Maternal Child Nursing Care in Canada 1st By Perry Hockenberry Wilson – Test Bank
To Purchase
this Complete Test Bank with Answers Click the link Below
If face any problem or
Further information contact us At tbzuiqe@gmail.com
Sample Questions
Chapter 04: Health Promotion
Test Bank
MULTIPLE CHOICE
1. Which
statement reflects one purpose of preconception care?
|
a. |
Ensure that pregnancy
complications do not occur. |
|
b. |
Identify women who should
not become pregnant. |
|
c. |
Encourage healthy
lifestyles for families desiring pregnancy. |
|
d. |
Ensure that women know
about prenatal care. |
ANS: C
Preconception counselling guides couples in how to avoid
unintended pregnancies, how to identify and manage risk factors in their lives
and their environment, and how to identify healthy behaviours that promote the
well-being of the woman and her potential fetus. Preconception care does not ensure
that pregnancy complications will not occur. In many cases, problems can be
identified and treated and may not recur in subsequent pregnancies. In many
instances, counselling enables behaviour modification before damage is done, or
a woman can make an informed decision about her willingness to accept potential
hazards. If a woman is seeking preconception care, she likely is aware of
prenatal care.
DIF: Cognitive Level:
Comprehension REF: page
43 OBJ: 1
TOP: Nursing Process: Planning
MSC: CRNE: HW-1
2. The
nurse who provides preconception care understands which of the following
statements about preconception care?
|
a. |
It is designed for women
who have never been pregnant. |
|
b. |
It includes risk factor
assessments for potential medical and psychological problems but does not
consider socioeconomic status. |
|
c. |
It avoids teaching about
safe sex, as the woman is seeking pregnancy. |
|
d. |
It could include
interventions to reduce substance use and abuse. |
ANS: D
If assessment indicates a drug problem, treatment can be
suggested or arranged. Preconception care is designed for all women of
childbearing potential, not just those who have never been pregnant. Risk
factor assessment includes consideration of socioeconomic status and its effect
on the determinants of health. Health promotion can include teaching about safe
sex.
DIF: Cognitive Level:
Comprehension REF: page
47 OBJ: 3
TOP: Nursing Process: Implementation
MSC: CRNE: HW-9
3. What
should nurses be aware of concerning the use and abuse of legal drugs or
substances?
|
a. |
Although cigarette smoking
causes a number of health problems, it has little direct effect on
maternity-related health. |
|
b. |
About 25% of women ages 18
to 24 report frequent excessive alcohol consumption. |
|
c. |
Coffee is a stimulant that
can interrupt body functions and has been related to birth defects. |
|
d. |
Prescription
psychotherapeutic drugs taken by the mother do not affect the fetus;
otherwise, they would not have been prescribed. |
ANS: B
Women aged 18 to 19 comprise 15% of this figure, whereas about
11% of women aged 20 to 24 reported excessive drinking above the Canadian
guidelines. Although a very small percentage of childbearing women have
alcohol-related problems, alcohol abuse during pregnancy has been associated
with a number of negative outcomes. Cigarette smoking impairs fertility and is
a cause of low birth weight. Caffeine consumption has not been related to birth
defects. Psychotherapeutic drugs have some effect on the fetus, and that risk
must be weighed against their benefit to the mother.
DIF: Cognitive Level:
Knowledge
REF: page 47
OBJ: 3
TOP: Nursing Process:
Planning
MSC: CRNE: HW-9
4. The
use of methamphetamine (meth) has been steadily increasing in Canada. What must
the nurse be cognizant of in relation to methamphetamine use, to provide
adequate nursing care to this patient population?
|
a. |
It is used only by those of
a higher socioeconomic status, because of the expense. |
|
b. |
It contains amphetamine, a
central nervous system stimulant, as the active ingredient. |
|
c. |
It manifests a response
similar to marijuana when smoked. |
|
d. |
Its use by fertile women
decreases their sexual activity. |
ANS: B
Clinical manifestations of methamphetamine use are euphoria,
abrupt awakening, increased energy, talkativeness, elation, agitation,
hyperactivity, irritability, grandiosity, diaphoresis, weight loss, insomnia,
hypertension, increased temperature, ectopic heartbeat, urinary retention,
constipation, dry mouth, paranoid delusions, and violent behaviour. Meth is
relatively cheap and is “hooking” more people across the socioeconomic
spectrum. When smoked, the behaviour of the patient is similar to that resulting
from use of cocaine, not similar to marijuana use. Users of meth can experience
feeling hypersexual and uninhibited, leading to unsafe sexual practices.
