final exam review

6. Which statement made by a nursing student would best indicate that her education on family-centered care was fully understood? A. "Childbirth affects the entire family, and relationships will change." B. "Families are usually not capable of making health care decisions for themselves, especially in stressful situations." C. "Mothers are the only family member affected by childbirth." D. "Since childbirth is a medical procedure, it may affect everyone."

Answer: A Rationale: Childbirth affects the entire family, and relationships will change. Childbirth is viewed as a normal life event, not a medical procedure. Families are very capable of making health care decisions about their own care with proper information and support.

11. When assessing a family for barriers to health care, the nurse documents the psychosocial barriers. What is an example of this type of health care deficit? A. Academic difficulties B. Respiratory illness C. Poor sanitation D. Inherited diseases

Answer: A Rationale: Environmental and psychosocial factors are now an identified area of concern in children. They include academic differences, complex psychiatric disorders, self-harm and harm to others, use of firearms, hostility at school, substance use disorder, HIV/AIDS, and adverse effects of the media. Respiratory illness and inherited diseases are health problems, and poor sanitation is an environmental factor.

7. A school nurse who is teaching a health course at the local high school is presenting information on human development and sexuality. When talking about the role of hormones in sexual development, which hormone does the nurse teach the class is the most important for developing and maintaining the female reproductive organs? A. estrogen B. progesterone C. androgens D. follicle-stimulating hormone

Answer: A Rationale: Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.

26. The nurse is teaching a family about the benefits of circumcising their male neonate. The parents decline this procedure. How does this decision reflect the use of the family-centered approach by the nurse? A. It empowers the family to make their own decision. B. It applies the ethical principle of beneficence. C. Education about circumcision is provided to both parents. D. Evidence-based research is presented to the parents about circumcism.

Answer: A Rationale: Family-centered care empowers the family to make their own decisions regarding care. The power of control becomes the family's, not the nurse's. This decision also takes into consideration the family's beliefs and culture. Beneficence is the act of being kind or helping someone. This term does not apply to this situation. Evidence-based information about circumcisim may have been used for teaching, but allowing the family empowerment to make decisions about their health care exemplifies the family-centered approach.

13. The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care? A. Softening unpleasant information or prognoses B. Evaluating and changing the nursing plan of care C. Collaborating with the child and family as equals D. Showing respect for the family's beliefs and wishes

Answer: A Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.

2. The nurse is caring for a 2-week-old newborn girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care? A. softening unpleasant information or prognoses B. evaluating and changing the nursing plan of care C. collaborating with the child and family as equals D. showing respect for the family's beliefs and wishes

Answer: A Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.

3. A client with a 28-day cycle reports that she ovulated on May 10. When would the nurse expect the client's next menses to begin? A. May 24 B. May 26 C. May 30 D. June 1

Answer: A Rationale: For a woman with a 28-day cycle, ovulation typically occurs on day 14. Therefore, her next menses would begin 14 days later, on May 24. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 102

10. A nurse is preparing an in-service program for a group of newly hired nurses about trends in care for pregnant women. When describing events of the past decade, the nurse would state that the average length of stay in the hospital for vaginal births is: A. 24 to 48 hours or less. B. 72 to 96 hours or less. C. 48 to 72 hours or less. D. 96 to 120 hours or less.

Answer: A Rationale: Hospital stays for vaginal births have averaged 24 to 48 hours or less during the past decade and 72 to 96 hours or less for cesarean births.

3. A nurse is conducting an orientation program for a group of newly hired nurses. As part of the program, the nurse is reviewing the issue of informed consent. The nurse determines that the teaching was effective when the group identifies which situation as a violation of informed consent? A. Performing a procedure on a 15-year-old without parental consent B. Serving as a witness to the signature process on an operative permit C. Asking whether the client understands what she is signing following receiving education D. Getting verbal consent over the phone for an emergency procedure from the spouse of a unconscious woman

Answer: A Rationale: In most states, only clients over the age of 18 can legally provide consent for health care. Serving as a witness to the signature process, asking whether the client understands what she is signing, and getting verbal consent over the phone for emergency procedures are all key to informed consent and are not violations.

9. A nurse working in the community is involved in providing primary prevention. Which intervention would be most appropriate to implement? A. teaching parents of toddlers about ways to prevent poisoning B. working with women who are victims of domestic violence C. working with clients at an HIV clinic to provide nutritional and CAM therapies D. teaching hypertensive clients to monitor blood pressure

Answer: A Rationale: Primary prevention involves preventing a disease or condition before it occurs, such as teaching parents of toddlers about poisoning prevention. Working with women who are victims of domestic violence, clients at an HIV clinic, or hypertensive clients are all examples of tertiary prevention, which is designed to reduce or limit the progression of a disease or condition.

24. The family is the basic unit of society. Which statement correctly illustrates the importance of this concept related to how society functions? A. Healthy, well-functioning families provide members of all ages with fulfilling, supporting relationships. B. The family serves as a place that encourages members to autonomously function in pursuit of personal pleasures. C. Society functions best when families determine how they will interface with others without having to deal with the overall consequences. D. Work is an important part of family function but is not necessary for success if one member can fulfill multiple roles.

Answer: A Rationale: The family is the basic unit of society. In order for this to work well, members of the family must work together. Families make a central contribution to enhance the quality of our society. Families must consider how their actions will impact others, and one member cannot fulfill all roles within the family.

9. The nurse is reviewing the process of oocyte maturation and ovulation with a client. What occurs during the follicular phase of the ovarian cycle that the nurse should include in the teaching session? A. Under the influence of follicle-stimulating hormone, several follicles begin to ripen, and the ovum with each begins to mature. B. The empty ruptured graafian follicle becomes the corpus luteum, and it begins to secrete progesterone and estrogen. C. About day 14, a surge of hormones cause the ovum to burst through the ovary. D. The uterus prepares for implantation of an ovum.

Answer: A Rationale: The follicular phase lasts from about day 4 to about day 14. During this time, under the influence of follicle-stimulating hormone, several follicles begin to ripen and the ovum within each begins to mature. About day 14, a surge of hormones causes the ovum to burst through the ovary; this act is called ovulation. During the luteal phase, the empty, ruptured graafian follicle becomes the corpus luteum, and it begins to secrete progesterone and estrogen. The endometrium of the uterus has a similar cycle. It is called the uterine cycle or endometrial cycle. This process prepares the uterus for implantation of an ovum (egg).

5. A nurse is reading a journal article about the changes in health care delivery and funding that have occurred over the years. Which factor would the nurse expect to find as a current trend in maternal and child health care settings? A. increase in ambulatory care B. decrease in family poverty level C. increase in hospitalization of children D. decrease in managed care

Answer: A Rationale: The health care system has moved from reactive treatment strategies in hospitals to a proactive approach in the community, resulting in an increased emphasis on health promotion and illness prevention in the community through the use of community-based settings such as ambulatory care. Poverty levels have not decreased, and the hospitalization of children has not increased. Case management also is a primary focus of care.

28. The nurse needs to provide discharge education to a family to whom English is a second language and who will need to provide several skills daily for their child who has been diagnosed with a chronic illness. What is the best way for the nurse to provide this teaching? A. Provide teaching in short sessions B. Provide printed material with images of the skills C. Utilize videos of the skills to demonstrate D. Provide written materials in both English and the first language

Answer: A Rationale: The most important element when teaching this family will be to break the teaching into short sessions so the family is not overwhelmed with the information and can better comprehend the content. Adding video and written material is a good idea, but these should be provided after the teaching is completed and the parents have returned demonstrations of the skill. The written and visual resources will be good for the family when they have returned home and need further clarification or additional understanding.

4. A pregnant woman is to undergo an invasive procedure to evaluate the status of her fetus. To ensure informed consent, which action would be the priority responsibility of the nurse providing care to this woman? A. Asking relevant questions to determine the client's understanding B. Providing a detailed description of the risks and benefits of the procedure C. Explaining the exact steps that will occur during the procedure D. Offering suggestions for alternative options for treatment

Answer: A Rationale: The nurse's responsibilities related to informed consent include: Ensuring the consent form is completed with signatures from the client; serving as a witness to the signature process; and determining whether the client understands what she is signing by asking her pertinent questions. The physician, advanced practice nurse, or midwife is responsible for informing the client about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, its potential risks and benefits, and alternative methods available.

