PREPU Chapter 26: Wellness and Health Promotion

A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which information about the colposcopy should the nurse provide? A. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done. B. There may be some pain while urinating for up to 1 week after the test. C. Sexual intercourse should be avoided for 2 weeks. D. The procedure may be painful.

A A colposcopy is performed when results of a Papanicolaou test are abnormal. This is a painless procedure with no aftereffects, so urinating afterwards is not a problem, and sexual intercourse need not be avoided.

What is the most common viral infection? A. human papillomavirus (HPV) B. trichomoniasis C. chlamydia D. gonorrhea

A HPV infection is the most common viral infection. Millions of Americans are infected with HPV, many unaware that they carry the virus.

The nurse reviews the meal choices for a client who is experiencing undernutrition. Which macronutrient percentage adheres to the current dietary guidelines? A. 30% protein B. 70% carbohydrates C. 20% sugar D. 10% fat

A Macronutrients are the nutrients the body needs to function and include fats, carbohydrates, and protein. According to current guidelines, 10% to 35% of calories should be from protein. This is the nutrient that is sufficiently represented on the client's meal choices. Fat calories should make up 20% to 35% of a client's daily calories. Added sugars should be limited to 10% or less of daily calories. Carbohydrates should make up 45% to 65% of daily calories.

A 63-year-old female client having a routine gynecologic examination asks the nurse about the best way to be screened for breast cancer. Which response should the nurse make? A. "Mammography is the standard screening method for breast cancer." B. "Ultrasound of the breasts is used the most to screen for breast cancer." C. "Performing self-examination of the breasts detects breast cancers before other approaches." D. "A clinical breast examination by the health care provider detects most cancers."

A Mammography is currently the standard imaging method for breast cancer screening. Ultrasound may be used for follow-up imaging if a suspicious lesion is noted on mammogram, but it is not a primary screening method. Although clinical breast examination was once a mainstay of breast cancer screening, it is no longer recommended for routine screening. Breast self-examination is no longer routinely recommended for screening. Breast awareness, or being familiar with one's own breasts to detect any changes, is now the recommended approach.

A client newly diagnosed with cervical cancer states, "I cannot believe I am going to die so young. My mother and aunt died from cervical cancer and I am next." Which response by the nurse is most appropriate? A. "You sound worried. Let's talk about how you are feeling with this new diagnosis." B. "There are several treatment options for you to consider including chemotherapy, radiation, and surgery." C. "I understand your concerns and fears. This is a scary diagnosis and genetics are a factor." D. "Tell me about the treatments your mother and aunt received, so those can be avoided."

A The nurse would talk with the client about her feelings and concerns at the moment upon receiving this new diagnosis. Determining the treatment that the client's mother and aunt received is not appropriate. The best treatment for the client will be based on the client's condition, stage, and available options. The nurse should not state understanding of the client's feelings because this changes the conversation to focus on the nurse and not the client. While chemotherapy, radiation, and surgery are all options, this statement does not address the client's feelings.

A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client education, what group should the nurse include as at risk for cervical cancer? A. clients who have genital warts B. clients who have not had babies C. clients with irregular menstrual cycles D. clients with fibrocystic breast disease

A The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.

A nurse is performing an assessment on a 25-year-old white female client who is obese and is trying to conceive. The client presents to the clinic concerned about a newly found lump in their breast. The nurse explains to the client the difference between benign nodules and breast cancer. Complete the following sentence(s) by choosing from the lists of options. The nurse determines client understanding of the difference between a lump that is a benign nodule and a lump that is breast cancer when the client states (A)_______________ is a sign of a benign nodule and (B)______________ is a sign of breast cancer.

A. Soft and movable B. Hard and fixed Benign nodules are painful, smooth, and movable. Cancerous nodules are hard, fixed, irregularly shaped, and painless. Benign nodules are painful. Cancerous nodules are painless. Benign nodules are smooth and round. The more a breast lump is irregularly shaped, the more likely the lump is cancerous.

The nurse is educating a female client diagnosed with human papillomavirus (HPV). Which information will the nurse include in the client's education plan? A. "Your best option is to surgically remove genital warts to prevent you from spreading the disease." B. "You should be sure to receive consistent testing for cervical cancer." C. "You will be prescribed an antiviral medication to take that will clear your infection." D. "During colder weather, you will note more outbreaks than during warmer weather."

B An infection with HPV is a risk factor for developing cervical cancer. Women with a history of HPV should receive consistent testing/screening for cervical cancer. HPV is a virus; however, no antiviral to date resolves the virus in the body. Surgical removal is an option for genital warts; however, it is not the best option as the virus can still be spread without the presence of warts. Wart removal is done for comfort and appearance. Outbreaks are most noted during times of stress or illness and trauma; outbreaks are not temperature related.

