Hinkle 56 Health Promotion and Maintenance

The nurse is providing teaching to the parents of a young child with a urinary tract infection. The nurse's goal is to help the parents understand their role in the treatment of the infection. Which statement by the parents lets the nurse know that the teaching has been successful? a) "We need to come to the emergency department for IV fluids." b) "We need to administer the oral antibiotics as prescribed." c) "We need to encourage cranberry juice to treat the infection." d) "We can treat the infection by increasing oral fluid intake."

"We need to administer the oral antibiotics as prescribed."

A nurse is teaching a client with diabetes mellitus about self-management of his condition. The nurse should instruct the client to administer 1 unit of insulin for every: a) 15 g of carbohydrates. b) 20 g of carbohydrates. c) 25 g of carbohydrates. d) 10 g of carbohydrates.

15 g of carbohydrates

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp? a) Middle area b) Temporal area c) Behind the ears d) Top of the head

Behind the ears

Which diagnostic test is indicated for postmenopausal bleeding? a) Magnetic resonance imaging b) Computed tomography c) Ultrasound d) Endometrial biopsy

Endometrial biopsy For postmenopausal bleeding, an endometrial biopsy or D&C is indicated.

According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage? a) Identity versus role confusion b) Industry versus inferiority c) Initiative versus guilt d) Trust versus mistrust

Industry versus inferiority

The nurse enlists the aid of an interpreter when caring for a primiparous client from Mexico who speaks only Spanish and gave birth to a viable term neonate 8 hours ago. When developing the postpartum dietary plan of care for the client, the nurse would encourage the client's intake of which of the following? a) Tomatoes. b) Meat products. c) Corn products. d) Potatoes

Meat products

A client tells a nurse that he has a rash on his back and right flank. The nurse observes elevated, round, blisterlike lesions filled with clear fluid. When documenting the findings, what medical term should the nurse use to describe these lesions? a) Papules b) Vesicles c) Plaque d) Pustules

Vesicles

Which structure is referred to as the vulva? a) external female genitalia b) clitoris c) vagina d) mons pubis

external female genitalia The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).

A primiparous client planning to breast-feed her term neonate born vaginally asks, "When will my 'real' milk come in?" The nurse explains to the client that after birth breasts begin to fill with milk within which of the following periods? a) 12 hours. b) 24 hours. c) 7 days. d) 2 to 4 days.

2 to 4 days.

Which of the following children should be referred for further assessment regarding language development? a) A 2-year-old who has a vocabulary of 100 words and can point to objects. b) A 3-year-old who has a vocabulary of 900 words and can make a complete sentence of three or four words. c) A 2-year-old who has a vocabulary of 300 words and can combine two or three words in a phrase. d) A 1-year-old who has a vocabulary of 8 words and can say "mommy" and "daddy" with specific reference to the correct person.

A 2-year-old who has a vocabulary of 100 words and can point to objects.

A primiparous client, who has just given birth to a healthy term neonate after 12 hours of labor, holds and looks at her neonate and begins to cry. The nurse interprets this behavior as a sign of which of the following? a) Grief over the ending of the pregnancy. b) Indication of postpartum "blues." c) Disappointment in the baby's gender. d) A normal response to the birth.

A normal response to the birth.

The nurse is preparing to administer the measles-mumps-rubella (MMR) and varicella vaccines to an infant who has an egg and wheat allergy. Which of the following is the appropriate action by the nurse? a) Administering both vaccines b) Administering neither vaccine c) Administering only the MMR vaccine d) Administering only the varicella vaccine

Administering only the MMR vaccine

The mother says that the infant's primary care provider recommends certain foods, but the infant refuses to eat them after breast-feeding. The nurse should suggest that the mother alter the feeding plan by doing which of the following? a) Offering breast milk as long as the infant refuses to eat solid foods. b) Allowing the infant to nurse for a few minutes and then offering solid foods. c) Mixing pureed food with some breast milk in a bottle with a large-holed nipple. d) Offering dessert followed by some vegetables and meat.