16. The nurse is caring for a 14-year-old boy with a growth hormone deficiency. Which action best reflects using the nursing process to provide quality care to children and their families? A. Reviewing the effectiveness of interventions B. Questioning the facility standards for care C. Earning continuing education credits D. Ensuring reasonable costs for care provided

Answer: A Rationale: The nursing process is used to care for the child and family during health promotion, maintenance, restoration, and rehabilitation. It is a problem-solving method based on the scientific method that allows nursing care to be planned and implemented in a thorough, organized manner to ensure quality and consistency of care. The nursing process is applicable to all health care settings and consists of five steps: assessment, nursing diagnosis, outcome identification and planning, implementation, and outcome evaluation. Reviewing the effectiveness of interventions is related to outcome evaluation in the nursing process. Even though the three remaining answer options are valuable in ensuring quality of care in health care facilities, they do not involve the direct care of the child and family using the nursing process.

3. The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which activity would be considered the tertiary level of prevention? A. arranging for a physical therapy session B. teaching parents to administer albuterol C. reminding parent to give a full course of antibiotics D. giving a DTaP vaccination at the proper interval

Answer: A Rationale: The tertiary level of prevention involves restorative, rehabilitative, or quality of life care such as arranging for a physical therapy session. Teaching parents to administer albuterol and reminding a parent to give the full course of antibiotics as prescribed are part of the secondary level of prevention, which focuses on diagnosis and treatment of illness. Giving a DTaP vaccination at the proper interval is an example of the primary level of prevention, which centers on health promotion and illness prevention.

13. A nurse is examining a female client and tests the client's vaginal pH. Which finding would the nurse interpret as normal? A. 4.5 B. 7 C. 8.5 D. 10

Answer: A Rationale: The vagina has an acidic environment; therefore, a pH of 4.5 would indicate an acidic environment. A pH of 7 is considered neutral; a pH above 7 is considered alkaline.

27. The nurse is obtaining a health history from a parent who has brought the infant to the clinic for a well-baby check-up. Which statement by the nurse indicates the most appropriate way to demonstrate empathy for the parent's concerns? A. "I am sure you must be very tired with your baby wanting to nurse every two hours during the night." B. "Your concerns about your infant's growth are valid but your infant is growing well." C. "I believe I heard you say your infant is not doing well. Can you explain why you feel this way?" D. "Is there any other reason you brought your infant to the clinic today other than immunizations?"

Answer: A Rationale: The way to demonstrate empathy through verbal communication is by paraphrasing the client's expressed feelings. This demonstrates the nurse heard what the client said and is being empathetic to the situation. Telling the parent not to worry about the infant's growth is a nontherapeutic and it also belittles the parent's concern. Asking the parent to explain one's feelings is using reflection to clarify the parent's feelings. Asking the parent why he or she brought the infant to clinic is a use of an open-ended question, which allows the parent to expand on the original statement.

14. The nurse is caring for a 14-year-old girl with multiple health problems. Which activity would best reflect evidence-based practice by the nurse? A. Following blood pressure monitoring recommendations B. Determining how often the vital signs are monitored C. Using hospital protocol for ordering diagnostic tests D. Deciding the prescribed medication dose

Answer: A Rationale: Using hospital protocol for ordering a diagnostic test, determining how often the vital signs are monitored, and deciding the medication dose ordered would be the health care provider's responsibility. However, following blood pressure monitoring recommendations would be part of evidence-based practice reflected in the nursing care delivered.

30. A nurse is preparing a breast cancer presentation for a health forum. Which fact would the nurse expect to address in this presentation? A. Breast cancer is more advanced in Black women when found. B. Black women have the BRCA1 and BRCA2 gene. C. More Hispanic women smoke, which increases their risk. D. White women respond better to breast cancer treatment.

Answer: A Rationale: White women get breast cancer at a higher rate than Black women; however, Black women are more likely to die becuase they get breast cancer before 40 years of age, cancer is more advanced when found, and survival at every cancer stage is worse among Black women. Black women are not at greater risk due to the BRCA1 or BRCA2 genes that cause breast cancer. There is no evidence that Hispanic women smoke more, placing them at risk. White women do not respond better to cancer treatment.

27. A nurse is conducting a health class about the reproductive system for a group of high school students. The nurse determines that the teaching was successful when the students identify which structure(s) as part of the external male reproductive system? Select all that apply. A. Penis B. Scrotum C. Prostate gland D. Vas deferens E. Seminal vesicles

Answer: A, B Rationale: The penis and the scrotum form the external genitalia in the male. The prostate gland, vas deferens, and seminal vesicles are internal male genitalia.

26. A nurse is assessing a 49-year-old client who has come to the clinic for her annual physical exam. The client tells the nurse, "I usually sleep about 8 hours a night without any problems but there are some nights where I wake up drenched in perspiration. And some days I feel on edge for no apparent reason." Additional assessment reveals use of a vaginal lubricant during sexual intercourse. The client also reports occasional flatus without constipation or bloating and continuation of her menstrual cycle every 32 days with a moderate flow. The nurse suspects that the client may be perimenopausal based on which finding(s)? Select all that apply. A. Reports of night sweats B. Unexplained irritabilty C. Use of vaginal lubrication D. Absence of bloating E. Expanded length of menstrual cycle

Answer: A, B, C Rationale: During the perimenopausal years (2 to 8 years prior to menopause), women may experience physical changes associated with decreasing estrogen levels, which may include vasomotor symptoms of hot flashes, irregular menstrual cycles, sleep disruptions, forgetfulness, irritability, mood disturbances, decreased fertility, weight gain and bloating, changing bleeding patterns, headaches, decreased vaginal lubrication, night sweats, fatigue, vaginal atrophy, and depression.

35. A nurse is preparing for a health promotion presentation for new mothers. Which topics would be appropriate for the nurse to include in the presentation? Select all that apply. A. Breastfeeding encouragement B. Proper infant sleep position C. Infants in smoke-free environments D. How to swaddle their infants E. How to bed share with their infants

Answer: A, B, C Rationale: Health promotion strategies can significantly improve an infant's health and chances of survival. Breastfeeding has been shown to reduce rates of infection in infants and to improve their long-term health. Emphasizing the importance of placing an infant on his or her back to sleep will reduce the incidence of sudden infant death syndrome (SIDS). Parents/partners should not share a bed with an infant younger than 12 weeks old and should avoid exposing the infant to tobacco smoke. Encouraging mothers to join support groups to prevent postpartum depression will improve the health of both mothers and their infants. Swaddling an infant and bed sharing is discouraged due to SIDS.

25. The public health nurse is preparing a presentation for an adolescent group with the focus being on primary prevention topics. Which topics would the nurse include? Select all that apply. A. Nutrition guidelines B. Hygiene practices C. Sun protection routine D. Smoking cessation programs E. Sexually transmitted infections

Answer: A, B, C Rationale: The concept of primary prevention involves preventing the disease or condition before it occurs through health promotion activities, environmental protection, and specific protection against disease or injury. Its focus is on health promotion to reduce the person's vulnerability to any illness by strengthening the person's capacity to withstand physical, emotional, and environmental stressors. Secondary prevention is the early detection and treatment of adverse health conditions from smoking or STIs.

21. A nurse working in the neonatal intensive care unit assists a family during the discharge of the premature newborn. What would the nurse prioritize in assessing the family's preparedness to care for the newborn? Select all that apply. A. The family's knowledge of newborn care B. The mother's and the family's concerns C. The family's available support system D. The availability of day care by the family's home E. The family's health insurance benefit program

Answer: A, B, C Rationale: The nurse should assess the family's knowledge of positioning and handling of their infant, nutrition, hygiene, elimination, growth and development, immunizations needed, and recognition of illnesses. The nurse should identify knowledge deficiencies so that they can be addressed in the nurse's teaching plan. Targeting the mother's areas of concern will help the nurse focus on needed education. The nurse should also assess physical and emotional support for the new mother by asking questions about the availability of support.

