Maternal child exam 1

26. A female patient from a refugee community is in the emergency department and needs urgent surgery. The patient defers making a choice on the operation, preferring to wait for a cultural elder to arrive. What action by the nurse is most appropriate? A. Encourage the patient's family to talk her into having the operation. B. Explain kindly to the patient that her situation cannot wait. C. Respect the patient's choice and wait for the elder to arrive. D. Take the patient to surgery under the principle of implied consent.

ANS: C This is a difficult situation, but because the patient's wishes are known, the nurse has no choice other than to wait. In the emergency department, sometimes surgery is performed under the principle of implied consent (for instance, on an unconscious patient with no known family), but in this case, the patient has been clear as to her wishes, so doing that would be an ethics violation. The nurse must be careful to not be coercive. The nurse (and physician) would ensure that the patient understands the risks of waiting.

37. A postpartum woman being dismissed complains to the nurse that she has extreme fatigue, shoulder pain, and has noticed what looks like blood in her urine. Which laboratory finding would the nurse correlate with these symptoms? A. Arterial blood pH: 7.35 B. Blood glucose: 100 mg/dL C. Platelet count: 98,000/mm3 D. White blood cell count: 9,000/mm3

ANS: C This woman has symptoms of possible HELLP syndrome, which is characterized by poor liver function and thrombocytopenia. The platelet count is very low, consistent with this condition. The other laboratory values are within normal limits.

18. A nurse is teaching a woman pregnant in the second trimester who has been diagnosed with a partial placenta previa. Which information is most important to document? A. Patient and partner show no anxiety or helplessness and were given educational support material. B. Patient instructed that bleeding may occur as placenta totally covers the cervical os. C. Patient instructed to tell all health-care providers that vaginal exams are prohibited. D. Patient received information about placenta previa and understood it well.

ANS: C If the patient needs care from another health-care provider, she must tell him or her that due to her placenta previa, all vaginal exams are prohibited. This is an important safety measure that must be taught and clearly documented. Assessing (and documenting) the psychosocial status of the patient and partner are important too, but safety takes priority. A partial placental previa only partly covers the cervical os. The statement that the patient received information and understood it well is vague and does not constitute an example of acceptable charting.

5. A mother brings her 8-year-old daughter to the clinic for the third time in 2 months. The mother states that her daughter is very active and often falls down. The mother states that her daughter eats well, but the child's weight falls below the 10th percentile. The clinic record shows the child had multiple bruises on her arms at the time of the last two visits. Today the nurse notes that the child has areas of ecchymosis on her left leg and ankle. Which action by the nurse is best? A. Ask the child and her mother again about the child's bruises. B. Question the child about her accident-prone behaviors. C. Speak with the child alone, asking if she feels safe at home. D. Teach the mother to keep a diary of what her child is eating.

ANS: C This child's presentation is suspicious. If child abuse is suspected, the nurse should question the child privately. In all situations the nurse is legally obligated to report the abuse to the proper investigating agency.

11. The nurse finds a woman who has recently suffered her third complete abortion crying and saying "Why me? What did I do to deserve being punished like this?" Which response by the nurse is best? A. Ask the woman if she uses illicit drugs or drinks alcohol during pregnancy. B. Explain that most miscarriages are related to genetic abnormalities. C. Offer to call a clergy member or social worker to visit with the woman. D. Reassure the woman that she is not being punished.

ANS: C Women (and their partners) frequently need support with any perinatal loss. The best option here would be for the nurse to offer to call a clergy member or social worker to visit and offer assistance. Asking if the woman uses illicit drugs or drinks alcohol sounds as if the nurse is trying to blame the woman for the miscarriages. Simply explaining that most spontaneous abortions involve a fetus with chromosomal abnormalities does nothing to address the woman's feelings, although it should be part of a comprehensive plan of action. Simply reassuring the woman that she is not being punished sounds paternalistic.

A woman comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. She is very concerned about her changing body shape. What disorder does the nurse suspect? A. Anemia B. Anorexia nervosa C. Gestational diabetes D. Gestational hypertension

B. Anorexia nervosa Anorexia nervosa is characterized by a distorted body image and an intense fear of becoming obese. Patients with anorexia nervosa lose weight either by excessive dieting or by purging themselves of calories they have ingested. Because this woman has gained very little weight and has concerns about her body shape, the nurse should suspect anorexia and assess the patient further. Anemia, gestational diabetes, and gestational hypertension do not manifest with these symptoms.

A nurse is assessing a woman pregnant with her third child. She has a history of pregnancy-related varicosities. Which action by the nurse takes priority? A. Advising the woman not to cross her legs while pregnant B. Assessing the woman's pedal pulses and circulation C. Having the woman rate her leg pain on a 1-to-10 scale D. Teaching the woman to wear knee-high stockings

B. Assessing the woman's pedal pulses and circulation Assessment is the first step of the nursing process, and issues related to airway, breathing, and circulation are priorities for all patients. The nurse should first assess the patient's circulation, including pedal pulses, warmth, skin color, and capillary refill. After a circulatory assessment is complete, the nurse should assess pain. After a thorough assessment, the nurse can plan teaching. Self-care measures include not crossing the legs, not wearing constrictive clothing such as knee-high stockings, and elevating the legs at least twice a day.

A patient in the prenatal clinic had a negative rubella titer. Which action by the nurse is most appropriate? A. Have the laboratory draw rubella titers as a double-check. B. Instruct the woman to avoid anyone who may have the disease. C. Prepare to administer a rubella vaccination to the woman. D. Reassure the woman that rubella has few fetal consequences.

B. Instruct the woman to avoid anyone who may have the disease Rubella (German measles) can cause fetal abnormalities if the pregnant woman contracts it during the first trimester, so all pregnant women are screened for immunity. A positive test means the woman is immune to the disease, whereas a negative test indicates susceptibility to it. The woman needs to avoid people who may be ill with rubella and be immunized after her delivery. There is no need for a double check of the results.

A nurse is describing various childbirth options to an expectant couple. The woman states "I want to do Lamaze because I hear you will have no pain with this method." Which response by the nurse is best? A. "If done right, you will have no childbirth pain." B. "Lamaze empowers you to cope with the pain." C. "No, Lamaze emphasizes epidural pain control." D. "Pain is a natural and normal part of childbirth."

B. Lamaze empowers you to cope with the pain Although Lamaze does teach that pain is a natural and normal part of childbirth, it also empowers the woman with strategies to cope with the pain in positive ways that facilitate the labor and birth process. It does not promise a pain-free childbirth and decisions about medications are left to the woman who has been educated about their effect on childbirth. Stating simply that pain is a normal part of childbirth without elaborating on how it is managed will not alleviate the patient's concern.

After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best? A. "As long as you get enough fluid, soda is all right to drink." B. "Less than two cups of caffeine a day is probably OK." C. "The major worry with soda is the sugar content." D. "You really should switch to decaffeinated colas."

B. Less than two cups of caffeine a day is probably OK The primary sources of caffeine for pregnant women are coffee, tea, and soda. Research shows that small amounts of caffeine (less than 2 cups a day) are probably safe; however, higher amounts cause central nervous system stimulation and can increase the chance of spontaneous abortions, stress the fetus's metabolic system, and decrease blood flow to the placenta. Women should be encouraged to restrict their intake of caffeinated beverages and taught that even decaffeinated beverages still contain some caffeine.

A nurse is reviewing the care plan for a woman in the third trimester of her first pregnancy. Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood? A. Attended three prenatal classes with her partner to learn about labor B. Continues to exercise, maintains a healthy diet, quit smoking recently C. Educated about pregnancy, fetal growth and development, and motherhood D. Has prepared a well-stocked nursery complete with stimulating toys

C. Educated about pregnancy, fetal growth and development, and motherhood Attending prenatal classes, maintaining a healthy lifestyle, and having a prepared space for the baby are all tasks that indicate some degree of positive adaptation to a pregnancy. However, the best indicator of positive adaptation is when the woman can be described as well educated on pregnancy, growth and development of the fetus, and motherhood. This is much more inclusive than the other individual tasks

A woman who is 26 weeks pregnant has a blood pressure of 158/100 mm Hg. Which action by the nurse is most appropriate? A. Assess the woman's risk for other cardiovascular problems. B. Have her rest for 20 minutes, then reassess her blood pressure. C. Obtain a urine dipstick for proteinuria and assess for headache. D. Prepare to teach the woman about anti-hypertensive medication.

C. Obtain a urine dipstick for proteinuria and assess for a headache Preeclampsia is defined as a blood pressure greater than 140/90 mm Hg after 20 weeks' gestation accompanied by proteinuria. Other signs and symptoms include headache, visual changes, and edema. The nurse should suspect this condition and confirm it with a urine test for protein and by asking about the other symptoms. Assessing for other cardiovascular risk problems and teaching about anti-hypertensive medications are not warranted in this situation.

A pregnant woman is being discharged from the hospital after an episode of preterm labor that has resolved. She asks the nurse if she can now return to her low-impact aerobics class. Which response by the nurse is best? A. "As long as it's low impact, it should be OK to return." B. "Make sure you can talk while you are exercising." C. "Preterm labor is a contraindication for aerobic exercise." D. "Wait 72 hours; if you don't have more contractions, it's OK."

C. Preterm labor is a contraindication for aerobic exercise Premature labor, along with several other conditions, is an absolute contraindication to aerobic exercise during pregnancy. Although being able to talk while exercising is an important safety tip, this woman should not be engaging in any aerobics for the duration of this pregnancy.

The perinatal nurse recommends muscle-strengthening exercises to a woman who is pregnant for the first time. The woman states that she does not want to be "muscle-bound and masculine." What response by the nurse is best? A. "As long as you use lighter weights, you won't get muscle-bound." B. "OK, what do you think about swimming for exercise then?" C. "Strengthening muscles will decrease risks of ligament and joint injury." D. "Stronger muscles will make the labor process much easier on you."

C. Strengthening muscles will decrease risks of ligament and joint injury Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle-strengthening exercises also help to decrease the risk of ligament and joint injury. The other options do not explain this information, making it much less likely she will participate in these exercises.

A patient on the postpartum floor of the hospital has a body mass index (BMI) of 38 and just gave birth to a healthy baby girl by Cesarean section. Which action by the nurse takes highest priority? A. Administering pain medication promptly when requested B. Assisting the woman to begin breastfeeding the infant C. Educating the woman about healthy weight loss D. Monitoring the incision site and using strict hand-washing technique

D. Monitoring the incision site and using strict hand washing technique All of these interventions are appropriate for this patient. However, patient safety is the priority. Women with Level 2 obesity (BMI 35-39.9) are at higher risk of wound infection and breakdown. The nurse should place a priority on hand hygiene and close monitoring of the incision.

The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following? A. Blood, uterine, and breast tissue B. Fetal tissue C. Maternal reserves D. Placental fluid

D. Placental fluid During early pregnancy, maternal weight gain is related to an increased blood volume, which is necessary to supply the enlarging uterus and to support fetal growth and development. As the pregnancy progresses, enlargement of the placenta and fetal body add to the woman's increase in weight. By term, maternal extracellular fluid, blood, uterine tissue, and breast tissue comprise 35% of the gestational weight gain; the maternal reserves comprise 27%; fetal tissue comprises 27%; and placental fluid comprises 11% of the total maternal weight gain (Cunningham et al., 2010).

The perinatal nurse notes that a patient has the diagnosis of ptyalism. What topic should the nurse include in the patient's teaching plan? A. The benefits of acupuncture B. The need to eat more red meat C. The importance of strict vulvar hygiene D. The suggestion to suck on hard candy

D. The suggestion to suck on hard candy Ptyalism is an excessive production of saliva. Possible helpful strategies include sucking on hard candy, brushing the teeth often, drinking plenty of water in small sips, and consuming small frequent meals with fewer starchy foods. Acupuncture can help with nausea and vomiting, vulvar hygiene would be recommended for leukorrhea, and eating more red meat may help with dietary insufficiencies.

A woman in her second trimester wants to continue her weight-lifting and exercise plan. Which exercise would the nurse advise against participating in? A. Calf stretches B. Weight lifting C. Pelvic tilts D. Walking lunges

D. Walking lunges Lunges may injure connective tissue in the pelvic area and should be avoided. The other exercises are acceptable, but the woman should be cautioned to use resistance bands instead of free weights.

A woman is in the first trimester of her first pregnancy and confides to the nurse that she is not really sure if she is happy because so many things in her life will change. She is not sure she is willing to alter her current lifestyle. What action by the nurse is most appropriate?

Reassure the woman that ambivalence is normal now.

A nurse is assessing fetal heart tones and gets a reading of 82 bpm. Which action by the nurse is best?

Take the woman's pulse for comparison

A nurse notes that a pregnant woman's chart states that she is having trouble binding in. Which action by the nurse is best?

Talk to the mother about how she conceptualizes the child

The nurse assesses a pregnant patient during the first prenatal visit. Which question by the nurse is the best example of therapeutic communication?

"To begin, what questions may I answer?"

A woman who might be pregnant is excited to learn when she will know the gender of the baby. What is the best response by the nurse?