Allowing the infant to nurse for a few minutes and then offering solid foods.

A nurse is assessing the family of an infant and observes that the parents are argumentative and appear fatigued. They indicate that the baby is not breastfeeding well and cries through the night. What would be the nurse's priority nursing diagnosis for this infant? a) Altered role performance related to new responsibilities within the family b) Knowledge deficit related to normal infant growth and development c) Altered nutrition (less than body requirements) related to difficulty sucking d) Parental sleep pattern disturbance related to the baby's feeding schedule

Altered nutrition (less than body requirements) related to difficulty sucking

Two hours ago, a multigravid client was admitted in active labor with her cervix dilated at 5 cm and completely effaced and the fetus at 0 station. Currently, the client is experiencing nausea and vomiting, a slight chill with perspiration beads on her lip, and extreme irritability. The nurse should first: a) Obtain an order for an intramuscular antiemetic medication. b) Assess the client's cervical dilation and station. c) Warm the temperature of the room by a few degrees. d) Increase the rate of intravenous fluid administration.

Assess the client's cervical dilation and station

A young woman would like to lower her risk of developing cancer and is following a low-fat diet. Which type of cancer is not associated with excess dietary fat intake? a) Breast cancer. b) Rectal cancer. c) Colon cancer. d) Prostate cancer

Breast cancer.

A nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which assessment findings? a) Uterine enlargement b) Presence of menses c) Fetal heart tones d) Breast sensitivity

Breast sensitivity

A primiparous woman has recently given birth to a term infant. Priority teaching for the patient includes information on: a) Breastfeeding b) Infant bathing c) Sudden infant death syndrome (SIDS) d) Infant sleep-wake cycles

Breastfeeding

Which type of yeast infection is manifested by white, cheeselike discharge? a) Trichomoniasis b) Candidiasis c) Bacterial vaginosis d) Cervicitis

Candidiasis The discharge of candidiasis may be watery or thick, but has a white, cheeselike appearance. The other disorders do not have a cheeselike appearance.

When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy should the nurse include in the teaching plan? a) Cardiac output increases by 25% to 50% during pregnancy. b) The anterior pituitary gland secretes oxytocin late in pregnancy. c) The temperature decreases slightly early in pregnancy. d) The circulating fibrinogen level decreases as much as 50% during pregnancy.

Cardiac output increases by 25% to 50% during pregnancy.

Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected? a) Cryotherapy b) Colporrhaphy c) Perineorrhaphy d) Cone biopsy (conization)

Cone biopsy (conization) Cone biopsy is a procedure done to remove abnormal cervical tissue. Colporrhaphy refers to repair of the vagina. Cryotherapy refers to destruction of tissue by freezing. Perineorrhaphy refers to sutural repair of perineal lacerations.

The nurse makes a home visit to a 3-day-old full-term neonate who weighed 3,912 g (8 lb, 10 oz) at birth. Today the neonate, who is being bottle-fed, weighs 3,572 g (7 lb, 14 oz). Which of the following instructions should the nurse give to the mother? a) Contact the primary health care provider if the weight loss continues over the next few days. b) Switch to a soy-based formula because the current one seems inadequate. c) Change to a higher-calorie formula to prevent further weight loss. d) Continue feeding every 3 to 4 hours since the weight loss is normal.

Continue feeding every 3 to 4 hours since the weight loss is normal.

A mother and grandmother bring a 2-month-old infant to the clinic for a routine checkup. As the nurse weighs the infant, the grandmother asks, "Shouldn't the baby start eating solid food? My kids started on cereal when they were 2 weeks old." Which response by the nurse would be appropriate? a) "Babies can't digest solid food properly until they're 3 or 4 months old." b) "The baby is gaining weight and doing well. There is no need for solid food yet." c) "Things have changed a lot since your children were born." d) "Introducing solid food early leads to eating disorders later in life."

