OB/Community Exam 3

Which activity demonstrates the nurse's role in secondary prevention of teenage pregnancy? Assisting with early initiation of prenatal care Offering support services to a new teenage mother Counseling about STDs Providing a comprehensive sex education program

Assisting with early initiation of prenatal care Assisting with early initiation of prenatal care is an activity that demonstrates secondary prevention. Offering support services to a new teenage mother is an activity that demonstrates tertiary prevention. Counseling about STDs is an activity that demonstrates tertiary prevention. Providing a comprehensive sex education program is an activity that demonstrates primary prevention.DIF: Cognitive level: ApplicationREF: p. 617

What is a responsibility of the government in protecting the community from infectious diseases? A. Ensure protection of individual rights B. Ensure safety of populations C. Ensure adequate public safety officers D. Ensure restrictions for ill workers

B Ensuring the safety of populations takes precedence over individual rights. Laws are created and regulated to protect the health of the population. Although the government does have control over the number of public safety officers, public safety officers do little to control infectious disease. Many states have laws to enforce treatment or isolation of persons with known communicable diseases. However, they do not implement restrictions for all ill workers.

Secondary prevention is used when a nurse: A. provides immunizations. B. screens for tuberculosis. C. educates about proper hygiene. D. provides counseling to a client diagnosed with HIV.

B Screening for tuberculosis is an intervention at the secondary level of prevention. Secondary prevention includes measures directed at early detection of disease in order to provide early treatment, ensure treatment effectiveness, and minimize the spread of disease within the population. Immunization is an intervention used at the primary level of prevention. It is used to prevent the disease from occurring. Education and counseling are not secondary prevention measures.

The primary strategy that a nurse can use to control communicable disease is to provide education about: A. disease reporting. B. proper handwashing. C. safe food preparation. D. home safety.

B Teaching about proper handwashing and other measures of proper hygiene is a primary focus in the control of communicable disease. Disease reporting is an important function of the community health nurse. However, reporting a disease does not help control the spread of the communicable disease. Safe food preparation is also important, but is not a primary strategy used to control communicable disease. Teaching about safety in the home does little to prevent the spread of communicable disease.

Which statement describes the infant mortality rate? A. The rate is gradually increasing in the United States. B. The rate is used to determine the overall improvement in health. C. The rate is similar between majority and minority populations. D. The rate in the United States is the lowest in the world.

B The infant mortality rate is used in determining the overall improvement in health in the United States; it is also used in making comparisons with international rates. Traditionally, the high rate of infant mortality has been viewed as an indicator of unmet health needs and unfavorable environmental conditions. The infant mortality rate has steadily declined. There is quite a large disparity between minority and majority populations in relation to infant mortality rate. White infant mortality rate was 5.7 per 1000 live births, compared with 14 per 1000 live births for black infants. The United States infant mortality rate is still higher than that of other industrial countries.

The morbidity rate relates to the: A. life expectancy of an individual. B. incidence of illness in a population. C. cause of death in a population. D. number of people who die from a disease.

B The morbidity rate relates to the incidence of illness in a population. It includes measures related to specific symptoms of a disease, days lost from work, and number of clinic visits. Morbidity rate reflects the frequency of illness, symptoms of disease, lost days of work, and number of clinic visits. It does not reflect an individual's life expectancy. The cause of death and number of people who die from a disease are reflected in the mortality (death) rates.

The nurse is providing education about condom use at a community clinic for older adults. Which of following statements demonstrates that the adults understand correct use of condoms? (Select all that apply.) A. "I can use any kind of lubricant such as lotions or baby oil." B. "Before using the condom, I should check the package for damage or expiration." C. "I need to use a condom to help reduce the risk of sexually transmitted infections." D. "A good place to store condoms is in the bathroom so they don't dry out."

B. "Before using the condom, I should check the package for damage or expiration." C. "I need to use a condom to help reduce the risk of sexually transmitted infections." Rationale: Older adults sometimes are not familiar with condom use and storage. Teach them to use water-based lubricants because oil-based products contribute to breakage of latex condoms. Condoms need to be stored in a cool, dry location away from sunlight.

Which of the following represents a nonjudgmental approach when gathering a sexual health history? A. How do you and your wife/husband feel about intimacy? B. Do you have sex with men, women, or both? C. Are you heterosexual or homosexual? D. What is your sexual orientation?

B. Do you have sex with men, women, or both? Rationale: A nonjudgmental attitude facilitates trust and open communication between the nurse and patient. Using terms such as partner versus wife or husband allows the patient to identify his or her sexual preference. The terms gay, lesbian, bisexual, or transgender are preferred over the terms heterosexual or homosexual and are more specific in reference to sexual practices

The nurse is providing education on sexually transmitted infections (STIs) to a group of adolescents. The nurse knows that further teaching is needed when one of the adolescents states: A. "A vaccine is available to reduce infection from certain types of human papillomavirus." B. "I should be screened for an STI after I am with a new partner." C. "I know I'm not infected if I don't have any symptoms such as discharge or sores." D. "A viral infection such as herpes or human papillomavirus cannot be treated with antibiotics."

C. "I know I'm not infected if I don't have any symptoms such as discharge or sores." Rationale: Many STIs have few symptoms and are often detected during routine screening. The risk of infection is higher in people who are under the age of 25 and who have multiple sex partners. Viral infections cannot be cured with antibiotics, but medication is available to suppress outbreaks. Bacterial infections can be treated with antibiotics, but the infection can recur with new exposure.

12.3 A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C."It is needed to counteract hypotension." D."It is needed to prevent oligohydramnios."

C. "It is needed to counteract hypotension." Maternal hypotension can occur following an epidural block and can be offset by administering an iV uid bolus.

A nurse is caring for a pregnant client who is being monitored for gestational hypertension. Which assessment finding indicates a worsening of gestational hypertension and the need to notify the healthcare​ provider? Edema​ 2+ Increased urine output Client complains of blurred vision and a headache . Blood pressure​ 140/90 mmHg

Client complains of blurred vision and a headache Rationale: Complaints of blurred​ vision, headache,​ and/or epigastric pain are indications that the condition is worsening. Baseline BP for preeclampsia is​ 140/90 mmHg. Any increase of 30 systolic and 15 diastolic can indicate possible gestational hypertension. Gestational hypertension will cause a decrease in urine​ output, not an increase. Edema of​ 2+ is a normal finding.

A 54-year-old male patient who is being seen for an annual physical tells the nurse that he is having difficulty sustaining an erection. The nurse reviews his health history and notes no current health problems except medical treatment for depression. The nurse understands that: A. A personal issue such as this is best addressed by the male physician during the examination. B. Erectile dysfunction affects most men over the age of 50. C. The patient needs to be screened for sexually transmitted infections (STIs). D. Antidepressant medication may be affecting his sexual functioning.

D. Antidepressant medication may be affecting his sexual functioning. Rationale: Many drugs can affect sexual function. Antidepressants can alter sexual functioning by blocking neurotransmitters. The decision to screen the patient is based on his health history, assessment, and sexual practices.

12.5 A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min. B. Apply a warm blanket. C. Assist the client to a side‐lying position. D. Place an oxygen mask over the client's nose and mouth.

D. Place an oxygen mask over the client's nose and mouth. The client is experiencing hyperventilation caused by low serum levels of PCO2. Placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the PCO2 to rise and alleviate the numbness and tingling.

11.1 A nurse in the labor and delivery unit receives a phone call from a client who reports that her contractions started about 2 hr ago, did not go away when she had two glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 seconds. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, which of the following clinical findings should the nurse recognize that the client is experiencing? A. Braxton Hicks contractions B. Rupture of membranes C. Fetal descent D. True contractions

D. True contractions True contractions do not go away with hydration or walking. They are regular in frequency, duration, and intensity and become stronger with walking.

Which statement about health concerns of school-age children is correct? The female teenage pregnancy rate has been increasing. The prevalence of obesity has been decreasing During the past 5 years, the prevalence of cigarette smoking has decreased. Dental caries is the single most common chronic childhood disease in the country.

Dental caries is the single most common chronic childhood disease in the country. Dental caries is the single most common chronic childhood disease in the country, five times more common than asthma. The female teenage pregnancy rate has been decreasing since its high in 1990. The prevalence of obesity among students has been increasing. It is now defined as an epidemic and is the fastest-rising public health problem in the United States. During the past 5 years, the prevalence of cigarette smoking among students has remained unchanged.DIF: Cognitive level: KnowledgeREF: p. 759

A nurse is working with a family that consists of a father, a mother, a 14-year-old daughter, a 7-year-old daughter, and a 4-year-old son. According to Duvall, which developmental stage would the family be experiencing? Families with adolescents (V) Families with school-age children (IV) Families with preschoolers (III) Families with infants and toddlers (II)

Families with adolescents (V) Duvall's eight stages for families are based on age and school placement of the oldest child. In this example, the 14-year-old would be the oldest child and would place the family in stage V, families with adolescents.DIF: Cognitive level: ApplicationREF: p. 682

The nurse is making a plan of care for a client with severe preeclampsia. Which of the following laboratory values would indicate the client has developed HELLP​ syndrome? ​(Select all that​ apply.) Low platelets Elevated liver enzymes Low liver enzymes Low hematocrit Low hemoglobin

Low platelets Elevated liver enzymes Low hematocrit Rationale: A client with HELLP syndrome will have a low​ hematocrit, (hemolysis), elevated liver​ enzymes, and low platelets. Low hemoglobin and low liver enzymes are not indicators of HELLP syndrome.

A nurse is caring for a pregnant client with preeclampsia. The nurse is at the bedside and notes that the client has now progressed to eclampsia. Which would be the​ nurse's first​ priority? Administer magnesium sulfate IV Assess BP and fetal heart rate Maintain an open airway Administer oxygen by mask

Maintain an open airway Rationale: When the client progresses from preeclampsia to​ eclampsia, a seizure is involved. A patent airway is the immediate priority when someone is having a seizure. The other options are all actions that would be​ taken, but maintaining a patent airway is the priority.

Which stage of addiction is a client in when alcohol and drugs are used on a daily basis to avoid pain and depression? First stage Second stage Third stage Fourth stage

Second stage The second stage in the process of addiction is dependency. Alcohol and drug use is daily or continuous and is done to avoid pain and depression. Use is out of control, as the addict attempts to feel normal. The first stage in the process of addiction involves experimental and social use. The second stage in the process of addiction is when the abuse happens. Alcohol and drugs are used regularly. Use may occur during the day and while alone rather than with others. There is not a third or fourth stage in the process of addiction.DIF: Cognitive level: KnowledgeREF: p. 635

A nurse is caring for a woman with​ preeclampsia, and is trying to keep her environment calm and quiet. What effect can overstimulation have on a client with​ preeclampsia? Seizure activity Weight gain Placental separation Sodium retention

Seizure activity Rationale:Overstimulation causes central nervous system​ changes, which can cause​ hyperreflexia, headache, and seizures. It does not cause weight​ gain, sodium​ retention, or placental separation. The client with preeclampsia should be encouraged to remain quiet and​ calm, with low lights and limited phone calls. Next Question

A client with​ pregnancy-induced hypertension desires to deliver vaginally. In which position will the nurse place this client to facilitate a vaginal​ birth? Lithotomy position ​High-Fowler position ​Sims' position Prone position

Sims Rationale For a client who wishes to deliver​ vaginally, the nurse would position the client in the​ Sims' (left​ side) or​ semi-sitting position.​ Lithotomy, high-​ Fowler, and prone positioning are not recommended for a vaginal birth in a client diagnosed with​ pregnancy-induced hypertension.

A client with menorrhagia asks why a complete blood count is being done. Which response by the nurse is the most​ appropriate? ​a "This will tell us if your blood count is low due to your increased​ bleeding." ​b "Because this may cause​ infection, we need to look at your white blood​ cells." c ​"You will have to speak to the midwife about​ this." ​d "The midwife ordered​ this; let​'s walk down to the​ lab."

a (Rationale Menorrhagia causes heavy menstrual bleeding and may increase the risk of anemia. A CBC may be completed to assess for the presence of anemia in these clients. Menorrhagia does not cause infection. The nurse is able to answer basic questions about laboratory tests.)

The nurse is discussing menopause with a​ 40-year-old client. During this​ discussion, the nurse identified which factor that determines when perimenopause may​ occur? a Genetics b Age of menarche c Being sexually active d Alcohol use

a (Rationale The age of perimenopause is genetically programmed and unrelated to the age of menarche. Cigarette smoking and living at high altitudes can lead to earlier menopause. Alcohol use and being sexually active does not influence perimenopause.)

A client who is interested in becoming pregnant is keeping a menstrual calendar and has a​ 29-day cycle. She asks the nurse when her ovaries are likely to be releasing an ovum. What is the nurse​'s best​ response? a "The most likely time for ovulation to occur is about two weeks after the start of your period. " b "You have an abnormal menstrual​ cycle, so you may need medication in order to produce mature​ ova." c "You will ovulate within a week after the end of your period. " d "There is no way to tell when the ovum will be released. It may happen at any time. "

a (Rationale The ovulatory phase occurs about midway through the reproductive cycle. The other answers would provide incorrect information to the client.)

A nurse caring for a client who has begun menopause selects the nursing diagnosis of deficient knowledge when the client makes which statement? a "I must be coming down with the flu because I am having hot flashes." b "I need to begin weight-bearing exercises such as walking." c "I should increase my daily calcium intake to 1200 mg." d "I need to obtain yearly mammograms."

a (Rationale: Hot flashes are a sign of menopause, not the flu. The nurse provides the client with education about symptoms and lifestyle changes for the woman entering menopause. Increasing calcium intake, weight-bearing exercises, and yearly mammograms are all recommendations for the perimenopausal woman.)

The nurse teaches a client who is to undergo a vaginal hysterectomy for dysfunctional uterine bleeding. The nurse knows the client has met teaching goals when she makes which statement? a "I will not begin menopause because only the uterus will be removed." b "I will continue to have menstrual periods." c "I will continue to take my oral contraceptives." d "I will no longer have ovaries."

a (Rationale: In a vaginal hysterectomy, only the uterus is removed. The ovaries are left in place so that the hormonal cycle continues and menopause does not ensue. The client will no longer have menstrual periods and there is no need to continue oral contraceptives since pregnancy cannot occur.)

A client with suspected menorrhagia is being assessed by the nurse at the clinic. What is the priority assessment the nurse must make in an effort to determine the cause of the disorder? a "Are you taking anticoagulants?" b "Have you increased your sodium intake?" c "Do you exercise vigorously?" d "Have you had the flu recently?"

a (Rationale: The client with menorrhagia (excessive or prolonged menstruation) should be evaluated for thyroid disorders, use of anticoagulants, and other uterine disorders. Intake of sodium and the flu are not associated with menorrhagia. Strenuous exercising is associated with amenorrhea. )

A vulnerable population is more likely to: a. include the middle-aged population. b. have difficulty accessing health care. c. have a longer life expectancy. d. have a primary health care provider.

b. have difficulty accessing health care. Vulnerable populations are more likely to have difficulty accessing health care to address health problems. Certain groups have been identified as being more vulnerable to health risks, including the poor, the homeless, the disabled, the severely mentally ill, the very young, and the very old. Vulnerable populations are more likely to have a shorter life expectancy or poor health outcomes from health conditions they experience. Vulnerable populations are less likely to have a primary health care provider because of the problems they have with accessing care.DIF: Cognitive level: ApplicationREF: p. 528

Ibrahim​ Moussad, an​ 18-year-old male, has come to the neighborhood clinic for an exam that is required before he can play sports. Ibrahim requests a male nurse. What will the nurse keep in mind as he takes​ Ibrahim's medical history and prepares to discuss contraceptive​ use? a Be aware of the​ client's cultural and religious beliefs b Influence the client so that he makes the choice recommended by the nurse c Remember that a teenager will not be truthful about his sexual history d Obtain​ Ibrahim's height and weight when obtaining the health history

a (The nurse needs to keep the​ client's cultural and religious beliefs in mind when discussing contraception. The nurse should provide useful information that allows the client to make an informed decision regarding contraception. A teenager will be truthful about his sexual history when treated with respect. The​ client's height and weight are obtained during a physical examination. )

Mrs. Makepeace is a​ 49-year-old woman who is being seen in the clinic for her annual physical examination. After her​ examination, she talks about her menopausal symptoms. Which information should the nurse include regarding home care planning to assist in management of menopausal​ symptoms? a Maintain adequate hydration b Wear​ tight-fitting dark clothing c Limit sexual activity d Keep bedroom warm at night

a (The nurse should educate the client to maintain adequate​ hydration, which will assist in management of menopausal symptoms. The nurse should educate the client to keep the bedroom cool to help with night sweats. Dressing in loose layers will provide comfort during hot flashes. Limiting sexual activities will not assist in managing menopausal symptoms.)

A​ 35-year-old woman, Shineka​ Majors, is being seen by the healthcare provider. The nurse collects the following data during the​ assessment: monthly​ dysmenorrhea, high stress​ job, and IUC device in place for 1 year. Which diagnostic test will the nurse prepare the client for during this​ appointment? a A pelvic exam b Therapeutic dilation and curettage​ (D&C) c Abdominal ultrasound d Urine drug screen

a (The nurse will prepare the client for a pelvic examination based on the symptoms the client is experiencing. A transvaginal​ ultrasound, not an abdominal​ ultrasound, may be required during the visit. There is no reason for a urine drug screen or therapeutic​ D&C based on the assessment findings.)

