Unit 6, 10, & 16 - Care of Family Ch. 4

2. Match each description with the correct disorder. Disorders may be used more than once. Descriptions may have more than one answer. 1. _____Rectum presses into vagina 2. _____Symptoms include constipation 3. _____ Bladder herniates into vagina 4. _____Difficulty completing a bowel movement 5. _____ Damaged muscles appear higher in the colon 6. _____ Symptoms include difficulty in voiding, incontinence, and dyspareunia a. Cystocele b. Rectocele c. Enterocele

ANS: 1: b; 2: b, c; 3: a; 4: b, c; 5: c; 6: a

1. Match the types of play with their characteristics. _____ Assume roles in games; games have goals _____Playing with the same items, but not really playing together _____ Plays alone, no regard for those in the area _____ Play together, but little organization _____ Observes other children while playing alone a. Solitary play b. Onlooker play c. Parallel play d. Associative play e. Cooperative play

ANS: e, c, a, d, b There are five types of play: solitary play (child plays alone without regard for those around him or her), onlooker play (child observes others playing and may talk to them, may alter his or her own play, or may continue playing as he or she was doing), parallel play (playing with the same materials and items, but not playing together), associative play (play together in a peer group, but in a loosely organized manner), and cooperative play (assume roles in games, games have goals, and rely on each other to continue and progress).

28. A nurse is volunteering for the local chapter of the cancer society and is planning breast cancer screening and educational activities in the community. In order to have the most impact on this disease, which women should the nurse target? A. African Americans B. Asian Americans C. Caucasian Americans D. Native Americans

ANS: A African American women are more likely to die from breast cancer because of late diagnosis, and in women under 45 in this group, breast cancer is more common. To have the greatest impact, the nurse should target this group of women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Caucasian women tend to develop breast cancer more frequently than African American women, but they die less often.

30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What action by the nurse takes priority? A. Ensure that an informed consent is signed and witnessed. B. Inventory and label all of the patient's belongings. C. Orient the patient's significant others to the waiting room. D. Premedicate the patient on arrival to the pre-op holding area.

ANS: A All actions are appropriate, but the priority action is in ensuring that an informed consent form has been signed and properly witnessed.

43. A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations? A. Annual screening after age 40 B. MRI to replace mammography C. No routine screening after age 65 D. Periodic screening if high risk

ANS: A Breast cancer screening is the subject of controversy. The American College of Obstetricians and Gynecologists (ACOG) recommends annual screening with mammography and clinical breast examinations every year starting at age 40.

23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication? A. 20-lb weight gain B. Cold intolerance C. Facial acne D. Facial hair growth

ANS: A Depo-Provera is used to treat endometriosis, but one undesirable side effect is weight gain. Danazol (Danocrine) is also used to treat this condition, but side effects of acne and facial hair growth cause this medication to be prescribed less often. Cold intolerance is not a common side effect of medications used to treat endometriosis.

31. A nurse in a family practice clinic sees several generations of the same family. For which family members should the nurse arrange routine screening colonoscopies? A. Daughter, age 52 B. Grandfather, age 80, no history of polyps or cancer C. Grandmother, age 72, history of polyps D. Grandson, age 30, no gastrointestinal symptoms

ANS: A Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 75-85 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening.

42. A nurse is educating a woman on the use of denosumab (Prolia). What information should the nurse provide? A. "Return in 6 months for another injection." B. "Take this medication on an empty stomach." C. "Take this medication with milk or food." D. "You may have increased night sweats."

ANS: A Prolia, a medication used for the treatment of osteoporosis, is given in subcutaneous injections every 6 months. Food intake is not related to administration. Increased night sweats and hot flashes can occur with raloxifene (Evista).

16. The parents of a 16-year-old boy are frustrated because the teen is always participating in risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful? A. Encourage an after-school program that includes rock climbing, rafting, and hiking. B. Reassure the parents that risk taking is just a normal part of adolescence. C. Show the teen statistics on preventable injuries and deaths among teenagers. D. Tell the teen his risky behavior can lead to injuries and worries his parents.