24. When teaching a group of female adolescents about reproduction and reproductive organs, the nurse describes the vulva. Which structure(s) would the nurse identify as being included? Select all that apply. A. Mons pubis B. Labia C. Clitoris D. Vagina E. Fallopian tubes

Answer: A, B, C Rationale: The structures that make up the vulva include the mons pubis, the labia majora and minora, the clitoris and prepuce, the structures within the vestibule, and the perineum. The vagina and fallopian tubes are internal reproductive structures.

20. A nurse is preparing to visit the home of a two-day postpartum client and her infant. Which assessments would the nurse expect to prioritize during the home visit? Select all that apply. A. a postpartum assessment B. assessment of the family members' well-being C. newborn nutritional assessment D. routine newborn exam E. socioeconomic family assessment F. community day care assessment

Answer: A, B, C, D Rationale: Postpartum care in the home environment usually includes monitoring the physical and emotional well-being of the family members; identifying potential or developing complications for the mother and newborn; newborn feeding; and instruction on pelvic floor exercises, nutrition, and self-hygiene care.

27. A perinatal nurse is interviewing a group a women in the community about health care services. Assessment of these services reveals that many of them are being underutilized. Which statement from the women would assist the nurse in identifying potential reasons for this underutilization? Select all that apply. A. "The services are hard to get to by public transportation." B. "The clinic is only open during the morning hours." C. "The staff seems to look down on us when we do come in." D. "There are staff there that can speak our language." E. "You need insurance to go to the clinic."

Answer: A, B, C, E Rationale: Access to care can be jeopardized by lower incomes and greater responsibilities when juggling work and family. Lack of finances or transportation, geographic misdistribution of health care providers, no babysitters, language or cultural barriers, distrust of health care providers, inconvenient clinic hours, and the poor attitudes of health care workers often discourage clients from seeking health care. Having staff that speak the language of the client population would be helpful in encouraging clients to use the services.

24. A nurse is providing preoperative instructions to a client undergoing an emergency cesarean birth. Which actions follow appropriate communication guidelines? Select all that apply. A. During the instructions, the nurse uses open-ended questions. B. The conversation is redirected while maintaining its focus. C. The client's feelings are addressed. D. The nurse does not acknowledge the emotions in the situation. E. The family's words are used to describe the necessary information. F. Only the correct medical terms are used when explaining the cesarean birth.

Answer: A, B, C, E Rationale: Good verbal communication skills are necessary. General guidelines for appropriate verbal communication include the following: Use open-ended questions that do not restrict the clients' answers; redirect the conversation to maintain focus; use reflection to clarify the parents' feelings; paraphrase the child's or parent's feelings to demonstrate empathy; acknowledge emotion; and demonstrate active listening by using the child's or family's own words.

17. A nurse educator is preparing a lecture for a group of students about the possible client indicators of poor health literacy. Which student statements would indicate that teaching was successful? Select all that apply. A. "Clients will have difficulty filling out registration forms." B. "They frequently have missed appointments." C. "There is a pattern of lack of follow-up with treatment." D. "Clients will report not be able to hear." E. "There is a pattern of history of medication errors." F. "Clients will ask many questions about their health situation."

Answer: A, B, C, E Rationale: Red flags that might indicate poor literacy skills include: difficulty filling out registration forms; frequently missed appointments; noncompliance and lack of follow-up with treatment regimens; history of medication errors; and avoiding asking questions for fear of looking "stupid." Reports of an inability to hear may be due to something else, like true hearing loss.

15. A nurse on a pediatric unit is asked by the mother of a young postoperative child, "What does atraumatic care mean?" Which responses by the nurse would be appropriate? Select all that apply. A. "Care on this unit attends to the distress experienced by children and their families." B. "Care that is provided minimizes the hospitalization stress." C. "Your child's care will prevent anxiety-provoking behaviors from occurring." D. "Attention will be paid to decreasing or preventing separation anxiety." E. "An early discharge will be planned so care can be given in the home."

Answer: A, B, D Rationale: Atraumatic care refers to the delivery of care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system. The key principles of atraumatic care include preventing or minimizing physical stressors, preventing or minimizing separation of the child from the family, and promoting a sense of control for family. Nurses must be alert for any situation that has the potential for causing distress and should be able to identify potential stressors. Nurses should minimize separation anxiety of the child from the family and should decrease the child's exposure to stressful situations in order to prevent or minimize pain and injury.

18. A nurse is preparing to teach insulin administration to a newly diagnosed diabetic adolescent and the adolescent's family. Which strategies would the nurse use to assist the client's learning? Select all that apply. A. Go slow and repeat information often. B. Use plain nonmedical language to explain procedures. C. Deliver the material in an educational lecture format. D. Teach the prioritized information. E. Use the accurate medical terms in the presentation.

Answer: A, B, D Rationale: Techniques that can help improve learning include: slow down and repeat information often; repeat important information at least four or five times; speak in conversational style using plain, nonmedical language; group information and teach it in small amounts using logical steps; and prioritize information first. Teach using an interactive, "hands-on" approach.

11. A nurse is conducting a class for a group of teenage girls about female reproductive anatomy and physiology. Which structures would the nurse include as an external female reproductive organ? Select all that apply. A. mons pubis B. labia C. vagina D. clitoris E. uterus

Answer: A, B, D Rationale: The external female reproductive organs collectively are called the vulva (which means "covering" in Latin). The vulva serves to protect the urethral and vaginal openings and is highly sensitive to touch to increase the female's pleasure during sexual arousal (Stables & Rankin, 2010). The structures that make up the vulva include the mons pubis, the labia majora and minora, the clitoris, the structures within the vestibule, and the perineum. The vagina and uterus are internal female reproductive organs.

25. A nursing group is examining their hospital's maternal outcomes for the previous 5 years. Which identified factors have contributed to the decline in the maternal mortality rate? Select all that apply. A. Increased participation of women in prenatal care B. Use of ultrasound to detect disorders C. Increased use of anesthesia with birth D. Closer monitoring for complications associated with hypertension of pregnancy E. Better management of hemorrhage and infection

Answer: A, B, D, E Rationale: The following factors have contributed to the decline in the maternal mortality rate: increased participation of women in prenatal care; greater detection of disorders such as ectopic pregnancy or placenta previa; prevention of related complications through the use of ultrasound; increased control of complications associated with hypertension of pregnancy; and decreased use of anesthesia with birth.

29. A hospital nurse is considering changing roles to become a home health nurse. What skill(s) will be important for this nurse to possess to be successful in the new role? Select all that apply. A. Be able to work with less structure B. Have good assessment skills C. Be knowledgeable about community resources D. Have good critical thinking skills E. Understand that not all environments will be desirable

Answer: A, B, D, E Rationale: The nurse providing home health care must understand that decisions will need to be made for care at the point of care. That means the nurse must have very good assessment and communication skills. The home health nurse also performs care that has to be individualized for the client and the environment. Thus, critical thing skills are essential. Equipment may not be available, so the nurse can improvise with what is available. The home health nurse must also understand that not every home the nurse visits will be a desirable environment. The nurse must make decisions based on safety for the client and the nurse. In the hospital setting, the nurse deals primarily with individual clients and has the advantage of having members of the health care team readily available. Hospitals tend to function with structure. Having structure is not always the case in the home environment. The nurse must be able to adapt to the immediate needs of the client in the situation. In the home setting, the nurse would not only be working with the client, but with the entire family. This role will require taking into consideration family issues, culture, and environmental threats. The new home health nurse would learn about community resources. This knowledge could be acquired over time and is not required to start in the new role.

31. A nurse is making a presentation at a parenting class dealing with divorce. A participant asks the nurse, "How should a parent handle telling the children about a divorce?" Which statements are the most helpful? Select all that apply. A. "Tell your children about the divorce and the reasons for it." B. "Reassure your children that the divorce is not their fault." C. "Make sure your children are aware of the potential financial issues." D. "Let them know they can decide how the future family will look." E. "Inform them in advance of someone moving out of the family home." F. "Routines, rules, and discipline can be minimized until a later time."

