test 6 OB/Ped

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. Polycythemia is an increase in red blood cells.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mm'. Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child's vital signs, including blood pressure, should be monitored every 4hours. 4. All visitors should be discouraged from coming to see the family.

1. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child's spleen is removed, it is not necessary to do exchange transfusions.

1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia. Exchange transfusion does not decrease risk of a transfusion reaction. Every time a transfusion is done, the child continues to be at risk for a reaction. This is not a routine procedure and is performed only when the number of sickle cells is elevated and the child is at high risk for thrombosis. After a splenectomy, transfusions still need to be done depending on the client's hemoglobin level. TEST-TAKING HINT: Consider the reasons transfusions are given with sickle cell clients, one of which is exchanging the sickled red cells with non-sickled cells.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1. Non-Hodgkin disease originates in the lymphoid system. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation. Reed-Sternberg cells are diagnostic for Hodgkin disease and are not seen in non-Hodgkin lymphoma. Reed-Sternberg cells arise from "B" cells and are large, multinucleated cells. TEST-TAKING HINT: The lymphomas are divided into Hodgkin disease (which primarily involves the lymph nodes with metastasis to extra lymphatic sites) and non-Hodgkin lymphoma (a heterogenous condition that has a variety of morphological, cytochemical, and immunological cell features).

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1. Seek medical attention for illness to prevent the child from going into a crisis. 3. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health. A cold environment causes vasoconstriction, which needs to be prevented to get good tissue perfusion.

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1. The first dose should be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so that the smell of the food does not make the child nauseated. The child should be allowed to take food and fluids as tolerated. Antiemetics are most beneficial if given before the onset of nausea and vomiting. TEST-TAKING HINT: These are measures to prevent nausea and vomiting.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap). There is no need to perform a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. ICP would be considered if the child had symptoms of headache, nausea, forceful vomiting, blurred or double vision, drowsiness, or seizure; an LP might then be performed. Leukemia is not staged. TEST-TAKING HINT: The primary site for leukemia involvement is the bone marrow. Rarely do children have CNS involvement.

Which test provides a definitive diagnosis of a plastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum IgG levels. 4. Basic metabolic panel.

2. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow. complete blood count would show pancytopenia, which would lead the health-care provider to look for the cause of the blood abnormality. Serum IgG levels do not diagnose aplastic anemia, which does not seem to have an immune cause. A basic metabolic panel tests for metabolic disorders. TEST-TAKING HINT: Focus on the fact that aplastic anemia is a failure in the bone marrow that causes pancytopenia, so analysis of the bone marrow would confirm the diagnosis

Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP. 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin. Platelets are large, not small. ITP is an acquired hematological condition that is characterized by excessive destruction of platelets, purpura, and normal bone marrow along with an increase in large, yellow platelets. TEST-TAKING HINT: Review the pathophysiology of ITP to determine the manifestations of the disease.

Which of the following should the nurse expect to administer to a child with ITPand a platelet count of 5000/mm'? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected In ITP, destruction of platelets is caused from what is believed to be an immune response, so giving additional platelets would only result in new platelets being destroyed.Red blood cells are not an effective treatment for ITP. Because this is a platelet deficiency, white blood cells are not an effective treatment for ITP. White blood cell infusion is rarely done with any disease process.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy: What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed. The cells involved with sickle cell disease are abnormal red blood cells, which do not decrease infections. Removal of the spleen will not prevent sickling, because it will not change the disease condition. The child will still have sickle cell disease and can still have sickle cell crises. TEST-TAKING HINT: Review splenic sequestration and when a child can go into sickle cell crisis.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 5. By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food. Because the child has a low hematocrit level, the child most likely has anemia. Iron-deficiency anemia is the most common nutritional anemia. The number of bowel movements the child has is important information but not necessary to make the diagnosis of iron-deficiency anemia. Knowing birth weight can help determine whether the child is following his or her own curve on the growth chart. Knowing if the child is taking any new medication is not necessary to make the diagnosis of iron-deficiency anemia. TEST-TAKING HINT: The most common anemia in children and in toddlers is iron- deficiency anemia, frequently the result of drinking too much milk and not eating enough iron-rich foods.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed, such as morphine, Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to occurring moderate. Meperidine (Demerol) should not be used because it may potentiate seizures. Aspirin should not be used in children because of the risk for Reye syndrome. TEST-TAKING HINT: One needs to consider using narcotics when a child has sickle cell crises, because tissue hypoxia can cause severe pain.

Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate

3. Postdates babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for nourishment when the placental function deteriorates. Infants of diabetic mothers are often large for gestational age, but they are not especially at high risk for cold stress syndrome. Infants born with Rh incompatibility are not especially at high risk for cold stress syndrome. Down syndrome babies are hypotonic, but they are not especially at high risk for cold stress syndrome. TEST-TAKING TIP: Cold stress syndrome results from a neonate's inability to create heat through metabolic means. In lieu of food intake, brown adipose tissue (BAT) and glycogen stores in the liver are the primary substances used for thermogenesis. The test taker can then deduce that the infant who is most likely to have poor supplies of BAT and glycogen is the postdates infant.

A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9°F /36.1°C. Which of the following could explain this finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby

3. Preterm babies are born with an insufficient supply of brown adipose tissue that is needed for thermogenesis, or heat generation. The normal temperature of a premature baby is the same as that of a full-term baby. Axillary temperatures, when performed correctly, provide accurate information. There is nothing in the question that would explain conduction heat loss. TEST-TAKING TIP: It is important for the test taker not to read into questions. Even though conduction can be a means of heat loss in the neonate and, more particularly, in the premature, there are three other means by which neonates lose heat— radiation, convection, and evaporation. Conduction could be singled out as a cause of the hypothermia only if it were clear from the question that conduction was the cause of the problem.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia. Medical treatment of sickle cell vaso- hypoxia. Tissue hypoxia is very painful, so Occlusive crises is directed toward preventing placing the child in a position of comfort is important.. Hot packs help relieve pain because they cause vasodilation, which allows increased blood flow and decreased hypoxia. TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep in mind measures that decrease tissue hypoxia. .

A premature newborn's neuronal immaturity may contribute to what complication? A) Apnea of prematurity B) Patent ductus arteriosus C) Respiratory distress syndrome D) Anemia of prematurity

A) Apnea of prematurity is primarily a result of neuronal immaturity, causing irregular breathing patterns and cessation of breathing for 20 seconds or longer in preterm infants. PDA, respiratory distress syndrome, and anemia of prematurity have other etiologies related to the premature development of the neonate.

The nurse is teaching a class to prospective parents about the role that deoxyribonucleic acid (DNA) plays in the development of the human fetus. Which statement made by the parents indicates understanding of the teaching? A) "DNA molecules are made up of genes." B) "DNA is used to form ribosomes." C) "DNA is outside the nucleus of the cell." D) "DNA is attached to the endoplasmic reticulum."

A) DNA is contained in the nucleus, and it contains all the instructions, or genes, needed to determine an individual's inherited characteristics and produce every protein needed by the body. RNA, not DNA, is used to form ribosomes, and ribosomes are found on the endoplasmic reticulum.

