Peds

48. A 9-year-old boy has been hospitalized following a bicycle injury. What should the nurse recommend to the child's parents to prevent future injury? 1. Their son should wear safety equipment while riding bicycles. 2. Their son should read educational material on bicycle safety. 3. Their son should watch a video on bicycle safety. 4. Their son should ride his bike in the presence of adults.

1 Safety equipment is essential for bicy- cling, skateboarding, and participating in contact sports. Most injuries occur during the school-age years, when children are more active and partici- pate in contact sports. 2. Educational material is a good way to re- inforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 3. Video material is a good way to reinforce the use of safety equipment, but the parents must insist that the child use his safety equipment. 4. The child's parents may not always be pres- ent when he rides his bike, so the use of safety equipment is the primary concern.

52. Four women with significant health histories wish to use the diaphragm as a contra- ceptive method. The nurse should counsel the woman with which of the following histories that the diaphragm may lead to a recurrence of her problem? 1. Urinary tract infections. 2. Herpes simplex infections. 3. Deep vein thromboses. 4. Human papilloma warts.

1 Women who use the diaphragm have increased incidence of urinary tract infections. Diaphragm may be used with a history of herpes simplex infections, but the device will not protect the woman's partner from contracting the virus. A woman with a history of DVT can safely use the diaphragm. Diaphragm may be used with a history of HPV, but the device will not protect the woman's partner from contracting the virus.

12. An ER nurse is assessing a 12-month-old female. Which statement accurately describes the best method for assessing this child? 1. The nurse should assess the child on the examining table. 2. The nurse should assess the child in a head-to-toe sequence. 3. The nurse should have the child's mother assist in holding her down. 4. The nurse should assess the child while she is in her mother's lap.

4 Children 12 months old are best assessed in proximity to their parents. The appropriate sequence for assessment with an infant is to auscultate first, palpate next, and assess ears, eyes, and mouth last. Least invasive procedures are recom- mended first. Infants do not like to be held down. This will likely cause the child distress. If the child neceds to be held down, it is best to enlist the aid of another staff member. Infants are most secure when in prox- imity to the parent. The parent's lap is an excellent place to assess the child.

65. A nurse is educating a group of women in her parish about osteoporosis. The nurse should include in her discussion that which of the following is a risk factor for the disease process? 1. Multiparity. 2. Increased body weight. 3. Late onset of menopause. 4. Heavy alcohol intake.

4 Early-onset menopause is a risk factor for osteoporosis, but not multiparity. 2. Not only does obesity not cause osteo- porosis, but some believe that obesity is a protective factor against loss of bone density. 3. Early-onset menopause is a risk factor for osteoporosis. 4. Alcohol consumption is a contributing factor to osteoporosis.

43. A client is hospitalized in the acute phase of severe ovarian hyperstimulation syn- drome. The following nursing diagnosis has been identified: Fluid volume excess (extravascular) related to third spacing. Which of the following nursing goals is highest priority in relation to this diagnosis? 1. Client's weight will be within normal limits by date of discharge. 2. Client's skin will show no evidence of breakdown throughout hospitalization. 3. Client's electrolyte levels will be within normal limits within one day. 4. Client's lung fields will remain clear throughout hospitalization.

4 This is an important goal, but it is not the priority nursing goal. 2. This is an important goal, but it is not the priority nursing goal. 3. This is an important goal, but it is not the priority nursing goal. 4. This is the priority nursing goal related to ovarian hyperstimulation syndrome.

5. Which statement by the client indicates that she understands the teaching provided about the intrauterine device (IUD)? 1. "The IUD can remain in place for a year or more." 2. "I will not menstruate while the IUD is in." 3. "Pain during intercourse is a common side effect." 4. "The device will reduce my chances of getting infected."

1 IUDs can remain in place for ex- tended periods of time. The client should expect to menstruate regularly while the IUD is in place. If dyspareunia occurs, the client should contact her health care practitioner. Women who have IUDs in place are at risk of developing pelvic infections.

35. A client is being taught about the care and use of the diaphragm. Which of the fol- lowing comments by the woman shows that she understands the teaching that was provided? 1. "I should regularly put the diaphragm up to the light and look at it carefully." 2. "This is one method that can be used during menstruation." 3. "I can leave the diaphragm in place for a day or two." 4. "The diaphragm should be well powdered before I put it back in the case."

1 The woman should regularly check the diaphragm by looking at it with a good light source. The diaphragm should not be used dur- ing menstruation. If left in place for extended periods of time, the woman is much higher risk forserious complications, especially toxic shock syndrome. The diaphragm should never be pow- dered because of the possibility of irrita- tion or infection.

70. Women who are on hormone replacement therapy (HRT) for an extended period of time have been shown to be high risk for which of the following complications? 1. Endometrial cancer. 2. Gynecomastia. 3. Renal dysfunction. 4. Mammary hypertrophy.

1 Women on HRT are high risk for gynecological cancers, especially endometrial and breast cancers. Women on HRT are not high risk for gynecomastia. Women on HRT are not high risk for renal dysfunction. Women on HRT are not high risk for mammary hypertrophy.

43. A child is admitted to the pediatric unit with spastic CP. Which of the following would the nurse expect this child to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills.

1, 3, 4, 5 Children with spastic CP have increased deep tendon reflexes. 2. Children with spastic CP have increased muscle tone. 3. Children with spastic CP have scoliosis. 4. Children with spastic CP have contrac- tures of the Achilles tendons, knees, and adductor muscles. 5. Children with spastic CP have scissoring when walking. 6. Children with spastic CP have poor control of posture. 7. Children with spastic CP have poor fine motor skills.

2. A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? 1. Fax the teen's teacher, and have her send in his homework. 2. Encourage the teen's friends to visit him in the hospital. 3. Encourage the teen's grandparents to visit frequently. 4. Tell the teen he is free to use his phone to call friends.

2 The teen may want to continue his school- work while in the hospital, but it is not the best means of enhancing his psychosocial development. Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment. The teen may want to see his grandparents, but they are not the primary focus in his life. Calling friends is a good means of remain- ing in contact with peers. However, having direct contact with friends is a better means of maintaining social contact.

3. A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is: 1. "At 6 months his weight should be approximately three times his birth weight." 2. "Each child gains weight at his or her own pace." 3. "At 6 months his weight should be approximately twice his birth weight." 4. "At 6 months a child should weigh about 10 lb more than his or her birth weight."

3 At 6 months his weight should be approxi- mately two times his birth weight. Children gain weight at their own pace but should double the birth weight by 4 to 6 months. Children should double their birth weight by 4 to 6 months of age. By 6 months an infant should have doubled the birth weight; 10 lb is a lot of weight to gain in 4 to 6 months.

59. A 4-year-old is visiting the pediatrician's office for his well-child checkup. The nurse needs to take his blood pressure. Which action by the nurse is a developmentally appropriate method for eliciting the child's cooperation? 1. Have the child's parents help put on the blood pressure cuff. 2. Tell the child that if he sits still, the blood pressure machine will go quickly. 3. Ask the child if he feels a squeezing of his arm. 4. Tell the child that blood pressures do not hurt.

3 The child is preschool age. Preschool chil- dren like to do things for themselves and will not likely behave any better for the parents than the nurse. The nurse should not promise the child that the procedure will go quickly. The nurse needs to develop a trusting relation- ship with the child so only promises than can be kept should be made. Preschool children enjoy games, and it is a good way to elicit their assistance and cooperation during a procedure. The nurse should not promise the child that the procedure will not hurt. Each child's perception of pain is individual in nature. The nurse needs to develop a trusting relationship with the child so only promises that can be kept should be made.

39. The parent of an infant asks the nurse what to watch for to determine if the infant has CP. The nurse should reply which of the following? 1. If the infant cannot sit up without support before 8 months. 2. If the infant demonstrates tongue thrust before 4 months. 3. If the infant has poor head control after 2 months. 4. If the infant has clenched fists after 3 months.

4 Children with CP frequently have devel- opmental delays, including not being able to sit by themselves after 8 months. Sitting alone usually occurs by 6 months, so 8 months would be the outer limit of nor- mal development and cause for concern. Tongue thrust is common in infants younger than 6 months, but if it goes on after 6 months it is of concern. Good head control is normally attained by 3 months. Clenched fists after 3 months of age may be a sign of CP.

32. The nurse is teaching a young woman how to use the female condom. Which of the following should be included in the teaching plan? 1. Reuse female condoms no more than five times. 2. Refrain from using lubricant because the condom may slip out of the vagina. 3. Wear both female and male condoms together to maximize effectiveness. 4. Remove the condom by twisting the outer ring and pulling gently.

4. The female condom should be re- moved by twisting the outer ring and pulling gently.

35. A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he and his friends were racing bikes near a major intersection. The child's parents are concerned about his judgment. What should the nurse understand? 1. The child's behavior is typical of young teens. 2. The child's behavior is related to hormonal surges during adolescence. 3. This was an isolated incident and will not likely happen again. 4. The child's behavior is related to teen rebellion.

1 The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control. Hormonal changes in teens play a primary role in the development of secondary sex characteristics. The child may be prone to other lapses in judgment. The brains of young teens are not completely developed, which often leads to poor judgment and low impulse control. The child's behavior had nothing to do with rebellion.

28. A female nurse caring for a 5-year-old boy is trying to encourage developmental growth. What can the nurse do to reinforce the child's intellectual initiative when he asks the nurse about his upcoming surgery? 1. Answer the child's questions about his upcoming surgery in simple terms. 2. Provide the child with a book that has vivid illustrations about his surgery. 3. Tell the child he should wait and ask the doctor his questions. 4. Tell the child that she will answer his questions at a later time.

1 The child is taking the initiative to ask questions, as all toddlers do, and the nurse should always answer those questions as appropriately and accu- rately as possible.

18. Which statement by the mother of an 18-month-old would lead the nurse to believe that the child should be referred for further evaluation for developmental delay? 1. "My child is able to stand but is not yet taking steps independently." 2. "My child has a vocabulary of approximately 15 words." 3. "My child is still thumb sucking." 4. "My child seems to be quite wary of strangers."

1 The child should be walking indepen- dently by 15 to 18 months. Because this toddler is 18 months and not walk- ing, a referral should be made for a developmental consult. The vocabulary of an 18-month-old should be 10 words or more. Thumb sucking is still common for 18-month-olds and may actually be at its peak at that age. It is very common for a child of 18 months to exhibit stranger anxiety.

51. A woman is being taught how to use the diaphragm as a contraceptive device. Which of the following statements by the woman indicates that further teaching is needed? 1. Petroleum-based lubricants may be used with the device. 2. The device must be refitted if the woman gains or loses 10 pounds or more. 3. The anterior lip must be pushed under the symphysis pubis. 4. Additional spermicide must be added if the device has been in place over 4 hours.

1 This response indicates that further teaching is needed. Only water-based lubricants should be used with the di- aphragm. This is true. If a woman's weight either increases or decreases by 10 lb or more, the device must be refitted. This is true. In order for the diaphragm to fit appropriately, the anterior lip must be pushed snugly under the symphysis. This is true. Although the device is a type of barrier, it is ineffective without spermicide and the action of spermicide is only effective for 4 hours.

9. The nurse is caring for a 6-month-old in the ER. The physician orders the nurse to give the child a dose of Rocephin IM. The 1.5-mL dose arrives from the pharmacy. The nurse must do which of the following? 1. Administer the injection in the deltoid muscle. 2. Split the dose into two injections. 3. Administer the injection in the dorsogluteal muscle. 4. Administer the dose as a single injection to the vastus lateralis muscle.

2 The deltoid of a 6-month-old is not devel- oped enough and should not be used for IM injections. A nurse should not deliver more than 1 mL per IM injection to a child of 6 months. The dorsogluteal muscle should not be used in children until they have been walking for at least 2 years.

29. The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup that she is concerned because her daughter has gained more weight and height than her twin brother. The mother is concerned that there is something wrong with her son. The nurse's best response is: 1. "I understand your concern. I will talk with the physician, and we can draw some lab work." 2. "I understand your concern. Has your son been ill lately?" 3. "It is normal for girls to grow a little taller and gain more weight than boys at this age." 4. "It is normal for you to be concerned, but I am sure your son will catch up with your daughter eventually."

3 This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. This is not an appropriate response. The nurse should be aware that it is normal for girls to grow taller and gain more weight than boys near the end of middle childhood. This is the appropriate response. The nurse understands that it is normal for girls to grow taller and gain more weight than boys near the end of mid- dle childhood. This is not the best response. The boy will likely surpass his sister when he reaches adolescence.

37. The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1 At least 80% of cases of CP result from unknown prenatal factors. It used to be thought that CP resulted from perinatal factors, but current knowl- edge is that CP results more commonly from existing prenatal brain abnormalities. It used to be thought that CP resulted from perinatal factors, but current knowl- edge is that CP results more commonly from existing prenatal brain abnormalities. Frequently, the exact cause is not known.

Which of the following applies to cerebral palsy? Select all that apply. 1. It is the most common chronic disorder of childhood. 2. Hyperbilirubinemia increases the risk of cerebral palsy. 3. It is a progressive chronic disorder. 4. Most children do not experience any learning disabilities. 5. There is a familial tendency seen in children with cerebral palsy.

1, 2 1. Cerebral palsy is the most common chronic disorder of childhood. 2. There is an increased risk of cerebral palsy in infants with hyperbilirubinemia. 3. Cerebral palsy is a nonprogressive chronic disorder. 4. Approximately 75% of children with cere- bral palsy experience learning disabilities.

43. A woman is being issued a new prescription for a low-dose combination birth con- trol pill. What advice should the nurse give the woman if she ever forgets to take her pill? 1. Take it as soon as she remembers, even if that means taking two pills in one day. 2. Skip that pill and refrain from intercourse for the remainder of the month. 3. Wear a pad for the next week because she will experience vaginal bleeding. 4. Take an at-home pregnancy test at the end of the month to check for a pregnancy.

1. This is correct. To maintain the hor- monal levels in the blood stream, the woman should take the pill as soon as she remembers.

6. A client has been diagnosed with pubic lice. Which of the following signs/ symptoms would the nurse expect to see? 1. Macular rash on the labia. 2. Pruritus. 3. Hyperthermia. 4. Foul-smelling discharge.

2 A macular rash is not indicative of pubic lice. Pruritus is, by far, the most common symptom of pubic lice. Hyperthermia is not commonly seen with an infestation of pubic lice. Foul-smelling discharge is not commonly seen with an infestation of pubic lice.

42. A female client seeks care at an infertility clinic. Which of the following tests may the client undergo to determine what, if any, infertility problem she may have? Select all that apply. 1. Chorionic villus sampling. 2. Endometrial biopsy. 3. Hysterosalpingogram. 4. Serum progesterone assay. 5. Postcoital test.