A 68-year-old client has just undergone a scheduled Papanicolaou (Pap) test. The client tells the nurse "My sister is 65 and the health care provider told my sister that she no longer needs to have Pap tests. Why do I still have to have them?" Which is the nurse's best response? A. "Your sister probably does not have an increased risk for developing cervical cancer." B. "You have a history positive for HPV and a high-grade cervical abnormality 3 years ago." C. "Women older than 65 years are unlikely to benefit from screening because of the slowness of HPV-related cervical changes." D. "Perhaps your sister is being tested for HPV instead of undergoing regular Papanicolaou testing."

B Cervical screening for women may end at the age of 65, provided they are not at an increased risk for cervical cancer, have had at least two consecutive negative cotests or three negative Papanicolaou (Pap) test in the past 10 years, and have no history of high-grade cervical abnormalities or cancer. This client had a recent high-grade abnormality. It may be true that the sister is not at an increased risk for cervical cancer, but it is not the best answer because it does not explain why the client needs to continue screening. It also may be true that women aged 65 and greater may not benefit from screening because of the slowness of HPV-related cervical changes but it still does not explain why the client has to continue screening. The sister would not be screened for HPV alone instead of a Pap test unless there were symptoms of HPV or a recent test with atypical cells of undetermined significance.

During an assessment, a client whose natal sex is identified as female reports a gender identity as being female. In which way should the nurse document this client's gender identity? A. transman B. cisgender C. transwoman D. transgender

B Gender identity is a person's innate sense of being male, female, or neither male nor female. A person whose gender identity aligns with the assigned natal sex may be referred to as cisgender. The general term transgender is used to refer to individuals whose gender identity is not the same as their assigned natal sex. The term transgender man or transman describes a person with a male gender identity who was assigned female at birth. The term transgender woman or transwoman describes a person with a female gender identity who was assigned male at birth.

A client comes to the clinic anxious and with self-described "sexual problems." Which response should the nurse make to the client first? A. Communicate respect. B. Provide assurance of confidentiality. C. Avoid making assumptions. D. Ask nonleading questions.

B It is essential that a client feel safe, particularly when communicating about sex and sexuality. Confidentiality is critical, and the nurse will need to remind the client of the nurse's discretion from the very beginning of the interaction. The nurse should communicate respect to the client, avoid making assumptions and using medical jargon, and listen carefully to the client's responses. This can only be done after the client feels secure in the situation.

The nurse is preparing a presentation for a local women's group about methods to reduce the risk of reproductive tract cancers. Which action should the nurse include? A. blood pressure evaluation every 6 months B. condom use with every sexual encounter C. consumption of two to three glasses of red wine per day D. yearly Papanicolaou test starting at age 40

B Staying healthy is a major way to reduce one's risk for cancer. Current recommendations include: using a condom with every sexual encounter; having blood pressure evaluated at least every 2 years; undergo a Papanicolaou test every 1 to 3 years, if sexually active, starting at age 21; and consuming alcohol in moderation (not more than one drink per day), if at all.

The nurse is caring for a client who has tested positive for the breast cancer (BRCA) gene mutation. The client is concerned about the possibility of passing the mutation to their future children. What is the nurse's best response? A. "Your child will not inherit this gene mutation." B. "There is a 50% chance your child will inherit this gene mutation." C. "The child will only inherit this gene mutation if the other parent also has this mutation." D. "Unfortunately, your child will inherit this gene mutation."

B The BRCA mutation is autosomal dominant, meaning that a parent with the mutation has a 50/50 chance of passing the gene and the greater susceptibility to breast cancer on to offspring. This means that for each child, there is a 50% chance they will inherit the mutation. The other options are incorrect as the inheritance of the BRCA gene mutation is not guaranteed, it is not impossible, and it does not require both parents to have the mutation.

A nurse is caring for a postmenopausal client concerned about having vaginal bleeding. The client states, "I had a sexually transmitted infection that treated successfully 8 years ago." When assessing the client further, which organism would be of highest concern at this time? A. chlamydia B. human papillomavirus C. syphilis D. gonorrhea

B Unexplained vaginal bleeding can be a concern for possible reproductive cancer. The nurse is correct that genital herpes infection is associated with an increased risk of cervical cancer. If untreated, syphilis can progress to affect the central nervous system, causing dementia. Chlamydia increases the risk for other STIs. Data suggest that gonorrhea facilitates HIV transmission.

