PEDS/OB EXAM 1

The nurse is caring for a child who has been diagnosed with a feeding disorder. Which areas should be included in the nursing assessment? SATA 1. The child's diet 2. Food content 3. Food preferences 4. Parent feeding practices 5. Parent's dietary habits

1, 2, 3, 4 The child's diet, food content, and food preferences must be assessed with the diagnosis of a feeding disorder. The feeding practices that the parent uses must also be assessed with the diagnosis of a feeding disorder. The dietary habits of the parent do not need to be assessed with the diagnosis of a feeding disorder.

When working with cultural differences, which of the following areas may differ from one culture to another? SATA 1. Religious beliefs 2. Alternative therapies 3. Time orientation 4. Nutrition 5. Hand signals

1, 2, 3, 4, and 5 Religious beliefs and the healing practices that can accompany them vary widely from culture to culture. The use of and belief in different alternative therapies can also differ widely. Time orientation and nutritional preferences are also areas for vast differences. In addition, the use of hands in talking or hand gestures may also differ from culture to culture.

Which of the following statements are true with regard to Factor V Leiden? SATA 1. Factor V Leiden is an autosomal dominant disorder. 2. It increases the likelihood of DVT in an affected patient. 3. It is due to a mutation in factor IV and V genes. 4. A woman who has one copy of the gene should not use oral contraceptives as a birth control method. 5. Factor V Leiden leads to increased susceptibility of activated protein C.

1, 2, 4 Factor V Leiden is an inherited disorder via autosomal dominant transmission. Presence of this genetic mutation increases the likelihood for blood clots to develop. This genetic mutation is found in Factor V gene only.A patient who tests positive for Factor V Leiden, regardless of whether she is homozygous or heterozygous for the trait, should not use oral contraceptives as a birth control method. The Factor V Leiden mutation leads to activated protein C resistance.

In which situations are children at risk of injury? SATA 1. An infant is crawling on the floor while older children are playing nearby. 2. An adolescent is learning how to become a safe baby-sitter. 3. A toddler is playing on the playground while at preschool. 4. A school-age child likes to imitate her older sibling's movements while on her bike. 5. An adolescent is attending a gathering of school friends after a dance.

1, 3, 4, 5 In all but one of these situations, there is the possibility of the child getting hurt. The infant may put small parts of the toys in his or her mouth; the toddler may fall while on the playground; the school-age child may not physically be capable of safely doing the same movements as her older sibling; and adolescents are more likely to do activities as a result of peer pressure, when other adolescents are around. The safe babysitter class poses no immediate threat to the adolescent's safety.

Which of the following findings would be a cause for concern for a nurse who is monitoring an obstetric patient who is in early labor? SATA 1. Biparietal diameter of less than 9.25 cm 2. Vertex presenting part 3. Transverse lie 4. General flexion attitude 5. Android pelvis

1, 3, 5 A biparietal diameter at term is typically noted as 9.25 cm, and the finding of a smaller measurement would cause a concern related to the mode of delivery. A transverse lie would also cause a concern relative to the mode of delivery because a cesarean section would be indicated. An android pelvis would cause a concern related to the mode of delivery. A vertex presenting part and a general flexion attitude are normal findings and would not cause concern.

In learning cultural competence, which statement best exemplifies a cultural perspective to avoid? 1. "I don't know of any other way that is better than mine." 2. "I think immigrants are required to have a green card." 3. "I think different kinds of people make life interesting." 4. "I hope to understand how different people view medicine."

1. "I don't know of any other way that is better than mine." Stating that one way is better than others represents ethnocentrism, which believes one cultural perspective and thinking is better than all others. The others are just opinions or thoughts about cultural differences in general.

Which statement indicates nutrition counseling has been effective for the mother of a 6-month-old infant? 1. "I will start my infant on rice cereal since it is iron fortified and has little chance of causing allergy." 2. "I will start my infant on egg whites since they are high in iron and protein and have little chance of causing allergy." 3. "I will start feeding fruits and vegetables and progress to whole grain cereals as tolerated." 4. "I know that I can start feeding my baby strained meats for the iron and protein and progress later to fruits and vegetables."

1. "I will start my infant on rice cereal since it is iron fortified and has little chance of causing allergy." Rice cereal is the recommended first food for infants since it has a low risk of causing allergy, and it is iron fortified. Infants should not have egg whites as they can cause severe allergies. Foods should be introduced one at a time, and the infant should progress to other single-ingredient cereals, followed by fruits and vegetables.

A key finding from the Human Genome Project is: 1. Approximately 20,000 to 25,000 genes make up the genome. 2. All human beings are 80.99% identical at the DNA level. 3. Human genes produce only one protein per gene; other mammals produce three proteins per gene. 4. Single-gene testing will become a standardized test for all pregnant women in the future.

1. Approximately 20,000 to 25,000 genes make up the genome. Approximately 20,500 genes make up the human genome, only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single-gene testing (e.g., alpha-fetoprotein test) is already standardized for prenatal care.

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? 1. Cervical cap 2. Condom 3. Vaginal film 4. Vaginal sheath

1. Cervical cap Women with a history of TSS should not use a cervical cap. Condoms, vaginal film, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

When performing vaginal examinations on a laboring woman, the nurse should be guided by what principle? 1. Cleanse the vulva and perineum before and after the examination as needed. 2. Wear a clean glove lubricated with tap water to reduce discomfort. 3. Perform the examination every hour during the active phase of the first stage of labor. 4. Perform an examination immediately if active bleeding is present.

1. Cleanse the vulva and perineum before and after the examination as needed. Cleansing will reduce the possibility that secretions and microorganisms will ascend into the vagina to the cervix. Maternal comfort will also be enhanced. Sterile gloves and lubricant must be used to prevent infection. Vaginal examinations should be performed only as indicated to limit maternal discomfort and reduce the risk for transmission of infection, especially when rupture of membranes occurs. Examinations are never done by the nurse if vaginal bleeding is present, because the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

The term used to describe professional interaction among health care providers in the clinical nursing practice is: 1. Collegiality 2. Ethics 3. Evaluation 4. Accountability

1. Collegiality Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. Accountability refers to legal and professional responsibility for practice.

The uterus is a muscular pear-shaped organ that is responsible for: 1. Cyclic menstruation. 2. Sex hormone production. 3. Fertilization. 4. Sexual arousal.

1. Cyclic menstruation. The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

The Centers for Disease Control and Prevention (CDC)-recommended medication for the treatment of chlamydia is: 1. Doxycycline 2. Podofilox 3. Acyclovir 4. Penicillin

1. Doxycycline Doxycycline is effective for treating chlamydia; however, it should be avoided if a woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papillomavirus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is the preferred medication for syphilis.

Which of the following conditions has not contributed to an increase in maternity-related health care costs? 1. Early postpartum discharges 2. Maternal medical risk factors, such as diabetes 3. The use of high-tech equipment 4. The cost of care for low-birth-weight (LBW) infants

1. Early postpartum discharges Early postpartum discharges are associated with decreased health care costs. High-risk factors and high-tech equipment both increase such costs. Clinical evidence indicates that maternity-related health care costs are increased for LBW and high-risk infants.

When planning nursing care for a hospitalized 9-year-old child, which intervention is most developmentally appropriate? 1. Encourage the child to continue schoolwork 2. Provide a separate recreation room for activities 3. Encourage the child to brush teeth twice a day 4. Offer medical equipment for play

1. Encourage the child to continue schoolwork The developmental task of a 9-year-old is industry according to Erikson; thus, the nurse should encourage the continuation of schoolwork. The separate recreation room is appropriate for adolescents, toddlers need reminders to brush, and playing with medical toys is appropriate for preschool-age children.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: 1. Encouraging the woman to try various upright positions, including squatting and standing. 2. Telling the woman to start pushing as soon as her cervix is fully dilated. 3. Continuing an epidural anesthetic so that pain is reduced and the woman can relax. 4. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

1. Encouraging the woman to try various upright positions, including squatting and standing. Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. An epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

During rounds, the nurse is performing an initial assessment on a 12-year-old child with sickle cell disease. The nurse notes that the child has hypoactive bowel sounds and is grimacing in pain. How can the nurse best assist this patient? 1. Ensure the child has pain medication for uncontrolled pain 2. Ask the child when the last bowel movement occurred 3. Make sure the child ambulates every 2 hours 4. There is no need to provide any intervention at this time

1. Ensure the child has pain medication for uncontrolled pain The assessment indicates that the child is experiencing pain. Uncontrolled pain can cause decreased bowel function as exhibited by hypoactive bowel sounds upon auscultation. The most appropriate intervention is to ensure the child has pain medication for uncontrolled pain.