A female client tells the nurse that she does not want to have children because there is a history of Down syndrome in her family. Which of the following statements should the nurse include in her response to this client? A) "Down syndrome is the most common genetic defect caused by an extra chromosome." B) "Babies born with Down syndrome do not live very long." C) "It is probably best to not give birth to a baby with birth defects." D) "Down syndrome only occurs in the babies of women who are over age 40."

A) Down syndrome is the most common trisomy abnormality seen in children. It is the product of the union of a normal egg or sperm with an egg or sperm that has an extra chromosome. This syndrome can occur at any time in a childbearing client of any age. Although children born with Down syndrome have a variety of physical ailments, advances in medical science have extended their life expectancy. The nurse should not provide an opinion about giving birth to a baby with birth defects.

The nurse is assessing the sexual health of a 20-year-old female client. Which of the following findings should the nurse identify as risk factors for dysfunctional uterine bleeding? Select all that apply. A) High level of stress B) Weight gain of 20 pounds in 2 months C) Use of birth control pills for contraception D) History of peptic ulcer disease E) Limited intake of high-fat foods

A, B, C) A number of factors may predispose a woman to dysfunctional uterine bleeding. These factors include stress, extreme weight changes, and use of hormonal birth control. Dysfunctional uterine bleeding is usually related to hormonal imbalances and not associated with peptic ulcer disease or low-fat diets.

The nurse is planning care for a young child who is admitted with sickle cell crisis. The parents are with the child, and neither has much information about the disease. When planning care for this family, the nurse will set which goal with this family? A) The child will drink adequate amounts of fluid each day. B) The child will play outside in the sun. C) The family will not have the child vaccinated. D) The family will plan vacations in high-altitude areas.

A) For the client with sickle cell disease, dehydration can lead to life-threatening consequences. The client's oral intake should be adjusted as necessary to keep the child well hydrated. Teach clients and parents how to monitor intake and output, and provide client teaching regarding fluid management. Playing outdoors in the sun can lead to dehydration, which can precipitate a crisis. Oxygen supply at high altitudes is too low for the client with sickle cell disease. The family should be taught to select low-altitude areas for vacation. Infection and illnesses with fever will increase the body's demand for oxygen, so it is important for the family to keep up with the child's immunization schedule.

A nurse educator is explaining the term hyperplasia to a group of nursing students. Which statement, made by a nursing student, indicates an understanding of why hyperplasia occurs with myocardial infarction? A) "Heart muscle cells experience hyperplasia with the prolonged need for oxygen." B) "Heart muscle cells are hyperplastic in response to muscle damage." C) "Heart muscle cells are hyperplastic when they have lost fluid." D) "Heart muscle cells experience hyperplasia when they respond to decreased metabolic demands."

A) Hyperplasia is an increase in density or number of normal cells in response to stress-in this case, the increased demand for oxygen. Cells that lose fluid will shrink in size. Muscle damage occurs because of inadequate nutrition, not because of hyperplasia. Heart muscle cells may become hyperplastic because of increased metabolic demands, not decreased metabolic demands.

A client is admitted to the emergency department in a sickle cell crisis. The nurse assesses the client and documents the following clinical findings: temperature 102°F, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority? A) Apply oxygen per nasal cannula at 3 L/minute. B) Assess and document peripheral pulses. C) Administer morphine sulfate 10 mg IM. D) Administer Tylenol 650 mg by mouth.

A) Hypoxia is often the cause of a sickle cell crisis from the clumping of damaged RBCs, which creates an obstruction and hypoxia distal to the clumping. Administering the oxygen will improve the pain and increase the oxygen saturation of body tissues. Therefore, applying the oxygen should be the first action by the nurse. Although the temperature is elevated and will increase oxygen demands in the body by increased basal metabolic activity, administering Tylenol is not the first action the nurse should take, because a sickle cell crisis is caused by oxygen deprivation in tissues, not by the fever. Morphine sulfate is a narcotic for pain, but it should be given after the oxygen is started, since the symptoms are caused by hypoxia. The morphine will decrease the pain and decrease metabolic oxygen needs by decreasing basal metabolic rates; therefore, supply is increased and demand is increased. Full body assessment, including peripheral pulses, is significant to identify the location of the potential obstruction, but this is secondary to treating the hypoxia that is known to be present from the sickling of the cells during sickle cell crisis.

A pediatric nurse is educating the client with sickle cell disease and the client's family regarding the genetic implications of the disease. Which information is inappropriate for the nurse to share with the client's family? A) If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 50%. B) The disorder is transmitted as an autosomal recessive genetic defect. C) The sickle cell gene may have originated to protect against lethal forms of malaria. D) In African Americans, sickle cell disease occurs in 1 of every 365 births.

A) In educating the client and the client's parents regarding sickle cell disease, the nurse will state that the disorder is transmitted as an autosomal recessive genetic defect. If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 25%, not 50%. The sickle cell gene may have originated to protect against lethal forms of malaria. In African Americans, sickle cell disease occurs in 1 of every 365 births.

________ is the absence of menstruation by age 14 without having undergone other changes associated with puberty or by age 15 with having undergone normal physical changes of puberty. A) Primary amenorrhea B) Oligomenorrhea C) Secondary amenorrhea D) Metrorrhagia

A) Primary amenorrhea is the absence of menstruation by age 14 without having undergone other changes associated with puberty or by age 15 with having undergone normal physical changes of puberty. Secondary amenorrhea occurs when a previously menstruating woman does not spot or bleed for a period of time that is three times that of her normal cycle length. Oligomenorrhea is light or infrequent menstruation and occurs when cycles are longer than 6-7 weeks. Metrorrhagia is bleeding of variable amount between menstrual periods.

Which race is at highest risk of inheriting sickle cell disease? A) African American B) Caucasian C) Hispanic D) Asian

A) Sickle cell disease is most common among people of African descent. An estimated 1 in 13 African Americans carries one abnormal hemoglobin gene, and 1 in 365 African American newborns are born with two Hb S genes.

The nurse is assigned to care for a client with sickle cell disease who is being admitted with splenic sequestration crisis. Which room would be the most appropriate for this client? A) Private room B) Semi-private room C) Contact-isolation room D) Airborne-isolation room

A) Splenic sequestration can be life-threatening, and there is profound anemia. The client should not be placed in a room with any other client who might have an infectious illness, so a semi-private room is not appropriate. A private room is appropriate for this client. The client is not contagious; therefore, neither airborne nor contact isolation is necessary.

Because of the immature development of the kidney, the nurse needs to assess preterm infants for what condition? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

A) The buffering capacity of the kidney is reduced in a preterm infant, predisposing the neonate to metabolic acidosis. Bicarbonate is excreted at a lower serum level, and acid is excreted more slowly. Therefore, the neonate is at higher risk for metabolic acidosis than metabolic alkalosis. Respiratory acidosis or alkalosis would be due to changes in lung physiology, not kidney physiology.