The nurse is taking a diet history from a client. The client has identified the foods eaten in the last 24 hours. What should the nurse assess next? A. amount of calories B. which foods were fried C. portion sizes D. number of sodas

C An assessment of the client's diet can identify the components that may contribute to or lessen health risks. An evaluation should include questions about portion size, food-related behaviors, and foods consumed. Many people have difficulty estimating portion size and tend to underestimate the quantity of the food they consume. A complete food assessment evaluates the client for weight loss or gain, food allergies and intolerances, alterations in the ability to digest food, eating disorders, changes in appetite, the ability to chew and swallow, and the skills and readiness of the client to implement change. If the client is having weight gain, then the nurse would want to how much daily food intake is fried and with what type of fat, along with how much sugar intake is derived from soda.

A nurse is reviewing the medical record of an adolescent client who has expressed feelings of gender dysphoria during previous clinic visits. The client is scheduled for a visit today. What is important for the nurse to consider when providing care for this client? A. The client should be referred to by the pronoun associated with the client's natal sex. B. The client's sexual orientation is related to the client's feelings of dysphoria. C. The client's gender identity and sex assigned at birth do not match. D. The client's outward appearance will align with the client's assigned natal sex.

C In providing care to the client, it is most important for the nurse to consider that the client's innate sense of being either male or female does not align with the client's sex assigned at birth, which has caused the client distress. Gender expression refers to how a person presents themselves to the world, which may not necessarily correlate with the person's assigned sex. The nurse should refer to the client by their preferred pronoun. Sexual orientation refers to whom a person is attracted to sexually and is not related to the client's feelings of gender dysphoria.

The nurse is caring for a pregnant client and advising them on diet recommendations. Which food would the nurse recommend as the most well-rounded source of protein? A. processed meat B. steak and hamburgers C. poultry and fish D. high-fat dairy products

C Protein is an essential nutrient, especially during pregnancy, and it can be sourced from both plant and animal products. However, not all sources of protein are equal in terms of their health impacts. Lean proteins such as poultry and fish are generally preferred to red meat like steak and hamburgers. Steak and hamburgers, as well as high-fat dairy products, are higher in fat content. Recommending poultry and fish as a source of protein would be a healthier choice for the pregnant client. Consumption of processed meat, foods high in saturated fat, and unprocessed red meat are associated with the risk for cardiovascular disease.

The nurse is providing education to a group of new nurses on testing for syphilis. Which individual would be tested for syphilis? A. individuals who have been vaccinated against syphilis B. individuals who are not sexually active C. a newly pregnant client at their first prenatal visit D. individuals who have been previously treated for syphilis and show no current symptoms

C Syphilis is a sexually transmitted infection that can have serious health consequences if left untreated, including complications in pregnancy and increased risk for HIV. Therefore, it is recommended that individuals who are sexually active be tested for syphilis. This is particularly important for pregnant individuals, as untreated syphilis can lead to adverse pregnancy outcomes including stillbirth, neonatal death, and infant disorders such as deafness and neurologic impairment. Therefore, testing for syphilis at the first prenatal visit is a standard part of prenatal care. Individuals who have not been sexually active or have been treated for syphilis with no current symptoms do not need to be tested. A vaccine for syphilis does not exist.

A client whose natal sex is identified as male reports issues with their parents because of wanting to wear female clothing and makeup. Which problem should the nurse use when planning care for this client? A. ineffective coping as a transman B. gender dysphoria risk C. conflict with family over gender expression D. conflict with gender identity

C The client's natal sex is male; however, gender expression is that of female. The client further reports issues with the parents because of the gender expression. The problem that would be most appropriate to guide this client's care is conflict with family over gender expression. There is not enough information to determine if the client is at risk for gender dysphoria, because the client is not describing distress or discomfort due to misalignment between gender identity and assigned sex. The client is not expressing a conflict with gender identity. The client is not a transman, because the client was identified as a male from birth.

A client diagnosed with human papillomavirus (HPV) asks the nurse if she will be at risk for developing cervical cancer. The nurse best responds by making which statement? A. "You will likely contract cervical cancer so frequent screening testing will be very important." B. "Cervical cancer is typically caused by the herpes simplex virus, not the human papillomavirus (HPV)." C. "Certain strains of the human papillomavirus (HPV) have been associated with causing cervical cancer." D. "If you get the human papillomavirus (HPV) vaccine you will no longer be at risk for developing cervical cancer."

C The human papillomavirus (HPV) is associated with causing both genital warts and cervical cancer. There is not enough information to definitively indicate that this client will or will not contract cancer. The herpes simplex virus is associated with shingles and genital herpes, not cervical cancer. The HPV vaccine prevents certain strains of HPV, but does not decrease the risk for cervical cancer if the person has already been exposed to the virus.