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? 1. Fetal position 2. Uterine contractions 3. Blood pressure 4. Umbilical cord blood flow

1. Fetal position Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow. Uterine contractions during labor tend to decrease circulation and subsequent perfusion. Most healthy fetuses are well able to compensate for this stress and exposure to increased pressure while moving passively through the birth canal during labor. Maternal blood pressure is likely to have a significant effect on fetal circulation. Compression of the cord and reduction of umbilical blood flow do affect fetal circulation.

Which statement about genital herpes is inaccurate? 1. Genital herpes is also known as genital warts. 2. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences. 3. Genital herpes is chronic and recurring and has no known cure. 4. Plain soap and water are all that is needed to clean hands that have come into contact with herpetic lesions.

1. Genital herpes is also known as genital warts. Genital warts are one of the most common sexually transmitted infections (STIs); however, it is also known as human papillomavirus (HPV), not genital herpes.

The nurse is caring for a child who is experiencing respiratory difficulty following the administration of a medication. What drug should the nurse initially plan to administer to this child if indicated? 1. Give epinephrine through an EpiPen 2. Give prednisone immediately 3. Give oxygen 4. Given diphenhydramine (Benadryl)

1. Give epinephrine through an EpiPen The nurse's first action will be to administer epinephirne though an EpiPen. Giving prednisone and oxygen would be done after the epinephrine. Diphenhydramine would be given if epinephrine is not available.

What is not a trend in the delivery of health care in the United States? 1. Greater emphasis has been placed on curing disease and disability than on preventing them. 2. Hospital stays for many conditions have been shortened. 3. Acute care is increasingly provided through home-based services. 4. Hospital-based nurses are increasingly involved in follow-up care after discharge.

1. Greater emphasis has been placed on curing disease and disability than on preventing them. Prevention now is emphasized. Hospitalization has been shortened to reduce cost. Acute care is increasingly done at home. Nurses now are more involved in postdischarge follow-up care.

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: 1. Hegar sign. 2. McDonald sign. 3. Chadwick sign. 4. Goodell sign.

1. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; it is seen around the fourth week of gestation. Softening of the cervical tip, which may be observed around the sixth week of pregnancy, is called the Goodell sign. (The McDonald's sign indicates a fast-food restaurant.)

The two most frequently reported maternal medical risk factors are: 1. Hypertension associated with pregnancy and diabetes. 2. Drug use and alcohol abuse. 3. Homelessness and lack of insurance. 4.Behaviors and lifestyles.

1. Hypertension associated with pregnancy and diabetes. Hypertension and diabetes are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of more health care services and longer hospital stays. Both drug use and alcohol abuse continue to increase in the maternal population; they are associated with low-birth-weight infants, mental retardation, and birth defects. The number of clients who are homeless or lack health care insurance is increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

From the nurse's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? 1. Implementing programs to ensure women's early participation in ongoing prenatal care 2. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days 3. Expanding the number of neonatal intensive care units (NICUs) 4. Mandating that all pregnant women receive care from an obstetrician

1. Implementing programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education; however, it does not affect the incidences of leading causes of infant mortality, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high-risk infants after they are born. Expanding the number of NICUs would offer better access for high-risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetrician care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have been demonstrated to provide reliable, safe care for pregnant women.

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping: 1. In a side-lying position. 2. On her back with a pillow under her knees. 3. With the head of the bed elevated. 4. On her abdomen.

1. In a side-lying position. Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium will be diminished. Although having a pillow under the knees is recommended and ideal for later in pregnancy, the woman must still maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women will find lying on the abdomen uncomfortable as pregnancy advances.

A maternity nurse should be aware of which fact about the amniotic fluid? 1. It serves as a source of oral fluid and as a repository for waste from the fetus. 2. The volume remains about the same throughout the term of a healthy pregnancy. 3. A volume of less than 300 ml is associated with gastrointestinal malformations. 4. A volume of more than 2 L is associated with fetal renal abnormalities.

1. It serves as a source of oral fluid and as a repository for waste from the fetus. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. Its volume changes constantly; too little fluid (oligohydramnios) is associated with renal abnormalities, and too much fluid (polyhydramnios) is associated with gastrointestinal and other abnormalities.

The nurse is asked to care for a child whose family is from a culture different from the nurse's culture. Which is the most effective strategy for this nurse to quickly learn how to care for this family? 1. Listen to the family's preferences. 2. Complete an internet search about the culture. 3. Ask other nurses who have cared for the child. 4. Involve other disciplines in the child's care.

1. Listen to the family's preferences The quickest and most accurate method for learning how to care for this child and family is to ask questions and then listen to their answers about preferences that may differ from traditional Western medicine.

A child and his grandfather arrive in the emergency department after a car collision. The grandfather does not have custody of the child. What should be the nurse's next action? 1. Obtain the custodial parent's telephone number for permission. 2. Provide emergency care to both under implied consent. 3. Register and provide care to the grandfather but transfer the child. 4. Ensure permission to treat is obtained prior to registering them.

1. Obtain the custodial parent's telephone number for permission No indication is given regarding the nature of the injuries for either the grandfather or the child. Therefore, permission to treat should be obtained from the custodial parent. Implied consent only applies in life or death situations and there is no indication of this in the stem. Registration can occur while permission to treat is obtained, and transferring cannot occur until the child has a medical screening exam.

In preparing to examine the genital area of a preschool-age child, which action by the nurse will most likely result in the best outcome? 1. Position the child on the parent's lap with his or her legs apart. 2. Position the child on the examination table. 3. Examine the genital area first. 4. Examine the genital area last.

1. Position the child on the parent's lap with his or her legs apart. This will help to alleviate stress from having privacy invaded. Positioning the child on the exam table will increase stress as most preschool-age children are taught strangers are not allowed to look at their "private parts". Examining the genital area last is appropriate for adolescents and examining the area first is not appropriate in any age group.

With regard to primary and secondary powers, the maternity nurse should understand that: 1. Primary powers are responsible for effacement and dilation of the cervix. 2. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies. 3. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. 4. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

1. Primary powers are responsible for effacement and dilation of the cervix. The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement is generally well ahead of dilation in first-timers; the two are more concurrent in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: 1. Primipara 2. Primigravida 3. Multipara 4. Nulligravida

1. Primipara A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: 1. Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. 2. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. 3. Identical twins are more common in Caucasian families. 4. Fraternal twins are same gender, usually male.

1. Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. If the parents-to-be are older and have taken fertility drugs, they would be very interested in this information. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.

Most of the genetic tests now offered in clinical practice are tests for: 1. Single-gene disorders. 2. Carrier screening. 3. Predictive values. 4. Predispositional testing.

1. Single-gene disorders. Most tests now offered are tests for single-gene disorders in clients who have clinical symptoms or a family history of a genetic disease. Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms. Predictive testing is used only to clarify the genetic status of asymptomatic family members. Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance that the condition will develop.

An essential component of counseling women regarding safe sex practices is discussion about avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: 1. Strategies to enhance condom use. 2. Choice of colors and special features. 3. Leaving the decision up to the male partner. 4. Places to safely carry condoms.

1. Strategies to enhance condom use. When the nurse opens discussion on safe sex practices, the woman is given permission to clear up any concerns or misapprehensions she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills, such as role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms (such as size ranges, where to purchase, and price), this issue is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about using condoms; if a man appears reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely carry condoms in shoes, wallets, or inside their bras. They should be taught to keep condoms away from heat. This information is important but is not germane if the woman cannot even discuss strategies on how to enhance condom use.

Which action taken made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? 1. The nurse encourages the mother and father to make choices whenever possible. 2. The nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth. 3. The nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout labor. 4. The father is discouraged from accompanying his wife during a cesarean birth.

