Exam 4

Which contraceptive method best protects against STIs and the HIV? a.Periodic abstinence b.Barrier methods c.Hormonal methods d.Same protection with all methods

b.Barrier methods Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV.

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a.Oral antiviral therapy b.Bed rest in a semi-Fowler position c.Antibiotic regimen continued until symptoms subside d.Frequent pelvic examination to monitor the healing progress

b.Bed rest in a semi-Fowler position The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the mostcommon technique used for the termination of a pregnancy in the second trimester? a.Dilation and evacuation (D&E) b.Methotrexate administration c.Prostaglandin administration d.Vacuum aspiration

a.Dilation and evacuation (D&E) D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a.Avoid sexual contact for at least 10 days after starting the pill. b.Use condoms and foam for the first few weeks as a backup. c.Use another method of contraception for 1 week after starting the pill. d.Begin sexual relations once vaginal bleeding has ended.

c.Use another method of contraception for 1 week after starting the pill. If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.

Which findings would cause the nurse to suspect physical abuse in a pregnant client? a. The client has a history of sexually transmitted infections. b. The client has a mother who was physically abused. c. The client has a partner who accompanies her to all prenatal visits. d. Multiple bruises in various stages of healing are found on physical examination.

d. Multiple bruises in various stages of healing are found on physical examination.

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the woman's cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a.HSV b.AIDS c.Venereal warts d.Chlamydia

d.Chlamydia The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

When the nurse is alone with a battered client, the client seems extremely anxious and says, It was all my fault. The house was so messy when he got home, and I know he hates that. What is the most suitable response by the nurse? a. No one deserves to be hurt. Its not your fault. How can I help you? b. What else do you do that makes him angry enough to hurt you? c. He will never find out what we talk about. Dont worry. Were here to help you. d. You have to remember that he is frustrated and angry so he takes it out on you.

a. No one deserves to be hurt. Its not your fault. How can I help you? The nurse should stress that the client is not at fault. Asking what the client did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not provide false reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation

The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following? (Select all that apply.) a. Physical b. Sexual c. Emotional d. Psychologic e. Financial

a. Physical b. Sexual d. Psychologic e. Financial Physical, sexual, financial, and psychologic abuse can all be components in a relationship with IPV. Emotional abuse is a form of psychologic abuse.

A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (Select all that apply.) a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner b. Asking the client if she is afraid of her partner c. Asking the client if she has been forced to perform sexual acts d. Diagramming the clients current injuries on a body map e. Asking the client what she did wrong to elicit the abuse

a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner b. Asking the client if she is afraid of her partner c. Asking the client if she has been forced to perform sexual acts d. Diagramming the clients current injuries on a body map Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as slap, kick, or punch to elicit information is best.

Which nursing diagnoses would be most applicable for battered women? (Select all that apply.) a. Loss of trust b. Ineffective family coping c. Situational low self-esteem d. Risk for self-directed violence e. Enhanced communication

a. Loss of trust b. Ineffective family coping c. Situational low self-esteem d. Risk for self-directed violence Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for a battered woman would be impaired communication.

A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the perpetrator was a very close friend. Which statement is most appropriate at this time? a. Rape is not limited to strangers and frequently occurs by someone who is known to the victim. b. I would be very upset if my best friend did that to me; that is very unusual. c. You must feel very betrayed. In what way do you think you might have led him on? d. This does not sound like rape. Didnt you just change your mind about having sex after the fact?

a. Rape is not limited to strangers and frequently occurs by someone who is known to the victim. Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape. It is not at all unusual for the victim to know and trust the perpetrator. Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victims fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim. Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victims claim.

Historically, what was the justification for the victimization of women? a. Women were regarded as possessions. b. Women were the weaker sex. c. Control of women was necessary to protect them. d. Women were created subordinate to men.

a. Women were regarded as possessions. Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the worlds societies. Viewing women as the weaker sex is a cultural and modern stereotype that contributes to the victimization of women. Control of women to protect them is another cultural and modern stereotype that contributes to the victimization of women. Yet another cultural stereotype that contributes to the victimization of women is the idea that women were created as subordinate to men.