Jim and Barbara Hernandez are attending a preconception appointment. During this​ appointment, Barbara becomes tearful and​ states, "I​ don't think that​ we'll ever have​ children." What recommendation should the nurse make to increase​ Barbara's chances of becoming​ pregnant? a Participate in 30 minutes of aerobic exercises daily b Take​ 5,000 units of vitamin A each day c Restrict alcohol intake to 1 glass of wine in the evenings d Request spouse to limit cigarette smoking

a (To increase​ Barbara's chances of becoming​ pregnant, the nurse should suggest that Barbara participate in 30 minutes of aerobic exercises daily. The client who wants to conceive needs to consume ample quantities of essential nutrients such as​ calcium, protein, iron B​ complex, vitamin​ C, and magnesium. Alcohol is a teratogen and should be avoided all together. Barbara should avoid exposure to secondhand smoke.)

What is the order of least invasive to most invasive for procedures related to menstrual​ dysfunction? a Therapeutic dilation and curettage​ (D&C), endometrial​ ablation, hysterectomy b ​Hysterectomy, therapeutic dilation and curettage​ (D&C), ablation c Therapeutic dilation and curettage​ (D&C), hysterectomy, ablation ​d Hysterectomy, ablation, therapeutic dilation and curettage​ (D&C)

a (​Rationale: In a​ D&C, the cervical canal is dilated and the uterine wall is scraped. With an​ ablation, extreme heat or​ cold, or energy waves are used to vaporize the endometrial lining. A hysterectomy involves removal of the uterus in totality or partially and can be vaginally or abdominally accomplished.)

A couple going through fertility treatment is reviewing the process of in vitro fertilization​ (IVF) with the nurse. Which statement by either the man or woman indicates that the teaching has been​ effective? ​(Select all that​ apply.) ​a "An ultrasound will be used during the procedure to remove my​ eggs." b ​"My wife will have to have injections prior to the​ procedure." . ​c "The sperm will be deposited into my​ uterus." ​d "We can freeze embryos if we have​ extras." ​e "The embryos will be placed in my uterus 7dash-10 days after​ retrieval."

a,b,d

The nurse is educating a​ client, who is trying to​ conceive, about nutrition. Which essential nutrients should the client include in her daily​ diet? ​(Select all that​ apply.) a Iron b Protein c Vitamin A d Calcium. e Vitamin E

a,b,d (Rationale A woman who is trying to conceive should include ample quantities of essential nutrients with emphasis on​ calcium, iron, and protein. Vitamin E and A are not essential for a client who is trying to conceive.)

One of the most important influences on a teenager's decision to become sexually active is: attitudes and behaviors of peers. ethnic background and socioeconomic status. neighborhood and dwelling. religious upbringing.

attitudes and behaviors of peers. Research suggests that one of the most important influences on a teenager's decision to begin sexual activity is the attitudes and behaviors of peers. Adolescent motives for sexual behavior are linked to the desire for intimacy, social status, and pleasure. Before 1980, race, socioeconomic status, type of neighborhood and dwelling, and religion were significantly related to age at first intercourse. These differences are diminishing in significance. Attitudes and behaviors of peers appear to be the most important influence at this time.DIF: Cognitive level: KnowledgeREF: p. 606

A client has just been fitted for a diaphragm. What information about the diaphragm should the nurse include in the client​ education? a Must be left in place for 12 hours after intercourse b Must be refitted after childbirth c Should be replaced every 3 years d Can be used during menstrual period

b

During a preconception​ visit, the nurse recognizes that a​ 33-year-old client may benefit from genetic counseling based on what​ data? a History of alcohol use b Family history of genetic disorders c Client​'s age d Exposure to secondhand smoke

b ( Rationale The nurse should suggest genetic counseling based on the couple​'s family history of genetic disorders. Genetic counseling should be suggested for a woman over 35 years. Genetic counseling is not recommended for a client exposed to secondhand smoke or with a history of alcohol use.)

Mrs. Chan is coming to the clinic for an initial prenatal visit. The nurse is teaching Mrs. Chan about process of fetal circulation. The nurse would explain to Mrs. Chan that most of the fetal blood bypasses the liver through which fetal​ shunt? a Foramen ovale b Ductus venosus c Ductus arteriosus d Umbilical vein

b (Rationale There are three shunts that allow fetal blood to flow into the heart and​ brain, bypassing other organs in the body. The ductus venosus allows blood to flow from the umbilical vein into the​ heart, bypassing the liver. The foramen ovale connects the right and left atria. The ductus arteriosus allows blood flow from the aorta to the lower body. The umbilical vein is not a fetal shunt.)

An infertile couple will have follicular stimulation and retrieval of​ ovum, followed by mixing with washed donor sperm. One day​ later, the fertilized ovum will be placed in the fallopian tube. The nurse knows that education has been successful if the client says she is having what​ procedure? a Gamete intrafallopian transfer​ (GIFT) b Zygote intrafallopian transfer​ (ZIFT) c in vitro fertilization​ (IVF) d Tubal embryo transfer​ (TET)

b (Rationale ZIFT is the return of fertilized​ ovum, at the zygote​ stage, into the fallopian tube 18dash-24 hours after retrieval. GIFT is placing retrieved ovum and washed sperm into the fimbriated end of the fallopian tube. TET is placing embryos into the fallopian tube 42dash-72 hours after retrieval. IVF is the placement of embryos into the uterus 2dash-3 days after the ova are retrieved.)

A 50-year-old client confides to the nurse that she is experiencing dyspareunia during sexual intercourse. The nurse recommends which therapy for this client? a Tell the partner that sex is no longer desired. b Use a vaginal lubricant. c Consume alcohol to reduce inhibitions. d Reduce sexual contact to once a month.

b (Rationale: Older women and those experiencing menopause may have decreased vaginal secretions, causing a dry entry that can be painful and irritating to the vagina. The nurse could suggest using a lubricant to replace normal secretions. Before assessing for the problem, it is not appropriate to advise the client to tell the partner that sex is not desired. Advising the client to reduce sexual contact or use alcohol does not address the client's problem)

The nurse is assessing a 37-year-old woman who is complaining of mood swings, breast tenderness, and food cravings. The nurse asks the client for which additional information? a "Do you have edema as well?" b "When and how often do these symptoms appear?" c "Have you been in an accident?" d "Do you have a chronic disease?"

b (Rationale: The client is exhibiting symptoms of premenstrual syndrome (PMS), and the nurse would ask the client when and how often the symptoms occur in an effort to determine if the menses is the problem. These symptoms are not those of a person experiencing trauma or a chronic disease. The client may well have edema, but asking that elicits only more symptoms; the goal is to associate the symptoms with the menstrual cycle to diagnose PMS.)

A spouse and his client who is perimenopausal is questioning the nurse regarding self-care during this process. The nurse plans to focus teaching for this client on which priority of care? a Referring the client to a support group b Reducing the risks associated with menopause c Recommending hormonal therapy d Stressing the importance of foot care

b (Rationale: The priority of care is teaching the client lifestyle changes that can help reduce the risks associated with menopause. Referring the client to a support group may be a consideration, but is not the priority. The nurse can offer information regarding hormonal therapy, but it is the physician who makes the recommendation. Foot care is important to the woman who has diabetes. )

Theresa​ Jones, a​ 28-year-old female, is being seen in the clinic. Ms. Jones tells you the following during the health​ history: three skipped menstrual​ periods, history of thyroid​ disorder, recent weight loss following a strict diet and exercise regimen. She is not sexually active so she does not believe she is pregnant. Which diagnosis does the nurse anticipate for this client based on the assessment​ data? a Primary amenorrhea b Secondary amenorrhea c Oligomenorrhea d Endometriosis

b (The nurse anticipates the client will be diagnosed with secondary amenorrhea due to the risk​ factors/causative factors for this disorder obtained during the health​ history, including a history of thyroid disorder and recent weight loss. The assessment findings do not support the diagnosis of​ endometriosis, primary​ amenorrhea, or oligomenorrhea)

Which medication is used​ off-label to reduce the occurrence of hot flashes associated with​ menopause? a Raloxifene​ (Evista) b Venlafaxine​ (Effexor) c Levothyroxine​ (Synthroid) d Triphenylethylene​ (Tamoxifen)

b (Venlafaxine​ (Effexor) is an antidepressant used​ off-label to reduce the occurrence of hot flashes. Triphenylethylene​ (Tamoxifen) and raloxifene​ (Evista) are used to improve bone density and serum lipids in women who are menopausal. Levothyroxine​ (Synthroid) is ordered for a client with a history of hypothyroidism.)

Homelessness describes a person who (select all that apply): a. has no permanent residence. b. sleeps in a temporary shelter. c. sleeps in public. d. lives with relatives. e. has no fixed nighttime residence. f. lives in substandard housing.

b, c, e Homelessness describes a person who has no fixed nighttime residence, or who has a nighttime residence that is designated to provide temporary shelter or is a public or private place not intended to provide sleeping accommodations for human beings. Those who live with relatives or friends are not nearly as visible and are more likely to be omitted from federal resources designated for issues relating to homelessness.DIF: Cognitive level: KnowledgeREF: p. 544

A nurse is reviewing orders for a client who is being discharged after having a hysterectomy. Which symptoms will the nurse include that require notification of the healthcare​ provider? ​(Select all that​ apply.) a Decreased bowel elimination b Vaginal bleeding greater than a normal menstrual flow c Temperature greater than 100degrees°F ​(37.7degrees°​C) d Any reports of pain e Brown vaginal bleeding

b,c (Rationale Greater than normal vaginal flow should be reported as it assesses for hemorrhage. Temperature greater than​ 100°F can be indicative of infection. Some pain is expected but it should not be severe. Bright red bleeding should be reported. Appetite may be depressed and bowel may be sluggish as a result of anesthesia.)

In the nursing​ assessment, what health history questions may be asked of both male clients and female clients in need of family planning​ care? ​(Select all that​ apply.) a History of premature ejaculation or impotence b History of sexual​ trauma, including rape and incest c History of sexual​ activity, including age at first intercourse d History of contraceptive use with barriers to prevent STIs e History of​ menses, including regularity and first onset

b,c,d (Males and females should be asked about their sexual​ history, if barrier methods of contraception are used to limit exposure to​ STIs, if they have ever been victims of rape or​ incest; all of which help identify actual and potential health alterations and​ client-specific outcomes. Questions about menses and impotence are gender specific.)

The nurse is teaching older women about health risks for the postmenopausal period and would include which as health risks? (Select all that apply.) a Joint degeneration b Macular degeneration c Breast cancer d Cognitive changes e Gout

b,c,d (Rationale: Due to hormonal changes, postmenopausal women have a greater risk for macular degeneration, breast cancer, and cognitive changes than do premenopausal women. Joint degeneration and gout are not associated with menopause.)

The nurse is preparing to examine a client who is experiencing menopause. What information should the nurse obtain when performing a health​ history? ​(Select all that​ apply.) a Posture b Menstrual history c Medications d Sleep pattern e Vital signs

b,c,d (When performing a health history on a client experiencing​ menopause, the nurse should obtain information on the client​'s menstrual​ history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical examination.)

The nurse is providing education to a client who has been diagnosed with menopause. Which health promotion intervention should the nurse discuss with the​ client? ​(Select all that​ apply.) a Wearing tight clothing b Eating a balanced diet that includes​ fruits, vegetables, and​ high-fiber foods c Doing Kegel exercises d Avoiding alcohol and cigarette use e Participating in yoga classes

b,c,d,e (Rationale Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Keeping the bedroom cool will help control and provide comfort during night sweats. Caffeine intake should be decreased during perimenopause because it can trigger hot flashes. Sexual intercourse does not have to be avoided during​ perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.)

The nurse is providing information to a woman deciding on a form of contraception. What should be considered when determining the best contraceptive​ method? ​(Select all that​ apply.) a Accountability b Affordability c Ease of use d Effectiveness e Safety

b,c,d,e (Rationale Nurses should provide contraceptive information to the individual to assist in making the decision. In deciding on the best​ method, the individual will need to consider​ safety, effectiveness, ease of​ use, side​ effects, whether it is easily​ available, and whether it is affordable.)

Which treatment is considered an alternative or complementary therapy in managing a menopausal​ client? ​(Select all that​ apply.) a Hormone replacement therapy b Herbs c Yoga d Bioidentical hormones e Massage

b,c,d,e (​Herbs, yoga, bioidentical​ hormones, and massage are all considered alternative or complementary therapies when managing menopausal symptoms. Hormone replacement therapy is not considered an alternative or complementary therapy.)

The nurse recognizes that family planning care involves more than preventing pregnancy. What are some other goals of family planning​ care? ​(Select all that​ apply.) a Recognizing acceptance of all available forms of fertility treatment and contraception methods b Promoting healthy sexual function c Promoting a healthy body image d Encouraging the use of one contraceptive method over another e Providing knowledge about sexual and reproductive health

b,c,e (Rationale The role of the nurse is to help the client by promoting a healthy body​ image, promoting healthy sexual function and providing knowledge of sexual and reproductive health. The nurse does not encourage one contraceptive practice over another or try to influence a client to accept all available forms of fertility treatment or contraception. Nurses should present all the options available to the client.)

The nurse is preparing teaching for home care to a client with family planning needs. What topics should the nurse​ address? ​(Select all that​ apply.) a Avoiding all vaccines b Making a dental appointment c Smoking cessation d Participating in a weekly exercise class e Maintaining a​ balanced, nutritional diet

b,c,e (Rationale When teaching on home care to a client with family planning​ needs, the nurse should include the importance of maintaining a​ balanced, nutritional diet and making a dental appointment. The nurse should also include smoking cessation or the importance of reducing the number of​ cigarettes, if possible. The client should maintain a regular exercise routine and not just participate in a weekly exercise class. The client should also receive the flu vaccine.)

The nurse is teaching a group of women with premenstrual syndrome (PMS). A client asks what the major risk factors are for developing this disorder. The nurse replies that the risk factors include: (Select all that apply.) a teenage women. b Age greater than 30 years. c heart disease. d Depression. e major life stressors.

b,d,e (Rationale: Those most at risk for developing PMS are over the age of 30, are experiencing major life stressors, and have a history of depression. This condition is not necessarily seen in the teenage group or those with heart disease)

Which statement about the incidence and prevalence of substance abuse is correct? The highest incidence of dependence and abuse is among those younger than 18 years of age. There are no significant differences in the incidence of drug abuse and dependence in black and white populations. Illicit drug use is highest among the black population. More substance dependence is found in those with higher socioeconomic levels.

There are no significant differences in the incidence of drug abuse and dependence in black and white populations. There are no significant differences in drug abuse and dependence in black and white populations. Rates for blacks are 9.6%; rates for whites are 8.8%. The highest dependence and abuse is among the young, especially those 18 to 20 years of age. Illicit drug use is highest among American Indians or Alaska Natives (18.3%), followed by blacks (9.6%). More substance dependence is found in those at poorer socioeconomic levels.DIF: Cognitive level: KnowledgeREF: pp. 640-641

A client with severe preeclampsia is 12 hours postpartum after delivering a healthy baby. Why has the health care provider ordered a magnesium sulfate infusion to be continued for this ​client? There is a need to control postpartum bleeding. There is indication that fluid intake and output is inadequate after delivery. There is a need to suppress lactation after delivery. There is the possibility of seizures after delivery.

There is the possibility of seizures after delivery. Rationale: Magnesium sulfate may be infused up to 48 hours after delivery in order to prevent a seizure in a client with severe​ preeclampsia, or to prevent a repeat seizure in a client who has eclampsia. Magnesium sulfate does not aid​ diuresis, control​ bleeding, or suppress lactation.

The uninsured are: a. able to access health care services. b. at risk for poor health and premature death. c. decreasing in number. d. likely to use appropriate medications and follow-up services.

b. at risk for poor health and premature death. The uninsured are at increased risk for poor health and premature death. The uninsured are less able to access health care services and are more likely to forgo needed health care. The number of uninsured has increased since 2000. The uninsured are less likely to use appropriate medications and follow-up services. They are sicker when they seek treatment.DIF: Cognitive level: KnowledgeREF: pp. 532-533

A woman experiencing menopause has been placed on hormone replacement therapy​ (HRT) by her health care provider. What information regarding HRT should the nurse provide the​ client? ​a "Hormone replacement therapy will assist in alleviating severe manifestations when used on a​ short-term basis." b "You can stay on HRT as long as you need​ it." ​c "You will find that HRT will improve bone density and serum lipids. " ​d "Hormone replacement therapy is safe for​ long-term use.

a (Rationale Hormone replacement therapy​ (HRT) may increase a woman​'s risk of gynecologic cancers and cerebrovascular accidents.​ Therefore, HRT is not safe for​ long-term use. Hormone replacement therapy will be prescribed​ short-term to alleviate severe manifestations to menopause. HRT does not improve bone density and serum lipids.)