1. The nurse encourages the mother and father to make choices whenever possible. With family-centered maternity care (FCMC), it is important to allow for choices for the couple and to include the partner in the care process. Also, FCMC involves collaboration between the health care team and the client. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her. In a family-centered care model, the partner or even a grandparent may be present for a cesarean birth (unless of course the birth is an emergency, for which guests may be requested to leave).

With regard to emergency contraception pills, nurses should be aware that: 1. The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. 2. The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap. 3. The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment. 4. Emergency contraception has no medical contraindications.

1. The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. A backup method of birth control is also a good idea for beginners. The woman has up to 120 hours after unprotected intercourse to take emergency contraception pills; they do not, however, protect against pregnancy from subsequent unprotected intercourse. These pills are contraindicated during pregnancy and if the woman has undiagnosed abnormal vaginal bleeding.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that: 1. The placenta has separated. 2. A cervical tear occurred during the birth. 3. The woman is beginning to hemorrhage. 4. Clots have formed in the upper uterine segment.

1. The placenta has separated. Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. Cervical tears that do not extend to the vagina result in minimal blood loss. Signs of hemorrhage are a boggy uterus, bright red vaginal bleeding, alterations in vital signs, pallor, lightheadedness, restlessness, decreased urinary output, and alteration in the level of consciousness. If clots have formed in the upper uterine segment, the nurse would expect to find the uterus boggy and displaced to the side.

Which is correct concerning the performance of a Papanicolaou (Pap) test? 1. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. 2. It should be performed once a year beginning with the onset of puberty. 3. A lubricant such as Vaseline should be used to ease speculum insertion. 4. The specimen for the Pap test should be obtained after specimens are collected for cervical infection.

1. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before a Pap smear specimen is collected so as not to alter the cytology results. Also, only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first. Pap tests are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women after three negative results on consecutive annual examinations.

In planning an educational session for parents of toddlers concentrating on primary prevention, which indicates the most appropriate topic on which the nurse should concentrate? 1. Unintentional injury prevention 2. Seizure management 3. Child abuse prevention 4. Sudden infant death prevention

1. Unintentional injury prevention Toddlers ages 1 to 4 are most likely to be hospitalized or killed from unintentional injury. Therefore, the nurse should concentrate on this topic for these parents. Seizure management is not primary prevention, and although child abuse can occur in this age group, injuries occur more frequently. SIDS does not occur in this age group.

In reviewing the history of a woman who wants to become pregnant, which medication profile would indicate a potential concern relative to toxic exposure? SATA 1. Tylenol OTC occasionally for a headache; twice last week 2. Anticonvulsant for seizure disorder 3. Lithium for bipolar disorder 4. Coumadin for atrial fibrillation 5. Multivitamins once a day

2, 3, 4 A patient being treated with an anticonvulsant or lithium is at risk for toxic effects during pregnancy. Warfarin (Coumadin) can put a patient at risk during pregnancy. Although acetaminophen (Tylenol) can have toxic effects on the liver, the reported frequency is not a concern at this time. Taking multivitamins is a healthy recommended option.

A pregnant patient is experiencing some integumentary changes and is concerned that they may represent abnormal findings. The nurse provides information to the patient that the following findings would be considered "normal abnormal" findings during pregnancy so that she should not be alarmed. SATA 1. Facial edema 2. Melasma 3. Linea nigra 4. Superficial thrombophlebitis 5. Vascular spiders 6. Allodynia

2, 3, 5 Facial edema is a concern because it can represent toxemia of pregnancy. Superficial thrombophlebitis is a concern because it can represent a risk factor for development of a DVT during pregnancy. The presentation of allodynia (pain upon normal touch) is considered to be a significant finding and requires additional investigation. Melasma (also known as the mask of pregnancy or chloasma), linea nigra (a hyperpigmentation line extending from the fundus to the symphysis pubis), and the presence of vascular spiders are all considered to be normal abnormal findings in pregnancy.

Which statements are true regarding the occurrence of obesity in the United States? SATA 1. 25% of women in the United States are currently considered to be obese. 2. Women in the age group 40 to 59 years have the highest prevalence. 3. Obesity is associated with hypercholesterolemia. 4. Obesity is associated with a decreased incidence of diabetes. 5. Women who are obese may be more likely to have irregularities of the menstrual cycle.

2, 3, 5 More than 33% of women in the United States are currently considered to be obese. Obesity is associated with an increased incidence of diabetes. The statements in B, C, and E are true according to reported evidence.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? 1. "Many women imagine what their baby is like." 2. "A baby in utero does respond to the mother's voice." 3. "You'll need to ask the doctor if the baby can hear yet." 4. "Thinking that your baby hears will help you bond with the baby."

2. "A baby in utero does respond to the mother's voice." Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice, and the nurse should instruct the mother so. Although statement A is accurate, it is not the most appropriate response. Statement D is not appropriate because it gives the mother impression that her baby cannot hear her and belittles her interpretation of her fetus's behaviors.

During a developmental assessment, a parent complains that she has a "difficult" toddler. What advice would the nurse offer to the parent? 1. "Toddlers are flexible. Accepting new rules will occur quickly." 2. "Do not expect the child to adapt quickly to new situations." 3. "Encourage associative play and this will get better." 4. "Spanking your child will make the difficult behavior improve."

2. "Do not expect the child to adapt quickly to new situations." Toddlers are not flexible and do not adapt to anything quickly. Associative play does not occur until preschool age, and spanking should not be encouraged.

The nurse-midwife is teaching a group of women who are pregnant about Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? 1. "I will see results only if I perform 100 Kegel exercises each day." 2. "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." 3. "I should perform Kegel exercises only in the sitting position." 4. "I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results."

2. "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." Guidelines suggest that women perform between 30 and 80 Kegel exercises daily. The correct technique is to hold the contraction for at least 10 seconds and to rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. The exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: 1. "Don't worry about it. You'll do fine." 2. "It's normal to be anxious about labor. Let's discuss what makes you afraid." 3. "Labor is scary to think about, but the actual experience isn't." 4. "You may have an epidural. You won't feel anything."

2. "It's normal to be anxious about labor. Let's discuss what makes you afraid." This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool. The statement in A negates the woman's fears and is not therapeutic. The statement in C also negates the woman's fears and offers a false sense of security. The statement in D is not true. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural.

The nurse is teaching a new parent about infant nutrition. The nurse knows that the parent has understood the teaching when the parent states which of the following statements? 1. "My infant can begin eating with a spoon at 2 weeks of age." 2. "My infant will only eat from a bottle or breast for 4 to 6 months." 3. "My baby pushes food out of her mouth with her tongue because she does not like it." 4. "I can expect my baby to begin eating table food at 3 months of age."

2. "My infant will only eat from a bottle or breast for 4 to 6 months." Infants do not begin eating with a spoon at 2 weeks of age. Sucking is the only method of feeding for infants for the first 4 to 6 months of life. Infants must use their tongue in a different way when learning to eat from a spoon. This is often confused with food dislike. Infants will not consume anything other than formula or breastmilk for the first 4 to 6 months of life.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: 1. "The lubricant prevents vaginal irritation." 2. "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." 3. "The additional lubrication improves sex." 4. "Nonoxynol-9 improves penile sensitivity."

2. "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Answer 2 is a true statement. Nonoxynol-9 may cause vaginal irritation.It has no effect on the quality of sexual activity or on penile sensitivity.

When discussing care requirements for a child with human immunodeficiency virus (HIV infection), the nurse discusses infection control precautions. Which statement indicates the need for further instruction? 1. "I should make sure to wash my hands frequently." 2. "The temperature should be taking rectally every day." 3. "When I perform diaper changes, I will wear gloves." 4. "I will not allow anyone with colds to visit."

2. "The temperature should be taken rectally every day." Rectal temperature should be avoided as this will increase the risk of infection. All other statements are appropriate.

Which time span delineates the appropriate length for a normal pregnancy? 1. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days 2. 10 lunar months, 9 calendar months, 40 weeks, 280 days 3. 9 calendar months, 10 lunar months, 42 weeks, 294 days 4. 9 calendar months, 38 weeks, 266 days

2. 10 lunar months, 9 calendar months, 40 weeks, 280 days Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth. Nine lunar months is just short of a term pregnancy, and 294 days is longer than the average length of a pregnancy and would be considered postterm. Because conception occurs approximately 2 weeks after the first day of the LMP, the length described in D represents the postconception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.