"Babies can't digest solid food properly until they're 3 or 4 months old."

A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask: a) "Do you have any birds at home?" b) "Do you have any cats at home?" c) "Have you ever had osteomyelitis?" d) "Have you recently had a rubeola vaccination?"

"Do you have any cats at home?"

Which of the following assessment questions is most likely to yield clinically meaningful data about a female client's sexual identity? a) "Do you find that your health allows you to enjoy a meaningful sex life?" b) "Are you satisfied with the quality of your relationships right now?" c) "How do you feel about yourself as a woman?" d) "Have you ever had any sexually transmitted diseases in the past?"

"How do you feel about yourself as a woman?"

vWhich of the following statements indicates that a client understands the need for routine screening to detect colorectal cancer? a) "I need to have a barium enema after age 20." b) "I need to have a carcinoembryonic antigen (CEA) test after age 50." c) "I need to have an annual digital examination after age 40." d) "I need to have a proctosigmoidoscopy after age 30."

"I need to have an annual digital examination after age 40."

vA 4-year-old girl has a urinary tract infection (UTI). Which statement by the mother demonstrates understanding of preventing future UTIs? a) "When she starts urinating frequently, I should call the physician to request antibiotics." b) "I should help my child learn to wipe her bottom from back to front." c) "I will let her take a warm bath for 15 minutes each day." d) "I shouldn't let my daughter take bubble baths."

"I shouldn't let my daughter take bubble baths."

Cone biopsy is a term used to describe a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which of the following statements made by the patient demonstrates that the patient undergoing a cone biopsy understands the discharge instructions? a) "I will avoid having sexual relations until I see the doctor again." b) "I require a repeat conization in 2 weeks after the edema subsides." c) "I will use a sitz bath to relieve pain caused by the sutures." d) "I will need to use a menstrual pad to capture the moisture as my cervix unfreezes."

"I will avoid having sexual relations until I see the doctor again." Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorraphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy.

A client with allergic rhinitis asks the nurse what to do to decrease the rhinorrhea. Which of the following instructions would be appropriate for the nurse to give the client? a) "It is important to increase your activity. A daily brisk walk will help promote drainage." b) "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." c) "Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks." d) "Use your nasal decongestant spray regularly to help clear your nasal passages."

"Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks."

A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct? a) "The office staff can schedule your clinical breast examination twice a year." b) "The clinical breast evaluation will be completed with annual gynecologic examination." c) "The diagnostic center will send you a reminder card to complete the annual examination." d) "You can complete the examination at home and report if you found anything abnormal."

"The clinical breast evaluation will be completed with annual gynecologic examination." A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.

A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse? a) "We will do the test and take into consideration that you are menstruating." b) "We will reschedule your examination when you have finished menstruating." c) "This will have no bearing on your test today." d) "We will proceed with the examination and reschedule your Pap smear for next week."

"We will reschedule your examination when you have finished menstruating." The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.

Which nursing question is essential when caring for a client prior to a pelvic examination? A) "Are you sexually active?" B) "Do you have any sexually transmitted diseases?" C) "Would you like to have assistance to get in position for the exam?" D) "Would you like to void at this time?"

"Would you like to void at this time?" Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.

A client with heart failure has bilateral +4 edema of the right ankle that extends up to midcalf. The client is sitting in a chair with the legs in a dependent position. Which of the following goals is the priority? a) Maintain normal respirations. b) Maintain body temperature. c) Decrease venous congestion. d) Prevent injury to lower extremities.

Decrease venous congestion.

Which of the following is an age-related functional change of the female reproductive system? a) Decreased pH of vagina b) Hormone level stability c) Decreased ovulation d) Increased vaginal lubrication

Decreased ovulation Functional changes of the female reproductive system include decreased ovulation, onset of menopause, hormonal fluctuations, decreased bone formation, decreased vaginal lubrication, and increased pH of the vagina.