ANS: A Risk taking is a part of adolescence, but the teen needs healthy risk-taking activities. The nurse can encourage the teen to take part in a program that offers risk-taking under adult supervision. Rock climbing, hiking, and rafting are all healthy alternatives. Simply reassuring the parents that teens take risks does not give them information that helps the teen. Showing the teen statistics and explaining that he is worrying his parents are both unlikely to have much effect.

36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness, heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman? A. Administration of leuprolide (Lupron) B. Hysterectomy and bilateral salpingo-oophorectomy C. None; issue will resolve spontaneously D. Surgical removal of the ovaries

ANS: A These are symptoms of a uterine leiomyoma (fibroid). The medical treatment includes nonsteroidal anti-inflammatory drugs, oral contraceptives, and Lupron. Ovarian cysts often resolve spontaneously. For ovarian cancer, a complete hysterectomy with bilateral salpingo-oopherectomy is the procedure of choice. Because some of these symptoms are also seen in ovarian cancer, the nurse should be sure to assess the patient further.

4. A 17-year-old girl comes to the health department clinic to renew her oral contraceptive pills. During the physical examination, the nurse observes that the girl has broken blood vessels on her face and her lips are cracked and chapped and her fingers are callused. What further actions will the nurse perform? (Select all that apply.) A. A weight assessment B. Assessment for depression C. Draw blood for electrolytes D. Discussion about anorexia nervosa E. Discussion about bulimia

ANS: A, B, C, E Bulimia nervosa is a syndrome that consists of a cycle of binge eating and purging. Physically, the adolescent with bulimia nervosa may exhibit physical changes related to forced, excessive vomiting: cracked and damaged lips, tooth damage, callused fingers and hands, and broken blood vessels in the face. Other findings that may not be readily apparent include throat irritation, esophageal inflammation, and parotitis from vomiting, as well as rectal bleeding from overuse of laxatives. Bulimia is also associated with depression. The nurse should assess the teen's weight, screen her for depression, draw blood for electrolyte imbalances, and discuss bulimia.

10. A visiting nurse is seeing an older woman with the nursing diagnosis of risk for trauma related to decreased bone density secondary to osteoporosis. Which assessment findings would indicate to the nurse that a priority goal for this diagnosis has been met? (Select all that apply.) A. All scatter rugs have been removed. B. Burned-out light bulbs have been replaced. C. Hot water heater temperature is set to 110°F. D. Patient wears non-skid shoes or slippers. E. Pets have been given away to friends.

ANS: A, B, D A priority goal for this diagnosis is to make the home safe. Removing scatter rugs, having the home well lit, and wearing non-skid footwear are all indications that the home is safe. The temperature on the water heater is important to prevent injury, but is not related to osteoporosis. Giving away pets is not advised, as pets often contribute to emotional well-being. However, they can get underfoot, and the nurse needs to caution the patient about this risk.

2. A community health nurse is packing a kit of play items for the families who will be visited today. One family has an infant and a preschooler. Which toys should the nurse include in the kit? (Select all that apply.) A. Blocks B. Coloring books C. Ride-on train D. Simple board game E. Stuffed animals

ANS: A, B, D An infant is in the stage of solitary play. Appropriate toys include blocks, books, rattles, push-pull toys, and musical toys. The preschooler is in the stage of associative play. Appropriate toys for this child include imitative games, simple arts and crafts, simple board games, interactive games, alphabet or color games, coloring and drawing, and simple computer games. The ride-on train and the stuffed animals are more appropriate for a toddler.

11. The reproductive care clinic nurse teaches young women about their risk for sexually transmitted infections (STIs). Which factors does the nurse include? (Select all that apply.) A. Alkaline pH of the vagina B. Increased genital mucosal surface area C. Increased number of pubic hair follicles D. Prolonged exposure to semen E. Temperature of the vaginal area

ANS: A, B, D Physiological factors that predispose women to increased susceptibility to sexually transmitted infections include an increased genital mucosal surface area, retention of semen in the vagina for several hours following intercourse, and the pH of the vagina. During menstruation, women are more vulnerable to infection because the pH of the vagina becomes more alkaline, thereby becoming more hospitable to viral and bacterial transmission and growth. Number of pubic hair follicles and vaginal temperature are not related.