12 weeks

A nurse is assessing a woman who is at 29 weeks of gestation. The nurse measures the woman's fundal height, which is 58.42 cm (23 inches). What does the nurse conclude about this information?

Fundal height is too small.

The nurse knows that in any volume of ejaculate, what percentage of sperm is motile?

40%

A nurse is using the RADAR model when working with women in the perinatal clinic. What actions does the nurse include when assessing patients with this model? (Select all that apply.)

-Assess the patient's safety. -Document findings in the chart. -Review options and referrals with the patient. -Routinely screen every patient.

A nurse is providing anticipatory guidance to a group of elementary school girls and their parents. What information is most accurate?

"Around age 10, girls will get interested in shaving their underarms."

A baby is born with several congenital anomalies. The parents are distraught and begin questioning each other about what they did wrong during the pregnancy. What response by the nurse is best?

"Chances are you did everything right; we may never know why this happened."

A male baby is born with undescended testes. After caring for the newborn, what question by the nurse is most important?

"How old is the house in which you live?"

A couple wishes to know the chances of passing on an X-linked dominant heritable disorder to their four sons. The father's family has the disorder. The sons appear healthy, but the couple wants to be prepared for possible future events related to the disease. What information does the nurse give them?

"None of your sons will be affected."

A mother brings her 9-year-old daughter to the family practice clinic. She is worried because the daughter already has definite breast buds and is asking to wear a bra. What response by the nurse is best?

"The average age for breast budding is 9.8 years, so she is normal."

A pregnant woman is confused about the terms "embryo" and "fetus." How does the nurse explain the difference?

"The baby is an embryo until 8 weeks' gestation; then it is called a fetus."

The nursing instructor is explaining the function of the placenta in hormone production. Which hormones does the instructor include in this discussion? (Select all that apply.)

-Estrogens -Human chorionic gonadotropin -Human placental lactogen -Progesterone

A woman asks the nurse about taking chasteberry tree supplements. What response by the nurse is best?

"There are no scientific data supporting the use of this supplement."

A nurse has taught a pregnant woman about good nutrition during pregnancy at her first prenatal visit. What statement by the patient indicates that more teaching is needed?

"We eat salmon once a week at least."

The nurse explaining fetal growth and development to a class of expectant parents describes events that occur during weeks 9 to 12 as which of the following? (Select all that apply.)

-External genitalia are distinguishable. -Intestines become visible in the abdomen. -Ossification centers appear in the skeleton.

The perinatal nurse explains to a group of nursing students that there are positive signs of pregnancy. Which of the following does the nurse include in this explanation? (Select all that apply.)

-Fetal heartbeat -Fetal movement palpated by the examiner -Visualization of the fetus

The nursing instructor is explaining mechanisms of substance transport across the placenta. Which substances require facilitated diffusion? (Select all that apply.)

-Glocose -Oxygen

The clinic nurse obtains a history from women who wish to use a cervical cap as their method of contraception. The nurse assesses for relative or absolute contraindications to this contraceptive device, including which of the following? (Select all that apply.)

-Patient is a commercial sex worker. -Patient has history of an abnormal Pap test. -Patient has human papillomavirus infection. -Patient has silicone allergy.

A woman is 10 weeks pregnant with her third baby. She has two living children with normal delivery histories. Using the GTPAL system, the nurse would document this woman's obstetrical history as ____________________.

G3 T2 P0 A0 L2

The nurse is assessing a sexually active heterosexual woman who does not use birth control. The nurse explains that the chance of becoming pregnant with each act of unprotected intercourse is what percentage?

15-20%

The perinatal nurse understands that 4 days after fertilization, the morula now contains how many cells?

16

The prenatal clinic nurse is providing information to a pregnant woman who is at 15 weeks' gestation. The patient asks when she should expect to feel fetal movement. Which of the following is the most appropriate answer by the nurse?

17 to 20 weeks

The perinatal nurse explains to a new nurse that a female fetus has a developed ovary by

10 weeks

A nurse is providing preconception counseling. The nurse explains that that fetus is most vulnerable to the effects of teratogens during which time period

2 to 8 weeks

During preconception counseling, the nurse explains that the fetus is most vulnerable to the effects of teratogens during which time period?

2 to 8 weeks

After an abortion, when should the nurse advise the patient to return for a follow-up visit?

2 weeks

A couple wishes to determine the chances of having a blue-eyed baby. Both parents have brown eyes, but have heterozygous gene pairs for eye color. Calculate the odds of their having a child with blue eyes.

25%

During prenatal classes for expectant parents, the perinatal nurse explains that fetal brain development is most critical during which gestational weeks?

3 to 16

A nurse is explaining that a woman will undergo follicular monitoring to evaluate her response to ovulation induction. For what test does the nurse prepare her?

3-D ultrasound and color flow Doppler

A student reviewing the anatomy and physiology of the fetal circulatory system learns that the highest concentration of oxygen in fetal blood is measured at what level?

30-35 mm Hg

A woman who is 32 weeks pregnant has concluded a prenatal visit. The nurse should schedule the next prenatal visit for which gestational week?

34 weeks

The clinic nurse is counseling a woman who had a Nexplanon rod implanted. The nurse reminds her that she will need an appointment to replace this birth control method in what time frame?

36 months

A nurse is reviewing the prenatal care schedule for a woman who is 10 weeks pregnant. When does the nurse advise the woman to return for her next appointment?

4 weeks

The clinic nurse is counseling a low risk woman who is at 20 weeks gestation. The nurse advises the woman to schedule her next routine prenatal appointment for?

4 weeks

Trace a drop of blood through the fetal circulation using the structures provided. _____ Aorta_____ Ductus arteriosus_____ Ductus venosus_____ Foramen ovale_____ Head and extremities_____ Left ventricle_____ Right atrium_____ Superior vena cava

5, 8, 1, 3, 6, 4, 2, 7 Blood travels through the fetus in a unique pattern. Most blood enters the inferior vena cava through the ductus venosus, empties into the right atrium, and passes through the foramen ovale into the left atrium. It then travels to the left ventricle, into the aorta, and out into the rest of the systemic circulation. Blood returns to the heart from the head through the superior vena cava, goes through the right side of the heart before entering the pulmonary artery, or bypasses the lungs and enters the aorta through the ductus arteriosus.

A client nurse schedules a patient for her initial dose of Depo-Provera (medroxyprogesterone) within

5-7 days of menstruation

A woman in the clinic complains of severe hot flashes associated with perimenopause. Her past medical history includes deep vein thrombosis (DVT) 10 years ago. The nurse can anticipate teaching the woman about what treatment?

A trial of a selective serotonin reuptake inhibitor

For which diseases does the prenatal nurse recommend a newly pregnant woman be screened? (Select all that apply.) A. Chlamydia B. Hepatitis A C. Mumps D. Rubella E. Varicella

A. Chlamydia D. Rubella E. Varicella Pregnant women should be screened for sexually transmitted infections, hepatitis B, HIV, rubella, and varicella. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella.

A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best? A. "It is the best time to find any conditions that could have a negative effect on a pregnancy." B. "It's a good time to educate women about birth control options before they need them." C. "Reproductive care is an important part of any woman's health care." D. "The Centers for Disease Control mandates that all women get preconception care."

A. It is the best tie to find any conditions that could have a negative effect on a pregnancy Preconception counseling is an ideal time to identify conditions (physical, psychosocial, environmental, or social) that could lead to a future negative pregnancy outcome. The patient can be educated about the risks and assist in developing a plan to mitigate or avoid them. Providing birth control options can be an important part of preconception care, but this answer is too limited to be the best choice. Stating that reproductive care is important is vague. A goal of Healthy People 2020 is to increase the number of women getting preconception and prenatal care.

A woman is in her fourth month of pregnancy and is in the clinic for a scheduled visit. She confides to the nurse that her husband seems detached and is no longer interested in hearing about the pregnancy. Which action by the nurse is best?

Explain that paternal reactions vary widely.

A pregnant woman calls the OB clinic nurse to complain of sharp abdominal pain with coughing or sneezing. What action by the nurse is best?

Explain that the pain is from stretching of the ligaments.

A woman in the infertility clinic is concerned that her religion may object to assisted reproductive technologies. Which process should the nurse explore with the woman as possibly acceptable?

GIFT (gamete intrafallopian transfer)

41. A 65-year-old patient is in the clinic for an annual influenza vaccination. What other health promotion activity should the nurse encourage specifically for this patient? A. Heart-healthy eating B. Participating in social activities C. Pneumococcal vaccination D. Regular exercise

ANS: C All options are important for the older adult, but around the age of 65, the older adult should receive the pneumococcal vaccine. The nurse planning individualized care for the patient would encourage the patient to get this vaccination.

The nursing faculty member explains to a class that embryonic stem cells have a special feature. Which feature is the instructor describing?

Ability to develop into any type of human cell

The reproductive health nurse counsels a 17-year-old woman who is interested in initiating contraception. Which of the following would be a short-term positive outcome of the visit?

Able to describe how to obtain and use the contraceptive chosen

The nursing instructor explains to the students that external female genitalia develop under what influence?

Absence of androgens

A woman is in her second trimester of pregnancy. Which behaviors by the woman's family or friends would best indicate to the nurse that they are accepting the unborn child?

An older sibling is talking about "my baby brother or sister."

A nursing faculty member is explaining the process of fertilization to a class of students. One student asks the instructor to clarify the term "secondary oocyte." What description is best?

An oocyte in which the first meiotic division has occurred

A woman is in the family planning clinic to learn about her cycle and the best times to get pregnant. What information should the nurse plan to teach her?

An ovum can be fertilized for 12 to 24 hours after ovulation.

A nurse is assessing a patient for Chadwick's sign. In order to do this correctly, what action does the nurse take?

Assesses the color of the patient's vaginal mucosa and cervix.

A woman is tracking her basal body temperature and is having inconsistent results. When assessing the patient, the nurse discovers that the patient has seasonal allergies. The nurse needs to assess for what further information?

Any over-the-counter allergy medications taken

A clinic nurse is working with a woman who has been diagnosed with "sexual dysfunction." What does this nurse understand as the best explanation of this diagnosis?

Any sexual situation that causes personal distress for the woman

A woman asks the perinatal nurse about gestational diabetes because she has been reading about it. The nurse should inform the patient that screening for this condition is usually done at what time during the pregnancy?

Around 24 to 28 weeks' gestation

A newborn nursery nurse notes that a neonate has hyperirritability and some difficulty breathing. Which response by the nurse is most appropriate?

Ask the mother about opioid use during pregnancy

A woman is having hysterosalpingography and begins complaining of severe left shoulder pain. What action by the nurse is best?

Ask the patient if she took a nonsteroidal anti-inflammatory drug (NSAID) prior to the procedure.

A nurse works with pregnant adolescents during pregnancy and for the first 2 years afterward. Which teen demonstrates the most successful resolution of the conflict between normal growth and development tasks and tasks associated with being a new mother?

Attends alternative school with an on-site day care

A woman is being started on oral contraceptive pills. Which screening assessments should the nurse perform or assist with?

Blood pressure

A nurse is interviewing a woman who is in her second trimester. The woman asks the nurse if blue cohosh is safe and useful to take during pregnancy. Which response by the nurse is best?

Blue cohosh causes fetal anoxia and should not be used

A newborn nursery nurse is arranging genetic screening for several newborns. The nurse should educate the parents of which baby about screening for Tay-Sachs disease?

Jewish baby

An instructor is explaining to students in the OB rotation that Goodell's sign is which of the following?

Cervical softening

A woman is being treated for infrequent ovulation. The nurse should educate her about what medication?

Clomiphene citrate (Clomid)

A patient and her partner are in the clinic to learn about contraception options. They are especially interested in Natural Family Planning. Which of the following would be the most important for the nurse to assess?

Commitment to the method

The nurse explains that the childbearing year is an ideal time to make healthy changes for the entire family. Which action does the nurse suggest?

Creating healthy menus for family meals

A nurse manager on the high-risk OB unit wants to improve the experience of women admitted for lengthy stays. What action by the manager is best?

Develop a program to help women attain developmental tasks.

The nurse teaches a class that which of the following is the first gender change to occur in the embryo?

Development of dominance in the primitive duct structure

A woman who is 28 weeks pregnant calls the clinic to complain of painless, irregular contractions. The clinic nurse informs her that this is related to circulating levels of which hormone?

Estrogen

A student asks the faculty member to explain the term "nidation." Which explanation is best?

Implantation of the fertilized ovum

A woman is starting on birth control, but tells the nurse she wants to become pregnant next year. What action by the nurse is most important?

Educate the woman about the need for folic acid supplementation before conceiving.

An adolescent in the pediatric clinic states that her vaginal secretions sometimes seem more thin, watery, and stretchable than usual. What response from the nurse is best?

Educated the patient that she is fertile when this occurs

The nurse caring for perinatal patients understands the term decidua to mean which of the following?

Endometrial lining of the uterus

During the initial visit with a couple in the infertility clinic, what action by the nurse is best to promote a trusting relationship?

Explain the process of a workup and its sensitive nature.

A father accompanies his partner to her OB clinic visit. The woman is near term. The father confides to the nurse that the patient is cranky, irritable, and yells at him for no reason. Which action by the nurse is best?