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a."It is highly unlikely that you will become pregnant after the procedure." b."Tubal ligation is an effective form of 100% permanent sterilization. You won't be able to get pregnant." c."Sterilization offers some form of protection against STIs." d."Sterilization offers no protection against STIs." e."Your menstrual cycle will greatly increase after your sterilization."

a."It is highly unlikely that you will become pregnant after the procedure." d."Sterilization offers no protection against STIs." A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be mosthelpful in achieving this goal? a."You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash." b."You should remove your diaphragm right after intercourse to prevent TSS." c."It's okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS." d."Make sure you don't leave your diaphragm in for longer than 24 hours, or you may get TSS."

a."You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash." The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a.Bacterial vaginosis b.Candidiasis c.Trichomoniasis d.Gonorrhea

a.Bacterial vaginosis Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

Which statement regarding emergency contraception is correct? a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b.Emergency contraception may be taken right after ovulation. c.Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d.Emergency contraception is commonly associated with the side effect of menorrhagia.

a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a.Family planning b.Birth control c.Contraception d.Assisted reproductive therapy

a.Family planning Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapyis one of several possible treatments for infertility.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners d.Dry kissing e.Abstinence

a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a.Fluconazole b.Tetracycline c.Clindamycin d.Acyclovir

a.Fluconazole The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a.Gallbladder disease b.Myocardial infarction and stroke c.Hypotension d.Breast tenderness and fluid retention e.Dry skin and scalp

a.Gallbladder disease b.Myocardial infarction and stroke d.Breast tenderness and fluid retention Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a.Herpes simplex virus 2 (HSV-2) b.HPV c.HIV d.CMV

a.Herpes simplex virus 2 (HSV-2) The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a.Intrapartum treatment with antiviral medications b.Cesarean birth c.Postpartum treatment with antiviral medications d.Avoidance of breastfeeding e.Pneumococcal, HBV, and Haemophilus influenzae vaccine

a.Intrapartum treatment with antiviral medications b.Cesarean birth d.Avoidance of breastfeeding The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a.Menstruation b.Trauma c.Febrile illness d.Soap e.Ultraviolet light

a.Menstruation b.Trauma c.Febrile illness e.Ultraviolet light Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a.Number of partners b.Level of physical activity c.Prevention of pregnancy d.Protection from STIs e.Past history

a.Number of partners c.Prevention of pregnancy d.Protection from STIs e.Past history Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a.Obtain a history of the woman's menstrual cycle lengths for the past 6 to 12 months. b.Determine the client's weight gain and loss pattern for the previous year. c.Examine skin pigmentation and hair texture for hormonal changes. d.Explore the client's previous experiences with conception control.

a.Obtain a history of the woman's menstrual cycle lengths for the past 6 to 12 months. The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a.Only one vaccine for the HPV is available. b.The vaccine is given in three doses over a 6-month period. c.The vaccine is recommended for both boys and girls. d.Ideally, the vaccine is administered before the first sexual contact.

a.Only one vaccine for the HPV is available. Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a.Standard days' variation b.Periodic abstinence c.Postovulation d.Coitus interruptus

a.Standard days' variation The standard days' variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a.Strategies to enhance condom use b.Choice of colors and special features c.Leaving the decision up to the male partner d.Places to carry condoms safely

a.Strategies to enhance condom use When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a.Toxoplasmosis b.Other infections c.Roseola d.Clostridium e.Herpes simplex

a.Toxoplasmosis b.Other infections e.Herpes simplex Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a.Vomiting and diarrhea b.Headache, myalgias, and arthralgia c.Preterm labor d.Jarisch-Herxheimer in the first 24 hours after treatment

a.Vomiting and diarrhea The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a.Wear gloves. b.Wear mouth, nose, and eye protection. c.Wear a mask. d.Wash the hands after medication administration.

a.Wear gloves. Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a.Fever higher than 39° C b.Chills c.Foul-smelling vaginal discharge d.Bleeding greater than four pads in 2 hours e.Severe abdominal pain

b.Chills c.Foul-smelling vaginal discharge e.Severe abdominal pain The client should report to a health care facility for any of the following symptoms: fever higher than 38° C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time? a. "Didn't the physician tell you about your son's problems?" b. "This must be a difficult time for you. Tell me how you're doing." c. Quietly stand beside the infant's father. d. "You'll have to face up to the fact that he is going to die sooner or later."

b. "This must be a difficult time for you. Tell me how you're doing." The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings during the initial steps in the grieving process. This father is in a phase of acute distress and is reaching out to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through a sharing and verbalization of their feelings of grief. Telling the father that his son is going to die sooner or later is dispassionate and an inappropriate statement on the part of the nurse.