DIF: Cognitive Level:
Comprehension REF: page
48 OBJ: 3
TOP: Nursing Process: Assessment
MSC: CRNE: HW-9
5. Which
opiate causes euphoria, relaxation, drowsiness, and detachment from reality and
has possible effects on the pregnancy, including pre-eclampsia, intrauterine
growth restriction, and premature rupture of membranes?
|
a. |
Heroin |
|
b. |
Alcohol |
|
c. |
PCP |
|
d. |
Cocaine |
ANS: A
The opiates include opium, heroin, meperidine, morphine,
codeine, and methadone. The signs and symptoms of heroin use are euphoria,
relaxation, relief from pain, detachment from reality, impaired judgement,
drowsiness, constricted pupils, nausea, constipation, slurred speech, and
respiratory depression. Possible effects on pregnancy include pre-eclampsia,
intrauterine growth restriction, miscarriage, premature rupture of membranes,
infections, breech presentation, and preterm labour. Alcohol, PCP, and cocaine
are not opiates.
DIF: Cognitive Level:
Comprehension REF: page
48 OBJ: 3
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-9
6. As a
powerful central nervous system stimulant, which of these substances can lead
to miscarriage, preterm labour, premature separation of the placenta, and
stillbirth?
|
a. |
Heroin |
|
b. |
Alcohol |
|
c. |
PCP |
|
d. |
Cocaine |
ANS: D
Cocaine is a powerful central nervous system stimulant. Effects
on pregnancy associated with cocaine use include abruptio placentae,
preterm labour, precipitous birth, and stillbirth. Heroin is an opiate. Its use
in pregnancy is associated with pre-eclampsia, intrauterine growth restriction,
miscarriage, premature rupture of membranes, infections, breech presentation,
and preterm labour. The most serious effect of alcohol use in pregnancy is
fetal alcohol syndrome. The major concerns regarding PCP use in pregnant women
are its association with polydrug abuse and the neurobehavioural effects on the
neonate.
DIF: Cognitive Level:
Comprehension REF: page
48 OBJ: 3
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-9
7. The
use of which of the following during pregnancy causes vasoconstriction and
decreased placental perfusion, resulting in maternal and neonatal
complications?
|
a. |
Alcohol |
|
b. |
Caffeine |
|
c. |
Tobacco |
|
d. |
Vitamin A |
ANS: C
Smoking in pregnancy is known to cause a decrease in placental
perfusion and is the cause of low birth weight. Prenatal alcohol exposure is
the single greatest preventable cause of mental retardation. Alcohol use during
pregnancy can cause high blood pressure, miscarriage, premature birth,
stillbirth, and anemia. Caffeine may interfere with certain medications and
make arrhythmias worse. Chocolate, particularly dark chocolate, contains
caffeine.
DIF: Cognitive Level:
Knowledge
REF: page 47
OBJ: 3
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-9
8. Which
statement is true in relation to Kegel exercises?
|
a. |
They were developed to
control or reduce incontinent urine loss. |
|
b. |
They are the best exercises
for a pregnant woman because they are so pleasurable. |
|
c. |
They help to manage stress. |
|
d. |
They are ineffective
without sufficient calcium in the diet. |
ANS: A
Kegel exercises help control the urge to urinate. They may be
fun for some, but the most important matter is the control they provide over
incontinence. Kegel exercises help manage urination, not stress. Calcium in the
diet is important but is not related to Kegel exercises.
DIF: Cognitive Level:
Knowledge
REF: page 51
OBJ: 2
TOP: Nursing Process:
Planning
MSC: CRNE: HW-2
9. Body
mass index is an important part of the health screening process, because
obesity is closely associated with which of the following?
|
a. |
Lower infant mortality
rates |
|
b. |
A large number of chronic
conditions |
|
c. |
Mostly acute illnesses |
|
d. |
Improved mental well-being |
ANS: B
Overweight and obesity are known risk factors for diabetes,
heart disease, dyslipidemia, stroke, hypertension, arthritis, osteoporosis, and
some types of cancer. Overweight and obesity are most frequently linked to
chronic conditions. It is a myth that obesity if associated with improved
mental well-being. In fact, obesity is associated with depression and increased
stress.
DIF: Cognitive Level:
Knowledge
REF: page 50
OBJ: 2
TOP: Nursing Process: Assessment
MSC: CRNE: HW-4
10. The
nurse is most likely aware of the psychological symptoms of stress, such as
anxiety and depression; however, a number of physiological symptoms may also
occur. To best assist the patient in managing these symptoms, the nurse should
be aware that stress may also result in which of the following?
|
a. |
Decreased heart rate and
blood pressure |
|
b. |
Rapid digestion resulting
in heartburn |
|
c. |
Decrease in hormone levels |
|
d. |
Flare-ups of arthritis and
asthma |
ANS: D
Flare-ups of arthritis, asthma, frequent colds, infections, and
cardiovascular problems may be the result of constant stress. Stress results in
increased blood pressure and heart rate. Stress often causes slowed digestion
and eating disorders. Stress often causes an increase in the level of both
hormones and neurotransmitters, which may result in infertility or a weakened
immune system.