Explain why the woman needs emotional support.

A nurse reads in a patient's chart that the patient has a condition caused by monosomy X. What can the nurse conclude about this patient?

Female with one missing X chromosome

A nursing student asks the faculty member to define "lanugo." Which description is best?

Fine, downy hair on the fetus

A nurse is teaching a patient how to track her menstrual cycle. What day does the nurse tell the patient to label as day 1?

First day of the menstrual cycle

The nurse places his or her hands on the maternal abdomen to gently palpate the fundal region of the uterus. This action is described as which Leopold maneuver?

First maneuver

The pediatric nurse explains to the student that production of testosterone by the male embryo causes what to occur?

Formation of the male genital tract

A nurse reads on a woman's chart that she has a past history of Asherman syndrome. What does the nurse conclude about this patient?

Has had an abortion

A nurse is reviewing a 36-year-old woman's chart. The woman has the diagnosis of infertility. What does the nurse conclude about this woman?

Has not conceived in 6 months of actively trying

A pediatric nurse is reviewing the chart of a new school-age patient. The chart notes the child is on a phenylalanine-free diet. What does the nurse conclude about this patient?

Has phenylketonuria (PKU)

A pregnant teen is in the clinic for a prenatal visit. The nurse needs to obtain informed consent. What action by the nurse is best?

Have the teen sign the consent and then place it on the chart.

A nurse is conducting a history on a new obstetric patient. The mother works in an animal shelter. Which instruction by the nurse is most appropriate?

Haver someone else clean the litter boxes

The prenatal nurse believes in advocating for the patient. What action by the nurse best reflects this role?

Helping the woman formulate and vocalize questions

The clinic nurse explains to a student that the hormone responsible for limiting the maternal immune response to pregnancy is which of the following?

Human chorionic gonadotropin

The experienced perinatal nurse explains hormone function to a new graduate. Which hormone does the nurse describe as being responsible for regulating glucose availability for the fetus?

Human placental lactogen

The nurse working in reproductive health care is aware that which of the following was a goal of the Human Genome Project?

Identity exact human DNA sequences and genes

According to Rubin (1975), completion of what task is paramount for a pregnant woman to master in order to have successful integration of the maternal role?

Incorporating the pregnancy into her total identity

The nurse is explaining to a student that a pregnant woman needs to complete a process called "binding in." Which is the best explanation of this phenomenon?

Incorporating the pregnancy into the woman's reality

A nurse is assessing a patient in the women's clinic for Chadwick's sign. How does the nurse perform this assessment?

Inspects the vulva and vagina for a bluish tint

A prenatal nurse manager wants to help pregnant women in the clinic decrease their stress. Which action by the manager would be best?

Institute primary nursing care for all patients

A woman complains that she feels dizzy and sweaty when she has been lying down for a few minutes. Which action by the nurse is best?

Instruct her to lie on her left side

A nurse is working with a woman in her second trimester and her partner. The partner comes to clinic appointments but spends his time texting on his cell phone in the waiting room. The woman states that this behavior makes her sad. Which action by the nurse is best?

Invite the father into the exam room to listen to the baby's heartbeat.

A nurse is working with a young woman planning to become sexually active. She has the nursing diagnosis of knowledge deficit related to contraceptive choices. Which action by the patient would indicate that a priority goal has been met?

Is able to choose the "best fit" from contraceptive choices

Which part of a woman's anatomy is used as the assessment landmark for the fetal presenting part?

Ischial spines

The perinatal nurse reads the diagnosis of ptyalism in a patient's chart. What teaching does the nurse plan for this patient?

Lozenges and chewing gum can help.

A pregnant woman's last normal menstrual period started on June 8, 2013. Calculate her expected date of birth (EDB) using Naegle's rule. Her EDB is what date?

March 15, 2013

A student nurse is giving a patient an intramuscular Depo-Provera injection. Which action by the student would cause the instructor to intervene?

Massages the site when the patient complains of pain

A woman with hypertension is experiencing infertility. After reviewing her medication list, which medication does the nurse advise the woman to discuss with her primary care provider?

Methyldopa (Aldomet)

A woman is being treated for infertility. The physician has prescribed a medication to stimulate follicle development. Which medication should the nurse begin teaching the patient about?

Mifepristone (Mifeprex)

A nursing instructor is explaining genetic concepts to a class of students. Where in the cell does the instructor tell the students that each person's genes can be found?

Nucleus

A pregnant woman has a midpelvis pelvimetry measurement of 3.8 inches (9.65 cm). What action by the labor and delivery nurse is most important?

Obtain consent for possible cesarean delivery.

A newborn has rachischisis. What action by the nurse takes priority?

Obtain informed consent for immediate surgery.

Prior to a sterilization procedure, which action by the nurse takes priority?

Obtaining the woman's informed consent

A nurse is interviewing a 22 year old primigravida. The patient's last menstrual period was december 25 and lasted 3 days (normal for her). The calculated estimated date of birth would be?

October 1

The nurse assessing a newborn's umbilical cord stump would document which finding as normal anatomy?

One vein, two arteries

The perinatal nurse is explaining blood transport through fetal circulation to the new nurse. How does the perinatal nurse describe the foramen ovale?

Opening in the heart's septum between the right and left atria

A woman has the diagnosis of "dyspareunia" on her chart. What does the nurse understand this term to mean?

Pain with intercourse

The nurse reads "positive Hegar's sign" in a patient's chart. What can the nurse conclude about the patient?

Patient may be pregnant

The perinatal nurse knows that the lowest portion of the true pelvis is which of the following anatomical landmarks ?

Pelvic outlet

The perinatal nurse understands that maternal antibodies pass through the placenta by which mechanism?

Pinocytosis

The clinic nurse knows that a probable sign of pregnancy is?

Piskacek's sign

A woman who is a Jehovah's Witness returns for a second prenatal visit and is discussing her plan of care with the nurse. The patient has returned a signed form in which she refuses all blood products. What action by the nurse is best?

Place the signed form on the patient's chart.

A woman is admitted with rubella. What action by the nurse manager is best?

Place the woman on droplet precautions.

According to Masters and Johnson's work on human sexual response phases, in which phase does a woman experience the highest sense of sexual tension?

Plateau phase

A patient in the emergency department has a positive serum hCG. What can the nurse surmise about this patient?

Pregnant

A nurse is teaching a woman who is in her first trimester of pregnancy about physical changes she can expect. Which information should the nurse provide?

Pregnant women are more susceptible to yeast infections.

A nurse is discussing contraceptive methods with a new patient. The patient is most interested in birth control pills. Which factor in her health history would be an absolute contraindication for using this method?

Previous pulmonary embolism

The perinatal nurse explains the function of Wharton's jelly to a class of expectant parents. What description is most accurate?

Protects the umbilical cord from compression

A woman in the first trimester of her first pregnancy is upset and worried about physical changes, the labor and birth process, and being able to care for a newborn. Which action by the nurse is best?

Provide information about childbirth preparation classes.

A nurse uses the CARE model when working with patients. How can this nurse use the model to help reduce racially related disparities in care for pregnant women?

Provide resources, authority, or opportunities.

A woman has been taking progesterone via intramuscular injection. She calls the clinic to complain of swollen ankles. What response by the nurse is best?

Reassure her that this is a common side effect.

A nurse is performing the third Leopold maneuver on a woman who is gravida 3, para 3 and is currently 37 weeks' gestation. The nurse's fingers can be pressed together below the presenting part, which is firm to the touch. What action should the nurse take regarding this assessment data?

Reassure the woman and document the findings.

A patient has had a screening test for gestational diabetes and the 1-hour result is 250 mg/dL. What does the nurse conclude about this patient?

Results are high; the patient has gestational diabetes.

A woman is in the clinic complaining of frequent constipation. During the assessment, the patient states that she has been trying to conceive for many months. Which of the following should the nurse ask this patient about using?

Senna (Senekot)

A nurse is assessing a patient who complains of an inability to achieve orgasm. The patient was recently started on several new medications. Which one would the nurse evaluate as possibly contributing to this problem?

Sertraline (Zoloft)

A nurse reads in a female patient's chart that she is Tanner stage V. What can the nurse conclude about this patient?

Sexually mature

The perinatal nurse reads in a chart that a woman has a lesion on her perineum. Where would the nurse assess this lesion?

Skin-covered region between the vagina and the anus

A nurse is teaching a prenatal class. What information about cigarette exposure should the nurse provide the woman?

Tobacco use can cause preterm labor and placental abruption

The nurse is teaching a group of women about hormonal emergency contraception. Which of the following is not a benefit of this type of contraception?

Typically has no side effects

What information should the nurse plan to teach a pregnant woman regarding safety in the third trimester?

Use handrails when using the stairs.

A nurse in an emergency pregnancy clinic is evaluating women for the IUD method of emergency contraception. Which woman would not be considered a good candidate for this method of emergency contraception?

Was raped by a stranger

A nurse is working with a young couple whose contraceptive choice is latex condoms. What statement by either partner indicates the need for more teaching?

Woman: "I buy nonoxynol-9 spermicide to use with condoms."

A healthy-appearing 68-year-old woman is in the clinic for a physical exam. Her laboratory work shows decreased levels of high-density lipoprotein (HDL) cholesterol and increased levels of low-density lipoprotein (LDL) cholesterol. What conclusion can the nurse make about this patient?

increased cardiovascular risk

A pregnant woman calls the clinic to complain of sharp, right-sided lower abdominal pain. Which question by the nurse would elicit the most relevant information?

"Do you have a fever, constipation, or any diarrhea?"

The nurse includes screening for intimate partner violence in the first prenatal visit for all patients. Which of the following is an appropriate question for the nurse to ask?

"We ask everyone this: Do you feel safe in your living environment and relationships?"

The clinic nurse uses the acronym "PAINS" when teaching a woman about warning signs associated with her intrauterine device (IUD). Warning signs include which of the following? (Select all that apply.)

-Fever and/or chills -Inability to feel the strings -Vaginal discharge

A nurse is working with women and issues of reproductive health practices to help meet the National Health Goals related to reproductive life planning. Which goals are included in this document? (Select all that apply.)

-Increase the proportion of young males who receive reproductive health care -Reduce the proportion of women with unplanned pregnancy despite contraception

The nurse is explaining to a student that several physiological factors cause a pregnant woman to be prone to venous thrombosis and embolic phenomena. What factors are included? (Select all that apply.)

-Increased blood factors -Venous stasis

The nursing instructor explains to a class of students that the pituitary gland has many functions related to pregnancy. Which of the following functions are performed by hormones secreted by this gland? (Select all that apply.)

-Influence ovarian follicular development -Maintain the pregnancy -Prompt ovulation -Stimulate the uterine lining

The student nurse in the perinatal clinic asks why it is so important to screen women for intimate partner violence during the first prenatal visit. What information does the registered nurse provide the student? (Select all that apply.)

-Intimate partner violence is more common than preeclampsia. -Many women may abuse substances to cope with the violence. -Partners abuse over 300,000 pregnant women each year.

During the first prenatal visit, a nurse teaches a pregnant woman about emergencies for which she needs to be seen immediately. Which situations does the nurse include in this education? (Select all that apply.)

-Low, dull backache or pelvic pressure -Maternal fever over 100.5°F (38.1°C) -Reduction in fetal movements

A couple is interested in fertility-awareness-based (FAB) family planning. The nurse should advise them about what drawbacks that accompany this method? (Select all that apply.)

-May interfere with sexual spontaneity -Requires months of charting cycles before use -Requires a lot of motivation and education

A clinic nurse explains to a pregnant woman that the amount of amniotic fluid present at 7 or 8 months' gestation is approximately what volume?

800 mL

1. The clinic nurse is taking a history from a woman who came to the clinic to get test results. The patient brought a coworker with her because she is worried. The patient asks to have her coworker remain in the exam room when the doctor describes the test findings. The patient states that the friend is "like a sister." The nurse would most correctly identify the two women as which of the following? A. Extended family B. Family C. Family of choice D. Family of origin

ANS: A A family consists of two or more members who self-identify as a "family" and interact and depend on one another socially, emotionally, and financially. Because the patient self-identifies the friend as "like a sister," the patient and friend consider themselves a family.

28. A nurse is volunteering for the local chapter of the cancer society and is planning breast cancer screening and educational activities in the community. In order to have the most impact on this disease, which women should the nurse target? A. African Americans B. Asian Americans C. Caucasian Americans D. Native Americans

ANS: A African American women are more likely to die from breast cancer because of late diagnosis, and in women under 45 in this group, breast cancer is more common. To have the greatest impact, the nurse should target this group of women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Caucasian women tend to develop breast cancer more frequently than African American women, but they die less often.

25. A family with a loud, disobedient child has been working with a nurse. Which action observed by the nurse indicates that goals for the diagnosis of impaired parenting have been met? A. The father delivers consequence to the child calmly. B. The father only asks the child twice not to do something. C. The mother doesn't cry when disciplining her child. D. The mother states that the child is still testing the limits.

ANS: A Consistency in setting and enforcing rules is critical. Consequences should be delivered immediately, without anger, and consistently. The father's disciplining the child without getting mad is demonstrating that goals have been (or are being) met. The other options do not show consistent, calm, immediate consequences.

42. A pregnant patient is admitted with possible deep venous thrombosis (DVT). Orders are left to start warfarin (Coumadin) 5 mg p.o., once daily. Which of the following actions by the nurse is most appropriate? A. Call the physician to clarify the order and document the conversation. B. Instruct the patient not to get out of bed without assistance. C. Start the warfarin as soon as it is available from the pharmacy. D. Teach the patient about the risks and benefits of anticoagulation.

ANS: A Coumadin is contraindicated in pregnant women because it crosses the placenta. If anticoagulation is needed, heparin is the drug of choice. The nurse should consult with the physician about the orders and carefully document the conversation and results. Teaching is an appropriate nursing activity but is not the priority. The patient on heparin should be counseled to call for assistance before getting up because of the risk for injury, but the priority is obtaining the correct drug. The nurse should not start the Coumadin.

23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication? A. 20-lb weight gain B. Cold intolerance C. Facial acne D. Facial hair growth

ANS: A Depo-Provera is used to treat endometriosis, but one undesirable side effect is weight gain. Danazol (Danocrine) is also used to treat this condition, but side effects of acne and facial hair growth cause this medication to be prescribed less often. Cold intolerance is not a common side effect of medications used to treat endometriosis.

14. A nurse who works with families uses Duvall's family developmental theory as the core of nursing practice. What action by this nurse takes priority? A. Assessing the developmental stage of the family B. Determining how the family interacts with society C. Observing what roles each family member assumes D. Tailoring teaching to the specific needs of the family

ANS: A Developmental theory has as its core the idea that every person moves through developmental stages with tasks that must be mastered before they can move on to the next stage. Family developmental theory assumes the same progression for families as a unit. Duvall's theory identifies eight family stages. The nurse using Duvall's family developmental theory must first assess the stage the family is in, because teaching and all other interventions must be tailored to that stage. Only tailoring the teaching to specific needs does not necessarily require assessment of the family using a developmental approach. Determining how the family interacts with society is more in line with systems theory. Observing roles is part of structural-functional theory.

7. A community health nurse explains to the nursing student that the best health-related programming includes which of the following elements? A. Has both individual and societal components B. Is directed toward individual responsibility C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective

ANS: A Intervention programs must be multi-tiered and oriented to the broader social context in which they occur, because that is where patients are located. Programs directed toward only individuals are less successful. Programs and interventions do not need to include legislation or incentives.

42. A nurse is educating a woman on the use of denosumab (Prolia). What information should the nurse provide? A. "Return in 6 months for another injection." B. "Take this medication on an empty stomach." C. "Take this medication with milk or food." D. "You may have increased night sweats."

ANS: A Prolia, a medication used for the treatment of osteoporosis, is given in subcutaneous injections every 6 months. Food intake is not related to administration. Increased night sweats and hot flashes can occur with raloxifene (Evista).

2. A nurse wishing to be an advocate for access to health care would most likely choose to participate in which of the following activities? A. Lobby for improved insurance access for all individuals, whether or not they are employed. B. Help establish fast-track or minor illness areas in local emergency rooms. C. Partner with medical centers to provide free services for low-income patients. D. Work with visiting nurses associations to create on-site clinics at day-care centers.

ANS: A The biggest determinant of access to and quality of health care is one's insurance status. The other actions might help improve access too, but would not be as effective as lobbying for improved ability for all individuals to get insurance.

39. A woman with a history of heart failure is in labor and has the following vital signs: blood pressure: 100/58 mm Hg, pulse: 120 beats/minute, respiratory rate: 36 breaths/minute, oxygen saturation: 88%. Which action should the nurse perform first? A. Administer oxygen at 10 L/min per rebreather mask. B. Call the health-care provider to report the results. C. Document the findings in the patient's chart. D. Increase the woman's IV infusion to 150 mL/hour.

ANS: A The patient is exhibiting signs of decreased cardiac output and her low SaO2 indicates that she needs oxygen, which should be supplied at 10 L/min per rebreather mask. Calling the provider and documentation are important actions but do not take priority over promptly treating the woman. She does not need increased IV fluids, and, in fact, increasing the IV fluid rate will likely worsen her condition.

36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness, heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman? A. Administration of leuprolide (Lupron) B. Hysterectomy and bilateral salpingo-oophorectomy C. None; issue will resolve spontaneously D. Surgical removal of the ovaries

ANS: A These are symptoms of a uterine leiomyoma (fibroid). The medical treatment includes nonsteroidal anti-inflammatory drugs, oral contraceptives, and Lupron. Ovarian cysts often resolve spontaneously. For ovarian cancer, a complete hysterectomy with bilateral salpingo-oopherectomy is the procedure of choice. Because some of these symptoms are also seen in ovarian cancer, the nurse should be sure to assess the patient further.

13. The perinatal nurse knows that tocolytic agents are most often used to do which of the following? (Select all that apply.) A. Allow for transport of the woman to a tertiary care facility B. Facilitate administration of antenatal corticosteroids C. Prevent development of fetal respiratory distress syndrome D. Prevent maternal infection E. Prolong pregnancy as long as possible

ANS: A, B Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of maternal antenatal corticosteroids to accelerate fetal lung maturity. In addition, delaying the preterm birth provides time for maternal transport to a facility that is equipped with a neonatal intensive care unit. Tocolytics themselves do not prevent the development of respiratory complications such as respiratory distress syndrome. Tocoytic agents do not prevent infection and are recommended for use only up to 48 hours.

1. The perinatal nurse is educating a group of women on common causes of miscarriage, or spontaneous abortion. Which of the following does the nurse describe? (Select all that apply.) A. Cervical anatomic defects B. Chromosomal abnormalities C. Maternal infections D. Recreational drug use E. Working during pregnancy

ANS: A, B, C, D Early spontaneous abortions have been linked to chromosomal abnormalities, infections, maternal anatomical defects, and immunological and endocrine factors. In some cases, no cause is found. Second-trimester spontaneous abortions can be caused by chronic infection, recreational drug use, maternal uterine or cervical anatomical defects, maternal systemic disease, exposure to fetotoxic agents, and trauma. In general, working during pregnancy is not a risk factor, although the nurse should assess the woman's work setting for environmental/work-related risks, such as fetotoxic agents or ionizing radiation.

8. A nurse is caring for a laboring woman from an unfamiliar culture who has limited English skills. Which nursing actions are important to provide nursing care to this patient? (Select all that apply.) A. Allow artifacts that have religious or cultural significance to remain with the woman. B. Assess the woman's beliefs about childbirth, breastfeeding, and postpartum nutrition. C. Communicate with the woman and family using a professional interpreter. D. Identify community resources that are culturally appropriate and acceptable. E. Restrict visitors to one person who can then communicate with the other family members.

ANS: A, B, C, D Working with patients from unfamiliar cultures can be challenging, especially if the patient has limited English skills. Ways to improve nursing care delivered to these patients includes using a professional interpreter, assessing relevant cultural beliefs, allowing items that hold special religious or cultural significance to remain with the woman, and finding community resources that are culturally acceptable and appropriate. Restricting visitors may cause resentment and suspicion.

2. The community health nurse knows that the public health intervention model is focused on which of the following intervention levels? (Select all that apply.) A. Community B. Family C. Government D. Hospitals E. Patient

ANS: A, B, E The public health intervention model is an inclusive framework that encompasses three levels at which interventions can be initiated, from the micro-level of the individual to the macro-level environment. Interventions are targeted toward individuals/families, communities, and larger institutional and societal systems. Government and hospitals are not one of the three levels.

10. A nurse is assessing a family whose patriarch died recently. Using Kübler-Ross's stages of grieving, what stages should the nurse assess for? (Select all that apply.) A. Bargaining B. Dealing C. Denial D. Remorse E. Shock

ANS: A, C Kübler-Ross's stages of grieving include denial, anger, bargaining, and acceptance. Dealing is one of Rodebaugh's stages. Remorse is one of Epperson's stages. Shock is one of Harvey's phases.

16. A family practice nurse is working with a patient who is asking for anti-anxiety medications to deal with the stress and frustration of an adult child who won't leave the home. Based on knowledge of the tasks of launching children, which resource should the nurse suggest first? A. Anger management counseling B. Contact numbers for vocational training C. Information on a parenting workshop D. Marriage and couples counseling

ANS: B An adult child who still lives at home is either using home base as a temporary arrangement while continuing education or as a "nonaction" until more permanent ties have been established elsewhere. With the parent's frustration and anxiety, this situation of incomplete launching needs to be addressed. The first suggestion should be about vocational assessment and training for the adult child. There is no indication the patient needs anger management, a parenting workshop, or marriage counseling.

27. The nurse prepares to offer health screening and promotion activities for women aged 40-60. Which activity does the nurse plan to include as a priority for this group? A. Alzheimer's disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations

ANS: B Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40-55. The priority screening activity is for breast cancer. Alzheimer's disease screening is typically done in the older patient. Gardasil is recommended for females aged 9-26. Influenza vaccinations are important for all ages.

5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much? A. 15% B. 25% C. 30% D. 35%

ANS: B Diet and nutrition are especially important for facilitating optimal growth and development during adolescence. Adequate nutritional intake is essential to accommodate the growth spurt that occurs during this time. Adolescents gain approximately 25% of their adult height and 50% of their adult weight throughout this time period.

11. A mother who has three older children now has a newborn. She complains to the physician that sleeping on his back has caused her baby to have "a funny-shaped head" that the other kids didn't have. She doesn't want to continue having the baby sleep on his back. Which action by the nurse is best? A. Document the comments and alert the physician to the concern. B. Encourage her to put the baby on his stomach during the day. C. Explain that babies need to sleep on their sides at all times. D. Tell her that back-sleeping isn't important after 5 months of age.

ANS: B The American Academy of Pediatrics recommends that all infants be placed on their backs when sleeping. This is probably new information the mother did not have for her older children. If the mother is concerned about plagiocephaly (misshapen head), she can be taught to place the baby on the stomach with a small rolled towel under the arms for support and comfort. Alternating positions in the crib and side-lying for short periods in the presence of an adult are also alternatives. Documentation should always occur, but is not the most important action. Telling the mother that babies need to sleep on their sides at all times is incorrect. Sleeping on the back is important for all infants.

3. A nurse working in the community uses the public health intervention model to combat diabetes mellitus type 2. Using this model, which interventions are appropriate? (Select all that apply.) A. Community: Encourage high-risk patients to have glucose screening. B. Community: Lobby for funds to build walking and biking trails. C. Community: Subsidize community gardens in areas where produce is expensive. D. Individual/family: Educate about the benefits of daily exercise. E. Societal: Pressure Congress for laws requiring insurance incentives for health promotion.

ANS: B, C, D, E The public health intervention model, also known as the Intervention Wheel, is a framework that contains three levels for health-care interventions, from the micro-level of the individual to the macro-level of the environment. Interventions are aimed at individuals/families, communities, and larger institutional and social systems. Lobbying to build walking/biking trails and assisting with community gardens are examples of community-level interventions. Encouraging high-risk individuals to have glucose screening is at the individual/family level, as is education about the benefits of daily exercise. An example of an institutional or societal intervention would be lobbying Congress to pass laws requiring insurance companies to provide incentives for health promotion activities.

12. Which childhood illnesses are the subject of a Healthy People initiative regarding vaccinations? (Select all that apply.) A. Asthma B. Measles C. Meningitis D. Mumps E. Pertussis

ANS: B, D, E One goal of the Healthy People initiative is to reduce vaccine-preventable illnesses such as measles, mumps, and rubella to zero cases and to reduce pertussis in children under 7 to no more than 2,000 cases/year. Asthma and meningitis are not included in this goal.

32. A nurse is reviewing the results of several patients' cholesterol and lipid screenings. For which patient is the action appropriate? A. HDL cholesterol 66 mg/dL: Evaluate patient for cardiovascular risk. B. LDL cholesterol 98 mg/dL: Instruct patient to take fish oil 3 gm daily. C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. D. Triglycerides 132 mg/dL: Refer to dietician for comprehensive diet education.

ANS: C A cholesterol below 200 mg/dL is desirable, so this patient's level is high. The nurse should plan to teach this patient about heart-healthy lifestyle changes. The other laboratory values are in the desirable range, so no action is necessary.

34. A nurse is working with a family with the diagnosis of impaired family processes. Although both parties worked, one person worked part time and had the main responsibility for the household. The other spouse retired recently and has not taken on more of this role. Both people are angry and resentful. What goal would be best for this couple? A. Adapt to role changes positively within 2 months. B. Divide up household duties between spouses more evenly. C. Express feelings using "I" statements within 1 month. D. Learn to discuss anger and other negative emotions.

ANS: C A good goal or outcome is specific, measurable, and has a time element. The goal that best meets that description is expressing feelings using "I" statements within 1 month. Adapting to role changes is vague and not measurable. Dividing duties more evenly is not measurable and has no time element. Learning to discuss negative emotions does not mean using what is learned, so it is not as specific as the correct answer.

34. A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin

ANS: C Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy.