A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? a. Anticipatory grief b. Acute distress c. Intense grief d. Reorganization

b. Acute distress The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, a lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress. Anticipatory grief applies to the grief related to a potential loss of an infant. The parent grieves in preparation of the infant's possible death, although he or she clings to the hope that the child will survive. Intense grief occurs in the first few months after the death of the infant. This phase encompasses many different emotions, including loneliness, emptiness, yearning, guilt, anger, and fear. Reorganization occurs after a long and intense search for meaning. Parents are better able to function at work and home, experience a return of self-esteem and confidence, can cope with new challenges, and have placed the loss in perspective.

Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)? a. Socially isolated b. Assertive personality c. Struggling with depression d. Dependent partner in a relationship

b. Assertive personality Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.

Which statement is most accurate regarding the reporting of IPV in the United States? a. Asian women report more IPV than do other minority groups. b. Caucasian women report less IPV than do non-Caucasians. c. Native-American women report IPV at a rate similar to other groups. d. African-American women are less likely to report IPV than Caucasian women

b. Caucasian women report less IPV than do non-Caucasians. Caucasian women report less IPV than other ethnic groups. Asian women report significantly less IPV than do other racial groups. Native-American and Alaska Native women report significantly more IPV than do women of any other racial background. African-American women tend to report violence at a slightly higher rate than Caucasian women.

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions.

b. The woman has injuries on various parts of her body that are in different stages of healing. The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be normal for the woman to be reticent and have a dull affect.

In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research, she found a similar pattern of abuse among many of the women. This concept is now referred to as the cycle of violence. Which phase does not belong in this three-cycle pattern of violence? a. Tension-building state b. Frustration, followed by violence c. Acute battering incident d. Kindness and contrite, loving behavior

b. Frustration, followed by violence Frustration, followed by violence, is not part of the cycle of violence. The tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him. An acute battering incident is phase II of the cycle. It results in the mans uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons. Phase III of the cycle is sometimes referred to as the honeymoon, kindness and contrite, and loving behavior phase, during which the batterer feels remorseful and profusely apologizes. He tries to help the woman and often showers her with gifts.

Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client? a. Preeclampsia b. IPV c. Diabetes d. Abnormal Pap test

b. IPV The prevalence of IPV during pregnancy is estimated at 6% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions. Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV. Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy. Some women are at risk for an abnormal Pap screening during pregnancy, but this finding is not as common as IPV.

During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding? a. Guilt, particularly in the mother b. Numbness or lack of response c. Bitterness or irritability d. Fear and anxiety, especially about getting pregnant again

b. Numbness or lack of response The second phase of grieving encompasses a wide range of intense emotions, including guilt, anger, bitterness, fear, and anxiety. What the nurse would hope not to see is numbness or unresponsiveness, which indicates that the parents are still in denial or shock.

Parents have asked the nurse about organ donation after that infant's death. Which information regarding organ donation is important for the nurse to understand? a. Federal law requires the medical staff to ask the parents about organ donation and then to contact their state's organ procurement organization (OPO) to handle the procedure if the parents agree. b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience. c. Most common donation is the infant's kidneys. d. Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term.

b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience. Evidence indicates that organ donation can promote healing among the surviving family members. The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request. The most common donation is the cornea. For cornea donation, the infant must have been born alive at 36 weeks of gestation or later.

What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman? (Select all that apply.) a. Report the incident to legal authorities. b. Provide resources for domestic violence shelters. c. Call a client advocate who can assist in the clients decision about what actions to take. d. Accurately and concisely document the incident (or findings) in the clients record. e. Reassure and support the client.

b. Provide resources for domestic violence shelters. c. Call a client advocate who can assist in the clients decision about what actions to take. d. Accurately and concisely document the incident (or findings) in the clients record. e. Reassure and support the client. Domestic violence is considered a crime in all states; however, mandatory reporting remains controversial. Nurses must become knowledgeable on the laws that apply in the state in which they practice. Caring for a client who may be a victim of domestic abuse is an ideal opportunity to provide the woman with information for safe houses or support groups for herself and her children. The nurse may assist in reaching out to a client advocate, which often occurs when potential legal action is taken or if the woman is seeking shelter. Documentation must be accurate and timely to be useful to the client later in court if she chooses to press charges. The primary functions for the nurse are to reassure the client and to provide her with emotional support.

