Care of Family Ch. 4, 6

27. 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.

38. 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.

42. A nurse is educating a woman on the use of denosumab (Prolia). What information should the nurse provide? A. "Return in 6 months for another injection." B. "Take this medication on an empty stomach." C. "Take this medication with milk or food." D. "You may have increased night sweats."

ANS: A Prolia, a medication used for the treatment of osteoporosis, is given in subcutaneous injections every 6 months. Food intake is not related to administration. Increased night sweats and hot flashes can occur with raloxifene (Evista).

36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness, heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman? A. Administration of leuprolide (Lupron) B. Hysterectomy and bilateral salpingo-oophorectomy C. None; issue will resolve spontaneously D. Surgical removal of the ovaries

ANS: A These are symptoms of a uterine leiomyoma (fibroid). The medical treatment includes nonsteroidal anti-inflammatory drugs, oral contraceptives, and Lupron. Ovarian cysts often resolve spontaneously. For ovarian cancer, a complete hysterectomy with bilateral salpingo-oopherectomy is the procedure of choice. Because some of these symptoms are also seen in ovarian cancer, the nurse should be sure to assess the patient further.

9. 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.

11. 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.

6. 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.

4. 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.

1. 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.

12. 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.

2. A community health nurse is packing a kit of play items for the families who will be visited today. One family has an infant and a preschooler. Which toys should the nurse include in the kit? (Select all that apply.) A. Blocks B. Coloring books C. Ride-on train D. Simple board game E. Stuffed animals

ANS: A, B, D An infant is in the stage of solitary play. Appropriate toys include blocks, books, rattles, push-pull toys, and musical toys. The preschooler is in the stage of associative play. Appropriate toys for this child include imitative games, simple arts and crafts, simple board games, interactive games, alphabet or color games, coloring and drawing, and simple computer games. The ride-on train and the stuffed animals are more appropriate for a toddler.

14. 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.

5. 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.

3. A nurse is preparing to educate a group of parents about injury prevention in adolescents. Which topics should the nurse plan to include as priorities? (Select all that apply.) A. Bicycle safety B. Gun safety C. Home safety D. Driving safety E. Water safety

ANS: A, B, D, E In adolescents, the most common causes of injury are motor vehicle crashes, bicycles (includes skateboarding and skating), firearms, and water activities. Home safety, although always important, is a topic more appropriate to families with younger children.

9. The nurse working with older women knows that risk factors for osteoporosis include which of the following? (Select all that apply.) A. Asian ethnicity B. Excessive consumption of caffeine C. Large frame D. Regular physical activity E. Cigarette smoking

ANS: A, B, E Risk factors for osteoporosis can be found in Box 4-9 and include Asian (and Caucasian) ethnicity, excessive caffeine or alcohol use, and smoking. A small frame, not a large one, is a risk factor due to decreased stress on the bones. Regular activity (particularly weight-bearing exercise) is a preventative factor.

13. 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.

16. 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.

10. 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.

5. The clinic nurse talks with parents about the signs and symptoms of substance use because their 12-year-old twins will be attending a new school in the fall and they wish to be prepared. The nurse correctly describes the potential symptoms of substance abuse, including which of the following? (Select all that apply.) A. Chronic cough B. Euphoria C. Irritability D. Nausea and vomiting E. Red and glazed eyes

ANS: A, C, E There are many warning signs to alert parents to adolescent substance abuse. Physical signs include fatigue, red and glazed eyes, chronic cough, and health complaints. Emotional signs include personality changes, sudden mood swings, irritability, poor judgment and decision making, depression, and lack of interest in things that were of previous interest.

7. 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.

27. The nurse prepares to offer health screening and promotion activities for women aged 40-60. Which activity does the nurse plan to include as a priority for this group? A. Alzheimer's disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations

ANS: B Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40-55. The priority screening activity is for breast cancer. Alzheimer's disease screening is typically done in the older patient. Gardasil is recommended for females aged 9-26. Influenza vaccinations are important for all ages.