3. A nurse is preparing to educate a group of parents about injury prevention in adolescents. Which topics should the nurse plan to include as priorities? (Select all that apply.) A. Bicycle safety B. Gun safety C. Home safety D. Driving safety E. Water safety

ANS: A, B, D, E In adolescents, the most common causes of injury are motor vehicle crashes, bicycles (includes skateboarding and skating), firearms, and water activities. Home safety, although always important, is a topic more appropriate to families with younger children.

9. The nurse working with older women knows that risk factors for osteoporosis include which of the following? (Select all that apply.) A. Asian ethnicity B. Excessive consumption of caffeine C. Large frame D. Regular physical activity E. Cigarette smoking

ANS: A, B, E Risk factors for osteoporosis can be found in Box 4-9 and include Asian (and Caucasian) ethnicity, excessive caffeine or alcohol use, and smoking. A small frame, not a large one, is a risk factor due to decreased stress on the bones. Regular activity (particularly weight-bearing exercise) is a preventative factor.

5. The clinic nurse talks with parents about the signs and symptoms of substance use because their 12-year-old twins will be attending a new school in the fall and they wish to be prepared. The nurse correctly describes the potential symptoms of substance abuse, including which of the following? (Select all that apply.) A. Chronic cough B. Euphoria C. Irritability D. Nausea and vomiting E. Red and glazed eyes

ANS: A, C, E There are many warning signs to alert parents to adolescent substance abuse. Physical signs include fatigue, red and glazed eyes, chronic cough, and health complaints. Emotional signs include personality changes, sudden mood swings, irritability, poor judgment and decision making, depression, and lack of interest in things that were of previous interest.

29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily.

ANS: B Alcohol intake, smoking, and weight maintenance all affect breast health. However, this woman's highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

27. The nurse prepares to offer health screening and promotion activities for women aged 40-60. Which activity does the nurse plan to include as a priority for this group? A. Alzheimer's disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations

ANS: B Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40-55. The priority screening activity is for breast cancer. Alzheimer's disease screening is typically done in the older patient. Gardasil is recommended for females aged 9-26. Influenza vaccinations are important for all ages.

5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much? A. 15% B. 25% C. 30% D. 35%

ANS: B Diet and nutrition are especially important for facilitating optimal growth and development during adolescence. Adequate nutritional intake is essential to accommodate the growth spurt that occurs during this time. Adolescents gain approximately 25% of their adult height and 50% of their adult weight throughout this time period.

17. A school nurse is preparing educational activities for all high school students on reproductive health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate? A. Argue that abstinence-only programs do not work and are not valuable. B. Discuss the need to have information appropriate to the teens' experience. C. Plan the program but encourage questions not related to the prepared material. D. Prepare an abstinence-only program because teens should not have sex.

ANS: B Education on sexual health should take into consideration the age and sexual experience of the audience. For teens who have not yet had sexual intercourse, an abstinence-only program might make sense. However, if the teens have already engaged in sexual intercourse, they are likely to continue this behavior, and the program should focus on using condoms in order to avoid unprotected sex and its risks. Abstinence-only programs cannot be characterized as being of no value. Encouraging teens to ask questions off the prepared topic is a passive-aggressive action. It is not up to the nurse to decide if teens should have sex or not.

25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil vaccination. After giving the shot, what instruction does the nurse provide to her? A. Return in 1 month for the next shot. B. Return in 2 months for the next shot. C. Return in 6 months for the next shot. D. Return in 1 year for the next shot.

ANS: B Gardasil is given in a series of three injections. The second shot is 2 months after the first. The third shot is 6 months after the first. The other options are incorrect.