Answer: A, B, E Rationale: Rules for divorcing parents suggest to tell the children about the divorce and the reasons for the divorce in terms that they can understand; reassure the children that the divorce is not their fault; inform the children about the family structure after the divorce; inform them in advance of any changes in the household (i.e., someone moving out); do not discuss money or finances with your children; and maintain rules and routines.

14. The nurse is preparing for a public health campaign with a focus on current trends with family-centered care. What information would the nurse include in the presentation? Select all that apply. A. Family-centered care requires sensitivity to the client's and family's beliefs. B. The family should be assessed according to the relative importance of each member. C. Family-centered care promotes greater family decision-making abilities. D. The client's family is considered in health care to be an expert partnership. E. Family members should be addressed individually before being addressed collectively.

Answer: A, C, D Rationale: Family-centered care above all requires sensitivity to the client's and family's beliefs. This involves listening to the family's needs and a shift of the nurse's authoritarian role to the family to empower them to make their own decisions within the context of a supportive environment. One expert partnership that nurses can make is with the client's family. The philosophy of family-centered care recognizes the family as the constant.

22. The nurse knows that the emancipated minor is considered to have the legal capacity of an adult and may make his or her own health care decisions. Which child would potentially be considered an emancipated minor? A. A minor with financial independence who is living with his parents B. A minor who is pregnant C. A child older than 13 years of age who asks for emancipation D. A minor who puts his or her medical decisions in writing

Answer: B Rationale: Emancipation may be considered in any of the following situations, depending on the state's laws: membership in a branch of the armed services, marriage, court-determined emancipation, financial independence and living apart from parents, college attendance, pregnancy, mother younger than 18 years of age, and a runaway.

16. The nurse would include which principle(s) of adult learner-centered care when preparing to teach a female client about medication compliance? Select all that apply. A. Client teaching may include the strategy of role playing. B. Client teaching strategies should focus on a lecture style. C. Adults learn best when they realize there is gap in their knowledge base. D. The best time for adults to learn is when it meets an immediate need for them. E. Client teaching should focus on the content not the process.

Answer: A, C, D Rationale: Teaching adults needs to focus more on the process than on the content. Adults are self-directed and value independence and want to learn on their own terms. Teaching strategies that include such concepts as role playing, demonstration, and self-evaluation are most helpful. Adults learn best when they perceive there is a gap in their knowledge base and want information to fill the gap. Adults learn best at a time when learning meets an immediate need. Adults value past experiences and beliefs.

36. A client asks the nurse about her potential risk factors for breast cancer. Which risks would be important for the nurse to include in the response? Select all that apply. A. Oral contraceptive use B. Age when children were born C. Irregularities in menstruation D. Smoking E. Obesity

Answer: A, C, E Rationale: A positive family history of breast cancer, aging, and irregularities in the menstrual cycle at an early age are major risk factors for breast cancer. Other risk factors include excess weight or obesity, not having children, oral contraceptive use, excessive alcohol consumption, a high-fat diet, sedentary lifestyle, and longterm use of hormones. Smoking is not a major risk factor for breast cancer, although it is considered. The age of the mother when children are born is not a risk factor.

32. A nurse is preparing for a presentation on parenting at a local school. Which information would the nurse include when describing the results of an authoritarian parent? Select all that apply. A. The child will have lower self-esteem. B. The child will have increased feeling of security. C. Children will have higher achievements. D. An increase in aggression may be a result. E. The child will have increased social skills. F. There is a greater childhood happiness.

Answer: A, D Rationale: This parenting style is associated with negative effects on self-esteem, happiness and social skills, increased aggression, and defiance. The child will not feel more secure as the parent is always in control. It will not result in higher achievements or an increase in social skills.

43. A public health nurse is developing programs to educate parents on infant mortality. Which complications would the nurse include in the education? Select all that apply. A. Tricuspid atresia B. 39-week gestation birth C. 3,6 kg birth weight D. Anencephalus E. Spina bifida

Answer: A, D, E Rationale: The main causes of early infant death in this country include problems occurring at birth or shortly thereafter. These include prematurity, low birth weight, congenital anomalies, sudden infant death syndrome (SIDS), and respiratory distress syndrome. A pregnancy at 39 weeks would be considered a term pregnancy. A birth weight of 3.6 kg would be considered appropriate.

38. When teaching a parenting class on childhood discipline, the nurse is asked by a parent, "How long do I place my child in time-out?" How should the nurse best respond? A. "Use the amount of time it takes to elicit a behavior change." B. "Use 1 minute per year of age, but do not exceed 5 minutes." C. "Use as much time as is needed to control the behavior." D. "Use 1 minute per year of the child's age as needed."

Answer: B Rationale: Another form of discipline is extinction, which focuses on reducing or eliminating the positive reinforcement for inappropriate behavior. Examples are "time-out." When using time-out, use 1 minute per year of the child's age (a 3- year-old would have time-out for 3 minutes). Do not exceed 5 minutes.

15. The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which activity is typical of advocacy? A. Instructing parents about proper home care B. Educating the family about choices they have C. Telling parents about clinical guidelines D. Teaching the family about types of cancers

Answer: B Rationale: Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions. Telling parents about proper home care, clinical guidelines, and the types of cancers are all done in the primary role of educator.

14. When describing the male sexual response to a group of students, the instructor determines that the teaching was successful when they identify emission as: A. semen forced through the urethra to the outside. B. movement of sperm from the testes and fluid into the urethras. C. dilation of the penile arteries with increased blood flow to the tissues. D. body's return to the physiologic nonstimulated state.

Answer: B Rationale: Emission refers to the movement of sperm from the testes and fluids from the accessory glands into the urethra, where it is mixed to form semen. As the urethra fills with semen, the base of the erect penis contracts, thus increases pressure. This pressure forces the semen through the urethra to the outside (ejaculation). Dilation of the penile arteries with increased blood flow describes

1. When describing the menstrual cycle to a group of young women, the nurse explains that estrogen levels are highest during which phase of the endometrial cycle? A. menstrual B. proliferative C. secretory D. ischemic

Answer: B Rationale: Estrogen levels are the highest during the proliferative phase of the endometrial cycle, when the endometrial glands enlarge in response to increasing amounts of estrogen. Progesterone is the predominant hormone of the secretory phase. Levels of estrogen and progesterone drop sharply during the ischemic phase and fall during the menstrual phase. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 104

33. Parents who recently experienced the death of their unborn child ask the nurse, "What is a fetal death?" What is the nurse's best response? A. "Fetal deaths occur later in pregnancy after 20 weeks' gestation." B. "It refers to the intrauterine fetal death at any time during pregnancy." C. "Fetal deaths occur earlier in pregnancy before 20 weeks' gestation." D. "Fetal death occurs only at the birth of the newborn."

Answer: B Rationale: Fetal death refers to the spontaneous intrauterine death of a fetus at any time during pregnancy. Fetal deaths later in pregnancy (after 20 weeks of gestation) are referred to as stillbirths, and deaths earlier than 20 weeks are referred to as a miscarriage.

18. A nurse is describing the hormones involved in the menstrual cycle to a group of young adult women who are planning to get pregnant. The nurse determines the teaching was successful when the group identifies the follicle-stimulating hormone as being secreted by the: A. hypothalamus. B. anterior pituitary gland. C. ovaries. D. corpus lute.

Answer: B Rationale: Follicle-stimulating hormone and luteinizing hormone are secreted by the anterior pituitary gland. The hypothalamus secretes gonadotropin-releasing hormone. The ovaries secrete estrogen. The corpus luteum secretes progesterone.

10. The nurse is reviewing a copy of the U.S. Surgeon General's Report, Healthy People 2020. Which nursing action best reflects the nurse fostering this health care agenda? A. The nurse signs up for classes to obtain an advanced degree in nursing. B. The nurse volunteers at a local health care clinic providing free vaccinations for low-income populations. C. The nurse performs an in-service on basic hospital equipment for student nurses. D. The nurse compiles nursing articles on evidence-based practices in nursing to present at a hospital training seminar.