25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil vaccination. After giving the shot, what instruction does the nurse provide to her? A. Return in 1 month for the next shot. B. Return in 2 months for the next shot. C. Return in 6 months for the next shot. D. Return in 1 year for the next shot.

ANS: B Gardasil is given in a series of three injections. The second shot is 2 months after the first. The third shot is 6 months after the first. The other options are incorrect.

20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most appropriate? A. Ask if she knows how overweight she is. B. Assess the woman for stress-related problems. C. Caution her about related chronic illnesses. D. Encourage the woman to exercise more.

ANS: B In young adulthood, women especially begin to manifest stress-related disorders, including comfort eating. The nurse's best action is to assess the woman for this problem. The nurse can encourage her to exercise and can caution her about the relationship between poor nutrition and chronic illness, but if stress is causing the woman to overeat, she probably will not be able to make significant changes without addressing the cause. Asking the woman if she knows how heavy she is right now is disrespectful and will likely end the therapeutic relationship.

8. 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.

7. 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).

15. 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.

12. 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.

3. 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.

2. 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.

45. A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls? A. Blood draw B. Limited pelvic exam C. No alternative D. Urine collection

ANS: D A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 13-18. The other options are incorrect.

41. 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.

37. A nurse notes that a woman's chart lists "dyspareunia" as a diagnosis. In planning education for the patient, which topics would the nurse include? A. Black cohosh and soy nuts B. Kegel exercises and use of a pessary C. Nonsteroidal anti-inflammatory medications D. Water-based vaginal lubricants

ANS: D Dyspareunia is painful intercourse, often seen in postmenopausal women. Prolonged foreplay and the use of water-based vaginal lubricants are helpful suggestions to ease this symptom. Black cohosh and soy nuts are often used to relieve menopausal symptoms. Kegel exercises and pessaries are used for urinary incontinence. Nonsteroidal anti-inflammatory medications are used for mild pain and swelling.

29. 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.

26. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching should the nurse plan for this patient? A. Avoid sexual intercourse during your period. B. Take prophylactic antibiotics daily. C. Void every 4 hours while awake. D. Wipe from front to back after using the bathroom.

ANS: D Preventative measures for UTIs include drinking plenty of water, voiding when the urge is felt, wiping from front to back, taking showers instead of baths, not using perfumes or bath oil if baths are taken, wearing cotton underwear, and avoiding feminine hygiene sprays and scented douches. The other options are not related.

26. 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.

8. 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.

42. 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.

19. 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.

7. The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.) A. Aspirin prophylaxis B. Breast cancer screen C. Colorectal cancer screen D. Influenza vaccine E. Tobacco and alcohol screen

ANS: D, E Priority health services for the young adult population include influenza vaccination and tobacco, alcohol, and drug screens, among other things. Aspirin prophylaxis and breast cancer screen are more appropriate for middle-aged adults.

1. 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%)

43. A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations? A. Annual screening after age 40 B. MRI to replace mammography C. No routine screening after age 65 D. Periodic screening if high risk

ANS: A Breast cancer screening is the subject of controversy. The American College of Obstetricians and Gynecologists (ACOG) recommends annual screening with mammography and clinical breast examinations every year starting at age 40.

1. Match the types of play with their characteristics. _____ Assume roles in games; games have goals _____Playing with the same items, but not really playing together _____ Plays alone, no regard for those in the area _____ Play together, but little organization _____ Observes other children while playing alone a. Solitary play b. Onlooker play c. Parallel play d. Associative play e. Cooperative play

ANS: e, c, a, d, b There are five types of play: solitary play (child plays alone without regard for those around him or her), onlooker play (child observes others playing and may talk to them, may alter his or her own play, or may continue playing as he or she was doing), parallel play (playing with the same materials and items, but not playing together), associative play (play together in a peer group, but in a loosely organized manner), and cooperative play (assume roles in games, games have goals, and rely on each other to continue and progress).