1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care? A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention

ANS: B Health promotion refers to the advancement of health to the highest degree possible for an individual. One activity is providing vaccination clinics for older adults. Disease prevention focuses on the implementation of strategies to reduce the incidence of disease or the development of comorbid illnesses in individuals with existing diseases. Health screening (secondary prevention) aims to diagnose diseases early and begin effective treatment immediately.

20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most appropriate? A. Ask if she knows how overweight she is. B. Assess the woman for stress-related problems. C. Caution her about related chronic illnesses. D. Encourage the woman to exercise more.

ANS: B In young adulthood, women especially begin to manifest stress-related disorders, including comfort eating. The nurse's best action is to assess the woman for this problem. The nurse can encourage her to exercise and can caution her about the relationship between poor nutrition and chronic illness, but if stress is causing the woman to overeat, she probably will not be able to make significant changes without addressing the cause. Asking the woman if she knows how heavy she is right now is disrespectful and will likely end the therapeutic relationship.

6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information? A. High risk: Call the school district counselor. B. High risk: Contact 911 immediately. C. Low risk: Send a referral home with the student. D. Moderate risk: Call the parents to come get the teen.

ANS: B Individuals who have suicidal thoughts should be assessed for a specific plan, the means to carry out the plan, and previous suicide attempts. This student has two of the three high-risk identifiers, so the teen should be seen by a mental health professional immediately. The safest way to ensure this occurs is to access the emergency medical system. The district counselor may not be prepared to deal with this situation and may not be available. The student is not low risk, so a referral should not be sent home. The student is not moderate risk, and the burden of ensuring immediate access to a health-care professional should not be placed on the parents, who also may be unavailable.

18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for violence. Which statement by a participant indicates understanding? A. "Friends of mine have said they would be willing to help in a crisis." B. "If good communication doesn't solve the problem, I will leave." C. "If we can't settle our differences, we will have to start talking all over again." D. "My mother can help my boyfriend and me resolve a conflict."

ANS: B Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message.

11. A mother who has three older children now has a newborn. She complains to the physician that sleeping on his back has caused her baby to have "a funny-shaped head" that the other kids didn't have. She doesn't want to continue having the baby sleep on his back. Which action by the nurse is best? A. Document the comments and alert the physician to the concern. B. Encourage her to put the baby on his stomach during the day. C. Explain that babies need to sleep on their sides at all times. D. Tell her that back-sleeping isn't important after 5 months of age.

ANS: B The American Academy of Pediatrics recommends that all infants be placed on their backs when sleeping. This is probably new information the mother did not have for her older children. If the mother is concerned about plagiocephaly (misshapen head), she can be taught to place the baby on the stomach with a small rolled towel under the arms for support and comfort. Alternating positions in the crib and side-lying for short periods in the presence of an adult are also alternatives. Documentation should always occur, but is not the most important action. Telling the mother that babies need to sleep on their sides at all times is incorrect. Sleeping on the back is important for all infants.

24. A nurse reads in a patient's chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this woman's treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron)

ANS: B The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation.

40. The nurse notes that a patient's chart contains the results of an MMSE. What can the nurse surmise about this patient? A. Behind on recommended immunizations B. Concerns about cognitive functioning C. Tracking changes in bone density D. Worried about cardiovascular health

ANS: B The MMSE (Mini-Mental State Examination) is a screening test for cognitive function. The other options are not related.

44. A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test? A. At age 19 B. At age 21 C. Before sexual activity D. No specific age

ANS: B Women should have their first Pap test at age 21.

1. The nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. What does the nurse tell the mothers about breast milk? (Select all that apply.) A. Fewer nutrients B. Less casein C. Less protein D. More calories E. More carbohydrates

ANS: B, C, E Human breast milk contains more carbohydrates, less protein, and less casein than cow's milk or infant formulas. Commercially prepared formulas have the same essential nutrients for growth and development and do not have fewer calories.