The provider has ordered a genetic testing to assess whether the patient's fetus is at risk for sickle cell disease. The patient is asymptomatic but relates a positive family history. On the basis of this information, the nurse realizes that the provider has ordered: 1. Predictive testing. 2. A carrier screening test. 3. Presymptomatic testing. 4. Predispositional testing.

2. A carrier screening test. Carrier screening test would help identify whether the mother had the genetic mutation, thereby increasing the risk for transmission to the fetus. Predictive testing is used to determine genetic status of an asymptomatic family member. Presymptomatic testing would indicate the presence of a specific genetic mutation that is associated with a clinical presentation that would occur over the course of time. Because sickle cell disease is an autosomal recessive transmission and the patient is asymptomatic, such testing would not be indicated. Predispositional testing would also not be indicated because sickle cell disease is an autosomal recessive disease; if the patient is asymptomatic and a genetic mutation is found, it would exist only in a carrier state.

With regard to abnormalities of chromosomes, nurses should be aware that: 1. They occur in approximately 10% of newborns. 2. Abnormalities of number are the leading cause of pregnancy loss. 3. Down syndrome is a result of an abnormal chromosomal structure. 4. Unbalanced translocation results in a mild abnormality that the child will outgrow.

2. Abnormalities of number are the leading cause of pregnancy loss. Chromosomal abnormalities occur in less than 1% of newborns. Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? 1. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours 2. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours 3. Lull: no contractions; dilation stable; duration of 20 to 60 minutes 4. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

2. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official lull phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

When assessing the chest of a young child, which sites are best for auscultation? 1. At the bases and midaxillary areas 2. At the apices and the midaxillary areas 3. Just below the clavicles 4. Just above the clavicles

2. At the apices and the midaxillary areas The apices and the midaxillary sites offer the greatest distance between the two lungs, which assists in identifying absent or diminished breath sounds in each lung separately.

A mother who uses time-out as a method of discipline for her 5-year-old child is asking the nurse what type of parenting this exemplifies. What response would be the most appropriate? 1. Indifferent 2. Authoritative 3. Authoritarian 4. Permissive

2. Authoritative The authoritative parent sets limits while establishing an atmosphere of open discussion, thus promoting developmental integrity and trust. Permissive and indifferent parents do not set limits whereas authoritarian parents use stricter methods of discipline than do authoritative parents.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? 1. Obtain data about the frequency of coitus. 2. Determine the woman's level of knowledge about contraception and commitment to any particular method. 3. Assess the woman's willingness to touch her genitals and cervical mucus. 4. Evaluate the woman's contraceptive life plan.

2. Determine the woman's level of knowledge about contraception and commitment to any particular method. All of these actions are part of the assessment, but determination of the woman's level of knowledge regarding contraception and her commitment to a method is the primary step and is necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with her to compare options, reliability, cost, comfort level, protection from sexually transmitted infections (STIs), and a partner's willingness to participate. Data about frequency of coitus should include the number of sexual partners, level of partner contraceptive involvement, and any partner objections. A woman's willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss only if the client expresses interest in using one of the fertility awareness methods of contraception.

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: 1. Reassure the woman that the examination will not reveal any problems. 2. Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. 3. Reassure the woman that "bumps" can be treated. 4. Reassure her that most women have "bumps" on their labia.

2. Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. During assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client's discomfort or the results of examination, any comments about findings or their treatment would be incorrect and inappropriate. The statement in D is not accurate and should not be used in this situation.

Which test is performed to determine whether membranes are ruptured? 1. Urine analysis 2. Fern test 3. Leopold maneuvers 4. AROM

2. Fern test In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery to determine the presence or absence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: 1. A positive pregnancy test result. 2. Fetal movement palpated by the nurse-midwife. 3. Braxton Hicks contractions. 4. Quickening.

2. Fetal movement palpated by the nurse-midwife. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat and palpating fetal movement. A positive pregnancy test result and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy.

The viral sexually transmitted infection (STI) that affects most people in the United States today is: 1. Herpes simplex virus type 2 (HSV-2) 2. Human papillomavirus (HPV) 3. Human immunodeficiency virus (HIV) 4. Cytomegalovirus (CMV)

2. Human papillomavirus (HPV) HPV infection is the most prevalent viral STI seen in ambulatory health care settings.

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? 1. Less audible heart sounds (S1, S2) 2. Increased pulse rate 3. Increased blood pressure 4. Decreased red blood cell (RBC) production

2. Increased pulse rate Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? 1. Disturbed body image 2. Interrupted family processes 3. Anxiety 4. Risk for injury

2. Interrupted family processes Women commonly experience body image disturbances in the postpartum period, but this development is unrelated to giving birth to a child with Down syndrome. This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. She likely will also have a mix of emotions that may include anxiety, guilt, and denial, but anxiety is not the most essential nursing diagnosis for this family. Risk for injury is not an applicable nursing diagnosis.

Which statement is inaccurate with regard to normal labor? 1. A single fetus presents by vertex. 2. It is completed within 8 hours. 3. A regular progression of contractions, effacement, dilation, and descent occurs. 4. No complications are involved.

2. It is completed within 8 hours. Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours. In normal labor, a single fetus presents by vertex. A regular progression of contractions, effacement, dilation, and descent is the trajectory that the nurse expects for a woman experiencing a normal labor, which usually occurs with no complications.

When teaching self-care prevention of genital tract infections, the nurse should instruct the woman to: 1. Increase dietary sugar and avoid yogurt. 2. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. 3. Choose underwear or hosiery with a nylon crotch. 4. Douche frequently.

2. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. Clinical observations and research have suggested that tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials (like nylon) create an environment in which a vaginal fungus can grow. Bathing in bath salts or bubble bath may further irritate sensitive genital tissue. Douching can irritate tissue, alter pH, and create an environment conducive to fungal growth. Prevention of genital tract infections includes reducing dietary sugar and eating yogurt.

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is coming to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should: 1. Remind the woman that she is long overdue for her examination and that she should come in annually. 2. Listen carefully and allow extra time for this woman's health history interview. 3. Reassure the woman that a nurse practitioner is just as good as her old doctor. 4. Encourage the woman to talk about the death of her husband and her fears about her own death.

2. Listen carefully and allow extra time for this woman's health history interview. The nurse has an opportunity to use reflection and empathy while listening and can ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. The comment in A is inappropriate. The client should be given positive reinforcement for coming in for her appointment even though it has been some time. A respectful and reassuring approach will ensure that women ages 50 and older will continue to seek care. The comment in C should be rephrased in a more positive manner. The nurse has an opportunity to use empathy and reflection; however, this is not the purpose of the client's visit. If the client continues to express grief over the loss of her husband, she can be referred to an appropriate support group or counseling.

A child presents in the emergency department experiencing a high fever alternating with chills, profuse diaphoresis, and fatigue that has been occurring over the last 48 hours. The child has recently returned from a trip to South America. What infectious disease does the nurse suspect based upon the symptoms and history of the child? 1. Lyme disease 2. Malaria 3. Tetanus 4. Rubella

2. Malaria Based on the patient's presenting symptoms and the history of travel to South America the nurse suspects the child may have contracted malaria. The child is not exhibiting symptoms of Lyme disease, tetanus or rubella.

A nurse is assessing a 2-year-old boy with the following vital signs: temperature 97.8 F axillary, apical pulse 100, respirations 28 breaths per minute, blood pressure 125/80. Which action by the nurse would be most appropriate? 1. Reevaluate the child's temperature in 1 hour. 2. Report the blood pressure to the physician. 3. Assess for additional signs of respiratory distress in the child. 4. Determine why the child has tachycardia.

2. Report the blood pressure to the physician All of the vital signs listed are normal for a 2-year-old child except for the blood pressure. This reading is greater than the 99th percentile for a 2-year-old child, and should be reported promptly to the physician.