4. The perinatal nurse is caring for a woman at 26 weeks' gestation who has a history of hypertension that has been well controlled. Today she presents with a blood pressure of 156/102 mm Hg and she has 2+ protein on urine dipstick. Which initial action by the nurse is most appropriate? A. Arrange admission to the high-risk OB unit. B. Instruct the woman on strict bedrest. C. Obtain a clean-catch urine sample. D. Prepare to administer IV anti-hypertensives.

ANS: C Preeclampsia can occur in a woman who has chronic hypertension. This woman has the characteristics of hypertension after a period of good control and proteinuria of at least 2+ on dipstick (100 mg/dL). The nurse needs to ensure protein levels are assessed in two samples at least 4 hours apart and ensure the woman has no signs of a urinary tract infection, as protein can occur in a sample of infected urine. The nurse should obtain a clean-catch urine sample to send to the laboratory for analysis. Asymptomatic UTI can occur in up to 11% of pregnant women, so assessing for signs and symptoms may not be accurate. The woman does not need admission to the high-risk OB unit, strict bedrest, or IV anti-hypertensives at this point.

11. A nurse is interested in providing tertiary prevention activities. Which of the following activities would this nurse choose to do? A. Assist with low-cost swimming lessons at the YMCA. B. Conduct monthly educational seminars at a church. C. Join the county pandemic outbreak response team. D. Provide glucose and cholesterol screening at the mall.

ANS: C Tertiary prevention attempts to restore health to its highest level of functioning. Working with a county response team in the event of a pandemic outbreak would be an example of tertiary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Assisting with swimming lessons and conducting monthly seminars will educate the target audiences in order to prevent a health problem. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing glucose and cholesterol screening is an example of secondary prevention.

47. The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching? A. "Are you sure your breasts are emptying?" B. "Does the baby put everything in his mouth?" C. "Does your baby sit in a high chair yet?" D. "Is your baby using the pincer grasp yet?"

ANS: C The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 8-10 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

22. A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin).

ANS: C This woman has manifestations of endometriosis. Diagnosis can be made via a pelvic exam, although it is often difficult to do so. Some physicians will order ultrasounds or laparoscopy with biopsy. The first step, however, is the pelvic exam, so the nurse should prepare the woman for this to occur. After making a diagnosis of endometriosis, the nurse can educate the woman on medical management, which includes using ibuprofen for pain.

43. A pregnant woman is HIV-positive. She is asking about ways to decrease the risk of vertical transmission to her baby. Which option given by the nurse would confer the least risk to the baby? A. Antiretroviral medications (zidovudine [ZDV]) B. Cesarean delivery C. Cesarean delivery plus antiretroviral medications for the newborn D. Vaginal delivery plus antiretroviral medications for the newborn

ANS: C Women with HIV should be counseled that the risk of vertical transmission (mother to child) is 25% without antiretroviral medication. With ZDV, the rate is 5 to 8%. When both options are combined, the risk drops to around 2%, so this is the best option.

9. The clinic nurse is interviewing a woman and her daughter who describe their address as"temporary." The mother appears thin, pale, and tired. Her blood work confirms anemia and pregnancy. What actions by the nurse would be most helpful? (Select all that apply.) A. Call the Department of Children and Family Services. B. Discuss nutrition needs for pregnancy. C. Facilitate the woman's opportunity to return for prenatal care. D. Determine if the family is in a safe location. E. Provide shelter information for this family.

ANS: C, D, E A priority for this family is to provide information regarding shelters, to facilitate follow-up clinic visits for the mother to address her pregnancy and anemia, and to determine if the family is currently in a safe place or if the family is vulnerable to violence. Nutrition in pregnancy should be discussed, but it is not the priority intervention at this point. There is no reason to call the Department of Children and Family Services unless abuse is suspected.

27. A nurse wishes to assess how often members of a family consume alcohol or use drugs during a typical week. What type of family assessment tool would this nurse choose? A. Ecomap B. Genogram C. Qualitative D. Quantitative

ANS: D A quantitative tool measures the frequency at which problems or behaviors occur. An ecomap is a tool that displays the outside systems used by the family. A genogram illustrates the family structures and compares generations within the same family. Qualitative tools measure the descriptions and depth of family experiences.

25. One goal of the Healthy People 2020 initiative is to increase the number of people who have some form of health insurance. What percentage of the population is the target? A. 25% B. 35% C. 55% D. 100%

ANS: D Healthy People 2020 has the ambitious goal of increasing the proportion of people with health insurance to 100%.

A pregnant woman has been advised that she has a platypelloid pelvis type. What action by the perinatal nurse is best?

Advise the woman that she may need a cesarean delivery

A woman in her third trimester of pregnancy complains of a painful burning sensation in her hands and lower arms. Which action by the nurse is best?

Advise the woman to elevate her hands at night.

The nursing faculty member explains to a class of nursing students that the ethnic/cultural group with the highest rate of teen pregnancy is which group?

African Americans

The nurse is conducting a prenatal visit with a newly expectant mother. The woman wants to know why the nurse is concerned about her drinking habits. Which is the best response by the nurse?

Alcohol has one of the strongest effects on fetal development we know of

A baby is born with trisomy 18. What action by the nurse is most appropriate?

Allow the family members to express their grief and anger.

The nurse auscultates fetal heart tones on a woman in her third trimester of pregnancy and counts a heart rate of 92 beats/minute. Which action by the nurse is best?

Assess the maternal heart rate.

A woman is having an infertility workup and has been told she has scarring of her fallopian tubes. What action by the nurse is best?

Assess the woman for previous vaginal infections and their treatment.

A new patient is having a speculum exam, and the nurse notes the cervix has a bluish purple discoloration. Which of the following does the nurse chart about this finding?

Chadwick's sign

A woman is receiving clomiphene citrate (Clomid). What assessment finding warrants immediate intervention by the nurse?

Chest pain worse with inspiration

Place the following methods of birth control in order of their effectiveness, starting with the most effective. Condoms, Depo-Provera, Diaphragm, Natural family planning, Oral contraceptive pills, Withdrawal

Depo-Provera (>99%), oral contraceptive pills (95%), condoms (85%), diaphragm (84%), natural family planning (73%), withdrawal (71%)

A faculty member is teaching a nursing class about fetal circulation. The faculty member explains that most blood bypasses the liver and enters in the inferior vena cava through the

Ductus venosus

A nurse teaching a prenatal class instructs the participants that early organ system development occurs during which period of time?

Embryonic period

A woman in her second trimester of pregnancy is in the clinic for a checkup. She complains of feeling short of breath at times. Her lungs are clear and her oxygen saturation is 98%. Her vital signs are all normal. What action by the nurse is best?

Encourage slow, deep breathing.

A woman in the clinic reveals that she is experiencing high levels of stress related to her pregnancy. What action by the nurse is best?

Encourage the woman to spend time with friends

A woman has returned to the clinic for her second prenatal visit. Her blood pressure is significantly higher than on her previous visit. What action should the nurse do first?

Ensure that the blood pressure cuff is the appropriate size.

A nurse is conducting prenatal classes. The nurse explains the incision made to enlarge the perineal opening for a vaginal birth. What is this incision called?

Episiotomy

A nurse is working with a patient who has the nursing diagnosis of altered sexuality patterns. What action by the nurse takes priority?

Establishes a trusting relationship

A nurse has completed a family pedigree on a patient with a known autosomal dominant inheritance disorder. No one else in the family has been affected by this disorder. How does the nurse explain this finding to the patient?

Genetic variation occurred via a mutation.

A nurse is interested in studying the functions and interactions of the genes in the human genome. What branch of science should this nurse pursue?

Genomics

1A woman in the emergency department is in her third trimester and is bleeding heavily from a laceration on her thigh from a car crash. She is pale and diaphoretic. Her blood pressure is 138/82 mm Hg. What can the nurse conclude from this information?

Her increased blood volume is maintaining the blood pressure.

A perinatal nurse is conducting prenatal classes. The nurse explains that an incision for cesarean birth is normally made in which uterine segment?

Isthmus

A nurse is teaching a group of middle school students about the functions of the male reproductive tract. Which information should the nurse include?

Maturing sperm are stored in the epididymis.

A pregnant woman's last normal menstrual period started on July 27, 2013. Calculate her expected date of birth (EDB) using Naegle's rule. Her EDB is what date?

May 3, 2013

A woman in her 26th week of pregnancy is in preterm labor. What can the nurse conclude about this baby's ability to survive?

Might survive, as lungs can breathe air with rhythmic breathing

A student asks what the phrase "probable signs of pregnancy" means. The instructor provides which answer?

Objective signs seen by an examiner; can be from other conditions

During a prenatal class, the nurse explains that one of the baby's protections during pregnancy is the cervical mucus. The nurse teaches the class members that the medical term for this is?

Operculum

The perinatal nurse explains to the new nurse that the maternal pelvic shape can determine the fetal presentation. A fetus in a transverse presentation may be due to which maternal pelvic type?

Platypelloid

A teenage girl wishes to obtain birth control and is interested in a diaphragm. What advice does the nurse provide?

Poor choice because it requires planning

The perinatal nurse explains to an adolescent that ova are produced and estrogen is secreted at which phase of life?

Puberty

A nurse is teaching a prenatal class on fetal growth and development. In which gestation week does the nurse inform thee parents that the heart begins to beat?

Second

The clinic nurse knows that the part of the uterine cycle that occurs during the period of time between ovulation and the onset of menses is known as which of the following?

Secretory phase

A woman is interested in the transdermal contraceptive patch. She is 5'5" tall and weighs 200 lb (90.9 kg). What information should the nurse provide this patient as a priority?

She can't use the patch at her weight.

To provide anticipatory psychosocial guidance to a woman entering her third trimester, what topic should the nurse plan to include?

She may worry about impending childbirth but see it as a relief.

A woman who smokes has just learned she is 10 weeks pregnant. She does not believe that quitting will help her fetus now because she has already exposed it to the smoking. Which response by the nurse is best?

Stop now and your baby's birth weight will probably be near normal

A pregnant woman complains of leukorrhea at her clinic visit. Which action by the nurse is best?

Teach her to cleanse her vulvar area gently with soap and water

A nurse reads a patient's chart and sees the diagnosis "pediculosis pubis." What does the nurse understand about this condition?

The patient has pubic lice.

A nurse is counseling a 40-year-old woman about her risks of giving birth to a child with Down syndrome. What information does the nurse provide?

The risk is about 1 in 85

A nurse reads in a pregnant woman's chart that she is "para 3." What does the nurse understand about this woman's obstetrical history?

Three pregnancies delivered past 24 weeks of gestation

A parent wonders why his baby needs all the blood samples to test for different diseases. What response by the nurse is best?

"Many serious disorders can be found before they cause damage or death."

The nurse has educated a woman about bromocriptine mesylate (Parlodel). Which statement by the patient indicates that she needs more teaching about this drug?

"My endometriosis will regress with this medication."

A nurse is working with a pregnant woman who has the nursing diagnosis of altered family processes. What statement by the patient indicates that a major goal for this diagnosis has been met?

"My husband has been doing more around the house so I can rest more."

A woman had an elective surgical abortion 7 weeks ago and calls the clinic to ask when her menstrual periods should return. What response by the nurse is most appropriate?

"Please come in to the clinic today for a checkup."

The nursing student in the perinatal clinic asks the registered nurse why so many pregnant women seem to be stressed despite their "happy" condition. What response by the nurse is best?

"Pregnancy is a developmental crisis."

A student has read that hematopoiesis occurring in the wall of the yolk sac declines after the eighth week of gestation and asks the instructor for clarification. What statement by the faculty member is most accurate?

"The fetal liver takes over that function then."

During prenatal class, the nurse teaches expectant couples about the importance of the amniotic fluid and its functions. What functions does the nurse describe? (Select all that apply.)

-Cushions the fetus from mechanical injury -Facilitates symmetrical growth of fetal limbs -Helps regulate fetal body temperature -Prevents the amnion from adhering to the fetus

The nurse is concerned about a woman who is undergoing her second in vitro fertilization (IVF) cycle. The patient is anxious, sad, and worried that her partner does not feel as motivated as she does to try to achieve a pregnancy. Which actions by the nurse are most appropriate? (Select all that apply.)

-Encourage the woman to talk honestly with her partner. -Instruct the woman to engage in relaxation techniques. -Encourage the woman and her partner to contact a support group

A nurse is providing anticipatory guidance regarding psychosocial adaptations to pregnancy to a group of women. Which topics are consistent with their associated trimesters? (Select all that apply.)

-First trimester: ambivalence about the pregnancy -Second trimester: active dreams and fantasy life

A woman is having a triple-screen test during her second trimester of pregnancy. The nurse teaches the patient that this test includes which of the following? (Select all that apply.)

-Free beta-human chorionic gonadotropin -Maternal serum alpha-fetoprotein -Unconjugated estriol

A nurse is providing anticipatory guidance to a pregnant woman who has another child. Which information should the nurse plan to include? (Select all that apply.)

-Teen: may feel resentment and embarrassment -Toddler: may regress in behavior

A pregnant woman asks a neighbor who is a nurse about using a midwife instead of a physician for her prenatal, labor, and childbirth care. What information does the neighbor share with the pregnant woman about certified nurse midwives (CNMs)? (Select all that apply.)