2, 3, 4, and 5 are correct. 1. Chorionic villus sampling is done to as- sess for genetic disease in the fetus. 2. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. 3. Hysterosalpingogram is performed af- ter menstruation to detect whether or not the fallopian tubes are patent. 4. Serum progesterone assay is per- formed about 1 week following ovula- tion to determine whether or not the woman's corpus luteum produces enough progesterone to sustain a pregnancy. 5. Postcoital tests are performed about 1-2 days before ovulation to determine whether or not healthy sperm are able to survive in the cervical mucus.

44. A mother requests that her child receive the varicella vaccine at her 9-month well-child checkup. The nurse tells the mother that: 1. Children who are vaccinated will likely develop a mild case of the disease from the vaccine. 2. The nurse cannot give the vaccine. 3. The nurse will administer the vaccine after the physician examines the child. 4. The child will need a booster vaccination at 18 months of age.

2. It is possible for children to develop a mild rash after receiving the varicella vaccine. However, the varicella vaccine is not usually administered prior to 1 year of age. The nurse should not give the vaccine. The varicella vaccine is not usually ad- ministered prior to 1 year of age. The varicella vaccine is not usually admin- istered prior to 1 year of age. The recommendation is that a second dose be administered at 4 to 6 years of age.

33. A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states, "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time? 1. "Please take a urine sample to the lab so they can check it for an infection." 2. "Those changes mean that you will menstruate within the next three days." 3. "It is important for you to come into the office to be examined today." 4. "Abdominal bloating is an expected response to the medications."

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20. A woman has been diagnosed with pelvic inflammatory disease. Which of the fol- lowing organisms is the most likely causative agent? 1. Herpesviridae. 2. Candida albicans. 3. Neisseria gonorrhoeae. 4. Treponema pallidum.

3 2. Candida albicans does not cause PID. 3. Neisseria gonorrhoeae is a common 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. Gonorrhea, usually symptom free, can even be mistaken for a urinary tract in- fection. Trichomoniasis is characterized by a yellowish green, foul-smelling dis- charge. Condylomata are vaginal warts. Menstrual cramping is not usually related TEST-TAKING TIP: Trichomoniasis is a sex- ually transmitted infection caused by a protozoan. Women who develop the in- fection during pregnancy may develop preterm labor. Women who are infected with trichomoniasis have an increased risk of contracting HIV if exposed. Herpesviridae do not cause PID. cause of PID. 4. Treponema pallidum does not cause PID.

41. The nurse is developing a teaching plan for a client undergoing a bilateral tubal ligation. Which of the following should be included in the plan? 1. The surgical procedure is easily reversible. 2. Menstruation will cease after the procedure. 3. Libido should remain the same after the procedure. 4. The incision will be made endocervically.

3. The woman's libido should remain unchanged.

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

3 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. Gonorrhea, usually symptom free, can even be mistaken for a urinary tract in- fection. Trichomoniasis is characterized by a yellowish green, foul-smelling dis- charge. Condylomata are vaginal warts.

40. The parent of a young child with CP brings the child to the clinic for a checkup. Which of the parent's following statements indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

3 This statement indicates that the par- ent understands the long-term needs of the child.

21. The public health nurse calls a woman and states, "I am afraid that I have some dis- turbing 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."

3. This is true. Women often have no symptoms when infected with gonorrhea.

30. 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."

3. This statement is true. Spermicidal creams have been shown to actually increase the transmission of some sexually transmitted infections.

42. The nurse is developing a plan of care for clients seeking contraception informa- tion. Which of the following issues about the woman must the nurse consider be- fore suggesting contraceptive choices? Select all that apply. 1. Age. 2. Ethical and moral beliefs. 3. Sexual patterns. 4. Socioeconomic status. 5. Childbearing plans.

All choices—1, 2, 3, 4, and 5—are correct. 1. The woman's age should be considered. 2. The woman's ethical and moral beliefs should be considered. 3. The woman's sexual patterns should be considered. 4. The woman's socioeconomic status should be considered. 5. The woman's childbearing plans should be considered.

29. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? 1. The couple has established a set schedule for their sexual encounters. 2. The couple has been married for more than eight years. 3. The couple lives with one set of parents. 4. The couple has close friends who gave birth to a baby within the last year.

1 Clients who "schedule" intercourse often complain that their sexual relationship is unsatisfying. Years of marriage are not directly related to a couple's sexual relationship. Clients may have a very healthy relationship after many years of marriage. The fact that the couple lives with one set of parents is unlikely related to their sexual relationship. Although it can be very difficult to be around couples who have become preg- nant and/or have healthy babies, this factor is not usually related to a couple's sexual relationship.

22. An infertile woman has been diagnosed with endometriosis. She asks the nurse why that diagnosis has made her infertile. Which of the following explanations is appro- priate for the nurse to make? 1. "Scarring surrounds the ends of your tubes preventing your eggs from being fertilized by your partner's sperm." 2. "You are producing insufficient quantities of follicle-stimulating hormone that is needed to mature an egg every month." 3. "Inside your uterus is a benign tumor that makes it impossible for the fertilized egg to implant." 4. "You have a chronic infection of the vaginal tract that makes the secretions hos- tile to your partner's sperm."

1 Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The tissue may be on, for example, the tubes, ovaries, or colon. Adhesions develop from the monthly bleeding at the site of the misplaced endometrial tissue, often resulting in infertility. 2. Endometriosis is not characterized by hormonal imbalances. Hormonal imbal- ances can, however, lead to infertility. 3. A benign tumor of the muscle of the uterus is called a fibroid. It can interfere with pregnancy, but it is not related to endometriosis. 4. Endometriosis is not caused by an infection.

13. 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.

1 Human papillomavirus (HPV) is char- acterized by flat warts on the vaginal and rectal surfaces. HIV/AIDS is characterized by nonspe- cific symptoms like weight loss, dry cough, and fatigue. Primary syphilis is characterized by a nonpainful lesion, called a chancre. Trichomoniasis is characterized by a yel- lowish green vaginal discharge that usu- ally has a very strong, offensive odor.

13. A client complaining of secondary amenorrhea is seeking care from her gynecolo- gist. Which of the following may have contributed to her problem? 1. Athletic activities. 2. Vaccination history. 3. Pet ownership. 4. Genetic history.

1 If the young woman exercises exces- sively—for example, as a competitive gymnast or runner—her body fat in- dex will be so low she will become amenorrheic. Vaccination history has not been shown to be related to secondary amenorrhea. Pet ownership has not been shown to be related to secondary amenorrhea. Genetic history has not been shown to be related to secondary amenorrhea. 14. 1. The seminal vesicles, which are not high- lighted in the diagram, produce a fluid that nourishes the sperm.

20. A nurse working in an infertility clinic should include which of the following in her discussions with the couple? 1. Adoption as an alternative to infertility treatments. 2. The legal controversy surrounding artificial insemination. 3. The need to seek marriage counseling before undergoing infertility treatments. 4. Statistics regarding the number of couples who never learn why they are infertile.

1 It is important for the couple to be provided with all relevant informa- tion. Adoption is a viable alternative to infertility treatments. Although there are moral/ethical issues surrounding artificial insemination, there are no legal controversies. Artificial in- semination is a legal procedure. Although it is not without merit, mar- riage counseling is not mandatory before seeking infertility treatments. 4. This response is not true. Although some causes of infertility may not be discov- ered, in the majority of cases a cause is found: 1/3 of cases related to female problems, 1/3 of cases related to male problems, and 1/3 of cases a combination of male and female problems.

51. The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

1 Sign language may help the child with CP communicate and ultimately de- crease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands. Sign language does not cause confusion and may help reinforce vocabulary and vocalization. CP is manifested differently in all children; therefore, generalizations cannot be made. The earlier sign language is taught, the more it will be beneficial.

28. A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs? 1. The testes are overheated. 2. The vas deferens is ligated. 3. The prostate gland is enlarged. 4. The flagella are segmented.

1 Spermatogenesis occurs in the testes. High temperatures harm the develop- ment of the sperm. When the vas deferens is ligated, a man has had a vasectomy and is sterile. The sterility is not, however, due to impaired spermatogenesis, but rather to the inabil- ity of the sperm to migrate to the woman's reproductive tract. The prostate does not affect spermatoge- nesis. An enlarged or hypertrophied prostate is usually a problem that affects older men.

34. During a counseling session on natural family planning techniques, how should the nurse explain the consistency of cervical mucus at the time of ovulation? 1. It becomes thin and elastic. 2. It becomes opaque and acidic. 3. It contains numerous leukocytes to prevent vaginal infections. 4. It decreases in quantity in response to body temperature changes.

1 The cervical mucus does become thin and elastic at the time of ovulation. The cervical mucus becomes almost transparent and alkaline at the time of ovulation. The mucus is leukocyte poor. The quantity of cervical mucus increases at the time of ovulation.

60. A 4-year-old has been hospitalized with FTT. The child has orders for daily weights, strict input and output, and calorie counts as a means of measuring her nutritional status. Which action by the nurse would be a concern? 1. The nurse weighs the child every morning before the child eats breakfast. 2. The nurse weighs the child with no clothing except for undergarments. 3. The nurse sits with the child when the child eats her meals. 4. The nurse weighs the child using the same scale every morning.

1 The child should be weighed every day before she eats. Her weight will not be an accurate reflection if she is fed prior to being weighed. The child should be weighed only in un- dergarments. The weight of clothing must not be included. The nurse should remain in the room while the child eats in order to accurately record a calorie count. The child should be weighed on the same scale every time. All scales are not equally accurate, so it is important to use the same scale in order to obtain an accurate trend.

52. The parents of a 2-year-old with CP are learning how to feed their child and avoid aspiration. When reviewing the teaching plan, the nurse should question which of the following? 1. Place the food on the tip of the tongue, as the child will be less likely to choke. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1 The food should be placed far back in the mouth to avoid tongue thrust. The child should be placed in an upright position. Soft and blended foods minimize the risk of aspiration. Allowing the child time to feed minimizes the risk of aspiration.

36. A woman, who wishes to use the calendar method for contraception, reports that her last 6 menstrual cycles were 28, 32, 29, 36, 30, and 27 days long, respectively. In the future, if used correctly, she should abstain from intercourse on which of the following days of her cycle? 1. Days 9 to 25. 2. Days 10 to 15. 3. Days 11 to 20. 4. Days 12 to 17.

1 The woman would abstain from inter- course from day 9 of her menstrual cycle until day 25. The woman would abstain from inter- course from day 9 of her menstrual cycle until day 25. The woman would abstain from inter- course from day 9 of her menstrual cycle until day 25. The woman would abstain from inter- course from day 9 of her menstrual cycle until day 25.

46. Parents bring their 2-month-old into the clinic with concerns that the baby seems "floppy." The parents say the baby seems to be working hard to breathe. The nurse can see some intercostal retractions, although the baby is otherwise in no distress. The parents say the baby eats very slowly and seems to fatigue rapidly. They add there was a cousin whose baby had similar symptoms. The nurse would be most concerned with what possible complications? 1. Respiratory compromise. 2. Dehydration. 3. Need for emotional support for the family. 4. Feeding intolerance.

1 This baby may have Werdnig-Hoffman disease, which is characterized by pro- gressive generalized muscle weakness that eventually leads to respiratory failure. Respiratory compromise is the most important complication. There is no history of being unable to ingest oral fluids; the baby is just a slow feeder. This is important, but respiratory compromise is a priority in this situation. There is no indication of feeding intoler- ance; the baby is just a slow feeder.

61. A nurse is providing contraceptive counseling to a perimenopausal client, G3 P2012, who is in a monogamous relationship. Which of the following comments by the woman indicates that further teaching is needed? 1. "The calendar method is the most reliable method for me to use." 2. "If I use the IUD, I am at minimal risk for pelvic inflammatory disease." 3. "I should still use birth control even though I had only 2 periods last year." 4. "The contraceptive patch contains both estrogen and progesterone."

1 This is not true. The menstrual cycle of perimenopausal women is very irregular. It is very difficult to identify safe and unsafe periods for these women. This is true. This client is a multigravida in a monogamous relationship. She is low risk for infections as well as sponta- neous expulsion of the device. This is true. Even with very irregular menses the client may still be ovulating. This is true. The patch contains both an estrogen and a progesterone medication.

57. The nurse is developing a standard care plan for the administration of Mifeprex (misepristone/misoprostol; formerly known as RU-486). Which of the following educational information should the nurse include when counseling women? 1. Women should be evaluated by their health care practitioners 2 weeks after tak- ing the medicine. 2. This is the preferred method for terminating an ectopic pregnancy when an in- trauterine device is in place. 3. The only symptom clients should experience is bleeding 2 to 3 days after taking the medicine. 4. Women who experience no bleeding within 3 days should immediately take a home pregnancy test.

1 This is true. It is very important that women be evaluated to make sure that the pregnancy is terminated. Even when bleeding occurs, the preg- nancy may still be intact. This is not true. Mifeprex should not be used when an IUD is in place. The IUD should be removed before the medication is administered. This is not true. Women usually com- plain of cramping, nausea, vomiting, and fatigue. A number of other complaints have also been made. 4. This is unnecessary. If there is no bleed- ing, she should be seen by the physician for additional treatment.

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 hu- man 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.

1 This is true. The CDC has not ap- proved any tests to detect HPV in men. The CDC has not approved any tests to detect HPV in men. The CDC has not approved any tests to detect HPV in men. The CDC has not approved any tests to detect HPV in men.

32. A client asks the nurse about the gamete intrafallopian transfer (GIFT) procedure. Which of the following responses would be appropriate for the nurse to make? 1. Fertilization takes place in the woman's body. 2. Zygotes are placed in the fallopian tubes. 3. Donor sperm are placed in a medium with donor eggs. 4. A surrogate carries the infertile woman's fetus.

1 This statement is true. Although the gametes are placed in the fallopian tubes artificially, fertilization does oc- cur within the woman's body. This statement is true of zygote intrafal- lopian transfer (ZIFT), not of gamete in- trafallopian transfer (GIFT). This statement is not true. Although donor eggs and sperm can be used, usu- ally the couple's own gametes are used. When they are harvested, the gametes are placed directly into the woman's fal- lopian tubes. This statement describes surrogacy. A surrogate is usually impregnated via arti- ficial insemination.

10. It is day 17 of a woman's menstrual cycle. She is complaining of breast tenderness and pain in her lower left quadrant. The woman states that her cycle is usually 31 days long. Which of the following is an appropriate reply by the nurse? 1. "You are probably ovulating." 2. "Your hormone levels should be checked." 3. "You will probably menstruate early." 4. "Your breast changes are a worrisome sign."

