1.         Her heart was overburdened by the necessity of pumping blood through the vessels of the fetus.      2.         Maximal cardiac contractile force is required to produce amniotic fluid as a transudate of maternal blood.      3.         The increase of blood volume during pregnancy constituted an excessive load for her damaged heart.      4.         She undoubtedly had the symptoms before pregnancy but they became more pronounced when she became pregnant. 13.      The nurse is caring for a woman who has been diagnosed as having pregnancy induced hypertension.  The physician tells her to take it easy at home and rest frequently. The nurse should teach the woman that when she rests she should            1.         Alternately sit up and lie down.             2.         Sit in a semi – sitting position with feet elevated.            3.         Lie in a supine position with two pillows.            4.         Lie mainly on her side. 14.      A pregnant woman comes for her 6 month check up and mentions to the nurse that she is gaining so much weight that even her shoes and rings are getting tight. What should the nurse plan to include in her care?            1.         Teaching about the basic food groups and the importance of a well balanced diet.            2.         Further assessment of her weight, blood pressure and fundal height.            3.         Encouraging the use of a comfortable walking shoe with a medium heel.            4.         Reassurance that weight gain is normal as long as it does not exceed 25 pounds.  15.      During her last month of pregnancy, a client tells the nurse she is “sick and tired of this whole thing.  I can hardly wait to get this out of me.” What is the most appropriate initial response for the nurse to make?              1.         Refer her to the psychiatric social worker, since she should be experiencing a positive response to her infant at this stage of pregnancy.            2.         Say to her, “I know exactly how you feel.  I felt like that when I had my last baby.”      3.         Say, “It sounds like you are ready for labor.  Do you have any s about your coming labor?”            4.         Say to her, “You are getting tired of being pregnant and the time is dragging?” 16.      An oxytocin challenge test is ordered for a woman who is 42 weeks pregnant. What should the nurse plan for in the care of this client?                 1.         Place her in the supine position during the test.            2.         Keep her NPO before the test.            3.         Have her empty her bladder before the test.            4.         Prepare the client for the insertion of internal monitors 17.      The nurse is caring for a laboring woman who developed congestive heart failure during pregnancy. Nursing care during labor differs from that of the non-cardiac woman in that the woman with cardiac disease should be                1.         given continuous intravenous infusion of a 10% glucose solution in water throughout labor.            2.         denied both solid and liquid feedings from the beginning of the first stage of labor.            3.         encouraged to drink small quantities of liquid at frequent intervals throughout labor.            4.         given a strong saline enema early in labor to withdraw tissue fluid by osmosis. 18.      A woman who has mitral stenosis is in labor.  She is 4 cms dilated and 100% effaced with contractions every 4 minutes lasting 45 seconds. The nurse assesses her for the development of impending congestive heart failure.  Which of her vital signs is the most reliable indicator of impending congestive heart failure?                 1.         Temperature.            2.         Pulse rate.            3.         Respiratory rate.            4.         Blood pressure.  19.      The nurse is caring for a laboring woman who has a history of rheumatic heart disease. How should the nurse position her during labor?            1.         Supine.            2.         Semi-sitting            3.         Side-lying.            4.         Sitting. 20.      The nurse is caring for a laboring woman who has a history of rheumatic heart disease. Which instructions should the nurse give to her during the second stage of labor?                 1.         Avoid prolonged bearing down.            2.         Breathe shallowly and rapidly.            3.         Sit on the side of the bed.            4.         Sleep between contractions. 21.      The physician advised a woman who has mitral stenosis and developed congestive heart failure during pregnancy not to have any more children.  She is discussing the types of contraceptives available. The nurse knows that estrogen-progesterone combination pills are contraindicated for her.  The primary reason for this is that this medication                       1.         might cause excessive retention of extracellular fluid.            2.         necessitates physically taxing monthly trips to the pharmacy for prescription refills.            3.         would be subconsciously rejected because of its identification with cardiac medications.            4.         is often omitted by a patient with the repressed need to incur discomfort and illness. 22.      The nursing care plan for a woman who has placenta abruptio should include careful assessment for signs and symptoms of                        1.         jaundice.            2.         hypovolemic shock.            3.         impending convulsions.            4.         hypertension. 23.      The nurse is caring for a woman who had a right simple mastectomy earlier in the day.  How should the nurse position this woman?            1.         On her right side.            2.         Supine with both arms elevated.            3.         Semi-sitting with the right arm elevated on pillows.            4.         Trendelenburg.  24.      Which of the following patients seen in clinic needs the most immediate attention?            1.         A 28-year-old, G1, P0, who is 30 weeks gestation, has a blood pressure of 145/95.            2.         A 32-year-old, G2, P1, who is 28 weeks gestation complains of abdominal pain and is bleeding.            3.         A 34-year-old, G1, P0 who is 12 weeks gestation states she has vomited once or twice a day every day for the last week.            4.         A 35-year-old, G#, P2 who is 36 weeks gestation says she frequently has cramp like pains that disappear after a few minutes. 25.      The nurse is caring for a woman who has Type I diabetes mellitus and has just delivered a 10-pound infant.  The nurse should observe both mother and baby for which potential problem?            1.         Respiratory distress.            2.         Metabolic acidosis.            3.         Hemorrhage.            4.         Hypoglycemia.Health Science Science Nursing MED SURG 200

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