Development

To help prevent osteoporosis, what should a nurse advise a young woman to do? a) Keep the serum uric acid level within the normal range. b) Avoid trauma to the affected bone. c) Consume at least 1,000 mg of calcium daily. d) Encourage the use of a firm mattress.

Consume at least 1,000 mg of calcium daily. Correct Explanation: To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it's 1,500 mg. Because osteoporosis affects all bones, avoiding trauma to the affected bone only is inappropriate. Using a firm mattress and keeping the uric acid level within the normal range don't relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range

Which child should the nurse assess as demonstrating behaviors that need further evaluation? a) Joey, age 2, who refuses to be toilet-trained and talks to himself b) Adrienne, age 6, who sucks her thumb when tired and has never spent the night with a friend c) Stephen, age 2, who is indifferent to other children and adults and is mute d) Curt, age 10, who frequently tells his mother that he is going to run away whenever they argue

Stephen, age 2, who is indifferent to other children and adults and is mute Correct Explanation: Indifference to other people and mutism may be indicators of autism and would require further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night with a friend would be normal at age 6. Threatening to run away when angry is considered within the range of normal behaviors for a 10-year-old child.

The nurse working at a family planning clinic evaluates a client's risk for complications from oral contraceptives. Which of the following places the client at highest risk? a) Smokes 1 pack cigerettes per week b) Age less than 35 c) Drinks 1 glass of wine daily d) History of diabetes

Smokes 1 pack cigerettes per week Correct Explanation: Complications for oral contraceptives include an increased incidence of blood clots, heart attacks, and stroke, especially in women who smoke.

A client is taking a progestin-only oral contraceptive, or minipill. When teaching the client about this medication, a nurse should include information on signs and symptoms of: a) female hypogonadism. b) endometriosis. c) tubal or ectopic pregnancy. d) premenstrual syndrome.

tubal or ectopic pregnancy. Correct Explanation: Women taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and premenstrual syndrome aren't associated with progestin-only oral contraceptives

Which example best supports the diagnosis of Sexual Dysfunction: Dyspareunia? a) A patient with a colostomy believes she cannot have a sexual relationship with her husband because he will be repulsed by her stoma. b) A 39-year-old alcoholic woman is no longer interested in having sex with her partner. c) A 50-year-old woman with a history of stroke is afraid to have sex with her partner for fear it will elevate her blood pressure. d) A 50-year-old woman in the process of menopause has pain and burning during intercourse.

A 50-year-old woman in the process of menopause has pain and burning during intercourse. Correct Explanation: Dyspareunia refers to pain and burning during intercourse. This is a common cause of sexual dysfunction, especially during menopause. A colostomy, fear of blood pressure elevation, and lack of interest in sex may lead to the nursing diagnosis of Sexual Dysfunction, but not related to dyspareunia.

A client has decided to use a transdermal contraceptive patch. The nurse instructs her that she can apply the patch to which area? Select all that apply. a) Chest b) Breasts c) Thighs d) Torso e) Arms

Chest • Torso • Arms • Thighs Explanation: A transdermal contraceptive patch can be applied to the torso, chest, arms, or thighs. It should not be applied to the breasts.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a) Clients with a history of recurrent candidiasis b) Clients with a long history of hormonal contraceptive use c) Clients infected with the human papillomavirus (HPV) d) Clients with a pregnancy before age 20

Clients infected with the human papillomavirus (HPV) Correct Explanation: HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.

A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception? a) Hormonal contraception b) Barrier methods c) Abstinence d) Sterilization

Abstinence Explanation: Abstinence is the only completely effective means of contraception. It is followed by sterilization. Hormonal contraceptives and barrier methods are effective but they must be used consistently to be effective

The nurse instructs a female client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for women who: a) Are in a monogamous relationship. b) Have had a history of ectopic pregnancies. c) Desire short-term use of a contraceptive. d) Have a history of sexually transmitted diseases (STDs).

Are in a monogamous relationship. Correct Explanation: The IUD is suitable for clients who desire long-term contraceptive use and are in a monogamous relationship. Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.

Which of the following dinner selections demonstrates an understanding of nutritional therapy used by women to decrease the signs and symptoms of menopause? a) Wheat toast, apple slices, broiled chicken breast, and steamed carrots b) White toast, apple sauce, grilled chicken, and glazed carrots c) Corn chips, grapes, lean meat, and baked beans d) Saltine crackers, fruit cocktail, lima beans, and meatloaf

Wheat toast, apple slices, broiled chicken breast, and steamed carrots Correct Explanation: To decrease the signs and symptoms of menopause, women are encouraged to decrease their fat and caloric intake and increase their intake of whole grains, fiber, fruit, and vegetables. Saltine crackers, white toast, and corn chips are not good sources of fiber. Fruit cocktail, applesauce, and grapes are high in artificial and natural sugars. Meatloaf is high in fat. Glazed carrots and baked beans can be high in sugar content

An emergency department nurse suspects neglect in a 3-year-old boy admitted for failure to thrive. Signs of neglect in the child would include: a) loud crying and screaming. b) slapping, kicking, and punching others. c) poor hygiene and weight loss. d) pulling hair and hitting.

poor hygiene and weight loss. Correct Explanation: Signs of neglect include poor hygiene and weight loss because neglect can involve failure to provide food, bed, shelter, health care, or hygiene. Slapping, kicking, pulling hair, hitting, and punching are examples of forms of physical abuse, not neglect. Loud crying and screaming are normal findings in a 3-year-old boy.

When assessing the development of a 15-month-old child with cerebral palsy, whichmilestone should the nurse expect a toddler of this age to have achieved? a) walking up steps b) using a spoon c) copying a circle d) putting a block in cup

putting a block in cup Explanation: Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of typically developing 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.

The nurse documents the following history obtained from a female patient: No known allergies Douching 2 to 3 times per week Use of barrier methods for contraception Recent viral upper respiratory infection Estrogen levels within acceptable parameters Which of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? a) Viral upper respiratory infection b) Normal estrogen levels c) Douching d) Barrier contraception

Douching Correct Explanation: Risk factors for vulvovaginal infections include frequent douching, allergies, oral contraceptive use, use of broad-spectrum antibiotics (for bacterial infections), and low estrogen levels.

An elderly male patient was admitted to the geriatric medical unit of the hospital with a diagnosis of failure to thrive and has not walked for several weeks. What exercise routine should the nurse teach the patient in order to prepare him for walking? a) Have the patient lift 2-pound sand bags with his legs while in a supine position. b) Place the patient prone and ask him to flex and extend his lower leg repeatedly. c) Have the patient tighten and relax his thigh muscles several times in succession. d) Teach the patient to perform rapid ankle flexion and extension while he is in a chair.

Have the patient tighten and relax his thigh muscles several times in succession. Correct Explanation: Quadriceps drills are an isometric exercise in which the patient repeatedly tightens and relaxes his or her thigh muscle in order to strengthen the leg muscles for future walking. Ankle and leg flexion (isotonic exercise) are less useful for restoring leg strength and weights (isokinetic exercise) are not normally used

The parent of a 10-year-old child with attention deficit hyperactivity disorder (ADHD) says her spouse won't allow their child to take more than 5 mg of methylphenidate every morning. The child isn't doing better in school. Which recommendation would the nurse make to the mother? a) Bring the child's parent to the clinic to discuss the medication. b) Ask the school nurse to give the child the rest of the medication. c) Put the child in charge of administering the medication. d) Sneak the medication to the child anyway.

Bring the child's parent to the clinic to discuss the medication. Correct Explanation: Bringing the parent to the clinic for an educational session about the medication should assist him in understanding why it's necessary for the child to receive the full dose. The parent should be included in the treatment as much as possible. A nurse shouldn't advise dishonesty to a client or family. Putting a 10-year-old in charge of medication is inappropriate. School nurses can only administer medications as per health care provider prescriptions.

A teenage female is in the community health clinic seeking contraception. The community health nurse demonstrates effective health promotion and prevention with the client when including which of the following in the health education teaching plan? a) Contraception plans prior to initiation of sexual activity. b) The need for a back-up contraceptive method when using antibiotics. c) Correct use of the contraception method selected. d) The importance of using a barrier method to prevent risk of HIV transmission.

Contraception plans prior to initiation of sexual activity. Explanation: The prevention of unwanted pregnancy must be a conscious decision. Anyone who is unprepared for pregnancy should refrain from intercourse or obtain a contraceptive method from a healthcare provider or from the pharmacy; it is too late to think about contraception during sexual intercourse. To practice responsible sexuality, the contraceptive method must be used consistently and according to instructions

A nurse who will be working at a health fair is preparing a presentation on reproductive health and contraception. Which of the following would the nurse expect to include as advantages of combined hormonal contraception? Select all that apply. a) Decreased risk of anemia b) Improved acne control c) Reduced incidence of benign breast disease d) Reduced risk of ovarian cancer e) Decreased risk of gallbladder disease

Decreased risk of anemia • Improved acne control • Reduced incidence of benign breast disease • Reduced risk of ovarian cancer Correct Explanation: Benefits of combined hormonal contraceptive use include reduced incidence of benign breast disease, improved acne, and reduced risk of uterine and ovarian cancers, anemia, and pelvic infection. Use, however, increases risk of gallbladder problems

A nurse is working with a young woman who has been diagnosed with premenstrual syndrome (PMS) to develop a plan to alleviate her symptoms. Which of the following would be most appropriate to include in this plan? a) Avoiding the intake of whole grains and fruits b) Planning work during the days of PMS c) Engaging in a regular exercise program d) Decreasing water intake

Engaging in a regular exercise program Correct Explanation: Appropriate interventions include engaging in a regular exercise program, eating whole grains and fruits, planning work activities to accommodate the days client is less productive, and increasing water intake

A nurse is explaining premenstrual syndrome to a female client. The nurse knows that the client understands when the client states that which of the following appears before menstruation? a) Headache b) Water loss c) Calmness d) Fatigue

Headache Explanation: Menstrual cycle-related distress, commonly called premenstrual(tension) syndrome (PMS), is characterized by the appearance of one or more of the following several days before the onset of menstruation: irritability, emotional tension, anxiety, mood changes, headache, breast tenderness, and water retention

A primiparous nonbreastfeeding client at 48 hours postpartum is to be given medroxyprogesterone before discharge. What information should the nurse include in the teaching plan before administering this medication? a) The client may experience periods of increased energy. b) Amenorrhea is common during the first 6 months. c) There is an increased risk of ovarian cancer with use of this drug. d) Heavy menstrual bleeding may occur.

Heavy menstrual bleeding may occur. Correct Explanation: As with other contraceptives that are progestin based, heavy menstrual bleeding may occur. Other adverse effects include rash, acne, alopecia, fluid retention, edema, and sudden loss of vision. Depression and weight gain have been reported. For clients taking this drug, the risk of endometrial or ovarian cancer is decreased. Amenorrhea has been reported in clients after receiving four injections 3 months apart for 1 year. Depression and loss of energy have been reported.

The nurse is assessing the muscle tone of a patient with cerebral palsy. Which of the following descriptions does the nurse determine to be an expected assessment of this patient's muscle tone? a) Hypertonic b) Atonic c) Atrophied d) Flaccid

Hypertonic Explanation: In patients with conditions characterized by upper motor neuron destruction, such as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic and/or atrophied and/or flaccid.

The nurse is reviewing the medical record of a client who has come to the clinic for contraception. The nurse determines that hormonal contraceptives would be inappropriate based on the client's history of which of the following? a) Migraine headaches with visual auras b) Controlled hypertension c) An irregular menstrual cycle d) Severe acne

Migraine headaches with visual auras Correct Explanation: Absolute contraindications to the use of hormonal contraceptives include a history of migraine headaches with visual auras. Hypertension if controlled in an otherwise healthy young nonsmoker is not a contraindication for the use of combination agents. However, the client would require a low dose and careful monitoring. Hormonal contraceptives may decrease acne in some situations and help to establish a regular bleeding cycle. Neither acne nor an irregular menstrual cycle is a contraindication

A postpartum client visits her physician to discuss contraception. After a thorough discussion, the client decides to use hormonal contraceptives. The physician orders ethinyl estradiol-ethynodiol diacetate, one tablet by mouth daily, followed by 7 days without a dose before beginning the next cycle of tablets. Which type of combination hormonal contraceptive is ethinyl estradiol-ethynodiol diacetate? a) Monophasic b) Biphasic c) Triphasic d) Progestin-dominant triphasic

Monophasic Correct Explanation: Ethinyl estradiol-ethynodiol diacetate is a monophasic oral contraceptive agent.

The nurse is discussing the use of hormonal contraception with a woman who just delivered twins and is not ready to get pregnant in the near future. Which methods might the nurse recommend? (Select all that apply.) a) Intrauterine device b) Norplant system c) Depo-Provera d) Vaginal sponge e) Vaginal ring f) Oral contraceptives

Oral contraceptives • Norplant system • Depo-Provera • Vaginal ring Explanation: Oral contraceptives, Norplant, Depo-Provera, and a vaginal ring are all forms of hormonal contraception. A vaginal sponge is considered a barrier method and the method of contraception involving an intrauterine device is unknown

A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client? a) Habitual abortions b) Combined hormonal contraceptive use c) Pelvic inflammatory disease (PID) d) Use of in vitro fertilization

Pelvic inflammatory disease (PID) Correct Explanation: PID is a major risk factor for ectopic pregnancy. Other risk factors include salpingitis, peritubal ahdesions, structural abnormalities of the tube, previous ectopic pregnancy, previous tubal surgery, multiple previous induced abortions, tumors that distort the tube, and IUD and progestin-only contraceptives. Combined hormonal contraceptive use, in vitro fertilization, and habitual abortions are not risk factors for ectopic pregnancy

A 55-year-old patient has hypertension. She has admitted to her physician that she stopped taking her regular medications about 3 months ago and started an alternative, new-age therapy. When the patient asks about herbal remedies to treat her hot flashes, which of the following natural estrogens is the physician likely to recommend? a) Ginkgo biloba b) Soy milk c) Bitter gourd tea d) Turmeric powder

Soy milk Correct Explanation: Alternative treatments like natural estrogens found in soy products may be effective in treating hot flashes associated with menopause. Ginkgo biloba is an herbal remedy that may help to treat blood disorders and improve memory. The benefits of drinking bitter gourd tea include possible blood sugar regulation, cancer prevention, and antioxidant protection. Turmeric is used in the treatment of digestive and liver problems

The nurse knows that there are three basic charting methods in predicting ovulation in order to prevent pregnancy. (Select All That Apply) a) Temperature method b) Calendar method c) Cervical mucus method d) Hormonal method

Temperature method • Calendar method • Cervical mucus method Correct Explanation: Three basic charting methods can be used to predict ovulation in order to plan or prevent pregnancy:temperature, cervical mucus, and calendar method.The best approach to monitoring fertility is a combination of all three methods called the symptothermal method. Hormonal methods are based on the feedback mechanism of hormones of the menstrual cycle used as a contraceptive method not a charting method.

A parent reports that her school-age child has been reprimanded for daydreaming during class. This is a new behavior, and the child's grades are dropping. The nurse should suspect which problem? a) The child may have attention deficit hyperactivity disorder (ADHD) and needs medication b) The child may be having absence seizures and needs to see his primary health care provider for evaluation c) The child may have a learning disability and needs referral to the special education department d) The child may have a hearing problem and needs to have his ears checked

The child may be having absence seizures and needs to see his primary health care provider for evaluation Explanation: Absence seizures are commonly misinterpreted as daydreaming. The child loses awareness but no alteration in motor activity is exhibited. A mild hearing problem usually is exhibited as leaning forward, talking louder, listening to louder TV and music than usual, and a repetitive "what?" from the child. There isn't enough information in the question scenario to indicate a learning disability. ADHD is characterized by episodes of hyperactivity, not quiet daydreaming

Which behavior demonstrated by a 6-year-old would help the nurse recognize a learning disability as opposed to attention deficit hyperactivity disorder? a) The child is always getting into fights during recess b) The child reverses letters and words while reading c) The child is easily distracted and reacts impulsively d) The child has a difficult time reading a chapter book

The child reverses letters and words while reading Correct Explanation: Children who reverse letters and words while reading have dyslexia. Two of the most common characteristics of children with ADHD include inattention and impulsiveness. Although aggressiveness may be common in children with ADHD, it isn't a characteristic that will aid in the diagnosis of this disorder. Six-year-old children aren't usually cognitively ready to read a chapter book.

The nurse prepares to discuss emergency contraception with a client who reportedly had unprotected sex the day before. The nurse knows the following information should be covered when counseling the client. (Select All That Apply) a) A copper intrauterine device (IUD) can be inserted five to seven days after sex. b) The need to take oral contraceptives within 120 hours after intercourse. c) Oral contraceptives are up to 89% effective in preventing pregnancy. d) Over the counter availability for persons 16 years and older.

The need to take oral contraceptives within 120 hours after intercourse. • Oral contraceptives are up to 89% effective in preventing pregnancy. • A copper intrauterine device (IUD) can be inserted five to seven days after sex. Explanation: Emergency contraception is provided in two ways: 1)Increased doses of specific oral contraceptive pills. Emergency contraceptive pills can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours). Most are up to 89% effective when taken within 72 hours after unprotected sex. They are less effective as time passes. 2)Insertion of a copper IUD within 5 to 7 days after unprotected intercourse. Discussing the over the counter availability may or may not be appropriate depending on the age of the client.

A client with ovarian cancer asks the nurse, "What is the cause of this cancer?" Which is the most accurate response by the nurse? a) The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. b) Women who have had at least two live births are protected from ovarian cancer. c) There is less chance of developing ovarian cancer when one lives in an industrialized country. d) Use of oral contraceptives increases the risk of ovarian cancer.

The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. Correct Explanation: A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer include women who are nulliparous. Use of oral contraceptives does not increase the risk for developing ovarian cancer, but may actually be protective.

A nurse is preparing a presentation to a group of female adolescents about pelvic inflammatory disease (PID). Which statement best reflects the focus of preventive education needs for this age group? a) There are risks of defects in future infants born to adolescents with PID. b) There are long-term complications related to reproductive tract infections. c) The use of hormonal contraceptives decreases the risk of PID. d) Poor hygiene practices increase the risk of PID.

There are long-term complications related to reproductive tract infections. Explanation: Long-term complications of PID include abscess formation in the fallopian tubes and adhesion formation leading to an increased risk of ectopic pregnancy or infertility. PID isn't prevented by proper personal hygiene or by any form of contraception, even though some forms of contraception, such as the male or female condom, do help to decrease the incidence. PID does not increase the risk of birth defects in infants born to adolescents with PID

A 12-year-old adolescent is being seen in the primary care office where you practice nursing. She has just had her first menses, and you are advising her on how to use a tampon. Your instructions include using the least absorbent tampon and to change tampons frequently, at least every 4 to 6 hours. Which of the following conditions are you most likely trying to prevent? a) Pelvic inflammatory disease b) Vaginitis c) Cervicitis d) Toxic shock syndrome

Toxic shock syndrome Correct Explanation: TSS is a type of septic shock that is a life-threatening systemic reaction to the toxin produced by several kinds of bacteria. TSS is associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer than necessary.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? a) Nulliparity b) Use of spermicidal jelly c) Use of corticosteroids d) Menopause

Use of corticosteroids Correct Explanation: A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis

A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the patient? a) Massage therapy b) Vitamin supplements c) Sodium restriction d) Adopting a vegan diet

Vitamin supplements Explanation: For some women, vitamins B6 and E have proven beneficial for the treatment of hot flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.

A 3-year-old is seen in the well child clinic. The mother is concerned that the child may be autistic. Which of the following assessment data would indicate a concern to the nurse? Select all that apply. a) Lack of communication abilities b) Inability to develop social skills c) Inability to separate from mother d) Inability to stay on task e) Withdrawing into a private world

Withdrawing into a private world • Lack of communication abilities • Inability to develop social skills Correct Explanation: Children with autism spectrum disorder (ASD) fail to develop interpersonal skills. The child with ASD withdraws into a private world and is not able to develop social skills and communication abilities. Inability to separate is a behavior found in children with separation anxiety. Inattention is associated with children who are diagnosed with Attention Deficit Disorder (ADD).

A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug? a) ampicillin b) omeprazole c) amitriptyline d) indomethacin

ampicillin Correct Explanation: Oral contraceptives may interact with other medications, and the effectiveness may be decreased if the client is prescribed ampicillin, tetracycline, or anticonvulsants, such as phenytoin. Indomethacin, an anti-inflammatory agent; amitriptyline, an antidepressant agent; and omeprazole, a drug used to suppress gastric acid secretion, do not decrease the effectiveness of oral contraceptives.

A child with spastic cerebral palsy is to begin botulinum toxin type A injections. Which treatment goals should the health care team set for the child related to botulinum toxin? Select all that apply. a) enhanced self-esteem b) reduced caregiver strain and improved self-care c) decreased speech impediments d) improved motor function e) decreased pain from spasticity f) improved nutritional status

decreased pain from spasticity • improved motor function • enhanced self-esteem • reduced caregiver strain and improved self-care Explanation: Botulinum toxin injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botulinum does not significantly affect nutritional status or speech.

The nurse knows that women may choose periodic abstinence for several reasons. In order to assist the client in her choice to return to sexual activity, while preventing pregnancy, the nurse should make sure to discuss which of the following with the client? a) the need for a barrier method b) how to use a temporary contraceptive method c) the need for frequent pregnancy testing d) how to chart her fertility pattern

how to chart her fertility pattern Explanation: Periodic abstinence and fertility awareness methods are two methods of contraception that involve charting a woman?s fertility pattern. Periodic abstinence is a method used by some sexually active women to prevent pregnancy. They become familiar with their fertility patterns and abstain from vaginal intercourse on the days they think they could become pregnant. Women who monitor their fertility to prevent pregnancy either abstain from vaginal intercourse for at least one third of each menstrual cycle or use barrier methods during the fertile or ?unsafe? period

The nurse should instruct a woman taking folic acid supplements for folic acid-deficiency anemia that: a) iron supplements are contraindicated with folic acid supplementation. b) folic acid should be taken on an empty stomach. c) oral contraceptive use, pregnancy, and lactation increase daily requirements. d) it will take several months to notice an improvement.

oral contraceptive use, pregnancy, and lactation increase daily requirements. Correct Explanation: Oral contraceptive use, pregnancy, and lactation are situations that increase demand for folic acid. With supplementation, a response should cause the reticulocyte count to increase within 2 to 3 days after therapy has begun. It is not necessary to take folic acid on an empty stomach. A client may safely take both iron and folic acid supplementation

A client tells the nurse that she has had sexual contact with someone whom she suspects has genital herpes. The nurse should instruct the client to: a) report any difficulty urinating. b) drink extra fluids to prevent lesions from forming. c) continue sexual activity unless lesions are present. d) anticipate lesions within 25 to 30 days.

report any difficulty urinating. Correct Explanation: The client should be encouraged to report painful urination or urinary retention. Lesions may appear 2 to 12 days after exposure. The client is capable of transmitting the infection even when asymptomatic, so a barrier contraceptive should be used. Drinking extra fluids will not stop the lesions from forming.

The nurse is evaluating a female client's understanding of how to prevent sexually transmitted infections (STIs). Which statement indicates that the client understands how to protect herself? a) "I will always douche after sexual intercourse." b) "I will be sure my partner uses a condom." c) "I need to be sure to take my birth control pills." d) "I will be sure to take antibiotics to prevent an STI."

"I will be sure my partner uses a condom." Correct Explanation: Barrier contraceptives must be used to protect against STIs. Birth control pills and douching are not effective for prevention of STIs. Prophylactic antibiotics are not used to prevent the acquisition of STIs

A client has just begun taking an oral contraceptive that contains estrogen and progestin. The nurse should instruct the client to use additional methods of contraception for at least: a) 2 months. b) 7 days. c) 2 weeks. d) 1 month.

7 days. Explanation: Because of the mechanism of action of oral contraceptives, the onset of action is somewhat delayed. Full contraceptive benefits don't occur until an oral contraceptive agent has been taken for at least 7 days.

The community health nurse is preparing for a family planning clinic. The nurse knows the following factors influence contraceptive choices. (Select All That Apply) a) Level of education b) Culture c) Marital status d) Economic status e) Desire for future pregnancy f) Age g) Religious beliefs

Age • Marital status • Desire for future pregnancy • Religious beliefs • Level of education Explanation: Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person?s choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Culture and economic status are not documented as known factors that influence a person's choice of contraception

A sexually active teenager seeks counseling from the school nurse about prevention of sexually transmitted infection (STI). Which contraceptive measure should the nurse recommend? a) Prophylactic antibiotic use b) Rhythm method c) Condom and spermicide use d) Withdrawal method

Condom and spermicide use Correct Explanation: Prevention of STIs is the primary concern of health care professionals. Barrier contraceptive methods, such as condoms with the addition of spermicide, seem to offer the best protection for preventing STIs and their serious complications. The other contraceptive choices don't prevent the transmission of an STI. Antibiotics can't be taken throughout the life span.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement? a) Incidence of dysmenorrhea may increase while taking this drug. b) Continue previous contraceptive use even if you're experiencing amenorrhea. c) This medication may result in heightened libido. d) Amenorrhea is irreversible.

Continue previous contraceptive use even if you're experiencing amenorrhea. Correct Explanation: Women may experience amenorrhea, which is reversible, while taking antipsychotics because amenorrhea doesn't indicate cessation of ovulation the client who experiences amenorrhea can still become pregnant. She should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and the depressant effect generally decreases libido

A client is prescribed a combination hormonal contraceptive. The nurse would instruct the client to report which of the following immediately? a) Difficulty hearing b) Nausea c) Headaches d) Mood changes

Headaches Correct Explanation: A client taking combined hormonal contraceptives should report the following immediately: abdominal pains, chest pains, headaches, eye problems, and severe leg pains. Although nausea and mood changes are bothersome adverse effects, they do not need to be reported immediately. Difficulty hearing is not associated with combined hormonal contraceptive use.

A client presents to the clinic seeking the safest contraceptive method for her. The nurse reviews the client's health history and notes that the client is 26 years old, married with no children, and a smoker. Based on the client's history the nurse knows the following methods are the most appropriate for this client. (Select All That Apply) a) Implanon b) Norplant System c) Depo-Provera d) Transdermal Contraceptive Patch e) Oral Contraceptives

Implanon • Norplant System • Depo-Provera Correct Explanation: According to the client's history she is a smoker. Smoking increases the risks associated with oral contraceptives. The transdermal contraceptive patch has the same contraindications as oral contraceptives. All of the other options are not contraindicated based on the client's history.

When planning sex education and contraceptive education for adolescents, which factor should the nurse consider? a) Neither sexual activity nor contraception requires planning b) Most teenagers today are knowledgeable about reproduction c) Most teenagers use pregnancy as a way to rebel against their parents d) Most teenagers are open about contraception but inconsistently use birth control

Most teenagers are open about contraception but inconsistently use birth control Correct Explanation: Most teenagers today are very open about discussing contraception and sexuality, but they may get caught up in the moment of sexuality and forget about birth control measures. Adolescents receive most of their information on reproduction and sexuality from their peers, who generally don't have correct information. Teenagers generally become pregnant because they fail to use birth control for reasons other than rebelling against their parents. Contraception should always be part of sex education and requires planning

A nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which referral is most appropriate? a) Registered dietitian b) Nursing assistant c) Occupational therapist d) Physical therapist

Occupational therapist Correct Explanation: An occupational therapist helps physically disabled clients adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living. A registered dietitian manages and plans for the nutritional needs of children with cerebral palsy but isn't trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but not to assist the child in performing activities of daily living. A nursing assistant can help a child eat; however, the nursing assistant isn't trained in modifying utensils.

A client is diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply. a) The disease is inherited, caused by an inability to tolerate milk products. b) Passive ROM exercises can promote bone growth. c) Osteoporosis is common in females after menopause. d) Osteoporosis is a degenerative disease characterized by a decrease in bone density. e) Weight-bearing exercise would be avoided. f) Osteoporosis can cause pain and injury.

Osteoporosis is common in females after menopause. • Osteoporosis is a degenerative disease characterized by a decrease in bone density. • Osteoporosis can cause pain and injury. Correct Explanation: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth.

A client takes a hormonal contraceptive to prevent pregnancy. The nurse should instruct her to use an alternative contraceptive method when receiving which drug concomitantly? a) Hydrocortisone b) Cyclosporine c) Erythromycin d) Primidone

Primidone Explanation: Primidone, an anticonvulsant, may decrease the efficacy of hormonal contraceptives, necessitating use of an alternative contraceptive method. Concomitant use of hormonal contraceptives with cyclosporine increases the plasma concentration of cyclosporine. No interaction occurs between erythromycin and hormonal contraceptives. Hormonal contraceptives enhance the anti-inflammatory actions of hydrocortisone.

A nurse who will be working at a health fair is preparing a presentation on reproductive health and contraception. Which of the following would the nurse expect to include as advantages of combined hormonal contraception? Select all that apply. a) Decreased risk of gallbladder disease b) Reduced incidence of benign breast disease c) Improved acne control d) Decreased risk of anemia e) Reduced risk of ovarian cancer

Reduced incidence of benign breast disease • Improved acne control • Decreased risk of anemia • Reduced risk of ovarian cancer Correct Explanation: Benefits of combined hormonal contraceptive use include reduced incidence of benign breast disease, improved acne, and reduced risk of uterine and ovarian cancers, anemia, and pelvic infection. Use, however, increases risk of gallbladder problems.

An elementary school nurse is conducting a program for parents on attention deficit hyperactivity disorder (ADHD). Which of the following is the most important information for the nurse to include in the program? a) The child will have fatigue from the increased activity level. b) Diagnosis usually occurs before the child reaches school age. c) Sleep disturbances are common for children with ADHD. d) Girls with ADHD show more aggression than boys with ADHD.

Sleep disturbances are common for children with ADHD. Correct Explanation: Sleep disturbances are common for children with ADHD. The diagnosis is commonly made after the child starts attending school and is unable to display attentive behavior in class.

A client is admitted to the facility with a suspected ectopic pregnancy. When reviewing the client's health history for risk factors for this abnormal condition, the nurse expects to find: a) grand multiparity (five or more births). b) a history of pelvic inflammatory disease. c) use of an intrauterine device for 1 year. d) use of a hormonal contraceptive for 5 years.

a history of pelvic inflammatory disease. Correct Explanation: Pelvic inflammatory disease with accompanying salpingitis is commonly implicated in cases of tubal obstruction, the primary cause of ectopic pregnancy. Ectopic pregnancy isn't associated with grand multiparity or hormonal contraceptive use. Ectopic pregnancy is associated with use of an intrauterine device for 2 years or more

A woman is taking oral contraceptives. The nurse teaches the client that medications that may interfere with oral contraceptive efficacy include: a) antihypertensives. b) diuretics. c) antihistamines. d) antibiotics.

antibiotics. Correct Explanation: Broad-spectrum antibiotics can cause decreased efficacy of oral contraceptives, placing the client at risk for an unplanned pregnancy. When a client is prescribed a course of antibiotics, a back-up method of contraception should be used. Antihypertensives, diuretics, and antihistamines do not interfere with oral contraceptive efficacy

A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric floor with vomiting and dehydration. The family tells the nurse that they were scheduled to refill the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: a) explain that the medication should be discontinued during illness. b) arrange for the pump to be refilled in the hospital. c) instruct caregivers to call for a refill when the low-volume alarm sounds. d) reschedule the pump refill for the day of discharge.

arrange for the pump to be refilled in the hospital. Correct Explanation: To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refill may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refill the pump may not be readily available under all circumstances.

A nulliparous client has been given a prescription for oral contraceptives. The nurse should instruct the client to report which sign to the health care provider (HCP) immediately? a) mild headache b) nausea c) blurred vision d) weight gain

blurred vision Correct Explanation: Blurred vision is a serious adverse effect of oral contraceptives, possibly because of severe hypertension as a result of the medication. If the client experiences blurred vision, she needs to contact her HCP immediately. Nausea, weight gain, and mild headache are common and possibly bothersome side effects and should be noted. However, they do not need to be reported immediately unless they are severe, prolonged, or accompanied by other symptoms

A young female client is receiving chemotherapy and mentions to the nurse that she and her husband are using a diaphragm for birth control. Which information is most important for the nurse to discuss? a) body changes related to hormones b) transmission of sexually transmitted diseases c) inconvenience of the diaphragm d) infection control

infection control Correct Explanation: The risk of becoming neutropenic during chemotherapy is very high. Therefore, an inserted foreign object such as a diaphragm may be a nidus for infection. Although the nurse may wish to inform the client about the ease with which various contraceptive modalities may be used, the focus of this discussion should be on preventing an infection, which can be fatal for the neutropenic client. There are no data to suggest the client is at risk for acquiring a sexually transmitted disease. The client will not be experiencing body changes directly related to hormonal changes.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? a) limiting interaction with extended family and friends b) seeking advice on coping on social media c) requesting teaching about cerebral palsy in general d) learning measures to meet the child's physical needs

limiting interaction with extended family and friends Correct Explanation: Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating that the family is dealing with the situation. Participating in social media may serve as a form of support and can be a healthy coping mechanism

Which oral contraceptive is considered safe for use while breastfeeding because it will not affect the breast milk supply once breastfeeding has been well established? a) estrogen b) testosterone c) progestin d) estrogen and progestin

progestin Correct Explanation: Progestin alone has no effect on breast milk or breastfeeding once the milk supply is well established. Estrogen suppresses milk output. Testosterone is not given as an oral contraceptive

In a children's unit team meeting, the staff is working on protocols for dealing with clients with autism spectrum disorder (ASD). Which protocols would be most important? Select all that apply. a) limitations on toys allowed b) types of verbalizations expected c) protections from harm to self and others d) reinforcements for appropriate interactions with peers and staff e) preparation for any changes in unit routines

protections from harm to self and others • preparation for any changes in unit routines • reinforcements for appropriate interactions with peers and staff Explanation: Children with autism may have behaviors, such as head banging or pinching, that harm themselves or others. They have a strong need for sameness and need to be prepared for changes. Any client efforts to interact appropriately need to be reinforced because social behaviors are typically limited. What toys these clients have is not as important as what they do with them, such as throwing them at others. Depending on the severity of the autism, the clients' verbalizations vary significantly, so a protocol for this is not possible.

The nurse tells a rape victim that even if she was protected against pregnancy by a contraceptive and has no intention of taking any legal action against her assailant, she should still be checked by a health care provider (HCP) for early detection of: a) menstrual difficulties. b) periurethral tears. c) anxiety reaction. d) sexually transmitted disease.

sexually transmitted disease. Correct Explanation: The post-rape examination is important for detecting the possibility of sexually transmitted disease, which can be spread through rape. The client should also be examined for infection that can result from trauma. Additionally, if the victim or the rapist was not using a contraceptive, postcoital contraceptive methods should be discussed. The information provided does not indicate anxiety or physical injury, such as periurethral tears, and these are not the primary reason for the examination. Menstrual difficulties are not a common result of rape

A client believes she is experiencing premenstrual syndrome (PMS). The nurse should next ask the client about what symptom? a) menstrual cycle irregularity with increased menstrual flow b) mood swings immediately after menses c) midcycle spotting and abdominal pain at the time of ovulation d) tension and fatigue before menses and through the second day of the menstrual cycle

tension and fatigue before menses and through the second day of the menstrual cycle Explanation: The timing of symptoms is important to the diagnosis of PMS. The client should keep a 3-month log of symptoms and menses. With PMS, the symptoms begin 3 to 7 days before menses and resolve 1 to 2 days after the menstrual cycle has started. Menstrual cycle irregularity and mood swings after menses are not related to PMS, and other causes should be investigated. Midcycle spotting and pain are related to ovulation.

A 20-year-old client visiting the clinic requests the use of oral contraceptives. When reviewing the client's history, which finding would alert the nurse to a possible contraindication to using these agents? a) thrombophlebitis b) menorrhagia c) ulcerative colitis d) urinary tract infections

thrombophlebitis Correct Explanation: Oral contraceptives are contraindicated for clients with a history of thrombophlebitis because a serious side effect of oral contraceptives is thrombus formation. Other contraindications include stroke and liver disease. Oral contraceptives are used cautiously in clients with hypertension or diabetes. Close follow-up of these clients is essential. Urinary tract infections (UTIs) do not contraindicate the use of oral contraceptives. If the client is suffering from UTIs, the nurse can instruct her to increase her fluid intake and wipe from front to back after urinating or defecating. Ulcerative colitis does not contraindicate using oral contraceptives. Menorrhagia is typically reduced through the use of oral contraceptives.

The health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which approach would be the most effective method of follow-up? a) enrollment in community parenting classes b) weekly visits by a community health nurse c) twice-weekly clinic appointments d) daily phone calls from the hospital nurse

weekly visits by a community health nurse Correct Explanation: The most effective follow-up care would occur in the home environment. The community health nurse can be supportive of the parents and will be able to observe parent-infant interactions in a natural environment. The community health nurse can evaluate the infant's progress in gaining weight, offer suggestions to the parents, and help the family solve problems as they arise.

A nurse assesses the effect of the environment and nutrition on patients visiting a walk-in clinic in a low-income community. Which statements accurately describe these effects? (Select all that apply.) a) Abuse of alcohol and drugs is more prevalent in teenagers who have poor family relationships. b) An increased incidence of teenage pregnancy can be linked to substance abuse by adolescents. c) Substance abuse by a pregnant woman increases the risk for congenital anomalies in her developing fetus. d) Failure to thrive cannot be linked to emotional deprivation. e) Infants who are malnourished in utero develop the same amount of brain cells as infants who had adequate prenatal nutrition. f) Child abuse can lead to deficits in physical development, but psychosocial development is not affected.

• An increased incidence of teenage pregnancy can be linked to substance abuse by adolescents. • Abuse of alcohol and drugs is more prevalent in teenagers who have poor family relationships. • Substance abuse by a pregnant woman increases the risk for congenital anomalies in her developing fetus. Correct Explanation: Environment and nutrition influence all stages of development. Environmental factors that might alter development include poverty, violence, unsafe living conditions, the presence of lead or mold in the home, and the quality of air and water in the surrounding environment. With this in mind, the following statements accurately describe the effect of the environment and nutrition on clients: substance abuse is a higher risk with this population, abuse of alcohol and drugs in teenagers is a higher risk with this population, and an increased incidence of teen pregnancy can be linked to substance abuse by adolescents. Infants who are malnourished in utero do not develop the same amount of brain cells as infants who have had adequate prenatal nutrition. Failure to thrive can be linked to emotional deprivation. Psychosocial development can be affected by child abuse.

A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the nurse about her concerns about the son's physical condition. The parent states that his medication, methylphenidate extended release, controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. He does not eat breakfast or very much of his lunch at school; he eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which action should the nurse suggest the parent do first? a) Suggest a change of medication to a nonstimulant drug that will treat ADHD without causing the appetite decrease. b) Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake. c) Monitor the child's weight closely for 1 month since he is likely to stop losing weight when the school year ends in 2 weeks. d) Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning.

Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. Correct Explanation: Because weight loss is a common side effect of methylphenidate and because the child's symptoms are controlled with the stimulant, the first action should be to increase the child's oral intake before the medication's side effects begin. Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the medication's side effects, so the child will continue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort since methylphenidate is the most effective medication for ADHD and has been successful with this child.

A 27-year-old patient is a regular smoker and is diabetic. She is requesting contraceptive therapy. She has been diagnosed with hypertension. She says she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure. Her vital signs are temperature 98.8°F, pulse 72, respirations 12, BP 112/72 mm Hg. In addition, laboratory reports show a hemoglobin A1C level of 5%. Which of the following aspects of patient teaching would the nurse recommend? Select all that apply. a) Prescribing a combination oral contraceptive pill b) Purchasing a self-monitoring cuff c) Administering glycemic control d) Discussing methods for stress reduction e) Advising a smoking cessation program

Prescribing a combination oral contraceptive pill • Purchasing a self-monitoring cuff • Discussing methods for stress reduction • Advising a smoking cessation program Correct Explanation: Because this patient finds it time consuming to visit the doctor just for a BP reading, the nurse can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction and advising a smoking cessation would constitute patient education in managing hypertension. Controlled hypertension in otherwise healthy young nonsmokers is generally not a contraindication to use of combination agents, but does require a low dose and careful BP monitoring. Hemoglobin A1C levels are within acceptable levels; administering glycemic control is not indicated at this time.

A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client? a) "Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative." b) "Client will schedule her first follow-up Papanicolaou (Pap) test and gynecologic examination for 6 months after discharge." c) "Client will state that she won't attempt another pregnancy until her human chorionic gonadotropin (hCG) level rises." d) "Client will state that she may attempt another pregnancy after 3 months of follow-up care."

"Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative." Correct Explanation: After a molar pregnancy, the client should receive follow-up care, including regular hCG testing, for 1 year because of the risk of developing chorionic carcinoma. After removal of a hydatidiform mole, the hCG level gradually falls to a negative reading unless chorionic carcinoma is developing, in which case the hCG level rises. A Pap test isn't an effective indicator of a hydatidiform mole. A follow-up examination would be scheduled within weeks of the client's discharge. The client must not become pregnant during follow-up care because pregnancy causes the hCG level to rise, making it indistinguishable from this early sign of chorionic carcinoma.

The nurse is teaching a young woman about using oxcarbazepine to control seizures. The nurse determines teaching is effective when the client states: a) "Since I am 28 years old, I should not delay starting a family." b) "I will use one of the barrier methods of contraception." c) "I will need a higher dose of oral contraceptive when on this drug." d) "I must weigh myself weekly to check for sudden gain in weight."

"I will use one of the barrier methods of contraception." Correct Explanation: An alternative or additional method of birth control must be used because oxcarbazepine reduces the effectiveness of oral contraceptives. Higher doses of oral contraceptives will not help in achieving this purpose, but the client needs an additional or alternative method of birth control. The client does not need advice about when to start a family. A side effect of oxcarbazepine may be weight gain, but it is typically gradual.

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which client statement indicates a need for further teaching? a) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." b) "If I gain or lose 20 lb (9 kg), I can still use the same diaphragm." c) "If I get pregnant, I will have to be refitted for another diaphragm after childbirth." d) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case."

"If I gain or lose 20 lb (9 kg), I can still use the same diaphragm." Correct Explanation: The client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 lb (9 kg). Gaining or losing more than 15 lb (7 kg) can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and childbirth because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.

A nurse is preparing to obtain a sexual history from a client using the PLISSIT model. Which question would be most appropriate for the nurse to ask first? a) "Have you ever used any contraceptive measures?" b) "May I ask you some questions about your sexual health?" c) "How long have you been sexually active?" d) "Are you currently having sex, and if yes, with whom?"

"May I ask you some questions about your sexual health?" Correct Explanation: The PLISSIT model prvides a framework for nursing interventions. The assessment begins by introducing the topic and asking the client for permission to discuss issues related to sexuality with her. Therefore, the nurse would ask the client if it would be okay to ask her some questions about her sexual health. The history continues by inquiring about present sexual activity and sexual orientation as well as any problems or concerns that the client may be having. Asking about how long the client has been sexually active, about the use of contraception, and current sexual activity level would be appropriate once the nurse has established a trusting relationship with the client and obtained permission. The nurse would need to maintain a nonjudgmental approach and respect the client's wishes if she does not want to discuss a topic or issue.

A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection. Which instruction should the nurse include in the teaching plan? a) "Take the antibiotics 2 hours after the oral contraceptive." b) "You should stop taking the oral contraceptives while taking the antibiotic." c) "Call your health care provider for increased hunger or fluid retention." d) "Use a barrier method of birth control for the rest of your cycle."

"Use a barrier method of birth control for the rest of your cycle." Correct Explanation: Antibiotics may decrease the effectiveness of oral contraceptives. The client should be instructed to continue the contraceptives and use a barrier method as a backup method of birth control until the next menstrual cycle. The client should not stop taking her oral contraceptives, and there is no indication for or benefit to taking the antibiotic 2 hours after the contraceptive. There is no incidence of the adverse effects of increased hunger and fluid retention with the interaction of antibiotic therapy and oral contraceptives

A young school-age girl whose mother and aunt have been diagnosed as having bipolar disorder and whose father is diagnosed with depression is brought to the clinic because of problems with behavior and attention in school and inability to sleep at night. The child says, "My brain does not turn off at night." The child is diagnosed as experiencing attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well. What should the nurse say to the father to explain what the provider said? Select all that apply. a) "Your child was diagnosed as having ADHD because of her attention and behavior problems at school." b) "The child's description of her inability to sleep is irrelevant to diagnosing her condition since she stays up late." c) "Your provider does not know how to diagnose your child's illness since she has symptoms of both bipolar disorder and ADHD." d) "ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." e) "Your provider is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues."

"Your child was diagnosed as having ADHD because of her attention and behavior problems at school." • "Your provider is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues." • "ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." Correct Explanation: The client's school problems, the presence of first-degree relatives diagnosed with bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and bipolar disorder, which are difficult to distinguish from each other in children. Health care providers (HCPs) are reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the other or both. Further monitoring and her response to medication will differentiate whether she is suffering from one of the disorders or both. Any comments indicating that the provider does not know what he or she is doing or that the child's perceptions of her illness are not valid will undermine any trust the father and child might be developing in their caregiver and so should be avoided.

A woman is using progestin injections for contraception. The nurse instructs the client to return for an appointment in: a) 4 months. b) 6 months. c) 3 months. d) 1 month.

3 months. Correct Explanation: At the time a client receives a progestin injection, a follow-up appointment should be made for 3 months later. The nurse should emphasize the need to adhere to the medication schedule to prevent an unplanned pregnancy. One of the most common reasons for failure of this contraceptive is lack of adherence to the appointment schedule for injections every 3 months.

A nurse is obtaining a 40-year-old male's health history before performing a physical examination. Which of the following information would most likely not be obtained? a) Age of first ejaculate b) Premature ejaculation or other concerns of a sexual nature c) Pain during sexual intercourse d) Contraceptive practices

Age of first ejaculate Correct Explanation: Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history

A 48-year-old client with challenging menopausal symptoms is visiting the OB-GYN practice where you practice nursing. She has discussed treatment options with the physician and now has some questions that she would like to further discuss with you. The client includes in her questioning, "What are the potential risks of hormone replacement therapy?" Which of the following is the best answer? a) Stroke (CVA) b) All options are correct. c) Breast cancer d) Heart disease

All options are correct. Correct Explanation: In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in blood clots and stroke in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in heart disease in postmenopausal women taking HRT

Which of the following patients in the ED should the advance nurse practitioner treat first? a) A 48-year-old woman presenting with irregular menses, breast tenderness, and profuse sweating b) A 32-year-old woman with bloating, headache, and reported depression c) A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness d) A 19-year-old woman with vaginal irritation, malodorous, copious frothy/yellow-green discharge

A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness Correct Explanation: The patient with sharp colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority patient at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, malodorous copious frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority patient

A nurse is caring for children in a children's hospital. Which child would the nurse expect to develop separation anxiety? a) A preschooler who is on an isolation ward b) An infant who was abandoned by his parents c) A school-aged child who has low self- esteem d) A newly hospitalized toddler

A newly hospitalized toddler Correct Explanation: A newly hospitalized toddler would be most prone to develop separation anxiety.

When developing a teaching plan for a client taking hormonal contraceptives, a nurse should ensure that the client knows she must have which vital sign monitored regularly? a) Temperature b) Respirations c) Pulse d) Blood pressure

Blood pressure Correct Explanation: The incidence of hypertension is three to six times greater in clients using hormonal contraceptives than in women who don't use these drugs. Age and duration of the drug's use increase this incidence. Hormonal contraceptives don't directly affect pulse, respirations, or temperature.

A client who has received a new prescription for oral contraceptives asks the nurse how to take them. Which symptom should the nurse instruct the client to report to her primary caregiver? a) Breast tenderness b) Blurred vision and headache c) Decreased menstrual flow d) Breakthrough bleeding within first 3 months of use

Blurred vision and headache Correct Explanation: Some adverse effects of birth control pills, such as blurred vision and headaches, require a report to the health care provider. Because these two effects in particular may result in cardiovascular compromise and embolus, the client may need to use another form of birth control. Breast tenderness, breakthrough bleeding, and decreased menstrual flow may occur as a normal response to the use of birth control pills

A nurse is conducting a healthy-living workshop with a group of female college students. Which of the following methods of contraception should the nurse recommend as a means of preventing both pregnancy and sexually transmitted infections? a) Intrauterine devices (IUD). b) Coitus interruptus. c) Condoms. d) Oral contraceptives.

Condoms. Correct Explanation: Coitus interruptus, oral contraceptives, and IUDs provide no protection against STIs, while condoms provide significant (but imperfect) protection against both pregnancy and STIs.

The nurse prepares to counsel a 28 year old female who is presenting to the infertility clinic for her first appointment. The nurse knows to include which of the following in the assessment? a) Recent untreated urinary tract infection (UTI) b) History of an untreated sexually transmitted infection (STI) c) Current and previously used contraceptive methods d) Age at onset of menses

History of an untreated sexually transmitted infection (STI) Explanation: Health problems caused by STIs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.Some STIs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. While it is important to note the current and previously used contraceptive methods used it is unlikely the cause for the client's infertility. The age at onset of menses is important to note for the client's overall health history however, it is not a cause of infertility. An untreated UTI will not lead to infertility.

The community health nurse is aware that many factors influence a client's decision for contraception. Which of the following is the most likely reason a client would select permanent contraception? a) Religious beliefs which prevent reproduction. b) The choice not to start a family. c) The desire to have multiple sex partners. d) To reduce the risk of sexually transmitted diseases.

The choice not to start a family. Correct Explanation: Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person?s choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Permanent contraception offers no protection against sexually transmitted infections.

A nurse is teaching a group of clients about birth control methods. When providing instruction about subdermal contraceptive implants, the nurse should cite which feature as the main advantage of this method? a) The implants can be removed easily if pregnancy occurs. b) The implants provide effective, continuous contraception that isn't user dependent. c) The implants cost less over the long term than other contraceptive methods. d) The implants require a lower hormonal dose than other hormonal contraceptive methods.

The implants provide effective, continuous contraception that isn't user dependent. Correct Explanation: Although all of the options accurately describe features of subdermal contraceptive implants, the main advantage of this contraceptive method is effective, continuous contraception that isn't user dependent. The effectiveness of other methods, such as the condom, diaphragm, and oral contraceptives, depends at least partly on the user's knowledge, skills, and motivation

A nurse is teaching a client about hormonal contraceptive therapy. If a client misses three or more pills in a row, the nurse should instruct the client to: a) take two pills for the next 2 days and use an alternative contraceptive method until the next cycle. b) discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. c) take three pills for the next 3 days and use an alternative contraceptive method until the next cycle. d) take all the missed doses as soon as she discovers the oversight.

discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. Correct Explanation: A client who misses three or more pills in a row should discard the pack, use an alternative contraceptive method until her period begins, and start a new pack on the regular schedule. Taking all the missed doses, taking two pills for the next 2 days, or taking three pills for the next 3 days doesn't ensure effectiveness and can increase the risk of adverse reactions.

A nulligravid client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. The nurse should tell the client to: a) use another form of contraception for 2 weeks. b) take two pills tonight before bedtime. c) take the medication immediately. d) restart the medication in the morning.

take the medication immediately. Correct Explanation: The nurse should instruct the client to take the medication immediately or as soon as she remembers that she missed the medication. There is only a slight risk that the client will become pregnant when only one pill has been missed, so there is no need to use another form of contraception. However, if the client wishes to increase the chances of not getting pregnant, a condom can be used by the male partner. The client should not omit the missed pill and then restart the medication in the morning because there is a possibility that ovulation can occur, after which intercourse could result in pregnancy. Taking two pills is not necessary and also will result in putting the client off her schedule

The nurse interviews a 22-year-old female client who is scheduled for abdominal surgery the following week. The client is obese and uses estrogen-based oral contraceptives. This client is at high risk for development of: a) Raynaud's disease. b) diabetes. c) thrombophlebitis. d) atherosclerosis.

thrombophlebitis. Correct Explanation: The data suggest an increased risk of thrombophlebitis. The risk factors in this situation include abdominal surgery, obesity, and use of estrogen-based oral contraceptives. Risk factors for atherosclerosis include genetics, older age, and a high-cholesterol diet. Risk factors for diabetes include genetics and obesity. Risk factors for vasospastic disorders include cold climate, age (16 to 40), and immunologic disorders.

An antenatal G2, T1, P0, A0, L1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which factor has the greatest impact on her birth control options? a) breast- or bottle-feeding plan b) preference of sexual partner c) satisfaction with prior methods d) desire for another child in 2 years

breast- or bottle-feeding plan Correct Explanation: Birth control plans are influenced primarily by whether the mother is breast- or bottle-feeding her infant. The maternal milk supply must be well established prior to the initiation of most hormonal birth control methods. Low-dose oral contraceptives would be the exception. Use of estrogen-/progesterone-based pills and progesterone-only pills are commonly initiated from 4 to 6 weeks postpartum because the milk supply is well established by this time. Prior experiences with birth control methods have an impact on the method chosen as do the preferences of the client's partner; however, they are not the most influential factors. Desire to have another child in 2 years would make some methods, such as an IUD, less attractive but would still be secondary to the choice to breast-feed.

During the home visit, a breastfeeding client asks the nurse what contraception method she and her partner should use until she has her 6-week postpartal examination. Which method would be most appropriate for the nurse to suggest? a) abstinence b) condom with spermicide c) rhythm method d) oral contraceptives

condom with spermicide Correct Explanation: If not contraindicated for moral, cultural, or religious reasons, a condom with spermicide is commonly recommended for contraception after birth until the client's 6-week postpartal examination. This method has no effect on the neonate who is breastfeeding. Oral contraceptives containing estrogen are not advised for women who are breastfeeding because the hormones decrease the production of breast milk. Women who are not breastfeeding may use oral contraceptive agents. The rhythm method is not effective because the client is unlikely to be able to determine when ovulation has occurred until her menstrual cycle returns. Although breastfeeding is not considered an effective form of contraception, breastfeeding usually delays the return of both ovulation and menstruation. The length of the delay varies with the duration of lactation and the frequency of breastfeeding. While abstinence is one form of birth control and safe while breastfeeding, it may not be acceptable to this couple who is asking about a method that will allow them to resume sexual relations

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? a) ovarian cancer b) weight gain c) headache d) nausea

ovarian cancer Correct Explanation: The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis

A 32-year-old female client visits the family planning clinic and requests an intrauterine device for contraception. When assessing the client, a history of which problem would be most important to determine? a) coronary artery disease b) pelvic inflammatory disease c) previous liver disease d) thrombophlebitis

pelvic inflammatory disease Explanation: The nurse should assess the client for a history of pelvic inflammatory disease because intrauterine devices have been associated with an increased risk of pelvic inflammatory disease and perforation of the uterus. A history of thrombophlebitis, liver disease, or cardiovascular disease would be important to assess if the client were to receive oral contraceptives. Thrombophlebitis is a contraindication for oral contraceptives.

When observing the mother feed her infant diagnosed with failure to thrive, which maternal behavior should cause the nurse to intervene? a) sitting on the floor to feed the infant b) maintaining eye contact with the infant c) talking to the infant during the feeding d) placing the infant in the crib for the feeding

placing the infant in the crib for the feeding Correct Explanation: Engagement with an infant is achieved through physical contact, eye contact, and voice contact during feeding. Most important of these is physical contact with the person feeding the infant. Holding the infant in a relaxed manner that provides the most physical contact is important. Thus, placing the infant in the crib for feeding should be a concern because of the lack of physical contact with the infant. Maintaining eye contact with the infant and talking to the infant during feeding promote engagement. The locale of feeding is unimportant as long as the infant's need for contact is met.

When collaborating with the health care provider (HCP) to develop a the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments? a) antidepressant medications, such as imipramine, and family therapy b) antianxiety medications, such as buspirone, and home schooling c) psychostimulant medications, such as methylphenidate, and behavior modification d) anticonvulsant medications, such as carbamazepine, and monthly blood levels

psychostimulant medications, such as methylphenidate, and behavior modification Correct Explanation: ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline, along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are indicated for major depressive disorders and must be used with extreme caution in children because they carry the risk of suicidal thinking. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.

A nurse plans a conference to discuss the care plan for an infant admitted to the hospital with a diagnosis of nonorganic failure to thrive. Appropriate participants in the care conference include the: a) infant's primary caregiver, RN, physician, and occupational therapist. b) registered dietitian, RN, physician, and infant's primary caregiver. c) social worker, RN, occupational therapist, and dietitian. d) registered nurse (RN), physician, social worker, and infant's parents.

registered dietitian, RN, physician, and infant's primary caregiver. Correct Explanation: The registered dietitian, RN, physician, and infant's primary caregiver are crucial interdisciplinary team members who should participate in this care conference. The dietitian can address nutritional needs. The primary caregiver can provide input. The social worker and occupational therapist may become involved after the infant's condition improves, but they aren't crucial members of the team at this point.

A female client is treated for trichomoniasis with metronidazole. The nurse instructs the client that: a) she should avoid alcohol during treatment and for 24 hours after completion of the drug. b) she should discontinue oral contraceptive use during this treatment. c) the medication should not alter the color of the urine. d) her partner does not need treatment.

she should avoid alcohol during treatment and for 24 hours after completion of the drug. Correct Explanation: Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection.

When developing a teaching plan about contraception with a 37-year-old woman during her annual gynecologic examination, which should the nurse identify as contraindications to combined oral contraceptive use? Select all that apply. a) mother with a history of lymphoma b) history of asthma c) healing of a currently casted fractured femur. d) use of phenytoin for a seizure disorder e) multiple sexual partners f) smoking 1 pack of cigarettes per day

smoking 1 pack of cigarettes per day • healing of a currently casted fractured femur. • use of phenytoin for a seizure disorder Explanation: Absolute contraindications to oral contraceptives include prolonged immobilization or surgery to the leg and age of more than 35 years when a cigarette smoker, especially in those women who smoke more than 20 cigarettes a day. Oral contraceptives also interact with many antiepileptic drugs including phenytoin, causing a reduction in the therapeutic dose and alteration in the seizure threshold. Multiple sexual partners is not a contraindication and is often a lifestyle situation in which pregnancy is undesired. Women with asthma can safely take oral contraceptives. There is no link between maternal or personal history of lymphoma and oral contraceptives

At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have caused this disease." What is the nurse's best response? a) "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." b) "Many parents feel this way, but I doubt there is anything that you did that caused ADHD to develop in your child." c) "What do you think you might have done that could have led to causing this disorder to develop in your son?" d) "Let us not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior."

"ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." Correct Explanation: Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child's behavior need help with education. Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father's guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father's concerns and feelings.

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best response by the nurse? a) "There may be some slight discrepancy between the measuring tools used." b) "After age 40, height may show a gradual decrease as a result of spinal compression" c) "The posture begins to stoop after middle age." d) "After menopause, the body's bone density declines, resulting in a gradual loss of height."

"After menopause, the body's bone density declines, resulting in a gradual loss of height." Correct Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question

A client has obtained levonorgestrel as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which statement? a) "I may feel nauseated and have breast tenderness or a headache after using the contraceptive." b) "My boyfriend can buy levonorgestrel from the pharmacy if he is over 18 years old." c) "The birth control works by preventing ovulation or fertilization of the egg." d) "I can wait up to 4 days after intercourse to start taking these to prevent pregnancy."

"I can wait up to 4 days after intercourse to start taking these to prevent pregnancy." Explanation: Levonorgestrel can reduce the chance of pregnancy if taken within 72 hours of unprotected intercourse, but pills are most effective if taken immediately after unprotected intercourse and then again 12 hours later,. Males can purchase this contraceptive as long as they are over 18 years of age. Levonorgestrel works by preventing ovulation or fertilization depending on where a client is the menstrual cycle. Common side effects include nausea, breast tenderness, vertigo, and stomach pain.

A 10-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) has been switched from a stimulant to atomoxetine 40 mg two times a day. The nurse is instructing the client and her mother about the change in medication. Which statement indicates that the client's mother needs further education about the medication? Select all that apply. a) "I have to give her both doses before lunch." b) "I'll have to make sure she's gaining weight appropriately." c) "She may have nausea or dizziness for 1 or 2 months." d) "If she has mood swings, I should call her psychiatrist." e) "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." f) "She can't take monoamine oxidase inhibitors while on Strattera."

"I have to give her both doses before lunch." • "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." Explanation: Atomoxetine is a selective norepinephrine reuptake inhibitor antidepressant, not a stimulant. Therefore, a two-times-a-day dosing schedule is appropriate, with a dose given in the morning and late afternoon. It may take more than 2 to 3 weeks to see the full effects of this medication. Nausea and dizziness are transient side effects. Monoamine oxidase inhibitors are contraindicated with atomoxetine

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: a) "This is a sign the cerebral palsy is progressing." b) "Your child has reached his maximum language abilities." c) "I need to refer you for more developmental testing." d) "We need to modify your therapy plan."

"I need to refer you for more developmental testing." Correct Explanation: It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modified, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan.

Which client statement indicates that the nurse's teaching about oral contraceptive agents has been successful? a) "I can make these drugs more effective by monitoring my basal body temperature." b) "If I forget to take my pill one day, I can take 2 pills to get back on schedule" c) "These agents usually only cause a few minor adverse effects when you take them." d) "Oral contraceptives help prevent pregnancy by changing the cervical mucus."

"If I forget to take my pill one day, I can take 2 pills to get back on schedule" Correct Explanation: If a client forgets to take her oral contraceptive pill, she should take the pill as soon as she remembers. If a whole day has passed, it is okay to take 2 pills on one day to get back on schedule. Oral contraceptive agents may cause numerous and often bothersome or dangerous adverse effects including nausea, vomiting, fluid retention, increased vaginal discharge, chloasma, headaches, weight gain, thromboembolic disorders, hepatic adenoma, and possible hypertension. A history of thromboembolic disease is an absolute contraindication to using oral contraceptive agents. Oral contraceptive agents inhibit ovulation by suppressing follicle-stimulating hormone and luteinizing hormone. They have no effect on cervical mucus. It is not necessary to monitor basal body temperature because ovulation does not occur when the medication is taken properly.

The parent asks the nurse whether a child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which response by the nurse would be most appropriate? a) "Being able to pull to a stand really only tells us his upper-body strength is good." b) "Ask the health care provider what he thinks at your next appointment." c) "It is difficult to predict, but his ability to bear weight is a positive factor." d) "If he really wants to walk, and works hard, he probably will eventually."

"It is difficult to predict, but his ability to bear weight is a positive factor." Correct Explanation: The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the HCP. Pulling to a stand requires both upper body and lower body strength. The will to walk is important, but without neurologic stability the child may be unable to do so

After discussing the various methods of contraception with a nurse, a client decides on the contraceptive sponge as her method of choice. Which of the following would the nurse include in the teaching plan for the client about this contraceptive method? a) "Clean the sponge with mild soap and water after using it." b) "You need to have the sponge fitted before using it." c) "You can use this at any time, even when you are menstruating." d) "Keep the sponge in place for at least 6 hours after intercourse."

"Keep the sponge in place for at least 6 hours after intercourse." Correct Explanation: The contraceptive sponge is left in place in the vagina for at least 6 hours after intercourse, and can be kept in place for up to 24 additional hours without the need to replace it with repeated acts of intercourse during that period of time. The sponge should not be used during menstruation. The sponge is available without a prescription, does not need to be fitted, and is discarded after use. The diaphragm and cervical cap need to be fitted before they are used. Mild soap and water are used to clean a diaphragm after use

A 25-year-old sales manager with a financial firm reports to the health care unit with high stress levels and a BP reading of 130/80 mm Hg. She admits that her life has been stressful as she is unable to meet sales targets and is going through a financial crisis. She suffers from frequent headaches and blurred vision. She currently uses a cervical ring for contraception. Which of the following additional assessment questions related to the patient's choice of contraception does the nurse need to ask? Select all that apply. a) "Have you noticed any episodes of chest pain?" b) "When was your last bowel movement?" c) "Tell me about the last time you had leg pain." d) "Describe any abdominal pain you may be experiencing." e) "When was your last self-breast exam?"

"Tell me about the last time you had leg pain." • "Describe any abdominal pain you may be experiencing." • "Have you noticed any episodes of chest pain?" Explanation: Using the American College of Healthcare Executives (ACHE) assessment for patients using combination contraceptives, the nurse needs to assess for abdominal pain, chest pains, and severe leg pains. Last bowel movement and self-breast exam are to be included in the patient's assessment, but do not directly relate to the assessment of the patient's method of contraception

A 22-year-old single female is discussing contraceptive methods with her health care provider and specifically asking about the ethinyl estradiol and etonogestrel vaginal insert. The nurse realizes the client needs further instruction when she makes which statement? a) "This ring contains only progesterone for birth control." b) "There is less breakthrough bleeding than with pills." c) "The risks are the same for this and combined pills." d) "If the ring falls out, it must be put back in place within 3 hours."

"This ring contains only progesterone for birth control." Correct Explanation: The vaginal ring contains a combination of estrogen and progesterone inserted into the vagina for 3 weeks, removed for 1 week, followed by reinsertion of a new ring. If the ring is out of place more than 3 hours contraceptive effectiveness decreases. A positive benefit of this form of contraception is a lessening of breakthrough bleeding often seen in other contraceptive methods. The risks associated with the ring are the same as experienced by someone using the combined estrogen/progesterone pills

The nurse is assessing a female patient who states that she notices an involuntary loss of urine following a coughing episode. What would be the nurse's best reply? a) "You are experiencing total incontinence. Have you had any surgeries or trauma that may be causing this?" b) "You are experiencing reflex incontinence. Have you had a spinal cord injury in the past?" c) "You are experiencing stress incontinence. Do you know how to do Kegel exercises?" d) "You are experiencing transient incontinence. Have you been administered diuretics or IV fluids lately?"

"You are experiencing stress incontinence. Do you know how to do Kegel exercises?" Correct Explanation: Pelvic floor muscle training (PFMT) can improve voluntary control of urination and significantly reduce or eliminate problems with stress incontinence (involuntary loss of urine related to an increase in intra-abdominal pressure) by strengthening perineal and abdominal muscle tone (Huebner et al., 2011). PFMT, more commonly called Kegel exercises, targets the inner muscles that lie under and support the bladder. These muscles can be toned, strengthened, and actually made larger by a regular routine of tightening and relaxing. Transient incontinence appears suddenly and lasts for 6 months or less. It is usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment, such as the use of diuretics or intravenous fluid administration. Stress incontinence (discussed earlier in the chapter) occurs when there is an involuntary loss of urine related to an increase in intra-abdominal pressure. This commonly occurs during coughing, sneezing, laughing, or other physical activities. Childbirth, menopause, obesity, or straining from chronic constipation can also result in urine loss. Total incontinence is a continuous and unpredictable loss of urine, resulting from surgery, trauma, or physical malformation. Urination cannot be controlled due to an anatomic abnormality.

A mother brings her child into the clinic for follow up after beginning treatment for Attention Deficit Hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a one hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child? a) "Mom, can you sit with him to make sure he meets the outcome?" b) "You will have to do better next time" c) "That's okay. I will just change the plan of care" d) "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?"

"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" Correct Explanation: "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" is a response that acknowledges that the client has not met the set outcomes but encouragement that they have made great improvement. The other responses could discourage the child towards meeting the outcome

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is a) "You will need to practice birth control measures." b) "You will continue having your menses every month." c) "You will experience menopause now." d) "You will be unable to have children."

"You will need to practice birth control measures." Correct Explanation: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." Which action is most indicated? a) Assess the child using the pediatric FACES scale. b) Notify the health care provider (HCP) of the change in behavior. c) Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. d) Administer prescribed pain medication.

Administer prescribed pain medication. Explanation: The parent is the child's HCP and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self-report which may not be possible in a child with a communication disorder. The HCP should be contacted regarding the change in behavior only if other available interventions are unsuccessful.

A nurse considers the culture of an Appalachian female patient when counseling her about contraceptives. Which beliefs are consistent with this culture? (Select all that apply.) a) Youth is valued over age. b) Illness is considered a punishment from God. c) Belief is in a divine existence rather than attending a particular church. d) Feelings about losses or death may be fatalistic. e) Independence and self-determination are valued. f) Isolation is an accepted way of life.

Belief is in a divine existence rather than attending a particular church. • Isolation is an accepted way of life. • Feelings about losses or death may be fatalistic. • Independence and self-determination are valued. Explanation: Within the Appalachian community the following beliefs are predominately found: isolation is an accepted way of life, feelings about losses or death may be fatalistic, and independence and self-determination are valued. It can also be commonly seen that the Appalachian culture has a belief in a divine existence rather than attending a particular church. The other statements listed are not found to be true within this community.

A 35-year-old African American who is a regular smoker visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. She is also diabetic. Which of the following contraceptive methods is best for this patient? a) Clomiphene (Clomid) therapy b) Menotropins (Repronex) therapy c) NuvaRing placement d) Cervical cap

Cervical cap Correct Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not utilize hormonal therapy and are appropriate in this case. Menotropins (Repronex, Pergonal), a combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), may be used to stimulate the ovaries to produce eggs. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this patient

A nurse is caring for a female client before surgery. The client states that she is glad that she will not be going through menopause as a result of her surgery and is only having her uterus removed. The nurse reviews the consent form and notes that the surgery is for a total abdominal hysterectomy with a salpingo-oophorectomy. What should the nurse do in this situation? a) Inform the client that menopause may occur from the removal of the uterus. b) No action is needed because the client is likely correct and knows what the surgery entails. c) Contact the surgeon and inform him/her that the client needs further clarification regarding surgery. d) Place a note on the front of the chart informing the surgeon to speak with the client before surgery.

Contact the surgeon and inform him/her that the client needs further clarification regarding surgery. Correct Explanation: The nurse should call the surgeon to clarify the extent of the surgery with the client and what is to be expected after surgery. The nurse acts as an advocate for the client. The other options do not demonstrate the nurse's understanding of the responsibility when obtaining consent. It is not the nurse's responsibility to explain the surgery to the client. Placing a note on the front of the chart is not acting in the best interest of the client because the note may get lost.

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability? a) Developmental b) Age-related c) Acute nontraumatic disorder d) Acquired

Developmental Correct Explanation: Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke

A nurse is preparing to provide contraceptive counseling for a client. What should the nurse plan to do first? a) Perform a complete physical assessment of the client. b) Explore her own personal beliefs and feelings about contraception. c) Help determine the most appropriate contraceptive method for the client. d) Obtain a thorough health history from the client.

Explore her own personal beliefs and feelings about contraception. Correct Explanation: The nurse must first explore her own personal beliefs and feelings about contraception to detect biases; if biases exist, the nurse must refer the client to another health care professional. Only after exploring personal beliefs and feelings does the nurse obtain a thorough health history, perform a complete physical assessment, and help determine the most appropriate contraceptive method

Which of the following behaviors demonstrated by a 6-year-old child would help the school nurse assess characteristics of attention deficit hyperactivity disorder (ADHD)? a) Is easily distracted in class b) Reverses letters and words c) Has speech impediments d) Gets into fights in cafeteria e) Does not sit still in class

Gets into fights in cafeteria • Is easily distracted in class • Does not sit still in class Explanation: Characteristics of ADHD are impulsive behaviors, inattention, and hyperactivity, including getting into fights, being easily distracted, and not sitting still. Reversing letters and words and speech impediments are learning disabilities.

The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? a) ?I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent an UTI.? b) ?Having sexual relationships does not put a woman at risk for developing an UTI.? c) ?Due to the physiological changes with aging, the elderly are at risk for developing an UTI.? d) ?A woman using an intrauterine device for contraceptive reason is at risk for developing an UTI.?

Having sexual relationships does not put a woman at risk for developing an UTI.? Correct Explanation: During sexual intercourse, bacteria from the perineal area may travel into the urethra and urinary bladder. The spermicide used with the diaphragm (IUD) decreases the vagina?s normally protective flora. The glucose in the urine acts an excellent medium for bacteria to proliferate in the client with diabetes mellitus. The elderly are predisposed to development of UTI due to the physiological changes associated with aging.

The forensic nurse is caring for a client who was raped four days ago. Which of the following could the nurse teach the client is an effective contraceptive? a) Depo-Provera injection b) Insertion of a copper intrauterine device (IUD) c) Transdermal contraceptive patch d) Use of the Norplant system

Insertion of a copper intrauterine device (IUD) Correct Explanation: Emergency contraception is provided in two ways: increased doses of oral contractptive pills (usually within 72 hours) or insertion of a copper IUD within 5-7 days after unprotected intercourse. The other options are used for routine contraception

Which action should the nurse be sure is included in the education plan of a newly married female client with a cervical spinal cord injury who doesn't wish to become pregnant at this time? a) Provide the client with brochures on sexual practice b) Instruct the client on the rhythm method of contraception c) Provide the client's husband with information on vasectomy d) Instruct the client's husband on proper insertion of a diaphragm with contraceptive jelly

Instruct the client's husband on proper insertion of a diaphragm with contraceptive jelly Explanation: Because the client experienced a cervical spinal cord injury, she can't insert any form of contraception protection; therefore, it's vital to provide her husband with instructions on inserting a diaphragm in order to prevent pregnancy. Providing the couple with literature on sexual practice doesn't address the client's concerns. During this time of crisis, the couple doesn't wish to have children, but they may reconsider, so providing information on vasectomy isn't appropriate. The rhythm method isn't the most effective way to prevent pregnancy.

A 23 year old female presents with the following symptoms: bleeding, feeling sad, headaches, increased acne, and recent weight changes. The nurse knows that the following need to be reviewed with the patient. a) Hormone imbalance caused by pregnancy b) Use of oral contraceptives in the past month c) Intrauterine device(IUD) placement within past 3 months d) Pregnancy related risk factors

Intrauterine device(IUD) placement within past 3 months Correct Explanation: With intrauterine devices the clinician should be aware that adverse side effects peak at 3 months of use and reduce in frequency after that. The most common side effects include bleeding, depression, headache, acne, and weight changes. While some of the symptoms are found as side effects of oral contraceptive use and as signs of pregnancy the age of the client and cluster of symptoms should alert the nurse to assess for the presence of an IUD.

Which nursing interventions are important when caring for a hospitalized toddler? Select all that apply. a) Maintain the toddler's routine when able b) Provide thorough explanation to toddler prior to a procedure c) Allow client autonomy by offering select choices d) Discourage parents' participation in client care e) Encourage use of a security object from home f) Instruct parent that regression commonly occurs

Maintain the toddler's routine when able • Encourage use of a security object from home • Instruct parent that regression commonly occurs • Allow client autonomy by offering select choices Correct Explanation: Hospitalization is a stressful time for both the toddler and the parents. Important nursing interventions decrease the stress level. Toddler inventions include allowing security objects from home, maintaining the usual routine and providing autonomy by allowing select, or appropriate choices. Parental interventions include instruction on common regression behavior and allowing participation in the toddler's care. Brief, age appropriate explanations to a toddler immediately prior to a procedure are best.

An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child? a) Encouraging the infant to hold a bottle b) Rotating caregivers to provide more stimulation c) Maintaining a consistent, structured environment d) Keeping the infant on bed rest to conserve energy

Maintaining a consistent, structured environment Correct Explanation: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

A 6-year-old client is diagnosed with attention deficit hyperactivity disorder (ADHD). When asking this client to complete a task, what techniques should the nurse use to communicate most effectively with him? a) Fully explain to the client the actions required of him, and offer verbal praise and a food reward for task completion. b) Demonstrate to the client what he is to do, have him imitate the nurse's actions, and give a food reward if he completes the task. c) Explain to the client what he is to do, the consequences if he does not comply, and follow through with praise or consequences as appropriate. d) Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task.

Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. Correct Explanation: Because the client with ADHD is easily distractible, it is important to obtain eye contact before explaining the task. Simple language and having him repeat what he is told are necessary because of his age. Praise encourages the client to repeat the task in the future as well as building the client's self-esteem. A full explanation with verbal praise and a food reward is inappropriate because a food reward increases the chance that he will expect a physical reward for completing tasks. In addition, a full explanation might be too confusing for someone his age. Explaining consequences focuses on punishment, rather than praise. Although demonstration and imitation is an effective teaching method, rewarding with food fosters dependence on food reward for task completion

The nurse is caring for a hospitalized toddler who is having a temper tantrum. What is the most realistic approach for the nurse to use to manage the child's temper tantrum? a) Offer disapproval and then ignore the tantrum. b) Offer material or emotional bribes. c) Punish the child after the tantrum. d) Display anger at the child during the tantrum.

Offer disapproval and then ignore the tantrum. Explanation: Stating one's disapproval and then ignoring the tantrum generally results in a quick resolution of the tantrum. Offering material or emotional bribes may actually increase the frequency of tantrums. Punishing the child does not decrease the frequency of tantrums because the tantrums are generated by an inability to express their feelings. Mirroring the tantrum behavior reinforces that style of communication.

The nurse is counseling a young rape victim in the emergency department and recommends emergency contraception. Which statements describe this process? (Select all that apply.) a) Plan B One-Step may be obtained without a prescription at a drugstore or family planning clinic b) A vaginal ring will be inserted within 36 hours of unprotected sex. c) The physician will prescribe increased doses of oral contraceptives. d) An emergency D&C;will be performed within 24 hours of unprotected sex. e) A vaginal sponge will be prescribed to be worn daily for seven days. f) The physician will order a copper IUD within 5 to 7 days of the unprotected sex.

Plan B One-Step may be obtained without a prescription at a drugstore or family planning clinic • The physician will prescribe increased doses of oral contraceptives. • The physician will order a copper IUD within 5 to 7 days of the unprotected sex. Correct Explanation: Increased doses of some oral contraceptives can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours) by 89%. Copper IUDs can help in emergency contraception. Plan B One-Step is an over-the-counter emergency contraceptive. A vaginal sponge and a vaginal ring are contraceptive devices used to prevent pregnancy prior to intercourse; they are not effective if used after intercourse has occurred. Dilation and curettage (D&C;) is a surgical procedure that scrapes the uterine lining. It is not use for emergency contraception. (less)

The nurse formulates a plan of care to address negative feeding patterns for a 5-month-old infant diagnosed with failure to thrive. To meet the short-term outcomes of the infant's plan of care, the nurse should expect to implement which intervention? a) Provide consistent staff to care for the infant. b) Give the infant high-calorie formula. c) Instruct the parents in proper feeding techniques. d) Allow the infant to sit in a high chair during feedings.

Provide consistent staff to care for the infant. Explanation: In the short-term care of this infant, it is important that the same person feed the infant at each meal and that this person be able to assess for negative feeding patterns and replace them with positive patterns. Once the infant is gaining weight and shows progress in the feeding patterns, the parents can be instructed in proper feeding techniques. This is a long-term outcome of nursing care. Because there is no organic reason for the failure to thrive, it should not be necessary to increase the formula calorie content. A 5-month-old infant is too young to be expected to sit in a high chair for feedings and should still be bottle-fed.

Which instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning? a) Amenorrhea is a common adverse effect of IUDs. b) IUDs are more costly than other forms of contraception. c) Severe cramping may occur when the IUD is inserted. d) The client needs to use additional protection for conception.

Severe cramping may occur when the IUD is inserted. Correct Explanation: Severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common adverse effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.

A nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which observation indicates that teaching has been effective? a) The toddler finishes the meal within a specified period of time. b) The toddler stays neat while eating. c) The child lies down to rest after eating. d) The child eats finger foods by himself.

The child eats finger foods by himself. Correct Explanation: The child eating finger foods by himself indicates effective teaching because a child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to eat neatly. In terms of a specified period of time, the child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed. A child shouldn't lie down to rest after eating because doing so may cause the child to vomit from a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.

An adolescent female is prescribed amoxicillin for an ear infection. The nurse should teach the adolescent about the risks associated with her concurrent use of: a) ibuprofen. b) OTC antihistamines. c) multiple vitamins. d) oral contraceptives.

oral contraceptives. Correct Explanation: When a person is taking amoxicillin as well as an oral contraceptive it renders the contraceptive less effective. Because pregnancy can occur in such a situation, the nurse should advise the client to use additional means of birth control during the time she is taking the antibiotic. There are no risks associated with the concurrent use of amoxicillin and OTC antihistamines, vitamins, or ibuprofen

When providing intermittent nasogastric feedings to an infant with failure to thrive, which method is preferred to confirm tube placement before each feeding? a) Auscultate the stomach while instilling an air bolus. b) Obtain a chest X-ray. c) Compare the tube insertion length to a standardized chart. d) Verify that the gastric PH is less than 5.5.

Verify that the gastric PH is less than 5.5. Explanation: For children receiving intermittent gavage feedings, the best method to verify the tube placement before each feeding is to aspirate a small amount of gastric contents to verify that the pH is acidic. A pH of 5.5 or less should indicate correct placement in most babies. Depending on the type of feeding tube used, an x-ray may be used to confirm the original tube placement, but use before every feeding would expose the child to unnecessary radiation. Air boluses are misleading because placement in the esophagus or respiratory tract may make the same sound in small infants. Charts might be helpful in determining initial tube insertion length, but do not substitute for nursing assessments

Question: The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used. a favorite non-electronic game medication that can be given as needed to calm the child a DVD player with headphones and favorite games, cartoons, and child films a favorite stuffed animal or other soft toy

a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child Explanation: Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite non-electronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.

The nurse is providing care to a group of clients in an acute care facility. The client most likely to prefer a room that is warm as well as wearing thermal blankets is the client who is a) a teenager. b) going through menopause. c) aged 74 years. d) 6 months pregnant.

aged 74 years. Correct Explanation: Older clients, such as the one aged 74 years, may prefer to have a room that is warm and being provided with thermal blankets.

A 5-month-old infant is brought to the clinic by his parents because he "cries too much" and "vomits a lot." The infant's birth weight was 6 lb, 10 oz (3,000 g), and his current weight is 7 lb, 4 oz (3,289 g), falling below the 5th percentile on a standard growth chart. Which data should the nurse identify as the priority? a) family dynamics b) feeding pattern c) pattern of weight gain d) frequency of regular checkups

feeding pattern Correct Explanation: Because the infant falls below the 5th percentile on a standard growth chart, the nurse should consider failure to thrive, a term applied to an infant who is not growing at an acceptable rate. Information about feeding patterns, including types and amounts of food, is needed to determine the cause of failure to thrive. If a child does not receive sufficient calories, growth slows. Whether or not the infant has received regular checkups is important but not the priority because that information alone does not provide evidence or substantiation about the infant's growth patterns. The infant's pattern of weight gain is important but not the priority. Rather, the infant's pattern of weight gain provides valuable and useful information over a period of time. Information about family dynamics is important to provide data about family stresses that may affect or help explain the infant's failure to thrive. However, it is not the priority. This information needs to be viewed in conjunction with the infant's feeding patterns to gain a complete picture.

Which information obtained during a health history is most consistent with the diagnosis of failure to thrive in an infant? a) fear of strangers b) fussiness during feedings c) needing to be awakened for feedings d) being quiet when held

fussiness during feedings Correct Explanation: Infants who have failure to thrive are typically fussy during feedings. This fussiness may be related to the caretaker not recognizing cues about what the infant needs or wants. Typically infants with failure to thrive are unafraid of strangers. Although they protest being put down, infants with failure to thrive are typically not content while being held because they are not used to it. Infants with failure to thrive typically have difficulty sleeping for any length of time. They often awaken because they are hungry.

The nurse is assessing a multigravid client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which information should the nurse obtain about the client's history? Select all that apply. a) cesarean section b) last menstrual period c) history of sexually transmitted infections d) contraceptive use e) number of sexual partners

history of sexually transmitted infections • number of sexual partners • last menstrual period • contraceptive use Explanation: The client may be experiencing an ectopic pregnancy. Contributing factors to an ectopic pregnancy include a prior history of sexually transmitted infection that can scar the fallopian tubes. Multiple sex partners increase the risk of sexually transmitted infections. Knowledge of the client's last menstrual period and contraceptive use may support or rule out the possibility of an ectopic pregnancy. The client's history of cesarean sections would not contribute information valuable to the client's current situation or potential diagnosis of ectopic pregnancy.

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms? a) dysmenorrhea b) acne vulgaris c) hypertension d) anemia

hypertension Correct Explanation: Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives commonly improves facial acne.

An 8-year-old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods and liquids through a syringe. The nurse determine's his biggest nutritional risk factor is: a) inability to metabolize fats. b) increased metabolism. c) impaired oral motor control. d) impaired absorption.

impaired oral motor control. Correct Explanation: A child with severe cerebral palsy commonly has a lack of oral motor control that interferes with tongue control, chewing, and swallowing. This is the reason that this child is being fed pureed foods and fluids. Lack of tongue control commonly causes the child to push the food back out of the mouth while trying to chew and swallow. A child with cerebral palsy has a nonprogressive central nervous system insult. Cerebral palsy does not affect the child's metabolism. This child should be able to absorb and metabolize ingested nutrients. Cerebral palsy does not affect the child's metabolism of fats. Cerebral palsy may affect elimination but does not significantly alter absorption.