Cherralene Lyons is a​ 22-year-old client who is currently trying to become pregnant. She asks the nurse to explain the time frame between ovulation and fertilization. The nurse bases the response to Cherralene on which​ rationale? a Three days on either side of ovulation is optimal for fertilization. b The ovum is fertile for only 18 hours. c Approximately 1 day before or after ovulation is optimal for fertilization. d A period of​ 48-72 hours after ovulation is ideal for fertilization.

c (Rationale Ova are fertile for about 24​ hours; however, sperm can remain viable in the female reproductive tract for​ 48-72 hours​ (although they are fertile for only 24​ hours). Therefore, the best time for fertilization to occur would be 1 day before or after ovulation​ (a 48-hour​ window). Although the ovum is fertile for 24​ hours, this response would not address the​ client's question.)

A sexually active​ 33-year-old woman is interested in using a natural​ (fertility awareness​ based) contraceptive method. She works rotating shifts and has an irregular menstrual cycle. Which method would be best for the nurse to​ recommend? a Calendar method b Basal body temperature c Cervical mucus method d Abstinence

c (Rationale The cervical mucus method evaluates the changes in cervical mucus as ovulation​ approaches; this method is not affected by irregular menses or rotating shifts. Working rotating shifts can affect the basal body​ temperature, making the outcome difficult to determine. The calendar method is less effective if the woman​'s cycles are variable. Abstinence would not be recommended if the client has chosen to be sexually active.)

In which phase of cellular division does the cell divide into two daughter​ cells, each containing its own nucleus with 46 chromosomes and the same genetic makeup as its​ parent? a Metaphase b Interphase c Telophase d Anaphase

c (Rationale The telophase of cellular division occurs when the cell divides into two daughter​ cells, each containing its own nucleus with 46 chromosomes and the same genetic makeup as the parent.​ Anaphase, interphase, and metaphase are other phases of cellular division.)

A pregnant client asks when her baby will have a heartbeat. Which response by the nurse is​ correct? ​a "The baby​'s heart will begin to form when you are about 12 weeks​ pregnant." ​b "The heart forms when you are almost 16 weeks​ pregnant." ​c "The heartbeat of the embryo is present by week 4 of​ pregnancy." ​d "The heartbeat usually occurs around week 8 of​ pregnancy."

c (Rationale Week 3 is when the tubular heart is beating with a regular rhythm and pushing its own primitive blood cells through the main blood vessels. By weeks​ 8, 12, and 16 of​ gestation, the heart and circulatory system are well established.)

The nurse is talking with a 15-year-old client experiencing dysmenorrhea who asks if there are any remedies for the pain. The nurse responds with which advice? a "Increase the intake of sodium." b "Antibiotics will help the symptoms to subside." c "The recommended medication is an NSAID." d "Pain lasts only a few days and does not need treatment."

c (Rationale: An NSAID is effective for pain and the reduction of inflammation that may be causing pain. The client is helped to be free of pain, not to endure it. Antibiotics are not effective against pain and increasing sodium intake will increase edema and possibly the discomfort. )

The nurse is caring for a client with an endometrial implant. The client asks the nurse what happens to the implant now that she is experiencing menopause. The best reply by the nurse is that the implant: a tends to become malignant. b enlarges in size. c tends to atrophy and disappear. d increases in numbers.

c (Rationale: Endometrial implants tend to atrophy and disappear after menopause since ovarian hormones no longer stimulate them. Implants do not tend towards malignancy and, with no or little hormone stimulation, will not increase in size or number)

A 53-year-old woman asks the nurse if there are any definitive laboratory tests that would show that she has entered menopause. The nurse responds that which test is done to clarify the diagnosis? a Complete blood count b Blood, urea, nitrogen (BUN) levels c Follicle-stimulating hormone (FSH) level d Estrogen levels

c (Rationale: FSH blood testing can be done after the woman has gone one year without a menstrual cycle. If the FSH is high, a diagnosis of menopause can be made. Complete blood count, estrogen levels, and BUN blood tests are not diagnostic for menopause)

When discussing dietary guidelines with a woman who has premenstrual syndrome (PMS), the nurse recommends that the client reduce sodium intake for which reason? a Sodium increases reactive hypoglycemia, increasing physical manifestations. b Sodium increases thirst, thereby facilitating increased oral fluid intake. c Sodium restriction helps minimize fluid retention. d In and of itself, sodium is not harmful, but it may reduce cancer risks.

c (Rationale: For a woman with PMS, the nurse would recommend a decrease in sodium intake to help minimize the fluid retention due to increased production of aldosterone, which results in sodium retention and edema. Sodium does not increase reactive hypoglycemia and does not reduce cancer risks. Sodium does increase thirst but is not the reason for restriction in this case.)

During the examination portion of her annual checkup, a 55-year-old client has several new complaints. Which subjective symptoms of menopause would the nurse expect to find during data collection? a Hair growth on the upper lip b Decreased skin elasticity c Night sweats d Rise in vaginal Ph

c (Rationale: Night sweats is the only symptom that is subjective, reported by the client. Facial hair, decreased skin elasticity, and a rise in vaginal pH are all objective signs that can be observed by the nurse. )

What is a​ phenotype? a The person who can pass on a​ single-gene disorder but has no observable characteristics of it b The pattern of an​ individual's genetic makeup on the chromosomes c The inherited disorders that are carried on the X chromosome d The translation of an​ individual's genetic makeup into observable characteristics

d (The observable expression of inherited traits is called the phenotype. The pattern of an​ individual's genetic makeup on the chromosomes is the genotype. Inherited disorders carried on the X chromosome are​ X-linked (or​ sex-linked) disorders. The person who can pass on a​ single-gene disorder without observable characteristics is a carrier.)

Which psychological manifestation is not associated with ​perimenopause? a Mood swings b Forgetfulness c Loss of libido d Anxiety

d (The perimenopausal woman may complain of the following psychological​ symptoms: forgetfulness, difficulty​ concentrating, mood​ swings, and a loss of libido. The nurse does not anticipate the occurrence of anxiety in the perimenopausal or menopausal woman.)

Which contraceptive is not a barrier method of​ contraception? a Contraceptive sponge b Spermicide c Diaphragm d Vaginal contraceptive ring

d (The vaginal contraceptive ring is a​ sustained-release hormonal method and is not considered a barrier method of contraception.​ Spermicide, the​ diaphragm, and the contraceptive sponge are barrier methods. Either they prevent transport of sperm to the​ ovum, immobilize​ sperm, or kill sperm.)

In autosomal dominant​ disorders, the affected parent has what chance of passing the abnormal gene to each​ child? ​a 25% ​b 75% ​c 100% ​d 50%

d (With autosomal dominant​ disorders, the affected parent has a​ 50% chance of passing the abnormal gene to each child. With autosomal recessive​ disorders, if both parents are​ carriers, there is a​ 25% chance that the abnormal gene will be passed on to each child.)

One of the overall goals of physical education is to: decrease premature mortality. reduce the risk of developing chronic illness. encourage participation in interscholastic sports. participate regularly in physical activity.

participate regularly in physical activity. One of the overall goals of physical education is to promote regular participation in physical activity. Decreasing premature mortality and reducing the risk of developing chronic illness are both benefits of engaging in regular physical activity. However, these are not considered to be overall goals of physical education. Participation in interscholastic sports should be encouraged as a form of physical activity outside of formal physical education, but it is not one of the overall goals of physical education.DIF: Cognitive level: KnowledgeREF: p. 753

Increased recovery from all addictions is due to (select all that apply): Select all that apply. positive social support. residence in a family setting. adequate socioeconomic resources. absence of family history of abuse. increased age. male gender.

positive social support. residence in a family setting. adequate socioeconomic resources. absence of family history of abuse. Positive social support, residence in a family setting, adequate socioeconomic resources, and absence of a family history of alcoholism and drug abuse have also been associated with better chances of increased recovery from all addictions. Age and gender do not predict recovery.DIF: Cognitive level: KnowledgeREF: pp. 651-652

Emancipated minors typically include (select all that apply): Select all that apply. pregnant female adolescents. high school graduates. married adolescents. military personnel. adolescents living independently. boarding school residents.

pregnant female adolescents. high school graduates. married adolescents. military personnel. adolescents living independently. Emancipated minors are adolescents who are legally underage, but recognized legally as adults under circumstances prescribed by state law. Situations resulting in emancipation vary from state to state, but usually include pregnant female adolescents, high school graduates, married adolescents, military personnel, or adolescents living independently from their parents or guardians. Boarding school residents are not typically emancipated minors; they are dependents who live away from home to attend school.DIF: Cognitive level: KnowledgeREF: p. 695

Nurses who abuse substances are most likely to abuse: prescription drugs. alcohol. illicit drugs. hallucinogens.

prescription drugs. Nurses who abuse substances are most likely to abuse prescription drugs. Nurses have easy access to prescription drugs and might use them at higher doses, more often than prescribed, or for nonapproved reasons. Trinkoff and colleagues (1991) reported that alcohol abuse among a large sample of nurses was low, but nurses had higher rates of prescription drug use. Nurses are more likely to abuse prescription drugs rather than illicit drugs. Nurses are more likely to abuse prescription drugs rather than hallucinogens.DIF: Cognitive level: KnowledgeREF: p. 642

The overall goal of maternal-child home visiting programs is to provide: primary prevention. secondary prevention. tertiary prevention. linkages to community resources.

primary prevention. The overall goal of maternal-child home visiting programs is to provide primary prevention and health promotion. Some secondary prevention strategies may be used because there is early identification of potential problems. Some tertiary prevention strategies may be used because there may be treatment of illness and disabling conditions during the home visits. Linkages to community resources may be accomplished through the home visiting programs. However, the overall goal of maternal-child home visiting programs is to provide primary prevention and health promotion.DIF: Cognitive level: KnowledgeREF: p. 690

The core functions of school health services are to provide (select all that apply): Select all that apply. healthy school meals. referrals and linkages with other health providers. safe extracurricular activities for students. health-promotion programming for staff. health-promotion and disease-prevention education. direct client care, such as screening.

referrals and linkages with other health providers. health-promotion and disease-prevention education. direct client care, such as screening.

A client is planning to be treated for infertility with zygote intrafallopian transfer. (ZIFT) method. Which information should the nurse include when teaching the client about this type of treatment method? 1. fertilization takes place outside the body 2. ZIFT is helpful for clients with bilateral blocked fallopian tubes 3. Ova and sperm are needed for instillation into the fallopian tube 4. Fertilized ova are instilled into the vagina to enter the uterus

1 (The ZIFT method requires that fertilization take place outside the body. After fertilization has occurred the fertilized eggs are transferred by laparoscopy to the open end of the fallopian tub. At least one tube must be patent for this procedure to succeed, so it is not beneficial if the client has bilateral blocked tubes. Ova and sperm are instilled in the fallopian tube for fertilization when the gamete intrafallopian transfer method is used. With in vitro fertilization a fertilized ovum is instilled into the vagina to enter the uterus for implantation. )

A nullligravida client calls the clinic and tells the nurse she forgot to take her oral contraceptive this morning. The nurse should tell the client to; 1. take the medication immediately 2. restart the medication in the morning 3. use another form of contraception for 2 weeks 4. take two pills tonight before bedtime

1 (the nurse should instruct the client to take the med immediately or as soon as she remembers she missed the med. There is only a slight risk that the client will become pregnant when only 1 pill has been missed, so there is no need to use another form of contraception. However if the client wishes to increase the chances of not getting pregnant, a condom can be used by the male partner. The client should not omit the missed pill and then restart the med in the morning because there is a possiblillity ovulation can occur, after which intercourse could result in pregnancy. Taking two pills is not necessary and also will result in putting the client off her schedule.)

The nurse at a community health center is teaching a group of menopausal women about normal changes in the female sexual response that occur with aging. The nurse knows that the information is understood when one of the women states that: A. It's normal for me to take longer to reach an orgasm. B. I might experience chest pain or shortness of breath during intercourse. C. It's normal for me to lose interest in sexual relationships. D. I won't need to be concerned about contraception or sexually transmitted infections because of my age.

A. It's normal for me to take longer to reach an orgasm. Rationale: Normal changes in the female sexual response include a decrease in sex hormone levels, decrease in vaginal lubrication, longer time to reach orgasm, and longer refractory times. Many factors such as chronic illness, medications, stress, or loss of partner can influence the older adult's sexual activity. Older adults may not be as comfortable using barrier methods such as condoms and therefore are at increased risk for sexually transmitted infections.

12.4 A nurse is caring for a client who is in the second stage of Labor. The client's labor has been progressing, and she is expecting to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical

A. Pudendal A pudendal block is a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus.

The epidemiological triangle includes (select all that apply): A. person. B. causative agent. C. environment. D. underlying factors, disease, and symptoms. E. environment, nursing, and person. F. causative agent, disease, and treatment.

ABC The person, the causative agent, and the environment are the three factors involved in the epidemiological triangle

Artificial immunity is developed: A. through vaccination rather than exposure. B. when an individual has been infected with the disease. C. from the body's antigen-antibody response to infection. D. when the immune system is compromised.

A Artificial immunity is developed through vaccination rather than through exposure to a communicable disease. It can be active or passive. Natural immunity occurs when an individual has been infected with the disease and results because of the body's antigen-antibody response to infection. When the immune system is compromised there is an increased risk of infection, but it does not play a role in developing artificial immunity.

What is the role of the Centers for Disease Control and Prevention (CDC) in disease investigation? A. Send teams to the location of a disease outbreak to assist local authorities. B. Publish summaries submitted by the local health department. C. Supervise research of disease worldwide. D. Coordinate immunizations worldwide.

A One role of the CDC is that whenever an unusual outbreak of a disease occurs, the CDC sends scientific teams to the location of the outbreak to assist local authorities. The CDC is equipped with modern computer and telecommunication technologies to track data and coordinate monitoring efforts. The CDC receives reports from local and state health departments and publishes a yearly summary in the Morbidity and Mortality Weekly Report. However, this is not a role related to disease investigation. The World Health Organization (WHO) supervises research of communicable diseases worldwide and is currently coordinating worldwide immunization efforts.

An educational offering about wearing seat belts is presented in the community. This is an example of: A. primary prevention. B. secondary prevention. C. tertiary prevention. D. health maintenance.

A Primary prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease. Providing an educational offering about wearing seat belts meets the criteria for primary prevention because it is aimed at reducing the exposure of persons to injury. Secondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or slow its progression and prevent disability or complications. Tertiary prevention is aimed at limiting disability in persons in the early stages of disease and at performing rehabilitation for persons who have experienced a loss of function resulting from a disease process or injury. Health maintenance focuses on staying at a certain level of health rather than improving it.

It has been reported that 20% of the population may develop heart disease during their lifetime. This is an example of a(n): A. incidence rate. B. prevalence rate. C. mortality rate. D. morbidity rate.

A The incidence rate is the rate at which a specific disease develops in a population. The example that 20% of the population may develop heart disease during their lifetime demonstrates an incidence rate. The prevalence rate is all of the existing cases at a given point of time. Because this statement reflects "during their lifetime" rather than a given point in time, it does not reflect a prevalence rate. The mortality rate reflects the death rate. The morbidity rate reflects the illness rate. This statement does not reflect an incidence of illness related to heart disease.

12.1 A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take?(Select all that apply.) A. Encourage use of patterned breathing techniques. B. Insert an indwelling urinary catheter. C. Administer opioid analgesic medication. D. Suggest application of cold. E. Provide ice chips.

A, C, D

Certain cultural groups in the United States are disproportionately affected by diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The nurse understands that this is most likely caused by: (Select all that apply.) A. Expectations about behavior by men or women in the culture. B. Higher percentages of lesbian, gay, bisexual, or transgender individuals in the culture. C. Genetic predisposition to the disease in the culture. D. Communication patterns and language practiced by the culture.

A. Expectations about behavior by men or women in the culture. D. Communication patterns and language practiced by the culture. Rationale: Cultural factors such as gender, education, socioeconomic status, religion, language, and values influence the use of the health care system. Populations that are at increased risk for HIV are people who are intravenous drug users, those with hemophilia, and those who practice unprotected sex. Genetic factors often increase risk for certain health problems such as cardiovascular disease or cancers but do not usually increase the risk for HIV since it is a viral infection and not a genetic disease.

11.2 A nurse in the labor and delivery unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min.Contractions are occurring every 8 min and 30 to 40 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station. Which of the following stages and phases of Labor is this client experiencing? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage of labor

A. First stage, Latent phase in stage 1, latent phase, the cervix dilates from 0 to 3 cm, and contraction duration ranges from 30 to 45 seconds.