A nulliparous client tells the nurse that during her last pelvic examination the physician said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which of the following? a) Frequent vaginal infections. b) Difficulty conceiving a child. c) Pain from endometriosis. d) Severe menstrual cramping.

Difficulty conceiving a child

Which of the following instructions would be appropriate to include when preparing a woman for an abdominal ultrasound? a) Empty the bladder immediately before the test. b) Drink at least 1 quart of water an hour before the test. c) Restrict solid food intake for 2 hours before the test. d) Refrain from douching for at least 1 week before the test.

Drink at least 1 quart of water an hour before the test. Drinking at least 1 quart of water 45 minutes to 1 hour before the test and no voiding until after the test ensures a full bladder and facilitates transmission of the ultrasound waves. It also elevates the bowel away from the other pelvic organs. The client should restrict solid food intake for 6 to 8 hours before the test to avoid having images of her test obscured by gas and intestinal contents. There is no restriction on douching for this test. A full bladder, not an empty one, facilitates this test.

At which of the following times should the nurse anticipate assisting a client to breast-feed her neonate? a) In about 4 hours, after the baby has had some sleep. b) In about 2 hours, after the baby has been evaluated. c) After the neonate's first period of reactivity. d) During the neonate's first period of reactivity.

During the neonate's first period of reactivity.

Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele? a) Atrophic vaginitis b) Dyspareunia c) Decreased pH of the vagina d) Irregular menses

Dyspareunia A cystocele can cause dyspareunia and incontinence. See Table 32-2 in the text for a complete list of both structural and functional age-related changes.

Which term refers to difficult or painful sexual intercourse? a) Amenorrhea b) Endometriosis c) Dyspareunia d)Dysmenorrhea

Dyspareunia Dyspareunia is a common problem in older women. Amenorrhea refers to the absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis.

A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate? a) Giving the client a mild sedative before the procedure b) Administering laxatives and an enema prior to the procedure c) Checking that it has been 5 days since the end of her menses d) Ensuring that the client has a full bladder

Ensuring that the client has a full bladder An abdominal ultrasound is a simple procedure that requires no specific preparation other than ensuring that the client has a full bladder to enhance visualization of abdominal area. A mild sedative, laxatives, and an enema would be used prior to a hysterosalpingography. A hysteroscopy should be done about 5 days after menstruation ceases.

A client, now 37 weeks pregnant, calls the clinic because she is concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to the client's concerns, the nurse should take which action? a) Make an appointment because the client needs to be evaluated. b) Arrange for the client to be admitted to the birth center and prepare for birth. c) Tell the client to go to the hospital; she may be experiencing signs of heart failure. d) Explain that these are expected problems for the latter stages of pregnancy.

Explain that these are expected problems for the latter stages of pregnancy.

A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle? a) January 30 b) January 27 c) February 8 d) February 5

February 5 February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors.

The most common cause of megaloblastic, macrocytic anemias is: a) Chronic disease. b) Folate or vitamin B12 deficiency. c) Iron deficiency. d) Infection.

Folate or vitamin B12 deficiency.

To assess a 9-year-old's social development, the nurse asks the parent if the child: a) Has a best friend. b) Enjoys active play. c) Thinks independently. d) Is able to organize and plan.

Has a best friend

The nurse is relating health education to male students when asked where sperm is actually made. Which location is most correct? a) In the seminiferous tubules b) In the male reproductive system c) Sperm are present from birth. d) In the testes within the scrotum

In the testes within the scrotum Health instruction should be clear, specific, and factual. The specific location for sperm production is in the testes, which lie in the scrotum. More general information is that the sperm are produced in the male reproductive system and immature spermatozoa are formed in the seminiferous tubules. Sperm are not present from birth.