32. A nurse is reviewing the results of several patients' cholesterol and lipid screenings. For which patient is the action appropriate? A. HDL cholesterol 66 mg/dL: Evaluate patient for cardiovascular risk. B. LDL cholesterol 98 mg/dL: Instruct patient to take fish oil 3 gm daily. C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. D. Triglycerides 132 mg/dL: Refer to dietician for comprehensive diet education.

ANS: C A cholesterol below 200 mg/dL is desirable, so this patient's level is high. The nurse should plan to teach this patient about heart-healthy lifestyle changes. The other laboratory values are in the desirable range, so no action is necessary.

41. A 65-year-old patient is in the clinic for an annual influenza vaccination. What other health promotion activity should the nurse encourage specifically for this patient? A. Heart-healthy eating B. Participating in social activities C. Pneumococcal vaccination D. Regular exercise

ANS: C All options are important for the older adult, but around the age of 65, the older adult should receive the pneumococcal vaccine. The nurse planning individualized care for the patient would encourage the patient to get this vaccination.

21. A nurse is teaching a 24-year-old male about reproductive health. Which information should the nurse provide this patient about testicular cancer? A. Annual screening is recommended for testicular cancer. B. If the epididymis is tender to the touch, that is concerning. C. Perform a testicular self examination after a warm shower. D. Because testicular cancer is rare at this age, no action is needed.

ANS: C Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 20-34. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure.

4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age? A. 1 month B. 2 months C. 3 months D. 4 months

ANS: C At 3 months, infants begin to roll over from the stomach to the back and to turn toward loud sounds. These activities can pose a safety hazard related to the changing tables used for changing diapers, and parents should be told to keep a hand on their infant at all times.

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best? A. Compliment the mother on her parenting skills. B. Document that the baby is eating finger foods now. C. Stop the mother from feeding the hot dog to the baby. D. Teach the mother that hot dogs are poor nutrition.

ANS: C At this age, examples of appropriate finger foods include small pieces of lightly toasted bagel, small pieces of ripe bananas, well-cooked pasta, teething crackers, and low-sugar "O" shaped cereal. Protein sources such as meat should be pureed to avoid choking. The nurse should gently stop the mother from feeding the hot dog to the baby. Hot dogs are not the most nutritional food, but safety comes first, so this is not the best answer. Documentation is always important but can be done later. The nurse should find something to compliment the mother on to help establish a trusting relationship.

3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her? A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age

ANS: C Between 8 and 11 years of age, children begin to focus on their own development and to contrast it with their friends' development. At this time, parents should begin to educate their children about the names and functions of the male and female sexual organs, puberty, the menstrual cycle, sexual intercourse, pregnancy, pregnancy prevention, same-sex relationships, masturbation, and the spread of sexually transmitted infections, and encourage dialogue about personal expectations and values regarding sexual activity.

34. A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin

ANS: C Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy.

38. A nurse is working with an older adult who has never exercised despite understanding the health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen? A. Ask the patient if dancing sounds like fun. B. Encourage the patient to join a fitness club. C. Explain how exercise increases independence. D. Have the family talk with the patient about it.

ANS: C Maintaining physical fitness in later years contributes to health, well-being, and independence. If the patient already understands the health benefits of exercising, asking about dancing and joining fitness clubs is not likely to get the desired response. However, if the nurse can show the patient how being physically fit may mean more years of independent living, the patient might be willing to make some small changes. Asking the family to talk with the patient is not showing the nurse in action.

47. The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching? A. "Are you sure your breasts are emptying?" B. "Does the baby put everything in his mouth?" C. "Does your baby sit in a high chair yet?" D. "Is your baby using the pincer grasp yet?"

ANS: C The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 8-10 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity.

ANS: C The most reliable theory on drug use focuses on role development. As young adults take on the roles of spouse and parent, illicit drug use can interfere with performing those roles. Also, when assuming adult roles is seen as incompatible with illicit drug use, substance use declines. The nurse's best action is to help the husband see how binge drinking and drug use are not compatible with the father and role model roles. The nurse could assess the father for reasons he continues to abuse substances, but this will not help him diminish his use. Stating that the baby can be taken away may be seen as a threat and will probably cut off communication. Likewise, telling the father he will be putting his baby at risk may sound judgmental and threatening as well.