The nurse assesses a 4-year-old who was adopted from Russia and had no immunizations. The child does not appear ill, but has a fine, pink maculopapular rash that progressed from the face to the neck, chest, and back, then to the extremities within 3 days. Which communicable disease would the nurse suspect? 1. Scarlet fever 2. Rubella (German measles) 3. Meningococcus 4. Varicella

2. Rubella (German measles) The child's pattern of rash eruption is characteristic of rubella. Hand, foot, and mouth lesions are papulovesicular and last 7 to 10 days. The child with scarlet fever has a fine, red, sandpaper rash that spares the face and appears on the neck and trunk. The toes and fingers can peel, and a strawberry tongue is seen on day 4 or 5. The child with meningococcus is very ill, and has a red-to-purple urticarial, maculopapular, or petechial rash that can progress to purpura. Chickenpox or varicella would have lesions all over that crust over as they age.

The nurse knows that the second stage of labor, the descent phase, has begun when: 1. The amniotic membranes rupture. 2. The cervix cannot be felt during a vaginal examination. 3. The woman experiences a strong urge to bear down. 4. The presenting part is below the ischial spines.

2. The cervix cannot be felt during a vaginal examination. The second stage of labor begins with full cervical dilation. During the active pushing phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as at 5 cm dilation.

Concerning the third stage of labor, nurses should be aware that: 1. The placenta eventually detaches itself from a flaccid uterus. 2. The duration of the third stage may be as short as 3 to 5 minutes. 3. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. 4. The major risk for women during the third stage is a rapid heart rate.

2. The duration of the third stage may be as short as 3 to 5 minutes. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage; the risk of hemorrhage increases as the length of the third stage increases.

Which behavior by a child's parents is the best indicator that they understand how to administer medication to the child at home following surgery? 1. The parents sign the written discharge instruction verifying understanding of the instructions 2. The parents give the medication to the child using the appropriate technique in the nurse's presence 3. The parents state they understand how to administer the medication and deny questions 4. The parents state they can give the medication to the child using appropriate technique

2. The parents give the medications to the child using the appropriate technique in the nurse's presence While all four options indicate understanding, watching the parents correctly administer the medication provides the most information about their understanding.

Under which circumstance would a nurse not perform a vaginal examination on a patient in labor? 1. An admission to the hospital at the start of labor 2. When accelerations of the fetal heart rate (FHR) are noted 3. On maternal perception of perineal pressure or the urge to bear down 4. When membranes rupture

2. When accelerations of the fetal heart rate (FHR) are noted An accelerated FHR is a positive sign not requiring vaginal examination; variable decelerations, however, merit a vaginal examination. Vaginal examination should be performed when the woman is admitted to the hospital or birthing center at the start of labor. When the woman perceives perineal pressure or the urge to bear down is another appropriate time to perform a vaginal examination, as is after rupture of membranes (ROM). The nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM.

Which of the following actions, if demonstrated by a nursing student, could lead to dismissal from the health program? SATA 1. A student nurse offers her phone number to a patient so that they can remain in touch. 2. Nursing students go out for lunch following a clinical rotation to a local restaurant while still in uniform. 3. A nursing student posts pictures of clinical site experiences on her Facebook page. 4. Student nurses share their thoughts about their clinical site experiences on Twitter.

3, 4 Although a nursing student can provide a phone number to a patient so that they remain in touch, the student should be aware of the limits of the relationship while in nursing school. Nursing students going out to lunch following a clinical experience while in uniform would not pose a problem as long as they maintained their professional demeanor and did not discuss clinical events. Posting of images related to clinical experiences on a Facebook page would make the student liable for violation of privacy. Sharing of thoughts related to clinical experiences on social media may result in dismissal from a health program if a student nurse provides information that results in violation of the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

In providing health promotion education to reduce the likelihood of transmission of sexually transmitted diseases, the nurse would describe which of the following practices as having a low but potential risk for disease transmission? SATA 1. Erotic conversation 2. Oral-anal contact 3. Oral sex with female or male wearing condom 4. Vaginal intercourse with condom 5. Blood contact during sexual act due to menses

3, 4 Erotic conversation would be considered a safe risk reduction practice. Oral-anal contact and blood contact during a sexual act due to menses would be considered high-risk practices. Both oral sex and vaginal sex while wearing condoms are practices with low but potential risks.

The nurse manager is teaching new graduates that it is important to assess culture when caring for a child. Which of the following questions is not particular to a cultural assessment? 1. "What do you usually do when your child has a fever?" 2. "Who is responsible for caring for the children in your family?" 3. "How do you know when your child is sick?" 4. "Is there a spiritual counselor you would like me to call?"

3. "How do you know when your child is sick?" Although asking how a person knows a child is sick is an assessment, it is not particular to a cultural assessment. The other options ask about healthcare practices, childrearing responsibilities, and spiritual practices.

The father of a 9-year-old Orthodox Jewish patient has requested a kosher diet for his son during his hospitalization. Which statement by the nurse indicates that she is sensitive to the cultural needs of this family? 1. "I will call the kitchen and see if they can provide a kosher meal." 2. "Just make sure your child does not eat anything not kosher." 3. "I will place the order for a kosher diet. I will check with you when his meal comes to make sure he received the appropriate foods." 4. "The physician ordered a regular diet and that is what I must enter into the computer."

3. "I will place the order for a kosher diet. I will check with you when his meal comes to make sure he received the appropriate foods." The hospital should be able to provide foods appropriate for a Kosher diet. The nurse is demonstrating cultural sensitivity when she assures the father that she will order this diet and make sure this diet is delivered. A child who has an order for a regular diet can have Kosher foods.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: 1. "Karyotyping will reveal whether the baby's lungs are mature." 2. "Karyotyping will reveal whether your baby will develop normally." 3. "Karyotyping will provide information about the gender of the baby and the number and structure of the baby's chromosomes." 4. "Karyotyping will detect any physical deformities the baby has."

3. "Karyotyping will provide information about the gender of the baby and the number and structure of the baby's chromosomes." The lecithin/sphingomyelin ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Karyotyping provides genetic information, such as gender and chromosomal structure. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. Deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? 1. "We don't really know when such defects occur." 2. "It depends on what caused the defect." 3. "They occur between the third and fifth weeks of development." 4. "They usually occur in the first 2 weeks of development."

3. "They occur between the third and fifth weeks of development." The nurse would be aware of when such defects occur. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week.

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: 1. "True labor contractions will subside when I walk around." 2. "True labor contractions will cause discomfort over the top of my uterus." 3. "True labor contractions will continue and get stronger even if I relax and take a shower." 4. "True labor contractions will remain irregular but become stronger."

3. "True labor contractions will continue and get stronger even if I relax and take a shower." True labor contractions occur regularly, become stronger, last longer, and occur closer together. They may become intense during walking and continue despite comfort measures. Typically, true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. During false labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions stop with walking or a change of position.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity according to the GTPAL system? 1. 2-0-0-1-1 2. 2-1-0-1-0 3. 3-1-0-1-0 4. 3-0-1-1-0

3. 3-1-0-1-0 According to the GPTAL system, this woman's gravidity and parity information is calculated as follows:G: Total number of times the woman has been pregnant (she is pregnant for the third time) T: Number of pregnancies carried to term (only one pregnancy resulted in a fetus at term)P: Number of pregnancies that resulted in a preterm birth (none)A: Abortions or miscarriages before the period of viability (she has had one)L: Number of children born who are currently living (she has no living children)3-1-0-1-0 is the correct calculation of this woman's gravidity and parity.

Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? 1. 38% HCT; 14 g/dL HGB 2. 35% HCT; 13 g/dL HGB 3. 33% HCT; 11 g/dL HGB 4. 32% HCT; 10.5 g/dL HGB

3. 33% HCT; 11 g/dL HGB 38% HCT; 14 g/dL HGB and 35% HCT; 13 g/dL HGB are within normal limits in a nonpregnant woman. 33% HCT; 11 g/dL HGB represents the lowest acceptable values during the first and the third trimesters, and 32% HCT; 10.5 g/dl HGB represents the lowest acceptable values for the second trimester, when the hemodilution effect of blood volume expansion is at its peak.

A patient who is breastfeeding has been diagnosed with Gonorrhea. Which treatment plan should be instituted? 1. Amoxicillin 500 mg three times a day for 1 week 2. Benzathine penicillin G 2.4 million units one injection 3. Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection 4. Ceftriaxone 250 mg IM injection

3. Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection Amoxicillin or ceftriaxone can be part of the treatment plan for gonorrhea but the patient should be treated empirically for chlamydia as well. Dual therapy with amoxicillin and ceftriaxone can be used for treatment of gonorrhea and empirical treatment of chlamydia. Benzathine penicillin is indicated for treatment of syphilis for the lactating patient.