The nurse makes a visit to the home of an adolescent recently discharged from the hospital following treatment for a tonic-clonic seizure disorder. Which observations indicate that outcomes for care have been achieved? Select all that apply. A) The client is not driving. B) The client has not had a seizure for 1 month. C) The client is participating in the school basketball team. D) The client has bruises on both arms. E) The client is complaining of constipation.

A, B, C) For a client with a tonic-clonic seizure disorder, driving privileges will be suspended until seizure activity is controlled and client is seizure-free for a period of time determined by state statutes, so this client would likely not be able to drive legally until the seizures are controlled for some time. Cessation of seizure activity indicates that medication therapy has been effective. The client's participation in well-supervised sports and activities will likely enhance the client's self-esteem, and it indicates that care has been effective. Physical bruising may indicate that treatment for a seizure disorder has not been effective. Constipation is a complication of a ketogenic diet used to help control seizure activity and would indicate that care has not been effective.

During a health history, the nurse learns that a female client has been trying to conceive for 2 years and does not understand why she cannot become pregnant. Which risk factors for infertility should the nurse assess for in this client? Select all that apply. A) Amount of alcohol consumed each day B) Poor nutrition C) Amount of exercise D) Employment status E) History of sexually transmitted infections

A, B, C, E) Risk factors for female infertility include excess alcohol consumption, poor diet, athletic training, or being infected with a sexually transmitted infection. Employment status is not a risk factor for female infertility.

A client wants to use the vaginal sponge as a method of contraception. Which statements indicate that the client needs further instruction about use of this method? Select all that apply. A) "I should never leave the sponge in for more than 6 hours." B) "I need to use a lubricant prior to insertion of the sponge." C) "I can insert the sponge up to 24 hours before having sex." D) "I need to add spermicidal cream to the sponge prior to having sex." E) "I need to moisten the sponge with water prior to use."

A, B, D) A lubricant is not needed, because the sponge is moistened with water prior to insertion. Spermicidal cream is also unnecessary, because it is already in the sponge. To activate this spermicide, the vaginal sponge must be moistened thoroughly with water. After insertion, the sponge can remain in place for up to 24 hours.

The nurse is caring for a client who is diagnosed with cancer. Which diagnostic tests may be helpful to assist with treatment options? Select all that apply. A) Tumor markers B) Urinalysis C) Physical assessment D) MRI E) Stool analysis

A, B, D) Many diagnostic tests are helpful in determining treatment for cancer. An MRI, urinalysis, and tumor markers are all diagnostic tests that may be used to determine treatment for cancer. A stool analysis is not a diagnostic test listed to determine treatment for cancer. A physical assessment may be useful to determine how a client is responding to treatment, but it is not considered a diagnostic test.

The nurse identifies the diagnosis Risk for Injury as appropriate for a client with a seizure disorder. Based on this diagnosis, which nursing interventions are appropriate when this client experiences a seizure? Select all that apply. A) Turn the client to a lateral position, if possible. B) Stay with the client. C) Insert a tongue blade into the client's mouth. D) Call for help. E) Restrain the client.

A, B, D) The nurse should stay with the client and call for assistance, if needed. If possible, the client should be turned onto the lateral position, not supine, to allow for any secretions to drain out of the mouth. Research has found that more injury can occur to the client if the caregiver tries to place something in the mouth during the seizure than if the caregiver does not. A client should never be restrained during a seizure.

A nurse is caring for a client with cancer. The nurse teaches the client about which potentially undesirable cellular alterations that can occur during the cell cycle? Select all that apply. A) Hyperplasia B) Differentiation C) Anaplasia D) Dysphagia E) Adaptation

A, C) Potentially undesirable cellular alterations that can occur during the cell cycle include hyperplasia and anaplasia. Hyperplasia is an increase in the number or density of normal cells, while anaplasia is the regression of a cell to an immature or undifferentiated cell type. Differentiation is a normal process occurring over many cell cycles that allows cells to specialize in certain tasks. Dysphagia and adaptation are not a part of the cell cycle.

The nurse is caring for an adolescent client with a strong family history of breast cancer. What should the nurse instruct the client regarding cancer prevention? Select all that apply. A) Encourage the client to learn more about the disease. B) Talk to family members who have the disease. C) Perform monthly breast self-examination. D) Teach the side effects of cancer treatment. E) Discuss cancer fears with the healthcare provider.

A, C) When there is a familial history of cancer, the family should be encouraged to learn more about the cancer. Talking to family members who have the disease will not help with early detection or prevention. In families with a history of breast cancer, the nurse should inform clients about breast self-examination. Teaching the side effects of cancer treatment would be appropriate if the client was diagnosed with breast cancer. The client can discuss cancer fears with the nurse; however, this action will not help prevent the development of the disease.

The nurse is instructing the parents who delivered their first child at 34 weeks' gestation. Which statements made by the parents indicate that additional teaching is needed? Select all that apply. A) "Tube feedings will be required because his stomach is small." B) "Breathing might be harder for our baby because he is early." C) "Our baby will be in an incubator to keep him warm." D) "The growth of our baby will be slower than if he were term." E) "Because he came early, he will not produce urine for 2 days."

A, E) Preterm infants grow more slowly than do term infants. Although tube feedings might be required, it would be because preterm babies lack sufficient suck and swallow reflexes to prevent aspiration. Although preterm babies have diminished kidney function due to incomplete development of the glomeruli, they will make urine. Preterm infants have little subcutaneous fat, and have difficulty maintaining their body temperature. An incubator or radiant warmer is used to keep the baby warm. Surfactant production might not be complete at 34 weeks, which leads to respiratory distress syndrome. In addition, respiratory effort is increased when the ductus arteriosus remains patent, which is common in preterm infants.

A nurse is reviewing a patient's chart and notes that the patient has a cancerous tumor that has invaded other organs. Based on this information, at which stage is this patient's cancer classified? A. Stage O B. Stage I C. Stage III D.Stage IV

ANS: D A stage IV cancer is one that has invaded other organs. Stage 0 is early cancer, present only in the cells in which it began. Stages I-III are more extensive, with larger tumors and spread to nearby lymph nodes or adjacent organs.

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider? A. Difficulty staying asleep at night B. Left-sided abdominal enlargement C. Polyphagia and polydipsia D. Swelling of the legs and feet

ANS: B This child has some manifestations of acute lymphocytic leukemia (ALL). Left-sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestation of ALL

A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication? A. Arranging an outpatient hearing test B. Having emergency drugs on hand C. Monitoring the child's intake and output D. Providing anti-emetic drugs as needed

ANS: B Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti-emetic drugs are important for any child receiving chemotherapy

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child? A. Do not let the child have chewing gum B. Flowers, plants, and produce are not allowed C. The child can only have one visitor at a time D. Toys and items from home cannot be brought in

ANS: B The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today. Which action by the nurse is most important when providing care to this patient and family? A. Educating family on side effects of chemotherapy B. Ensuring a signed consent is on the chart C. Providing distraction techniques during the process D. Reassuring the child the parents will be present

ANS: B Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord) is an invasive procedure and requires a signed consent. Although all actions are important for this child, the priority is ensuring the consent is executed appropriately and on the chart

A nursing student asks the faculty member to explain an oncogene. Which response by the faculty member is the most appropriate? A. A cell that changes into a malignancy after environmental stress B. Any gene found inside a solid tumor that can be removed for biopsy C. A gene in a virus that encourages malignant transformation in cells D. An inherited gene that is programmed to become a malignant cell

ANS: C An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant.