1 This statement is true. Breast tender- ness and mittleschmerz often occur at the time of ovulation. Breast tenderness and mittleschmerz are symptoms of ovulation, not of abnormal hormonal levels. Menstruation occurs approximately 14 days after ovulation. The breast changes are normal and often are felt by women at the time of ovulation.

33. A woman has a history of toxic shock syndrome. She should be taught to avoid which of the following forms of birth control? 1. Diaphragm. 2. Intrauterine device. 3. Birth control pills (estrogen-progestin combination). 4. Depo-Provera (medroxyprogesterone acetate).

1 Toxic shock syndrome (TSS) is asso- ciated with diaphragm use. TSS is not associated with IUD use. TSS is not associated with the use of birth control pills. TSS is not associated with the use of Depo-Provera.

A 2-year-old is brought to the emergency department for fever and ear pain. The parents note the child has had many ear infections and that polyethylene tubes have been recommended, but the parents cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and a parent is carrying a pack of cigarettes. What one preventive measure could be taught the parents to decrease the incidence of ear infections? 1. Wean the toddler from the bottle. 2. Give the toddler a decongestant before bedtime. 3. Encourage the parent to smoke outside the house. 4. Have the child's hearing checked.

1 Weaning the toddler off the bottle is the best tactic. Giving the toddler a decongestant before bedtime is not recommended because the primary problem is obstruction of the eu- stachian tube due to intrinsic or extrinsic causes. Decongestants thicken and make passage of fluid out of the middle ear more difficult. Smoking outside the house is frequently recommended as a way to prevent expo- sure of second-hand smoke to children, but the smoke still clings to the parents' clothing and hands and continues to be a source. Following treatment for otitis media, it is important to have the child's hearing checked because drainage from the middle ear may persist beyond the days of treat- ment. It will not prevent recurrence of the otitis media.

39. A woman has gotten pregnant with a Copper T intrauterine device (IUD) in place. The physician has ordered an ultrasound to be done to evaluate the pregnancy. The client asks the nurse why this is so important. The nurse should tell the woman that the ultrasound is done primarily for which of the following reasons? 1. To assess for the presence of an ectopic pregnancy. 2. To check the baby for serious malformations. 3. To assess for pelvic inflammatory disease. 4. To check for the possibility of a twin pregnancy.

1 When pregnancy occurs with an IUD in place, an ectopic pregnancy should be ruled out. Malformations of the fetus are uncom- mon. Symptoms of PID are not similar to those of early pregnancy. The most com- mon symptoms of PID are abdominal pain, dyspareunia, foul-smelling vaginal discharge or bleeding, and fever. Twin pregnancies are no more common with a failed IUD than in general.

49. Five women wish to use the OrthoEvra (patch) for family planning. Which of the women should be carefully counseled regarding the safety considerations of the method? Select all that apply. 1. The woman who smokes 1 pack of cigarettes each day. 2. The woman with a history of lung cancer. 3. The woman with a history of deep vein thrombosis. 4. The woman who runs at least 50 miles each week. 5. The woman with a history of cholecystitis.

1 and 3 are correct. 1. Women who smoke should be coun- seled against using the patch. 2. A history of lung cancer is not a con- traindication to the patch. 3. Women who have a history of deep venous thrombosis (DVT) should be counseled against using the patch. Being a runner is not a contraindication to the patch. 5. A history of cholecystitis is not a con- traindication to the patch.

18. The nurse is providing counseling to a group of sexually active single women. Most of the women have expressed a desire to have children in the future, but not within the next few years. Which of the following actions should the nurse suggest the women take to protect their fertility for the future? Select all that apply. 1. Use condoms during intercourse. 2. Refrain from smoking cigarettes. 3. Maintain an appropriate weight for height. 4. Exercise in moderation. 5. Refrain from drinking carbonated beverages.

1, 2, 3, 4 are the correct choices. 1. Condoms should be worn during sexual contacts to prevent becoming infected with a sexually transmitted disease, which can impact the long- term health of the woman's reproduc- tive system. 2. Women who smoke have a higher in- cidence of infertility than those who do not smoke. (See http://www.asrm. org/Patients/FactSheets/smoking.pdf ) 3. Women who are either overweight or underweight have increased incidence of infertility. 4. Body mass index (BMI) is related to the amount of exercise a woman en- gages in. Those who exercise exces- sively are more likely to have a very low BMI and those who rarely exercise to be obese. Since fertility is related to body weight, it is recommended that women exercise in moderation. 5. There is some evidence that caffeine in large quantities may affect fertility, but decaffeinated carbonated beverages have never been cited as impacting

23. A Roman Catholic couple is infertile. Their health care practitioner advises them that their best chance of getting pregnant is via in vitro fertilization with a mixture of the man's sperm and donor sperm. Which of the following issues, related to this procedure, should the nurse realize may be in conflict with the couple's religious beliefs? Select all that apply. 1. The man will ejaculate by masturbation into a specially designed condom. 2. The woman may become pregnant with donor sperm. 3. Fertilization is occurring in the artificial environment of the laboratory. 4. More embryos will be created than will be used to inseminate the woman. 5. The woman will receive medications to facilitate the ripening of her ova.

1, 2, 3, and 4 are the correct choices. 1. Masturbation, as well as the use of a condom, even for the express purpose of creating life, are considered sins in the Catholic tradition. 2. Procreation with the man's sperm alone is unlikely. The addition of the donor sperm makes this unacceptable in the eyes of the Catholic Church since a woman should only become pregnant by her husband. 3. According to the precepts of the Catholic church, fertilization may only take place within the body of the woman. 4. It is immoral, in the Catholic tradi- tion, to create more embryos than are needed to conceive. 5. The medications, alone, would not be contraindicated per the Catholic Church—but only if the ova were being ripened in order for them to become fer- tilized within her own body. Only then does the church condone the use of the medications.

36. A couple, who have been attempting to become pregnant for 5 years, is seeking as- sistance from an infertility clinic. The nurse assesses the clients' emotional re- sponses to their infertility. Which of the following responses would the nurse ex- pect to find? Select all that apply. 1. Anger at others who have babies. 2. Feelings of failure because they can't make a baby. 3. Sexual excitement because they want so desperately to conceive a baby. 4. Sadness because of the perceived loss of being a parent. 5. Guilt on the part of one partner because he or she is not able to give the other a baby.

1, 2, 4, and 5 are correct. 1. Infertility clients often express anger at others who are able to conceive. 2. Infertility clients often express a feeling of personal failure. 3. Infertility clients often express an aversion to sex because of the many restrictions/schedules/intrusions that are placed on their sexual relationship. 4. Sadness is another common feeling expressed by infertility clients. 5. Guilt is commonly expressed by infer- tility clients.

10. A nurse is reading a research article on the incidence of sexually transmitted dis- eases in one population as compared with a second population. The relative risk (RR) is reported as 0.80 and the 95% confidence interval (CI) is reported as 0.62 to 1.4. How should the nurse interpret the results? 1. Because the CI of the RR includes the value of 1, the difference between the groups is meaningless. 2. A 95% confidence interval is a statistically significant finding. 3. A relative risk of 0.80 is moderately powerful. 4. Because there is no P value reported for the CI, the nurse is unable to make any conclusions about the data.

1. This is true. Relative risk connotes the probability of an experimental event occurring in relation to the con- trol. An RR 1 means that the rate of an experimental event occurring is the same as the rate of the control event occurring. An RR 1 means that the rate of an experimental event occurring is less than the rate of the control event occurring. An RR 1 means that the rate of an experimen- tal event occurring is greater than the rate of the control event occurring.

20. A 2-year-old boy has been admitted to the hospital for anemia. His mother asks the nurse what foods to include in his diet to improve his nutritional status. Which of the following should the nurse recommend? 1. Increase the child's intake of whole cow's milk to 32 ounces a day. 2. Increase the child's intake of meats, eggs, and green vegetables. 3. Increase the child's intake of fruits, whole grains, and rice. 4. Increase the number of snacks the child eats during the day.

2 One of the primary reasons toddlers de- velop anemia is because they are consum- ing too much milk, which is limiting their intake of iron-rich foods. Milk is a poor source of iron and should be limited to 24 ounces per day for a child with anemia. 2. Meat, eggs, and green vegetables are excellent sources of iron. 3. Iron-enriched cereals are a good choice for children, but this list of foods is not the choice of the most iron-rich foods.

22. A woman has been diagnosed with primary syphilis. Which of the following physi- cal findings would the nurse expect to see? 1. Cluster of vesicles. 2. Pain-free lesion. 3. Macular rash. 4. Foul-smelling discharge.

2 A cluster of vesicles is consistent with a diagnosis of herpes, not primary syphilis. A pain-free lesion, called a chancre, is consistent with a diagnosis of primary syphilis. A reddish brown rash is seen with stage 2 syphilis. A macular rash is not seen with primary syphilis. A reddish brown rash is seen with stage 2 syphilis. A foul-smelling discharge is not seen with primary syphilis. It is seen with tri- chomoniasis.

30. An infertile man is being treated with Viagra (sildenafil citrate) for erectile dysfunc- tion (ED). Which of the following is a contraindication for this medication? 1. Preexisting diagnosis of herpes simplex 2. 2. Nitroglycerin ingestion for angina pectoris. 3. Retinal damage from type I diabetes mellitus. 4. Postsurgical care for resection of the prostate.

2 A diagnosis of herpes simplex 2 is not a contraindication for taking Viagra. It is unsafe to take Viagra while also taking nitroglycerin for angina. Viagra is often prescribed for clients with erectile dysfunction (ED) from diabetes mellitus. Viagra is often prescribed for clients with ED from prostate resection.

38. A 16-year-old girl is having a discussion with her nurse about her recent diagnosis of lupus. The nurse understands how to best answer the young woman's questions about her prognosis because she understands that cognitively: 1. Adolescents are preoccupied with thoughts of the here and now. 2. Adolescents are able to understand and imagine possibilities for the future. 3. Adolescents are capable of thinking only in concrete terms. 4. Adolescents are overly concerned with past events and relationships.

2 Adolescents are becoming abstract thinkers and are able to imagine possibili- ties for the future. Adolescents are becoming abstract thinkers and are able to imagine possi- bilities for the future. Preschool and school-age children think in concrete terms. Adolescents are begin- ning to think in abstract terms. Adolescents are becoming abstract thinkers and are able to imagine possibilities for the future. They are not preoccupied with past events.

63. Which of the following clients, who are all seeking a family planning method, is the best candidate for birth control pills? 1. 19-year-old with multiple sex partners. 2. 27-year-old who bottle feeds her newborn. 3. 29-year-old with chronic hypertension. 4. 37-year-old who smokes one pack per day.

2 Although this client has no medical contraindications to using birth control pills, she is having intercourse with a number of partners and, therefore, needs a method that will protect her from infection. Of the 4 clients listed, this client is the best candidate for the use of the birth control pill. This client has chronic hypertension. She is already high risk for thrombus forma- tion and stroke and birth control pills would increase her risk. This client is over 35 years old and smokes. She is already high risk for thrombus formation and stroke and the birth control pill would increase her risk.

32. An 18-year-old boy comes to the ER complaining of a rash and itching in the groin area. He is concerned that he has contracted a sexually transmitted disease and worries that his parents will find out. The nurse's best response is: 1. "We will need to contact your parents to let them know you are in the ER." 2. "We will not contact your parents regarding this visit." 3. "Who would you like us to contact about your visit here today?" 4. "We cannot promise that the hospital will not contact your parents."

2 An 18-year-old has a right to privacy; if he does not want his parents contacted, as long as no harm has come to him they do not need to be contacted. An adolescent has every right to pri- vacy as long as the situation is not life-threatening. The nurse can ask if the patient would like the nurse to contact someone; again, if the teen says no, that is his or her right. An adolescent has every right to privacy as long as the situation is not life-threatening. Therefore, the hospital can promise not to contact the parents.

11. A male infant is visiting the pediatrician for his 6-month well-child checkup. His mother tells the nurse she wants to advance the infant's diet. Which statement by the infant's mother leads the nurse to believe that she needs further education about the nutritional needs of a 6-month-old? 1. "I will continue to breastfeed my son and will give him rice cereal three times a day." 2. "I will start my son on fruits and gradually introduce vegetables." 3. "I will start my son on carrots and will introduce one new vegetable every few days." 4. "I will not give my son any more than 8 ounces of baby juice per day."

2 Breastfeeding is the ideal nutrition for the first year of life. Cereal can be introduced between 4 and 6 months of age. 2. Infants should be started on vegetables prior to fruits. The sweetness of the fruits may inhibit them from taking vegetables. 3. It is essential to introduce new foods one at a time to determine if a child has any allergies. 4. Infants can be given fruit juice by 6 months of age, but it is recommended not to ex- ceed 4 to 6 ounces per day.

50. A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2 CP is a nonprogressive disorder. 2. CP can be manifested in different ways as the child grows. It does not progress, but its clinical manifestations may change. 3. Children with CP have different abilities and needs. CP can result in mild to severe motor deficits; therefore, one treatment regimen cannot be used or recommended for all children. 4. Although braces may assist some children with ambulation, they will not be useful in all cases.

42. A 5-year-old boy has always been one of the shortest children in class since pre- school. His mother tells the school nurse that her husband is 6' and she is 5'7". She is concerned about her son's height. Based on her knowledge of a child's physical growth during the school-age years, what should the nurse tell the child's mother? 1. She should expect him to grow about 3 inches every year from ages 6 to 9 years. 2. She should expect him to grow about 2 inches every year from ages 6 to 9 years. 3. She should have him seen by an endocrinologist for growth hormone injections. 4. Be sure to have her son's growth reevaluated when he is 7 years old.

2 During the school-age years, a child grows approximately 2 inches per year. 2. During the school-age years, a child grows approximately 2 inches per year. 3. This is not the appropriate time to have the child evaluated. His mother needs to reserve her concerns until he is older. He will likely begin to catch up with his peers within the next year.

69. A woman states that she feels "dirty" during her menses so she often douches to "clean myself." The nurse advises the woman that it is especially important to re- frain from douching while menstruating because douching will increase the likeli- hood of her developing which of the following gynecological complications? 1. Fibroids. 2. Endometritis. 3. Cervical cancer. 4. Polyps.

2 Fibroids are benign tumors of the myometrium. Douching does not increase the incidence of fibroids. Douching can increase a client's po- tential for endometritis. Cervical cancer is almost exclusively caused by the human papillomavirus that is contracted through sexual contact. 4. Polyps are abnormal tissue growths. They do not develop as a result of douching.

27. The nurse caring for an 8-year-old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry? 1. Allow the child to choose what time to take his medication. 2. Provide the child with the homework his teacher has sent in. 3. Allow the child to assist with his bath. 4. Allow the child to help with his dressing change.