-There is increased patient satisfaction with CNMs. -There is a lower rate of cesarean births with CNMs.

The perinatal nurse is providing information on fetal growth and development. The nurse explains that fetal urine production begins at

9 to 12 weeks

A pregnant woman lifts weights regularly with a partner. What modification to this activity should the nurse suggest? A. Adjust the weight bench so that it is tilted, not flat. B. Do fewer repetitions by using heavier weights. C. Do not hold your breath for more than 30 seconds. D. Use free weights instead of resistance bands.

A. Adjust the weight bench so that is tilted, not flat Lifting from a supine position can cause vena cava syndrome and decreased placental perfusion, so the woman should be instructed to adjust the weight bench to a tilted position. Heavy weights can overload the loosened joints, so using lighter weights with more repetitions is recommended. Holding the breath can cause a Valsalva maneuver, which decreases placental perfusion. Resistance bands are preferred to reduce the likelihood of abdominal injury.

A woman is admitted to the hospital with a birth plan that specifies the Bradley method of childbirth. Which actions by the nurse are most appropriate for this patient? (Select all that apply.) A. Assist the woman in conserving energy for childbirth. B. Call the anesthesiologist to place an epidural. C. Ensure the patient has a quiet environment. D. Establish a relationship with the husband-coach. E. Turn the lights down in the patient's room.

A. assist the woman in conserving energy for childbirth C. Ensure the patient has a quiet environment D. Establish a relationship with the husband/coach E. Turn the lights down in the patient's room The Bradley method emphasizes inward relaxation, allowing the woman to conserve energy for the impending birth. There is an emphasis on darkness, solitude, and quiet in order to reduce stimulation and enhance the calm and comfort needed by the woman. The Bradley method is also known as "husband-coached childbirth." The nurse will need to establish a professional, caring relationship with both the woman and her partner. Medication is discouraged in this method.

29. A nurse explains the benefits of a strengths-and-problems list to a student. Which is the best explanation? A. Can use their strengths to work on identified priority problems B. Demonstrates that each family has both strengths and problems C. Forces people to be accountable and take responsibility for problems D. Lets families see which members have problems affecting them

ANS: A A strengths-and-problems list requires the family members to list their strengths as well as what each member brings to the group that is positive. The problems list helps the family prioritize problems to work on. By seeing this information in writing, the family members can capitalize on their strengths to work on the problems. It does demonstrate that each family has both strengths and problems, but that is not the main purpose. It does not force families to take responsibility, although it does encourage this. Its purpose is not to point out who has which problems.

19. A nurse is providing anticipatory guidance to a mother of a toddler. Using communication theory, which information is the most appropriate? A. "Don't nod your head 'yes' when you say 'no.'" B. "Explain things in several different ways." C. "There is no need to see if a toddler understands." D. "You shouldn't yell at such a young child."

ANS: A According to communication theory, verbal and nonverbal messages should be congruent. A verbal "no" accompanied by nodding the head "yes" is sending inconsistent messages. Messages should be clear, so explaining things in many different ways would not be recommended. Good communicators determine if the listener has understood. Good communication demonstrates love and support clearly, but the advice to not yell is vague and seems to send the message that yelling at an older child would be more acceptable.

30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What action by the nurse takes priority? A. Ensure that an informed consent is signed and witnessed. B. Inventory and label all of the patient's belongings. C. Orient the patient's significant others to the waiting room. D. Premedicate the patient on arrival to the pre-op holding area.

ANS: A All actions are appropriate, but the priority action is in ensuring that an informed consent form has been signed and properly witnessed.

38. A patient has just been admitted to the hospital in critical condition. In caring for the entire family, what action by the nurse is most important? A. Assessing who in the family will make decisions B. Determining if the family needs financial resources C. Ensuring each member understands the situation D. Orienting the family to visiting hours on the unit

ANS: A All options are important activities to keep the family engaged fully with the patient. However, for a patient who is critically ill, determining who makes medical decisions (and if there are advance directives) is crucial. The other actions can occur later.

17. A school nurse is increasingly concerned with a growing absentee problem. To best address this issue, which of the following actions should the nurse take? A. Begin a structured follow-up program for asthmatic children. B. Hold informational meetings on the importance of childhood vaccines. C. Partner with providers on continuity plans for kids with chronic illness. D. Work with law enforcement to develop a truancy response team.

ANS: A All plans sound like they could be innovative strategies for dealing with school absenteeism. But because asthma is the most common reason for a child to miss school (and the primary reason for visits to pediatric emergency rooms), the nurse's best response is to develop a structured follow-up program for kids with asthma.

12. A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency. The woman is in her 18th week of a viable pregnancy. Which action by the nurse is most appropriate? A. Assist with obtaining informed consent for a cerclage. B. Draw blood to assess the maternal Rh status. C. Facilitate a transvaginal and abdominal ultrasound. D. Refer the woman to a perinatal grief specialist.

ANS: A Because the woman has diagnosed cervical insufficiency, a cerclage is appropriate therapy. This purse-string suture closes the cervix so the uterus can contain the pregnancy. It is usually removed in the 37th week to allow for vaginal delivery. Because it is an invasive procedure, informed consent is required. The other options are not necessary in this situation, although if the woman has unresolved grief following prior spontaneous abortions, a referral would be appropriate.

39. A hospice nurse is making the initial home visit to a patient who just returned home after a lengthy hospitalization. What action by the nurse is most appropriate to help the family continue to function? A. Assess the degree of comfort in family caregiving. B. Ensure the family understands the hospice concept. C. Provide information about available hospice services. D. Refer the family to a community counseling center.

ANS: A In the at-home hospice setting, family members must find a balance between direct caregiving activities and their own needs for personal time. The nurse must assess this to help the family avoid caregiver strain and resentment and to maintain roles necessary for family functioning. Ensuring the family understands the hospice concept and providing information are also important, but are not directly related to family functioning. The family may or may not need counseling.

31. A nurse in a family practice clinic sees several generations of the same family. For which family members should the nurse arrange routine screening colonoscopies? A. Daughter, age 52 B. Grandfather, age 80, no history of polyps or cancer C. Grandmother, age 72, history of polyps D. Grandson, age 30, no gastrointestinal symptoms

ANS: A Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 75-85 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening.

16. The parents of a 16-year-old boy are frustrated because the teen is always participating in risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful? A. Encourage an after-school program that includes rock climbing, rafting, and hiking. B. Reassure the parents that risk taking is just a normal part of adolescence. C. Show the teen statistics on preventable injuries and deaths among teenagers. D. Tell the teen his risky behavior can lead to injuries and worries his parents.

ANS: A Risk taking is a part of adolescence, but the teen needs healthy risk-taking activities. The nurse can encourage the teen to take part in a program that offers risk-taking under adult supervision. Rock climbing, hiking, and rafting are all healthy alternatives. Simply reassuring the parents that teens take risks does not give them information that helps the teen. Showing the teen statistics and explaining that he is worrying his parents are both unlikely to have much effect.

31. A student nurse asks the perinatal nurse why teenagers might be vulnerable to intimate partner violence. Which answer by the nurse is best? A. "Because teens are dependent on others for their everyday living needs." B. "Being younger and smaller makes them more apt to be physically abused." C. "Pregnant teens are often addicted to drugs and alcohol, or are prostitutes." D. "So many teens make bad choices, and choosing abusive men is one of them."

ANS: A Teenagers, especially the younger ones, are very dependent on others for the basics of their everyday lives, and this vulnerability often makes it difficult to leave an abusive situation in which they depend on their abusers. The other options are inaccurate, dismissive, and stereotypical.

21. A nurse wants to conduct a community education session for women at high risk of preterm birth. Which teaching site would best meet this objective? A. After services at a predominantly African American church B. At the local Asian and African markets during a weekday C. In the lobby of several OB-GYN clinics in the suburbs D. Near the food court at the local shopping mall

ANS: A The March of Dimes reports that the ethnic group with the highest rate of preterm births is African American women, at 18.4%. Although teaching all women about preterm births is an important goal, to reach the group with the highest risk, the nurse should plan to teach at a predominantly African American church over the other sites.

11. The jail nurse is interviewing a woman who has been brought to the clinic for prenatal care. Which of the following are appropriate actions for the nurse to perform? (Select all that apply.) A. Assess the woman for drug and alcohol abuse and possible withdrawal. B. Assess the woman's health knowledge and health literacy. C. Ask if the woman has other children and who is caring for them. D. Determine if the woman has risk factors for pregnancy complications. E. Inquire about the woman's criminal history and background.

ANS: A, B, C, D A nurse who is able to deliver culturally competent care to incarcerated women quickly becomes cognizant of the challenges of caring for this population. These women tend to have many health problems, including substance abuse and dependency. They frequently have not had access to health-related knowledge. Because nearly 1.3 million children of incarcerated women have no mother figure in their lives, women in prison or jail are often deeply concerned about their welfare. This demonstrates caring and can often be the motivation for making changes. The nurse needs to complete a thorough obstetrical history, including determining risk factors for high-risk pregnancy. The nurse does not need to know about the woman's criminal history.

8. The clinic nurse keeps resource numbers and contacts for assistance with situations in which family members may potentially require assistance to restore balance and function to the family. These developmental crises may include which of the following situations? (Select all that apply.) A. Home fire requiring a lengthy hotel stay B. Hospitalization of a family member C. Identification of domestic violence D. Postpartum depression in a young family E. The anticipated birth of a new baby

ANS: A, B, C, D Sometimes families are in special need of nursing intervention due to situational or developmental crises that go beyond the family's internal resources. Developmental crises occur as part of expected growth events that can take place during any developmental stage of the family or its individual members and include such situations as being displaced, hospitalization of a family member, domestic violence, and serious depression. Childbirth is a normal event that does not generally require special nursing intervention unless complications occur.

1. A nurse working in a women's health clinic has several patients who are from a minority culture, live in the inner city, lack employment that offers benefits, have large families, and often lack transportation to health care. Which of these factors are considered broad determinants of health? (Select all that apply.) A. Access to health care B. Employment C. Environment D. Family size E. Race

ANS: A, B, C, E Broad determinants of health care are personal, community, and societal systems and include environment, employment, insurance, class, race, social support, access to health services, genetic endowment, and personal histories. Family size itself is not a broad determinant of health care; however, it could be included in the larger category of personal history.

7. A perinatal nurse is working with a woman who has had four perinatal losses in the first 20 weeks of pregnancy. The nurse should anticipate orders for which of the following diagnostic tests? (Select all that apply.) A. Cervical cultures B. Hysterosalpingogram C. Maternal/paternal karyotype D. Sickle cell screening E. Thyroid-stimulating hormone (TSH) levels

ANS: A, B, C, E Patients who experience habitual (three or more) spontaneous abortions may be offered these tests as part of the diagnostic workup: a karyotype obtained from the products of conception and from both parents and an examination of the maternal anatomy, beginning with a hysterosalpingogram. Additional testing may include hysteroscopy or laparoscopy; screening tests for maternal hypothyroidism, diabetes mellitus, antiphospholipid syndrome (APS), and systemic lupus erythematosus (SLE); testing of the serum progesterone level during the luteal phase of the menstrual cycle; cultures of the cervix, vagina, and endometrium; and endometrial biopsy during the luteal phase of the menstrual cycle. Sickle cell screening would not be part of this workup.

10. A visiting nurse is seeing an older woman with the nursing diagnosis of risk for trauma related to decreased bone density secondary to osteoporosis. Which assessment findings would indicate to the nurse that a priority goal for this diagnosis has been met? (Select all that apply.) A. All scatter rugs have been removed. B. Burned-out light bulbs have been replaced. C. Hot water heater temperature is set to 110°F. D. Patient wears non-skid shoes or slippers. E. Pets have been given away to friends.

ANS: A, B, D A priority goal for this diagnosis is to make the home safe. Removing scatter rugs, having the home well lit, and wearing non-skid footwear are all indications that the home is safe. The temperature on the water heater is important to prevent injury, but is not related to osteoporosis. Giving away pets is not advised, as pets often contribute to emotional well-being. However, they can get underfoot, and the nurse needs to caution the patient about this risk.

11. The reproductive care clinic nurse teaches young women about their risk for sexually transmitted infections (STIs). Which factors does the nurse include? (Select all that apply.) A. Alkaline pH of the vagina B. Increased genital mucosal surface area C. Increased number of pubic hair follicles D. Prolonged exposure to semen E. Temperature of the vaginal area

ANS: A, B, D Physiological factors that predispose women to increased susceptibility to sexually transmitted infections include an increased genital mucosal surface area, retention of semen in the vagina for several hours following intercourse, and the pH of the vagina. During menstruation, women are more vulnerable to infection because the pH of the vagina becomes more alkaline, thereby becoming more hospitable to viral and bacterial transmission and growth. Number of pubic hair follicles and vaginal temperature are not related.