DIF: Cognitive Level:
Analysis
REF: page 52
OBJ: 2
TOP: Nursing Process:
Diagnosis
MSC: CRNE: HW-10
11. The
nurse’s best measure when evaluating the care of a woman in an abusive
situation is based on which of the following?
|
a. |
The woman’s decision to
leave her partner |
|
b. |
The woman’s declaration of
a safety plan |
|
c. |
The couple’s follow-through
on a referral for counselling |
|
d. |
The woman’s gratitude to
the nurse for the helpful information |
ANS: B
Safety is the most significant part of the intervention. This
statement would be a positive step for the woman, but it is not the most
significant part of the intervention. In addition, many women choose to return
to the relationship. Couples counselling generally is not recommended.
Initially, individual counselling is more beneficial. Neither is a measure of
success in the evaluation of the care plan of an abused woman. The woman may
express her gratitude to the nurse in an effort to end the conversation. This
does not indicate the woman’s readiness to leave the relationship or to make a
plan for safety.
DIF: Cognitive Level:
Comprehension REF: page
59 OBJ: 7
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-7
12. Intervention
for the survivor of sexual abuse often is not attempted by maternity and
women’s health nurses because of their concern about increasing the woman’s
distress and the lack of expertise in counselling. Which initial intervention
is appropriate and most important in facilitating the woman’s care?
|
a. |
Initiate a referral to an
expert counsellor. |
|
b. |
Set limits on what the patient
discloses. |
|
c. |
Listen and encourage
therapeutic communication skills. |
|
d. |
Acknowledge the nurse’s
discomfort to the patient as an expression of empathy. |
ANS: C
The survivor needs support on many different levels, and a
women’s health nurse may be the first person to whom she relates her story.
Therapeutic communication skills and listening are initial interventions.
Referring this patient to a counsellor is an appropriate measure but not the
most important initial intervention. A patient should be allowed to disclose
any information she believes the need to discuss. As a nurse, you should
provide a safe environment in which she can do so. Either verbal or nonverbal
shock and horror reactions from the nurse are particularly devastating. Professional
demeanor and professional empathy are essential.
DIF: Cognitive Level:
Analysis
REF: page 60, Box 4-12
OBJ:
7
TOP: Nursing Process: Implementation MSC: CRNE:
NCP-1
13. Which
of the following is one of the Five A’s of the Interventions for Smoking
Cessation?
|
a. |
Abuse |
|
b. |
Advise |
|
c. |
Advocate |
|
d. |
Accommodate |
ANS: B
Advise is one of the Five A’s of the Interventions for Smoking
Cessation, in addition to Ask, Assess, Assist, and Arrange follow-up. Abuse is
not one of Interventions for Smoking Cessation Five A’s. Advocate is not one of
the Interventions for Smoking Cessation Five A’s. Accommodate is not one of the
Interventions for Smoking Cessation Five A’s.
DIF: Cognitive Level:
Comprehension REF: page 56, Box 4-9
OBJ:
4
TOP: Nursing Process: Implementation MSC: CRNE:
HW-13
14. Which
statement is true in relation to intimate partner violence?
|
a. |
Alcohol and drug use cause
battering. |
|
b. |
Many offenders are
successful professionals. |
|
c. |
Battering occurs in a small
percentage of the population. |
|
d. |
Only people who come from
abusive families end up in abusive relationships. |
ANS: B
Many offenders are successful professionals; research indicates
that only a small number of abusers have psychological problems. Although
alcohol and drugs may be involved in abusive incidents, it is not the cause.
Battering occurs in more than a small percentage of the population; about 25%
of all women experience violence by an intimate partner. Most women report that
their partners were the first person to beat them; therefore, it is a myth that
only people who come from abusive families end up in abusive relationships.
DIF: Cognitive Level: Comprehension
REF: page 60, Table 4-3
OBJ:
8
TOP: Nursing Process:
Planning
MSC: CRNE: HW-7
15. What
should an intimate partner violence (IPV) nurse be aware of?
|
a. |
Relationship violence
usually consists of a single episode that the couple can put behind them. |
|
b. |
Violence often declines or
ends with pregnancy. |
|
c. |
Economic abuse is
considered part of IPV. |
|
d. |
Battered women generally
are poorly educated and come from a deprived social background. |
ANS: C
Economic abuse accompanies physical assault and psychological
attacks. IPV almost always follows an escalating pattern. It includes
psychological attacks and economic coercion. IPV often begins with and
escalates during pregnancy. Race, religion, social background, age, and
education level are not significant factors in differentiating women at risk.
DIF: Cognitive Level:
Comprehension REF: page 58, Fig. 4-3
OBJ:
8
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-24
16. What
percentage of women experience violence by an intimate partner?
|
a. |
10% |
|
b. |
15% |
|
c. |
20% |
|
d. |
25% |
ANS: D
It is reported that 25% of all women experience violence by an
intimate partner.