2 Giving the child choices while in the hos- pital is important. However, medications should be kept on schedule. It is essential to give them at the prescribed time. The school-age child is focused on aca- demic performance; therefore the child can achieve a sense of industry by com- pleting his homework and staying on track with his classmates. The child should have already mastered bathing. It is not likely to give him a sense of accomplishment. The child may enjoy assisting with his dressing change, but it is not the best ex- ample of industry.

50. An 11-month-old girl has a diagnosis of iron-deficiency anemia. The child's mother tells the nurse that her daughter is currently taking iron and a multivitamin. Which statement made by the mother should be of concern to the nurse? 1. "I give my daughter her iron and multivitamin at the same time each morning." 2. "I give my daughter her iron and her multivitamin in her morning 6-oz bottle." 3. "I give my daughter her iron and multivitamin in a nipple before I feed her the morning bottle." 4. "I give my daughter her iron and multivitamin in oral syringes toward the back of her cheek."

2 It is always a good idea for parents to administer medications at the same time each day. Medications should never be mixed in a large amount of food or formula be- cause the parent cannot be sure that the child will take the entire feeding. Formula decreases the absorption of iron. Giving medications in a nipple is an ac- ceptable method of administering liquid oral medications to infants. An oral syringe is a good method of ad- ministering oral medications. The syringe should be placed in the back side of the cheek. Small amounts of the medication should be given at a time.

Parents confide to the nurse that their child, who is 35 months old, does not talk and spends hours sitting on the floor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question? 1. "Does your child have brothers or sisters?" 2. "Does your child seek you out for comfort and love?" 3. "Do you have trouble getting babysitters for your child?" 4. "Does your child receive speech therapy?"

2 It is important to discuss the findings that the parents have presented and not pe- ripheral information that may or may not be necessary to their concern. Children with autistic-like features lack many social skills, such as seeking reciprocity and comfort from parents and maintaining eye contact when someone is speaking with them. They have an inability to develop peer relationships. It is important to discuss the findings that the parents have presented and not peripheral information that may or may not be necessary to their concern. It is important to discuss the findings that the parents have presented and not pe- ripheral information that may or may not be necessary to their concern.

44. A client is receiving Pergonal (menotropins) intramuscularly for ovarian stimula- tion. Which of the following is a common side effect of this therapy? 1. Piercing rectal pain. 2. Mood swings. 3. Visual disturbances. 4. Jerky tremors.

2 Piercing rectal pain has not been cited as a side effect of Pergonal. Mood swings and depression are com- mon side effects of the hormonal therapy. Visual disturbances have not been cited as a side effect of Pergonal. Jerky tremors have not been cited as a side effect of Pergonal.

34. The parent of a pediatric client who has had frequent ear infections asks the nurse if there is anything that can be done to help the child avoid future ear infections. Which is the nurse's best response? 1. "Your child should be put on a daily dose of Singulair." 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis." 4. "Your child should always wear a hat when outside."

2 Singulair is an allergy medication, but it has not been proved to help reduce the number of ear infections a child gets. Tobacco smoke has been proved to increase the incidence of ear infec- tions. The tobacco smoke damages mucociliary function, prolonging the inflammatory process and impeding drainage through the eustachian tube. Otitis is not transmitted from one child to another. Otitis is often preceded by a URI, so children who are around other children with URIs may contract one, in- creasing their chances of developing an ear infection. Wearing a hat outside will have no impact on whether a child contracts an ear infection.

35. Which of the following children would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 7-year-old who has had two ear infections this year. 4. A 3-year-old whose sibling has had four ear infections.

2 Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections. A 7-year-old who has had two ear infec- tions is not the appropriate candidate. Surgical intervention is usually reserved for children who have suffered from recurrent ear infections. Surgery is not a prophylactic treatment. Just because the sibling has had several ear infections does not suggest that the 3-year-old will also have frequent ear infections. The 3-year-old has not had an ear infection yet.

23. A woman has been diagnosed with syphilis. Which of the following nursing inter- ventions 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.

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

24. A 5-year-old is at the pediatrician's office for his well-child checkup. The nurse will be administering three immunizations to the child. The nurse should expect which reaction from the child when she gives his immunizations? 1. The child will likely remain silent and still. 2. The child will likely cry and tell the nurse that it hurts. 3. The child will likely try to stall the nurse. 4. The child will likely remain still while telling the nurse that she is hurting him.

2 Teens are more likely to be stoic and re- main still and silent during injections. The common response of a 5-year-old is to cry and protest during an immunization. School-age children are most likely to try to stall the nurse. Teens usually remain still, and they may calmly tell the nurse that they are feeling pain during the injection.

5. A 17-year-old male is being seen in the ER. In order to obtain the adolescent's health information, his nurse should: 1. Interview the adolescent using direct questions. 2. Gather information during a casual conversation. 3. Interview the adolescent only in the presence of his parents. 4. Gather information only from the parents.

2 Teens may not speak as freely when asked direct questions. Frequently adolescents will share more information when it is gathered during a casual conversation. Teens may share more information when they are not in the presence of their par- ents. It is important to interview the child first. Parent information can be obtained following the interview with the child. It is important to gather information from both the teen and the parent.

17. The nurse is caring for a 12-month-old girl. The child's mother asks if the unit has any toys that her daughter can play with. The nurse goes to the toy area in search of a toy for the child. Which toy is the best choice for this child? 1. A doll. 2. A musical rattle. 3. A board book. 4. Colorful beads.

2 The child can play with a small doll, but she will likely just put the doll in her mouth. She is not old enough to play ap- propriately with this toy. A musical rattle is the perfect toy for this child. Infants have short attention spans and enjoy auditory and visual stimulation. Reading to children is essential through- out childhood. However, the child will likely just chew on the book, so it is not the ideal choice. 4. Beads are not appropriate for infants due to the risk of choking.

30. A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside her clubhouse that says "No boys allowed." The child's parents are concerned that she is excluding their neighbor's son, and they are upset. What should the school nurse tell the child's parents? 1. Her behavior is cause for concern and should be addressed. 2. Her behavior is common among school-age children. 3. Her feelings about boys will subside within the next year. 4. They should have their daughter speak with the school counselor.

2 The child's behavior is normal. Girls of 9 and 10 generally prefer to have friends who are of the same gender. This is common behavior. Girls of 9 and 10 generally prefer to have friends who are of the same gender. Girls of 9 and 10 generally prefer to have friends who are of the same gender. The child will likely have the same feelings next year. There is no need for the child to see the counselor. Girls of 9 and 10 generally pre- fer to have friends who are of the same gender.

38. The nurse is working with a client who states that she has multiple sex partners. Which of the following contraceptive methods would be best for the nurse to rec- ommend to this client? 1. Intrauterine device. 2. Female condom. 3. Bilateral tubal ligation. 4. Birth control pills.

2 The intrauterine device is an effective contraceptive device, but it will not protect against sexually transmitted infections. The female condom is recommended both for contraception and for infec- tion control. Bilateral tubal ligation is an effective contraceptive method, but it will not protect against sexually transmitted infections. Birth control pills are effective contra- ceptive methods, but they will not protect against sexually transmitted infections.

25. A client is to receive Pergonal (menotropins) injections for infertility prior to in vitro fertilization. Which of the following is the expected action of this medication? 1. Prolongation of the luteal phase. 2. Stimulation of ovulation. 3. Suppression of menstruation. 4. Promotion of cervical mucus production.

2 The luteal phase occurs after ovulation. Pergonal is given to induce ovulation. Pergonal is administered to infertile women to increase follicular growth and maturation of the follicles and to stimulate ovulation. Pergonal does not suppress menstruation or promote cervical mucus production. Pergonal does not suppress menstruation or promote cervical mucus production.

4. The nurse is administering Depo-Provera (medroxyprogesterone acetate) to a post- partum client. Which of the following data must the nurse consider before adminis- tering the medication? 1. The medicine must be administered subcutaneously in the upper arm. 2. The client must be taught to use sunscreen whenever in the sunlight. 3. The medicine is contraindicated if the woman has lung or esophageal cancer. 4. The client must use an alternate form of birth control for the first two months.

2 The medication is administered intra- muscularly, not subcutaneously. The client should use sunscreen while receiving Depo-Provera for birth control. The medication is contraindicated for use by women who have breast cancer or who are pregnant. It is not contraindi- cated for use by those suffering from lung or esophageal cancers. There is no need to use another contra- ceptive method. The client should know, however, that Depo-Provera will not protect her from sexually transmitted infections.

16. A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she was dis- charged 4 days ago. The nurse's best response to the mother is: 1. "I will let the doctor know, and he will talk with you about possible causes of your infant's weight loss." 2. "An initial weight loss of a few ounces is common among newborns, especially for breastfeeding mothers." 3. "I can tell you are a first-time mother. Don't worry; we will find out why she is losing weight." 4. "Maybe she isn't getting enough milk. How often are you breastfeeding her?"

2 The nurse should inform the physician how many ounces the infant lost. How- ever, a loss of a few ounces during the first few days of life is normal. There will be reason for concern if the infant does not gain weight within the next week. Newborns can lose up to 10% of their birth weight without concern but should regain their birth weight by 2 weeks of age. The nurse should not make this comment. The mother will likely feel belittled, and she may be afraid to ask questions in the future. A loss of a few ounces during the first few days of life is normal. Many times infants of breastfeeding mothers lose weight ini- tially because the mother's milk has not come in yet.

53. A woman is using the contraceptive sponge as a birth control method. Which of the following actions is important in order to maximize the sponge's effectiveness? 1. Insert the sponge at least one hour before intercourse. 2. Thoroughly moisten the sponge with water before inserting. 3. Spermicidal jelly must be inserted at the same time the sponge is inserted. 4. A new sponge must be inserted every time a couple has intercourse.

2 The sponge may be inserted any time be- tween 24 hours and within a few minutes before intercourse. The sponge must be moistened with water until it is foamy. Additional spermicide need not be used. This is not true. The sponge offers con- traceptive protection for up to 24 hours no matter how many times a couple has intercourse.

44. A 3-year-old child with CP is admitted for dehydration following an episode of diar- rhea. The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which of the following nursing diagnoses is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: mother sole caretaker. 4. Alteration in elimination: diarrhea.

2 This child is definitely at risk for skin breakdown, but alteration in nutrition is the priority. The child weights 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The mother needs help to manage the coughing spells while the child is being fed. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so less coughing occurs. The parent needs support in caring for this child, but alteration in nutrition is the priority. The child weights 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The parent needs help to manage the coughing spells while the child is being fed. The child has not had a diarrheal stool for 48 hours, so the assumption is safe that the illness is over. The child weights 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The parent needs help to manage the coughing spells while the child is being fed.

47. A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is crying and states, "This is all my fault." Which is the nurse's best response to the child's mother? 1. "Accidents happen. You shouldn't blame yourself." 2. "Falls are one of the most common injuries for toddlers." 3. "It may be a good idea to put a baby gate on the stairs." 4. "Your son should be proficient at walking down the stairs by now."

2 This comment will not make the mother feel any better. The mother is going to blame herself regardless of where the blame lies. The nurse would do better to just listen than to make this sort of comment. Falls are one of the most common in- juries, and it may make the parent feel better to know that this is common among all toddlers. Itmaybeagoodideatoputupababy gate, but in this situation the nurse's comment may be interpreted as judgmental. Toddlers are still working on maintaining stability while walking, climbing stairs, and running. The toddler should not be expected to be proficient at this time.

24. After a sex education class, the school nurse overhears an adolescent woman dis- cussing 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."

2 This is a fallacy. Both men and women can become infected from oral sex. 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. 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. This is a fallacy. Females are more sus- ceptible to disease than are males.

40. Which instruction by the nurse should be included in the teaching plan for an in- fertile woman who has been shown to have a 28-day biphasic menstrual cycle? 1. Douche with a cider vinegar solution immediately before having intercourse. 2. Schedule intercourse every day from day 8 to day 14 of the menstrual cycle. 3. Be placed on follicle-stimulating hormone therapy by the fertility specialist. 4. Assess the basal body temperature pattern for at least 6 more months.

2 Unless medically indicated, douching should never be performed. A vinegar so- lution is especially inappropriate since sperm are unable to survive in an acidic environment. This action is recommended. Preg- nancy is most likely to occur with daily intercourse from 6 days before ovulation up to the day of ovulation. If a client is experiencing a biphasic cy- cle, FSH therapy is probably not indicated. The BBT chart need not be monitored for 6 more months, although it can be used to help time intercourse.

54. A 3-year-old was admitted to the hospital with croup. His nurse just obtained vital signs. The child's heart rate is 90, his respiratory rate is 44, his blood pressure is 100/52, and his temperature is 98.8°F (37.1° C). The parents ask the nurse if his vital signs are appropriate for a child his age. The nurse's best response to the parents is: 1. "Your son's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your son's temperature is elevated, but the other vital signs are within normal limits." 3. "Your son's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your son's heart rate is elevated, but the ogther vital signs are within normal limits."

3 A normal systolic blood pressure for a child from 3 to 6 years is 78 to 111. A normal diastolic blood pressure for a child from 3 to 6 years is 42 to 70. A normal temperature is 96.6°F to 100°F (35.8° C to 37.7° C). A normal respiratory rate for a child from 3 to 6 years is 20 to 30 breaths per minute. A normal heart rate for a child from 3 to 6 years is 75 to 120.

49. The nurse is giving morning medications to a 4-year-old female who has just had a surgical procedure to release her hamstrings. The child has a history of CP. When the nurse prepares to administer baclofen, the child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3 Baclofen is not given for postoperative pain control. Baclofen is not given for seizures. Baclofen is given to help control the spasms associated with CP. Baclofen is not given for bladder control.

15. The nurse is instructing a new breastfeeding mother in the need to provide her pre- mature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3 Breast milk or an iron-fortified formula is recommended as the primary source of nutrition for the first year of life. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Premature infants have iron stores from the mother that last approxi- mately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that last approximately 4 to 6 months. Iron-fortified cereals are a good source of iron once a child is old enough to consume solid foods.

The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

3 Children experience fewer ear infections as they age because their immune system is maturing. 3. Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections sec- ondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis. 4. Children who have repeated ear infections are at a higher risk of having decreased hearing during and between infections. Hearing loss directly affects a child's speech development.

45. The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which of the following is the nurse's best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

3 Children with CP have a range of intellec- tual abilities, from being profoundly re- tarded to having a high intelligence quo- tient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is se- verely affected when that may not be true. Children with CP have a range of intellec- tual abilities, from being profoundly re- tarded to having a high intelligence quo- tient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is se- verely affected when that may not be true. Many children with CP have normal intelligence. Children with CP have a range of intellectual abilities, from being pro- foundly retarded to having a high intelli- gence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true.

19. A couple is seeking advice regarding actions that they can take to increase their po- tential of becoming pregnant. Which of the following recommendations should the nurse give to the couple? 1. The couple should use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The man should be on top during intercourse.