The nurse notes that a 6-month-old infant boy who weighed 7 pounds at birth now weighs 15 pounds. Based on the evaluation of the infant's current weight, what is the nurse's next action? 1. Ask the parent why the child does not eat enough. 2. Immediately inform the physician. 3. Chart the assessment. 4. Teach how to not overfeed the baby.

3. Chart the assessment The baby's weight should be just about double the birth weight by 6 months. The other options treat the weight as if it is either too high or too low.

Which description of the phases of the second stage of labor is accurate? 1. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes 2. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes 3. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies 4. Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

3. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The latent phase is the lull, or "laboring down" period, at the beginning of the second stage. It lasts 10 to 30 minutes on average. The second stage of labor has no active phase. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.

A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: 1. Tell the couple they need to have an abortion within 2 to 3 weeks. 2. Explain that the fetus has a 50% chance of having the disorder. 3. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. 4. Refer the couple to a psychologist for emotional support.

3. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination? 1. Fetus is in a breech position 2. FHR baseline is within normal range 3. Fetus with possible renal problems 4. Increased fundal height

3. Fetus with possible renal problems Oligohydramnios reflects a decrease in the amount of amniotic fluid and is associated with renal abnormalities in the fetus and compromised fetal well-being. The position of the fetus is due to gestational age and the maternal uterine environment. FHR may be within normal range because it is affected by gestational age and fetal well-being. An increase in fundal height would be associated with polyhydramnios and/or gestational age assessment.

Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause(s)? 1. Amenorrhea—stress, endocrine problems 2. Quickening—gas, peristalsis 3. Goodell sign—cervical polyps 4. Chadwick sign—pelvic congestion

3. Goodell sign—cervical polyps Goodell sign might be the result of pelvic congestion, not polyps. Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Chadwick sign might be the result of pelvic congestion.

A nurse is caring for a 4-year-old child in a pediatric clinic. The child's parents both work and have mentioned they are having financial difficulties and can no longer afford a private babysitter. Which support service would be the most appropriate for the nurse to recommend to this family? 1. School-based counseling services 2. Play groups 3. Head Start or Early Head Start 4. Home visiting programs

3. Head Start or Early Head Start The parents are looking to save money by decreasing the use of a private babysitter. Both parents work but are having financial difficulty. This family may qualify for Head Start or Early Head Start. These programs provide an all-day preschool for children who financially qualify. School-based counseling services are not appropriate as the child is not school age. Although a play group may help the child to socialize, it does not save the family money on a babysitter. There is no indication that the child is high-risk and would require a home visiting program.

A 16-year-old male begins to act out in school, and his teacher observes a sudden drop in his grades. Knowing this adolescent was adopted 10 years ago, which indicates what might be causing these behavioral changes? 1. Industry versus inferiority 2. Trust versus mistrust 3. Identity versus role confusion 4. Intimacy versus isolation

3. Identity versus role confusion Identity versus role confusion is the developmental task of adolescence. Given the history of adoption, the behavioral changes may be even more pronounced. Industry versus inferiority is the developmental task of the school-age child, trust versus mistrust is the developmental task of the infant, and intimacy versus isolation is the developmental task of the young adult.

Regardless of age, which is the priority nursing diagnosis for children in need of immunizations? 1. Injury, Risk for related to immunization reaction 2. Immunization Status, Readiness for Enhanced related to planned health promotion visit 3. Infection, Risk for related to inadequate acquired immunity 4. Anxiety related to receiving scheduled immunizations

3. Infection, Rick of related to inadequate acquired immunity If children do not receive immunizations as scheduled, they are at risk for infection from many infectious diseases. If children do not receive immunizations as scheduled, there is no effective therapy management or risk for injury related to immunization reaction. Children who receive immunizations will always have anxiety. However, the risk for infection is the priority should they not receive them.

When providing dietary guidance to a child with spina bifida with a known allergy to latex, the nurse should make the suggestion that which foods be avoided? 1. Oranges 2. Broccoli 3. Kiwi fruit, bananas, and avocados 4. Carrots

3. Kiwi fruit, bananas, and avocados Some of the proteins present in latex are also present in kiwi fruit, bananas, and avocados. Oranges, broccoli, and carrots should be encouraged in the diet due to vitamin enrichment.

The nurse is caring for an 8-year-old child who is hospitalized following a motor vehicle accident. Based upon what the nurse knows about the child's development what is the most appropriate nursing intervention? 1. Using toys for distraction from painful medical procedures 2. Offering medical equipment for play to decrease anxiety 3. Knocking on the door before entering the room 4. Providing information on sexuality

3. Knocking on the door before entering the room The most appropriate intervention for the school-age child is knocking on the door prior to entering. According to Freud this child is experiencing the latency stage where the child places importance on privacy and understanding the body. Using toys for distraction of a painful medical procedure is appropriate for an infant in Piaget's sensorimotor stage. Offering medical equipment to decrease anxiety is appropriate for the preschooler who is experiencing Erikson's intiative versus guilt stage. Providing information on sexuality is appropriate for the adolescent patient experiencing Freud's genital stage.

If used consistently and correctly, which of the barrier methods of contraception has the lowest failure rate? 1. Spermicides 2. Female condoms 3. Male condoms 4. Diaphragms

3. Male condoms For typical users, the failure rate for male condoms may approach 15%; however, if condoms are used correctly, the failure rate is only 2%. Failure rates are about 29% for spermicides, about 21% for female condoms, and 16% for diaphragms with spermicides.

When caring for pregnant women, the nurse should keep in mind that violence during pregnancy: 1. Affects more than 25% of pregnant women in the United States. 2. Increases a pregnant woman's risk for gestational hypertension. 3. May be associated with substance abuse by both the pregnant woman and her partner. 4. Has decreased in incidence as a result of better assessment techniques and record-keeping.

3. May be associated with substance abuse by both the pregnant woman and her partner. Approximately 8% of pregnant women are battered; the incidence of battering increases during pregnancy. Violence itself has no correlation with the incidence of gestational hypertension. Alcoholism and substance abuse by the woman or her abuser are associated with violence. The rates of violence have actually increased, possibly because of better assessment and reporting mechanisms.

During an assessment of the neck of a 2-year-old child, the nurse notes firm, nontender, movable lymph nodes 1 cm in diameter in the cervical chain. Which would the nurse consider the most likely cause of this finding? 1. Abnormal and indicative of illness requiring antibiotic treatment 2. Abnormal and probably related to minor upper respiratory infection 3. Normal finding in a child at this age 4. Abnormal and potentially indicative of a serious health problem

3. Normal finding in a child at this age Firm, nontender, movable lymph nodes up to 1 cm in diameter are common in young children, and therefore do not require antibiotics.

A 3-year-old is scheduled to return to the clinic in one week to have blood drawn by venipuncture to reassess electrolyte values. The child's parents ask if there is anything they can do to decrease the child's discomfort from the procedure. Which would be the most appropriate action by the nurse? 1. Suggest distraction techniques the parents can use for the child during the procedure 2. Suggest the parents reassure the child the procedure will not hurt as long as he or she holds completely still 3. Suggest the parents obtain L-M-X4 from a pharmacy and instruct them how to use it 4. Suggest therapeutic play prior to the procedure to ensure the child understands what will occur

3. Obtain a prescription for EMLA from the healthcare provider or L-M-X4 from the pharmacy and instruct the parents how to use it. EMLA and L-M-X4 are topical anesthetics that are appropriate to use to prevent or decrease pain associated with minor medical procedures. Venipuncture is a painful procedure and intervention prior to the procedure is indicated. Although distraction is helpful, it is not as effective as topical anesthesia. Therapeutic play can be a useful method to teach the child briefly about the procedure and to help relieve anxiety following the procedure, but it will not actually decrease the discomfort that a child of this age will experience from a needle stick.