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? a. The parents say that they "feel no pain." b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings. c. The parents have abandoned those moments of "bittersweet grief." d. The parents' questions have progressed from "Why?" to "Why us?"

b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings. Many couples have conflicting feelings about sexuality and future pregnancies. A little pain is always present, certainly beyond the first year when recovery begins to peak. Bittersweet grief describes the brief grief response that occurs with reminders of a loss, such as anniversary dates. Most couples never abandon these reminders. Recovery is ongoing. Typically, a couple's search for meaning progresses from "Why?" in the acute phase to "Why me?" in the intense phase to "What does this loss mean to my life?" in the reorganizational phase.

Which statement regarding human trafficking is correct? a. Human trafficking is a multibillion-dollar business that primarily exists in the United States. b. Victims often experience the Stockholm syndrome. c. Vast majority of the victims are young boys and girls. d. Human trafficking primarily refers to commercial sex work.

b. Victims often experience the Stockholm syndrome. Although victims of sex trafficking can be young boys and girls, the vast majority are women and girls. They are often lured by false promises, such as a job or marriage, sold by their parents, or kidnapped by traffickers. These individuals are forced into sex work, hard labor, and organ donation. This $32 billion business exists in the United States and internationally. The Stockholm syndrome occurs when the slaves become attached to their enslavers. Health care professionals may interact with victims who are in captivity should they require emergent health care. The nurse is challenged to find an opportunity to speak with the client alone and assess for victimization

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a."They're not very effective, and it is very likely that you'll get pregnant." b."FAMs can be effective for many couples; however, they require motivation." c."These methods have a few advantages and several health risks." d."You would be much safer going on the pill and not having to worry."

b."FAMs can be effective for many couples; however, they require motivation. FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client's part.

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide? a."It's just a little lump on your cervix. We can just freeze it off." b."HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." c."HPV is a type of early human immunodeficiency virus. You will die from this." d."You probably caught this from your current boyfriend. He should get tested for this."

b."HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a."The lubricant prevents vaginal irritation." b."Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions." c."The additional lubrication improves sex." d."Nonoxynol-9 improves penile sensitivity."

b."Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions." Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a."The IUD does not interfere with sex." b."The risk of pelvic inflammatory disease will be higher with the IUD." c."The IUD will protect you from sexually transmitted infections." d."Pregnancy rates are high with the IUD."

b."The risk of pelvic inflammatory disease will be higher with the IUD." Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse's best response? a."Oral contraceptives are a highly effective method, but they have some side effects." b."Your current medications will reduce the effectiveness of the pill." c."Oral contraceptives will reduce the effectiveness of your seizure medication." d."The pill is a good choice for a woman of your age and with your personal history."

b."Your current medications will reduce the effectiveness of the pill." Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Which benefit regarding FAMs makes it an appealing choice for some women? a.Adherence to strict recordkeeping b.Absence of chemicals and hormones c.Decreased involvement and intimacy of partner d.Increased spontaneity of coitus

b.Absence of chemicals and hormones The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a.Obtain data about the frequency of coitus. b.Determine the woman's level of knowledge concerning contraception and her commitment to any particular method. c.Assess the woman's willingness to touch her genitals and cervical mucus. d.Evaluate the woman's contraceptive life plan.

b.Determine the woman's level of knowledge concerning contraception and her commitment to any particular method. Determining the woman's level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partner's willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partner's objections. Assessing the woman's willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the client's plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a.Vaccine exists for hepatitis C virus (HCV) but not for HBV. b.HAV is acquired by eating contaminated food or drinking polluted water. c.HBV is less contagious than HIV. d.Incidence of HCV is decreasing.

b.HAV is acquired by eating contaminated food or drinking polluted water. Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a.HIV screening b.HIV antibody testing c.Cluster of differentiation 4 (CD4) counts d.Cluster of differentiation 8 (CD8) counts

b.HIV antibody testing The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

Importantly, the nurse must be aware of which information related to the use of IUDs? a.Return to fertility can take several weeks after the device is removed. b.IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c.IUDs offer the same protection against STIs as the diaphragm. d.Consent forms are not needed for IUD insertion.

b.IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a.Sterilization should be performed under general anesthesia. b.Pain, bleeding, and infection are possible complications. c.Pregnancy may still be possible. d.Vasectomy may affect potency. e.Secondary sex characteristics are unaffected.

b.Pain, bleeding, and infection are possible complications. c.Pregnancy may still be possible. e.Secondary sex characteristics are unaffected. Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a.LAM is effective until the infant is 9 months of age. b.This popular method of birth control works best if the mother is exclusively breastfeeding. c.Its typical failure rate is 5%. d.Feeding intervals should be 6 hours during the day.

b.This popular method of birth control works best if the mother is exclusively breastfeeding. The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a.Miconazole ointment b.Topical podofilox 0.5% solution or gel c.Two doses of penicillin administered intramuscularly (IM) d.Metronidazole by mouth

b.Topical podofilox 0.5% solution or gel Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Which statements regarding the HPV are accurate? (Select all that apply.) HPV infections: a.are thought to be less common in pregnant women than in women who are not pregnant. b.are thought to be more common in pregnant women than in women who are not pregnant. c.were previously called genital warts. d.were previously called herpes. e.may cause cancer.

b.are thought to be more common in pregnant women than in women who are not pregnant. c.were previously called genital warts. e.may cause cancer. HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

Which options for saying good-bye should the nurse discuss with a woman who is diagnosed as having a stillborn girl? a. The nurse shouldn't discuss any options at this time; there is plenty of time after the baby is born. b. "Would you like a picture taken of your baby after birth?" c. "When your baby is born, would you like to see and hold her?" d. "What funeral home do you want notified after the baby is born?"

c. "When your baby is born, would you like to see and hold her?"

Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? a. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born. b. "Would you like a picture taken of your baby after birth?" c. "When your baby is born, would you like to see and hold her?" d. "What funeral home do you want notified after the baby is born?"

c. "When your baby is born, would you like to see and hold her?" Mothers and fathers may find it helpful to see their infant after delivery. The parents' wishes should be respected. Interventions and support from the nursing and medical staff after a prenatal loss are extremely important in the healing of the parents. The initial intervention should be directly related to the parents' wishes concerning seeing or holding their dead infant. Although information about funeral home notification may be relevant, this information is not the most appropriate option at this time. Burial arrangements can be discussed after the infant is born.

When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful? a. Using the words lost or gone rather than dead or died b. Making sure the family understands that naming the baby is important c. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby d. Setting a firm time for ending the visit with the baby so that the parents know when to let go

c. Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby Presenting the baby as nicely as possible stimulates the parents' senses and provides pleasant memories of their baby. Baby lotion or powder can be applied, and the baby should be wrapped in a soft blanket, clothed, and have a cap placed on his or her head. Nurses must use the words dead and died to assist the bereaved in accepting the reality. Although naming the baby can be helpful, creating the sense that the parents have to name the baby is not important. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. Parents need different times with their baby to say "good-bye." Nurses need to be careful not to rush the process.

Nurses who provide care to victims of IPV should be keenly aware of what? a. Relationship violence usually consists of a single episode that the couple can put behind them. b. Violence often declines or ends with pregnancy. c. Financial coercion is considered part of IPV. d. Battered women are generally poorly educated and come from a deprived social background.

c. Financial coercion is considered part of IPV. Economic coercion may accompany physical assault and psychologic attacks. IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence. IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion. Race, religion, social background, age, and education level are not significant factors in differentiating women at risk

A nurse is providing discharge instructions to a client who has just been diagnosed with human papillomavirus (HPV) on her cervix. What is the most important discharge instruction for this client? a. Take a multivitamin every day. b. Check for external lesions around the vagina every month. c. Have Pap tests done as recommended by her provider. d. Avoid using an intrauterine device (IUD).

c. Have Pap tests done as recommended by her provider.

Which statement most accurately describes complicated grief? a. Occurs when, in multiple births, one child dies and the other or others live b. Is a state during which the parents are ambivalent, as with an abortion c. Is an extremely intense grief reaction that persists for a long time d. Is felt by the family of adolescent mothers who lose their babies

c. Is an extremely intense grief reaction that persists for a long time Parents showing signs of complicated grief should be referred for counseling. Multiple births, in which not all of the babies survive, create a complicated parenting situation but not complicated bereavement. Abortion can generate complicated emotional responses, but these responses do not constitute complicated bereavement. Families of lost adolescent pregnancies may have to deal with complicated issues, but these issues are not complicated bereavement.