A menopausal woman is taking hormone replacement therapy (HRT). The nurse teaches the client that a warning sign for endometrial cancer that needs to be reported is: 1. hot flashes 2. irregular vaginal bleeding 3. urinary urgency 4. dyspareunia

2 (endometrial cancer has very few warning signs; irregular bleeding may be the only sign. Any irregular bleeding in a menopausal woman should be investigated, and an endometrial biopsy may be prescribed. Hot flashes result from decreased estrogen levels that acompany menopause. Urinary urgency should be monitored and treated as a separete problem. Dyspareunia is the occurrence of pain in the labial, vaginal or pelvic areas during or after sexual intercourse. It may be caused by inadequate vaginal lubrication in the menopausal woman)

A couple has completed testing and is a candidate for in vitro fertilization. The nurse is reviewing the procedure with them and realizes that further instruction is needed when the woman states: 1. one of the greatest risks is multiple pregnancies 2. I will need to redefine how I view my job if I do become pregnant 3. The fertilization procedure can be done any time during my cycle 4. We can use our own eggs and sperm or someone else's

3 (The best opportunity for successful pregnancy is when the normal menstrual cycle is created either naturally or through hormonal augmentation. Implantation can occur only when the levels of estrogen and progesterone are at particular levels. For many women, more than one fertilized egg is placed into the uterus. This increases the risk that more than one embryon will implant and reach maturity. Couples can choose to utilize their own eggs and sperm if they have been determined to be healthy, or they can choose to use donor oocytes and sperm. For many women who utilize in vitro fertilization, a career has taken precedence over family, and these women will need to rebalance a career with the demands of pregnancy and parenting.)

Which oral contraceptive is considered safe for use while breast feeding because it will not affect the breast milk supply once breast feeding has been well established? 1. estrogen 2. estrogen and progestin 3. progestin 4. testosterone

3 (progestin alone has no effect on breast milk or breast feeding once the milk supply is well established. Estrogen suppressess milk output. Testosterone is not given as a contraceptive)

A client 6 weeks postpartum is asking the nurse about progesterone for birth control. Prior to discussing options, what should the nurse determine? select all that apply 1. If the client has a STI 2. How willing her husband is to have her take the drug 3. If the woman is experiencing postpartum depression 4. That the woman is not currently pregnant 5. If the woman is breastfeeding

3,4,5 (Before discussing the use of medroxyprogesterone acetate as a birth control option, the nurse should determine if the woman has been depressed because medroxyprogesterone acetate can increase depression in a client with depression. The drug can be transmitted in breast milk, and the long term effects on the baby are not known. Women who are pregnant should not take medroxyprogesterone acetate. Medroxyprogesterone acetate does not tret or prevent STI, so this information is not essential when considering its use. Although the husband should be part of birth control decisions, the final decision is made by the client)

A client who is post menopausal with an intact uterus asks the nurse why her hormone medicine has two drugs, estrogen and progesterone. Which statement by the nurse provides the client with accurate information? 1. The progesterone will help prevent cervical cancer 2. the progesterone will help prevent breast cancer 3. The progesterone will help prevent liver disease 4. The progesterone will help prevent endometrial cancer

4 (a woman with a uterus who takes unopposed estrogen has an increased risk of endometrial cancer. The addition of progesterone prevents the formation of endometrial hyperplasia. Progesterone does not prevent breast, liver, or cervical cancer)

A male client has been diagnosed as having a low sperm count during infertility studies. After instructions by the nurse about some causes of low sperm counts, the nurse determines that the client needs further instructions when he says low sperm counts may be caused by: 1. varicocele 2. frequent use of saunas 3. endocrine imbalances 4. decreased body temperature

4 (increased temp NOT decreased temp resulting from infections or occupations can contribute to low sperm counts caused by decreased sperm production. Heat can destroy sperm. Varicocele, an abnormal dilation of the veins in the spermatic cord, is an associated cause of low sperm count. The varicosity increases the temperature within the testes, inhibiting sperm production. Frequent use of saunas or hot tubs may lead to low sperm count. The temp of the scrotum becomes elevated, possibly inhibiting sperm production. Endocrine imbalances (thyroid problems) are associated with low sperm counts in men because of possible interference with spermatogenesis)

Approximately what percentage of 18- and 19-year-olds have engaged in sexual activity? 25% 45% 70% 85%

70% By 18 to 19 years of age, 59.7% of girls and 65.2% of boys have engaged in sexual activity.DIF: Cognitive level: KnowledgeREF: p. 604

Which individual would be most likely to be considered an emancipated minor? A 17-year-old who is married A 17-year-old who is pregnant A 17-year-old who is living with her parents A 17-year-old who has dropped out of high school

A 17-year-old who is married Married minors, members of the armed forces, and teenagers who live apart from their parents are most often considered legally mature by state standards.DIF: Cognitive level: ApplicationREF: p. 612

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which of the following actions enhances the nurse's comfort in discussing sexual issues with the patients? (Select all that apply.) A. Clarifying personal values related to sexuality B. Role playing discussion of sexual concerns with another nurse C. Attending a conference to enhance knowledge about sexuality D. Avoiding a discussion of sexual concerns until after completing new nurse orientation

A. Clarifying personal values related to sexuality B. Role playing discussion of sexual concerns with another nurse C. Attending a conference to enhance knowledge about sexuality Rationale: Nurses often avoid discussing sexual issues with patients because they are uncomfortable, lack knowledge, or have personal values in conflict with the patients. Nurses who have difficulty addressing sexual issues need to seek education and experiences to increase knowledge and explore their personal values.

Since the majority of sexually transmitted infections (STIs) have few if any symptoms, it is important for the nurse to: A. Encourage regular screenings in all sexually active individuals. B. Provide information about contraception options. C. Administer prescribed antibiotics for human papillomavirus (HPV) or genital herpes outbreaks. D. Ask all patients if they are experiencing any symptoms.

A. Encourage regular screenings in all sexually active individuals. Rationale: One of the challenges in reducing the incidence of STIs is that most STIs have few symptoms in males or females. Asymptomatic STIs can be diagnosed during a physical examination with appropriate laboratory tests. Screening after each new sex partner is the most effective method to detect and manage STIs. HPV and herpes are viral infections and cannot be treated with antibiotics.

During fetal​ circulation, most fetal blood is shunted away from which​ organ? a Brain b Lungs c Heart d Kidneys

b (Rationale The unique nature of fetal circulation allows most fetal circulation to bypass the lungs and allows for most of the fetal blood to be shunted to the heart and brain.)

Yael Nasir is a​ 27-year-old woman who is at 30​ weeks' gestation with her first child. She has mild preeclampsia and presents for a routine prenatal exam with swollen hands and ankles. The nurse suspects that the client is not adhering to the suggested meal plan but wants to be mindful of her cultural background. Which intervention would be appropriate with this​ client? Instruct the client on the risks of seizures and premature delivery if she does not eat properly Arrange for a consultation with a dietitian who will take into consideration the​ client's cultural dietary restrictions Tell the client to go home and elevate her feet Have the client admitted to the​ hospital, where her diet will be strictly monitored

Arrange for a consultation with a dietitian who will take into consideration the​ client's cultural dietary restrictions Rationale:The focus of nursing care is to maintain the safety of the mother with delivery of a healthy baby. The​ client's cultural​ practices, values, and beliefs are factors that must be considered when implementing any treatment plan. A dietitian can help this client develop a diet plan customized to reflect her​ culture, lifestyle, and financial situation. If the client is​ stable, she does not need to be admitted to the hospital. Instructing the client that she may risk her pregnancy if she does not eat properly is neither therapeutic nor helpful. Advising the client to go home and elevate her feet does not address the potential problem. OK

Which illness accounts for the most absences from school for school-age children? head lice bacterial infection asthma depression

asthma Asthma accounts for the most absences from school for school-age children. The environment, environmental tobacco smoke, birth history, and family history of asthma are all associated with the etiology of the disease.DIF: Cognitive level: KnowledgeREF: p. 770

A 15-year-old girl states that she is having unprotected intercourse with her boyfriend. She asks for more information about birth control methods. The nurse informs the patient that: (Select all that apply.) A. Condoms or diaphragms must be used with each sexual encounter. B. Hormonal methods offer little protection against sexually transmitted infections (STIs). C. Barrier methods offer some protection against STIs. D. Sterilization is an effective option that she should consider.

B. Hormonal methods offer little protection against sexually transmitted infections (STIs). C. Barrier methods offer some protection against STIs. Rationale: The most effective methods are longer-acting methods (such as an intrauterine device [IUD] or hormonal injection), which are not associated with the sexual act itself. Sterilization is the most effective method besides abstinence but would not be a good option for a young woman since it is not easily reversible. Hormonal methods do not provide any barrier against STIs, whereas barrier methods may help reduce the risk.

11.4 A nurse in labor and delivery unit is completing an admission assessment for a client who is at 39 weeks gestation. The client reports that she has been leaking fluid from her vagina for 2 days. Which of the following conditions us the client at risk for developing? A. Cord prolapse B. Infection C. Postpartum hemorrhage D. Hydramnios

B. Infection Rupture of membranes for longer than 24 hr prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus.

A 26-year-old married woman recently discovered that she is pregnant and is at her first prenatal visit. While assessing the patient, the woman's health nurse practitioner discovers that she has purulent vaginal discharge. The patient states, "It burns when I urinate, and I seem to have to go to the bathroom frequently." Based on these symptoms, the nurse practitioner determines that further follow-up is needed because the patient: A. Should be tested for human immunodeficiency virus (HIV). B. May have a sexually transmitted infection (STI) such as chlamydia. C. Is experiencing normal signs of pregnancy. D. Needs education on proper perineal hygiene.

B. May have a sexually transmitted infection (STI) such as chlamydia. Rationale: Chlamydia does not cause symptoms in about 75% of women; thus they are often unaware that they have an STI. It often causes genitourinary track infections in men and women. Serious complications can result from untreated STIs in pregnancy such as preterm labor and rupture of membranes and premature delivery of the newborn. Purulent discharge indicates infection and is not an expected finding in pregnancy or from poor hygiene practices.

11.3 A client experiences a large gush of fluid from vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take first? A. Check the amniotic fluid for meconium. B. Monitor FHR for distress. D. dry the client and make her comfortable. D. Monitor uterine contractions.

B. Monitor FHR for distress. The greatest risk to the client and fetus is umbilical cord prolapse, leading to fetal distress following rupture of membranes. The first action by the nurse is to monitor the FHr for clinical ndings of distress.

The nurse is gathering a sexual history from a 68-year-old man in a nursing home. It is important for the nurse to keep in mind that: A. Older adults are usually not part of a sexual minority group. B. Older adults sometimes do not reveal intimate details. C. Older men and women lose their interest in sex. D. Older adults in nursing homes do not usually participate in sexual activity.

B. Older adults sometimes do not reveal intimate details. Rationale: Older adults are sometimes hesitant to reveal information relating to sexual issues because they are embarrassed. Sexual health is sometimes not addressed by the nurse, but it is important to include a sexual history as a routine aspect of assessment to communicate that sexual activity is normal. Studies have shown an increase in sexual dysfunction with aging but no decrease in sexual activity or interest.

12.2 A nurse is caring for a client who is in active labor. The client reports lower back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal ef eurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage

B. Sacral counterpressure Sacral counterpressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus.

A 25-year-old patient is in the emergency department and states that she has had a cough and fever for the past 3 days. While performing a physical assessment, the nurse finds several bruises that are in various stages of healing and suspects that the patient possibly is a victim of sexual abuse. Which of the following is the nurse's first action?: A. Refer the patient to a sexual counselor B. Tell the patient about the safe house for women C. Ask the patient to describe how she got the bruises D. Report the abuse immediately to the proper authorities

B. Tell the patient about the safe house for women Rationale: The first action is to educate the patient about available resources in the community to help her develop an escape plan. Reporting the abuse to authorities may put her at increased risk for violence but is legally required.

Which is an example of a communicable disease? Select all that apply. A. Cancer B. West Nile virus C. Heart disease D. Osteoporosis E. Hepatitis F. SARS

BEF West Nile virus, hepatitis, and SARS are examples of communicable diseases. Cancer, heart disease, and osteoporosis are examples of chronic disease

From 1988 to 1995, adolescent AIDS cases: A. steadily declined. B. remained stable. C. doubled. D. were not recorded.

C

What strategy can be used to safeguard a community against communicable disease? A. Providing a health program about heart disease B. Encouraging workers to wear safety goggles C. Administering influenza vaccine D. Planning a health fair

C Administering influenza vaccine can be used to safeguard a community against communicable disease. Influenza is a communicable disease that is transmitted from person to person, and administering the vaccine can help prevent the disease from occurring or spreading. Teaching about heart disease and encouraging use of safety goggles are not topics related to communicable disease. Planning a health fair will help increase the knowledge about various health practices in the community; however, it will probably not stop the spread of communicable diseases.

Epidemiology is: A. part of the nursing process for community health nurses. B. used to examine the incidence of communicable diseases. C. used to understand and explain how and why health and illness occur. D. important in determining the prevalence of chronic diseases.

C Epidemiology is used to understand and explain how and why health and illness occur. Nursing and medicine use these concepts to help guide clinical practice and influence health outcomes. Epidemiology is a discipline that provides the structure for systematically studying the distribution and determinants of health, disease, and conditions related to health status. Epidemiology may be used as nurses work through the nursing process, but it is not part of the nursing process. Epidemiology looks at both chronic and communicable diseases and is used to understand and explain how and why health and illness occur.

Which is an example of a vital statistic? A. Incidence rate of cancer B. Prevalence rate of heart disease C. Infant mortality rate D. Morbidity rate from heart attack

C Vital statistics is the term used for the data collected from the ongoing registration of vital events, such as death certificates, birth certificates, and marriage certificates. Infant mortality rate is the only indicator that could be gathered from one of these vital documents. The incidence rate of cancer, the prevalence rate of heart disease, and the morbidity rate from heart attacks are statistics related to population health, but are not considered vital statistics.

Establishing trust and encouraging disclosure about sexuality are often facilitated if the nurse begins by asking the patient: A. How often he or she has sexual intercourse. B. To disrobe in preparation for the physical assessment. C. For permission to discuss sexual issues. D. For specific examples of sexual practices and problems.

C. For permission to discuss sexual issues. Rationale: According to the PLISSIT assessment of sexuality (see Box 34-4), the nurse should first ask for Permission to discuss sexual issues with the patient, followed by open-ended questions to determine the patient's concerns.

A school nurse is completing a health history on an adolescent female and notices several body piercings and tattoos. The student tells the nurse that she is planning to get more tattoos and piercings over the summer break. The nurse tells the student piercing and tattoos can: A. Prevent you from being involved in contact sports. B. Only create health problems if they are located in the nipples or genital area. C. Increase your risk for infection at the site and in the body. D. Be a safe and important way of establishing your personality.

C. Increase your risk for infection at the site and in the body. Rationale: Studies have shown that adolescents with multiple tattoos and piercings are more likely to engage in high-risk behaviors such as drug use and sex with multiple partners. Piercings and tattoos in any location can increase the risk for localized and systemic infection.

The nurse reviews the health history of a 24-year-old woman who indicates that she has had three new sexual partners since her previous examination 2 years ago. The nurse discusses the need for sexually transmitted infection (STI) screening with the patient even though she denies symptoms or discomfort. The nurse realizes that the most serious complication from untreated STIs in females is: A. Genital discharge and dyspareunia. B. Painful menstrual cycles. C. Infertility and pelvic inflammatory disease. D. Genital warts.

C. Infertility and pelvic inflammatory disease. Rationale: STIs can certainly cause discharge, discomfort, and genital warts; however, the most serious complications from untreated bacterial STIs are damage to the reproductive organs and increase in the risk of pelvic inflammatory disease, ectopic pregnancy, and infertility.

11.5 A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." Which of the following stages of Labor is the client experiencing? A. Second stage B. Fourth stage C. Transition phase D. Latent phase

C. Transition phase The transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar to the need to have a bowel movement, and can become nauseous with emesis.

A physician orders magnesium sulfate IV for a primigravida client at 37​ weeks' gestation diagnosed with severe preeclampsia. Which medication would the nurse have readily available at the​ client's bedside? Hydralazine​ (Apresoline) Diazepam​ (Valium) Phenytoin​ (Dilantin) Calcium gluconate

Calcium gluconate Rationale: Because the client is receiving magnesium sulfate​ IV, she is at risk of magnesium toxicity. Calcium gluconate is the antidote for magnesium toxicity. Diazepam​ (Valium) and phenytoin​ (Dilantin) are used to treat a client having​ seizures; Hydralazine​ (Apresoline) is used to treat hypertension.

Which statement about adolescent sexual activity is correct? Contraceptive use among adolescents has remained steady. The prevalence of sexually transmitted diseases (STDs) in the adolescent population is similar to that of the general population. Condoms are the most common type of contraception at first intercourse. Males are more likely to experience complications from STDs.

Condoms are the most common type of contraception at first intercourse. Condoms are the most common type of contraception at first intercourse. More than 95% of sexually active teenagers report using condoms. Contraceptive use among adolescents has steadily increased since the 1980s. The rates of sexually transmitted diseases (STDs), specifically chlamydia, gonorrhea, genital herpes, and syphilis, among sexually active adolescents are higher than the rates in the general population. Females are more likely to experience health complications from STDs, such as pelvic inflammatory disease, cervical cancer, infertility, and ectopic pregnancy. Males are usually asymptomatic and are more likely to go undetected.DIF: Cognitive level: KnowledgeREF: p. 608

An appropriate question for a community health nurse to ask when conducting an assessment at the population level would be: A. "How old are you?" B. "Where do you live?" C. "What chronic diseases do you have?" D. "Where are the areas for recreational activity?"

D "Where are the areas for recreational activity?" asks a question at the population level. The emphasis is placed on what makes a healthy community rather than focusing on individual assessment information. Asking about age, specific location, and personal illness relates to the individual. It would be difficult to find out any information about the population by asking these questions

An analytic study may be used to: A. describe the amount of disease within a population. B. manipulate variables believed to influence a population's health. C. determine the effectiveness of a new drug. D. answer questions about cause-and-effect relationships.

D Analytic studies use observational methodology, so that the cause-and-effect relationship may be studied. Descriptive studies are used to describe the amount of a disease within a population. Analytic studies allow things to occur rather than trying to manipulate variables before an occurrence. Experimental trials are used to further confirm cause and effect, such as determining the effectiveness of a new drug.

The leading cause of death in the United States is: A. pneumonia. B. cancer. C. stroke. D. heart disease.

D Heart disease is the leading cause of death in the United States, followed by cancer, cerebrovascular diseases, and chronic lower respiratory diseases.

Which statement about sexually transmitted diseases (STDs) is correct? A. All STDs can be easily treated. B. Adolescents are at low risk to contract STDs. C. STDs are easily recognized because of the severe symptoms. D. Individuals who engage in unprotected sexual activity are at greatest risk to contract STDs.

D The greatest risk to contract an STD is run by individuals who engage in unprotected sexual activity. Others at increased risk include adolescents and young adults, drug addicts, persons with multiple sex partners, and prostitutes. Some STDs may be treated easily. However, some STDs have developed drug-resistant strains and others have no cure. Adolescents are at greater risk to contract STDs. They are particularly vulnerable because they tend to ignore the consequences of unprotected sex. Most people who have STDs are asymptomatic or have mild symptoms. Because of this, many are left untreated.

Which would be considered an agent in the chain of infection? A. Human host B. Excessive heat C. Overcrowding D. Tuberculosis

D Tuberculosis is an example of an agent in the chain of infection. The agent is what is needed to produce the illness or disease. The human host is an example of the host in the chain of infection. Excessive heat and overcrowding are examples of environments in the chain of infection.

A client with preeclampsia at 32 weeks​' gestation has been admitted to the hospital with signs of a worsening condition. She tells the nurse that she is worried about injury to her baby. Which action may the nurse take to help the client remain calm about her own and her​ baby's condition? ​(Select all that​ apply.) Educate the client on how to monitor and record fetal movement throughout the day Invite the client to identify and discuss any concerns she has about her​ baby's well-being Keep the client and her family informed about fetal status Inform the client that a nurse will be with her to offer support during the administration of any tests for fetal​ well-being Inform the client that a preterm delivery may be unavoidable if she does not remain calm and her blood pressure continues to rise

Educate the client on how to monitor and record fetal movement throughout the day Invite the client to identify and discuss any concerns she has about her​ baby's well-being Keep the client and her family informed about fetal status Inform the client that a nurse will be with her to offer support during the administration of any tests for fetal​ well-being Rationale: The nurse can and should offer support and practical help to the client and her family during this difficult time. When the client knows how to monitor her own symptoms in order to be able to report worsening conditions that will affect her​ baby, it can ease her mind. Some of her fears of the unknown can be allayed when she and her family are kept informed of any tests that are being performed and how the baby is doing. Talking about her concerns lets the nurse know how to best help her. Emphasizing the possibility of a preterm delivery will not contribute to a calm environment for the client.

Which nursing interventions can assist the client with preeclampsia after her delivery and return​ home? ​(Select all that​ apply.) Educating about nutritious meal choices Educating about community resources and support groups Educating about recognizing the signs of infection Educating about the possibility of delivering by caesarean section Educating about pain management during delivery

Educating about nutritious meal choices Educating about community resources and support groups Educating about recognizing the signs of infection Rationale:After​ delivery, the client and her family may need community support to maintain her physical and emotional comfort. Her meal plan should support her health​ status, lifestyle, and culture. Avoiding undue stress at home and monitoring her health for signs of infection or any other worsening condition are also important to maintaining her​ well-being. Because her delivery has already taken​ place, information about delivery options is no longer relevant.

What are some interventions that may be appropriate to include in the plan of care for the client with gestational ​hypertension? ​(Select all that​ apply.) Educating the client about treatment alternatives for an ectopic pregnancy Educating the client about the effect of the disease process on pregnancy Assessing the​ client's blood glucose level once daily before breakfast Taking frequent blood pressure readings Consider cultural limitations when educating the client about nutritious meal planning

Educating the client about the effect of the disease process on pregnancy Taking frequent blood pressure readings Consider cultural limitations when educating the client about nutritious meal planning Rationale: Assessing blood pressure more​ frequently, educating the client about proper​ nutrition, and helping the client maintain her physical and emotional comfort are important nursing interventions. It is important to take cultural considerationsinto account during the educational process to help ensure compliance. The client with gestational hypertension has no need for information about ectopic pregnancy. Blood glucose levels do not need to be monitored in a woman with gestational hypertension.

Which act protects privacy by limiting access to student records only to parents, students older than 18 years or emancipated minors, and educators who have a legitimate educational interest? Public Law 94-142 Individuals with Disabilities Education Act (IDEA) No Child Left Behind Act Federal Educational Rights and Privacy Act (FERPA)

Federal Educational Rights and Privacy Act (FERPA) The Federal Educational Rights and Privacy Act (FERPA) protects student record privacy by limiting access only to parents, students older than 18 years or emancipated minors, and educators who have a legitimate educational interest. It also addresses the need to keep records in locked cabinets, to protect computer records with passwords, and to be vigilant about the illegal use of he health sign-in logs. Public Law 94-142, also known as the Education for All Handicapped Children Act, gives all students between 6 and 18 years of age the right to a "free and appropriate public education" in the least restrictive environment possible, regardless of their physical or mental disabilities. The Individuals with Disabilities Education Act (IDEA) succeeded Public Law 94-142 by further defining the responsibility of the school districts to provide students 3 to 21 years of age with disability participation in the general curriculum. The No Child Left Behind Act focuses on increasing accountability for student progress and achievement.DIF: Cognitive level: KnowledgeREF: p. 754

Which is used as an indicator of the health status of a community or a nation? Incidence of low-birth-weight infants Infant mortality rate Infant morbidity rate Incidence of accidental deaths

Infant mortality rate The infant mortality rate provides an indicator of health status of a community or a nation. Infant mortality is defined as death that occurs during the first year of life. Low birth weight contributes to infant mortality, birth injuries, neurological defects, and mental retardation. However, low birth weight is not used as an indicator of health status of a community or a nation. The infant morbidity rate relates to the incidence of disease and disability within a population. The morbidity rate is usually not reported specifically for the infant population. Although the incidence of accidental deaths is important, it is not used as an indicator of health status of a community or a nation.DIF: Cognitive level: KnowledgeREF: p. 686

A postpartum client with preeclampsia voices concerns about avoiding a second pregnancy. What information can the nurse provide​ her? Information about postpartum depression Information about recurrence of preeclampsia with a subsequent pregnancy Information about various forms of contraception Information about postpartum onset of HELLP syndrome

Information about various forms of contraception Rationale: ​ The nurse should provide the client and her partner with information about family planning and the various methods of contraceptionwithout bias or​ judgment, allowing them to make an informed decision. Information concerning postpartum​ depression, the recurrence of​ preeclampsia, or HELLP syndrome will not address her concerns about avoiding a second pregnancy.

Which observation might lead a nurse to modify the plan of care for a client with​ preeclampsia? The client cannot verbalize the implications of treatment. The client is responding to nursing interventions. The client is​ seizure-free. The client is monitoring her blood pressure frequently when she is at home.

The client cannot verbalize the implications of treatment. Rationale The nurse relies on feedback from the client to devise and implement a plan of care. The nurse may modify her plan of care to include improving communication and helping the client identify and discuss all matters that affect her health and her​ baby's health. The nurse will need to explore any cultural​ implications, or the possibility that a language barrier is preventing full understanding or verbalization. If the client is responding to​ interventions, is monitoring her blood pressure at​ home, and has remained​ seizure-free, the plan of care does not need to be modified as these are successful outcomes.

The nurse is providing education to a community group. Which disorders presented are considered multifactorial inheritance​ disorders? ​(Select all that​ apply.) a Clubfoot b Neural tube defect c Cleft lip d Huntington disease e Spina bifida

a,b,c,e (Rationale Multifactorial inheritance disorders are a combination of environmental and genetic factors. Examples of multifactorial inheritance disorders include neural tube​ defects, spina​ bifida, clubfoot, and cleft lip. Huntington disease is an autosomal dominant disorder.)

What would be found in a healthy psychosocial school environment? Sanitary conditions in classrooms Crosswalks in front of the school Tobacco- and substance-free environment Daily physical education classes for students

Tobacco- and substance-free environment A tobacco- and substance-free environment would be found in a healthy psychosocial school environment. This encompasses both physical and psychological safety. Sanitary conditions in the classrooms and crosswalks in front of the school would be part of a healthy physical school environment. Daily physical education classes for students would be part of the physical education component of a comprehensive school health program.DIF: Cognitive level: KnowledgeREF: p. 754

What educational topic would be appropriate when providing anticipatory guidance to a family with a 4-year-old child? Installing gates in high-risk areas such as stairs Using a bicycle helmet Receiving timely immunizations Promoting open communication

Using a bicycle helmet Using a bicycle helmet would be an appropriate anticipatory guidance topic to a family with a 4-year-old child. A 4-year-old will begin riding a bicycle soon and education about bicycle safety will be important for this family. Installing gates in high-risk areas such as stairs would be an important anticipatory guidance topic for a family with an infant. Anticipatory guidance should provide the family with information that they will need in the future to meet their family's needs. Receiving timely immunizations would be an important anticipatory guidance topic for a family with an infant, because by the time a child is 4 years old he/she should have received the majority of the required childhood immunizations. Promoting open communication would be an important anticipatory guidance topic for a family with an adolescent.DIF: Cognitive level: ApplicationREF: p. 684

A​ 34-year-old client with preeclampsia delivers a baby whose birth weight graphs in the 10th percentile although he is full term and the delivery was uncomplicated. Which causal factor of preeclampsia may have contributed to the low birth​ weight? Preterm delivery Vasospasm Maternal obesity Proteinuria

Vasospasm Rationale Vasospasm is the constriction of blood vessels. This condition leads to decreased blood flow to the uterus and placenta. The baby then receives less oxygen and fewer​ nutrients, restricting fetal growth. Preterm​ delivery, proteinuria, and maternal obesity are not causal factors of preeclampsia.

During a woman​'s ​pre-pregnancy physical​ exam, what referral is essential for the nurse to​ make? a Dentist b Ophthalmologist c Social worker d Occupational therapist

a ( Rationale During a woman​'s ​pre-pregnancy physical​ exam, the nurse should refer the client to a dentist in order to avoid exposure to radiation or infection while pregnant. Referral to a social​ worker, ophthalmologist, or occupational therapist is not essential.)

Mrs. Wilson is a​ 50-year-old woman who is being seen in the clinic for an annual physical examination. She indicates that she is tired all the​ time, snaps at her​ husband, and cannot sleep at night due to night sweats. She states that she does not smoke or drink. She is in good health after being successfully treated for breast cancer 7 years ago. She asks what can be done. What nonpharmacologic treatment would you include in your teaching regarding alleviation of menopausal​ symptoms? a Biofeedback b Hormone replacement therapy c Vitamin D d Bioidentical hormones

a (Biofeedback is an effective nonpharmacologic therapy to alleviate symptoms of menopause. Because of her history of breast​ cancer, you would not anticipate Mrs. Wilson being placed on hormone replacement therapy. Bioidentical hormones are​ hormone-like substances that have not been proven safe or effective in the treatment of menopause. Because of​ this, this treatment should not be included in client education. Vitamin D does not alleviate symptoms of menopause. his is a custom wrong answer.)

The nurse is educating a group of women about conception. During the​ session, the nurse explains that fertilization of the ovum occurs in which part of the female reproductive​ tract? a In the ampulla of the fallopian tube b In the uterus c Fertilization may occur at any location in the female reproductive tract. d In the space between the ovary and the fimbria of the fallopian tube

a (Rationale Fertilization takes place in the ampulla of the fallopian tube. Implantation takes place in the uterus. The rest of the female reproductive tract is not involved with fertilization.)

The National Association of School Nurses (NASN) states the minimum qualifications for a school nurse should be: an advanced-practice degree in school nursing. a baccalaureate degree and licensure as a registered nurse. licensure as a registered nurse and certification as a school nurse. at least 3 years of previous practice in an acute setting and a baccalaureate degree.

a baccalaureate degree and licensure as a registered nurse. A baccalaureate degree and licensure as a registered nurse are the minimum qualifications for a school nurse as stated by the NASN. NASN also recommends that school nurses receive national school nurse certification. An advanced-practice registered nurse provides services to students through expanded school health services. However, it is not the recommended minimum qualification for a school nurse according to the NASN. Licensure as a registered nurse and certification as a school nurse are not the minimum qualifications for a school nurse stated by the NASN. Certification is available through examination for registered nurses who have a current license, a bachelor's degree, current employment in school health services or school-related services, and a recommended 3 years of experience as a school nurse. Certain states may require certification in addition to the minimum qualifications. There is no recommendation for previous practice in acute care by the NASN. However, the NASN does state a baccalaureate degree as a minimum for entry into school nurse practice.DIF: Cognitive level: KnowledgeREF: p. 756

Blacks, Hispanics, and American Indians experience (select all that apply): a. a greater risk for nutritionally related diseases. b. vitamin and mineral deficiencies in their pediatric populations. c. a three times greater risk for poverty than white Americans. d. growth stunting in their poverty pediatric populations. e. anemia in their poverty pediatric populations. f. obesity in their elderly populations.

a, b, c, d, e Studies indicate that American Indians, Alaska Natives, Mexican Americans, and African Americans—all populations with greater levels of poverty than whites—have a significantly greater risk for nutritionally related diseases. In studies of minority children, vitamin and mineral deficiencies are found to be relatively commonplace. Blacks, Hispanics, and American Indians experience a three times greater risk for poverty than white Americans. Some studies find that all children in poverty show a greater incidence of growth stunting than do children from other economic environments. Studies have found anemia to be especially prevalent in blacks, American Indians, and Mexican American children in poverty. Obesity is common in all age ranges of all economic levels.DIF: Cognitive level: KnowledgeREF: p. 541

The nurse is teaching a group of high school students about reproduction and shows a slide featuring an image of a placenta. A student​ exclaims, open double quote"What is that ​for?close double quote" What can the nurse tell the group about the function of the​ placenta? ​(Select all that​ apply.) a It has blood vessels that bring oxygenated blood to the baby and carry deoxygenated blood away from it. b It secretes hormones that help maintain the pregnancy. c It uses resources from the mother​'s body to produce fatty acids that provide energy for the baby. d It provides a cushion to protect the baby from injury. e It filters out everything in the mother​'s system that could harm the baby.

a,b,c (Rationale The placenta produces glycogen and fatty​ acids, which are part of the endocrine system that maintains the pregnancy. The placenta also produces hormones that help maintain the pregnancy. The placenta has blood vessels that carry oxygenated blood to the baby and deoxygenated blood that returns to the maternal circulation. Amniotic fluid creates a cushion for the fetus. A number of drugs and pathogens are able to cross the placenta.)

What preconception counseling may the nurse provide to the individual or couple who is of childbearing​ age? ​(Select all that​ apply.) a Encourage discussion of each​ partner's goals,​ expectations, and desire to be a parent b Provide information on good exercise habits that can be maintained with the​ client's lifestyle c Provide information on different kinds of birth control and their advantages and risks d Discuss the benefits of good nutrition and obtaining and maintaining a normal weight for the​ client's height e Discuss the unreasonableness of not planning for a pregnancy

a,b,c,d (Each partner benefits from understanding how each will be affected by a family planning​ decision, whether it is to have a pregnancy or prevent one. Those who object to the idea of family planning can see the wisdom of improving their own health so​ that, should a pregnancy​ occur, it can be at minimized risk. The nurse will not be judgmental when a client opts not to participate in family planning.)

Which nursing diagnosis should the nurse include when planning care for a client experiencing​ menopause? ​(Select all that​ apply.) a Impaired mood b Altered sleep pattern c Potential for urinary dysfunction d Increased risk of low​ self-esteem e Constipation

a,b,c,d (Rationale A client with menopause may have problems associated with impaired​ mood, low​ self-esteem, altered sleep​ pattern, and urinary dysfunction. Constipation is not a problem associated with menopause)

A client has been diagnosed with menopause and is complaining of increased severity of manifestations. Which treatments can be used for the treatment of menopausal​ symptoms? ​(Select all that​ apply.) a Hormone replacement therapy b Herbs c Acupuncture d Bioidentical hormones e Gabapentin​ (Neurontin)

a,b,c,d (Rationale Menopausal symptoms can be treated with medications or the use of alternative and complementary therapies. Medications include hormone replacement​ therapy, raloxifene,​ triphenylethylene, fluoxetine,​ paroxetine, and venlafaxine. Alternative and complementary therapies include bioidentical​ hormones, acupuncture,​ biofeedback, massage,​ meditation, yoga, and herbs.Gabapentin​ (Neurontin) is not used to treat manifestations of menopause.)

What are the clinical manifestations of​ menopause? ​(Select all that ​apply.) a Vaginal dryness b Thinning hair c Headaches d Hot flashes e Cold intolerance

a,b,c,d (The physical manifestations of menopause are thought to be related to diminishing estrogen. This accounts for the hot​ flashes, vaginal​ dryness, thinning​ hair, and headaches. Women experiencing menopause do not typically experience cold intolerance.)

The nurse educator is presenting material about secondary dysmenorrhea to a group of students. Which information should be included in the​ presentation? ​(Select all that​ apply.) a It can be associated with several disorders including​ tumors, pelvic​ adhesions, and infections. b It generally affects women age 30 - 50. c The pain diminishes with time and is often much less after childbirth. d Endometriosis is an example of a secondary dysmenorrhea and is considered to be one of the most painful gynecologic disorders. e Pain is always on the first day of menses and radiates to the groin.

a,b,d (Rationale Secondary dysmenorrhea is associated with pathologies that affect the uterus and pelvic area. It is likely to occur in women ages​ 30-50. Endometriosis is an example of secondary dysmenorrhea. With secondary​ dysmenorrhea, pain is likely to occur anytime through the menstrual cycle and can be severe. Pelvic pain generally on or before the first day of menses that radiates to the groin is the main symptom of primary dysmenorrhea. It generally diminishes with time or after childbirth.)

The nurse is performing a health history on a woman with family planning needs. What data should the nurse​ collect? ​(Select all that​ apply.) a Medication history b Family history of breast cancer c Genital exam d Number of sexual partners e Vital signs

a,b,d (Rationale When performing a health history on a client with family planning​ needs, the nurse needs to obtain information on the client​'s medication​ history, family history of breast​ cancer, and number of sexual partners. Vital signs and genital exam are part of the physical examination of a woman with family planning needs.)

The nurse is caring for a client after a hysterectomy. Which assessment findings support the diagnosis of shock related to uterine​ bleeding? ​(Select all that​ apply.) a Tachypnea b Decreased urine output c Rapid capillary refill d Hypotension e Tachycardia

a,b,d,e (Rationale Decreased urine​ output, hypotension,​ tachycardia, and tachypnea are all related to shock due to uterine​ bleeding, and the nurse must use the nursing process of assessing and evaluating to determine necessary steps to be taken. One would expect​ delayed, not​ rapid, capillary refill for the client in shock.)

During a preconception exam of a​ 28-year-old client, the nurse identifies that which health risks may affect the pregnancy​ outcome? ​(Select all that​ apply.) a Diabetes mellitus b Alcohol use c Hypotension d Caffeine intake e Secondhand smoke

a,b,d,e (Rationale Risk factors that may affect the client​'s pregnancy outcome include secondhand​ smoke, caffeine​ intake, alcohol​ use, and diabetes mellitus.​ Hypertension, not​ hypotension, is a risk factor.)

A female client presents to her healthcare provider​'s office with manifestations of menopause. What are the VASOMOTOR manifestations of​ menopause? ​(Select all that​ apply.) a Hot flashes b Palpitations c Decreased body hair d Night sweats e Dizziness

a,b,d,e (Rationale The manifestations of menopause affect many body​ systems, including the vasomotor system. Vasomotor manifestations include hot​ flashes, palpitations,​ dizziness, headaches,​ insomnia, and night sweats. Decreased body hair is an​ integumentary, not​ vasomotor, manifestation of menopause. Menopausal clients have integumentary manifestations that include decreased body​ hair, decreased skin​ elasticity, and decreased subcutaneous tissue.)

What are the disadvantages of oral​ contraceptives? ​(Select all that​ apply.) a Oral contraceptives require daily use of medication. b Oral contraceptives require a medical prescription. c Oral contraceptives are extremely effective at preventing pregnancy. d Oral contraceptives often reduce menstrual cramping. e Oral contraceptives carry an increased risk of blood clots.

a,b,e (Disadvantages include the need for medical​ care, the need for a​ prescription, the use of a daily​ medication, and the potential risks and side​ effects, such as developing blood clots with use of oral contraception. The reduction of menstrual cramping and the effectiveness of oral contraceptives are​ advantages, not disadvantages.)

he nurse is discussing the need for therapeutic donor insemination​ (TDI) with a client. Which would be an indication for​ TDI? ​(Select all that​ apply.) a Severe oligospermia b Genetic male​ sex-linked disorder c Erectile dysfunction d Epispadias e Azoospermia

a,b,e (Rationale TDI is used in cases of severe oligospermia​ (low sperm​ count), in cases of azoospermia​ (absence of​ sperm), or in those with a history of genetic male​ sex-linked disorders. Epispadias is a penile anatomic abnormality. The male​'s sperm can be used for​ insemination; donor sperm is not needed. Sperm from men with erectile dysfunction can still be used for​ insemination; donor sperm is not needed.)

Which data are included in a physical examination of a male with family planning​ needs? ​(Select all that​ apply.) a Inspect for varoceles b Postcoital exam c Genital examination d Monitor weight e Blood pressure

a,c,d,e (Blood​ pressure, inspecting for​ varoceles, weight, and genital examination are data that the nurse should obtain when performing a physical examination on a male with family planning needs. A postcoital exam is performed on a female​ client, not the male​ client, to determine the presence of live sperm.)

A pregnant client wants to know what substances cross the placenta. Which substances does the nurse explain are transported across the placenta by simple​ diffusion? ​(Select all that​ apply.) a Oxygen b Glucose c Illicit drugs d Sodium e Water

a,c,d,e (Rationale Simple diffusion works by passively moving substances across cell membranes from an area of higher concentration to one of lower concentration. This is the transport method for​ oxygen, electrolytes,​ water, illicit​ drugs, and some​ lipid-soluble vitamins. Glucose is transported through facilitated diffusion.)

Teenagers who are pregnant (select all that apply): are unlikely to get married. are unlikely to end their pregnancy in abortion. likely did not intend to become pregnant. are likely to drop out of high school. are likely to live in poverty. are likely to live in poverty. have unlimited career choices.

are unlikely to get married. are unlikely to end their pregnancy in abortion. likely did not intend to become pregnant. are likely to drop out of high school. are likely to live in poverty. Teenagers who are pregnant are not likely to get married. Approximately 84% of pregnant adolescents remain unwed. Approximately 25% of teenage pregnancies end in abortion. Most teenage pregnancies (82%) are unintended. Teenagers who are pregnant are likelier to drop out of high school, live in poverty, and have limited occupational choices than girls who do not become pregnant during the teenage years.DIF: Cognitive level: KnowledgeREF: p. 618

A​ 52-year-old woman complains of hot​ flashes, night​ sweats, irritability, decreased vaginal​ lubrication, and no menstrual period in the past 15 months. Over the past several​ weeks, the hot flashes and night sweats have increased in​ frequency, and she has noticed that she is more irritable. Laboratory values reveal increased​ follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse​ initiate? ​(Select all that​ apply.) a Asking​ open-ended questions about the​ client's body image b Instructing the client to avoid​ over-the-counter vaginal lubricants c Explaining such physiological manifestations of menopause as hot flashes and night sweats d Providing information about medications that might be prescribed to help with menopausal symptoms e Encouraging discussion of how menopausal symptoms are affecting sexual functioning

a,c,d,e (Rationale The client is undergoing menopause. The client with menopause may have problems understanding the natural female aging​ process, sexual​ dysfunction, low​ self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiological manifestations of​ menopause; providing information about medications that might be prescribed to help with menopausal​ symptoms; encouraging discussion of how menopausal symptoms are affecting sexual​ functioning; and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking​ open-ended questions will further explore the client​'s thoughts and feelings about body image in a therapeutic manner.)

When planning care for a client with family planning​ needs, which interventions should the nurse​ include? ​(Select all that​ apply.) a Teach client about fertility and contraception b Consult social worker for genetic counseling c Encourage client to verbalize feelings about sexual health d Provide environment that promotes discussion e Emphasize the importance of using condoms for disease prevention

a,c,d,e (Rationale ZIFT is the return of fertilized​ ovum, at the zygote​ stage, into the fallopian tube 18 -24 hours after retrieval. GIFT is placing retrieved ovum and washed sperm into the fimbriated end of the fallopian tube. TET is placing embryos into the fallopian tube 42 -72 hours after retrieval. IVF is the placement of embryos into the uterus 2dash-3 days after the ova are retrieved.)

A nurse is reviewing information about abnormal uterine bleeding with a client. Which important aspects of client teaching should the nurse​ include? ​(Select all that​ apply.) a The importance of adequate fluid intake b Avoid foods such as​ eggs, beans,​ beef, and shrimp c Stress reduction and relaxation strategies d The importance of eating foods rich in iron e Information about​ self-care in order to minimize the clinical manifestations

a,c,d,e (Rationale ​Iron-rich foods are encouraged to stave off anemia from abnormal bleeding.​ Eggs, beans, beef and shrimp are foods that are rich in​ iron; therefore the client should not avoid them.​ Hydration, self-care to minimize clinical​ manifestations, and stress reduction strategies are all appropriate interventions. Clients will be better able to cope with abnormal uterine​ bleeding, both long term and on a​ day-to-day basis, if they understand the disorder and possible interventions.)

The nurse is conducting a health history on a client being seen for a yearly gynecological examination. The client states that she believes she has endometriosis. Which findings in the client​'s health history support this​ diagnosis? ​(Select all that​ apply.) a Menstrual cycle less than 27 days b Menarche before age 14 c Sedentary lifestyle d Decreased dietary fat e Heavy prolonged menses

a,c,e (Rationale Risk factors for endometriosis include menstrual cycles that are less than 27​ days, heavy and prolonged​ menses, and a sedentary lifestyle. Increased dietary fat and menarche before the age of 11 would also support this diagnosis.)

Which diagnostic tests are used to recognize structural​ abnormalities, hormone​ imbalances, and abnormal pathologies with menstrual​ disorders? ​(Select all that​ apply.) a Pelvic exam b Bronchoscopy c Colonoscopy d Pap test e Ultrasound

a,d,e (Diagnostic tests used to recognize structural​ abnormalities, hormone imbalances and abnormal pathologies with menstrual disorders include pelvic​ examinations, pap​ tests, and ultrasounds. A bronchoscopy is use to diagnosis lung disorders. A colonoscopy is use to diagnosis bowel disorders.)

Which statement about the prison population is true? a. Prisoners have lower levels of education than the general public. b. The majority of prisoners are white Americans. c. Less than half of prisoners experience a mental problem. d. Prisoners are at low risk to be exposed to HIV/AIDS.

a. Prisoners have lower levels of education than the general public. Prisoners have lower levels of education than the general public. The majority of prisoners are black Americans (39.4%); whites (34%) and Hispanics (20.6%) make up the remaining prison population. It is reported that 64% of inmates were found to have a mental problem. Prisoners are at high risk to be exposed to HIV/AIDS because of the high rate of risky behaviors.DIF: Cognitive level: KnowledgeREF: p. 534

The nurse is providing care to a client experiencing abnormal uterine bleeding and menstrual pain. Which lab and diagnostic tests does the nurse anticipate to determine hormonal​ imbalances, pathologic​ conditions, or structural anomalies that are causing the client​'s ​symptoms? ​(Select all that​ apply.) a Papanicolaou​ (Pap) test b Colposcopy c Hysterectomy d Progesterone and estradiol levels e FSH and LH level

a.b.d.e (Rationale The Pap test is used to diagnose cervical cancer and dysplasia. FSH and LH levels are used to help correlate the luteal phase of the menstrual cycle. Progesterone and estradiol levels are used to assess ovarian function. Colposcopy is used to inspect the cervix and help determine areas for biopsy. Hysteroscopy is used to inspect the endometrial lining. Hysterectomy would not be used as a diagnostic test.)

An example of a central nervous system depressant is: nicotine alcohol marijuana LSD

alcohol. Alcohol is an example of a central nervous system depressant. Nicotine is considered to be a central nervous system stimulant. Marijuana is an example of a central nervous system stimulant. LSD is an example of a hallucinogen.DIF: Cognitive level: KnowledgeREF: p. 636

Natasha Martin is a​ 19-year-old young woman at her intake visit for prenatal​ care, having found out 2 weeks before that she is pregnant with her first child. She tells the​ nurse, "I'm scared to have a baby. I think I might want to have a​ C-section. If a baby weighs 8​ pounds, doesn't it really damage the vaginal​ area?" What is the​ nurse's best​ response? a ​"Don't worry. Your health care provider knows how to fix​ that." ​b "I know it seems​ scary, but your body is designed to give birth without​ damage." ​c "It is so early in your pregnancy. You have plenty of time to get used to the idea of having a​ baby." ​d "I will schedule your next visit with your health care​ provider, who can plan the surgery for​ you."

b (Acknowledging her concerns and providing information that is both reassuring and factual is the best way to support the normal physiologic and psychological processes the mother experiences in the perinatal period. Telling the client not to worry or that she will get used to the idea of being pregnant is not therapeutic because it dismisses the​ client's concerns. Cesarean birth places the client at risk of injury through surgical complications and is not indicated unless the benefits clearly outweigh the risks.)

What is the clinical term for a lack of​ menses? a Oligomenorrhea b Amenorrhea c Menorrhagia d Metrorrhagia

b (Amenorrhea is the clinical term for lack of menses. Oligomenorrhea is the clinical term for infrequent or light menses. Menorrhagia is the clinical term for very heavy menses. Metrorrhagia is the clinical term for abbreviated menses or breakthrough bleeding between menstrual periods.)

Which medication might be prescribed for the bloating associated with the menstrual​ cycle? a Oral iron supplements b Diuretic medications c Nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) d Combined oral contraceptives​ (COCs)

b (Bloating associated with the menstrual cycle may be treated with diuretics. NSAIDs are used to treat cramping. COCs are used to treat secondary dysmenorrhea or abnormal uterine bleeding. Oral iron supplements may be used to treat anemia associated with heavy menstrual periods.)

Clinical interruption of a pregnancy in the first 7 to 9 weeks may be performed by what​ procedure? a Surgical abortion by dilation and curettage and minisuction b Medical abortion by administration of mifepristone and misoprostol c Surgical abortion by dilation and extraction and hypertonic saline d Medical abortion by dilation and curettage and minisuction

b (Clinical interruption of a​ pregnancy, abortion, is performed in the early weeks by medical​ abortion, meaning there is no surgical procedure involved. Medical abortion does not involve dilation and curettage. Mifepristone is administered to alter the uterine​ lining, followed 1 to 3 days later by administration of misoprostol to induce contractions to expel the embryo. Surgical abortions are performed at the later stages of pregnancy by dilation and​ curettage, and dilation and extraction)

A client is prescribed combined oral contraceptives​ (COCs) for treatment of dysfunctional uterine bleeding. The client asks the nurse why this will be helpful. The nurse bases the response on which​ rationale? a COCs act as selective serotonin reuptake inhibitors​ (SSRIs) and help control mood and chronic pain. b COCs help suppress ovulation. c COCs help reduce bloating. d COCs are​ anti-inflammatory agents and will decrease cramping.

b (Rationale COCs help suppress ovulation. NSAIDs are utilized to decrease​ cramping, and diuretics decrease bloating. SSRIs may be prescribed to help the client regulate mood or control chronic pain.)

The nurse is explaining fetal circulation to a pregnant client. Which statement by the nurse correctly describes fetal gas​ exchange? ​a "Oxygen is vital to the fetus and is exchanged through amniotic​ fluid." ​b "Oxygen and carbon dioxide gas exchange occurs through the​ placenta." ​c "Oxygen is exchanged through the​ placenta, whereas other gases go to the​ lungs." ​d "Gas exchange occurs through the lungs in the​ fetus."

b (Rationale Fetal circulation is unique in that oxygen and carbon dioxide gas exchange takes place across the placenta. Fetal circulation allows the highly oxygenated blood to bypass the​ lungs, shunting to the heart and brain. Oxygen and carbon dioxide must be exchanged for the fetus to​ survive, but this is not a function of amniotic fluid. All​ gases, including oxygen and carbon​ dioxide, are exchanged through the placenta.)

The nurse is reviewing a client medical record to gain an understanding regarding the absence of menstruation. As the nurse speaks with the​ client, she mentions that she has really been working out a lot at her gym.​ Which menstrual dysfunction does the nurse suspect the client is​ experiencing? a Menorrhagia b Amenorrhea c Metrorrhagia d Dysmenorrhea

b (Rationale Greater than normal vaginal flow should be reported as it assesses for hemorrhage. Temperature greater than​ 100°F can be indicative of infection. Some pain is expected but it should not be severe. Bright red bleeding should be reported. Appetite may be depressed and bowel may be sluggish as a result of anesthesia.)

The nurse is planning care for a client with endometriosis. The nursing diagnosis for this client is the potential for enhanced wellness. Which nursing intervention is appropriate to include in the plan for care for this​ diagnosis? a Monitor the client​'s vital signs per order b Teach the client about the importance of proper nutrition c Prepare the client for surgical intervention d Assess the client​'s level of pain

b (Rationale Teaching the client about the importance of proper nutrition is an intervention that is specific for this diagnosis. Monitoring vital​ signs, assessing level of​ pain, and preparing the client for surgical intervention are not nursing interventions that support the potential for enhanced wellness.)