3 Delaying intercourse until the day of ovulation is a poor recommendation. The sperm live for about 3 days. If the couple has daily intercourse beginning 5 or 6 days before ovulation and continu- ing until the day of ovulation, they will maximize their potential of becoming pregnant. (See Wilcox AJ, et al. Timing of sexual intercourse in relation to ovula- tion. N Engl J Med 1995; 333:1517-21.) 3. The woman should refrain from douching. Douching can change the normal flora and the pH in the vagina, making the environment hostile to the sperm. 4. The position of the couple during inter- course will not affect the potential fertil- ity of the woman.

41. An 8-year-old girl is at the pediatrician's office for a well-child checkup. Her mother tells the nurse that she has been having some difficulty getting her daughter to com- plete her chores. The child's mother asks the nurse for techniques for gaining the child's cooperation with chores. Which of the following should the nurse suggest the mother do? 1. Use "grounding" as a technique. 2. Use "time-out" as a technique. 3. Use a reward system as a technique. 4. Use spanking as a technique.

3 Grounding is a technique that generally works well with adolescents. Time-out is a technique that is primarily used for toddler and preschool children. School-age children usually respond very well to a reward system and often enjoy the rewards so much that they will continue chores without continual reminders. Spanking is never a suggestion that should be given to families.

40. A 13-year-old boy is visiting the pediatrician's office for his well-child checkup. The child tells the nurse that he is worried because his breasts are growing and they hurt. He tells the nurse he is afraid to take his shirt off in front of the other boys during gym class. What should the nurse tell him? 1. "The pediatrician will draw some blood to find out why your breasts are growing." 2. "It is just a slight hormonal imbalance that can be easily corrected with medication." 3." This is a normal condition of puberty that will resolve within a year or two." 4. "This is a rare finding that occurs in about 5% of boys during puberty."

3 Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually re- solves in 2 years. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually re- solves in 2 years. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years. Gynecomastia and breast tenderness are common for about a third of boys during middle puberty. Gynecomastia usually resolves in 2 years.

7. How can the nurse best facilitate the trust relationship between infant and parent while the infant is hospitalized? 1. The nurse should encourage the parents to remain at their child's bedside as much as possible. 2. The nurse should keep parents informed about all aspects of their child's condition. 3. The nurse should encourage the parents to hold their child as much as possible. 4. The nurse should encourage the parents to participate actively in their child's care.

3 Having parents close to the child is impor- tant, but infants are most secure when they are being held, patted, and talked to. It is important that the nurse keep the par- ents informed about their child's condition, but it does not have any impact on the child's trust versus mistrust relationship with the parents. Having parents hold their child while in the hospital is an excellent means of building the trust relationship. Infants are most secure when they are being held, patted, and spoken to. Parents should be encouraged to learn their child's care, but it is not the best means of enhancing the trust relationship.

36. A 2-month-old is diagnosed with otitis. The parent asks the nurse if the otitis will have any long-term effects for the child. Understanding the complications that can occur with otitis, which is the nurse's best response? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."

3 Hearing loss is not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop hearing loss. Speech delays are not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop some hearing loss, which often results in delayed language development. When children acquire an ear infection at such a young age, there is an in- creased risk of recurrent infections. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections.

37. A 6-month-old is diagnosed with an ear infection. The parents report that the child is not sleeping well and is crying frequently. The child also has a moderate amount of yellow drainage coming from the infected ear. This is the parents' first baby. Which of the following nursing objectives is the priority for this family at this time? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

3 It is important to educate the family about the signs and symptoms of an ear infection, but that is not the priority at this time. The infant has already been diagnosed with the infection. The parents may need emotional support because they are likely suffering from a lack of sleep because their infant is ill. However, this will not solve their current problems with their infant. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better. Promoting drainage flow from the ear is important, but providing pain relief is the highest priority.

1. A 3-year-old female is hospitalized for a femur fracture. As her nurse, what nursing action would help foster the child's sense of autonomy? 1. Allow the child to choose what time to take her oral antibiotics. 2. Allow the child to have a doll for medical play. 3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe. 4. Allow the child to watch age-appropriate videos.

3 Medication administration times must be adhered to. A 3-year-old should not be al- lowed to choose administration times. A doll for medical play is an excellent method for teaching children about medical procedures, but it will not enhance her sense of autonomy. Allowing toddlers to participate in actions of which they are capable is an excellent way to enhance their autonomy. Age-appropriate videos are a good way to occupy the child while she is hospitalized, but they will not enhance her autonomy.

33. A 2-day-old girl is being discharged home. The nurse is working on discharge teach- ing with her parents. They are asking the nurse about how to use the infant car seat and where it should be placed in their vehicle. Which of the following should the nurse do? 1. Give the parents a pamphlet explaining how to install the car seat. 2. Accompany the parents to the car, and show them how to install the car seat. 3. Contact the hospital's car-seat safety officer, and ask the officer to accompany the parents to the car for car-seat installation. 4. Show the parents a video on car-seat installation and safety, and ask if they are comfortable with the information.

3 Pamphlets may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation. The nurse could accompany the parents if she is proficient in car-seat safety and installation. The car-seat safety officer is the best choice, as that individual would have the needed information and certification to help the family. A video may be a useful tool to reinforce teaching. However, a hands-on approach is best in this situation.

46. The parents of a 7-month-old girl are attending a class on child safety. Following the class, what should the child's parents understand as one of the most common causes of injury and death for a 7-month-old child? 1. Poisoning. 2. Child abuse. 3. Aspiration. 4. Dog bites.

3 Poisoning is more common among tod- dlers and preschoolers who are ambulating. Child abuse is not one of the leading causes of injury and death in children. Accidents are the most common cause of injury and death. Aspiration is a common cause of injury and death among children of this age. These children often find small objects lying on the floor and place them in their mouths. Older siblings are often responsible for leaving small objects around. Dog bites are not a leading cause of injury or death in children.

8. The nurse is caring for a 7-year-old female on the school-age unit. Her mother is con- cerned that she may have some developmental delays. Which of the following statements would indicate to the nurse that the child is not developmentally on track for her age: 1. The child is able to follow a four-to-five-step command. 2. The child started wetting the bed on this admission to the hospital. 3. The child has an imaginary friend named Kelly. 4. The child enjoys playing board games with her sister.

3 School-age children should be able to fol- low a four- to five-step command, so this does not indicate that the child has a devel- opmental delay. The child was potty-trained before entering the hospital, and it is important to inform her mother that bedwetting is a common form of regression seen in hospitalized chil- dren. The child will likely return to her nor- mal toileting habits when she returns home. Most school-age children do not have imaginary friends. This is much more common for children of 3 and 4 years of age. Most school-age children do enjoy playing board games.

25. An 8-year-old is NPO while he awaits surgery for central line placement later in the afternoon. The nurse is trying to engage the child in some form of activity to distract him from thinking about his upcoming surgery. Which is the best method of distraction for a child of this age in this situation? 1. Encourage the child to use the telephone to call friends. 2. Encourage the child to watch television. 3. Encourage the child to play a board game. 4. Encourage the child to read the central line pamphlet he was given.

3 Talking to friends may distract the child for some time. However, the conversation could revert to a discussion about the up- coming surgery. Watching television may distract the child for some time, but he may still be thinking about his surgery. A board game is the optimal choice be- cause school-age children enjoy being engaged in an activity with others that will require some skill and challenge. Reading material about the surgery will only increase his thoughts about the surgery.

51. The mother of a 15-year-old boy is frustrated because he spends much of his weekend time sleeping. She informs the nurse, "My son sleeps longer now than he did when he was in kindergarten." What is the nurse's best response to the child's mother's frustration? 1. "Your son may be trying to catch up on the sleep he misses during the week while he is studying." 2. "Developmental theorists believe that teens require more sleep as they begin to integrate new roles into their lives." 3. "Teens require more sleep due to the rapid physical growth that is occurring during adolescence." 4. "Teens require more sleep due to the increase in their social obligations."

3 Teens require more sleep due to the rapid physical growth that occurs during adolescence. Teens are trying to integrate new roles into their lives. However, that has no impact on their need for increased sleep. Teens require more sleep due to the rapid physical growth that occurs during adolescence. Teens are generally more social and may be staying out late. However, their in- creased requirement for sleep is related to their rapid growth during adolescence.

52. A 5-year-old boy is being screened for developmental delays using the Denver Developmental Screening Test. The child's mother is explaining to the nurse her understanding of the screening test. The nurse realizes that the child's mother needs further education about the test when she states which of the following? 1. "It screens my son's gross motor skills." 2. "It screens my son's fine motor skills." 3. "It screens my son's intelligence level." 4. "It screens my son's language development."

3 The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development. The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development The Denver Developmental Test does not test a child's level of intelligence. The Denver Developmental Test, which evaluates children from 1 month to 6 years, is used to screen gross motor skills, fine motor skills, language development, and personal/social development.

4. The nurse caring for a 4-year-old female in the ER is about to start a peripheral IV. The nurse's best method for explaining the procedure to the child is to: 1. Show the child a pamphlet with pictures showing the IV placement procedure. 2. Have the 5-year-old patient next door tell the 4-year-old about her experience with her IV placement. 3. Show the child the IV placement equipment, and demonstrate the procedure on a doll. 4. Tell the child that if she remains still, the procedure will be over quickly.

3 The child is too young to understand the procedure using pamphlets. Children 4 years old are egocentric and will not relate the other child's experience to their own. A 4-year-old child understands things in very concrete and simple terms. Therefore, medical play is an excellent method for helping her understand the procedure. The nurse has no idea how long the proce- dure will take and should not give the child information that may not be reliable.

39. The mother of a 13-year-old girl tells the nurse that she is concerned because her daughter has gained 10 lb since she began puberty. The child's mother asks the nurse for advice about what to do about her daughter's weight gain. Which of the following should the nurse do? 1. Provide the child's mother with some pamphlets on nutrition and healthy eating. 2. Provide the child's mother with information about a new exercise program for teens. 3. Inform the child's mother that it is common for teen girls to gain weight during puberty. 4. Inform the child's mother that her daughter will likely gain another 5 to 10 lb in the next year.

3 The child's mother may be interested in information relating to proper nutrition and exercise. However, the most impor- tant thing is for the nurse to let the child's mother know that this is a normal finding in teenage girls as they enter puberty. The child's mother may be interested in information relating to proper nutrition and exercise. However, the most important thing is for the nurse to let the mother know that this is a normal finding in teenage girls as they enter puberty. The nurse should tell the child's mother that this is a normal finding in teenage girls as they enter puberty. The nurse knows that it is normal for girls to gain weight during puberty but has no idea how much weight the child will gain or if she will gain any more.

41. A child with spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 31/2 hours post dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. If the spasticity were decreased. 4. If the spasticity were increased.

3 The expected benefit from intrathecal ba- clofen is less spasticity, which allows the child to have more muscle control. This leads to more fine-motor control and am- bulation. The onset of action is 30 min- utes, and it peaks in 6 hours. The expected benefit from intrathecal baclofen is less spasticity, which allows the child to have more muscle control. This leads to more fine motor control and ambulation. The onset of action is 30 minutes, and it peaks in 6 hours. If baclofen were going to work for this patient, one could tell because spastic- ity would be decreased. Baclofen should decrease, not increase, spasticity.

41. A couple has been told that the male partner, who is healthy, is producing no sperm "because he has cystic fibrosis." Which of the following explanations is accurate in relation to this statement? 1. Since the man is healthy he could not possibly have cystic fibrosis. 2. Men with cystic fibrosis often have no epididymis. 3. The expressivity of cystic fibrosis is variable. 4. Cystic fibrosis is a respiratory illness having nothing to do with reproduction.

3 The man may have both recessive genes for cystic fibrosis even though he is not ill. 2. This answer is incorrect. Some men with cystic fibrosis, however, have no vas deferens. 3. This statement is correct. Cystic fi- brosis can be expressed in a number of ways. Some affected individuals have very serious illness resulting in early death, while others experience few symptoms. 4. This statement is incorrect. Some males with cystic fibrosis have no vas deferens and, even if the vas is present, if the man is producing large amounts of thick mu- cus, the vas may become obstructed. Sim- ilarly, in women, the fallopian tubes may become obstructed with thick mucus.

The nurse is caring for a 2-month-old male infant who is at risk for CP due to extreme low birth weight and prematurity. There is a multidisciplinary team caring for him. His parents ask why there is a speech therapist involved in his care. Select the nurse's best response. 1. "Your child is likely to have speech problems because of his early birth. Involving the speech therapist at this point will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "It is the hospital routine to involve as many members of the health-care team in your child's care so that we will know if he has any unmet needs."

3 The nurse cannot assume that the child will have speech difficulties. Speech therapy does not guarantee vocalization at a developmentally appropriate age. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements. Members of a multidisciplinary team become involved in a child's care based on specific needs, not hospital routine.

6. A 7-year-old female is being admitted to the hospital for a diagnosis of acute lympho- cytic leukemia. The nurse wants to gather information from the child regarding her feelings about her diagnosis. Which nursing action is most appropriate to gain infor- mation about how the child is feeling? 1. The nurse should actively attempt to make friends with the child before asking her about her feelings. 2. The nurse should ask the child's parents what feelings she has expressed in regard to her diagnosis. 3. The nurse should provide the child with some paper to draw a picture of how she is feeling. 4. The nurse should ask the child direct questions about how she is feeling.

3 The nurse should not attempt to make friends with the child too quickly. The child should be given the opportunity to observe the nurse working in order to increase her comfort level with the nurse. The child's parents are a good source of in- formation, but the child may not have ex- pressed all of her feelings to her parents. Often children will include much more detail of their feelings in drawings. They will often express things in pictures they are unable to verbalize. School-age children do not often share all of their feelings verbally, especially to peo- ple with whom they are not familiar.

22. In order to prevent separation anxiety in a hospitalized toddler, which of the following should the nurse do? 1. Assume the parental role when parents are not able to be at the bedside. 2. Encourage the parents to remain at the bedside always. 3. Establish a routine that is similar to that of the child's home. 4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.

3 The nurse should try to comfort the child and be friendly, but she should not try to replace the parent. Parents should be encouraged to be with their child as much as possible. However, parents may feel guilty if they leave knowing the staff believes the parents should always be at the bedside. It is very important to try to maintain a child's home routine both when par- ents are present and when they have to leave the hospital. This will increase the child's sense of security and de- crease anxiety. Providing consistent nursing care is important, not rotating staff. The child needs consistent care to decrease anxiety.

33. A physician prescribes 10 days of amoxicillin to treat a 6-year-old male with an ear infection. The nurse is reviewing discharge instructions with the parent. Which information should be included in the discharge instructions? 1. "Administer the amoxicillin until the child's symptoms subside." 2. "Administer an over-the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."