12. A pregnant woman in her second trimester arrives at the labor unit triage station with complaints of lower abdominal cramping and urinary frequency. Appropriate nursing actions include which of the following? (Select all that apply.) A. Assess the fetal heart rate. B. Assess the patient's pulse rate. C. Insert an indwelling Foley catheter. D. Obtain a urine sample for culture and sensitivity. E. Palpate the patient's abdomen for contractions.

ANS: A, B, D, E Women who experience preterm labor may complain of backache, pelvic aching, menstrual-type cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity should be obtained on all patients with symptoms of preterm labor, and the nurse must remember that symptoms of urinary tract infection often mimic normal pregnancy complaints (e.g., urgency, frequency). The patient's abdomen should be palpated to assess for contractions, and the fetal heart rate should be monitored. It is not necessary to insert a Foley catheter at this time.

4. The community health nurse is aware that the goals of Healthy People 2020 include which of the following? (Select all that apply.) A. Creating physical environments that promote health B. Developing healthy behaviors in children and teens C. Eliminating health disparities and increasing equity D. Improving the health of all groups in the country E. Increasing the average life span for all adults

ANS: A, C, D Goals of the Healthy People 2020 document include the following: (1) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) to achieve health equity, eliminate disparities, and improve the health of all groups; (3) to create social and physical environments that promote good health for all; and (4) to promote quality of life, healthy development, and healthy behaviors across all life stages. The blueprint does not call for developing healthy behaviors only in children and teens, nor does it call for simply increasing the average life span.

9. A nurse is assessing all patients in the perinatal clinic for culturally related increased risk for gestational diabetes mellitus. Which patients would the nurse assess as being in the highest risk groups? (Select all that apply.) A. African American B. Caucasian C. Chinese D. Hispanic E. Native American

ANS: A, C, D, E Ethnic groups with a higher incidence of gestational diabetes mellitus include African Americans, Asian Americans, Hispanics, and Native Americans. Pacific Islanders also have increased risk. Caucasians do not have an increased risk.

6. The family nurse completes a genogram map when conducting a family assessment. Appropriate information the nurse should include in the genogram map includes which of the following? (Select all that apply.) A. Congenital diseases in the family B. Country of origin for family members C. Dates of birth for all family members D. Dates of divorce and deaths for family members E. Three or more generations

ANS: A, C, D, E The genogram may be used to highlight generational influences of behaviors, illnesses, vocational information, or any other pertinent information that provides a larger picture of patterns that exert influence on the family's current situation. The genogram should include at least three family generations and should list dates of births, divorces, deaths, stillbirths, and other pertinent elements of family information.

2. A nurse is conducting an educational class for expectant couples. What information about preterm birth does the nurse include in the discussion? (Select all that apply.) A. A diagnosis of preterm labor requires cervical changes. B. African Americans have the lowest rate of preterm birth of all ethnic groups. C. The vast majority of infants born at 29 weeks' gestation survive. D. Today, 1 in 25 babies are born prematurely in America. E. Worldwide, preterm birth is the leading cause of neonatal morbidity and mortality.

ANS: A, C, E Although many pregnant women experience preterm contractions, only those with cervical changes are diagnosed with preterm labor. More than 90% of infants born at 28-29 weeks' gestation survive today. Worldwide, premature birth is the leading cause of infant morbidity and mortality. According to the March of Dimes (2012), the rate of preterm birth is highest for African American infants (18.4 %). In the United States, more than 1 in 8 babies are born too soon.

A mother is worried about her three children developing an inherited medical condition because many members of her family have died from this disease. To start an assessment of this family, which tool should the nurse choose? A. Ecomap B. Genogram C. Problem list D. Quantitative tool

ANS: B A genogram is a diagram of at least three generations that illustrates the present family structures and compares past generations with the present ones. To determine the prevalence of this inherited disorder in the family, the nurse would use a symbol to denote each family member with this disease. An ecomap displays the outside systems with which the family interacts. A problem list helps family members identify difficulties or negative characteristics. A quantitative tool assesses the frequency of a behavior or problem. A genogram has a quantitative influence, as it documents how many people in the family have the characteristic being studied, but a genogram is more specific.

22. A woman who is in her third trimester and is at risk for preterm birth calls the clinic to get the results of her fetal fibronectin test (fFN). The nurse sees the result is negative. Which advice to the patient is most appropriate? A. Come to the perinatal clinic for a screening ultrasound. B. Continue the current management plan as directed. C. Go to the hospital immediately for imminent delivery. D. Plan to continue taking betamethasone (Celestone) for 1 week.

ANS: B A negative fFN test indicates that the chance of a woman giving birth in the next week is approximately 1%, so she should continue her management plan already in place. There is no need for a screening ultrasound or hospitalization. Betamethasone is a corticosteroid shown to improve outcomes in premature birth. Because this woman is at low risk of delivery within the next week, betamethasone is not indicated.

30. A perinatal nurse has developed a birth plan with a woman who is in her third trimester and has a physical disability. Which action by the nurse would be best for this patient? A. Arrange for a social work home visit after the woman gives birth and goes home. B. Consult with the OB clinical nurse specialist to plan for the woman's birth. C. Notify the unit manager about the upcoming delivery of a woman with a disability. D. Prepare a written birth plan document and ensure the woman has a copy to take with her.

ANS: B Consulting with the clinical nurse specialist (or the unit manager) allows for special needs to be documented and prepared for. There is no indication that the woman needs a social worker to visit her at home after the birth, but home health-care options should be investigated and planned ahead of time, if needed or desired. Simply telling the unit manager about this woman's upcoming birth will not allow for her needs to be anticipated and planned for. Although a written copy of a birth plan is good to facilitate communication, this alone will not allow for pre-planning for any special needs.

1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care? A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention

ANS: B Health promotion refers to the advancement of health to the highest degree possible for an individual. One activity is providing vaccination clinics for older adults. Disease prevention focuses on the implementation of strategies to reduce the incidence of disease or the development of comorbid illnesses in individuals with existing diseases. Health screening (secondary prevention) aims to diagnose diseases early and begin effective treatment immediately.

37. A grade school nurse is conducting vision screening before school and notes the student is accompanied by an older sister who has also brought a middle school child. The older child states that time is a problem because middle school starts in a few minutes and tells the younger child to go right to the classroom after the screening, then leaves. What question by the nurse would be most appropriate to ask the youngest child during the screening? A. "Do you feel safe at home or is someone hurting you there?" B. "Does your sister always bring you and your sibling to school?" C. "Have you ever seen your parents drinking a lot or using drugs?" D. "Why aren't your parents available to bring you to school?"

ANS: B In substance-abusing families, one child often takes the role as the responsible person, allowing the family to continue functioning. The fact that a sibling was bringing the children to school is a little unusual, and the nurse should assess the reason behind it. However, substance-abusing families often keep secrets for both social and legal reasons. The nurse should not ask directly about substance abuse, but rather open a line of discussion by introducing a nonthreatening question. There is no indication of abuse, so asking if the child is safe is not appropriate at this time. In a secret-keeping family, asking directly about drinking or drug use would most likely elicit a negative response. Asking "why" questions is confrontational.

32. The nurse has admitted a patient to the high-risk OB unit with preterm premature rupture of the membranes. After obtaining maternal vital signs and the fetal heart rate, which action should the nurse do next? A. Assess for coping skills in the woman and her partner. B. Attach the woman to continuous electronic fetal monitoring. C. Consult social work for diversionary activities to enhance bedrest. D. Prepare to administer antibiotics for presumed chorioamnionitis.

ANS: B Management of premature rupture of the membranes consists of prolonged maternal and fetal monitoring and modified bedrest. The nurse should attach the fetal monitor to the patient. In high-risk pregnancies, coping skills are often exhausted, and the nurse would do well to assess the state of coping in this patient, but this does not take priority. Providing diversionary activities would help enhance the bedrest experience, but, again, this does not take priority. There is no indication that the woman has chorioamnionitis, although it is a common cause of premature rupture of membranes. If diagnostic data indicate an infection, an antibiotic would be appropriate at that time.

25. A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor. Orders include bedrest with continuous fetal monitoring, administration of magnesium sulfate (Sulfamag) and betamethasone (Celestone), and laboratory work. In reviewing the patient's record, the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia) and diet-controlled diabetes mellitus type 2. Which action by the nurse is best? A. Assist the woman to choose appropriate food items from the menu. B. Call the physician to question the orders and document the conversation. C. Order a pressure-relieving mattress overlay and perform a skin assessment. D. Prepare to give the magnesium sulfate and betamethasone as ordered.

ANS: B The combination of nifedipine and magnesium sulfate can cause sudden cardiac death. The nurse should contact the health-care provider to question the orders. The nurse should also document all aspects of this communication clearly. The woman may or may not need assistance in choosing food items appropriate for her diabetes. All patients need a full skin assessment and, depending on how long bedrest is anticipated, a pressure-relieving mattress overlay might be appropriate. The nurse should not give the medications without further clarification.

26. A nurse is working with a woman who is 4 months pregnant. The woman has had a series of temporary housing, has no job, and is wearing clothing that is obviously way too big for her. What action can the nurse take to most improve the health of this woman and child? A. Arrange transportation for her to get to a community food bank. B. Consult a social worker to help her apply for the WIC program. C. Encourage the woman to make her return appointment before leaving.

ANS: B WIC, or the Women, Infants, and Children Program, targets pregnant women, infants, and children up to age 5 who are nutritionally at risk. WIC provides supplemental nutritious foods and nutrition counseling. Forty-five percent of infants born in this country participate in the WIC program. Helping with transportation needs and facilitating return appointments is helpful too, but not to the degree that improving this woman's nutrition will be. The woman might be eligible for Medicaid, but not Medicare, which is for the elderly.

7. Which of the following activities should the perinatal nurse encourage women who come for preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation E. Ensuring iron supplementation

ANS: B, C, D Folic acid supplementation helps to prevent certain birth defects. A fetus's exposure to harm could potentially be prevented if a woman were counseled prior to pregnancy about the adverse effects of alcohol, tobacco, toxoplasmosis, and other teratogens in her home or workplace. During the preconception period, it is too early for the woman to take iron supplements (unless she is anemic), and debating infant feeding methods is not the priority at this time

9. A nurse assessing a family includes which components in the assessment? (Select all that apply.) A. Dietary habits B. Family size and structure C. Parenting style D. Religious affiliation E. Socioeconomic status

ANS: B, C, D, E A family assessment includes family size and structure; parenting style; and religious, cultural, and socioeconomic orientation. Dietary habits are not specifically assessed, although this information may be part of a cultural assessment.

10. The clinic nurse explains to a student that an appropriate nursing action is screening all children for child abuse. What other information does the nurse give the student about child abuse? (Select all that apply.) A. It is frequently carried out by a stranger. B. The most common form is neglect. C. It is most often perpetrated by a parent. D. Only 1 out of 1,000 girls is sexually abused. E. It is part of an ongoing cycle of violence.

ANS: B, C, E The National Child Abuse and Neglect Data System reports that three children die of child abuse in the home each day. Children are most commonly abused by someone they know, and in 79% of cases, the perpetrator is a parent. Child abuse can set up a perpetuating cycle of suffering and more violence later in life, potentially reaching to future generations. Neglect is the most common form of child abuse. One out of every four girls will be sexually abused by the time she reaches 18.

6. The public health nurse explains to students that diversity is an increasing phenomenon in this country. What facts about this phenomenon does the nurse share with the students? (Select all that apply.) A. As immigrants acculturate, their unique cultural care needs will diminish. B. By 2050, the minority population in America is estimated to be 50%. C. Hispanics, blacks, and Asians are the historically designated minority groups. D. One in five people in this country will be over the age of 65 by the year 2030. E. Racial differences are rooted in biological factors that explain illness trends.

ANS: B, D The population of ethnic minorities is expected to reach 50% by the year 2050, which increases the need for culturally competent health care. One in five people will be over the age of 65 by 2030, increasing the impact of chronic illnesses. Hispanics, blacks, Asians, and Native Americans are the historically designated minority groups. There is no biologic basis for race; racial and ethnic categories are socially created.

12. A nurse works a great deal with refugees and is frustrated because, as a group, they don't seem to want to implement desired health behaviors. What action by the nurse would be most helpful? A. Conduct a health screening and educational event each month. B. Provide written information in the group's native language. C. Teach selected group representatives to be lay health educators. D. Try to establish relationships within the refugee community.

ANS: C According to family systems theory, each family system contains boundaries that affect how the outside world interacts with the family. Families that have recently immigrated to the United States might have closed boundaries and may only be receptive to health information provided by extended family members or members of their community. Establishing a lay health educator program in which community members can be taught health information with the intent of delivering it to their communities would be a good way to work with these families while respecting their boundaries. Regularly occurring health events might improve the nurse's standing in the community. Written information may or may not be helpful; many refugees are illiterate in their native languages and some languages do not have a written form. Establishing relationships within the community is advisable, but does not go far enough to solve the problem.

21. A nurse is teaching a 24-year-old male about reproductive health. Which information should the nurse provide this patient about testicular cancer? A. Annual screening is recommended for testicular cancer. B. If the epididymis is tender to the touch, that is concerning. C. Perform a testicular self examination after a warm shower. D. Because testicular cancer is rare at this age, no action is needed.