The nurse is teaching a client ways to improve the diet. The nurse teaches the client that it is important to limit simple carbohydrates in the diet because these types of foods produce: A. decreased hemoglobin A1C. B. decreased glycemic index. C. increased blood glucose. D. increased insulin resistance.

C The ingestion of simple carbohydrates such as sugar and white flour can lead to short-term spikes in the blood glucose level. Simple carbohydrates also produce a higher glycemic index. The HgbA1C is a laboratory test that measures the levels of glucose over a 3-month time frame. Simple carbohydrates will not affect insulin resistance, which is caused by the pancreas.

Why is a Papanicolaou test done at the first prenatal visit? A. It predicts whether cervical cancer will occur. B. It detects if uterine cancer is present. C. It helps to date the pregnancy. D. It identifies abnormal cervical cells.

D A Pap test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

A client who received the human papillomavirus (HPV) vaccination is having a routine gynecologic examination. Which screening for HPV does the nurse anticipate for this client? A. none B. HPV test only C. Papanicolaou (Pap) test only D. Papanicolaou (Pap) test and HPV test based upon age

D Although it is anticipated that the advent of the human papilloma (HPV) vaccine will dramatically reduce the incidence of cervical abnormalities and cancer, the available vaccines do not protect against all forms of HPV. In addition, many young clients may already have been exposed to HPV prior to vaccine administration. The vaccine is effective in protecting individuals from select strains of HPV, but it does not treat HPV infections that were acquired previously. At this time, no alteration in the screening schedule is recommended for clients who have been vaccinated. Therefore the client should have a Papanicolaou (Pap) test and HPV test based upon the age per the current recommendations. No testing is not a viable option. The HPV test is not done alone. If a Papanicolaou (Pap) test is done without an HPV test, any previous HPV infections would not be detected.

A young adult woman is admitted to the hospital with symptoms of anorexia nervosa. What information should the nurse obtain in determining the client's psychological status? A. family history B. previous psychological trauma C. desire to gain weight D. body perception

D Anorexia nervosa is defined as an intense fear of weight gain, abnormally low weight, calorie restriction, and a distorted perception of one's body. The acute problems of low weight and calorie restriction are physiologic problems that need to be addressed first because they are a threat to the life of the client. The distorted perception of the body is a psychological problem that will need to be identified. In planning care, this need will be identified as a long-term goal. The goal is to have the client understand positive body image.

The nurse is completing a 24-hour diet recall with a client who is demonstrating symptoms of anorexia nervosa. Which question should the nurse ask to obtain the most valid information? A. "Was the spaghetti with meat sauce?" B. "Were there meatballs with the spaghetti?" C. "Did you sprinkle cheeses on your spaghetti?" D. "What did you put on your spaghetti?"

D During a 24-hour diet recall interview, the nurse asks the client to report what the client ate and drank, the portion size, and the method of food preparation over the course of the past 24 hours. These interviews are guided by clusters of questions about eating and avoid using leading questions. To find out what a client ate with spaghetti, a specific question such as "what did you put on your spaghetti?" should be asked instead of leading questions such as "was the spaghetti with meat sauce?"; "were there meatballs with the spaghetti?"; or "did you sprinkle cheeses on your spaghetti?"

The nurse is helping a young mother with a toddler improve the daily diet for the family. What is one way the nurse could teach the mother to improve the daily intake of complex carbohydrates? A. Use sugar-free cookies for snacks. B. Increase the servings of potatoes. C. Decrease the servings of green vegetables. D. Provide whole fruit instead of juice.

D One way to increase the intake of complex carbohydrates and decrease simple carbohydrates is to include more whole fruit into the diet and decrease the amount of fruit juice. Fruit juice is concentrated and contains more sugar. It is also refined so that it does not contain fiber. Using sugar-free cookies and crackers would not be beneficial because the decreased sugar means increased fat. Generally, that fat is not healthy fat. Increasing the serving of potatoes would only provide complex carbohydrates (if the potatoes are sweet potatoes, not white potatoes). Green vegetable servings should be increased, not decreased.

Which statement is false regarding screening for intimate partner violence in women? A. An older adult woman may be a victim of intimate partner violence. B. Although women who are victims of intimate partner violence may exhibit certain behavior patterns, all women should be screened for IPV. C. Screening should be routinely done at every visit. D. Women tend to fit a profile for intimate partner violence, and victims tend to share similar physical characteristics.

D Women do not typically fit a physical profile, and any woman can be a victim of intimate partner violence. Therefore, all women, even older adult women, should be screened for IPV at every visit.