23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication? A. 20-lb weight gain B. Cold intolerance C. Facial acne D. Facial hair growth

ANS: A Depo-Provera is used to treat endometriosis, but one undesirable side effect is weight gain. Danazol (Danocrine) is also used to treat this condition, but side effects of acne and facial hair growth cause this medication to be prescribed less often. Cold intolerance is not a common side effect of medications used to treat endometriosis.

40. The nurse notes that a patient's chart contains the results of an MMSE. What can the nurse surmise about this patient? A. Behind on recommended immunizations B. Concerns about cognitive functioning C. Tracking changes in bone density D. Worried about cardiovascular health

ANS: B The MMSE (Mini-Mental State Examination) is a screening test for cognitive function. The other options are not related.

44. A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test? A. At age 19 B. At age 21 C. Before sexual activity D. No specific age

ANS: B Women should have their first Pap test at age 21.

1. The nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. What does the nurse tell the mothers about breast milk? (Select all that apply.) A. Fewer nutrients B. Less casein C. Less protein D. More calories E. More carbohydrates

ANS: B, C, E Human breast milk contains more carbohydrates, less protein, and less casein than cow's milk or infant formulas. Commercially prepared formulas have the same essential nutrients for growth and development and do not have fewer calories.

31. 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.

46. At what age should the nurse prepare patients to begin thyroid function screening? A. 30 years B. 40 years C. 50 years D. 60 years

ANS: C Thyroid hormone function screening should begin at age 50 and occur every 5 years.

28. A nurse is volunteering for the local chapter of the cancer society and is planning breast cancer screening and educational activities in the community. In order to have the most impact on this disease, which women should the nurse target? A. African Americans B. Asian Americans C. Caucasian Americans D. Native Americans

ANS: A African American women are more likely to die from breast cancer because of late diagnosis, and in women under 45 in this group, breast cancer is more common. To have the greatest impact, the nurse should target this group of women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Caucasian women tend to develop breast cancer more frequently than African American women, but they die less often.

28. 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.

30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What action by the nurse takes priority? A. Ensure that an informed consent is signed and witnessed. B. Inventory and label all of the patient's belongings. C. Orient the patient's significant others to the waiting room. D. Premedicate the patient on arrival to the pre-op holding area.

ANS: A All actions are appropriate, but the priority action is in ensuring that an informed consent form has been signed and properly witnessed.

33. 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.

16. 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.

31. A nurse in a family practice clinic sees several generations of the same family. For which family members should the nurse arrange routine screening colonoscopies? A. Daughter, age 52 B. Grandfather, age 80, no history of polyps or cancer C. Grandmother, age 72, history of polyps D. Grandson, age 30, no gastrointestinal symptoms

ANS: A Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 75-85 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening.

34. 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.

30. 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.

16. The parents of a 16-year-old boy are frustrated because the teen is always participating in risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful? A. Encourage an after-school program that includes rock climbing, rafting, and hiking. B. Reassure the parents that risk taking is just a normal part of adolescence. C. Show the teen statistics on preventable injuries and deaths among teenagers. D. Tell the teen his risky behavior can lead to injuries and worries his parents.

ANS: A Risk taking is a part of adolescence, but the teen needs healthy risk-taking activities. The nurse can encourage the teen to take part in a program that offers risk-taking under adult supervision. Rock climbing, hiking, and rafting are all healthy alternatives. Simply reassuring the parents that teens take risks does not give them information that helps the teen. Showing the teen statistics and explaining that he is worrying his parents are both unlikely to have much effect.

6. 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.

1. 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.

14. 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.

15. 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.

21. 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.

4. A 17-year-old girl comes to the health department clinic to renew her oral contraceptive pills. During the physical examination, the nurse observes that the girl has broken blood vessels on her face and her lips are cracked and chapped and her fingers are callused. What further actions will the nurse perform? (Select all that apply.) A. A weight assessment B. Assessment for depression C. Draw blood for electrolytes D. Discussion about anorexia nervosa E. Discussion about bulimia

ANS: A, B, C, E Bulimia nervosa is a syndrome that consists of a cycle of binge eating and purging. Physically, the adolescent with bulimia nervosa may exhibit physical changes related to forced, excessive vomiting: cracked and damaged lips, tooth damage, callused fingers and hands, and broken blood vessels in the face. Other findings that may not be readily apparent include throat irritation, esophageal inflammation, and parotitis from vomiting, as well as rectal bleeding from overuse of laxatives. Bulimia is also associated with depression. The nurse should assess the teen's weight, screen her for depression, draw blood for electrolyte imbalances, and discuss bulimia.