3 The parent should administer all of the medication. Stopping the medication when symptoms subside may not clear up the ear infection and may actually cause more severe symptoms. Antihistamines have not been shown to decrease the number of ear infections a child gets. It is essential that all the medication be given. The child is old enough to participate in the administration of medication but should only do so in the presence of the parents.

15. A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, and takes a sauna every day after work. Which of the following is an appropriate response by the nurse? 1. It is unlikely that any of these factors is impacting his fertility. 2. Daily alcohol consumption could be causing his infertility problems. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males.

3 This response is incorrect because exposing the testes to the heat of the sauna can alter the normal morphology of the sperm. Alcohol consumed in excessive amounts can alter spermatogenesis, but one beer per day has not been shown to be a problem. The high temperature of the sauna could alter the number and morpho- logy of the sperm. Chemotherapy has been shown to affect the ability of males to create sperm.

8. 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."

3 This statement is inappropriate. Vaccines are not administered to prevent vertical transmission, but rather to prevent con- tracting the virus in the future. If a preg- nant woman is hepatitis B positive, her baby would receive the hepatitis B im- mune 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. 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. 4. This response implies that the mother in the scenario is not interested in protect- ing her child. That is very unlikely.

28. 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.

3 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. 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. This statement is true. There are very few side effects experienced by those who receive the vaccine. This statement is not true.

2. A 19-year-old client with multiple sex partners is being counseled about the hepati- tis 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.

3 To be immunized against hepatitis B, a three-injection vaccine series is ad- ministered.

12. A nonpregnant young woman has been diagnosed with bacterial vaginosis (BV). The nurse questions the woman regarding her sexual history, including her fre- quency of intercourse, how many sexual partners she has, and her use of contracep- tives. 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.

3 Unless the partner is female, the trans- TEST-TAKING TIP: The important lesson for the test taker to learn from this example is that math principles do not change simply because numbers are large. Penicillin is ordered in millions of units. That should not frighten the test taker. Simply proceed slowly with each step of the process and the correct result will be found. mission to partners is low. 2. There is no law that requires the nurse to ask these questions. 3. This statement is true. The change in normal flora increases the woman's susceptibility to other organisms. 4. There is no need to provide the labora- tory with this information.

7. A nurse teaches a woman who wishes to become pregnant that if she assesses for spinnbarkeit she will be able closely to predict her time of ovulation. Which tech- nique should the client be taught in order to assess for spinnbarkeit? 1. Take her temperature each morning before rising. 2. Carefully feel her breasts for glandular development. 3. Monitor her nipples for signs of tingling and sensitivity. 4. Assess her vaginal discharge for elasticity and slipperiness.

4 2. The breasts do become sensitive and The temperature does elevate after ovu- lation, but the elevation is not defined as spinnbarkeit some women do palpate tender nodules in the breasts at the time of ovulation, but those changes are not spinnbarkeit. 3. The nipples may tingle and become sensitive. 4. Spinnbarkeit is defined as the "thread" that is created when the vaginal dis- charge is slippery and elastic at the time of ovulation. The changes are in response to high estrogen levels. The woman inserts her index and middle fingers into her vagina and touches her cervix. After removing her fingers, she separates her fingers and "spins a thread" between her fingers. When she is not in her fertile period, the mucus is thick and gluey.

26. A 35-year-old client is being seen for her yearly gynecological examination. She states that she and her partner have been trying to become pregnant for a little over 6 months, and that a friend had recently advised her partner to take ginseng to im- prove the potency of his sperm. The woman states that they have decided to take their friend's advice. On which of the following information should the nurse base his or her reply? 1. Based on their history, the client and her partner have made the appropriate de- cision regarding their fertility. 2. Ginseng can cause permanent chromosomal mutations and should be stopped immediately. 3. It is unnecessary to become concerned about this woman's fertility because she has only tried to become pregnant for a few months. 4. Although ginseng may be helpful, it would be prudent to encourage the woman to seek fertility counseling.

4 Because fertility drops as a woman ages, it is advisable to encourage the couple to use conventional therapies in conjunction with the complemen- tary therapy to maximize their poten- tial of becoming pregnant.

21. The parents of a 2-year-old boy are concerned about his behavior. Since the child's admission to the hospital 2 days ago he has been crying much more than usual and is inconsolable much of the time. The nurse's best response to the child's parents is: 1. The child is in the detachment phase of separation anxiety, which is normal for children during hospitalization. 2. The child is in the despair stage of separation anxiety, which is normal for children during hospitalization. 3. The child is in the bargaining stage of separation anxiety, which is normal for children during hospitalization. 4. The child is in the protest stage of separation anxiety, which is normal for children during hospitalization.

4 During the detachment phase of separa- tion anxiety, children are usually fairly cheerful, and they often lack a preference for their parents. During the despair stage of separation anxiety, children usually have a loss of ap- petite, altered sleep patterns, and a lack of much interest in play. The bargaining stage is not a stage of sep- aration anxiety; it is one of the stages of grief. During the protest stage of separation anxiety, children are often inconsolable, and they often cry more than they do when they are at home. These children also frequently ask to go home.

A 7-year-old child in a classroom is disruptive with loud talking, short attention span, difficulty organizing work, unable to finish assigned class work, and moodiness. Which of the following is the most likely diagnosis for this child? 1. Enuresis. 2. Sexual abuse. 3. Learning disability. 4. Attention deficit/hyperactivity disorder.

4 Enuresis is bed-wetting, which can have an array of causes. It is important to rule out sexual abuse before deciding on the attention deficit/ hyperactivity disorder diagnosis. It is also important to have a medical provider do a complete physical examination and have both the teacher and the family complete behavioral checklists before making that diagnosis. It is important to rule out a learning dis- ability before deciding on the attention deficit/hyperactivity disorder diagnosis. It is also important to have a medical provider do a complete physical examina- tion and have both the teacher and the family complete behavioral checklists before making that diagnosis. The most likely diagnosis is attention deficit/hyperactivity disorder because the child has the classic symptoms.

58. A 17-year-old male has had some recent behavioral changes. His mother calls the nurse at the pediatrician's office and tells her that her son has been coming home from school every day, closing his door, and refraining from interaction with his parents. The child's mother does not know what she should do about her son's unsociable behavior. The nurse's best response to the child's mother is: 1. "You should go speak with your son and ask him directly what is wrong with him." 2. "You should set limits with your son and tell him that this is unacceptable behavior." 3. "Your son's behavior is abnormal, and he is going to need a psychiatric referral." 4. "Your son's behavior is normal. You should listen to him without being judgmental."

4 If the child's parents confront him, he may feel like they are being judgmental, and he will likely not want to communicate with them. When parents begin a dialogue with their child early on in life, they are more capable of approaching the child when they do notice behavioral changes. Setting limits is always a good thing to do with children. However, the child's par- ents are not addressing the reason for his behavioral changes. The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence. He does not need a psychological referral at this time. The child's behavior is typical of a teen's response to developmental and psychosocial changes of adolescence.

21. An Orthodox Jewish couple is seeking infertility counseling. The woman states that her menstrual cycle is 21 days long. After testing, no physical explanation is found for the infertility. Which of the following may explain why the woman has been un- able to conceive? 1. Her Kosher diet is lacking in the essential nutrients needed for achieving opti- mal reproductive health. 2. The positions allowed Orthodox Jewish couples during intercourse hinder the process of fertilization. 3. Orthodox Jewish couples are known to have a high rate of infertility because of inborn genetic diseases. 4. Orthodox Jewish couples refrain from intercourse during menses and for seven days after it ends.

4 Jewish law does prohibit intercourse during the menses and for 7 days following menses. The woman then goes through a cleansing bath called a mikvah before she and her husband may have intercourse. With such a short cycle, she is ovulating during the time frame in which intercourse is restricted.

7. The nurse is teaching a client regarding the treatment for pubic lice. Which of the following should be included in the teaching session? 1. The antibiotics should be taken for a full 10 days. 2. All clothing should be pretreated with bleach before wearing. 3. Shampoo should be applied for at least 2 hours before rinsing. 4. The pubic hair should be combed after shampoo is removed.

4 Lice are not treated with antibiotics. 2. Clothing should be washed thoroughly in hot water (130°F) and dried in a hot dryer for at least 20 minutes. 3. The over-the-counter shampoo should be applied for 10 minutes and then rinsed off. 4. To remove the nits, or eggs, the pubic hair should be combed with a fine- toothed nit comb after the shampoo is removed.

38. A client is to have a hysterosalpingogram. In this procedure, the physician will be able to determine which of the following? 1. Whether or not the ovaries are maturing properly. 2. If the endometrium is fully vascularized. 3. If the cervix is incompetent. 4. Whether or not the fallopian tubes are obstructed.

4 Only the uterus and the fallopian tubes are evaluated during a hysterosalpin- gogram. Tumors and other gross assessments of the uterus can be made out, but the vascularization of the endometrium is be- yond the scope of the test. The competency of the cervix cannot be evaluated during a hysterosalpingogram. The primary goal of a hysterosalpin- gogram is to learn whether or not the fallopian tubes are patent.

13. An 11-year-old male is being evaluated in the ER for an inguinal hernia. Which statement accurately describes how the nurse should approach him for his physical assessment? 1. The nurse should ask the child's parents to remain in the room during the physical exam. 2. The nurse should auscultate the child's heart, lungs, and abdomen first. 3. The nurse should explain to the child that the physical exam will not hurt. 4. The nurse should explain to the child what the nurse will be doing in basic understandable terms.

4 Privacy is very important to school-age children. The child should be given the choice whether his parents are present for the exam. School-age children can be assessed in a head-to-toe sequence. The nurse should not promise that the exam will not hurt. Palpation of the area of the hernia may hurt the child, and that may jeopardize the trust relationship between the nurse and the child. School-age children are capable of understanding basic functions of the body and should be taught about their diagnosis in simple, basic terms.

31. The school nurse is preparing a discussion on nutrition with the fourth-grade class. Based on the childrens' developmental level, what information should she include in her presentation? 1. A review of the number of calories that a fourth-grade child should consume in a day. 2. A review of a list of high-calorie foods that all fourth-graders should avoid. 3. A review of how to read food labels so children know which foods are good for them. 4. A review of nutritious foods with basic scientific information about how they affect the body organs and systems.

4 School-age children do not engage in calorie counting. This is an adult activity. Children may not want to hear this infor- mation, as most of them enjoy consuming high-calorie foods that taste good. School-age children do not engage in calorie counting. This is an adult activity. Reviewing nutritious choices keeps the lesson on a positive note, and school- age children are very interested in how food affects their bodies. They are ca- pable of understanding basic medical terminology.

53. The nurse is caring for a 5-year-old male with CP. His weight is in the fifth percentile, and he has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube put in. Which of the following would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4 Sharing information may not be helpful if the family is not ready to listen. 2. Sharing information may not be helpful if the family is not ready to listen. 3. The family may have other concerns that would be communicated through an open-ended question. An open-ended question will encour- age family members to share what they know and potentially clear any misconceptions.

1.) The nurse in a pediatric clinic is caring for a 9-year-old girl who has been diag- nosed with gonorrhea. Which of the following actions is appropriate for the nurse to take? 1. Notify the physician so the child can be admitted to the hospital. 2. Discuss with the girl the need to stop future sexual encounters. 3. Question the mother about her daughter's menstrual history. 4. Report the girl's medical findings to child protective services.

4 The child need not be admitted to the hospital. This assumes that the child has control over the sexual encounter. It is likely that this child is a victim of sexual abuse. The child's menstrual history is irrele- vant. It is possible that she has yet to reach menarche. This child must be reported to child protective services.

62. The nurse is interviewing a client regarding contraceptive choices. Which of the following client statements would most influence the nurse's teaching? 1. "I have 2 children." 2. "My partner and I have sex twice a week." 3. "I am 25 years old." 4. "I feel funny touching my private parts."

4 The fact that the client has two children will not necessarily impact her contra- ceptive choice. Some couples with two children have completed their childbearing while others wish to have many more children. 2. The frequency of intercourse is usually not a consideration unless the client has intercourse with a number of partners. 3. This client's age does not preclude her from using any device. Clients over age 35, especially if they smoke, should not use any of the hormonally based contra- ceptive methods. 4. This statement is very important. If the client refuses to touch her genital area, she is an unlikely candidate for a number of contraceptive devices: fe- male condom, diaphragm, sponge, cervical cap, and IUD.

23. A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should the nurse use to gather information from the child? 1. The nurse should promise the child that her parents will not know what she tells the nurse. 2. The nurse should promise the child that she will not have to see the suspected abuser again. 3. The nurse should use correct anatomical terms to discuss body parts. 4. The nurse should tell the child that the abuse is not her fault and that she is a good person.

4 The nurse should not promise not to tell. The nurse should always be honest with the child in order to develop a level of trust. The nurse should not make a promise that cannot be kept. Once again, the trust rela- tionship could be jeopardized if the child feels the nurse lied to her. The nurse should discuss body parts in re- lation to the child's vocabulary. Many young children believe abuse or illness is their fault, and they should be reminded they are not to blame. Many children of this age believe they have acquired a disease or have been abused because they are bad people.

26. 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.

4 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 usu- ally spontaneously disappear after a pe- riod of time. 3. This statement is incorrect. It is a com- mon practice to remove warts surgically. 4. This statement is true. It is not un- common for warts to return a few months after an initial treatment.

33. A child who has been diagnosed with conjunctivitis is ordered to have eye ointment applied three times a day. Which of the following should the nurse do first? 1. Remove any discharge from the affected eye. 2. Ensure the ointment is at room temperature. 3. Hold the tip of the eye ointment parallel to the eye. 4. Wash hands.

4 This is correct, but it is not done first. 2. This is correct, but it is not done first. 3. This is correct, but it is not done first. 4. The procedure for instilling eye oint- ment begins with washing hands fol- lowed by donning clean gloves.

37. A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling? 1. "You will have the test the day after your menstruation ends." 2. "You will have a dye put into your vein that will show up on x-ray." 3. "You should refrain from having intercourse for the four days immediately prior to the test." 4. "You should experience the same sensations you feel when your doctor does your Pap test."

4. The client will undergo a speculum examination when cervical mucus will be harvested.

17. 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.

1 The initial infection of herpes sim- plex 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. Metrorrhagia is not associated with her- pes simplex 2. Amenorrhea is not associated with herpes simplex 2. Abdominal cramping is not associated with herpes simplex 2.

29. 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.

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

10. A 3-year-old female is hospitalized for an ASD repair. Her parents have decided to go home for a few hours to spend time with her siblings. The child asks when her mommy and daddy will be back. The nurse's best response is: 1. "Your mommy and daddy will be back after your nap." 2. "Your mommy and daddy will be back at 6 p.m." 3. "Your mommy and daddy will be back later this evening." 4. "Your mommy and daddy will be back in 3 hours."