Answer: B Rationale: Healthy People 2020 is a comprehensive health promotion and disease prevention agenda that is working toward improving the quantity and quality of life for all Americans. Overarching goals are to eliminate preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create physical and social environments that promote good health; and promote healthy development and behaviors across every stage of life. Volunteering at a local health care clinic directly reflects the goal of improving the health of all groups of people. Signing up for classes, performing in-services on equipment, and compiling nursing articles on evidence-based practices in nursing are all worthwhile activities that foster health care delivery, but are not as directly linked to the agenda of promoting health in the community.

4. A pregnant client tells her nurse that she is interested in arranging a home birth. After educating the client on the advantages and disadvantages of a home birth, which statement would indicate that the client understood the information? A. "I like having the privacy, but it might be too expensive for me to set up in my home." B. "I want to have more control, but I am concerned if an emergency would arise." C. "It is safer because I will have a midwife." D. "The midwife is trained to resolve any emergency, and she can bring any pain meds."

Answer: B Rationale: Home births have many advantages, such as having more control over the birth, being the least expensive option, creating a good relationship with a midwife, and having more flexibility in the comfort of your home. However, the limited availability of pain medication and danger to the mother and baby if an emergency arises are two of the main disadvantages.

41. The nurse notes that an older adult client receives only one visitor and asks the client if family members could be called. The client states, "I consider her to be all of my family." What would the nurse consider in responding to the client? A. The nurse could encourage the client to reconnect with other family members. B. The client defines who is and who is not part of the family without undue influence. C. The nurse realizes individuals exist without a family and do not often adopt substitutes. D. Family is more important to those individuals with a large number of family members.

Answer: B Rationale: It is important for nurses to remain neutral to all they hear and see in order to enhance trust and maintain open communication lines with all family members. Nurses need to remember that clients are experts of their own health and can define their own family.

12. A woman comes to the clinic for an evaluation. During the visit, the woman tells the nurse that her menstrual cycles have become irregular. "I've also been waking up at night feeling really hot and sweating. The nurse interprets these findings as: A. menopause. B. perimenopause. C. climacteric. D. menarche.

Answer: B Rationale: Perimenopause is the time period occurring 2 to 8 years prior to menopause during which women may experience physical changes associated with decreasing estrogen levels, which may include vasomotor symptoms of hot flashes, irregular menstrual cycles, sleep disruptions, forgetfulness, irritability, mood disturbances, decreased vaginal lubrication, night sweats, fatigue, vaginal atrophy, and depression (Burbos & Morris, 2011). Vasomotor symptoms (hot flushes and night sweats) are the most common complaints for which women seek treatment. Menopause or climacteric is defined as 1 year without a menstrual period. Menarche refers to the onset of the first menses.

6. The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in the future offspring of pregnant women? A. calcium B. folic acid C. vitamin C D. iron

Answer: B Rationale: Prevention of neural tube defects in the offspring of pregnant women via the use of folic acid is an example of a primary prevention strategy. Calcium, vitamin C, and iron have no effect on the prevention of neural tube defects.

4. The nurse is assessing a 13-year-old girl. Which event would the nurse expect to have occurred first? A. evidence of pubic hair B. development of breast buds C. onset of menses D. growth spurt

Answer: B Rationale: Pubertal events preceding the first menses have an orderly progression beginning with the development of breast buds, followed by the appearance of pubic hair, then axillary hair, then a growth spurt. Menses typically occurs about 2 years after the start of breast development. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 104

17. A preschool child is scheduled to undergo a diagnostic test. Which action by the nurse would violate a child's bill of health care rights? A. Arranging for her mother to be with her B. Telling the child the test will not hurt C. Assuring the child that the test will be done quickly D. Introducing the child to the lab technicians

Answer: B Rationale: Telling the child the test will not hurt lacks veracity. It is not a lie, but it does not honor the child's right to be educated honestly about his or her health care. Arranging for the mother to be with the child, assuring the child that the test will be done quickly, and introducing the child to the lab technicians are actions that honor the child's bill of health care rights.

25. A nurse is teaching a group of female adolescents and young adult females about the female sexual response. The nurse determines that the teaching was successful when the group identifies which structure as being most erotically sensitive? A. Labia minora B. Clitoris C. Mons pubis D. Prepuce

Answer: B Rationale: The clitoris is sensitive to touch, stimulation, and temperature and can become erect. For its small size, 9 to 11 cm, it has a generous blood and nerve supply. There are more free nerve endings of sensory reception located on the clitoris than on any other part of the body, and it is therefore unsurprisingly the most erotically sensitive part of the genitalia for most females. Its function is sexual stimulation. The labia minora lubricate the vulva, swell in response to stimulation, and are highly sensitive. However, they are not the most sensitive. The mons pubis protects the symphysis pubis during sexual intercourse.The joining of the folds above the clitoris forms the prepuce, a hood-like covering over the clitoris.

2. The nurse is working with a group of community health members to develop a plan to address the special health needs of women. The group would design educational programs to address which priority condition? A. Smoking B. Heart disease C. Diabetes D. Cancer

Answer: B Rationale: The group needs to address cardiovascular disease, the number one cause of death in women regardless of racial or ethnic group. Smoking is related to heart disease and the development of cancer. However, heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women. However, it is not the major health problem that heart disease is.

40. A public health nurse visits the home of a young toddler. What aspect of the home environment would the nurse expect to address with the parents? A. The presence of power cords plugged into capped outlets B. Cartoons playing on a television in the child's room C. The family dog is present in the house during the visit D. The presence of pots on the stove with handles pointing toward back

Answer: B Rationale: The nurse is encouraged to ask questions regarding the amount of recreational screen time and if the child has a television or Internet-connected device in his or her bedroom. The American Academy of Pediatrics discourages any screen media before the age of 2. The nurse would question why the TV is being used in the child's room. The family dog may be a threat to observe during the visit, but having a TV in the child's room indicates that it is being exposed to earlier than advised screen time. Pot handles are in the appropriate position. Cords are plugged into capped outlets, which is safe.

15. A nurse is describing the structure and function of the reproductive system to an adolescent health class. How would the nurse describe the secretion of the seminal vesicles? A. mucus-like B. alkaline C. acidic D. semen

Answer: B Rationale: The paired seminal vesicles secrete an alkaline fluid that contains fructose and prostaglandins. The fructose supplies energy to the sperm on its journey to meet the ovum, and the prostaglandins assist in sperm mobility. The Cowper's glands secrete a mucus-like fluid. The vagina is an acidic environment. Semen refers to the sperm-containing fluid.

44. The pediatric nurse would be participating in the role of advocate when completing which action? A. Instructing parents on the side effects of vaccinations they are requesting for their child B. Contributing input on a task force with the aim to reduce the rate of mortality of infants and children C. Teaching parents to keep their prescribed medication safely out of reach of children D. Explaining to parents the reason for each medication their child was recently prescribed

Answer: B Rationale: The role of advocacy is being fulfulled when the nurse works to safeguard and advance the interest of children and infants through many means, including contributing to the learning and application of a task force aimed at reducing infant and children mortality. The actions of instructing about side effects, explaining the purposes of medications, and teaching about medication safelty would fall under the role of educator.

8. After explaining the function of the seminal vesicles to a class, the instructor determines the need for additional teaching when the students identify which action as a function of the seminal vesicles? A. nourishes the sperm B. reduces sperm motility C. aids sperm to reach the ovum D. prevents sperm destruction by female antibodies

Answer: B Rationale: The seminal vesicles are a pair of glands that produce fluid with various substances that function to (1) nourish sperm, (2) enhance sperm motility by enzymatically liquefying ejaculated semen (3) stimulate contraction of the uterus to help the sperm reach the ovum, and (4) resist sperm destruction by female antibodies.