10. A visiting nurse is seeing an older woman with the nursing diagnosis of risk for trauma related to decreased bone density secondary to osteoporosis. Which assessment findings would indicate to the nurse that a priority goal for this diagnosis has been met? (Select all that apply.) A. All scatter rugs have been removed. B. Burned-out light bulbs have been replaced. C. Hot water heater temperature is set to 110°F. D. Patient wears non-skid shoes or slippers. E. Pets have been given away to friends.

ANS: A, B, D A priority goal for this diagnosis is to make the home safe. Removing scatter rugs, having the home well lit, and wearing non-skid footwear are all indications that the home is safe. The temperature on the water heater is important to prevent injury, but is not related to osteoporosis. Giving away pets is not advised, as pets often contribute to emotional well-being. However, they can get underfoot, and the nurse needs to caution the patient about this risk.

11. The reproductive care clinic nurse teaches young women about their risk for sexually transmitted infections (STIs). Which factors does the nurse include? (Select all that apply.) A. Alkaline pH of the vagina B. Increased genital mucosal surface area C. Increased number of pubic hair follicles D. Prolonged exposure to semen E. Temperature of the vaginal area

ANS: A, B, D Physiological factors that predispose women to increased susceptibility to sexually transmitted infections include an increased genital mucosal surface area, retention of semen in the vagina for several hours following intercourse, and the pH of the vagina. During menstruation, women are more vulnerable to infection because the pH of the vagina becomes more alkaline, thereby becoming more hospitable to viral and bacterial transmission and growth. Number of pubic hair follicles and vaginal temperature are not related.

10. 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.

29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily.

ANS: B Alcohol intake, smoking, and weight maintenance all affect breast health. However, this woman's highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

4. 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.

37. 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.

5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much? A. 15% B. 25% C. 30% D. 35%

ANS: B Diet and nutrition are especially important for facilitating optimal growth and development during adolescence. Adequate nutritional intake is essential to accommodate the growth spurt that occurs during this time. Adolescents gain approximately 25% of their adult height and 50% of their adult weight throughout this time period.

35. 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.

32. 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.

17. A school nurse is preparing educational activities for all high school students on reproductive health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate? A. Argue that abstinence-only programs do not work and are not valuable. B. Discuss the need to have information appropriate to the teens' experience. C. Plan the program but encourage questions not related to the prepared material. D. Prepare an abstinence-only program because teens should not have sex.

ANS: B Education on sexual health should take into consideration the age and sexual experience of the audience. For teens who have not yet had sexual intercourse, an abstinence-only program might make sense. However, if the teens have already engaged in sexual intercourse, they are likely to continue this behavior, and the program should focus on using condoms in order to avoid unprotected sex and its risks. Abstinence-only programs cannot be characterized as being of no value. Encouraging teens to ask questions off the prepared topic is a passive-aggressive action. It is not up to the nurse to decide if teens should have sex or not.

1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care? A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention

ANS: B Health promotion refers to the advancement of health to the highest degree possible for an individual. One activity is providing vaccination clinics for older adults. Disease prevention focuses on the implementation of strategies to reduce the incidence of disease or the development of comorbid illnesses in individuals with existing diseases. Health screening (secondary prevention) aims to diagnose diseases early and begin effective treatment immediately.

6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information? A. High risk: Call the school district counselor. B. High risk: Contact 911 immediately. C. Low risk: Send a referral home with the student. D. Moderate risk: Call the parents to come get the teen.