A woman who is 10 weeks pregnant arrives at the emergency department reporting vaginal bleeding and cramping. She states, "I've passed some small clots." Inspection of the perineal pad reveals moderate bleeding and some tissue. The client's cervix is dilated. The nurse interprets these findings as indicative of which of the following? a) Threatened abortion b) Habitual abortion c) Inevitable abortion d) Incomplete abortion

Incomplete abortion The client is most likely experiencing an incomplete abortion as evidenced by the cramping, passage of tissue, vaginal bleeding, and cervical dilation. Cervical dilation would be absent in a threatened abortion. An inevitable abortion is indicated by the continued signs and symptoms of an abortion despite measures to prevent it. Habitual abortion involves successive, repeated, spontaneous abortions of unknown cause.

The nurse should teach the client with viral hepatitis to: a) Intensify routine exercise and increase strength. b) Avoid contact with others and live separately. c) Limit caloric intake and reduce weight. d) Increase carbohydrates and protein in the diet.

Increase carbohydrates and protein in the diet.

Nursing students are reviewing information about the age-related changes in the reproductive system and their effects. The students demonstrate a need for additional study when they identify which of the following as an expected change? a) Increased vaginal pH b) Decreased bone formation c) Increased labial thickness d) Decreased vaginal lubrication

Increased labial thickness Age-related changes include a thinning of the labia, decreased bone formation, increased vaginal pH, and decreased vaginal lubrication.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? a) It's normal and requires no action. b) It calls for a biopsy as soon as possible. c) It calls for a repeat Pap test in 6 weeks. d) It calls for a repeat Pap test in 3 months.

It calls for a biopsy as soon as possible

The parents of a 9-month-old bring the infant to the clinic for a regular checkup. The infant has received no immunizations. Which vaccine order would the nurse question? a) Haemophilus influenzae type B (Hib). b) Diphtheria, tetanus, and acellular pertussis (DTaP). c) Hepatitis B (Hep B). d) Measles, mumps, and rubella (MMR).

Measles, mumps, and rubella (MMR).

Which is the main cause of anemia in a client with active uterine leiomyoma? a) Hemolysis b) Menorrhagia c) Pressure of the fibroid on the pelvic veins d) Poor intake of foods containing iron

Menorrhagia Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone? a) Birth control pills can be used to terminate the pregnancy. b) Clomiphene (Clomid) is used only in early pregnancy to terminate a pregnancy nonsurgically. c) Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. d) Methotrexate is used only in early pregnancy to terminate a pregnancy nonsurgically.

Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Mifepristone (Mifeprex), formerly known as RU-486, is a medication used only in early pregnancy (up to 49 days from the last menstrual period) to induce abortion. It works by blocking progesterone.

A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which emotional response is typical during early adolescence? a) Moodiness b) Combativeness c) Cooperativeness d) Frequent anger

Moodiness

The mother of a newborn is voicing concerns about her baby's ability to hear. The nurse should tell the mother: a) She can test the baby's hearing by clapping her hands 24 inches (60 cm) from the infant's head. b) Most American states and Canadian jurisdictions mandate hearing tests for infants. c) Her concern is unfounded because hearing problems are rare in newborns. d) Newborns cannot hear well until they are at least 6 weeks old.

Most American states and Canadian jurisdictions mandate hearing tests for infants

A nurse is giving discharge instructions to a parent of a 13-month-old infant who weighs 18 lb (8.2 kg). Which statement by the parent demonstrates understanding of car-seat safety? a) "If I have a sports utility vehicle, my infant may ride in a rear-facing or front-facing car seat." b) "My infant may ride in a front-facing car seat as soon as he weighs 21 pounds." c) "My child will need to ride in a rear-facing care seat until he's 3 years old." d) "My infant may ride in a front-facing car seat because he's 1 year old."

My infant may ride in a front-facing car seat as soon as he weighs 21 pounds."