17. A woman is diagnosed with a vaginal infection. After teaching the client about measures to reduce her risk, the nurse determines that the client needs additional teaching when she states which factor as increasing her risk? A. antibiotic therapy B. menstruation C. douching D. use of feminine hygiene sprays

Answer: B Rationale: The vagina has an acidic environment, which protects it against ascending infections. Antibiotic therapy, douching, perineal hygiene sprays, and deodorants upset the acid balance within the vaginal environment and can predispose women to infections. Menstruation is not considered a risk factor.

5. The nurse is preparing an outline for a class on the physiology of the male sexual response. Which event would the nurse identify as occurring first? A. sperm emission B. penile vasodilation C. psychological release D. ejaculation

Answer: B Rationale: With sexual stimulation, the arteries leading to the penis dilate and increase blood flow into erectile tissue. Blood accumulates, causing the penis to swell and elongate. Sperm emission (movement of sperm from the testes and fluid from the accessory glands) occurs with orgasm. Orgasm results in a pleasurable feeling of physiologic and psychological release. Ejaculation results in the discharge of semen from the urethra.

19. A nurse has been invited to be a guest speaker for a female high school health class about the menstrual cycle and reproduction. When describing the hormones involved in the menstrual cycle, a nurse identifies which hormone as responsible for initiating the cycle? A. estrogen B. luteinizing hormone C. progesterone D. prolactin

Answer: B Rationale: With the initiation of the menstrual cycle, luteinizing hormone rises and stimulates the follicle to produce estrogen. As this hormone is produced by the follicle, estrogen levels rise, inhibiting the output of LH. Ovulation occurs after an LH surge damages the estrogen-producing cells leading to a decline in estrogen. The LH surge results in the corpus luteum, which produces estrogen and progesterone. These two levels rise, suppressing LH. Lack of LH promotes degeneration of the corpus luteum, which then leads to a decline in estrogen and progesterone. The decline of ovarian hormones ends their negative effect on the secretion of LH, which is then secreted and the menstrual cycle begins again. Prolactin is the hormone responsible for breast milk production.

11. A nurse is teaching a local women's group about women's health care and changes that have occurred. When describing women's health care today, which statement would the nurse likely include? A. Women spend 50 cents of every dollar spent on health care. B. Women make almost 80% of all health care decisions. C. Women are still the minority in the United States. D. Men use more health services than women.

Answer: B Rationale: Women make almost 80% of all health care decisions (those related to caregiver, mother, client); they represent the majority of the population; they spend 66 cents of every health care dollar; and they use more health services than men, with 7 of every 10 most frequently performed surgeries being specific to women.

29. A nurse is preparing a class discussion on the clinical manifestations of a heart attack observed in women. Which symptoms would the nurse include as key assessment data? Select all that apply. A. syncope B. unusual fatigue C. sleep disturbances D. arm pain E. extreme hunger

Answer: B, C, D Rationale: Nurses need to go beyond the obvious crushing chest pain textbook symptom that indicates heart attack in men. Clinical manifestations of a heart attack observed in women include nausea, dizziness, irregular heartbeat, unusual fatigue, sleep disturbances, indigestion, anxiety, shortness of breath, pain or discomfort in one or both arms, and weakness.

16. A nurse is completing a continuing education program about the male and female reproductive organs. After reviewing the information, the nurse demonstrates understanding of the information by identifying which structures as male accessory organs? Select all that apply. A. testes B. vas deferens C. bulbourethral glands D. prostate gland E. penis

Answer: B, C, D Rationale: The organs of the male reproductive system include the two testes (where sperm cells and testosterone are made), the penis, the scrotum, and the accessory organs (epididymis, vas deferens, seminal vesicles, ejaculatory duct, urethra, bulbourethral glands, and prostate gland).

13. A nurse is working at a community prenatal drop-in clinic. Which actions best reflect the principles of family nursing within this clinic? Select all that apply. A. The clients and their families are assessed for adherence to federal health guidelines. B. Health promotion education activities are planned for the clients and their families. C. The clients and their families are included in all decision-making collaborations. D. The nurse would seek other health care provider input to plan care. E. The client is viewed as the ultimate decision maker.

Answer: B, C, D Rationale: When implementing family-centered care, nurses seek other caregiver input. These suggestions and advice are incorporated into the client's plan of care as the nurse counsels and teaches the family appropriate health care interventions. Health promotion activities are offered to the client and family. The nurses partner with various experts to provide high-quality and costeffective care. One expert partnership that nurses can make is with the client's family. The client and family are the health care decision makers.

34. Which factors are causes of the high infant mortality rate? Select all that apply. A. postmaturity B. low birth weight C. sudden infant death syndrome D. cardiac complications E. viral infections F. necrotizing enterocolitis

Answer: B, C, F Rationale: The main causes of early infant death in the United States include problems occurring at birth or shortly thereafter, such as prematurity, low birth weight, congenital and chromosomal anomalies, sudden infant death syndrome, respiratory distress syndrome, unintentional injuries, bacterial sepsis, and necrotizing enterocolitis.

37. A public health nurse is preparing a presentation for a parenting class with the focus on childhood discipline. Which principles of childhood discipline would the nurse expect to emphasize? Select all that apply. A. The use of punishment will reduce or eliminate undesirable behaviors. B. Discipline methods should ensure the preservation of the child's self-esteem. C. Time-out technique for discipline is no longer acceptable. D. Positive reinforcement will increase desirable behaviors. E. Maintain a positive, supportive, nurturing parent-child relationship.

Answer: B, D, E Rationale: Discipline should focus on the development of the child while ensuring to preserve the child's self-esteem and dignity. The American Academy of Pediatrics suggests three strategies for effective discipline: maintaining a positive, supportive, nurturing caregiver-child relationship; using positive reinforcement to increase desirable behaviors; and removing positive reinforcements or using punishment to reduce or eliminate undesirable behaviors. When using time-out, use 1 minute per year of the child's age (a 3-year-old would have time-out for 3 minutes). Do not exceed 5 minutes.

12. When integrating the principles of family-centered care, the nurse would include which concept? A. Parents want nurses to make decisions about their child's treatment. B. Families are unable to make informed choices. C. People have taken increased responsibility for their own health. D. Families require little information to make appropriate decisions.

Answer: C Rationale: Due to the influence of managed care, the focus on prevention, better education, and technological advances, people have taken increased responsibility for their own health. Parents now want information about their child's illness, to participate in making decisions about treatment, and to accompany their children to all health care situations.

8. A nurse is planning a continuum of care for a client during pregnancy, labor, and childbirth. What is the most important factor in enhancing the birthing experience? A. Adhering to strict specific routines B. Involving a pediatric physician C. Educating the client about the importance of a support person D. Assigning several nurses as a support team

Answer: C Rationale: Educating the client about the importance of a support person during labor and delivery has been shown to improve and enhance the birthing experience.

1. When integrating the principles of family-centered care into the birthing process, the nurse would base care upon which belief? A. Birth is viewed as a medical event. B. Families are unable to make informed choices due to stress. C. Birth results in changes in relationships. D. Families require little information to make appropriate decisions for care.

Answer: C Rationale: Family-centered care is based on the following principles: Birth affects the entire family, and relationships will change; birth is viewed as a normal, healthy event in the life of the family; and families are capable of making decisions about their own care if given adequate information and professional support.

22. After teaching a group of nursing students about family-centered care, which statement made by the students would best indicate that the teaching was successful? A. "Family-centered care recognizes the health of the client." B. "Family-centered care is a component of health care." C. "Family-centered care recognizes the concept of family as the constant." D. "Family-centered care is one part of a system."

Answer: C Rationale: Family-centered care recognizes the concept of the family as the constant. The health and functioning ability of the family influences and impacts the health of the client and other members of the family. It recognizes the client and the family as the source of control and a full partner in their care.

20. After teaching a group of adolescents about female reproductive anatomy, the nurse determines that the teaching was successful when the adolescents identify which structure as the site of fertilization? A. vagina B. uterus C. fallopian tubes D. vestibule

Answer: C Rationale: Fertilization occurs in the distal portion of the fallopian tubes. The lining of the uterus is shed with menstruation. The vagina connects the external genitalia to the uterus. The vestibule is an oval area enclosed by the labia minora laterally.