ANS: B Individuals who have suicidal thoughts should be assessed for a specific plan, the means to carry out the plan, and previous suicide attempts. This student has two of the three high-risk identifiers, so the teen should be seen by a mental health professional immediately. The safest way to ensure this occurs is to access the emergency medical system. The district counselor may not be prepared to deal with this situation and may not be available. The student is not low risk, so a referral should not be sent home. The student is not moderate risk, and the burden of ensuring immediate access to a health-care professional should not be placed on the parents, who also may be unavailable.

36. 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.

20. 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.

40. 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.

18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for violence. Which statement by a participant indicates understanding? A. "Friends of mine have said they would be willing to help in a crisis." B. "If good communication doesn't solve the problem, I will leave." C. "If we can't settle our differences, we will have to start talking all over again." D. "My mother can help my boyfriend and me resolve a conflict."

ANS: B Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message.

11. A mother who has three older children now has a newborn. She complains to the physician that sleeping on his back has caused her baby to have "a funny-shaped head" that the other kids didn't have. She doesn't want to continue having the baby sleep on his back. Which action by the nurse is best? A. Document the comments and alert the physician to the concern. B. Encourage her to put the baby on his stomach during the day. C. Explain that babies need to sleep on their sides at all times. D. Tell her that back-sleeping isn't important after 5 months of age.

ANS: B The American Academy of Pediatrics recommends that all infants be placed on their backs when sleeping. This is probably new information the mother did not have for her older children. If the mother is concerned about plagiocephaly (misshapen head), she can be taught to place the baby on the stomach with a small rolled towel under the arms for support and comfort. Alternating positions in the crib and side-lying for short periods in the presence of an adult are also alternatives. Documentation should always occur, but is not the most important action. Telling the mother that babies need to sleep on their sides at all times is incorrect. Sleeping on the back is important for all infants.

24. A nurse reads in a patient's chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this woman's treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron)

ANS: B The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation.

32. A nurse is reviewing the results of several patients' cholesterol and lipid screenings. For which patient is the action appropriate? A. HDL cholesterol 66 mg/dL: Evaluate patient for cardiovascular risk. B. LDL cholesterol 98 mg/dL: Instruct patient to take fish oil 3 gm daily. C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. D. Triglycerides 132 mg/dL: Refer to dietician for comprehensive diet education.

ANS: C A cholesterol below 200 mg/dL is desirable, so this patient's level is high. The nurse should plan to teach this patient about heart-healthy lifestyle changes. The other laboratory values are in the desirable range, so no action is necessary.

25. 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.

41. A 65-year-old patient is in the clinic for an annual influenza vaccination. What other health promotion activity should the nurse encourage specifically for this patient? A. Heart-healthy eating B. Participating in social activities C. Pneumococcal vaccination D. Regular exercise

ANS: C All options are important for the older adult, but around the age of 65, the older adult should receive the pneumococcal vaccine. The nurse planning individualized care for the patient would encourage the patient to get this vaccination.

21. A nurse is teaching a 24-year-old male about reproductive health. Which information should the nurse provide this patient about testicular cancer? A. Annual screening is recommended for testicular cancer. B. If the epididymis is tender to the touch, that is concerning. C. Perform a testicular self examination after a warm shower. D. Because testicular cancer is rare at this age, no action is needed.

ANS: C Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 20-34. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure.

4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age? A. 1 month B. 2 months C. 3 months D. 4 months

ANS: C At 3 months, infants begin to roll over from the stomach to the back and to turn toward loud sounds. These activities can pose a safety hazard related to the changing tables used for changing diapers, and parents should be told to keep a hand on their infant at all times.

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best? A. Compliment the mother on her parenting skills. B. Document that the baby is eating finger foods now. C. Stop the mother from feeding the hot dog to the baby. D. Teach the mother that hot dogs are poor nutrition.

ANS: C At this age, examples of appropriate finger foods include small pieces of lightly toasted bagel, small pieces of ripe bananas, well-cooked pasta, teething crackers, and low-sugar "O" shaped cereal. Protein sources such as meat should be pureed to avoid choking. The nurse should gently stop the mother from feeding the hot dog to the baby. Hot dogs are not the most nutritional food, but safety comes first, so this is not the best answer. Documentation is always important but can be done later. The nurse should find something to compliment the mother on to help establish a trusting relationship.

3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her? A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age

ANS: C Between 8 and 11 years of age, children begin to focus on their own development and to contrast it with their friends' development. At this time, parents should begin to educate their children about the names and functions of the male and female sexual organs, puberty, the menstrual cycle, sexual intercourse, pregnancy, pregnancy prevention, same-sex relationships, masturbation, and the spread of sexually transmitted infections, and encourage dialogue about personal expectations and values regarding sexual activity.

34. A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin

ANS: C Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy.

3. A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nterm-61urse 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.

38. A nurse is working with an older adult who has never exercised despite understanding the health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen? A. Ask the patient if dancing sounds like fun. B. Encourage the patient to join a fitness club. C. Explain how exercise increases independence. D. Have the family talk with the patient about it.

ANS: C Maintaining physical fitness in later years contributes to health, well-being, and independence. If the patient already understands the health benefits of exercising, asking about dancing and joining fitness clubs is not likely to get the desired response. However, if the nurse can show the patient how being physically fit may mean more years of independent living, the patient might be willing to make some small changes. Asking the family to talk with the patient is not showing the nurse in action.

2. 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.

24. 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.

47. The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching? A. "Are you sure your breasts are emptying?" B. "Does the baby put everything in his mouth?" C. "Does your baby sit in a high chair yet?" D. "Is your baby using the pincer grasp yet?"

ANS: C The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 8-10 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity.

ANS: C The most reliable theory on drug use focuses on role development. As young adults take on the roles of spouse and parent, illicit drug use can interfere with performing those roles. Also, when assuming adult roles is seen as incompatible with illicit drug use, substance use declines. The nurse's best action is to help the husband see how binge drinking and drug use are not compatible with the father and role model roles. The nurse could assess the father for reasons he continues to abuse substances, but this will not help him diminish his use. Stating that the baby can be taken away may be seen as a threat and will probably cut off communication. Likewise, telling the father he will be putting his baby at risk may sound judgmental and threatening as well.

9. 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%.

15. The school nurse wants to create a safe driving program for the high school students. In order to have the greatest impact on safety, on which issue should the nurse focus? A. Female driving B. Late-night driving C. Seat-belt use D. Sleep deprivation

ANS: C The risk for motor vehicle accidents is greater among adolescents than for any other age group. Factors associated with this include the inability to assess hazardous situations while driving, speeding, driving under the influence of drugs and/or alcohol, and a low compliance with seat-belt use. Females are actually less likely to be in a motor vehicle crash than males. Late-night driving does not appear to increase risk. Although teens are often sleep deprived, this does not appear to be related.

35. A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. "Acupuncture has been shown to work better than other body therapies." B. "Herbs are a great option as they do not typically have side effects." C. "Mind-body, manipulative, or traditional Chinese medicine are safer than herbs." D. "Research shows that black cohosh significantly reduces hot flashes."

ANS: C There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind-body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse's best answer is to explain this to the patient.

22. A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin).

ANS: C This woman has manifestations of endometriosis. Diagnosis can be made via a pelvic exam, although it is often difficult to do so. Some physicians will order ultrasounds or laparoscopy with biopsy. The first step, however, is the pelvic exam, so the nurse should prepare the woman for this to occur. After making a diagnosis of endometriosis, the nurse can educate the woman on medical management, which includes using ibuprofen for pain.

23. 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.

6. The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. Gonorrhea C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

ANS: C, D, E Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health effects, what else should the nurse assess the patient for? A. Alcoholism B. Hepatitis C C. Lanugo D. Seat-belt use

ANS: D According to the results of a recent study, overweight teens tended to engage in high-risk behaviors such as smoking, chewing tobacco, and neglecting to wear a seat belt. The nurse should assess the teen for these behaviors. Alcoholism, presence of lanugo, and hepatitis C are not related.

14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What statement by the teen indicates that goals for this diagnosis have been met? A. "I don't want to cut out any more evening activities." B. "I sleep until about noon on Saturdays to catch up." C. "I take a long nap when I get home from school each day." D. "I try to keep the same sleep and wake times all week."