DIF: Cognitive Level:
Comprehension REF: page 60, Table 4-3
OBJ:
8
TOP: Nursing Process:
Planning
MSC: CRNE: HW-24
17. The
nurse is teaching the patient about health screening recommendations for women
aged 18 and older. What is the recommended frequency at which women should have
a Pap smear?
|
a. |
Annually |
|
b. |
Every 2 years |
|
c. |
Every 1 to 3 years |
|
d. |
Every 3 to 5 years |
ANS: C
The recommendation is that women over the age of 18 years should
have a Pap test every 1 to 3 years.
DIF: Cognitive Level: Comprehension
REF: page 57, Table 4-2
OBJ:
5
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-2
Chapter 07: Infertility, Contraception, and Abortion
Test Bank
MULTIPLE CHOICE
1. Which
test used to diagnose the basis of infertility is done during the luteal or
secretory phase of the menstrual cycle?
|
a. |
Hysterosalpingogram |
|
b. |
Endometrial biopsy |
|
c. |
Laparoscopy |
|
d. |
Follicle-stimulating
hormone (FSH) level |
ANS: B
Endometrial biopsy is scheduled after ovulation, during the
luteal phase of the menstrual cycle. A hysterosalpingogram is scheduled in the
early proliferative phase to avoid flushing potentially fertilized ovum out
through a uterine tube into the peritoneal cavity. Laparoscopy usually is scheduled
early in the menstrual cycle. Hormone analysis is performed to assess endocrine
function of the hypothalamic–pituitary–ovarian axis when menstrual cycles are
absent or irregular.
DIF: Cognitive Level:
Knowledge
REF: page 129, Table 7-1
OBJ:
3
TOP: Nursing Process:
Planning
MSC: CRNE: CH-30
2. A man
smokes two packs of cigarettes a day. He wants to know if smoking is
contributing to the difficulty he and his wife are having getting pregnant.
What is the nurse’s most appropriate response?
|
a. |
“Your sperm count seems to
be okay in the first semen analysis.” |
|
b. |
“Only marijuana cigarettes
affect sperm count.” |
|
c. |
“Smoking can give you lung
cancer, but it has no effect on sperm.” |
|
d. |
“Smoking can reduce the
quality of your sperm.” |
ANS: D
Use of tobacco, alcohol, and marijuana may affect sperm counts.
“Your sperm count seems to be okay in the first semen analysis” is inaccurate.
Sperm counts vary from day to day and depend on emotional and physical status
and sexual activity. Therefore, a single analysis may be inconclusive. A
minimum of two analyses must be performed several weeks apart to assess male
fertility.
DIF: Cognitive Level:
Application
REF: page 131, Box 7-2
OBJ:
1
TOP: Nursing Process:
Diagnosis
MSC: CRNE: NCP-11
3. A
couple comes in for an infertility workup, having attempted to get pregnant for
2 years. The woman, 37, has always had irregular menstrual cycles but is
otherwise healthy. The man has fathered two children from a previous marriage
and underwent a vasectomy reversal 2 years ago. The man has had two normal
semen analyses, but the sperm seem to be clumped together. What additional test
is needed?
|
a. |
Testicular biopsy |
|
b. |
Antisperm antibodies |
|
c. |
Follicle-stimulating
hormone (FSH) level |
|
d. |
Examination for testicular
infection |
ANS: C
The woman has irregular menstrual cycles. The scenario does not
indicate that she has had any testing related to this irregularity. Hormone
analysis is performed to assess endocrine function of the
hypothalamic–pituitary–ovarian axis when menstrual cycles are absent or
irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone
(LH), estradiol, progesterone, and thyroid hormones may be necessary to
diagnose the cause of irregular menstrual cycles. A testicular biopsy would be
indicated only in cases of azoospermia (no sperm cells) or severe oligospermia
(low number of sperm cells). Antisperm antibodies are produced by a man against
his own sperm. This is unlikely to be the case here, because the husband has
already produced children. Examination for testicular infection would be done
before semen analysis. Furthermore, infection would affect spermatogenesis.
DIF: Cognitive Level:
Analysis
REF: page 129
OBJ: 3
TOP: Nursing Process:
Diagnosis
MSC: CRNE: CH-8
4. A
couple is trying to cope with an infertility problem. They want to know what
they can do to preserve their emotional equilibrium. What is the nurse’s most
appropriate response?
|
a. |
“Tell your friends and
family so they can help you.” |
|
b. |
“Talk only to other friends
who are infertile because only they can help.” |
|
c. |
“Get involved with a
support group. I’ll give you some names.” |
|
d. |
“Start adoption proceedings
immediately because it is a lengthy process.” |
ANS: C
Venting negative feelings may unburden the couple. A support
group may provide a safe haven for the couple to share their experiences and
gain insight from others’ experiences. Although talking about their feelings
may unburden them of negative feelings, infertility can be a major stressor
that affects the couple’s relationships with family and friends. Limiting their
interactions to other infertile couples may be a beginning point for addressing
psychosocial needs, but depending on where the other couple is in their own
recovery process, this may or may not help them. The statement about adoption
proceedings is not supportive of the psychosocial needs of this couple and may
be detrimental to their well-being.