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? 1. The healthy newborn should be taken to the nursery for a complete assessment. 2. After drying, the infant should be given to the mother wrapped in a receiving blanket. 3. Skin-to-skin contact of mother and baby should be encouraged. 4. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

3. Skin-to-skin contact of mother and baby should be encouraged. The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. Although complete assessment in the nursery is the practice in many facilities, it is neither evidence-based nor supportive of family-centered care. Handing the mother the blanket-wrapped baby is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed on the mother skin to skin. The father or support person is likely also anxious to hold and admire the newborn. This can happen after the infant has been placed skin to skin with the mother and breastfeeding has been initiated.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? 1. Semirecumbent 2. Sitting 3. Squatting 4. Side-lying

3. Squatting Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. Sitting may assist with fetal descent, but like a semirecumbent or side-lying position, it does not increase the size of the pelvic outlet.

A woman taking an oral contraceptive pill (OCP) as her birth control method of choice should notify her health care provider immediately if she notes: 1. Breast tenderness and swelling 2. Weight gain 3. Swelling and pain in one of her legs 4. Mood swings

3. Swelling and pain in one of her legs Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. Breast tenderness and weight gain are expected side effects of OCPs, and mood swings are a common side effect.

The nurse takes the vital signs of an infant who has just returned from surgery. What indicates that the infant may have acute pain requiring nursing intervention? 1. The infant eagerly takes the bottle 2. The infant watches the crib mobile 3. The infant has a heart rate of 180 4. The infant responds to the parents

3. The infant has a heart rate of 180 Tachycardia is a physiologic consequence of pain and stress and is one that infants exhibit frequently. The other options suggest controlled pain.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates that: 1. The fetus is at risk for Down syndrome. 2. The woman is at high risk for developing preterm labor. 3. The lungs are mature. 4. Meconium is present in the amniotic fluid.

3. The lungs are mature. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. This result is unrelated to Down syndrome and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.

Which statement about female sexual response is not accurate? 1. Women and men are more alike than different in their physiologic responses to sexual arousal and orgasm. 2. Vasocongestion is the congestion of blood vessels. 3. The orgasmic phase is the final state of the sexual response cycle. 4. Facial grimaces and spasms of hands and feet are often part of arousal.

3. The orgasmic phase is the final state of the sexual response cycle. Men and women are surprisingly alike. Arousal is characterized by increased muscular tension (myotonia). Vasocongestion causes vaginal lubrication and engorgement of the genitals. The final state of the sexual response cycle is the resolution phase after orgasm.

The nurse is caring for a 5-year-old male child who will be having a tonsillectomy performed. What teaching method is most appropriate for this child prior to the surgical procedure? 1. Provide the child's mother with brochure about the procedure 2. Sit with the child while he watches a video about the procedure 3. Use dolls to teach the child about the procedure 4. Allow the child to talk to other children who have had the procedure

3. Use dolls to teach the child about the procedure A 5-year-old child should be taught about a surgical procedure through the use of pictures, books, dolls, and safe medical equipment in order to clarify misconception and teach about the upcoming procedure. Although providing the mother with a brochure may be appropriate, this does not teach the child. Sitting with the child while he watching a video or allowing the child to talk to other children who have had the procedure is not appropriate for this age group.

A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make? 1. "Male and female sterilization methods are 100% effective." 2. "A vasectomy may have a slight effect on sexual performance." 3. "Tubal ligation can be easily reversed if you change your mind in the future." 4. "Major complications after sterilization are rare."

4. "Major complications after sterilization are rare." Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5% and for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.

The nurse is caring for a female child who is recovering from a motor vehicle accident. The child's parents ask if it is okay to bring the child's siblings to visit. What is the most appropriate response by the nurse? 1. "No, it would not be good for your child to see her siblings as it may make her worse." 2. "No, it would be very upsetting for your child's siblings to see her this way." 3. "Yes, it is okay to bring your child's siblings to see her as long as you bring someone to watch them." 4. "Yes, it is okay to bring your child's siblings for a visit as long as we educate them on what to expect when they visit."

4. "Yes, it is okay to bring your child's siblings for a visit as long as we educate them on what to expect when they visit." The child's siblings should be allowed to visit as long as the child and the siblings all wish to see each other an the siblings are educated on what to expect during the visit. Seeing siblings would not necessarily make the child feel worse. Although it may be upsetting for the child's siblings to see the patient, proper education on what to expect is required prior to the visit. The parents would not be required to bring someone to watch their other children during the visit.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: 1. "This probably means you're pregnant." 2. "Don't worry; it's probably nothing." 3. "Have you been sick this month?" 4. "You probably didn't ovulate during this cycle."

4. "You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). The absence of a temperature decrease most likely is the result of lack of ovulation. Illness would most likely cause an increase in BBT. A comment such as the one in B discredits the client's concerns.

Which sign does not precede the onset of labor? 1. A return of urinary frequency as a result of increased bladder pressure 2. Persistent low backache from relaxed pelvic joints 3. Stronger and more frequent uterine (Braxton Hicks) contractions 4. A decline in energy, as the body stores up for labor

4. A decline in energy, as the body stores up for labor A surge of energy is a phenomenon that is common in the days preceding labor. After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Prior to the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength; bloody show may be passed.

The nurse is planning the equipment needs for a new pediatric clinic where immunizations will be given, among other services. Which indicates the priority consideration? 1. A new office is not allowed to have vaccines for at least one year 2. Educating staff on vaccine administration 3. Cabinet space should be allocated specifically for vaccines 4. A medication refrigerator is necessary for vaccine storage

4. A medication refrigerator is necessary for vaccine storage The Join Commission requires medications and food items be stored separately. Most vaccines require refrigeration to maintain safety and potency. Thus, medication refrigeration is the priority consideration. Although educating staff on proper vaccine administration is important, it is not the priority and it is not related to equipment needs.

The nurse is teaching a family about ways to minimize contact with allergens. What items should the nurse include in the teaching? 1. Keeping pets outside 2. Using cloth covers on mattresses and pillows 3. Avoiding hardwood floors in the home 4. Cleaning frequently with moist cloths

4. Cleaning frequently with moist cloths The family should be taught to clean frequently with moist cloths and mops to remove dust. Pets should be kept outside of the child's room. Plastic covers should be used on mattresses and pillows. Carpeting, not hardwood floors, should be avoided.

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: 1. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. 2. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. 3. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. 4. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

4. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy. In addition to hemorrhoids, compression of the iliac veins and inferior vena cava by the uterus also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, each blood pressure measurement should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases.

When a nurse is unsure about how to perform a client care procedure, the best action would be to: 1. Ask another nurse. 2. Discuss the procedure with the client's physician. 3. Look up the procedure in a nursing textbook. 4. Consult the agency procedure manual and follow the guidelines for the procedure.

4. Consult the agency procedure manual and follow the guidelines for the procedure. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies. Each nurse is obligated to follow the standards of care for safe client care delivery. It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines.

The nurse who provides preconception care understands that it: 1. Is designed for women who have never been pregnant. 2. Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions. 3. Avoids teaching about safe sex to avoid political controversy. 4. Could include interventions to reduce substance use and abuse.

4. Could include interventions to reduce substance use and abuse. Preconception care is designed for all women of childbearing potential. Risk factor assessment includes financial resources and environmental conditions at home and work. Health promotion can include teaching about safe sex. If assessments indicate a drug problem, treatment can be suggested or arranged.

How can the nurse best limit the amount of separation anxiety that the hospitalized toddler will experience? 1. Reduce the amount of time spent with the child when the parents are not present. 2. Discourage the amount of time the parents hold their child while hospitalized. 3. Encourage the parents to leave the child's room when care is being provided. 4. Encourage parental involvement in the child's care and suggest rooming in if possible.

4. Encourage parental involvement in the child's care and suggest rooming in if possible. Parents should be encouraged to room-in with and hold their child and to participate in the child's care as much as possible. The child's anxiety will increase when the parent leaves or the child is left alone.

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? 1. Radioimmunoassay 2. Radioreceptor assay 3. Latex agglutination test 4. Enzyme-linked immunosorbent assay (ELISA)

4. Enzyme-linked immunosorbent assay (ELISA) OTC pregnancy tests use ELISA for its one-step, accurate results. Radioimmunoassays test for the subunit of hCG in serum or urine samples and must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather it is done to detect specific antigens and antibodies.