ANS: D Adolescents are commonly sleep deprived and often try to make up for their sleep deficit by sleeping more on weekends. This is actually detrimental, as the body has difficulty adapting to changing sleep routines. The teen who is keeping consistent sleep and wake times during the entire week has learned this fact and is probably getting better sleep than before. The other statements do not show understanding of sleep deprivation and ways to improve it.

2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant's immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months

ANS: D Because an infant's immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonate's immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infant's immune system.

11. 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.

22. 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.

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide? A. Brush the baby's teeth with special baby toothpaste. B. The child should see a dentist before the age of 2. C. All teeth should be in by age 2. D. Wipe the baby's gums with moist gauze.

ANS: D Dental hygiene should be started early. Even before a child has teeth, the gums can be wiped with a damp cloth or gauze. Toothpaste cannot be used before age 2 (because of the risks associated with swallowing it). A dentist should examine a baby's teeth within 6 months of the eruption of the first tooth, but no later than the first birthday. Children should have all 20 primary teeth by the third birthday.

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight? A. "Are you willing to talk about your weight gain this year?" B. "Do you realize your weight puts you into an obese category?" C. "Do you participate in any activities or exercise?" D. "What do you think about your weight right now?"

ANS: D During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. The other questions may put the teen on the defensive and close communication. Answer choice 1 particularly is an example of poor communication, as it is a "yes-no" question. The teen could simply answer "no" and the nurse would have no recourse other than to end that line of discussion.

17. 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.

5. 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.

33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best? A. "No, at your age, fluctuations in your menstrual cycle are normal findings." B. "No, menopause only begins in women after the age of 55." C. "Yes, not having a period for more than 6 months is diagnostic of menopause." D. "You have to go 1 year without a menstrual period to be sure that menopause has occurred."

ANS: D Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a woman's cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 35-60 years.

39. 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.

13. 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.

39. An older patient has never exercised, but wants to begin now. What response by the nurse is best? A. "At your age, exercise will not benefit you." B. "Good for you! I am so proud of you!" C. "Remember to stretch before exercising." D. "Start with exercising for only 5 minutes a day."

ANS: D Older adults who are beginning to exercise for the first time in their lives (or for the first time in a long time) should begin with only 5 minutes per day. Exercise is beneficial at any age. Reminders about stretching and praising the patient are also good options, but safety comes first.

13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula. The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best? A. Ask the student if she had pain medication this morning. B. Document the findings and send the student to classes. C. Have the student lie down and call 911 immediately. D. Question the student about eating and exercising patterns.

ANS: D Signs of anorexia nervosa include weakness, dizziness, excessive weight loss, intolerance to cold, bradycardia, hypotension, bone loss with fractures, constipation, and the development of lanugo. The nurse should assess the student for the restricted eating and excessive exercise that is characteristic of this disorder. The lower blood pressure and pulse might be the result of pain medication, but the student should not have been allowed to return to school on these medications, and this does not explain why the student appears to feel cold. Documenting the findings is important, but the school nurse has an excellent opportunity to assess and intervene if needed. Calling 911 immediately is not warranted.

10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention? A. A cat is sitting on the kitchen counter by the stove. B. Roaches are evident in the kitchen and in the pantry. C. The baby is on a carpet that is stained and worn out. D. The crib has dirty bumper pads and a dirty comforter.

ANS: D To prevent sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that all babies be put to sleep on their backs and that cribs be free of toys, comforters, and bumpers. Vaccinations and breastfeeding are also recommended. The other options show a house that is dirty but does not rise to the level of needing immediate intervention.

18. 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.

8. A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticity E. Vaginal dryness

ANS: D, E Physical changes in the older woman that increase susceptibility to HIV infection include loss of vaginal elasticity and vaginal dryness. Increased promiscuity is not a physical factor (and is not known to be a characteristic of the older adult). Mild isotonic dehydration is often seen in older adults, but is not related. Vaginal pH is not related.