Intervention for the sexual abuse survivor is often not attempted by maternity and womens health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the womans care? a. Initiating a referral to an expert counselor b. Setting limits on what the client discloses c. Listening and encouraging therapeutic communication skills d. Acknowledging the nurses discomfort to the client as an expression of empathy

c. Listening and encouraging therapeutic communication skills The survivor needs support on many different levels, and a womens health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions. Referring this client to a counselor is an appropriate measure but not the most important initial intervention. A client should be allowed to disclose any information she feels the need to discuss. A nurse should provide a safe environment in which she can do so. Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

What is the primary theme of the feminist perspective regarding violence against women? a. Role of testosterone as the underlying cause of mens violent behavior b. Basic human instinctual drive toward aggression c. Male dominance and coercive control over women d. Cultural norm of violence in Western society

c. Male dominance and coercive control over women The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances an understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace. The role of testosterone as an underlying cause of mens violent behavior, the basic human instinctual drive toward aggression, and the cultural norm of violence in Western society are not associated with the feminist perspective regarding violence against women.

An induced abortion client calls the nurse to report postprocedural symptoms. Which condition is not an indication for the nurse to ask her to come into the office for care? a. Abdominal tenderness when pressure is applied b. Chills and a fever of 101° F c. Return of her period in less than 6 weeks d. Foul-smelling vaginal discharge

c. Return of her period in less than 6 weeks

Which statement is the most comprehensive description of sexual violence? a. Sexual violence is limited to rape. b. Sexual violence is an act of force during which an unwanted and uncomfortable sexual act occurs. c. Sexual violence encompasses a number of sexual acts. d. Sexual violence includes degrading sexual comments and behaviors.

c. Sexual violence encompasses a number of sexual acts. Sexual violence is a broad term that includes a range of sexual victimization including sexual assault, sexual harassment, and rape. It may include but is not limited to rape. Sexual assault includes unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It is a component of sexual violence. Unwelcome or degrading e-mail messages, comments, contact, or behavior, such as exhibitionism, that makes any environment feel unsafe is known as sexual harassment.

In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS? a. Acute Phase: Disorganization b. Outward Adjustment Phase c. Shock/Disbelief: Disorientation Phase d. Long-Term Process: Reorganization Phase

c. Shock/Disbelief: Disorientation Phase Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and douche repeatedly, even though doing so may destroy evidence. The victim relives the scene over and over in her mind, thinking of things she should have done. During the Outward Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of daily living and work. Other women may move, leave their job, and buy a weapon to protect themselves. Disorientation is a reaction during which the victim may feel disoriented, have difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization phase. This recovery phase may take years and may be difficult and painful.

What are some common characteristics of a potential male batterer? (Select all that apply.) a. High level of self-esteem b. High frustration tolerance c. Substance abuse problems d. Excellent verbal skills e. Personality disorders

c. Substance abuse problems e. Personality disorders Substance abuse and personality disorders are often observed in batterers. Typically, the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they easily lose their temper). Batterers characteristically have poor verbal skills and can especially have difficulty expressing their feelings

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? a. Photographs of injuries b. Clear and legible written documentation c. Summary of information (e.g., The client is a battered woman.) d. Accurate description of the clients demeanor

c. Summary of information (e.g., The client is a battered woman.) A statement such as, The client is a battered woman lacks the supporting factual information and will render the report inadmissible. More appropriate documentation would include exact statements from the woman in quotations (e.g., My husband kicked me in the stomach). The time and date of the examination should also be included.

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a.The natural family planning method is the same as coitus interruptus or "pulling out." b.This contraception method uses the calendar method to align the woman's cycle with the natural phases of the moon. c.This practice is the only contraceptive method acceptable to the Roman Catholic Church. d.The natural family planning method relies on barrier methods during the fertility phases.

c.This practice is the only contraceptive method acceptable to the Roman Catholic Church. Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. "Pulling out" is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurse's role at this time? a. To take over as much as possible to relieve the pressure b. To encourage the grandparents to take over c. To ensure that the parents, themselves, approve the final decisions d. To leave them alone to work things out

c. To ensure that the parents, themselves, approve the final decisions The nurse is always the client's advocate. Nurses can offer support and guidance and yet leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions. For the nurse to be able to present options regarding burial and autopsy, among other issues, in a sensitive and respectful manner is essential. The nurse should assist the parents in any way possible; however, taking over all arrangements is not the nurse's role. Grandparents are often called on to help make the difficult decisions regarding funeral arrangements or the disposition of the body because they have more life experiences with taking care of these painful, yet required arrangements. Some well-meaning relatives may try to take over all decision-making responsibilities. The nurse must remember that the parents, themselves, should approve all of the final decisions. During this time of acute distress, the nurse should be present to provide quiet support, answer questions, obtain information, and act as a client advocate.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a.6 to 10 days b.2 to 4 weeks c.6 to 12 weeks d.6 months

c.6 to 12 weeks Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a.B stands for birth control. b.R stands for reproduction. c.A stands for alternatives. d.I stands for ineffective.