While a 31-year-old multigravida at 39 weeks' gestation in active labor is being admitted, her amniotic membranes rupture spontaneously. The client's cervix is 5 cm dilated and the presenting part is at 0 station. Which of the following should the nurse do first? a) Prepare the client for imminent birth. b) Note the color, amount, and odor of the amniotic fluid. c) Auscultate the client's blood pressure. d) Perform a vaginal examination to determine dilation.

Note the color, amount, and odor of the amniotic fluid.

A parent of a toddler brings the child to the emergency room because the child has accidentally been scalded by hot water spilling from the stove. In order to differentiate the burn from potential abuse, the nurse first should assess the child: a) For a circular or glove pattern. b) On the front of the body. c) On the back of the body. d) On the buttocks

On the front of the body.

The nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which of the following would be least appropriate for the nurse to include? a) Performing douching with a dilute vinegar solution twice a day b) Maintaining a reclining position for 30 minutes after inserting vaginal medication c) Refraining from unprotected sexual intercourse with partners d) Wearing cotton underwear that is loose-fitting and allows for air flow

Performing douching with a dilute vinegar solution twice a day Research has shown that douching provides no benefit in the prevention or care of vulvovaginal infections. Douching usually is unnecessary because daily baths or showers and proper hygiene after voiding and defecation keep the perineal area clean. In addition, douching tends to eliminate normal flora, reducing the body's ability to ward off infection. Repeated douching may result in vaginal epithelial breakdown and chemical irritation. The client should recline for approximately 30 minutes after inserting any vaginal medication to prevent the medication from escaping from the vagina. Loose-fitting cotton underwear is advised rather than tight-fitting synthetic, nonabsorbent, heat-retaining underwear. Unprotected sexual intercourse is associated with risks and should be avoided.

Which of the following is the period of transition from normal periods to the complete cessation of menses for 1 year? a) Menstruation b) Menarche c) Menopause d) Perimenopause

Perimenopause Perimenopause is the period of transition from normal periods to the complete cessation of menses for 1 year. Menopause marks the end of a woman's reproductive capacity and generally occurs between 45 and 52 years of age. Menstruation is the cyclic shedding of the uterine lining that occurs when pregnancy has not been established. Menarche is the first menstrual cycle.

A nurse is providing care for a postpartum client. Which condition increases this client's risk for a postpartum hemorrhage? a) Placenta previa b) Uterine infection c) Hypertension d) Severe pain

Placenta previa

The absence of which of the following behaviors in an 18-month-old child would cause the nurse to be concerned? a) Copying a circle. b) Playing with pull toys. c) Building a tower of eight blocks. d) Playing tag with other children.

Playing with pull toys.

The nurse is caring for a 38-year-old primigravida in the third trimester of pregnancy. The nurse plans to assess the client for symptoms of: a) Pelvic inflammatory disease. b) Preeclampsia. c) Cardiac overload. d) Ruptured membranes

Preeclampsia

A client is diagnosed with hypertension. The client also reports skin discoloration, weight gain, and nausea. Which contraceptive preparations would the nurse practitioner recommend for this client? a) Biphasic b) Progestin-only c) Triphasic d) Monophasic

Progestin-only Progestin-only preparations are useful for women who have had estrogen-related side effects (e.g., headaches, hypertension, leg pain, chloasma or skin discoloration, weight gain, or nausea) on combination pills. Combined preparations can be monophasic, biphasic, and or triphasic. Monophasic preparations supply the same dose of estrogen and progestin for 21 days. Biphasic preparations and triphasic pills vary the amount of hormonal components during the cycle.

The nurse in the emergency department is caring for a 3-year-old child with a fractured humerus. The child is crying and screaming, "I hate you." Which of the following would be appropriate? a) Tell the parents they will need to wait out in the lobby. b) Reassure the parents that this a normal behavior under the circumstances. c) Ask the charge nurse to assign this client to another nurse. d) Ask the parents to discipline the child so that the physician can treat her.