The nurse is educating women about the physiological changes that occur during delivery. What role does the pelvic floor have in this​ process? a Protects the maternal urethra b Positions the fetal head for descent into the pelvic outlet c Secretes hormones that soften connective tissue d Places pressure on the fetal head to stimulate newborn neurologic function

b (Rationale The pelvic floor positions the fetal head for descent into the pelvic outlet. The pelvic floor does not protect the maternal​ urethra, stimulate newborn neurological​ function, or secrete hormones that soften connective tissue.)

The sperm and ovum each contain how many​ autosomes? a 46 b 22 c 44 d 24

b (Rationale The sperm and ovum each contain 22 autosomes and 1 sex chromosome. The ovum contains an X sex chromosome and the sperm contains either an X or a Y sex chromosome. The genetic material combines at the same​ time, resulting in a total of 46 chromosomes. Two of these are sex chromosomes and 44 are the combined autosomes.)

Temporary Assistance for Needy Families (TANF): a. provides assistance to legal immigrants. b. places a 5-year lifetime limit on the length of time that a family can remain on welfare. c. has increased the number of low-income households receiving assistance. d. encourages all recipients to continue their education.

b. places a 5-year lifetime limit on the length of time that a family can remain on welfare. TANF places a 5-year lifetime limit on the length of time a family can remain on welfare. This program was developed in 1996 and is part of Welfare Reform. After August 22, 1996 legal immigrants who entered the country were barred from TANF as well as from Supplemental Security Income (SSI), Medicaid, and state block grants. TANF has decreased the number of households receiving welfare assistance. In 1991, over half of all low-income families received Aid to Families with Dependent Children (AFDC, the precursor to TANF); in 2005, only 20% of families received TANF assistance. TANF does not encourage all recipients to continue their education. States may have only 20% of their caseload in educational activities; thus, only a minority of those receiving TANF are eligible for benefits to further their education.DIF: Cognitive level: KnowledgeREF: p. 538

The fastest-growing family constellation is the: nuclear family. blended or reconstituted family. single-parent family. extended family.

blended or reconstituted family. The fastest-growing family constellation is the blended or reconstituted family. Blended or reconstituted families consist of stepparents, stepsiblings, and extra sets of grandparents. Nuclear families consist of husband, wife, and their children, adopted or natural. Single-parent families consist of a single parent and children. Extended families include the nuclear family along with blood relatives or those related by marriage.DIF: Cognitive level: KnowledgeREF: p. 682

Which action is not a suspected or known health risk for the couple planning a​ pregnancy? a Taking prescription medicine b Breathing secondhand smoke c Getting a flu shot d Drinking coffee

c (All women of childbearing age should be​ up-to-date on​ vaccinations, including flu​ shots, which can be given during​ pregnancy, if necessary.​ Caffeine, secondhand​ smoke, some prescription​ drugs, and chronic health​ problems, like​ hypertension, are all suspected or known risks to a healthy pregnancy.)

Which nursing intervention is appropriate for a client experiencing menstrual​ dysfunction? a Using​ close-ended questions b Teaching about foods low in iron c Administering analgesics d Encouraging frequent exercise

c (An appropriate nursing intervention for a client with menstrual dysfunction is to administer​ analgesics, per order. The nurse would encourage​ resting, eating foods high in​ iron, and using​ open-ended questions when talking with the client.)

The nurse is discussing contraceptive options with Tina Jacobs. Tina is interested in information about intrauterine contraception​ (IUC). Which statement would the nurse include when discussing the disadvantages of these​ devices? ​a "This type of contraceptive causes the loss of bone​ density." ​b "These require the use of daily​ medication." ​c "The device may cause cramping and heavier​ bleeding." ​d "You will need to insert the device​ daily."

c (IUC requires the woman to check the string after each menstrual cycle. Disadvantages of these devices include increased cramping and heavier bleeding. Oral contraception requires the use of daily medication. IUC remains in place for years and is not inserted daily. IUC does not lead to a reduction in bone density.)

Oligohydramnios is diagnosed when the amniotic fluid is less than which percent expected for gestational​ age? a 80 b 35 c 50 d 65

c (Rationale In​ oligohydramnios, amniotic fluid is less than​ 50% of the amount expected for gestational age.)

A couple is beginning evaluation for infertility. Which diagnostic test would the nurse expect to be done first for evaluation of the male​ partner? a Testicular biopsy b Hormonal evaluation c Semen analysis d Scrotal ultrasound

c (Rationale Male infertility is usually identified from an abnormal semen analysis. This test is noninvasive and should be completed as the first step in assessment for male infertility. A scrotal ultrasound may be needed to help identify any structural​ abnormalities, a testicular biopsy is an invasive surgery that may be required for some​ conditions, and an evaluation of the male hormones may need to be​ done; however, a semen analysis should be completed first.)

The nurse is preparing a presentation about chromosome abnormalities. Nondisjunction involves an addition or deletion of a​ chromosome, and if it occurs after​ fertilization, the embryo may have two or more chromosomes that evolve into more than one cell line. What is this known​ as? a Monosomy b Trisomy 13 c Mosaicism d Trisomy 21

c (Rationale Mosaicism is nondisjunction that occurs after​ fertilization, and the embryo may have two or more chromosomes that evolve into one cell​ line, each with a different number of chromosomes. Trisomy 13 and 21 occur during the second meiotic division of a gamete before​ fertilization; the embryo or fetus will have abnormal chromosomes added to every cell. Monosomy is nondisjunction that deletes a chromosome and can result in Turner syndrome)

The nurse is caring for a client who has been diagnosed with primary dysmenorrhea and tells the client about which treatment for the disorder? a "Treatment will include surgery to correct the defect." b "You will need to have a laparoscopy to cure the disorder." c "You will be scheduled for an MRI to determine treatment." d "Treatment is aimed at reducing symptoms."

d (Rationale: Primary dysmenorrhea is treated by reducing symptoms. Secondary dysmenorrhea is the result of an organic problem requiring diagnosis with a laparoscopy, MRI, or CT scan and then surgery to correct the problem, if appropriate)

Alicia and Jeremy Brown are expecting their first child in a few weeks. Alicia voices concerns about sickle cell​ disease, a genetic disorder associated with the African American​ population, and asks you if their child will be affected. How do you​ respond? a Sickle cell disease is a dominant disorder and the child is at high risk related to heredity. b Sickle cell disease is more prevalently found in metropolitan areas. c Sickle cell disease is an autosomal recessive disorder requiring two abnormal genes for an individual to be affected. d Sickle cell disease is not linked to either parent and therefore it is difficult to predict whether the child will be affected.

c (Sickle cell disease is an autosomal recessive disorder requiring two abnormal genes for an individual to be affected. Affected parents have a​ 25% chance of having an affected child. There may be no family history of the trait but it may be seen in groups isolated by​ geography, culture, or religion. Sickle cell disease is not more prevalent in metropolitan areas but is strongly associated with the African American population.)

A​ 22-year-old woman, Tamara​ Woodard, is being seen in the clinic for a yearly examination. Ms. Woodard states she is experiencing worsening monthly dysmenorrheal and postcoital bleeding. Which question will the nurse ask during the health history portion of the nursing assessment based on the data collected from Ms.​ Woodard? a ​"When was the last time you had sexual​ intercourse?" ​b "Have you ever been tested for sexually transmitted​ infections?" c ​"When did you have your last menstrual​ period?" ​d "When was your last gynecological​ examination?"

c (The most appropriate question for the nurse to ask this client is the date of her last menstrual period. The dates of her last sexual experience and last gynecological examination are not typically questions the nurse asks during the health history. There is no indication the client has a sexually transmitted infection and asking the client if she has ever been tested is not appropriate for this situation.)

What is the most common noninvasive method for assessing ovulation in female​ clients? a Mapping menstrual cycles for 3 months b Performing an endometrial biopsy c Measuring basal body temperature d Conducting a postcoital examination

c (The most common noninvasive method for assessing ovulation is monitoring basal body temperature. The temperature decreases slightly the day before​ ovulation, followed by a rise of approximately​ 0.5-1.0°F until menstruation begins. Mapping menstrual cycles will provide information about the regularity of the​ client's menstrual​ cycle, but will not directly provide information about ovulation. A postcoital examination evaluates vaginal secretions for​ sperm, consistency of cervical​ mucus, and sperm survival time. An endometrial biopsy is done to detect changes in the endometrium and is an invasive procedure.)

When planning care for a​ client, which nursing diagnosis addresses a physical concern associated with​ menopause? a Risk of low​ self-esteem b Impaired mood c Potential for urinary dysfunction d Negative body image

c (When planning care for a​ client, potential for urinary dysfunction addresses a physical concern the client may experience with menopause. Impaired​ mood, risk of low​ self-esteem, and negative body image are nursing diagnoses that address psychological concerns.)

The nurse is teaching a woman about the hormonal changes that occur during menopause. Which hormonal change would the nurse state is responsible for the symptoms of​ menopause? a Decreased​ follicle-stimulating hormone b Decreased progesterone c Decreased estrogen d Decreased luteinizing hormone

c (​Rationale: The amount of estrogen produced by the ovaries​ decreases, leading to the symptoms of menopause. Progesterone will not be produced during anovulatory cycles but does not produce the symptoms of menopause.​ Follicle-stimulating hormone will increase in the​ body's attempt to stimulate the ovaries. The level of luteinizing hormone will vary depending on the ovulatory cycle but does not produce the symptoms of menopause.)

A woman experiencing perimenopausal symptoms asks the nurse what she can do to help control the symptoms. What interventions should the nurse​ recommend? ​(Select all that​ apply.) a Increase caffeine intake b Avoid sexual intercourse c Start a regular exercise routine d Dress in layers e Keep the bedroom cool

c,d,e (Rationale Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Keeping the bedroom cool will help control and provide comfort during night sweats. Caffeine intake should be decreased during perimenopause because it can trigger hot flashes. Sexual intercourse does not have to be avoided during​ perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.)

Which are the metabolic functions of the​ placenta? ​(Select all that​ apply.) a Hormone production b Red blood cell production c Nutrition d Excretion e Fetal gas exchange

c,d,e (Rationale ​Maternal-fetal exchange of gases and nutrients occurs through the metabolic functions of the placenta. The exchange occurs in the intervillous spaces within the cotyledons of the placenta. Excretion is also a metabolic function of the placenta. The placenta does produce​ hormones, but this secretion is considered an endocrine function of the​ placenta, not metabolic. Red blood cells are produced by the​ liver, not the placenta.)

The best definition of the poverty index is: a. people who are poor. b. families who have an annual income less than $20,000. c. a government calculation that sets an "adequate" living standard. d. people who have difficulty providing the basic necessities for their families.

c. a government calculation that sets an "adequate" living standard. The poverty index is a government calculation that sets an "adequate" living standard and is adjusted based on the size of the family. In 2006, the poverty index for a family of four was $20,516. Although people who have difficulty providing the basic necessities for their families may be considered to live in poverty, the poverty index is a specific government calculation.DIF: Cognitive level: KnowledgeREF: p. 529

A client with dysfunctional uterine bleeding (DUB) tells the nurse that she is having problems with sexual performance. The nurse selects sexual dysfunction as a nursing diagnosis and suspects that the dysfunction is related to which factor? a Edema b Obesity c Sweating d Fatigue

d (Rationale: The woman who is bleeding heavily is losing hemoglobin and is usually fatigued, which affects interest in sex. The nurse plans interventions aimed at conserving energy in this client. Obesity, edema, and sweating are not usually associated with the lack of sexual desire in the client with DUB. )

A family experiences financial hardship because the father in the household is unexpectedly fired by his employer. A risk factor for poor health status that will be experienced by this family is: a. low socioeconomic status. b. genetic inheritance. c. a sudden change in financial situation. d. multigenerational poverty.

c. a sudden change in financial situation. The father's unexpected job loss is best described as a sudden change in financial situation. Although this places the family at risk, a family placed in this situation is more likely to find it easy to improve their financial situation. Low socioeconomic status and genetic inheritance are both risk factors for poor health status and increased vulnerability. However, the father's unexpected job loss best describes a sudden change in the financial situation. Multigenerational poverty is also a risk factor for poor health status and increased vulnerability. However, multigenerational poverty is best described as poverty that occurs from one generation to the next, whereas in this example poverty is potentially affecting only one generation.DIF: Cognitive level: ApplicationREF: p. 528

A community health nurse is referring one of her clients to an Alcoholics Anonymous (AA) program in the community. This would be an example of using: professional resources. federal resources. community resources. pharmacotherapeutic resources.

community resources. Community resources include self-help and other support groups such as Alcoholics Anonymous (AA). It is important that the nurse be familiar with these resources in the community. The nurse is in a better position to refer clients to these groups if the nurse has attended some group meetings and gained first-hand experience and knowledge. One source of professional resources for the community health nurse is the International Nurses Society on Addictions, a professional organization of nurses who work with addicted clients in varied settings. Federal resources include publications that are provided for free by the federal government as well as low-cost subscriptions for materials that summarize research findings and provide guidance for developing alcohol and drug treatment and prevention programs. Pharmacotherapeutic resources would be medications that are available to help those who are addicted.DIF: Cognitive level: ApplicationREF: p. 651

The most successful and effective approach to sex education is: life options programs. family life programs. abstinence-only curriculum. comprehensive sex education programs.

comprehensive sex education programs. Comprehensive sex education programs teach about abstinence, contraception, and STDs. They use a more balanced approach that is more successful and does not encourage sexual activity. These programs delay the onset of sexual activity in teenagers, reduce the frequency of sex, reduce the frequency of unprotected sexual activity, increase the use of contraceptives among sexually active teenagers, reduce the teenage pregnancy rate, and lower the number of sex partners. Life options programs are comprehensive programs that provide a broad range of support services for adolescents. They attempt to expand an adolescent's future goals and expectations by improving educational and employment prospects. Family life programs offer information on family systems. They are usually taught as an elective course at the junior or senior high school and do not reach all teenagers. An abstinence-only curriculum teaches abstinence as the only option for the unmarried and adolescents.DIF: Cognitive level: KnowledgeREF: p. 616

The original focus of school nursing was to: control communicable disease. incorporate health education into the curriculum. offer medical examinations. provide family-centered care.

control communicable disease. The original focus of school nursing was to control infectious diseases. Originally, school health services identified and excluded students with infectious diseases. The first school nurse, Lina Rogers Struthers, drafted protocols for specific illnesses and was able to drop the absenteeism rate by 90%. After World War I, one of the focus areas was to incorporate health education into the curriculum to teach students responsible health behaviors. Also during this time, one of the focus areas was to offer medical examinations for all children to ensure child health. This expanded in the 1970s when the school nurse practitioner concept emerged. School nursing during the 1940s and 1950s provided a more family-centered approach to care.DIF: Cognitive level: KnowledgeREF: p. 750

Sally​ Jones, a​ 25-year-old client, visits the clinic for evaluation of possible infertility. She states that she and her husband have been trying to conceive for over 3 months and are concerned that something is wrong with one of them. On what knowledge is the​ nurse's response​ based? a infertility is likely related to an underlying medical condition. b Infertility is likely associated with​ Sally's age. c Infertility is on the rise in the United States. d Infertility is the inability to conceive after one year of unprotected regular intercourse.

d (Infertility is the inability to conceive after 1 year of unprotected regular​ intercourse; therefore,​ Sally's inability to conceive after only 3 months would not be considered infertility. Although there is a perception that infertility is on the rise in the United​ States, there has been no change in the incidence of infertility. Underlying medical conditions can contribute to​ infertility; however, there is no reason to suspect an underlying medical condition in this case. A client is at greater risk of infertility when over the age of 35)

The nurse is interviewing Melinda Britt during her annual gynecologic exam. Which statement by Melinda would cause you to believe she is experiencing​ perimenopause? a ​"I am so cold​ lately." b ​"I feel that my appetite is really​ increasing." ​c "I have problems with​ constipation." ​d "I often experience sweating at​ night."

d (Sweating at night is a manifestation during perimenopause. Cold​ intolerance, increased​ appetite, and constipation are not symptoms manifested with perimenopause.)

A client with sickle cell disease asks the nurse to explain how she has this disease when no one else in her family is affected. The nurse understands that sickle cell disease follows what type of genetic inheritance​ pattern? ​a Sex-linked inheritance disorder b Mendelian inheritance disorder c Autosomal dominant disorder d Autosomal recessive disorder

d (Rationale Autosomal recessive disorders require two abnormal genes for an individual to be affected. If the individual has only one affected​ gene, he or she is considered a carrier of the disorder. For this client to be diagnosed with sickle cell​ disease, both parents are carriers of the genetic disorder. Autosomal dominant disorders are inherited if the disease trait is​ heterozygous; the abnormal trait overpowers the normal​ gene, producing the disorder. For these disorders to be​ diagnosed, one of the parents is affected by the disorder. Mendelian inheritance disorders are mathematically predictable and have fixed occurrence rates. The characteristics are inherited from the genes in each chromosome and are classified as dominant​ (strong) or recessive​ (weak). Inheritance is also determined by whether the chromosome is located on an autosome​ (body) or a gamete. Normal and abnormal characteristics are transmitted this​ way, and a parent can be a carrier for a​ single-gene disorder without having any observable characteristics.​ X-linked, or​ Sex-linked, inheritance disorders can be dominant or recessive and are carried on the X chromosome.​ X-linked recessive disorders are expressed in males who carry the disorder on their X chromosome. There are some conditions where the female will be​ affected, but the symptoms tend to be milder.)

Anika Winters recently discovered that she is pregnant. During her first office​ visit, she complains that her external genitalia have enlarged since finding out she was going to be a mother. The nurse informs Anna that this enlargement has occurred because of which hormone that is stimulated during​ pregnancy? a Human placental lactogen​ (hPL) b Human chorionic gonadotropin​ (hCG) c Progesterone d Estrogen

d (Rationale During​ pregnancy, estrogen enlarges the​ uterus, external​ genitalia, and the ductal system of the breasts. Human chorionic gonadotropin preserves the corpus luteum. Progesterone is essential for maintaining the pregnancy. Human placental lactogen assists in maintaining the​ fetus's glucose levels.)

How much more percentage of oxygen is carried in fetal hemoglobin when compared with adult ​hemoglobin? a 75 b 25 c 10 d 50

d (Rationale Its higher affinity for oxygen allows fetal hemoglobin to carry​ 50% higher concentrations of oxygen than that of adults.)

A client is complaining of menstrual problems. Which statement indicates that the client may be experiencing​ oligomenorrhea? ​a "I usually have bleeding in between my periods every other​ month." ​b "I saturate a pad in 1 hour when I am on my​ period." ​c "I am 15 and I have still not started my​ period." d "My periods are very light and some months I don​'t have​ one

d (Rationale Oligomenorrhea describes a condition in which there are infrequent or light menstrual periods. The client who has never had a menstrual period at age 15 may be experiencing amenorrhea. This term also refers to cessation of menstrual flow after initially having a period. Breakthrough​ bleeding, or bleeding in between​ periods, is referred to as metrorrhagia. Unusually heavy menstrual blood flow is called menorrhagia.)

A client is diagnosed as perimenopausal. Which psychological manifestation is the client most likely​ experiencing? a Increased vaginal pH b Decreased skin elasticity c Irritability d Fatigue

d (Rationale Perimenopausal women often complain of such psychological manifestations as fatigue. Decreased skin​ elasticity, increased vaginal​ pH, and irritability are physical manifestations of menopause.)

The nurse is educating a couple who are asking questions about fertilization. How long are sperm considered fertile in the female reproductive​ tract? a 12 hours b 36 hours c 48 hours d 24 hours

d (Rationale Sperm remain viable in the female reproductive tract for 48-72 hours but are considered fertile for only 24 hours.)

A​ 34-year-old client presents to the family practice clinic with complaints of not having a menstrual period in the past 14 months. What data should the nurse obtain when performing a physical examination on the​ client? a Drug and alcohol use b Sexual history c Menstrual history d Weight and height

d (Rationale When performing a physical examination on a perimenopausal​ client, the nurse needs to obtain the client​'s weight and height. The client​'s sexual and menstrual history and use of alcohol and drugs are data obtained when performing the health history.)

The nurse is providing home care instructions to a client experiencing menopause. Which activity will assist in managing mood​ swings? a Doing Kegel exercises b Keeping the bedroom cool c Avoiding cigarettes d Performing deep breathing exercises

d (Rationale When providing home care​ instructions, the nurse should educate the client to perform deep breathing exercises to assist in managing mood swings. Avoiding cigarettes will help manage hot flashes. Doing Kegel exercises will assist with urinary leakage. Keeping the bedroom cool will assist in managing night sweats.)

A​ 35-year-old client is interested in starting oral contraceptives. She smokes one pack of cigarettes a day. About which side effect should the nurse be most​ concerned? a Allergic reaction b Vaginal infection c Hypertension d Blood clot

d (Rationale Women on oral contraceptives are at risk of developing blood clots. Women over the age of 35 who smoke are at an even greater risk. Some women may experience an increase in blood pressure while taking oral​ contraceptives, but it would not take priority over the possibility of the formation of blood clots. Vaginal infections are not the result of oral contraceptive use. Allergic reactions to oral contraceptives are rare.)

The nurse concludes that a client has understood teaching about menopause when the client states the following: a "I have missed two periods now and am grateful I will have no more." b "I will experience symptoms of menopause for 2 weeks." c "I am depressed about having this disease." d "I know I have begun menopause and it will take a while to finish."

d (Rationale: Menopause is a lengthy process since estrogen levels decrease gradually. The process may take years. Menopause is not a disease, but a normal physiological process. The client may miss several menstrual periods only to have one at a later time. Symptoms of menopause can last years, but do gradually decline with time.)

A migrant/seasonal worker would most likely: a. have health insurance. b. be employed in a factory. c. be American-born. d. be at risk to experience a work-related injury.

d. be at risk to experience a work-related injury. A migrant/seasonal worker would most likely be at risk to experience a work-related injury because agricultural workers in general are exposed to pesticides and do not receive training about the safe handling of pesticides. A migrant/seasonal worker would probably not have health insurance and would most likely be employed in an agricultural setting (nurseries, orchards, canneries, or farm fields). A migrant/seasonal worker would most likely be foreign born.DIF: Cognitive level: ApplicationREF: p. 533

An example of a nurse partnering with community groups is: a. being aware of eligibility criteria for federal programming. b. providing health education. c. initiating care for a client's family member. d. forming a work group to respond to a community issue.

d. forming a work group to respond to a community issue. Forming a work group to respond to a community issue is an example of a community nurse partnering with community groups. Nurses should become active in identifying potential community partners to help address specific health needs for at-risk groups. Being aware of eligibility criteria for federal programming is an example of a community nurse being knowledgeable about available programs. Providing health education is an example of a community nurse performing an intervention at the primary level of prevention. Initiating care for a client's family member is an example of a community nurse performing case finding.DIF: Cognitive level: SynthesisREF: pp. 539-540

A strategy for primary prevention of teenage pregnancy is to encourage: early prenatal care. delayed participation in sexual activity. access to STD counseling. early detection of pregnancy.

delayed participation in sexual activity. Encouraging delayed participation in sexual activity is a primary prevention strategy. Encouraging early prenatal care is a secondary prevention strategy. Encouraging access to STD counseling is a tertiary prevention strategy. Encouraging early detection of pregnancy is a secondary prevention strategy.DIF: Cognitive level: ApplicationREF: pp. 612-614

Adolescents who become pregnant are more likely to (select all that apply): Select all that apply. have a cesarean section. develop pregnancy-induced hypertension. develop toxemia. receive prenatal care in the first trimester. abstain from drugs and alcohol during the pregnancy. deliver prematurely.

develop pregnancy-induced hypertension. develop toxemia. deliver prematurely. Teenagers are at greater risk for developing pregnancy-induced hypertension and toxemia. The incidence is higher in this population than any other age group except women older than 40 years. Young girls are more likely to deliver prematurely, undergo rapid or prolonged labor, experience eclampsia, and develop fetal infections. Current research indicates that there is little difference in cesarean rates in women 15 to 30 years of age. The number of adolescents who receive first-trimester care has increased over the past 10 years. However, more than 33% have had no prenatal care at the end of their first trimester. Pregnant adolescents are more likely to smoke than pregnant women older than 20 years of age. About 50% of all pregnant teenagers drink alcohol during their pregnancy.DIF: Cognitive level: KnowledgeREF: p. 620

Comprehensive school health curricula should (select all that apply): Select all that apply. emphasize student assessments that measure skill and knowledge. introduce content in the early grades and reinforce it in later grades. provide at least 50 hours of health education at every grade level. be taught by all school teachers. accommodate local needs and preferences. include input from a comprehensive health education advisory committee.

emphasize student assessments that measure skill and knowledge. introduce content in the early grades and reinforce it in later grades. provide at least 50 hours of health education at every grade level. accommodate local needs and preferences. include input from a comprehensive health education advisory committee. Comprehensive school health curricula should emphasize student assessmentsthat measure skill acquisition as well as knowledge. Comprehensive school health curricula should introduce content in the early grades and reinforce it in later grades and provide at least 50 hours of health education at every grade level. Curriculum planning and development should accommodate the unique local needs and preferences of each community. Creation of a comprehensive health education advisory committee that includes parent representation should help guide the school health curricula. Comprehensive school health curricula should be taught by teachers who are trained to teach the subject.DIF: Cognitive level: KnowledgeREF: p. 768

A trend in child health services that will influence the practice of community health nurses is the (select all that apply): Select all that apply. increase in the number of communicable diseases experienced by children. increase in number of children requiring home health services. increase in the number of children with chronic conditions who attend school. decrease in the availability of high-quality child care. increase in the emphasis of normalization of children with chronic conditions. decrease in the number of technology-dependent children.

increase in the number of communicable diseases experienced by children. increase in number of children requiring home health services. increase in the number of children with chronic conditions who attend school. decrease in the availability of high-quality child care. increase in the emphasis of normalization of children with chronic conditions. There has been an increase in the number of communicable diseases experienced by children. A refocusing on provision of preventive and primary care to all children is mandatory, especially in light of resurgent measles and mumps epidemics, the increase in tuberculosis, and the outbreaks of infectious agents. There has been an increase in the number of children requiring home health services owing to improved treatment modalities and survival rates. Community health agencies must respond to this expanding population. There is an increase in the number of children with chronic conditions who attend school. This will enhance the role of the school nurse. One of the needs of families is the availability of high-quality child care. This is true as welfare reform moves many mothers into employment at potentially low wages. Child care issues must also address the needs of caring for mildly ill children, technology-dependent children, and those with other special needs. The increased emphasis on normalization of children with chronic conditions will enhance the role of school nurses. Home care services for the medically fragile or technology-dependent child are increasing.DIF: Cognitive level: KnowledgeREF: p. 695

The community health nurse demonstrates the role of systems change agent by: providing direct care to a child and his/her family. educating families about growth and development. coordinating care among providers and service systems. informing and educating policymakers about services.

informing and educating policymakers about services. Informing and educating policymakers about current services for medically fragile children demonstrates the role of systems change agent. Providing direct care to a child and his family demonstrates the role of care provider. Educating families about growth and development demonstrates the role of educator. Coordinating care among providers and service systems demonstrates the role of coordinator.DIF: Cognitive level: ApplicationREF: p. 694

The school nurse seeks input from the community when initiating the establishment of a school-based clinic at the school. This is an example of the nursing role of: liaison between school personnel, family, community, and health care providers. provider of direct health care to students and staff. health screener and source of referrals for health conditions. promoter of a healthy school environment.

liaison between school personnel, family, community, and health care providers. As a liaison between school personnel, family, community, and health care providers, the school nurse seeks input from the community when initiating the establishment of a school-based clinic at the school. Involving the community in planning health services programs increases support for these initiatives if they have participated in the planning of the program. As a provider of direct health care to students and staff, the school nurse provides direct care to students and staff who have been injured or are suffering from acute illness. As health screener and source of referrals for health conditions, the school nurse performs routine health screenings in the schools. As promoter of a healthy school environment, the school nurse is concerned with the physical and emotional safety of the school community.DIF: Cognitive level: KnowledgeREF: p. 758

When considering family dysfunction related to substance abuse and dependence, the role of the enabler is to: blame an individual as the sole source of the family's problem. limit or eliminate the harmful consequences of the user's behavior. become overly close to one special child. compensate for the irresponsible behaviors exhibited by the user.

limit or eliminate the harmful consequences of the user's behavior. Limiting or eliminating the harmful consequences of the user's behavior is the role of the enabler. The abuser is enabled to continue the abuse pattern because he/she does not have to face the problems brought on by their behavior. Blaming an individual as the sole source of the family's problem is known as

Temporary Assistance to Needy Families (TANF) provides: unlimited public assistance to teenage mothers and their children. limited support to teenage mothers and their children for up to 2 consecutive years. support for teenage mothers to secure employment. limited support for the children of teenage mothers.

limited support to teenage mothers and their children for up to 2 consecutive years. TANF provides limited public assistance to teenage mothers and their children. All able-bodied adults receiving TANF are expected to look for work. Persons are limited to 2 consecutive years of TANF benefits and a lifetime maximum of 5 years.DIF: Cognitive level: KnowledgeREF: p. 609

A community health nurse uses tertiary prevention when: organizing a 12-step Alcoholics Anonymous (AA) program in the community. providing health education programs about substance use. screening for alcohol and other drug abuse or addiction. targeting at-risk populations.

organizing a 12-step Alcoholics Anonymous (AA) program in the community. Organizing a 12-step Alcoholics Anonymous (AA) program in the community is an example of tertiary prevention. It involves ongoing follow-up and treatment to prevent relapses and maintain recovery. Providing health education programs about substance use is an example of primary prevention. Primary prevention involves the identification and modification of risk and protective factors that apply to alcohol and other drug use. Screening for alcohol and other drug abuse or addiction is an example of secondary prevention. Secondary prevention involves early diagnosis and treatment. Targeting at-risk populations is an example of a primary prevention strategy.DIF: Cognitive level: ApplicationREF: p. 645

Ventilator-dependent children who are cared for at home: acquire more infections owing to the lack of sterility in the home environment. lack social skills because they are only around their family in the home. require a back-up ventilator in case of ventilator failure. increase health care costs because of the need for constant nursing care.

require a back-up ventilator in case of ventilator failure. Ventilator-dependent children who are cared for at home require a back-up ventilator in case of ventilator failure and to facilitate movement from one area of the home to another. Ventilator-dependent children who are cared for at home experience fewer infections compared with institutionalized children. Ventilator-dependent children who are cared for at home demonstrate increased socialization and improved motor skills compared with institutionalized children. Ventilator-dependent children who are cared for at home reduce health care costs as much as 80% to 90% in some cases. In many cases, family members become the primary caregiver for the child.DIF: Cognitive level: KnowledgeREF: p. 691

A cluster of cognitive, behavioral, and physiological symptoms that indicate that an individual continues to use a substance despite significant substance-related problems is called: substance use disorder. substance abuse. substance dependence. addiction.

substance dependence. Substance dependence refers to a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues to use a substance despite significant substance-related problems. Unlike substance abuse, substance dependence also includes tolerance, withdrawal, and a pattern of compulsive use. Substance use disorder is an overarching term, encompassing both substance abuse and substance dependence. Substance abuse refers to a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences occurring within a 12-month period. Addiction focuses on genetic, psychosocial and environmental influences in the development of substance use, abuse, and dependence.DIF: Cognitive level: KnowledgeREF: p. 634

The Children's Health Insurance Program (CHIP) provides health insurance: to children who are eligible for Medicaid. to children who are enrolled in the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. to children who are disabled. to children whose families are above the financial eligibility for Medicaid.

to children whose families are above the financial eligibility for Medicaid. The Children's Health Insurance Program provides health insurance to children whose families are above the financial eligibility for Medicaid. This is done at the state level by either expanding the Medicaid program or developing a new children's health insurance program. Children who are eligible for Medicaid receive Medicaid services. The EPSDT program is part of the Medicaid program. It funds but does not provide direct services. Its goal is to ensure that all children enrolled in Medicaid receive a basic set of comprehensive services to promote health and identify and treat problems at early stages. Children who are disabled may receive care through Title V of the Social Security Act, which authorizes the State CSHCN programs to provide care to eligible children with severe or chronic illness.DIF: Cognitive level: KnowledgeREF: p. 680

Children diagnosed with fetal alcohol syndrome (FAS) (select all that apply): Select all that apply. will experience small gestational age. will display symptoms immediately after birth. will experience failure to thrive. will experience abnormalities in the central nervous system. will experience smaller-than-normal brain size. will experience learning disabilities.

will experience small gestational age. will experience failure to thrive. will experience abnormalities in the central nervous system. will experience smaller-than-normal brain size. will experience learning disabilities. Children diagnosed with FAS will experience abnormalities in the central nervous system, as well distinctive facial features, small gestational age, and failure to thrive that is not related to poor nutrition. FAS children experience smaller-than-normal brain size and decreased white matter. Some common symptoms observed may include learning disabilities, intellectual disabilities or low IQ, speech and language delays, poor reasoning and judgment skills, attention deficits, poor memory, and poor coordination. It is not easy to detect FAS during the neonatal period because facial features associated with the syndrome are difficult to recognize and the central nervous system dysfunction might not be identified until several years after birth.DIF: Cognitive level: KnowledgeREF: p. 652

At a prenatal​ visit, a client with gestational hypertension laments the amount of weight she has gained since her last appointment. Her blood pressure and other vital signs are within acceptable limits. What does the client say that indicates that she needs additional education about good​ nutrition? ​"I couldn't taste much of a difference when I made my curried goat with half as much​ salt, but my family​ could." ​"I have stopped drinking diet​ soda." ​"I go for a walk around my neighborhood most​ evenings." ​"I try not to eat more than​ 1,200 calories a​ day."

​"I try not to eat more than​ 1,200 calories a​ day." Rationale: Restricting her calorie intake to less than​ 1,200 calories daily is not only counterproductive to weight​ control, it will not provide the nutrients the client needs for good health for herself and her baby. When discussing appropriate​ intake, it is important for the nurse to explore any cultural restrictions on diet. Walking each​ evening, limiting salt​ intake, and cutting out diet soda are positive practices.