c.A stands for alternatives. In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

What is the drug of choice for the treatment of gonorrhea? a.Penicillin G b.Tetracycline c.Ceftriaxone d.Acyclovir

c.Ceftriaxone Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a.Gonorrhea b.Syphilis c.Chlamydia d.Candidiasis

c.Chlamydia Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

Which STI does not respond well to antibiotic therapy? a.Chlamydia b.Gonorrhea c.Genital herpes d.Syphilis

c.Genital herpes Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

Which condition is the most life-threatening virus to the fetus and neonate? a.Hepatitis A virus (HAV) b.Herpes simplex virus (HSV) c.Hepatitis B virus (HBV) d.Cytomegalovirus (CMV)

c.Hepatitis B virus (HBV) HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? a.Spermicides b.Female condoms c.Male condoms d.Diaphragms

c.Male condoms For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%.

A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a.Limit sexual contact for one cycle after starting the pill. b.Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c.Take one pill at the same time every day. d.Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

c.Take one pill at the same time every day. To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a.The ideal candidate for DMPA wants menstrual regularity and predictability. b.The client has a history of thrombotic problems or breast cancer. c.The ideal candidate has difficulty remembering to take oral contraceptives daily. d.The client is homeless or mobile and rarely receives health care.

c.The ideal candidate has difficulty remembering to take oral contraceptives daily. Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt? a. Siblings b. Mother c. Father d. Grandparents

d. Grandparents Survivor guilt is sometimes felt by grandparents because they feel that the death is out of order; they are still alive, while their grandchild has died. They may express anger that they are alive and their grandchild is not. The siblings of the expired infant may also experience a profound loss. A young child will respond to the reactions of the parents and may act out. Older children have a more complete understanding of the loss. School-age children are likely to be frightened, whereas teenagers are at a loss on how to react. The mother of the infant is experiencing intense grief at this time. She may be dealing with questions such as, "Why me?" or "Why my baby?" and is unlikely to be experiencing survival guilt. Realizing that fathers can be experiencing deep pain beneath their calm and quiet appearance and may need help acknowledging these feelings is important. This need, however, is not the same as survivor guilt.

A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: a. "My egg will be fertilized and then placed into my uterus." b. "My husband's sperm will be inserted into my uterus." c. "My husband's sperm and my egg will be placed into my fallopian tube." d. "A fertilized egg will be placed into my fallopian tube."

d. "A fertilized egg will be placed into my fallopian tube."

After giving birth to a stillborn infant, the woman turns to the nurse and says, "I just finished painting the baby's room. Do you think that caused my baby to die?" What is the nurse's most appropriate response? a. "That's an old wives' tale; lots of women are around paint during pregnancy, and this doesn't happen to them." b. "That's not likely. Paint is associated with elevated pediatric lead levels." c. Silence. d. "I can understand your need to find an answer to what caused this. What else are you thinking about?"

d. "I can understand your need to find an answer to what caused this. What else are you thinking about?" The statement "I can understand your need to find an answer to what caused this. What else are you thinking about?" is very appropriate for the nurse. It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving. The nurse should resist the temptation to give advice or to use clichés in offering support to the bereaved. In addition, trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feeling does not help the process of grieving. Silence would probably increase the mother's feelings of guilt. One of the most important goals of the nurse is to validate the experience and feelings of the parents by encouraging them to tell their stories and then listening with care. The nurse should encourage the mother to express her thoughts.

Which statement is the most appropriate for the nurse to make when caring for bereaved parents? a. "This happened for the best." b. "You have an angel in heaven." c. "I know how you feel." d. "What can I do for you?"

d. "What can I do for you?" Acknowledging the loss and being open to listening is the best action that the nurse can do. No bereaved parent would find the statement "This has happened for the best" to be comforting in any way, and it may sound judgmental. Nurses must resist the impulse to speak about the afterlife to people in pain. They should also resist the temptation to give advice or to use clichés. Unless the nurse has lost a child, he or she does not understand how the parents feel.

Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships; however, many women develop mental health problems as a result of long-term abuse. Which condition is unlikely to be a psychologic consequence of continued abuse? a. Substance abuse b. Posttraumatic stress disorder (PTSD) c. Eating disorders d. Bipolar disorder

d. Bipolar disorder Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently re-experienced through distress recollection and dreams. Eating disorders, depression, psychologic-physiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant? a. Refers to the two live infants as twins b. Asks about the dead triplet's current status c. Brings in play clothes for all three infants d. Refers to the dead infant in the past tense

d. Refers to the dead infant in the past tense Accepting that the infant is dead (in the past tense of the word) demonstrates an acceptance of the reality and that the family has begun to grieve. Parents of multiples are challenged with the task of parenting and grieving at the same time. Referring to the two live infants as twins does not acknowledge an acceptance of the existence of their third child. Bringing in play clothes for all three infants indicates that the parents are still in denial regarding the death of the third triplet. The death of the third infant has imposed a confusing and ambivalent induction into parenthood for this couple. If the two live infants are referred to as twins and/or if play clothes for all three infants are still considered, then the family is clearly still in denial regarding the death of one of the triplets.

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information? a. Autopsies are usually covered by insurance. b. Autopsies must be performed within a few hours after the infant's death. c. In the current litigious society, more autopsies are performed than in the past. d. Some religions prohibit autopsy.

d. Some religions prohibit autopsy. Some religions prohibit autopsies or limit the choice to the times when it may help prevent further loss. The cost of the autopsy must be considered; it is not covered by insurance and can be very expensive. There is no rush to perform an autopsy unless evidence of a contagious disease or maternal infection is present at the time of death. The rate of autopsies is declining, in part because of a fear by medical facilities that errors by the staff might be revealed, resulting in litigation.

Nurses are often the first health care professional with whom a woman comes into contact after being sexually assaulted. Which statement best describes the initial care of a rape victim? a. All legal evidence is preserved during the physical examination. b. The victim appreciates the legal information; however, decides not to pursue legal proceedings. c. The victim states that she is going to advocate against sexual violence. d. The victim leaves the health care facility without feeling re-victimized.

d. The victim leaves the health care facility without feeling re-victimized. Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care. Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating the care of a rape victim. Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings. Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery but not a measure of evaluating her care.

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a."No spermicide is used with the cervical cap, so it's less messy." b."The diaphragm can be left in place longer after intercourse." c."Repeated intercourse with the diaphragm is more convenient." d."The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later."

d."The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later." The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." What is the nurse's mostappropriate response? a."This probably means that you're pregnant." b."Don't worry; it's probably nothing." c."Have you been sick this month?" d."You probably didn't ovulate during this cycle."

d."You probably didn't ovulate during this cycle." The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, "Don't worry; it's probably nothing," discredits the client's concerns. Illness is most likely the cause of an increase in BBT.

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a.Fever, headache, and malaise b.Widespread rash c.Identified by serologic testing d.Appearance of a chancre 2 months after infection

d.Appearance of a chancre 2 months after infection Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a.COCs can cause TSS if the prescription is wrong. b.Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c.COCs increase the risk of endometrial and ovarian cancers. d.Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

d.Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

Which statement regarding the term contraceptive failure rate is the most accurate? a.The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b.It refers to the minimum rate that must be achieved to receive a government license. c.The contraceptive failure rate increases over time as couples become more careless. d.It varies from couple to couple, depending on the method and the users.

d.It varies from couple to couple, depending on the method and the users. Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a.Positive prenatal culture b.Preterm birth at 37 weeks or less of gestation c.Maternal temperature of 38° C or higher d.Premature rupture of membranes (PROM) 24 hours or longer before the birth

d.Premature rupture of membranes (PROM) 24 hours or longer before the birth PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

What is the importance of obtaining informed consent for a number of contraceptive methods? a.Contraception is an invasive procedure that requires hospitalization. b.The method may require a surgical procedure to insert a device. c.The contraception method chosen may be unreliable. d.The method chosen has potentially dangerous side effects.

d.The method chosen has potentially dangerous side effects. Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.

Which statement is the most complete and accurate description of medical abortions? a.Medical abortions are performed only for maternal health. b.They can be achieved through surgical procedures or with drugs. c.Medical abortions are mostly performed in the second trimester. d.They can be either elective or therapeutic.

d.They can be either elective or therapeutic. Medical abortions can be either elective (the woman's choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a.Bacterial vaginosis b.Candidiasis c.Yeast infection d.Trichomoniasis

d.Trichomoniasis Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.