1 Preschoolers understand time in rela- tion to events. Preschoolers cannot tell time. Preschoolers want concrete information, and the words "this evening" are not meaningful to them. Preschoolers have no concept how long an hour is.

54. A man has just had a vasectomy. Which of the following postprocedure instructions should the nurse provide the client? 1. The man may have unprotected intercourse within 1 week after having the surgery. 2. The man should rest at home for at least 1 day following the surgery. 3. The man should be taught the signs and symptoms of prostatitis. 4. The man will be sedated from the anesthesia for a few hours after the surgery.

2 This is true. The postprocedure course is usually uneventful but 1 day of rest is advisable.

31. The nurse is teaching an uncircumcised male to use a condom. Which of the fol- lowing items should be included in the teaching plan? 1. Apply mineral oil to the shaft of the penis after applying the condom. 2. Pull back the foreskin before applying the condom. 3. Create a reservoir at the tip of the condom after putting it on. 4. Wait five minutes after ejaculating before removing the condom.

2 Oil- and petroleum-based products can destroy the latex in condoms. The foreskin should be pulled back before applying the condom. Before beginning to put the condom on, a reservoir should be created by pinching the end of the condom. The condom should be removed imme- diately after ejaculation.

47. A young woman is seen in the emergency department. She states, "I took a preg- nancy test today. I'm pregnant. My parents will be furious with me!! I have to do something!" Which of the following responses by the nurse is most appropriate? 1. "You can take medicine to abort the pregnancy so your parents won't know." 2. "Let's talk about your options." 3. "The best thing for you to do is to have the baby and to give it up for adoption." 4. "I can help you tell your parents."

2 This response is inappropriate. The nurse must provide the client with all of her options. This is correct. The nurse should dis- cuss with the young woman all of her possible choices. This response is inappropriate. The nurse must provide the client with all of her options. This is an appropriate follow-up com- ment. Once the options are provided for the young woman, she may decide to maintain the pregnancy and be in need of assistance to tell her parents. However, it is not appropriate as an initial response.

61. Which of the following are stressors common to hospitalized toddlers? Select all that apply. 1. Social isolation. 2. Interrupted routine. 3. Sleep disturbances. 4. Self-concept disturbances. 5. Fear of being hurt.

2, 3, 5. 1. Social isolation is a stressor of the hospitalized teen. 2. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 3. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. 4. Self-concept disturbance is a stressor of the hospitalized teen. 5. Common stressors of the hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. The stressors of social iso- lation and self-concept disturbances are stressors of the hospitalized teen.

34. Nurses working in a midwifery office have attended a conference to learn about factors that increase a woman's risk of becoming infertile. To evaluate the nurses' learning, the conference coordinator tested the nurses' knowledge at the conclusion of the seminar. Which of the following problems should the nurses state increase a client's risk of developing infertility problems? Select all that apply. 1. Women who have menstrual cycles that are up to 30 days long. 2. Women who experience pain during intercourse. 3. Women who have had pelvic inflammatory disease. 4. Women who have excess facial hair. 5. Women who have menstrual periods that are over 5 days long.

2, 3, and 4 are correct. 1. A 30-day menstrual cycle is well within normal limits. 2. Dyspareunia, or pain during inter- course, may be a symptom of a sexu- ally transmitted infection (STI) or of endometriosis. Both STIs and en- dometriosis can adversely affect a woman's fertility. 3. A woman who has had PID is much more likely to have blocked fallopian tubes than a woman who has never had PID. 4. Women who have facial hair (hirsutism) often have polycystic ovar- ian syndrome (PCO). PCO patients are usually obese and have irregular menses. Women with PCO are very often infertile. 5. A 5-day menstrual period is well within normal limits.

36. A 2-day-old girl is being discharged from the hospital. Her mother asks the nurse when she will receive her first hepatitis B immunization. Which is the nurse's best response? 1. "Babies receive the hepatitis B vaccine only if their mother is hepatitis B-positive." 2. "She will receive her first dose of the hepatitis B vaccine prior to discharge today." 3. "She will receive her first hepatitis B vaccine when she is 1 year of age." 4. "She will receive her first hepatitis B vaccine at 6 months of age."

2. The first dose of hepatitis B vaccine is recommended between birth and 2 months. Most hospitals give the vac- cine prior to discharge home.

53. The mother has brought her 16-year-old daughter to the ER because she is concerned her daughter is anorexic. During the child's initial physical assessment, the nurse notes the daughter has signs and symptoms of nutritional deficit. Which assessment item led the nurse to this initial conclusion? 1. The child has a protein level within normal limits. 2. The child's blood pressure is 110/66. 3. The child's hair and nails are brittle and dry. 4. The child's teeth appear to be eroded.

3 A low protein level could indicate a nutri- tional deficit. However, this would not be an indication that the nurse sees on an initial assessment. Lab work would be required to have this information. This is a normal blood pressure for a teen. Dry and brittle hair and nails are common among people who have a nutritional deficit. Eroded teeth are more common of people who have frequent vomiting. The acidic nature of the vomitus causes the enamel of the teeth to deteriorate causing erosion. This practice is most common among teens with bulimia.

45. A 16-year-old boy has a diagnosis of new onset diabetes. The child is meeting with the nurse educator regarding changes that will need to be made in his diet. What would most influence a teenager's food choices? 1. Parents and their dietary choices. 2. Cultural background. 3. Peers and their dietary choices. 4. Television and other forms of media influence.

3 The child's family does have some influence on his dietary choices, but teens are more focused on being like their peers. The child's culture does affect his food choices. However, teens are more likely to choose "junk foods" and foods that their peers are eating. As a teen, the child is most influenced by his peers. Teens long to be like oth- ers around them. Television does affect personal food choices, but the peer group still has the most prevalent impact in a teen's life.

56. A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental mile- stones, what should the nurse caring for the child calculate his current weight as? 1. Approximately 16 lb 4 oz. 2. Approximately 20 lb 5 oz. 3. Approximately 24 lb 6 oz. 4. Approximately 32 lb 8 oz.

3 Children should double their birth weight by 6 months of age. Children should triple their birth weight by 12 months of age. Children should triple their birth weight by 12 months of age. Children should triple their birth weight by 12 months of age.

19. The mother of a child 2 years 6 months has arranged a play date with the neighbor and her 3-year-old daughter. During the play date the two mothers should expect that the children will do which of the following? 1. The children will share and trade their toys while playing. 2. The children will play with one another with little or no conflict. 3. The children will play alongside one another but not actively with one another. 4. The children will play with one or two items, ignoring most of the other toys

3 Toddlers do not share their possessions well. One of their favorite words is "mine." Because toddlers do not share well, they are often in conflict with one another dur- ing play. Toddlers engage in parallel play. They often play alongside another child but they rarely engage in activities with the other child. Toddlers have very short attention spans and commonly play with various items for short periods.

37. The nurse teaches a couple that the diaphragm is an excellent method of contracep- tion providing that the woman does which of the following? 1. Does not use any cream or jelly with it. 2. Douches promptly after its removal. 3. Leaves it in place for 6 hours following intercourse. 4. Inserts it at least 5 hours prior to having intercourse.

3 The diaphragm should be left in place for at least 6 hours after intercourse has ended.

50. A postpartum woman is using the lactational amenorrhea method of birth control. The nurse should advise the client that which of the following situations would be incompatible with the method? 1. Being three months postpartum. 2. Being amenorrheic since delivery of the baby. 3. Supplementing breastfeeding with formula. 4. Working full time outside of the home.

3. If the mother gives any supplementa- tion, the LAM is not reliable.

40. An adolescent woman confides to the school nurse that she is sexually active. The young woman asks the nurse to recommend a "very reliable" birth control method, but she refuses to be seen by a gynecologist. Which of the following methods would be best for the nurse to recommend? 1. Contraceptive patch. 2. Withdrawal method. 3. Female condom. 4. Contraceptive sponge.

3. The female condom is about 95% ef- fective as a contraceptive device and is also effective as an infection-control device.

56. The nurse is providing education to a couple regarding the proper procedure for male condom use. The nurse knows that the teaching was effective when the couple states that which of the following procedures should be taken if the man's penis be- comes flaccid immediately after ejaculation? 1. The woman should douche with white vinegar and water. 2. The woman should consider taking a postcoital contraceptive. 3. The man should hold the edges of the condom during its removal. 4. The man should apply spermicide to the upper edges of the condom.

3. This is true. The man should carefully remove the condom while holding its edges.

31. A client has been notified that because of fallopian tube obstruction, her best option for becoming pregnant is through in vitro fertilization. The client asks the nurse about the procedure. Which of the following responses is correct? 1. "During the stimulation phase of the procedure, the physician will make sure that only one egg reaches maturation." 2. "Preimplantation genetic diagnosis will be performed on your partner's sperm to make sure that the sperm are normal." 3. "After ovarian stimulation, you will be artificially inseminated with your part- ner's sperm." 4. "Any extra embryos will be preserved for you if you wish to conceive again in the future."

4 Artificial insemination will not be per- formed because the client's tubes are blocked. 4. This response is correct. Since multi- ple embryos are usually created dur- ing the in vitro process, there are of- ten more embryos created than are implanted. The couple may preserve the embryos.

24. Infertility increases a client's risk of which of the following diseases? 1. Diabetes mellitus. 2. Nystagmus. 3. Cholecystitis. 4. Ovarian cancer.

4 Diabetes has been shown to affect a woman's fertility, but infertility has not been shown to increase a woman's risk of developing diabetes. Infertility has not been shown to increase a woman's risk of developing nystagmus. Infertility has not been shown to increase a woman's risk of developing cholecystitis. Infertility has been shown to increase a woman's risk of developing ovarian cancer.

64. The nurse met four clients in the family planning clinic today. It would be most ap- propriate for the nurse to recommend the intrauterine device (IUD) to which of the clients? 1. Unmarried, 22-year-old, recent college graduate. 2. Married, 24-year-old, G0 P0000. 3. Unmarried, 25-year-old, history of chlamydia. 4. Married, 26 year old, G3 P0121.

4 This client is in a stable relationship and has had children. She is the best candidate for the IUD.

27. A couple is seeking infertility counseling. The practitioner has identified the factors listed below in the woman's health history. Which of these findings may be con- tributing to the couple's infertility? 1. The client is 36 years old. 2. The client was 13 years old when she started to menstruate. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles every day.

1 The eggs of an older woman (for reproductive purposes considered 35 years ) do age and fertility is reduced. Age 13 at the time of menarche is not a significant factor. Working as a dental hygienist has not been shown to affect fertility. Excessive exercise can interrupt hor- monal function, but jogging 2 miles a day is a moderate exercise pattern.

45. What is essential for the nurse to teach a woman who has just had an intrauterine device (IUD) inserted? 1. Palpate her lower abdomen each month to check the patency of the device. 2. Remain on bed rest for 24 hours after insertion of the device. 3. Report any complaints of painful intercourse to the physician. 4. Insert spermicidal jelly within 4 hours of every sexual encounter.

3. Reports of dyspareunia should be communicated to the physician.

29. A nurse is caring for a child with spastic cerebral palsy. Which of the following medications should be used for the treatment of spasticity? 1. Dexamethasone (Decadron). 2. Baclofen. 3. Diclofenac (Voltaren). 4. Carbamazepine (Tegretol).

2 Dexamethasone (Decadron) is a cortico- steroid used to decrease inflammation. Spinal cord-related spasms are not caused by inflammation. Baclofen is used to treat the spasticity in cerebral palsy. It is a centrally acting muscle relaxant. Diclofenac (Voltaren) is a nonsteroidal anti-inflammatory drug. Carbamazepine (Tegretol) is an antiepilep- tic used to treat seizures.

14. The school nurse is planning an educational program centered on abstinence for adolescents. Which of the following methods does the nurse recognize as the most effective way to present this program? 1. Use peer-led programs that emphasize the consequences of unprotected sexual contact. 2. Teach students methods to resist peer pressure. 3. Offer students the opportunity to care for a simulator infant for 1 week. 4. Offer statistics, pamphlets, and films discussing the consequences of unprotected sexual contact.

1 Adolescents are most concerned with what their peers think and feel. They are most receptive to information that comes from another adolescent. It is very difficult for teens to resist peer pressure even with the appropriate tools of resistance. Infant simulators are useful, but they are very expensive and often difficult to obtain. Pamphlets are helpful aids in relaying information to teens, but hearing the information firsthand from a peer is the most effective method of education.

47. The mother of a newborn brings her infant in for a 2-week checkup. The mother relates that this is her first child, that the baby seems to sleep very often, and that the baby does not cry much. What question would the nurse ask the mother? 1. "How many ounces of formula does your baby take at each feeding?" 2. "How many bowel movements does your baby have in a day?" 3. "How much sleep do you get every night?" 4. "How long does the baby stay awake at each feeding?"

1 Babies can lose up to 10% of birth weight but should regain it by 2 weeks of age. Knowing how much the baby eats can help the nurse determine if the infant is receiving adequate nutrition.

35. An infertility specialist is evaluating whether a woman's cervical mucus contains enough estrogen to support sperm motility. Which of the following tests is the physician conducting? 1. Ferning capacity. 2. Basal body temperature. 3. Culposcopy. 4. Hysterotomy.

1 When a woman's cervical mucus is estrogen rich, it is slippery and elastic (thread-like), and when assessed un- der a microscope, the practitioner will observe "ferning,"—that is, an image that looks like a fern. The woman is then in her fertile period. When she is not in her fertile period, the mucus is thick and gluey. Basal body temperature assessments are performed to determine if and when ovu- lation occurs.

79. Which of the following questions should be asked of women during all routine medical examinations? Select all that apply. 1. "Has anyone ever forced you to have sex?" 2. "Are you sexually active?" 3. "Are you ever afraid to go home?" 4. "Does anyone you know ever hit you?" 5. "Have you ever breastfed a child?"

1, 2, 3, and 4 are correct. 1. This is a question that should be asked at each health care contact. 2. This is a question that should be asked at each health care contact. 3. This is a question that should be asked at each health care contact. 4. This is a question that should be asked at each health care contact. 5. It is not necessary to ask this question every time a female client is seen for a health care visit.

25. 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."

3 The viral load and CD4 counts should be monitored regularly but they need not be assessed daily. 3. This is true. She and her partner should use condoms during sexual intercourse. 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.

34. A 3-year-old girl is attending her grandfather's funeral. Her parents have told her that her grandfather is in heaven with God. The child is taken up to the open casket with her parents. Which statement by the child describes a 3-year-old child's understanding of spirituality? 1. "Grandpa's body is here with us on Earth, and his spirit is in heaven." 2. "Grandpa is in heaven. Is this heaven?" 3. "Grandpa's spirit is no longer in his body." 4. "Grandpa won't need his body in heaven."