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? A. Antibiotic administration B. Bone marrow transplant C. Chemotherapy D. Liver transplant

ANS: C The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the child's course of care. A liver transplant would not be a treatment for ALL.

The nurse is preparing to provide an enteral feeding to a preterm infant. Which is the priority nursing action prior to administering the feeding? A) Weigh the current diaper. B) Measure abdominal girth. C) Weigh the baby. D) Measure pulse oximetry.

B) Before each feeding, the nurse should measure the abdominal girth to determine abdominal distention, which is seen in necrotizing enterocolitis or paralytic ileus. Weighing the baby and weighing diapers are interventions to assess for fluid volume status. Measuring pulse oximetry is an intervention for assessing oxygenation.

The nurse provides teaching about phenytoin (Dilantin) to the mother of a school-age client with a seizure disorder. Which statement made by the mother indicates that teaching has been effective? A) "I will give his medicine on an empty stomach so he will absorb it better." B) "I will check his gums and increase visits to the dentist." C) "I will use a carbonated beverage to dilute his medication." D) "I will allow him to chew the tablet."

B) Client teaching for school-age and adolescent clients taking phenytoin (Dilantin) is to discuss the importance of regular dental care because of phenytoin's effects on the gingiva. Gingival hyperplasia can occur in clients who take phenytoin (Dilantin). There is no dietary recommendation for taking phenytoin (Dilantin). Carbonated beverages should not be used to dilute medication doses. Unless the medication is prescribed as chewable, the client should not be permitted to chew the dose.

What independent nursing intervention is important for the nurse to implement for clients who have alterations in cellular regulation? A) Administer pain and other medications B) Help the client identify support systems C) Design a diet that provides proper nutrition D) Suggest contacting the nurse's spiritual leader

B) Clients who are diagnosed with an alteration in cellular regulation will experience many different emotions, and they will need a proper support system to help them cope with the diagnosis and provide care when needed. The nurse can help the client identify a support system of friends, family, and support groups. Administering medications is a collaborative intervention. Nurses should refer clients to a dietitian for a diet plan. The nurse should facilitate contact with the client's spiritual leader if desired, not the nurse's spiritual leader.

A client with anemia is prescribed synthetic erythropoietin. When teaching the client about the therapeutic effect of this treatment, which is appropriate for the nurse to include? A) Increase in platelets B) Increase in red blood cells C) Decrease in white blood cells D) Decrease in lymph fluid

B) Erythropoietin is a hormone produced in the body to stimulate production of red blood cells; synthetic forms are available for administration to cancer clients or others with significantly low red blood cell counts. Erythropoietin will not stimulate or decrease the production of platelets, white blood cells, or lymph fluid.

Which of the following statements best describes a seizure threshold? A) The threshold is the length of time a seizure will last. B) The threshold is the limit beyond which the occurrence of a seizure is possible. C) Unless a seizure results in convulsions, it is considered to be below the threshold. D) When the threshold is exceeded, a seizure is considered to be generalized.

B) Everyone has a seizure threshold. When this threshold is exceeded, a seizure may occur. Some individuals have abnormally low seizure thresholds, increasing their risk for seizure activity. Others may experience seizures as the result of a pathologic process such as epilepsy. A seizure threshold is not the length of time a seizure will last and is not a way of classifying seizures as generalized. The presence of convulsions does not determine whether the threshold has been exceeded.

Why would a healthcare provider most likely recommend that a 37-year-old pregnant woman seek prenatal genetic testing? A) Because women over age 35 are at increased risk for gestational diabetes and other pregnancy complications B) Because babies born to women over age 35 are at increased risk for chromosomal abnormalities C) Because women over age 35 have a higher likelihood of giving birth to twins D) Because women over age 35 are more likely to give birth to male children

B) Genetic testing is recommended for women over age 35 because of the increased risk of giving birth to a child with chromosomal abnormalities. Although women over 35 are at increased risk for pregnancy complications, genetic screening does not reduce this risk. Similarly, while women over age 35 are more likely to have twins, the presence of multiple embryos or fetuses can be determined without the need for genetic testing. Finally, the likelihood of having a male or female child does not vary with maternal age.

A female client tells the nurse she would like to wait to start a family, even though her partner seems interested in having children in the near future. The client then asks the nurse what she should do. Which response from the nurse is best? A) "Maybe you should babysit a friend's child for a while to see whether you really want children." B) "You and your partner need to discuss the decision to start a family." C) "If you don't want to start a family, then you don't have to." D) "What would you do if you became pregnant now?"

B) Making the decision to have children is the first step a couple makes in the process of conception. Sometimes one individual wishes to have a child but the other does not. In these situations, open discussion is essential to reach a mutually acceptable decision. Telling the client that she does not need to start a family if she doesn't want to ignores the issue of the partner's desire for children. Asking what the client would do if she became pregnant now does not address the client's desire to wait to start a family. Suggesting the client babysit a friend's child would be a strategy to help a person decide if he or she wants to have a family, but it does not address the client and spouse's current issue.

In what way does menometrorrhagia differ from menorrhagia? A) Menometrorrhagia involves excessive menstruation, whereas menorrhagia does not. B) Menometrorrhagia involves irregular menstruation, whereas menorrhagia does not. C) Menometrorrhagia involves prolonged menstruation, whereas menorrhagia does not. D) Menometrorrhagia involves the absence of menstruation, whereas menorrhagia does not.

B) Menorrhagia is excessive or prolonged menstruation that occurs at regular intervals. Menometrorrhagia is irregular, excessive, prolonged menstruation. It is essentially a combination of the heavy bleeding of menorrhagia and the irregularity of metrorrhagia.

Which of the following statements is true regarding the etiology and pathophysiology of primary dysmenorrhea? A) Primary dysmenorrhea is caused by decreased levels of prostaglandins, which cause uterine contractions to increase in strength. B) Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties. C) Secondary dysmenorrhea is more common than primary dysmenorrhea. D) Causes of primary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adenomyosis.

B) Pain associated with menses, called dysmenorrhea, is one of the most common menstrual dysfunctions. Primary dysmenorrhea is common among women with normal menstrual function and is more common than secondary dysmenorrhea. Primary dysmenorrhea is caused by the release of prostaglandins that cause the contractions of the uterus needed to expel menstrual fluid and tissue. Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties. Secondary dysmenorrhea is related to pathology or diseases that affect the uterus and pelvic area. Causes of secondary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adenomyosis.

A nurse educator is teaching student nurses about methods of cellular transport. When instructing on passive transportation, which process will the nurse include in the teaching plan? A) Endocytosis B) Facilitated diffusion C) Exocytosis D) Phagocytosis

B) Passive cellular transportation does not require energy and includes facilitated diffusion, diffusion, osmosis, and filtration. Active cellular transportation requires energy and includes active transport pumps, endocytosis, phagocytosis, pinocytosis, and exocytosis.

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease. The client is at risk for infection. Which medication does the nurse expect to administer to this client? A) Acetaminophen B) Penicillin C) Morphine sulfate D) Tamoxifen

B) Prophylactic penicillin is often prescribed to children between the ages of 2 months and 5 years of age who are diagnosed with sickle cell disease because of the increased risk for infection. Morphine and acetaminophen may be given for the pain the client experiences during a sickle cell crisis. Tamoxifen is a medication used to treat breast cancer.

A preschool-age client with myoclonic seizures has been following a ketogenic diet for the last 6 months to reduce seizure activity and is complaining of left-sided lower abdominal pain. Which complication of the ketogenic diet should the nurse suspect the client is experiencing? A) Bowel obstruction B) Kidney stone C) Urinary tract infection D) Appendicitis

B) Renal calculi, or kidney stones, are seen in 5% of children on a ketogenic diet. Appendicitis does not occur as a result of the ketogenic diet. A ketogenic diet does not typically cause bowel obstructions, but it can cause constipation. Urinary tract infections are not a result of a ketogenic diet.

The nurse is caring for a client with leukemia. Which treatment should the nurse expect to be prescribed for this client? A) Diuretic therapy B) Chemotherapy C) Electrolyte replacement therapy D) IV fluid therapy

B) The client with an alteration in cell growth has cancer and will most likely be treated with chemotherapy and antibiotics. Diuretic therapy, IV fluids, and electrolyte replacement are not typically used to treat cancer, although they may be used if complications develop.

The nurse is caring for a client with sickle cell anemia. The nurse teaches the client that the inherited alteration of which type of hemoglobin causes the abnormal shape to the red blood cell? A) Hgb A B) Hgb S C) Hgb B D) Hgb E

B) The inherited alteration of Hgb S causes the abnormal sickle-shaped red blood cell in sickle cell anemia.

A nurse is caring for a premature infant with a central line. The otherwise healthy, growing infant suddenly develops apnea, bradycardia, and metabolic acidosis. Which is the most likely condition causing this change in health status? A) Hyperbilirubinemia B) Bacterial sepsis C) Hypoglycemia D) Intracranial hemorrhage

B) The sudden onset of apnea, bradycardia, and metabolic acidosis in a premature infant with a central line in place who had previously been growing and doing well is suggestive of bacterial sepsis rather than hyperbilirubinemia, hypoglycemia, or intracranial hemorrhage.

The nurse educator is teaching a group of student nurses regarding human growth and development. Which statement by the student nurse indicates that teaching has been effective? A) "The zygote undergoes differentiation to form a multicellular embryo, which becomes a fetus and then an infant." B) "Meiosis occurs only in the sex cells of the testes and ovaries." C) "Mitosis reduces the amount of genetic material by half." D) "When the two sex cells combine during fertilization, a total of 50 chromosomes are present in the offspring's cells."

B) The zygote undergoes mitosis to form a multicellular embryo, which becomes a fetus and then an infant. Meiosis, which reduces the amount of genetic material by half, occurs only in the sex cells of the testes and ovaries. When the two sex cells combine during fertilization, the total number of chromosomes present in the offspring's cells is 46, not 50.

A nurse educator is teaching a group of parents how to prevent a sickle cell crisis in the child with sickle cell disease. What precipitating factors that could contribute to a sickle cell crisis should the nurse teach the parents? Select all that apply. A) Increased fluid intake B) High altitudes C) Fever and infection D) Emotional or physical stress E) Warm temperatures

B, C, D) Fever, stress, and altitude are some of the precipitating factors that contribute to a sickle cell crisis. Increased fluid intake is recommended for a child with sickle cell disease and will not contribute to a sickle cell crisis. Cold temperatures, not warm temperatures, are a trigger for sickle cell crisis.

The nurse is caring for a young adult client who reports that she has painful periods. Which assessment findings suggest that this client is experiencing primary dysmenorrhea? Select all that apply. A) Bleeding between menstrual periods B) Headache C) Fatigue D) Diarrhea E) Scant menses

B, C, D) Manifestations of primary dysmenorrhea include headache, diarrhea, fatigue, vomiting, breast tenderness, and pain radiating to the lower back and thighs. Scant menses is a symptom of hormone imbalance. Bleeding between menstrual periods is characteristic of metrorrhagia.

Which of the following interventions should the nurse recommend to a client who is experiencing primary dysmenorrhea? Select all that apply. A) Increase caffeine intake. B) Use a heating pad. C) Try relaxation techniques. D) Engage in regular exercise. E) Avoid vitamin supplements.

B, C, D) Regular aerobic activity helps decrease dysmenorrhea symptoms. Caffeine intake should be restricted to reduce irritability. Relaxation techniques may be useful because they promote the release of pain-relieving endorphins. Vitamin supplements should not be avoided and may be needed to help control symptoms. A heating pad can help reduce abdominal cramping and pain.

During an evaluation for infertility, a male client is asked to provide a sperm sample. What information from the client's health history could impact the quality and effectiveness of the client's sperm? Select all that apply. A) Activity level B) Smoking C) Use of over-the-counter analgesics D) Mumps after adolescence E) Number of siblings

B, C, D) The quality and effectiveness of sperm is affected by smoking history, use of over-the-counter medications, and experiencing mumps after adolescence. Activity level and number of siblings are not criteria to evaluate the quality and effectiveness of a man's sperm.

An emergency department nurse is caring for a child in sickle cell crisis. The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply. A) The client has profound pallor and fatigue. B) The client is in extreme pain. C) The client has profound hypotension and shock. D) The client has a fever. E) The client's chest CT reveals a pulmonary infarct.

B, D) A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.

The nurse instructs a group of community members about ways to reduce the development of cancer. Which participant statements indicate that teaching has been effective? Select all that apply. A) "I should eat at least two servings of fruits or vegetables each day." B) "Sunscreen should be applied before spending time outdoors." C) "I need to cut down on my smoking." D) "I need to get my home tested for radon." E) "I need to minimize my child's exposure to secondhand smoke."

B, D, E) Efforts to reduce the development of cancer include eating five servings of fruits and vegetables each day. Sunscreen should be used by those who spend time outside regularly for work or recreation. All smoking should be discouraged. The home should be tested for radon, which is a known cancer-causing substance. Children should be protected from exposure to tobacco smoke.

A nursing faculty member explains to the class that which item is the most important for tumor cell growth? A. Age of transforming cells B. Programmed cell death C. Proximity to a capillary D. Rapidity of cell growt

C All cells, including tumor cells, need a consistent supply of oxygen and nutrients, delivered via the capillaries. Neoplastic cells must be in close enough proximity to a capillary to provide these required elements. The other factors do not have such an important role, if any, in neoplastic growth.

the nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? select all A. Polycythemia B. Hemarthrosis C. Aplastic crisis D. Thrombocytopenia E. Vaso-occlusive crisis

C Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. E. Vaso-occlusive crisis is the most common problem in children with sickle cell disease. Polycythemia is seen in children with chronic hypoxia, such as cyanotic heart disease. Hemarthrosis, bleeding into a joint, is commonly seen in children with hemophilia. Thrombocytopenia is associated with idiopathic thrombocytopenia purpura, high altitude, medication side effects, and pregnancy TEST-TAKING HINT: Defining the terms will make the correct responses evident.