Reassure the parents that this a normal behavior under the circumstances.

A nurse is obtaining health history from a young adult woman. Which of the following would alert the nurse to a possible problem? a) Age of 13 years at menarche b) Mucus-like vaginal discharge c) Menstrual cycle averaging 28 to 29 days d) Reports of dyspareunia

Reports of dyspareunia Dyspareunia, or pain with intercourse, is an abnormal finding associated with numerous potential problems. Onset of menarche is usually between 12 to 14 years but could be as early as age 10 or 11 years. The menstrual cycle typically averages 28 days but it can vary from 21 to 42 days. A mucus-like vaginal discharge is normal.

The nurse is preparing a client for a pelvic examination. Which of the following would be most appropriate to promote client comfort when the speculum is inserted? a) Tightening the set-screw of the thumb rest b) Applying a water-soluble lubricant to the speculum c) Running the speculum under warm tap water d) Inserting the speculum into the anterior portion of the introitus

Running the speculum under warm tap water A speculum can be warmed by placing it under running warm tap water. Lubricants are not used because they can interfere with cervical cytology. The set-screw of the thumb rest is tightened once the speculum is inserted and then slowly opened. The speculum should be inserted into the posterior portion of the introitus.

A preschool-age child refuses to take ordered medication. Which nursing strategy is most appropriate? a) Making the child feel ashamed for not cooperating b) Showing trust in the child's ability to cooperate even with an unpleasant procedure c) Explaining the medication's effects in detail to ensure cooperation d) Mixing the medication in milk so the child isn't aware that it's there

Showing trust in the child's ability to cooperate even with an unpleasant procedure

Which of the following changes are associated with normal aging? a) Collagen becomes elastic and strong. b) The dermis becomes highly vascular and assists in the regulation of body temperature. c) Subcutaneous fat and extracellular water decrease. d) The outer layer of skin is replaced with new cells every 3 days.

Subcutaneous fat and extracellular water decrease.

Which desired outcome demonstrates effective parent teaching about disciplining a toddler? a) The parents will call immediate attention to undesirable behavior. b) The parents will raise their voices when reprimanding the child. c) The parents will verbalize requests for behavior in negative terms. d) The parents will set flexible rules

The parents will call immediate attention to undesirable behavior.

A client is on complete bed rest. The nurse should assess the client for risk for developing which of the following complications? a) Fat embolus. b) Air embolus. c) Thrombophlebitis. d) Stress fractures.

Thrombophlebitis

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder? a) Candida b) Eschar c) Trichomonas d) Escherichia coli

Trichomonas A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curdlike, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? a) Nulliparity b) Use of corticosteroids c) Use of spermicidal jelly d) Menopause

Use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning? a) Vagina b) Labia majora c) Mon pubis d) Vulva

Vagina The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort? a) Water-based lubricant b) Petroleum jelly c) Ibuprofen d)Aspirin

Water-based lubricant For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.

lifestyle. Which of the following foods can the nurse safely recommend as part of the adolescent's diet? Select all that apply. a) Potatoes b) Pizza c) Corn d) Bagels e) Apples

a) Potatoes c) Corn e) Apples

An older female client reports pain during intercourse, disrupting the intimacy that she and her husband are accustomed to sharing. What might be the cause of her pain? a) lack of desire b) atrophy of Bartholin glands c) decreased sensitivity d) increased vascularity

atrophy of Bartholin glands The female genitalia change during the aging process. Changes include thinning of pubic hair; decrease in the size of the labia majora and minora; shortening and narrowing of the vagina; and atrophy of Bartholin's glands, which results in less lubrication.

nurse is teaching the parents of a 6-month-old infant about usual growth and development. Which statements about infant development are true? Select all that apply. a) Head lag is commonly noted in infants at age 6 months. b) Stranger anxiety usually peaks at 12 to 18 months. c) A 6-month-old infant has difficulty holding objects. d) A teething ring is appropriate for a 6-month-old infant. e) Lack of visual coordination usually resolves by age 6 months. f) A 6-month-old infant can usually roll from prone to supine and supine to prone positions

d) A teething ring is appropriate for a 6-month-old infant. e) Lack of visual coordination usually resolves by age 6 months. f) A 6-month-old infant can usually roll from prone to supine and supine to prone positions.