15. The school nurse wants to create a safe driving program for the high school students. In order to have the greatest impact on safety, on which issue should the nurse focus? A. Female driving B. Late-night driving C. Seat-belt use D. Sleep deprivation

ANS: C The risk for motor vehicle accidents is greater among adolescents than for any other age group. Factors associated with this include the inability to assess hazardous situations while driving, speeding, driving under the influence of drugs and/or alcohol, and a low compliance with seat-belt use. Females are actually less likely to be in a motor vehicle crash than males. Late-night driving does not appear to increase risk. Although teens are often sleep deprived, this does not appear to be related.

35. A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. "Acupuncture has been shown to work better than other body therapies." B. "Herbs are a great option as they do not typically have side effects." C. "Mind-body, manipulative, or traditional Chinese medicine are safer than herbs." D. "Research shows that black cohosh significantly reduces hot flashes."

ANS: C There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind-body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse's best answer is to explain this to the patient.

22. A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin).

ANS: C This woman has manifestations of endometriosis. Diagnosis can be made via a pelvic exam, although it is often difficult to do so. Some physicians will order ultrasounds or laparoscopy with biopsy. The first step, however, is the pelvic exam, so the nurse should prepare the woman for this to occur. After making a diagnosis of endometriosis, the nurse can educate the woman on medical management, which includes using ibuprofen for pain.

46. At what age should the nurse prepare patients to begin thyroid function screening? A. 30 years B. 40 years C. 50 years D. 60 years

ANS: C Thyroid hormone function screening should begin at age 50 and occur every 5 years.

6. The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. Gonorrhea C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

ANS: C, D, E Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

45. A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls? A. Blood draw B. Limited pelvic exam C. No alternative D. Urine collection

ANS: D A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 13-18. The other options are incorrect.

12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health effects, what else should the nurse assess the patient for? A. Alcoholism B. Hepatitis C C. Lanugo D. Seat-belt use

ANS: D According to the results of a recent study, overweight teens tended to engage in high-risk behaviors such as smoking, chewing tobacco, and neglecting to wear a seat belt. The nurse should assess the teen for these behaviors. Alcoholism, presence of lanugo, and hepatitis C are not related.

14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What statement by the teen indicates that goals for this diagnosis have been met? A. "I don't want to cut out any more evening activities." B. "I sleep until about noon on Saturdays to catch up." C. "I take a long nap when I get home from school each day." D. "I try to keep the same sleep and wake times all week."

ANS: D Adolescents are commonly sleep deprived and often try to make up for their sleep deficit by sleeping more on weekends. This is actually detrimental, as the body has difficulty adapting to changing sleep routines. The teen who is keeping consistent sleep and wake times during the entire week has learned this fact and is probably getting better sleep than before. The other statements do not show understanding of sleep deprivation and ways to improve it.

2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant's immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months

ANS: D Because an infant's immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonate's immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infant's immune system.

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide? A. Brush the baby's teeth with special baby toothpaste. B. The child should see a dentist before the age of 2. C. All teeth should be in by age 2. D. Wipe the baby's gums with moist gauze.

ANS: D Dental hygiene should be started early. Even before a child has teeth, the gums can be wiped with a damp cloth or gauze. Toothpaste cannot be used before age 2 (because of the risks associated with swallowing it). A dentist should examine a baby's teeth within 6 months of the eruption of the first tooth, but no later than the first birthday. Children should have all 20 primary teeth by the third birthday.

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight? A. "Are you willing to talk about your weight gain this year?" B. "Do you realize your weight puts you into an obese category?" C. "Do you participate in any activities or exercise?" D. "What do you think about your weight right now?"

ANS: D During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. The other questions may put the teen on the defensive and close communication. Answer choice 1 particularly is an example of poor communication, as it is a "yes-no" question. The teen could simply answer "no" and the nurse would have no recourse other than to end that line of discussion.