21. The nurse is caring for a child brought to the emergency department by a babysitter. The child needs an emergency appendectomy and the parents cannot be contacted. What would be the nurse's best response to this situation? A. Have the babysitter sign the consent form even if she does not have signed papers to do so. B. Have the primary care physician for the child sign the consent form. C. Document failed attempts to obtain consent to allow emergency care. D. Delay medical care until the child's next of kin can be contacted.

Answer: C Rationale: Health care providers can provide emergency treatment to a child without consent if they have made reasonable attempts to contact the child's parent or legal guardian (American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2007). If the parent is not available, then the person in charge may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so. During an emergency situation, a verbal consent via the telephone may be obtained. In urgent or emergent situations, appropriate medical care never should be delayed or withheld due to an inability to obtain consent.

12. A nurse is educating a client about a care plan. Which question would be appropriate to assess whether the client is learning? A. "Did you graduate from high school, and how many years of schooling did you have?" B. "Do you have someone in your family who would understand this information?" C. "Many people have trouble remembering information; is this a problem for you?" D. Would you prefer that the primary care provider give you more detailed medical information?"

Answer: C Rationale: It is appropriate to ask the client if the client will have trouble remembering the information. Many clients have this problem. It removes any judgment or stereotypes regarding education level, ability to understand, or learning skills. Avoid giving information that uses a lot of medical language or jargon, and use a simple, conversational style.

19. A public health nurse is preparing to visit the home of teenage parents with a new infant. Which action would be the priority? A. Determine the family's willingness for home visits. B. Prepare a schedule of follow-up visits. C. Review previous home visits to validate interventions. D. Review the family record to assess if the visit is necessary.

Answer: C Rationale: It is essential to review previous interventions to eliminate unsuccessful ones. Checking with previous home visit narratives will validate interventions. It would be necessary to communicate with previous nurses to ask questions and clarify. The other actions would not be the priority.

2. After teaching a group of adolescent girls about female reproductive development, the nurse determines that teaching was successful when the girls state that menarche is defined as a woman's first: A. sexual experience. B. full hormonal cycle. C. menstrual period. D. sign of breast development.

Answer: C Rationale: Menarche is defined as the establishment of menstruation. It does not refer to the woman's first sexual experience, full hormonal cycle, or sign of breast development. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 104

9. The nurse is administering a number of therapeutic interventions for neonates, infants, and children on the pediatric unit. Which intervention contributes to an increase in chronic illness seen in early childhood? A. Administering antibiotics to prevent lethal infections B. Vaccinating children to prevent childhood diseases C. Using mechanical ventilation for premature infants D. Using corticosteroids as a treatment for asthma

Answer: C Rationale: Using mechanical ventilation and medications to foster lung development in premature infants increases their survival rate. Yet the infants who survive are often faced with myriad chronic illnesses. Administering antibiotics to prevent lethal infections, vaccinating children to prevent childhood diseases, and using corticosteroids as a treatment for asthma may cause side effects, but do not contribute to chronic illness in children.

18. The pediatric nurse knows that the children being treated are considered minors. Which statement accurately describes the regulations related to consent for medical treatment? A. Children older than age 16 can provide their own consent for, or refusal of, medical procedures. B. A guardian ad litem may be appointed by the parents to serve to protect the child's best interests. C. Parents ultimately are the decision makers regarding medical treatment for their children younger than the age of 18. D. When divorce occurs, the parent with whom the child is living on a daily basis will be granted custody of the child.

Answer: C Rationale: Parents ultimately are the decision makers for their children. Generally, only persons over the age of majority (18 years of age) can legally provide consent for health care. Minors (children younger than 18 years of age) generally require adult guardians to act on their behalf. Biological or adoptive parents are usually considered to be the child's legal guardian. When divorce occurs, one or both parents may be granted custody of the child. In certain cases (such as child violence or neglect, or during foster care), a guardian ad litem may be appointed by the courts. This person generally serves to protect the child's best interests.

7. Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection? A. Provide treatment for clients who test positive for HIV. B. Monitor viral load counts periodically. C. Educate clients on how to practice safe sex. D. Offer testing for clients who practice unsafe sex.

Answer: C Rationale: Primary prevention involves preventing disease before it occurs. Therefore, educating clients about safe sex practices would be an example of a primary prevention strategy. Providing treatment for clients who test positive for HIV, monitoring viral loads periodically, and offering testing for clients practicing unprotected sex are examples of secondary preventive strategies, which focus on early detection and treatment of adverse health conditions.

10. The nurse is reviewing the process of egg maturation and ovulation with a client. What occurs during ovulation in the ovarian cycle that the nurse should include in the teaching session with the client? A. Under the influence of follicle-stimulating hormone, several follicles begin to ripen, and the ovum with each begins to mature. B. The empty ruptured cavity in the ovary becomes the corpus luteum and begins to secrete progesterone and estrogen. C. About day 14, a surge of hormones cause the ovum to burst through the ovary. D. The uterus is prepared for implantation of an ovum.

Answer: C Rationale: The follicular phase lasts from about day 4 to about day 14. During this time, under the influence of FSH, several follicles begin to ripen, and the ovum within each begins to mature. About day 14, a surge of hormones causes the ovum to burst through the ovary. This act is called ovulation. During the luteal phase, the empty, ruptured graafian follicle becomes the corpus luteum and begins to secrete progesterone and estrogen. The endometrium of the uterus has a similar cycle. It is called the uterine cycle or endometrial cycle. This process prepares the uterus for implantation of an ovum (egg).

26. The nurse is working with a group of community health members to develop a plan to address the special health needs of women. Which educational program would the group most likely identify as the priority? A. risk reduction strategies for diabetes B. methods for smoking cessation C. ways to adopt a heart-healthy lifestyle D. importance of cancer screening and early detection

Answer: C Rationale: The group needs to address cardiovascular disease, the number one cause of death in women regardless of racial or ethnic group. Thus, education for adopting a heart-healthy lifestyle would be the priority. Smoking is related to heart disease and the development of cancer. However, heart disease and cancer can occur in any woman regardless of her smoking history. Cancer is the second leading cause of death, with women having a one in three lifetime risk of developing cancer. Diabetes is another important health condition that can affect women. However, it is not the major health problem that heart disease is, and thus educational programs focusing on smoking cessation, cancer screening and early detection, and diabetes risk reduction would be lesser priorities.

8. The nurse is preparing the discharge plan for a woman whose newborn requires ventilatory support at home. Which action by the nurse would be most appropriate to do when assuming the role of discharge planner? A. Confer with the client's parents. B. Teach new self-care skills to the client. C. Determine if there is a need for back-up power. D. Discuss coverage with the insurance company.

Answer: C Rationale: The nurse should establish if there is a need for back-up power during discharge planning. Conferring with a woman's parents and dealing with insurance companies are case management activities. Teaching self-care skills are activities associated with the nurse as an educator.

7. Which aspect of client wellness has not been a focus of health during the 21st century ? A. Disease prevention B. Health promotion C. Wellness D. Analysis of morbidity and mortality

Answer: D Rationale: The focus on health has shifted to disease prevention, health promotion, and wellness. In the last century, much of the focus was on analyzing morbidity and mortality rates.

23. After describing the procedure and medical necessity, the nurse asks a 14-yearold child to assent to a skin graft. Which statement accurately describes the requirements for this type of assent? A. The age of assent occurs at 12 years old. B. It is not necessary to obtain assent from a minor for a procedure. C. A minor can dissent to a procedure but his or her wishes are not binding. D. In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden.

Answer: D Rationale: Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care (McCullough & Stein, 2009). In some cases, such as cases of significant morbidity or mortality, dissent may need to be overridden. The age of assent depends on the child's developmental level, maturity, and psychological state. The converse of assent, dissent (disagreeing with the treatment plan), when given by an adolescent 13 to 17 years of age, is considered binding in some states.

42. The nurse working in a maternity clinic suspects that a client and her children are in a violent relationship. While waiting for test results, the nurse decides to teach the client about intimate partner violence. What would be the best rationale for the nurse's decision? A. The nurse knows that the woman may be weak and controlled by her partner. B. The nurse has a legal responsibility to protect clients. C. The nurse understands there is an ethical responsibility to protect clients. D. The nurse knows that children exposed to family violence are likely to be victims of abuse.

Answer: D Rationale: Children exposed to family violence are more likely to be physically, sexually, or emotionally abused themselves. Children have died from family violence and neglect when no one has intervened on their behalf. Children who are exposed to stressors such as family violence or who are victims of childhood violence or neglect are at high risk for short- and long-term problems. Witnessing and being exposed to violence in childhood results in a higher tolerance, and greater use, of violence as an adult. The nurse may feel an ethical responsibility towards clients, but the nurse does not have a legal responsibility to protect clients. Women being the weaker sex is a myth.

23. An oncology nurse is preparing a plan of care for a young father newly diagnosed with lung cancer. What action would be the nurse's priority? A. Complete the application for emergency financial assistance. B. Suggest that community members be sought to assist with child care. C. Recommend that the father join a community cancer support group. D. Teach the family how to navigate the health care system.

Answer: D Rationale: Family-centered care refers to the collaborative partnership among the individual, family, and caregivers to determine the plan of care, gather information, offer support, and formulate plans for health care. It is generally understood to be an approach in which clients and their families are considered integral components of the health care decision making and delivery processes. The other options do not include the family in the process.

22. After teaching a group of pregnant women about breastfeeding, the nurse determines that the teaching was successful when the group identifies which hormone as being inhibited during pregnancy but is important for the production of breast milk after birth? A. placental estrogen B. progesterone C. gonadotropin-releasing hormone D. prolactin

Answer: D Rationale: Following birth and the expulsion of the placenta, levels of placental hormones (progesterone and lactogen) fall rapidly, and the action of prolactin (milk-producing hormone) is no longer inhibited. Prolactin stimulates the production of milk within a few days after birth. Placental estrogen and progesterone stimulate the development of the mammary glands during pregnancy. Gonadotropin-releasing hormone induces the release of follicle-stimulating hormone and luteinizing hormone to assist with ovulation.

19. The nurse is caring for a 12-year-old child hospitalized for internal injuries following a motor vehicle accident. For which medical treatment would the nurse ensure that an informed consent is completed beyond the one signed at admission? A. Diagnostic imaging B. Cardiac monitoring C. Blood testing D. Spinal tap

Answer: D Rationale: Most care given in a health care setting is covered by the initial consent for treatment signed when the child becomes a client at that office or clinic or by the consent to treatment signed upon admission to the hospital or other inpatient facility. Certain procedures, however, require a specific process of informed consent, including major and minor surgery; invasive procedures such as lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk, such as chemotherapy or radiation therapy; procedures or treatments involving research; photography involving children; and applying restraints to children.

21. The nurse is assessing a 12-year-old girl who has had her first menses. When reviewing the client's history, which event would the nurse expect to have most likely occurred last? A. evidence of pubic hair B. breast bud development C. growth spurt D. onset of menses

Answer: D Rationale: Pubertal events preceding the first menses have an orderly progression beginning with the development of breast buds, followed by the appearance of pubic hair, then axillary hair, then a growth spurt. Menses typically occurs about 2 years after the start of breast development.

39. After teaching a group of parents on childhood discipline, the nurse understands that which statement, made by a parent, demonstrates an understanding of spanking as a form of discipline? A. "When responding to inappropriate behavior it is OK to lightly spank." B. "Use a combination of spanking along with other methods of discipline." C. "Use spanking as a last resort when time-out has failed." D. "Use methods other than spanking to respond to inappropriate behavior."

Answer: D Rationale: Some research says spanking provides children with a model of aggressive behavior as a solution for conflict, is associated with increased aggression in children, and can lead to an altered parent-child relationship. Because of the negative consequences of spanking, and because it has been shown to be no more effective than other methods for managing inappropriate behavior, it is recommended that parents use methods other than spanking to respond to inappropriate behavior.

6. A woman comes to the clinic reporting that she has little sexual desire. As part of the client's evaluation, the nurse would anticipate the need to evaluate which hormone level? A. progesterone B. estrogen C. gonadotropin-releasing hormone D. testosterone

Answer: D Rationale: Testosterone is thought to be the hormone of sexual desire in women. Thus, an evaluation of this level would be done. Progesterone is often called the hormone of pregnancy because of its calming effect (reduction in uterine contractions) on the uterus, allowing pregnancy to be maintained. Estrogen is the predominant hormone at the end of the follicular phase. Gonadotropin-releasing hormone induces the release of FSH and LH to assist with ovulation.

5. A 9-month-old with glaucoma requires surgery. The infant's parents are divorced. To obtain informed consent, which action would be most appropriate? A. Contacting the father for informed consent B. Obtaining informed consent from the mother C. Seeking a court ruling on the course of care D. Determining sole or joint custody by the parents

Answer: D Rationale: The most appropriate action would be to determine legal custody by court decree. If the parents have joint custody, then either parent may give consent, but it is always best to have consent given by both parents. The parent with only physical custody may give consent for emergency care. The last resort is getting a court ruling; usually this is not necessary unless the parents disagree about the care of the child.

1. The nurse is providing care to a pregnant woman who speaks a different language from that of the nurse. When communicating with this client, the nurse demonstrates best practice by which action? A. speaking to the client in a loud voice at a slow pace B. standing close to the client while using a strong emphatic tone C. having a family member communicate the information to the client D. arranging for an interpreter to be present during any communication

Answer: D Rationale: The nurse should arrange for an interpreter when communicating with a client who speaks another language. Speaking loudly, standing close to the client, and speaking emphatically would be of little benefit if the client does not understand the spoken language. Additionally, it can be interpreted as threatening to the client. Having a family member communicate the information to the client is inappropriate, violates client confidentiality (if the client has not given permission for that member to have the information), and does not ensure that the client will receive the correct information.

20. A child needs a consent form signed for a minor surgical procedure. Which statement accurately describes the responsibilities of the health care providers when obtaining the consent? A. The physician is responsible for ensuring that the consent form is completed with signatures from the parents or legal guardians. B. The physician is responsible for serving as a witness to the signature process. C. The nurse is responsible for informing the child and family about the procedure and obtaining consent. D. The nurse is responsible for determining that the parents or legal guardians understand what they are signing by asking them pertinent questions.

Answer: D Rationale: The nurse's responsibility related to informed consent includes the following: determining that the parents or legal guardians understand what they are signing by asking them pertinent questions, ensuring that the consent form is completed with signatures from the parents or legal guardians, and serving as a witness to the signature process. The physician or advanced practitioner providing or performing the treatment and/or procedure is responsible for informing the child and family about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, the potential risks and benefits, and alternative methods available.

28. A nurse is preparing a class discussion on cardiovascular disease in women. When discussing the priority risk factors for this disease, which would the nurse least likely include? Select all that apply. A. Menopause B. Diabetes diagnosis C. Weight cycling D. Gender E. Age

Answer: D, E Rationale: CVD is the leading cause of death in women. Risk factors of CVD differ between men and women with menopause, diabetes, and repeated weight losses and gains increasing the risk for coronary morbidity and mortality in women. Yo-yo dieting or yo-yo effect, also known as weight cycling is a major risk factor. Gender and age are not major risk factors and should not be considered in this list.

23. A nurse is asked to be a guest speaker for a parents' meeting at the local middle school. Part of the presentation is to focus on the events girls will experience when going through puberty. Place the events in the order that the nurse would address them, from first to last. Use all options. A. Development of the breast B. Appearance of pubic hair C. Appearance of axillary hair D. Growth spurt E. Menstruation

Rationale: Pubertal events preceding the first menses have an orderly progression: thelarche, the development of breast buds; adrenarche, the appearance of pubic and then axillary hair followed by a growth spurt; and menarche (occurring about 2 years after the start of breast development).