A 23-year-old African-American woman is pregnant with her first child. On the basis of the statistics for infant mortality, which plan is most important for the nurse to implement? 1. Perform a nutrition assessment. 2. Refer the woman to a social worker. 3. Advise the woman to see an obstetrician, not a midwife. 4. Explain to the woman the importance of keeping her prenatal care appointments.

4. Explain to the woman the importance of keeping her prenatal care appointments. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but this also is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. Additionally, this is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive. Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.

Which of the following would not be included in a labor nurse's plan of care for an expectant mother? 1. The onset of progressive, regular contractions 2. The bloody, or pink, show 3. The spontaneous rupture of membranes 4. Formulation of the woman's plan of care for labor

4. Formulation of the woman's plan of care for labor Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment.

Which statement is true about the term contraceptive failure rate? 1. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. 2. It refers to the minimum level that must be achieved to receive a government license. 3. It increases over time as couples become more careless. 4. It varies from couple to couple, depending on the method and the users.

4. It varies from couple to couple, depending on the method and the users. The contraceptive failure rate is strictly a statistical measure of likely accidental pregnancy over a couple's first year of use. Failure rates decline over time because users gain experience. Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple.

If a woman complains of back labor pain, the nurse might best suggest that she: 1. Lie on her back for a while with her knees bent. 2. Do less walking around. 3. Take some deep, cleansing breaths. 4. Lean over a birth ball with her knees on the floor.

4. Lean over a birth ball with her knees on the floor. The hands-and-knees position, with or without the aid of a birth ball, should help with the back pain. The supine position should be discouraged. Walking generally is encouraged. Deep cleansing breaths will assist with any labor pain; however, it is very important that this woman's position is changed so that she is not on her back.

Which developmental finding is accurate with regard to fetal growth? 1. Heart starts beating at 12 weeks. 2. Lungs take shape by 8 weeks. 3. Brain configuration is complete by 8 weeks. 4. Main blood vessels form by 8 weeks.

4. Main blood vessels form by 8 weeks. The heart starts beating by 4 weeks, the lungs take shape by 12 weeks, and brain configuration is complete by 12 weeks.

With regard to the most common bacterial sexually transmitted infections, which statement is not accurate? 1. Chlamydial infections and gonorrhea are more likely to occur in women younger than age 20. 2. Gonorrhea can be transmitted to the newborn by direct contact with gonococcal organisms in the cervix. 3. Syphilis can be transmitted through kissing, biting, or oral-genital sex. 4. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear.

4. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear. For any infection, the entire prescription must always be taken.

Group B streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which of the following would not be considered to be a risk factor for neonatal GBS infection? 1. Positive prenatal culture result 2. Preterm birth at less than 37 weeks of gestation 3. Maternal fever of 38° C or greater 4. Premature rupture of membranes for longer than 24 hours

4. Premature rupture of membranes for longer than 24 hours Premature rupture of membranes for 18 hours or more increases the risk for neonatal GBS infection.

A new registered nurse (RN) is preparing to care for a group of pediatric patients. The nurse is unable to participate in which of the following activities? 1. Patient advocacy 2. Family education 3. Case management 4. Prescription of medication

4. Prescription of medication All nurses are able to act as patient advocates, educators, and case managers. The new RN can administer medication but is not able to prescribe medication. A nurse with an advanced practice degree, such as a pediatric nurse practitioner, is able to prescribe medication.

The hormone responsible for maturation of mammary gland tissue is: 1. Estrogen. 2. Testosterone. 3. Prolactin. 4. Progesterone.

4. Progesterone. Progesterone causes maturation of the mammary gland tissue, specifically the lobules acinar structures. Estrogen increases the vascularity of the breast tissue.Prolactin is produced after birth and is released from the pituitary gland; it is produced in response to infant suckling and emptying of the breasts. Testosterone has no bearing on breast development.

A 38-year-old maternity patient receives information based on genetic testing that her fetus has a deformity and decides to terminate the pregnancy. There is a family history of genetic abnormalities. Following the termination of pregnancy, the pathology report indicates that the fetus had no structural abnormalities. This finding suggests that: 1. The patient should have asked for a second opinion from a perinatal specialist. 2. The genetic test results provided indicated a false-negative finding. 3. Genetic testing results vary with patient demographics and information provided. 4. Results indicated a false-positive finding leading to an adverse outcome.

4. Results indicated a false-positive finding leading to an adverse outcome. Because the pathology report identified no abnormalities, the results of genetic testing in this case were false-positive, in that they indicated that there was an abnormality when there was not. This information unfortunately led to a poor health outcome. Although no genetic test provides 100% reassurance, most patients do not automatically seek a second opinion unless there are additional variables that may influence the reliability of the result. Because the patient had a family history of genetic abnormalities, it is unlikely that the patient and/or provider would necessarily have opted for a second opinion. A false-negative result would indicate that a condition was not present even though it was; the patient was provided with a negative result. Genetic test results do not vary with patient demographics or information provided.

The nurse is caring for a 12-year-old child who injured his leg in a backyard football game. He is currently complaining of mild pain at the site and has received oral pain medication. What is the most appropriate complementary therapy for pain management for this child? 1. Wrap the child in a blanket 2. Offer the child a sugary drink 3. Offer bubbles to the child 4. Teach progressive muscle relaxation

4. Teach progressive muscle relaxation Progressive muscle relaxation is a complementary therapy for pain management that is appropriate for a child 6 years of age or older. Wrapping blanket is appropriate for newborns and infants but not for a 12-year-old. Offering bubbles would be appropriate for a child who is 2 to 6 years of age.

The school nurse has established a nursing diagnosis of Imbalanced Nutrition: More than Body Requirements for a student related to excess intake compared to metabolic needs. What is an appropriate outcome for this child? 1. The child is limited to eating out and fast foods no more than once weekly. 2. The child loses weight to achieve correct proportion between weight and height on a growth grid. 3. TV and video gaming are removed from the child's bedroom. 4. The child demonstrates sufficient intake of all nutrients while achieving or maintaining optimal weight for height.

4. The child demonstrates sufficient intake of all nutrients while achieving or maintaining optimal weight for height. The desired outcome is that the child takes in nutrients sufficient to meet metabolic needs, but without taking in excess. The child may need to lose weight or to maintain weight while height grow in proportion to weight. Plans to achieve this outcome would likely include an increase in activity, healthy food choices, and appropriate serving sizes.

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: 1. The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. 2. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. 3. Having the woman point her toes reduces leg cramps. 4. The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.

4. The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second-stage labor because of a number of unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself.

In a variation of rooming-in called couplet care, the mother and infant share a room and the mother shares the care of the infant with: 1. The father of the infant. 2. Her mother (the infant's grandmother). 3. Her eldest daughter (the infant's sister). 4. The nurse.

4. The nurse. In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care. This may also be known as mother-baby care or single-room maternity care. The father is included in instruction regarding infant care whenever he is present. The grandmother is welcome to stay and take part in the woman's postpartum care, but she is not part of the couplet. An older sibling may stay with the client and her baby but is also not part of the couplet.

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: 1. With a dominant disorder, the likelihood of the second child also having the condition is 100%. 2. An autosomal recessive disease carries a one in eight risk that the second child will also have the disorder. 3. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. 4. The risk factor remains the same no matter how many affected children are already in the family.

4. The risk factor remains the same no matter how many affected children are already in the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children of a mother who used drugs would be at risk only if she continued to do so; the rate of risk would be difficult to calculate. Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

What important aspects do all the fertility awareness-based (FAB) methods have in common? 1. They all require a woman to be able to touch her genitals to assess cervical mucus. 2. They all involve abstinence at some point. 3. They all rely on measurement of body temperature. 4. They all require the cooperation of the woman's partner.

4. They all require the cooperation of the woman's partner. Fertile phases can be determined in a number of ways, but the sexual partner must cooperate in the method. Not all FAB methods calculate fertility phases by examining mucus; some use body temperatures and other signs. Some methods use chemical or physical barriers to conception during fertile periods.

The recommended treatment to prevent transmission of human immunodeficiency virus (HIV) to the fetus during pregnancy is: 1. Acyclovir 2. Ofloxacin 3. Podophyllin 4. Zidovudine

4. Zidovudine Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for herpes simplex virus (HSV). Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus.