Maternal And Child Health Nursing NCLEX Practice Quiz

1. For the client who is using oral contraceptives, the nurse informs the client about the need to take the pill at the same time each day to accomplish which of the following.

Decrease the incidence of nausea

Maintain hormonal levels

Reduce side effects

Prevent drug interactions

Regular, timely ingestion of oral contraceptives is necessary to maintain hormonal levels of the drugs to suppress the action of the hypothalamus and anterior pituitary, leading to inappropriate secretion of FSH and LH. Therefore, follicles do not mature. Ovulation is inhibited, and pregnancy is prevented. The estrogen content of the oral site contraceptive may cause nausea, regardless of when the pill is taken. Side effects and drug interactions may occur with oral contraceptives regardless of the time the pill is taken.

Explanation

Regular, timely ingestion of oral contraceptives is necessary to maintain hormonal levels of the drugs to suppress the action of the hypothalamus and anterior pituitary, leading to inappropriate secretion of FSH and LH. Therefore, follicles do not mature. Ovulation is inhibited, and pregnancy is prevented. The estrogen content of the oral site contraceptive may cause nausea, regardless of when the pill is taken. Side effects and drug interactions may occur with oral contraceptives regardless of the time the pill is taken.

2. When teaching a client about contraception, which of the following would the nurse include as the most effective method for preventing sexually transmitted infections?

Spermicides

Diaphragm

Condoms

Vasectomy

Condoms, when used correctly and consistently. are the most effective contraceptive method or barrier against bacterial and viral sexually transmitted infections. Option A: Although spermicides kill sperm, they do not provide reliable protection against the spread of sexually transmitted infections, especially intracellular organisms such as HIV. Option B: Insertion and removal of the diaphragm, along with the use of spermicides, may cause vaginal irritations, which could place the client at risk for infection transmission. Option D: Male sterilization eliminates spermatozoa from the ejaculate, but it does not eliminate bacterial and/or viral microorganisms that can cause sexually transmitted infections.

Explanation

Condoms, when used correctly and consistently. are the most effective contraceptive method or barrier against bacterial and viral sexually transmitted infections. Option A: Although spermicides kill sperm, they do not provide reliable protection against the spread of sexually transmitted infections, especially intracellular organisms such as HIV. Option B: Insertion and removal of the diaphragm, along with the use of spermicides, may cause vaginal irritations, which could place the client at risk for infection transmission. Option D: Male sterilization eliminates spermatozoa from the ejaculate, but it does not eliminate bacterial and/or viral microorganisms that can cause sexually transmitted infections.

3. A client in her third trimester tells the nurse. "I'm constipated all the time!" Which of the following should the nurse recommend?

Daily enemas

Laxatives

Increased fiber intake

Decreased fluid intake

During the third trimester, the enlarging uterus places pressure on the intestines. This coupled with the effect of hormones on smooth muscle relaxation, causes decreased intestinal motility (peristalsis). Increasing fiber in the diet will help fecal matter pass more quickly through the intestinal tract, thus decreasing the amount of water that is absorbed. As a result, the stool is softer and easier to pass. Option A: Enemas could precipitate preterm labor and electrolyte loss and should be avoided.Option B: Laxatives may cause preterm labor by stimulating peristalsis and may interfere with the absorption of nutrients. Use for more than 1 week can also lead to laxative dependency. Option D: Liquid in the diet helps provide a semisolid, soft consistency to the stool. Eight to ten glasses of fluid per day are essential to maintain hydration and promote stool evacuation.

Explanation

During the third trimester, the enlarging uterus places pressure on the intestines. This coupled with the effect of hormones on smooth muscle relaxation, causes decreased intestinal motility (peristalsis). Increasing fiber in the diet will help fecal matter pass more quickly through the intestinal tract, thus decreasing the amount of water that is absorbed. As a result, the stool is softer and easier to pass. Option A: Enemas could precipitate preterm labor and electrolyte loss and should be avoided.Option B: Laxatives may cause preterm labor by stimulating peristalsis and may interfere with the absorption of nutrients. Use for more than 1 week can also lead to laxative dependency. Option D: Liquid in the diet helps provide a semisolid, soft consistency to the stool. Eight to ten glasses of fluid per day are essential to maintain hydration and promote stool evacuation.

4. The client tells the nurse that her last menstrual period started on January 14 and ended on January 20. Using Nagele’s rule. The nurse determines her EDD to be which of the following?

27-sept

21-oct

07-nov

27-déc

To calculate the EDD by Nagele’s rule, add 7 days to the first day of the last menstrual period and count back 3 months, changing the year appropriately. Option A: To obtain a date of September 27, 7 days have been added to the last day of the LMP (rather than the first day of the LMP), plus 4 months (instead of 3 months) were counted back. Option C: To obtain the date of November 7. 7 days have been subtracted (instead of added) from the first day of LMP, plus November indicates counting back 2 months (instead of 3 months) from January.Option D: To obtain the date of December 27, 7 days were added to the last day of the LMP (rather than the first day of the LMP), and December indicates counting back only 1 month (instead of 3 months) from January.

Explanation

To calculate the EDD by Nagele’s rule, add 7 days to the first day of the last menstrual period and count back 3 months, changing the year appropriately. Option A: To obtain a date of September 27, 7 days have been added to the last day of the LMP (rather than the first day of the LMP), plus 4 months (instead of 3 months) were counted back. Option C: To obtain the date of November 7. 7 days have been subtracted (instead of added) from the first day of LMP, plus November indicates counting back 2 months (instead of 3 months) from January.Option D: To obtain the date of December 27, 7 days were added to the last day of the LMP (rather than the first day of the LMP), and December indicates counting back only 1 month (instead of 3 months) from January.

5. When preparing to listen to the fetal heart rate at 12 weeks gestation, the nurse would use which of the following?

The stethoscope placed midline at the umbilicus

Doppler placed midline at the suprapubic region

Fetoscope placed midway between the umbilicus and the xiphoid process

External electronic fetal monitor placed at the umbilicus

At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate, so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. Option A: The fetal heart rate at this age is not audible with a stethoscope.Option C: The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks, the FHR would be difficult to auscultate with a fetoscope. Option D: Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.

Explanation

At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate, so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. Option A: The fetal heart rate at this age is not audible with a stethoscope.Option C: The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks, the FHR would be difficult to auscultate with a fetoscope. Option D: Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.

6. Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant teenager concerned about gaining too much weight during pregnancy?

10 pounds per trimester

1 pound per week for 40 weeks

½ pound per week for 40 weeks

A total gain of 25 to 30 pounds

In order to ensure adequate fetal growth and development during the 40 weeks of a pregnancy, a total weight gain of 25 to 30 pounds is recommended. Option A: 1.5 pounds in the first 10 weeks, 9 pounds by 30 weeks, and 27.5 pounds by 40 weeks. The pregnant woman should gain less weight in the first and second trimesters than in the third. Option B: During the first trimester, the client should only gain 1.5 pounds in the first 10 weeks, not 1 pound per week.Option C: A weight gain of ½ pound per week would be 20 pounds for the total pregnancy, less than the recommended amount.

Explanation

In order to ensure adequate fetal growth and development during the 40 weeks of a pregnancy, a total weight gain of 25 to 30 pounds is recommended. Option A: 1.5 pounds in the first 10 weeks, 9 pounds by 30 weeks, and 27.5 pounds by 40 weeks. The pregnant woman should gain less weight in the first and second trimesters than in the third. Option B: During the first trimester, the client should only gain 1.5 pounds in the first 10 weeks, not 1 pound per week.Option C: A weight gain of ½ pound per week would be 20 pounds for the total pregnancy, less than the recommended amount.

7. When taking an obstetrical history on a pregnant client who states, “I had a son born at 38 weeks gestation. a daughter born at 30 weeks gestation, and I lost a baby at about 8 weeks.” The nurse should record her obstetrical history as which of the following?

G2 T2 P0 A0 L2

G3 T1 P1 A0 L2

G3 T2 P0 A0 L2

G4 T1 P1 A1 L2

The client has been pregnant four times, including her current pregnancy (G). Birth at 38 weeks gestation is considered full-term (T), while birth from 20 weeks to 38 weeks is considered preterm (P). A spontaneous abortion occurred at 8 weeks (A). She has two living children (L).

Explanation

The client has been pregnant four times, including her current pregnancy (G). Birth at 38 weeks gestation is considered full-term (T), while birth from 20 weeks to 38 weeks is considered preterm (P). A spontaneous abortion occurred at 8 weeks (A). She has two living children (L).

8. When preparing a woman who is 2 days postpartum for discharge, recommendations for which of the following contraceptive methods would be avoided?

Diaphragm

Female condom

Oral contraceptives

Rhythm method

The diaphragm must be fitted individually to ensure effectiveness. Because of the changes to the reproductive structures during pregnancy and following delivery, the diaphragm must be refitted, usually at the 6 weeks examination following childbirth or after a weight loss of 15 lbs or more. In addition, for maximum effectiveness, the spermicidal jelly should be placed in the dome and around the rim. However, the spermicidal jelly should not be inserted into the vagina until involution is completed at approximately 6 weeks. The use of a female condom protects the reproductive system from the introduction of semen or spermicides into the vagina and may be used after childbirth. Oral contraceptives may be started within the first postpartum week to ensure suppression of ovulation for the couple who has determined the female’s fertile period, using the rhythm method. The avoidance of intercourse during this period is safe and effective.

Explanation

The diaphragm must be fitted individually to ensure effectiveness. Because of the changes to the reproductive structures during pregnancy and following delivery, the diaphragm must be refitted, usually at the 6 weeks examination following childbirth or after a weight loss of 15 lbs or more. In addition, for maximum effectiveness, the spermicidal jelly should be placed in the dome and around the rim. However, the spermicidal jelly should not be inserted into the vagina until involution is completed at approximately 6 weeks. The use of a female condom protects the reproductive system from the introduction of semen or spermicides into the vagina and may be used after childbirth. Oral contraceptives may be started within the first postpartum week to ensure suppression of ovulation for the couple who has determined the female’s fertile period, using the rhythm method. The avoidance of intercourse during this period is safe and effective.

9. When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority?

Dietary intake

Medication

Exercise

Glucose monitoring

Although all of the choices are important in the management of diabetes, diet therapy is the mainstay of the treatment plan and should always be the priority. Option B: Women diagnosed with gestational diabetes generally need only diet therapy without medication to control their blood sugar levels. Option C: Exercise. is important for all pregnant women and especially for diabetic women, because it burns up glucose. Thus decreasing blood sugar. However, dietary intake, not exercise, is the priority. Option D: All pregnant women with diabetes should have periodic monitoring of serum glucose. However, those with gestational diabetes generally do not need daily glucose monitoring. The standard of care recommends fasting and a 2-hour postprandial blood sugar level every 2 weeks.

Explanation

Although all of the choices are important in the management of diabetes, diet therapy is the mainstay of the treatment plan and should always be the priority. Option B: Women diagnosed with gestational diabetes generally need only diet therapy without medication to control their blood sugar levels. Option C: Exercise. is important for all pregnant women and especially for diabetic women, because it burns up glucose. Thus decreasing blood sugar. However, dietary intake, not exercise, is the priority. Option D: All pregnant women with diabetes should have periodic monitoring of serum glucose. However, those with gestational diabetes generally do not need daily glucose monitoring. The standard of care recommends fasting and a 2-hour postprandial blood sugar level every 2 weeks.

10. For which of the following clients would the nurse expect that an intrauterine device would not be recommended?

Women over the age 35

Nulliparous woman

Promiscuous young adult

Postpartum client

An IUD may increase the risk of pelvic inflammatory disease, especially in women with more than one sexual partner, because of the increased risk of sexually transmitted infections. An IUD should not be used if the woman has an active or chronic pelvic infection, postpartum infection, endometrial hyperplasia or carcinoma, or uterine abnormalities. Option A: Age is not a factor in determining the risks associated with IUD use. Most IUD users are over the age of 30. Option B: Although there is a slightly higher risk for infertility in women who have never been pregnant. The IUD is an acceptable option as long as the risk-benefit ratio is discussed. Option D: IUDs may be inserted immediately after delivery, but this is not recommended because of the increased risk and rate of expulsion at this time.

Explanation

An IUD may increase the risk of pelvic inflammatory disease, especially in women with more than one sexual partner, because of the increased risk of sexually transmitted infections. An IUD should not be used if the woman has an active or chronic pelvic infection, postpartum infection, endometrial hyperplasia or carcinoma, or uterine abnormalities. Option A: Age is not a factor in determining the risks associated with IUD use. Most IUD users are over the age of 30. Option B: Although there is a slightly higher risk for infertility in women who have never been pregnant. The IUD is an acceptable option as long as the risk-benefit ratio is discussed. Option D: IUDs may be inserted immediately after delivery, but this is not recommended because of the increased risk and rate of expulsion at this time.