The nurse is assessing a premature newborn who is being cared for in the newborn intensive care unit (NICU). Which assessment finding indicates the newborn is experiencing respiratory distress? A) Acrocyanosis B) Respiratory rate of 58 breaths per minute C) Substernal and intercostal retractions D) Abdominal breathing

C) A premature newborn who is experiencing retraction may indicate respiratory distress. Acrocyanosis, a respiratory rate of 58 breaths per minute, and abdominal breathing are considered normal assessment findings in the premature newborn.

The nurse is caring for a toddler who is undergoing treatment for sickle cell crisis. The parents ask the nurse, "Our child has been potty trained for 2 years, but suddenly he's wetting the bed again. What do we do?" How should the nurse respond? A) "He is likely rebelling because he doesn't like the treatments. You may need to discipline him." B) "Bedwetting is often a sign of urinary tract infection. I will have the provider check for that." C) "Toddlers often regress in behaviors when they are sick. Just be patient with him." D) "Nocturnal enuresis is a side effect of his medications. Once he's done with his treatment, he will stop wetting the bed."

C) A toddler who has been potty trained will often regress in behaviors and begin wetting the bed when faced with a stressful illness. It is important for the parents to understand that this is common and that the child will likely return to previous behaviors once the health crisis is past. Bedwetting is not usually a sign of rebellion. It may be a sign of a urinary tract infection or a side effect of medications, but without additional signs or symptoms, these explanations are less likely to be true.

Which of the following statements is true with regard to women's sexual health during the postpartum period? A) The lactational amenorrhea method is the most reliable form of contraception during the postpartum period, but only if a woman is breastfeeding exclusively. B) Condoms and spermicides should not be used for contraception in the immediate postpartum period, because they increase a woman's risk for uterine infection. C) Hormonal contraceptives can affect the quantity and quality of breast milk and increase the risk for deep vein thrombosis (DVT) if used in the first month after giving birth. D) Women who use diaphragms as their primary means of contraception should be refitted for these devices no more than 6 weeks after giving birth.

C) Clients who are breastfeeding exclusively may choose the lactational amenorrhea method (LAM). However, the effectiveness of LAM varies greatly, so women who use this method should be encouraged to consider a secondary method of contraception. Condoms and spermicides are an excellent and safe option in the immediate postpartum period. Hormonal contraceptives may be inappropriate because they can affect the quantity and quality of breast milk and increase the risk for DVT if used in the first month after giving birth. Diaphragms should not be used until at least 6 weeks postpartum, at which time the woman will need to be refitted for a new device.

The nurse is teaching a client with infertility about the medication clomiphene (Clomid). Which statement on the part of the client indicates that this teaching has been effective? A) "This medication increases the amount of gonadotropin-releasing hormone." B) "This medication leads to increased levels of follicle-stimulating hormone." C) "This medication stimulates the secretion of luteinizing hormone." D) "This medication increases my estrogen levels so that I can ovulate."

C) Clomiphene (Clomid) stimulates the secretion of luteinizing hormone (LH), resulting in the maturation of more ovarian follicles than would normally occur. Clomiphene (Clomid) does not increase estrogen levels, nor does it stimulate secretion of FSH or gonadotropin-releasing hormone.

A nurse is caring for a client who wants more information about fertility awareness-based contraceptive methods. Which statement made by the nurse provides the client with correct information? A) "For women, the fertility window occurs between days 19 and 26 of the menstrual cycle." B) "The calendar rhythm method is based on the assumption that ovulation tends to occur about 7 days before the start of a woman's next menstrual period." C) "To use the calendar rhythm method, a woman must record her menstrual cycles for 6 months to identify the shortest and longest cycles." D) "The calendar method is the most reliable fertility awareness-based method of contraception."

C) Fertility awareness-based methods, also known as natural family planning, are based on an understanding of the changes that occur throughout a woman's ovulatory cycle. For women, the fertility window occurs between days 8 and 19 of 26- to 32-day cycles. The calendar rhythm method, also called the standard days method, is based on the assumption that ovulation tends to occur about 14 days before the start of a woman's next menstrual period. To use this method, the woman must record her menstrual cycles for 6 months to identify the shortest and longest cycles. The calendar method is the least reliable of the fertility awareness methods.

An older adult client is experiencing a tonic-clonic (grand mal) seizure exceeding 10 minutes in length. Which medication should the nurse prepare to administer to this client? A) Intramuscular injection of diazepam B) Intramuscular injection of phenytoin C) Intravenous diazepam slowly over several minutes D) Oral administration of gabapentin

C) Grand mal, or tonic-clonic, seizure requires prompt management if it continues after 10 minutes has elapsed. Diazepam may be administered by an IV slowly over several minutes, but not intramuscularly. Phenytoin is administered intravenously for longer term control of seizures. Gabapentin is an antiseizure drug used to prophylactically reduce or control seizure activity; gabapentin is administered orally 2 hours after antacids, which would be inappropriate for this client.

A nurse educator is teaching a group of student nurses about problems of infertility and genetic inheritance of disease. Which statement made by a student nurse indicates that teaching has been effective? A) "A person's genotype is the observable expression of his or her traits." B) "The total genetic makeup of an individual is referred to as the phenotype." C) "In an autosomal recessive inherited disorder, the individual must have two abnormal genes to be affected." D) "An individual is said to have an autosomal dominant inherited disorder if the disease trait is homozygous."

C) In an autosomal recessive inherited disorder, the individual must have two abnormal genes to be affected. A person's phenotype is the observable expression of his or her traits, and the person's genotype is his or her total genetic makeup. An individual is said to have an autosomal dominant inherited disorder if the disease trait is heterozygous—that is, the abnormal gene overshadows the normal gene of the pair to produce the trait.

Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents? A) "Since neither of you actually has sickle cell disease, your baby is not at risk." B) "Your baby has the disease, as you both carry the trait." C) "We are required to test all babies for sickle cell disease." D) "Have you talked to a genetic counselor about your concerns?"

C) In the United States, newborn screening for sickle cell disease is mandatory. Therefore, the nurse can assure the parents that the baby will be tested so they know for sure if the baby has sickle cell disease. Because both parents only have sickle cell trait, the baby has a 25% chance of having sickle cell disease.

The nurse is working with a client who experiences severe premenstrual syndrome. Which of the following interventions should the nurse suggest to assist the client in coping with this disorder? A) "Take frequent rest periods." B) "Consider drinking 4 ounces of wine each day." C) "Be sure to exercise and use relaxation techniques on a regular basis." D) "Avoid contraception during menstruation when engaging in sexual intercourse."

C) Interventions to promote effective coping in a client with severe premenstrual syndrome include encouraging exercise and use of relaxation techniques. Alcohol intake should be avoided, so the client should not be encouraged to have 4 ounces of wine each day. The client should be instructed to use contraception if engaging in sexual intercourse during menstruation because ovulation and pregnancy can occur. Frequent rest periods would be beneficial for a client with dysfunctional uterine bleeding but not a client with premenstrual syndrome.

A nurse is preparing to teach a group of young women about strategies for the relief of menstrual cramping. What should be the focus of these strategies? A) Minimizing menstrual flow B) Avoiding uterine contraction C) Increasing blood flow to the uterine muscle D) Decreasing estrogen production

C) Menstrual cramping is a result of muscle ischemia that occurs when the client experiences powerful uterine contractions. Increasing blood flow to the uterine muscle through rest, certain exercises, application of heat to the abdomen, and presence of milder uterine contractions (such as those associated with orgasm) can decrease pain and cramping. There is no connection between pain and the actual amount of menstrual flow. Estrogen production should follow normal patterns and should not be altered.

A young adolescent client is concerned about experiencing severe cramps with menstruation. She tells the nurse, "I don't like the pain, and I'm also worried the cramps mean there is something wrong with me." How should the nurse respond to this client? A) "Menstrual cramping is not normal but is something that can be treated." B) "You have cramps because you started your periods too early." C) "Cramps are common in young women who just started having their periods, but they can be managed and often become less severe over time." D) "You need to see a gynecologist for a pelvic examination."

C) Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in girls who have just begun menstruating, usually becoming less severe after a woman's mid-20s. The client is an early adolescent, so she is in the normal age range to start having periods. Cramps are common in this age range, so the client does not need to see a gynecologist for a pelvic examination. However, the client would benefit from teaching about how to reduce and manage her menstrual pain.

A client tells the nurse she plans to use oral contraceptives for birth control. Given this information, which client behavior would cause the nurse the most concern? A) The client has several sexual partners. B) The client is being treated for bipolar disorder. C) The client smokes a pack of cigarettes each day. D) The client drinks two glasses of wine per day.

C) Smoking while taking oral contraceptives increases the client's risk of developing a thrombolytic disorder. Drinking two glasses of wine a day is not a contraindication to the use of oral contraceptives, nor is being treated for bipolar disorder. Having several sexual partners does not preclude the use of oral contraceptives, but the client should be advised that oral contraceptives do not provide protection against sexually transmitted infections so use of a barrier method is also recommended.

A nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis. Which intervention is inappropriate for the nurse to include in this plan of care? A) Administer prescribed analgesic medications around the clock. B) Place client in position of comfort. C) Use heat or cold packs as tolerated. D) Support the client's joints and extremities with pillows

C) The client with sickle cell disease who is in a sickle cell crisis will likely have extreme pain. To aid in caring for this client, the nurse will administer ordered analgesic medications around the clock, place the patient in position of comfort, and support the client's joints and extremities with pillows. The use of heat or cold packs is contraindicated in the sickle cell client.

The nurse is preparing to perform a health assessment on an adult client who has a family history of cancer. Which questions should the nurse ask the client to assess for the early warning signs of cancer? Select all that apply. A) "Do you have a cough that is associated with seasonal allergies?" B) "Have you noticed a change in your appetite?" C) "Have you noticed any cuts that have not healed?" D) "Have you had any changes in bowel or bladder habits?" E) "Have you experienced any problems swallowing?"

C, D, E) Nurses should assess all clients, especially those with a history of cancer, for early warning signs of cancer. The early warning signs include change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in wart or mole, or a nagging cough or hoarseness. Changes in appetite or cough that is associated with seasonal allergies are not associated with the early warning signs of cancer.

A client is prescribed an oral contraceptive that contains estrogen and progesterone. What information should the nurse include when educating the client about this contraceptive? Select all that apply. A) The estrogen portion of the contraceptive may cause an increase in appetite and subsequent weight gain. B) The progesterone portion of the contraceptive may cause headaches and nausea. C) Breast tenderness may occur when taking oral contraceptives that contain estrogen. D) Taking an oral contraceptive that contains progesterone can lead to an increase in blood pressure. E) Acne and oily skin are common side effects of the progesterone component in combined oral contraceptives.

C, E) There are a variety of possible side effects when taking oral contraceptives that contain both estrogen and progesterone. The estrogen component of these contraceptives may cause headaches, nausea, breast tenderness, and an increase in blood pressure. The progesterone portion may cause acne, oily skin, an increase in appetite, and weight gain.

The nurse observes a school-age client have an absence seizure. Which statement will the nurse likely include when documenting this seizure? A) "Reported experiencing tingling sensations but denied loss of consciousness." B) "Became unconscious, and all four extremities were jerking uncontrollably for 2 minutes." C) "Repeatedly moved from the chair to the bed while touching the arms for a length of 2 minutes." D) "Sat very still and was unresponsive with a blank stare for 30 seconds."

D) Absence (petit mal) seizures are characterized by sudden, brief cessation of all motor activity accompanied by a blank stare and unresponsiveness. These seizures are more common in children than in adults. During a simple partial seizure, if the sensory portion of the cortex is involved, manifestations may include abnormal sensations such as tingling, numbness, or hallucinations, but there is no alteration in consciousness. Loss of consciousness and jerking of extremities is characteristic of tonic-clonic seizures. Aimless activity may happen during complex partial seizures.

A seizure that is not provoked by known stimuli is known as which of the following? A) Acquired B) Congenital C) Febrile D) Idiopathic

D) An idiopathic seizure is not provoked by known stimuli. Genetic factors may lower the seizure threshold by making brain cells more vulnerable to abnormal electrical discharges, but congenital is not a type of seizure. An acquired seizure may be caused by underlying pathologic conditions such as trauma, infection, hypoglycemia, hypotonic dehydration, electrolyte imbalance, endocrine dysfunction, toxins, tumors, or lesions that may be manifested at any time. Febrile seizures usually occur in children as the result of a rapid temperature rise above 102.2°F (39°C, rectal), often in association with an acute illness.

The nurse is planning discharge teaching for a child with epilepsy who is prescribed phenytoin (Dilantin). The nurse should recommend a diet rich in which of the following to this client? A) Carbohydrates B) Fats C) Protein D) Vitamin D

D) Clients on prolonged antiseizure drug therapy may need a diet rich in vitamin D, but not necessarily carbohydrates, fats, or protein.

The mother of a preterm infant tells the nurse that she was not looking forward to having a baby and now that the baby is sick, she feels worse. Which nursing diagnosis is appropriate based on this data? A) Parental Role Conflict B) Impaired Parenting C) Dysfunctional Family Processes D) Compromised Family Coping

D) Compromised Family Coping is the nursing diagnosis most appropriate for this situation at this time because the mother is expressing anger and guilt at having given birth to a premature baby. Parental Role Conflict is seen if the role of parent is in conflict with other expectations. Impaired Parenting is seen if the mother is unable to fulfill the role of mother to the baby. Dysfunctional Family Processes is seen if the addition of a baby leads to the family's inability to function as a family.

The nurse is caring for a toddler-age client who starts to have a tonic-clonic (grand mal) seizure while in a crib in the hospital. The child's jaws are clamped shut. What is the most appropriate nursing action? A) Place a tongue blade between the child's jaws. B) Restrain the child to prevent injury. C) Prepare the suction equipment. D) Stay with the child to observe for complications.

D) During a seizure, the nurse remains with the child, watching for complications. Be sure nothing is placed in the child's mouth during a seizure. Suction equipment should already be set up at the bedside before a seizure begins. The child should not be restrained during a seizure.

What type of seizure does not affect memory or awareness and occurs when abnormal electrical activity is contained to a limited area of the brain? A) Absence B) Complex focal C) Generalized D) Simple focal

D) Focal seizures (also known as partial seizures) occur when abnormal electrical activity is contained to a limited area of the brain. They can be classified as simple or complex. Simple focal seizures do not affect memory or awareness. In contrast, complex focal seizures can affect behavior, awareness, or memory before, during, or after the seizure episode. A generalized seizure is caused by abnormal electrical discharges that originate from both hemispheres of the brain. An absence seizure is a generalized seizure that involves a brief cessation of all motor activity accompanied by blank stare and unresponsiveness.

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis. Which medication should the nurse expect to administer to this client? A) Acetaminophen (Tylenol) B) Ibuprofen (Advil) C) Meperidine (Demerol) D) Hydroxyurea

D) Hydroxyurea decreases production of abnormal blood cells and leads to a lesser amount of pain being experienced. Meperidine is not used for pain control for clients in sickle cell crisis because it can cause seizures. Acetaminophen or ibuprofen is used for mild pain, but they would not be effective for the severe pain experienced by a client in sickle cell pain crisis.

Which of the following is characteristic of triggers for seizures? A) They are externalized. B) They are generalized. C) They are internalized. D) They are variable.

D) Individuals with epilepsy often experience seizure activity upon exposure to a trigger. Triggers may be individualized (e.g., odors, flashing lights). General triggers include fatigue, hypoglycemia, fever, alcohol, hyperventilation, and menstruation. Individuals who are able to identify triggers may succeed in reducing their frequency. A trigger is not externalized if it is an internal condition or internalized if it is an external factor, but different individuals may have different triggers, or none at all.

After giving birth to a preterm infant who is being cared for in the neonatal intensive care unit (NICU), a client says, "My baby doesn't seem real because she's in the hospital and I'm at home." What can the nurse do to promote parent-infant attachment? A) Limit visits to the intensive care unit so as not to disrupt care the baby needs. B) Explain that once the baby is discharged to home, she will have evidence that the baby is real. C) Have the mother visit when the baby is asleep or resting. D) Provide a picture of the infant including a footprint and current weight and length.

D) Nurses need to take measures to promote positive parental feelings toward the preterm infant. One way to do this would be to provide the mother with a picture of the infant, including a footprint and current weight and length. This promotes bonding. The mother needs to begin bonding with the infant now, not wait until the baby is discharged to home. Visits to the intensive care unit should be encouraged and supported. The mother should try to visit with the infant when the baby is awake to encourage interaction.

The nurse instructs a client on ways to reduce premenstrual difficulty. Which statement on the part of the client indicates that the instruction was beneficial? A) The client states the need to increase dietary sugar intake to promote energy. B) The client states that guided imagery does not help with premenstrual symptoms. C) The client states the need to increase intake of simple carbohydrates. D) The client states that reducing caffeine intake will help.

D) The client stating that a reduction in caffeine intake will help reduce premenstrual difficulty is evidence that the instruction was beneficial. The other client statements all indicate the* need for additional instruction, because guided imagery can be used to reduce stress and promote relaxation and intake of simple carbohydrates and sugars should be reduced.

When planning the care for a preterm infant with ineffective thermoregulation, the nurse should include which intervention? A) Keep the baby's head uncovered. B) Rinse hands with cold water before providing care to the infant. C) Place incubator near a window or source of fresh air. D) Allow skin-to-skin contact with the mother to maintain warmth.

D) The nurse needs to plan for a neutral thermal environment to minimize oxygen consumption, prevent cold stress, and facilitate growth of the preterm infant. To do this, the nurse should plan for the infant to have skin-to-skin contact with the mother to maintain warmth. The hands should be rinsed with warm water before providing care to the infant. The baby's head should be covered because the head is 25% of the baby's size and is prone to evaporative heat loss. Incubators should be moved away from drafts or open windows to reduce radiative and conductive heat loss.

Which factor contributes to increased respiratory complications in the preterm infant? A) Increased constriction of blood vessels B) Decreased prostaglandin E levels C) Absence of muscular coat on pulmonary blood vessels D) Inadequate surfactant

D) The preterm neonate is unable to produce adequate amounts of surfactant in the lungs, decreasing compliance and increasing the pressure needed to expand the lungs with air. Collapsed alveoli do not facilitate exchange of oxygen and carbon dioxide, leading to hypoxia, inefficient pulmonary blood flow, and energy depletion. In preterm infants, the muscular coat on pulmonary blood vessels is incompletely developed, not absent, leading to decreased constriction of blood vessels. Prostaglandin E levels are increased, not decreased.

A client in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. The client reports a pain level of 8 on a pain scale from 1 to 10. Which nursing diagnosis is a priority for this client? A) Fluid Volume Excess B) Risk for Self-Mutilation C) Knowledge Deficit D) Acute Pain

D) The priority for this client would be pain. The client has reportedly been skiing, which would be in an area of high altitude, which is contraindicated for someone with sickle cell. This client appears to have a knowledge deficit about self-care. This diagnosis, however, does not take priority. There is no evidence from the information given that the client has fluid volume excess or is at risk for self-mutilation.

The nurse is monitoring the intake and output for a preterm infant. Which action by the nurse indicates correct assessment technique when monitoring urine output? A) Document "unable to obtain" on the graphic sheet. B) Apply an external condom catheter. C) Insert an indwelling urinary catheter. D) Weigh diapers using the estimate that 1 mL = 1 gram of weight.

D) Weight change is one of the most sensitive indicators of fluid balance. Weighing diapers is the intervention used to accurately measure the output of an infant. The estimate is that 1 g of diaper weight is equal to 1 mL of fluid. The nurse should not insert an indwelling urinary catheter or apply an external condom catheter on the infant. Documenting "unable to obtain" on the graphic sheet does not support the need to accurately measure the infant's output.

The nurse is caring for a pregnant woman with a cellular regulation disorder. The nurse understands that the woman is at higher risk for certain serious complications of pregnancy, so the nurse is planning a client teaching session related to signs and symptoms of these complications. Which condition should the nurse include in her teaching? A) Gestational diabetes B) Placenta previa C) Urinary tract infection D) Preeclampsia

D) Women with cellular regulation disorders are at higher risk for preeclampsia and eclampsia during pregnancy. They may also be at risk for other complications of pregnancy, but the specific risks will depend on the woman's underlying condition. Urinary tract infection is not a serious complication. Gestational diabetes and placenta previa are not specifically related to cellular regulation disorders.