DIF: Cognitive Level:
Application
REF: page 131
OBJ: 2
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-10
5. A
woman inquires about herbal alternative methods for improving fertility. Which
statement by the nurse is most appropriate when instructing the patient about
which herbal preparations to avoid while trying to conceive?
|
a. |
“You should avoid nettle
leaf, dong quai, and vitamin E while you are trying to get pregnant.” |
|
b. |
“You may want to avoid
licorice root, lavender, fennel, sage, and thyme while you are trying to
conceive.” |
|
c. |
“You should not take
anything with vitamin E, calcium, or magnesium. They will make you infertile.” |
|
d. |
“Herbs have no bearing on
fertility.” |
ANS: B
Herbs that a woman should avoid while trying to conceive include
licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender,
juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage,
thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E are all remedies
that promote fertility. Vitamin E, calcium, and magnesium may promote fertility
and conception.
DIF: Cognitive Level:
Application
REF: page 131
OBJ: 3
TOP: Nursing Process:
Planning
MSC: CRNE: NCP-10
6. In
vitro fertilization–embryo transfer (IVF-ET) is a common approach for women
with blocked fallopian tubes or unexplained infertility and for men with very
low sperm counts. A husband and wife have arrived for their preprocedural
interview. The husband asks the nurse to explain what the procedure entails.
What is the nurse’s most appropriate response?
|
a. |
“Eggs from your wife’s
ovaries are fertilized in the lab with your sperm and the embryo is
transferred to her uterus.” |
|
b. |
“A donor embryo will be
transferred into your wife’s uterus.” |
|
c. |
“Donor sperm will be used
to inseminate your wife.” |
|
d. |
“Don’t worry about the
technical stuff; that’s what we are here for.” |
ANS: A
A woman’s eggs are collected from her ovaries, fertilized in the
laboratory with sperm, and transferred to her uterus after normal embryonic
development has occurred. The statement “A donor embryo will be transferred
into your wife’s uterus” describes therapeutic donor insemination. “Donor sperm
will be used to inseminate your wife” describes the procedure for a donor
embryo. “Don’t worry about the technical stuff; that’s what we are here for”
discredits the patient’s need for teaching and is not the most appropriate
response.
DIF: Cognitive Level:
Application
REF: page 134, Table 7-2
OBJ:
4
TOP: Nursing Process:
Planning
MSC: CRNE: HW-26
7. When
working with patients who are experiencing infertility, the nurse should be
aware of which of the following related to infertility?
|
a. |
Infertility is perceived
differently by women and men. |
|
b. |
Fertility has a relatively
stable prevalence throughout a woman’s reproductive years. |
|
c. |
Infertility is more likely
the result of a physical deviation in the woman than one in the man. |
|
d. |
Infertility is the same
thing as sterility. |
ANS: A
Women tend to be more stressed about infertility tests and to
place more importance on having children. The prevalence of infertility is
stable among the overall population, but it increases with a woman’s age,
especially over age 40. Of cases with an identifiable cause, about 40% are
related to female factors, 40% to male factors, and 20% to both partners. Sterility is the
inability to conceive. Infertility is
a state of requiring a prolonged time to conceive, or subfertility.
DIF: Cognitive Level:
Comprehension REF: page
126 OBJ: 1
TOP: Nursing Process:
Assessment MSC: CRNE:
NCP-7
8. What
should the nurse be aware of with regard to the assessment of female, male, and
couple infertility?
|
a. |
The couple’s religious,
cultural, and ethnic backgrounds provide emotional clutter that does not
affect the clinical scientific diagnosis. |
|
b. |
The investigation takes 3
to 4 months and a lot of money. |
|
c. |
The woman is assessed
first; if she is not the problem, the male partner is analyzed. |
|
d. |
Semen analysis is for men;
the postcoital test is for women. |
ANS: B
Fertility assessment and diagnosis take time, money, and
commitment from the couple. Religious, cultural, and ethnic-bred attitudes
about fertility and related issues always have an impact on diagnosis and
assessment. Both partners are assessed systematically and simultaneously, as
individuals and as a couple. Semen analysis is for men, but the postcoital test
is for the couple.
DIF: Cognitive Level:
Application
REF: page 127
OBJ: 3
TOP: Nursing Process:
Assessment MSC: CRNE:
CH-12
9. What
should the nurse do when implementing a plan of care for infertile couples?
|
a. |
Reserve judgement about the
couple until the relationship develops. |
|
b. |
Avoid discussion of
lifestyle changes that may enhance fertility. |
|
c. |
Promote the use of herbs
that might help the couple conceive. |
|
d. |
Be knowledgeable about
potential drug and surgical remedies. |
ANS: D
Nurses should be open to and ready to help with a variety of
pharmacological and non-pharmacological approaches. They should practice in a
nonjudgemental manner at all times. When implementing a plan of care for
infertile couples the nurse should engage in discussions of lifestyle changes
that may enhance fertility rather than avoid discussing them. Before the nurse
promotes the use of herbs it is important that the couple`s readiness for
herbal remedies be assessed.
DIF: Cognitive Level:
Comprehension REF: pages 131-132
OBJ:
3
TOP: Nursing Process: Implementation MSC: CRNE:
CH-12
10. Although
remarkable developments have occurred in reproductive medicine, assisted
reproductive therapies are associated with a number of legal and ethical
issues. Nurses can provide accurate information about the risks and benefits of
treatment alternatives so that couples can make informed decisions about their
choice of treatment. Which issue would need to be addressed by an infertile
couple before treatment?
|
a. |
Risk of multiple gestations |
|
b. |
Ways to avoid disclosing
the facts of conception to offspring |
|
c. |
Inability to freeze embryos
for later use |
|
d. |
Financial ability to cover
the cost of treatment |
ANS: A
The risk of multiple gestations is indeed a risk of treatment
that the couple needs to be aware of. In order to minimize the chance of multiple
gestations, generally only three or fewer embryos are transferred. The couple
should be informed that there may be a need for multifetal reduction. Nurses
can provide anticipatory guidance on this matter. Although the method of
payment is important, obtaining this information is not the responsibility of
the nurse. All provinces in Canada provide coverage for diagnostic testing and
some medical treatment. Teaching regarding disclosure of the facts of
conception should provide neutral information and not assume that the couple
only wants information on how to avoid disclosure. It is possible to freeze
embryos for later use. Couples who have excess embryos frozen for later
transfer must be fully informed before consenting to the procedure. A decision must
be made regarding the disposal of embryos in the event of death or divorce or
if the couple no longer wants the embryos at a future time.
DIF: Cognitive Level:
Application
REF: page 133, Box 7-6
OBJ:
4
TOP: Nursing Process: Implementation MSC: CRNE:
CH-12
11. A
woman has chosen the calendar method of conception control. During the
assessment process, what is most important for the nurse to do?
|
a. |
Obtain a history of
menstrual-cycle lengths for the past 6 months. |
|
b. |
Determine the patient’s
weight gain and loss pattern for the previous year. |
|
c. |
Examine skin pigmentation
and hair texture for hormonal changes. |
|
d. |
Explore the patient’s
previous experiences with conception control. |
ANS: A
The calendar method of conception control is based on the number
of days in each cycle, counting from the first day of menses. The fertile
period is determined after the lengths of menstrual cycles have been accurately
recorded for 6 months. Weight gain or loss may be partly related to hormonal
fluctuations, but it has no bearing on use of the calendar method.
Integumentary changes may be related to hormonal changes, but they are not
indicators for use of the calendar method. Exploring previous experiences with
conception control may demonstrate patient understanding and compliancy, but it
is not the most important aspect to assess for discussion of the calendar
method.
DIF: Cognitive Level:
Analysis
REF: page 138
OBJ: 6
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-13
12. A
woman is using the basal body temperature (BBT) method of contraception. She
calls the clinic and tells the nurse, “My period is due in a few days, and my
temperature has not gone up.” What is the nurse’s most appropriate response?
|
a. |
“This probably means that
you’re pregnant.” |
|
b. |
“Don’t worry; it’s probably
nothing.” |
|
c. |
“Have you been sick this
month?” |
|
d. |
“You probably didn’t
ovulate during this cycle.” |
ANS: D
A pattern of lower body temperature with no increase is most
likely is the result of lack of ovulation. Pregnancy cannot occur without
ovulation (which is being measured using the BBT method). A comment such as
“Don’t worry; it’s probably nothing” discredits the patient’s concerns. Illness
would most likely cause an increase in basal body temperature.
DIF: Cognitive Level:
Application
REF: page 139
OBJ: 6
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-13
13. A
married couple is discussing alternatives for pregnancy prevention and has
asked about fertility awareness methods (FAMs). What is the nurse’s most
appropriate response?
|
a. |
“They’re not very
effective, and it’s very likely you’ll get pregnant.” |
|
b. |
“They can be effective but
they require adherence to strict record keeping.” |
|
c. |
“These methods have a few
advantages and several health risks.” |
|
d. |
“You would be much safer
going on the pill and not having to worry.” |
ANS: B
FAMs are effective with proper vigilance about ovulatory changes
in the body and adherence to coitus intervals and strict record keeping. They
are effective if used correctly by a woman with a regular menstrual cycle. FAMs
have no health risks other than pregnancy. The use of birth control has
associated health risks; this response disregards the patients’ question and
provides false reassurance.
DIF: Cognitive Level:
Application
REF: page 138
OBJ: 6
TOP: Nursing Process:
Planning
MSC: CRNE: HW-13
14. A
male patient asks the nurse why it is better to purchase condoms that are not
lubricated with nonoxynol-9 (a common spermicide). What is the nurse’s most
appropriate response?
|
a. |
“The lubricant prevents
vaginal irritation.” |
|
b. |
“Nonoxynol-9 has been
linked to HIV transmission and can cause genital herpes.” |
|
c. |
“The additional lubrication
improves sex.” |
|
d. |
“Nonoxynol-9 improves
penile sensitivity.” |
ANS: B
Nonoxynol-9 does not provide protection against sexually
transmitted infections; it has also been linked to an increase in the
transmission of HIV and can cause genital lesions. Nonoxynol-9 may cause
vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual
activity. Nonoxynol-9 has no effect on penile sensitivity.
DIF: Cognitive Level: Application
REF: page 142
OBJ: 6
TOP: Nursing Process:
Planning
MSC: CRNE: HW-13
15. A
woman who has a seizure disorder and takes barbiturates and phenytoin sodium
daily asks the nurse about the pill as a contraceptive choice. What is the
nurse’s most appropriate response?
|
a. |
“This is a highly effective
method, but it has some adverse effects.” |
|
b. |
“Your current medications
will reduce the effectiveness of the pill.” |
|
c. |
“The pill will reduce the
effectiveness of your seizure medication.” |
|
d. |
“This is a good choice for
a woman of your age and personal history.” |
ANS: B
“Your current medications will reduce the effectiveness of the
pill” is a true statement. It is not highly effective for her because the liver
metabolizes oral contraceptives and their effectiveness is reduced when they
are taken simultaneously with anticonvulsants. The anticonvulsant will reduce
the effectiveness of the pill, not the other way around. “This is a good choice
for a woman of your age and personal history” does not teach the patient that
the effectiveness of the pill may be reduced because of her anticonvulsant
therapy.
DIF: Cognitive Level:
Application
REF: page 148
OBJ: 5
TOP: Nursing Process:
Planning
MSC: CRNE: CH-44
16. Injectable
progestins (DMPA, Depo-Provera) are a good contraceptive choice for which of
the following women?
|
a. |
Women who want menstrual
regularity and predictability |
|
b. |
Women who have a history of
thrombotic problems or breast cancer |
|
c. |
Women who have difficulty
remembering to take oral contraceptives daily |
|
d. |
Women who are homeless or
mobile and rarely receive health care |
ANS: C
Advantages of DMPA include a contraceptive effectiveness
comparable to that of combined oral contraceptives, with the requirement of
only four injections a year; therefore, women who have difficulty remembering
to take a daily pill will find this method attractive. Disadvantages of
injectable progestins are prolonged amenorrhea and uterine bleeding. Use of
injectable progestin carries an increased risk of venous thrombosis and
thromboembolism. To be effective, DMPA injections must be administered every 11
to 13 weeks. Access to health care is necessary to prevent pregnancy or potential
complications.
DIF: Cognitive Level:
Comprehension REF: pages 149-150
OBJ:
5
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-13
17. A
woman currently uses a diaphragm and spermicide for contraception. She asks the
nurse what the major differences are between the cervical cap and diaphragm.
What is the nurse’s most appropriate response?
|
a. |
“No spermicide is used with
the cervical cap, so it’s less messy.” |
|
b. |
“The diaphragm can be left
in place longer after intercourse.” |
|
c. |
“Repeated intercourse with
the diaphragm is more convenient.” |
|
d. |
“The cervical cap can
safely be used for repeated acts of intercourse without adding more
spermicide later.” |
ANS: D
The cervical cap can be inserted hours before sexual intercourse
without the need for additional spermicide later. No additional spermicide is
required for repeated acts of intercourse. Spermicide should be used inside the
cap as an additional chemical barrier. The cervical cap should remain in place
for 6 hours after the last act of intercourse. Repeated intercourse with the
cervical cap is more convenient, because no additional spermicide is needed.
DIF: Cognitive Level:
Application
REF: page 144
OBJ: 5
TOP: Nursing Process: Planning
MSC: CRNE: HW-13
18. A
woman was treated recently for toxic shock syndrome (TSS). She has intercourse
occasionally and uses over-the-counter protection. On the basis of her history,
which contraceptive method should she and her partner avoid?
|
a. |
Cervical cap |
|
b. |
Condom |
|
c. |
Vaginal film |
|
d. |
Vaginal sheath |
ANS: A
Women with a history of TSS should not use a cervical cap.
Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman
with a history of TSS.