37. A nurse notes that a woman's chart lists "dyspareunia" as a diagnosis. In planning education for the patient, which topics would the nurse include? A. Black cohosh and soy nuts B. Kegel exercises and use of a pessary C. Nonsteroidal anti-inflammatory medications D. Water-based vaginal lubricants

ANS: D Dyspareunia is painful intercourse, often seen in postmenopausal women. Prolonged foreplay and the use of water-based vaginal lubricants are helpful suggestions to ease this symptom. Black cohosh and soy nuts are often used to relieve menopausal symptoms. Kegel exercises and pessaries are used for urinary incontinence. Nonsteroidal anti-inflammatory medications are used for mild pain and swelling.

33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best? A. "No, at your age, fluctuations in your menstrual cycle are normal findings." B. "No, menopause only begins in women after the age of 55." C. "Yes, not having a period for more than 6 months is diagnostic of menopause." D. "You have to go 1 year without a menstrual period to be sure that menopause has occurred."

ANS: D Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a woman's cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 35-60 years.

39. An older patient has never exercised, but wants to begin now. What response by the nurse is best? A. "At your age, exercise will not benefit you." B. "Good for you! I am so proud of you!" C. "Remember to stretch before exercising." D. "Start with exercising for only 5 minutes a day."

ANS: D Older adults who are beginning to exercise for the first time in their lives (or for the first time in a long time) should begin with only 5 minutes per day. Exercise is beneficial at any age. Reminders about stretching and praising the patient are also good options, but safety comes first.

26. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching should the nurse plan for this patient? A. Avoid sexual intercourse during your period. B. Take prophylactic antibiotics daily. C. Void every 4 hours while awake. D. Wipe from front to back after using the bathroom.

ANS: D Preventative measures for UTIs include drinking plenty of water, voiding when the urge is felt, wiping from front to back, taking showers instead of baths, not using perfumes or bath oil if baths are taken, wearing cotton underwear, and avoiding feminine hygiene sprays and scented douches. The other options are not related.

13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula. The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best? A. Ask the student if she had pain medication this morning. B. Document the findings and send the student to classes. C. Have the student lie down and call 911 immediately. D. Question the student about eating and exercising patterns.

ANS: D Signs of anorexia nervosa include weakness, dizziness, excessive weight loss, intolerance to cold, bradycardia, hypotension, bone loss with fractures, constipation, and the development of lanugo. The nurse should assess the student for the restricted eating and excessive exercise that is characteristic of this disorder. The lower blood pressure and pulse might be the result of pain medication, but the student should not have been allowed to return to school on these medications, and this does not explain why the student appears to feel cold. Documenting the findings is important, but the school nurse has an excellent opportunity to assess and intervene if needed. Calling 911 immediately is not warranted.

10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention? A. A cat is sitting on the kitchen counter by the stove. B. Roaches are evident in the kitchen and in the pantry. C. The baby is on a carpet that is stained and worn out. D. The crib has dirty bumper pads and a dirty comforter.

ANS: D To prevent sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that all babies be put to sleep on their backs and that cribs be free of toys, comforters, and bumpers. Vaccinations and breastfeeding are also recommended. The other options show a house that is dirty but does not rise to the level of needing immediate intervention.

8. A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticity E. Vaginal dryness

ANS: D, E Physical changes in the older woman that increase susceptibility to HIV infection include loss of vaginal elasticity and vaginal dryness. Increased promiscuity is not a physical factor (and is not known to be a characteristic of the older adult). Mild isotonic dehydration is often seen in older adults, but is not related. Vaginal pH is not related.

7. The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.) A. Aspirin prophylaxis B. Breast cancer screen C. Colorectal cancer screen D. Influenza vaccine E. Tobacco and alcohol screen

ANS: D, E Priority health services for the young adult population include influenza vaccination and tobacco, alcohol, and drug screens, among other things. Aspirin prophylaxis and breast cancer screen are more appropriate for middle-aged adults.