2 2. 3. 4. Children 3 years old do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. Children 3 years old are literal thinkers. The child's parents told her that Grandpa was in heaven. She sees his body, so she thinks they are all in heaven. Children 3 years old do not understand the difference between body and spirit. Their understanding of spirituality is literal in nature. Children 3 years old think of spirituality in literal terms and do not understand the concept of heaven.

60. The nurse has taught a couple about the temperature rhythm method of fertility control. Which of the following behaviors would indicate that the teaching was effective? 1. The woman takes her basal body temperature before retiring each evening. 2. The couple charts information from at least six menstrual cycles before using the method. 3. The couple resumes having intercourse as soon as they see a rise in the basal body temperature. 4. The woman assesses her vaginal discharge daily for changes in color and odor.

2 This is not appropriate. The basal body temperature (BBT) should be taken upon awakening in the morning. The couple should chart tempera- tures for at least 6 months. This is not appropriate. The couple should wait to engage in intercourse until the woman's temperature has been ele- vated above preovulation baseline for at least 3 days. An additional action that can be taken as a complement to the temperature rhythm method is cervical mucus assessment, but it is not required. The elasticity of the mucus should be assessed, however, not the color and odor of the mucus.

68. A client asks a nurse to express an opinion on the value of taking hormone replace- ment therapy (HRT). The nurse should be aware that it is recognized that HRT is effective in which of the following situations? 1. No woman should ever take hormone replacement therapy. 2. Women experiencing severe menopausal symptoms. 3. Women with severe coronary artery disease. 4. Women with a history of breast cancer.

2 This is not true. There are situations when hormone replacement therapy (HRT) is recommended. Women who are experiencing severe menopausal symptoms can benefit from HRT therapy. However, it is recommended that they not be on the medication for an extended period of time. HRT should not be given to women to prevent or treat coronary artery disease. Women with a history of breast cancer should not take HRT.

55. The nurse has given postvasectomy teaching to a client. Which of the following re- sponses by the client indicates that the teaching was effective? 1. "I will measure my urinary output for two days." 2. "I will ejaculate the same amount of semen as I did before the surgery." 3. "I will refrain from having an erection until next week." 4. "I will irrigate the wound twice today and once more tomorrow."

2 This is unnecessary. The client need not measure his urinary output. This is true. The seminal vesicles and the prostate are untouched. If he feels comfortable, there is no con- traindication to having an erection. This is not true. There is no need to irrigate the wound.

In analyzing the need for teaching regarding sexual health in a client who is sexu- ally active, which of the following questions is the most important for a nurse to ask? 1. "How old are your children?" 2. "Did you have intercourse last evening?" 3. "With whom do you have intercourse?" 4. "Do you use vaginal lubricant?"

3 The ages of a client's children may be important, but it is not the most impor- tant information for the nurse to ask about. 2. Whether or not the client had inter- course the preceding night is important, but it is not the most important informa- tion for the nurse to ask about. 3. This question is the most important for the nurse to ask. The nurse is try- ing to learn whether or not the client is having intercourse with more than one partner and/or whether the client has intercourse with men, women, or both. 4. Whether or not the client uses vaginal lubricant is important, but it is not the most important information for the nurse to ask about.

57. An 8-week-old male has just had surgery for pyloric stenosis. His nurse is assessing his level of pain. The child's mother asks the nurse what vital sign changes she should expect to see in a child who is experiencing pain. The nurse's best response is: 1. "We expect to see a child's heart rate decrease and respiratory rate increase." 2. "We expect to see a child's heart rate and blood pressure decrease." 3. "We expect to see a child's heart rate and blood pressure increase." 4. "We expect to see a child's heart rate increase and blood pressure decrease."

3 When a child is experiencing pain, the normal physiological response is for the heart rate and respiratory rate to increase. When a child is experiencing pain, the normal physiological response is for the heart rate and blood pressure to increase. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase. When a child is experiencing pain, the normal physiological response is for the heart rate, respiratory rate, and blood pressure to increase.

8. A breastfeeding woman is requesting that she be prescribed Seasonale (ethinyl estradiol and levonorgestrel) as a birth control method. Which of the following in- formation should be included in the patient teaching session? 1. The woman will menstruate every 8 to 9 weeks. 2. The pills are taken for 3 out of every 4 weeks. 3. Breakthrough bleeding is a common side effect. 4. Breastfeeding is compatible with the medication.

3 Women who take Seasonale menstruate 47. 1. 2. 3. 4. This response is inappropriate. The nurse must provide the client with all of her options. This is correct. The nurse should dis- cuss with the young woman all of her possible choices. This response is inappropriate. The nurse must provide the client with all of her options. This is an appropriate follow-up com- ment. Once the options are provided for the young woman, she may decide to maintain the pregnancy and be in need of assistance to tell her parents. However, it is not appropriate as an initial response. every 3 months. 2. Seasonale is a daily birth control pill. 3. Women who take Seasonale fre- quently do experience breakthrough bleeding. 4. Breastfeeding is not compatible with this pill.

19. 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.

4 4. Most commonly, women experience no signs or symptoms when they have contracted a sexually transmitted infection.

35. The nurse is developing a plan of care for a child recently diagnosed with CP. Which of the following should be the nurse's priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

4 Adequate calories are an appropriate goal, but the priority for a special-needs child is that the child develop to full potential. Children with CP do not have increased intracranial pressure. Teaching appropriate parenting strategies for a special-needs child is important and is done so the child can reach full potential. The priority for all children is to develop to their full potential.

16. A woman, seen in the emergency department, is diagnosed with pelvic inflamma- tory disease (PID). Before discharge, the nurse should provide the woman with health teaching regarding which of the following? 1. Endometriosis. 2. Menopause. 3. Ovarian hyperstimulation. 4. Sexually transmitted infections.

4 PID is not related to endometriosis. 2. PID is not related to menopause. 3. PID is not related to ovarian hyperplasia. 4. PID usually occurs as a result of an ascending sexually transmitted infection.

46. A 16-year-old woman, who had unprotected intercourse 24 hours ago, has entered the emergency department seeking assistance. Which of the following responses by the nurse is appropriate? 1. "You can walk into your local pharmacy and buy Plan B (levonorgestrel)." 2. "I am sorry but because of your age I am unable to assist you." 3. "The emergency room doctor can prescribe high-dose birth control pills (BCP) for you." 4. The nurse's response is dependent upon which state he or she is practicing in.

4 This is true in some states but not in all. 2. There are some states, like New York, that enable adolescents to obtain contra- ception, including emergency contracep- tion, without a parent's consent. How- ever, that is not true in all states. 3. This is true in some states but not in all. 4. This statement is true. Access to health care by adolescents, including access to birth control methods, is de- termined by individual states.

5. A client is to have a hysterosalpingogram. Which of the following information should the nurse provide the client prior to the procedure? 1. "The test will be performed through a small incision next to your belly button." 2. "You will be on bed rest for a full day following the procedure." 3. "An antibiotic fluid will be instilled through a tube in your cervix." 4. "You will be asked to move from side to side so that x-ray pictures can be taken."

4 This statement is correct. A number of pictures will be taken throughout the procedure. The client, who will be awake, is asked to move into positions for the x-rays.

43. A 2-year-old girl has just become a big sister. Her mother has been a stay-at-home mother. Based on the developmental level of a 2-year-old, which comment should the child's mother expect from her toddler about her new baby brother? 1. "Mommy, when my baby brother takes a nap, will you play with me?" 2. "Mommy, can I play with my baby brother?" 3. "Mommy, he is so cute. I love him." 4. "Mommy, it is time to put him away so we can play."

4 Toddlers are egocentric and are not yet capable of delayed gratification. It is un- likely that the child will wait to play with her mother until the baby sleeps. Toddlers do not usually engage in play with others. They are generally involved in parallel play. Toddlers usually initially resent the pres- ence of new siblings because they take away some of the parents' time and attention. This is a typical statement that would be made by a toddler. Toddlers are very egocentric and do not consider the needs of the other child.

26. According to developmental theories, which important event does the nurse understand is essential to the development of the toddler? 1. The child learns to feed self. 2. The child develops friendships. 3. The child learns to walk. 4. The child participates in being potty-trained.

4 Toddlers are in a stage of life where they like to do for themselves. However, devel- opmental theorists like Erickson and Freud believe that toilet training is the es- sential event that must be mastered by the toddler. Toddlers engage in more parallel play. Building friendships is not common until school age and adolescence. Walking should be mastered by 18 months of age. Developmental theorists like Erickson and Freud believe that toilet training is the essential event that must be mas- tered by the toddler.

3. A postpartum client has decided to use Depo-Provera (medroxyprogesterone acetate) as her contraceptive method. What should the nurse advise the client regarding this medication? 1. Take the pill at the same time each day. 2. Refrain from breastfeeding while using the method. 3. Expect to have no periods as long as she takes the medicine. 4. Consider switching to another birth control method in a year or so.

4. Many women who use Depo-Provera for over 2 years have been found to suffer from loss of bone density. Some of the changes in bone density may be irreversible.

44. A couple is seeking family planning advice. They are newly married and wish to de- lay childbearing for at least 3 years. The woman, age 26, G0 P0000, has no medical problems and does not smoke. She states, however, that she is very embarrassed when she touches her vagina. Which of the following methods would be most ap- propriate for the nurse to suggest to this couple? 1. Diaphragm. 2. Cervical cap. 3. Intrauterine device (IUD). 4. Birth control pills (BCP).

4. The birth control pill would be the best choice for this client. She has no medical contraindications to the pill, she wishes to bear children in the future, and it requires no vaginal manipulation.

37. The nurse is performing a physical assessment on a 6-month-old baby. Which finding should the nurse understand as abnormal for this child? 1. The child's posterior fontanel is open. 2. The child's anterior fontanel is open. 3. The child has the beginning signs of tooth eruption. 4. The child is able to track and follow objects.

1 The posterior fontanel should close between 6 and 8 weeks of age. The anterior fontanel usually closes between 12 and 18 months. The infant usually has a first tooth by 6 months. The infant should be able to track objects.

38. Which of the following developmental milestones should the nurse be concerned about if a 10-month-old could not do it? 1. Crawl. 2. Cruise. 3. Walk. 4. Have a pincer grasp.

1 Most infants are able to crawl unassisted by 8 months. Infants learn to cruise (walk around holding onto furniture) at about 9 to 10 months. Walking occurs on average at about 12 months. Pincer grasp (thumb and forefinger) occurs at about 9 to 10 months.

58. The nurse has provided a single, perimenopausal woman, G3 P2012, with contra- ceptive counseling. The woman has four sex partners and smokes 1 pack of ciga- rettes per day. Which of the following methods is best suited for this client? 1. Male condom. 2. Intrauterine device. 3. NuvaRing. 4. Oral contraceptives.

1 The male condom is the best device for this client. Because she has multiple sex partners, the IUD is not the best choice for this client. The NuvaRing is a hormonal device. Because this client is over 35 years old and is a smoker, the NuvaRing is not the best choice for her. Oral contraceptives are hormonally based. Because this client is over 35 years old and is a smoker, birth control pills are not the best choice for her.

11. A gravid, married client, 24 weeks' gestation, is found to have bacterial vaginosis. Her health care practitioner has ordered metronidazole (Flagyl) to treat the prob- lem. 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.

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

42. The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following? 1. "Your child is developing normally." 2. "Your child needs to see the primary care provider." 3. "You need to help your child learn to sit unassisted." 4. "Push the food back when your child pushes food out."

2 A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing nor- mally and must see the primary care provider. 2. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider. 3. The mother will need help to teach the child how to sit alone.

59. A client, who has been taking birth control pills for 2 months, calls the clinic with the following complaint: "I have had a bad headache for the past couple of days and I now have pain in my right leg." Which of the following responses should the nurse make? 1. "Continue the pill, but take one aspirin tablet with it each day from now on." 2. "Stop taking the pill, and start using a condom for contraception." 3. "Come to the clinic this afternoon so that we can see what is going on." 4. "Those are common side effects that should disappear in a month or so."

3 3. This is an appropriate statement. This client should be seen by her health care practitioner

55. The nurse caring for a 9-month-old is using the FLACC scale to rate her pain level. The child's parents ask the nurse what the FLACC scale is. Which is the nurse's best response? 1. "It estimates a child's level of pain utilizing vital sign information." 2. "It estimates a child's level of pain based on parents' perception." 3. "It estimates a child's level of pain utilizing behavioral and physical responses." 4. "It estimates a child's level of pain utilizing a numeric scale from 0 to 5."

3 Vital signs are not considered when mea- suring pain using the FLACC scale. The parents' perception of their child's pain level is not considered when using the FLACC scale. The FLACC scale utilizes behavioral and physical responses of the child to measure the child's level of pain. The scale utilizes facial expression, leg position, activity, intensity of cry, and level of consolability. The FLACC scale assigns a numeric value to a child's pain level, which is from 0 to 10.

49. An 8-day old female was admitted to the hospital with vomiting and dehydration. The nurse has just obtained vital signs. The child's heart rate is 185, her respiratory rate is 44, her blood pressure is 85/52, and her temperature is 99°F (37.2° C). The child's parents ask the nurse if her vital signs are within normal limits. What is the nurse's best response to the parents? 1. "Your daughter's blood pressure is elevated, but the other vital signs are within normal limits." 2. "Your daughter's temperature is elevated, but the other vital signs are within normal limits." 3. "Your daughter's respiratory rate is elevated, but the other vital signs are within normal limits." 4. "Your daughter's heart rate is elevated, but the other vital signs are within normal limits."

4 A normal systolic blood pressure for a child from birth to 1 month is 50 to 101. A normal diastolic blood pressure for a child from birth to 1 month is 42 to 64. A normal temperature is 96.6°F to 100°F (35.8° C to 37.7° C). A normal respiratory rate for a child from birth to 1 month is 30 to 60. A normal heart rate for a child from birth to 1 month is 90 to 160.

15. Four women who use superabsorbent tampons during their menses are being seen in the medical clinic. The woman with which of the following findings would lead the nurse to suspect that the woman's complaints are related to her use of tampons rather than to an unrelated medical problem? 1. Diffuse rash with fever. 2. Angina. 3. Hypertension. 4. Thrombocytopenia with pallor.

1 A diffuse rash with fever should be taken very seriously. These are symptoms of toxic shock syndrome (TSS). Angina is not related to tampon use. Hypertension is not related to tampon use. Hypotension, however, is related.

36. The nurse knows that teaching of parents of a child newly diagnosed with CP is successful when the parents state that CP is which of the following? 1. Inability to speak and drooling. 2. Poor dentition due to poor hygiene. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes.

4 The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intel- ligence. Spastic CP is the most com- mon type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension.