Exam 2: RDC, special considerations, infections, perfusion

A client with 4+ protein and 4+ reflexes is admitted to the hospital with severe preeclampsia. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.

ANS: 1. Clients with severe preeclampsia are high risk for seizure. 2. Clients with severe preeclampsia should be monitored for a drop in platelets. 3. Clients with severe preeclampsia are not at risk for explosive diarrhea. 4. Clients with severe preeclampsia are not at risk for fractured pelvis.

4. The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2+ proteinuria. 3. Decrease in plasma protein. 4. 3+ patellar reflexes.

ANS: 1. Weight loss is a positive sign. 2. This client is losing protein. The nurse would evaluate a 0-to-trace amount of protein as a positive sign. 3. A decrease in serum protein is a sign of pathology. An increase in serum protein would be a positive sign. 4. 3+ reflexes are pathological. Normal reflexes are 2+.

47. A client, G8P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider veins.

ANS: 2

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6ºF, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2ºF, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0ºF, 76, 18.

ANS: 2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver. 1. The vital signs are within normal limits. 3. Trace urine protein is considered normal in pregnancy. The blood pressure is within normal limits. 4. The client has had a normal 2-lb weight gain in the past 2 weeks and her vital signs are within normal limits.

46. Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? 1. 30-week gestation with prolapsed mitral valve (PMV). 2. 32-week gestation with urinary tract infection (UTI). 3. 34-week gestation with gestational diabetes (GDM). 4. 36-week gestation with deep vein thrombosis (DVT).

ANS: 3

42. A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range of motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep breathing exercises.

ANS: 3,4,5

62. A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of milk and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

ANS: 4

A 26-week-gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.

ANS: 4. Epigastric pain is associated with the liver involvement of HELLP syndrome. 1. The nurse would expect to see high serum creatinine levels associated with severe preeclampsia. 2. The nurse would expect to see low serum protein levels with severe preeclampsia. 3. Bloody stools are never associated with severe preeclampsia.

39. A gravid client, G6P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bedrest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom-free until at least 37 weeks' gestation. 4. The client will call her children shortly after admission.

ANS: 3

53. A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.

ANS: 4

A woman is noted to have multiple soft warts on her perineum and rectal areas. The nurse suspects that this client is infected with which of the following sexually transmitted infections? 1. Human papillomavirus (HPV). 2. Human immunodeficiency virus (HIV). 3. Syphilis. 4. Trichomoniasis.

ANS: 1. Human papillomavirus (HPV) is characterized by flat warts on the vaginal and rectal surfaces. 2. HIV/AIDS is characterized by nonspecific symptoms like weight loss, dry cough, and fatigue. 3. Primary syphilis is characterized by a nonpainful lesion, called a chancre. 4. Trichomoniasis is characterized by a yellowish green vaginal discharge that usually has a very strong, offensive odor.

A woman has contracted herpes simplex 2 for the first time. Which of the following signs/symptoms is the client likely to complain of? 1. Flu-like symptoms. 2. Metrorrhagia. 3. Amenorrhea. 4. Abdominal cramping.

ANS: 1. The initial infection of herpes simplex 2 is often symptom free but, if symptoms do occur, the client may complain of flu-like symptoms as well as vesicles at the site of the viral invasion. 2. Metrorrhagia is not associated with herpes simplex 2. 3. Amenorrhea is not associated with herpes simplex 2. 4. Abdominal cramping is not associated with herpes simplex 2.

A client with mild preeclampsia, who has been advised to be on bed rest at home, asks why it is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

ANS: 3. Bed rest, especially side-lying, helps to improve perfusion to the placenta. 1. Bed rest for the preeclamptic client is not ordered in order for her to conserve energy. 2. Preeclamptic clients rarely complain of nausea or anorexia. 4. Although indirectly this response may be accurate, that is not the primary reason for the positioning.

A 19-year-old client with multiple sex partners is being counseled about the hepatitis B vaccination. During the counseling sessions, which of the following should the nurse advise the client to receive? 1. The hepatitis B immune globulin before receiving the vaccine. 2. A vaccine booster every 10 years. 3. The complete series of three intramuscular injections. 4. The vaccine as soon as she becomes 21.

ANS: 3. To be immunized against hepatitis B, a three-injection vaccine series is administered. 1. The immune globulin is not administered before giving the vaccine. 2. The vaccine is administered in a series of 3 injections. There are no booster shots being administered at this time. 4. The vaccine can be administered at any age.

40. Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? 1. "During the first phase of labor you will do slow chest breathing." 2. "You should ambulate in the halls at least two times each day." 3. "The doctor will deliver you once you reach 25 weeks' gestation." 4. "Please remember to tell me if you become constipated."

ANS: 4

56. A 25-week-pregnant client, who had eaten a small breakfast, has been notified that her glucose challenge test results were 132 mg/dL 1 hour after ingesting the glucose. Which of the following is appropriate for the nurse to say at this time? 1. "Because you ate before the test, the results are invalid and will need to be repeated." 2. "Because your test results are higher than normal, you will have to have another more specific test." 3. "Because of the results you will have to have weekly glycohemoglobin testing done." 4. "Because your results are within normal limits you need not worry about gestational diabetes."

ANS: 4

The nurse is educating a group of adolescent women regarding sexually transmitted infections. The nurse knows that learning was achieved when a group member states that the most common sign/symptom of sexually transmitted infections is which of the following? 1. Menstrual cramping. 2. Heavy menstrual periods. 3. Flu-like symptoms. 4. Lack of signs or symptoms.

ANS: 4. Most commonly, women experience no signs or symptoms when they have contracted a sexually transmitted infection. 1. Menstrual cramping is not usually related to sexually transmitted infections. 2. Heavy menstrual periods are not usually related to a sexually transmitted infection. 3. Flu-like symptoms are not usually related to sexually transmitted infections.

A man has been diagnosed with a chlamydial infection. The nurse would expect the client to complain of pain at which of the following times? 1. When urinating. 2. When ejaculating. 3. When the penis becomes erect. 4. When the testicles are touched.

ANS: 1. Men infected with Chlamydia often complain of pain on urination. 2. Painful ejaculation is not a common sign of chlamydial infection. 3. Painful erections are not commonly seen when men are infected with Chlamydia. 4. It is not common for men infected with Chlamydia to experience pain when their testes are touched.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? 1. Assess deep tendon reflexes. 2. Obtain complete blood count. 3. Assess baseline weight. 4. Obtain routine urinalysis.

ANS: 1. The nurse should check the client's patellar reflexes. The most common way to assess the deep tendon reflexes is to assess the patellar reflexes. 2. The blood count is important, but the nurse should first assess patellar reflexes. 3. The baseline weight is important, but the nurse should first assess patellar reflexes. 4. The urinalysis should be obtained, but the nurse should first assess patellar reflexes.

55. A woman's glucose challenge test (GCT) results are 155 mg/dL at 1 hour post- glucose ingestion. Which of the following actions, as ordered by the physician, is appropriate? 1. Send the woman for a glucose tolerance test. 2. Teach the woman how to inject herself with insulin. 3. Notify the woman of the normal results. 4. Provide the woman with oral hypoglycemic agents.

ANS: 3

A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon. 2. Palpate the woman's ankle. 3. Dorsiflex the woman's foot. 4. Position the woman's feet flat on the floor.

ANS: 3. To assess clonus, the nurse should dorsiflex the woman's foot. 1. Patellar reflexes are assessed by striking the patellar tendon. 2. Clonus is not assessed by palpating the woman's ankle. 4. Clonus is not assessed by positioning the woman's feet flat on the floor.

The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? 1. +1. 2. +2. 3. +3. 4. +4.

ANS: 3 1. +1 reflexes are defined as hyporeflexic. 2. +2 reflexes are defined as normal. 3. +3 reflexes are defined as slightly brisker than normal or slightly hyperreflexic. 4. +4 reflexes are defined as much brisker than normal or markedly hyperreflexic.

27. A triage nurse answers a telephone call from the male partner of a woman who was recently diagnosed with cervical cancer. The man is requesting to be tested for human papillomavirus (HPV). The nurse's response should be based on which of the following? 1. There is currently no approved test to detect HPV in men. 2. A viral culture of the penis and rectum is used to detect HPV in men. 3. A Pap smear of the meatus of the penis is used to detect HPV in men. 4. There is no need for a test because men do not become infected with HPV.

ANS: 1. This is true. The CDC has not approved any tests to detect HPV in men. 2. The CDC has not approved any tests to detect HPV in men. 3. The CDC has not approved any tests to detect HPV in men. 4. The CDC has not approved any tests to detect HPV in men.

Which of the following sexually transmitted infections is characterized by a foulsmelling, yellow-green discharge that is often accompanied by vaginal pain and dyspareunia? 1. Syphilis. 2. Gonorrhea. 3. Trichomoniasis. 4. Condylomata acuminata.

ANS: 3. Trichomoniasis is characterized by a yellowish green, foul-smelling discharge. 1. Syphilis is caused by the spirochete, Treponema pallidum. If untreated, syphilis is a three stage illness. The primary symptom is a pain free lesion called a chancre. 2. Gonorrhea, usually symptom free, can even be mistaken for a urinary tract infection. 4. Condylomata are vaginal warts.

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.

ANS: 4. The fetus should be assessed for intrauterine growth restriction. 1. The fetus will not be assessed for signs of severe anemia. 2. The fetus will not be assessed for signs of hypoprothrombinemia. 3. The fetus will not be assessed for signs of craniosynostosis.

Low birth weight

2500g or less

Late preterm birth

Births occuring between 34-36 weeks

Causes of low birth weight

Preterm birth, IUGG

59. A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.

ANS: 2

52. A type 1 diabetic client has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

ANS: 1

61. A nurse who is caring for a pregnant diabetic should carefully monitor the client for which of the following? 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic alkalosis. 4. Pathological hypotension.

ANS: 1

A 32-week-gestation client was last seen in the prenatal client at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? 1. Weight change from 128 pounds to 138 pounds. 2. Pulse rate change from 88 bpm to 92 bpm. 3. Blood pressure change from 120/80 to 118/78. 4. Respiratory rate change from 16 rpm to 20 rpm.

ANS: 1. A weight gain of 10 pounds in a 4-week period is worrisome. The recommended weight gain during the second and third trimesters is approximately 1 pound per week. 2. The pulse rate normally increases slightly during pregnancy. 3. A slight drop in BP is normal during pregnancy. 4. The respiratory rate normally increases during pregnancy.

A nurse remarks to a 38-week-gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? 1. Altered glomerular filtration. 2. Cardiac failure. 3. Hepatic insufficiency. 4. Altered splenic circulation.

ANS: 1. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands. 2. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of cardiac failure. 3. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of hepatic insufficiency. 4. Monitoring women for the appearance of swollen hands and puffy face is related to the development of preeclampsia, not of altered splenic circulation.

A gravid, married client, 24 weeks' gestation, is found to have bacterial vaginosis. Her health care practitioner has ordered metronidazole (Flagyl) to treat the problem. Which of the following educational information is important for the nurse to provide the woman at this time? 1. The woman must be careful to observe for signs of preterm labor. 2. The woman must advise her partner to seek therapy as soon as possible. 3. The main side effect of the medicine is a copious vaginal discharge. 4. A repeat culture should be taken two weeks after completing the therapy.

ANS: 1. Clients with bacterial vaginosis are high risk for preterm labor. 2. Male partners rarely need treatment. Female partners, in lesbian relationships, may, however, need to be treated. 3. Bacterial vaginosis is characterized by a discharge that is often foul-smelling. The discharge is not related to the therapy. 4. An initial, diagnostic microscopic and culture assessment is done. It is not required that a repeat test be done 2 weeks later.

A female client asks the nurse about treatment for human papilloma viral warts. The nurse's response should be based on which of the following? 1. An antiviral injection cures approximately fifty percent of cases. 2. Aggressive treatment is required to cure warts. 3. Warts often spread when an attempt is made to remove them surgically. 4. Warts often recur a few months after a client is treated.

ANS: 4. This statement is true. It is not uncommon for warts to return a few months after an initial treatment 1. There are no injections for treating warts. There are gels and creams that can be applied to the warts. 2. This statement is incorrect. Warts usually spontaneously disappear after a period of time. 3. This statement is incorrect. It is a common practice to remove warts surgically.

Fetal fibronectin test

Fetal fibronectin is a glycoprotein. If it is found in the cervix and vaginal secretions in the late second or early third trimester, it is believed to indicate placental inflammation, which may be relation to spontaneous preterm labor.

Interventions for preterm labor

Transfer to appropriate facility, GBS antibiotics, administering 2 doses of glucocorticoids 24 hours apart, magnesium sulfate before 32 weeks

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.

ANS: 1. Headache and decreased output are signs of preeclampsia. 2. Dependent edema is seen in most pregnant women. It is related to the weight of the uterine body on the femoral vessels. 3. Hemorrhoids and vaginal discharge are experienced by many pregnant women. Hemorrhoids are varicose veins of the rectum. They develop as a result of chronic constipation and the weight of the uterine body on the hemorrhoidal veins. An increase in vaginal discharge results from elevated estrogen levels in the body. 4. Backache is seen in most pregnant women. It develops as a result of the weight of the uterine body and the resultant physiological lordosis.

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1P0000, age 44 with history of diabetes mellitus. 2. G2P0101, age 27 with history of rheumatic fever. 3. G3P1102, age 25 with history of scoliosis. 4. G3P1011, age 20 with history of celiac disease.

ANS: 1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia. 2. Multigravid clients with a history of rheumatic fever are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have developed a vascular or hypertensive disease since their last pregnancy. 3. Multigravid clients with scoliosis are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have developed a vascular or hypertensive disease since their last pregnancy. 4. Multigravid clients with celiac disease are not significantly at high risk for preeclampsia, unless they have a history of preeclampsia with their preceding pregnancies, or have developed a vascular or hypertensive disease since their last pregnancy.

A woman has been diagnosed with syphilis. Which of the following nursing interventions is appropriate? 1. Council the woman about how to live with a chronic infection. 2. Question the woman regarding symptoms of other sexually transmitted infections. 3. Assist the primary health care practitioner with cryotherapy procedures. 4. Educate the woman regarding the safe disposal of menstrual pads.

ANS: 2. Any time someone is infected with one STI, it is recommended that he or she be assessed for other STIs. 1. Syphilis is treatable. The treatment of choice is penicillin. 3. Cryotherapy is not performed on clients with syphilis. 4. This is an inappropriate response.

A 24-week-gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? 1. Inquire whether or not the client has allergies. 2. Take the woman's blood pressure. 3. Assess the woman's fundal height. 4. Ask the woman about stressors at work.

ANS: 2. The nurse should assess the client's blood pressure. 1. Discovering whether or not the client has allergies is important for the nurse to learn if medications are to be ordered, but that is not the most important information the nurse needs to learn. 3. Fundal height assessment is important, but not the most important information the nurse needs to learn at this time. 4. Discovering whether or not the client has stressors at work is important, but it is not the most important information the nurse needs to learn about.

A 29-week-gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the last 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of +2. 4. Nystagmus.

ANS: 2. The nurse would expect to see papilledema. 1. At 29-weeks' gestation, the normal fundal height should be 29 cm. With severe preeclampsia, the nurse may see poor growth—that is, a fundal height below 29 cm. 3. The nurse would expect to see hyperreflexia—that is, patellar reflexes higher than 2 4. The nurse would not expect to see nystagmus.

After a sex education class, the school nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that teaching about infection control was effective? 1. "I don't have to worry about getting infected if I have oral sex." 2. "Teen women are most high risk for sexually transmitted infections (STI)." 3. "The best thing to do if I have sex a lot is to use spermicide each and every time." 4. "Boys get human immunodeficiency virus (HIV) easier than girls do."

ANS: 2. This is true. The mucous membranes of the female and of the teenager are more permeable to STIs than are the mucous membranes of adults and of men. 1. This is a fallacy. Both men and women can become infected from oral sex. 3. The best thing a sexually active man or woman can do is to use a condom—male or female—during intercourse. The only way absolutely to stay disease free is to become celibate. 4. This is a fallacy. Females are more susceptible to disease than are males

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 37 weeks' gestation, complains of bleeding gums and urinary frequency.

ANS: 3. Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife. 1. Fatigue and nausea and vomiting are normal in clients at 10 weeks' gestation. 2. Ankle edema and chloasma are normal in clients at 26 weeks' gestation. 4. Bleeding gums and urinary frequency are normal in clients at 37 weeks' gestation.

When counseling a preeclamptic client about her diet, what should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars.

ANS: 3. It is important for the client to eat a well-balanced diet. 1. Sodium restriction is not recommended. 2. There is no need to increase fluid intake. 4. Although not the most nutritious of foods, there is no need to restrict the intake of simple sugars.

The parent of a newborn angrily asks the nurse, "Why would the doctor want to give my baby the vaccination for hepatitis B. It's a sexually transmitted disease, you know!" Which of the following is the best response by the nurse? 1. "The hepatitis B vaccine is given to all babies. It is given because many babies get infected from their mothers during pregnancy." 2. "It is important for your baby to get the vaccine in the hospital because the shot may not be available when your child gets older." 3. "Hepatitis B can be a life-threatening infection that is contracted by contact with blood as well as sexually." 4. "Most parents want to protect their children from as many serious diseases as possible. Hepatitis B is one of those diseases."

ANS: 3. This is the best answer. Hepatitis B is a very serious disease that can be transmitted sexually or via contact with blood and blood products. The vaccine is given in infancy to prevent future infections. 1. This statement is inappropriate. Vaccines are not administered to prevent vertical transmission, but rather to prevent contracting the virus in the future. If a pregnant woman is hepatitis B positive, her baby would receive the hepatitis B immune globulin (HBIG), in addition to the vaccine, within 12 hours of delivery. This protocol minimizes the incidence of vertical transmission. 2. This statement is inappropriate. Vaccines are not administered simply because they are available. 4. This response implies that the mother in the scenario is not interested in protecting her child. That is very unlikely.

An asymptomatic woman is being treated for HIV infection at the women's health clinic. Which of the following comments by the woman shows that she understands her care? 1. "If I get pregnant, my baby will be HIV positive." 2. "I should have my viral load and antibody levels checked every day." 3. "Since my partner and I are both HIV positive, we use a condom." 4. "To be safe, my partner and I only engage in oral sex."

ANS: 3. This is true. She and her partner should use condoms during sexual intercourse. 1. This is not true. When clients with HIV receive therapy during pregnancy and labor and delivery and their babies receive oral therapy after delivery, the transmission rate of HIV is almost zero. 2. The viral load and CD4 counts should be monitored regularly but they need not be assessed daily. 4. Even though the transmission of HIV via oral sex is likely much lower than from genital or rectal intercourse, it is still a dangerous practice.

The public health nurse calls a woman and states, "I am afraid that I have some disturbing news. A man who has been treated for gonorrhea by the health department has told them that he had intercourse with you. It is very important that you seek medical attention." The woman replies, "There is no reason for me to go to the doctor! I feel fine!" Which of the following replies by the nurse is appropriate at this time? 1. "I am sure that you are upset by the disturbing news, but there is no reason to be angry with me." 2. "I am sorry. We must have received the wrong information." 3. "That certainly could be the case. Women often report no symptoms." 4. "All right, but please tell me your contacts because it is possible for you to pass the disease on even if you have no symptoms."

ANS: 3. This is true. Women often have no symptoms when infected with gonorrhea. 1. This is not appropriate. Instead of reprimanding the client, the nurse should acknowledge how difficult it is to hear the news and continue the discussion. 2. This is not appropriate. The nurse must pursue the discussion since women often have no symptoms when infected with gonorrhea. 4. This is not appropriate. The nurse must pursue the discussion since women often have no symptoms when infected with gonorrhea

A couple seeking contraception and infection-prevention counseling state, "We know that the best way for us to prevent both pregnancy and infection is to use condoms plus spermicide every time we have sex." Which of the following is the best response by the nurse? 1. "That is correct. It is best to use a condom with spermicide during every sexual contact." 2. "That is true, except if you have intercourse twice in one evening. Then you do not have to apply more spermicide." 3. "That is not true. It has been shown that condoms alone are very effective and that the spermicide might increase the transmission of some viruses." 4. "That is not necessarily true. It has been shown that spermicide alone is just as effective as condoms with spermicide."

ANS: 3. This statement is true. Spermicidal creams have been shown to actually increase the transmission of some sexually transmitted infections. 1. This statement is false. Spermicidal creams have been shown to actually increase the transmission of some sexually transmitted infections. 2. This statement is false. Spermicidal creams have been shown to actually increase the transmission of some sexually transmitted infections. 4. This statement is false. Spermicidal creams have been shown to actually increase the transmission of some sexually transmitted infections.

A nonpregnant young woman has been diagnosed with bacterial vaginosis (BV). The nurse questions the woman regarding her sexual history, including her frequency of intercourse, how many sexual partners she has, and her use of contraceptives. What is the rationale for the nurse's questions? 1. Clients with BV can infect their sexual partners. 2. The nurse is required by law to ask the questions. 3. Clients with BV can become infected with HIV and other sexually transmitted infections more easily than uninfected women. 4. The laboratory needs a full client history in order to know for which organisms and antibiotic sensitivities it should test.

ANS: 3. This statement is true. The change in normal flora increases the woman's susceptibility to other organisms. 1. Unless the partner is female, the transmission to partners is low. 2. There is no law that requires the nurse to ask these questions. 4. There is no need to provide the laboratory with this information.

A client, who is sexually active, is asking the nurse about the vaccine that is given to prevent human papillomavirus (HPV). Which of the following should be included in the counseling session? 1. Gardasil® is not recommended for women who are already sexually active. 2. Gardasil® protects recipients from all strains of the virus. 3. The most common side effect from the vaccine is pain at the injection site. 4. Anyone who is allergic to eggs is advised against receiving the vaccine.

ANS: 3. This statement is true. There are very few side effects experienced by those who receive the vaccine. 1. This statement is not true. The vaccine can be administered to women as young as 9 and up to age 26, whether sexually active or not. 2. This statement is not true. The vaccine does not protect against viruses that can cause about 30% of the cancers and about 10% of the warts. 4. This statement is not true.

57. In analyzing the need for health teaching in a client, G5P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"

ANS: 4