During physical examination of the male reproductive system, which method would best provide the nurse information about the prostate for size as well as evidence of tumor? a) Using a scrotal radiography b) Performing digital rectal examination c) Inspecting the size of the scrotum d) Using transillumination

digital rectal examination A digital rectal examination (DRE) is performed to assess the prostate for size as well as evidence of tumor.

A nurse is educating a client who is at risk for coronary artery disease (CAD). The nurse knows that the client needs more education when he states that the risk factors that can be controlled or modified include: a) inactivity, stress, gender, and smoking. b) gender, family history, and older age. c) obesity, inactivity, diet, and smoking. d) stress, family history, and obesity

gender, family history, and older age

A nurse is caring for a toddler who has just been immunized. When teaching the child's parents about potential adverse effects, the nurse should instruct the parents to immediately report: a) generalized urticaria. b) mild temperature elevation. c) pain at the injection site. d) local swelling at the injection site

generalized urticaria

A 10-month-old child with phenylketonuria (PKU) is being weaned from breast-feeding. When teaching the parents about the proper diet for their child, the nurse should stress the importance of restricting meats and dairy products because: a) they contain high levels of phenylalanine. b) they are not well tolerated in children with PKU until after age 2. c) they contain high levels of phenylketones, which inhibit muscle growth. d) they are difficult for clients with PKU to digest.

they contain high levels of phenylalanine.

A nurse is advising a client who has just had her first menses on how to use a tampon. Instructions include using the least absorbent tampon and changing tampons frequently, at least every 4 to 6 hours. Which condition is the nurse most likely trying to prevent? a) cervicitis b) pelvic inflammatory disease c) vaginitis d) toxic shock syndrome

toxic shock syndrome TSS is a type of septic shock that is a life-threatening systemic reaction to the toxin produced by several kinds of bacteria. TSS is associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer than necessary.

A group has asked the nurse to discuss how lifestyle factors affect heart health. Which of the following statements by members of the group would indicate that the teaching was effective? Select all that apply. a) "Gradually increasing my exercise levels will help enhance circulation through the heart." b) "As a borderline diabetic, if I lose weight and lessen my intake of simple carbohydrates, this should benefit my heart." c) "Walking is excellent exercise to strengthen my heart." d) "If I change my diet and lessen my intake of saturated fats and trans fatty acids, this may decrease my cholesterol levels." e) "Chewing tobacco rather than smoking it lessens the negative effect on the heart."

• "Gradually increasing my exercise levels will help enhance circulation through the heart." • "As a borderline diabetic, if I lose weight and lessen my intake of simple carbohydrates, this should benefit my heart." • "Walking is excellent exercise to strengthen my heart." • "If I change my diet and lessen my intake of saturated fats and trans fatty acids, this may decrease my cholesterol levels."

The nurse is assessing a pregnant client using Leopold's maneuvers. Which of the following nursing actions are appropriate for this assessment? Select all that apply. a) Palpate the client's upper abdomen using both hands b) Note the shape and consistency of the palpated part c) Have the client refrain from voiding for 2 hours prior to the exam d) Position the client on her side e) The palpated part should be noted for mobility

• Palpate the client's upper abdomen using both hands • Note the shape and consistency of the palpated part • The palpated part should be noted for mobility

Values are known to affect a person's functional health. Which of the following values may be related to the perception of health? Select all that apply. a) Responsibility. b) Intuition. c) Language. d) Cooperation. e) Discipline.

• Responsibility. • Discipline. • Cooperation.