DIF: Cognitive Level:
Comprehension REF: page
144 OBJ: 5
TOP: Nursing Process:
Planning
MSC: CRNE: HW-13
19. An
unmarried young woman describes her sex life as “active” and involving “many”
partners. She wants a contraceptive method that is reliable and does not
interfere with sex. She requests an intrauterine device (IUD). What is the
nurse’s most appropriate response?
|
a. |
“The IUD does not interfere
with sex.” |
|
b. |
“The risk of pelvic
inflammatory disease (PID) will be higher for you.” |
|
c. |
“The IUD will protect you
from sexually transmitted infections (STIs).” |
|
d. |
“Pregnancy rates are high
with the IUDs.” |
ANS: B
Disadvantages of IUDs include an increased risk of PID in the
first 20 days after insertion and the risks of bacterial vaginosis and uterine
perforation. The IUD offers no protection against STIs or the human
immunodeficiency virus. Because this woman has multiple sex partners, she is at
higher risk of developing an STI. The IUD does not protect against infection,
as does a barrier method. Although the statement “The IUD does not interfere
with sex” may be correct, it is not the most appropriate response. The IUD
offers no protection from STIs. The typical failure rate of the IUD ranges from
0.8 to 2%.
DIF: Cognitive Level:
Application
REF: page 150
OBJ: 5
TOP: Nursing Process:
Planning
MSC: CRNE: HW-13
20. A
woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is
the most common technique used for medical termination of a pregnancy in the
second trimester?
|
a. |
Dilation and evacuation
(D&E) |
|
b. |
Instillation of hypertonic
saline into the uterine cavity |
|
c. |
Intravenous administration
of oxytocin |
|
d. |
Vacuum aspiration |
ANS: A
The most common technique for medical termination of a pregnancy
in the second trimester is D&E. It is usually performed between 14 and 18
weeks. Hypertonic solutions injected directly into the uterus account for less
than 1% of all abortions because other methods are safer and easier to use.
Intravenous administration of oxytocin is used to induce labour in a woman with
a third-trimester fetal demise. Vacuum aspiration is used for abortions in the
first trimester.
DIF: Cognitive Level:
Comprehension REF: page
154 OBJ: 7
TOP: Nursing Process: Implementation
MSC: CRNE: CH-8
21. A
woman will be taking oral contraceptives using a 28-day pack. What should the
nurse advise this woman for protection against pregnancy?
|
a. |
Limit sexual contact for
one cycle after starting the pill. |
|
b. |
Use condoms and foam
instead of the pill for as long as she takes an antibiotic. |
|
c. |
Take one pill at the same
time every day. |
|
d. |
Stop taking the pills and
use a backup method if she misses two pills during week 1 of her cycle. |
ANS: C
To maintain adequate hormone levels for contraception and to
enhance compliance, patients should take oral contraceptives at the same time
each day. If contraceptives are to be started at any time other than during
normal menses or within 3 weeks after birth or abortion, another method of
contraception should be used through the first week to prevent the risk of
pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation,
and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link
between the use of broad-spectrum antibiotics and altered hormone levels in
oral contraceptive users. If the patient misses two pills during week 1, she
should continue to take one pill a day, finish the package, and use a backup
method the next 7 consecutive days.
DIF: Cognitive Level:
Application
REF: page 149, Figure 7-12
OBJ:
6
TOP: Nursing Process:
Planning
MSC: CRNE: HW-13
22. A
woman had unprotected intercourse 36 hours ago and is concerned that she may
become pregnant because it is her “fertile” time. In response to her question
about emergency contraception, what should the nurse tell her?
|
a. |
It is too late; she needed
to begin treatment within 24 hours after intercourse. |
|
b. |
Plan B, an emergency
contraceptive method, is 98% effective at preventing pregnancy. |
|
c. |
An over-the-counter
antiemetic can be taken 1 hour before each contraceptive dose to prevent
nausea and vomiting. |
|
d. |
The most effective approach
is to use a progestin-only preparation. |
ANS: C
To minimize the adverse effect of nausea that occurs with high
doses of estrogen and progestin, the woman can take an over-the-counter
antiemetic 1 hour before each dose. Emergency contraception is used within 5
days of unprotected intercourse to prevent pregnancy. Postcoital contraceptive
use is 75 to 89% effective at preventing pregnancy. Oral emergency
contraceptive regimens may include progestin-only and estrogen-progestin pills.
Women with contraindications to estrogen use should use progestin-only pills.
DIF: Cognitive Level:
Analysis
REF: page 150
OBJ: 7
TOP: Nursing Process:
Planning
MSC: CRNE: CH-44
23. Which
statement is true about the term contraceptive
failure rate?
|
a. |
It refers to the percentage
of users expected to have an accidental pregnancy over a 5-year span. |
|
b. |
It refers to the minimum
level that must be achieved to receive a government license. |
|
c. |
It increases over time as
couples become more careless. |
|
d. |
It varies from couple to
couple, depending on the method and the users. |
ANS: D
Contraceptive effectiveness varies from couple to couple,
depending on how well a contraceptive method is used and how well it suits the
couple. The contraceptive failure rate measures the likelihood of accidental
pregnancy in the first year only. Failure rates decline over time because users
gain experience.
DIF: Cognitive Level:
Knowledge
REF: page 135
OBJ: 5
TOP: Nursing Process:
Assessment MSC:
CRNE: HW-13
Comments
Post a Comment