ANS: C Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 20-34. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure.

10. A student in a perinatal clinic asks the clinic nurse what an incomplete abortion is. Which response by the nurse is best? A. Complete loss of all products of conception before 20 weeks' gestation B. Fetal death before 20 weeks with retention of all products of conception C. Loss of some, but not all, products of conception before 20 weeks D. When the patient initiates an abortion, but then stops the procedure

ANS: C An incomplete abortion is the expulsion of some, but not all, products of conception prior to 20 weeks. Fetal death with retention of all products of conception prior to 20 weeks is called a missed abortion. Complete expulsion of all products of conception before 20 weeks is a complete spontaneous abortion. If a patient chooses to have an abortion, it is termed an elective abortion.

31. A family has weekly game nights and monthly family together days. The nurse documents these events as examples of which of the following? A. Family beliefs B. Family bonding C. Family building D. Family rituals

ANS: C Family-building activities are an extension of family rituals and center on recreation and leisure. They do contribute to family bonding, but the most specific answer is family building. Family activities are influenced by family beliefs.

35. A woman pregnant with triplets is a patient in the high-risk OB unit. Which action by the nurse is most appropriate? A. Document serial, individual fetal monitor strips. B. Label the monitor lines in descending fetal order. C. Monitor the fetuses simultaneously with a triplet monitor. D. Obtain fetal monitor strips in presenting order.

ANS: C Fetal monitoring of multiples may be difficult, but triplet monitors are available and should be used, if possible, for triplets. This is preferable to obtaining serial, individual tracings. The fetuses are labeled in ascending order, with the presenting fetus labeled "A." It is not necessary to monitor the fetuses in presenting order so long as they are clearly labeled.

13. A nurse wants to know the trend concerning death due to cardiovascular disease. What source should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data

ANS: C Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education.

5. A mother and her 12-year-old daughter visit the clinic often because of the daughter's asthma. The clinic nurse recognizes that one of the most important nursing actions in this situation is which of the following? A. Continue to schedule regular clinic visits for the child to follow her condition. B. Give the mother time to talk about her daughter's illness while she is present. C. Listen patiently to the child as she talks about her illness, letting her tell her story. D. Regulate and modify the child's medications in response to her asthma symptoms.

ANS: C Research shows that children feel that health-care providers don't really listen to them. It is important to advocate for the child and to develop a therapeutic relationship characterized by a caring attitude. The nurse should encourage the child to discuss her asthma and modify interventions accordingly.

35. A patient is being discharged from a psychiatric facility after a suicide attempt. The family consists of the patient, two parents, and two other teenage children. What action should the nurse teach the entire family as a priority? A. Assess for drugs or alcohol in the patient's room. B. Encourage the patient to take medications. C. Monitor the patient for signs of suicidal thoughts. D. Plan menus that contain nutritious food items.

ANS: C Safety is a priority concern in every family and all members should be made aware that the patient could have continued suicidal thoughts. If the siblings notice this, they should be taught to tell the parents immediately and could also be taught some effective communication to use. Looking for drugs or alcohol in the patient's room, encouraging medication use, and planning menus are all actions more appropriate for the parents.

19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity.

ANS: C The most reliable theory on drug use focuses on role development. As young adults take on the roles of spouse and parent, illicit drug use can interfere with performing those roles. Also, when assuming adult roles is seen as incompatible with illicit drug use, substance use declines. The nurse's best action is to help the husband see how binge drinking and drug use are not compatible with the father and role model roles. The nurse could assess the father for reasons he continues to abuse substances, but this will not help him diminish his use. Stating that the baby can be taken away may be seen as a threat and will probably cut off communication. Likewise, telling the father he will be putting his baby at risk may sound judgmental and threatening as well.

35. A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. "Acupuncture has been shown to work better than other body therapies." B. "Herbs are a great option as they do not typically have side effects." C. "Mind-body, manipulative, or traditional Chinese medicine are safer than herbs." D. "Research shows that black cohosh significantly reduces hot flashes."

ANS: C There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind-body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse's best answer is to explain this to the patient.

22. A student observes as an adult brother and sister lash out at the nurse caring for their hospitalized parent. The parent lives at home but is dependent on the children for care and is obviously neglected. The nurse has informed the children that social work will be involved in their father's case. How does the nurse explain this interaction? A. "Don't worry; they will calm down eventually." B. "Families often get emotional in these situations." C. "They are focusing attention on me, not the problem." D. "This family is obviously highly dysfunctional."

ANS: C This family is dysfunctional, but that does not go far enough to explain the situation. This behavior is known as triangulation, and occurs when a dyad diverts attention away from their problems and chooses instead to focus on a third party, in this case the nurse. Reassuring the student they will calm down is neither helpful nor accurate as the family members may choose to continue to lash out. Families often do get emotional, but again, this information is not really helpful.

46. At what age should the nurse prepare patients to begin thyroid function screening? A. 30 years B. 40 years C. 50 years D. 60 years

ANS: C Thyroid hormone function screening should begin at age 50 and occur every 5 years.

21. A clinic nurse is using group theory to assess a family whose youngest child recently moved back home after graduating from college and is unable to find a job. Which statement by a parent would indicate to the nurse that goals for norming have been met? A. "I'm glad my son stays in his room in the basement all day so he doesn't bother us." B. "It's hard to decide how much food to buy because we don't know where he's eating." C. "My son is gone a lot of the time, so we really don't notice that he moved back in." D. "We have agreed not to have a curfew as long as we know when he will be home."

ANS: D According to group theory, a healthy family adjusts to changes in its structure by resetting roles and norms. In this family, a launched child has moved back in, disrupting the patterns established when he left. Agreeing to new rules and roles is a sign of adaptation. The other responses do not show adaptation to the new situation.

20. A nurse is working with a woman who is newly married and pregnant and says she is distressed because she and her husband seem to be so different and they argue over petty issues. What action by the nurse using group theory would be best? A. Ask the woman if she can remember why she and her husband fell in love. B. Caution her that this level of disagreement will cause stress to the unborn baby. C. Offer the woman a referral to a community counseling center for couples therapy. D. Reassure her that this is normal and help her brainstorm ways to work cooperatively.

ANS: D According to group theory, groups evolve through the distinct stages of forming, storming, norming, performing, and adjourning. Storming often occurs when a group that has recently formed notices differences in members, leading to chaos or confusion. This couple is in this stage. At this point, the nurse's best action is to reassure the woman and help her brainstorm ways of working together cooperatively, which might include forming rules or procedures that both parties agree to follow. Asking about their early relationship does not give the woman information that will help the present situation. Warning the patient about the negative effects of stress on her unborn baby sounds judgmental and threatening. A referral for counseling might be needed at a future date.

12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health effects, what else should the nurse assess the patient for? A. Alcoholism B. Hepatitis C C. Lanugo D. Seat-belt use

ANS: D According to the results of a recent study, overweight teens tended to engage in high-risk behaviors such as smoking, chewing tobacco, and neglecting to wear a seat belt. The nurse should assess the teen for these behaviors. Alcoholism, presence of lanugo, and hepatitis C are not related.

36. A nurse is caring for a pregnant woman admitted to the high-risk OB unit. Which finding indicates to the nurse that outcomes for a priority nursing diagnosis have been met? A. Patient can list community resources available for her after childbirth. B. Patient describes skills she and partner use for dealing with stress. C. Patient states that with next pregnancy, she will obtain consistent prenatal care. D. Patient's blood pressure is 128/62 mm Hg without orthostatic changes.

ANS: D All options show that outcomes for important nursing diagnoses for a high-risk pregnancy have been met. However, physical needs take priority over psychosocial needs, so describing community resources and coping skills are not the most important. Prenatal care is important to help prevent adverse outcomes, but the patient is describing actions she intends to take for a subsequent, not current, pregnancy. For physical needs, airway, breathing, and circulation take priority. A stable blood pressure without orthostatic changes demonstrates hemodynamic stability and shows that outcomes for the diagnosis of risk for deficient fluid volume have been met.

2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant's immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months

ANS: D Because an infant's immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonate's immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infant's immune system.

37. A nurse notes that a woman's chart lists "dyspareunia" as a diagnosis. In planning education for the patient, which topics would the nurse include? A. Black cohosh and soy nuts B. Kegel exercises and use of a pessary C. Nonsteroidal anti-inflammatory medications D. Water-based vaginal lubricants

ANS: D Dyspareunia is painful intercourse, often seen in postmenopausal women. Prolonged foreplay and the use of water-based vaginal lubricants are helpful suggestions to ease this symptom. Black cohosh and soy nuts are often used to relieve menopausal symptoms. Kegel exercises and pessaries are used for urinary incontinence. Nonsteroidal anti-inflammatory medications are used for mild pain and swelling.

7. A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate? A. Advise the woman that she can try to get pregnant in 3 months. B. Arrange a consultation with a radiation oncology nurse. C. Facilitate screening for systemic lupus erythematosus (SLE). D. Give the patient information on perinatal loss support groups.

ANS: D Gestational trophoblastic disease (GTD) is a disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters (instead of normal placental tissue) and a vast proliferation of trophoblastic tissue. GTD includes the diagnosis of hydatidiform mole ("molar pregnancy"). Complete moles have a proliferation of trophoblastic tissue, but no fetal parts. An incomplete mole is associated with a coexistent fetus that is genetically abnormal and usually only survives a few weeks before being spontaneously aborted. Support groups for grieving parents are an important community resource, and the nurse should ensure that the woman has information on local organizations. Management includes emptying the uterus of its contents with strict follow-up. Women should not become pregnant for at least a year afterward. Incomplete moles are almost always benign, so a consultation for a radiation oncology nurse is most likely not needed. Screening for SLE is done in women who have habitual abortions.

9. A nurse is interested in primary prevention programs. Which of the following activities would this nurse choose to do? A. Assist with blood pressure screening at the local mall. B. Collect and distribute used eyeglasses for poor people. C. Staff a mobile mammogram unit for underserved groups. D. Teach teenagers about the dangers of texting and driving.

ANS: D Primary prevention includes activities designed to keep health problems from happening. It often includes education. Teaching teens the dangers of texting and driving will (hopefully) prevent motor vehicle crashes. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing blood pressure screening and mammograms are examples of secondary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Providing eyeglasses for needy people with vision problems is an example of tertiary prevention.

8. A nursing student wishes to investigate national health goals. Where should the student research this information? A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative

ANS: D The Healthy People initiative is the blueprint for the nation's health goals. Updated every 10 years, it lists national health priorities. Information related to the Healthy People initiative can be found on the other sites, but they are secondary sources. The student would do best to investigate the primary source.

19. A nurse reads in the paper that the death rate for women overall has declined substantially. To what does the nurse correlate this finding? A. Abundant new choices in contraception B. Better detection and treatment of breast cancer C. Greater access to sources of fresh produce D. Improved diagnosis of heart disease in women

ANS: D The leading cause of death in women overall is heart disease. Women face significant barriers to timely diagnosis and treatment of heart disease than do men. The nurse can conclude that this has improved, leading to the significant decrease in the female death rate. Contraception choices would not lead to a significant decrease in mortality, as childbirth is not a common fatal event, although the number of perinatal deaths has not declined in recent years. And even with multiple choices in contraception, at least half of all pregnancies are unintended or mistimed. Access to fresh produce could improve many health conditions for women. Cancer is the second leading cause of death in women.

5. A 22-year-old woman presents to the emergency department with abdominal pain and vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness. Which action by the nurse takes priority? A. Assess the woman for sexually transmitted infections. B. Collect a urine sample for pregnancy testing. C. Obtain informed consent for a salpingectomy. D. Start two large-bore IVs for fluid replacement.

ANS: D This patient has both signs (hypotension, tachycardia) and symptoms (complaints of dizziness) of acute volume loss. The nurse should consider a ruptured ectopic pregnancy as a possible problem in this patient and assess her for other manifestations and risk factors. However, the priority is starting large-bore IV lines for fluid resuscitation. The nurse may need to obtain informed consent for an operative procedure once a definitive diagnosis is made.

The birthing center nurse is assisting with pain management for a laboring woman at 18 weeks' gestation. The fetus is born and the weight is 450 gm. The nurse would document this birth as which of the following?

Aboriton

The birthing center nurse caring for a 21-year-old laboring woman is given a report about the patient's cocaine use throughout pregnancy. This history prompts the labor nurse to assess for which condition?

Abruptio placentae

An adolescent is in the family practice clinic to obtain birth control. She began menstruating 4 days ago and wants the Depo-Provera injection because of the convenience associated with the method. What action by the nurse is best?

Administer the injection as prescribed.

A woman who is entering her third trimester complains of tingling and numb sensations that radiate up to the elbow in her dominant hand. Which action by the nurse is best?

Advise her to elevate her hands at night

The nurse manager on the high-risk OB unit has been told by an OB office nurse to prepare for a woman with a spinal cord injury (SCI) to deliver there. The woman wants to try a vaginal birth. What response by the nurse manager is best?

Assess the level of the woman's spinal cord injury.

A woman in the third trimester of her first pregnancy complains of excessive fatigue. Her hemoglobin is 11.2 g/dL. What action by the nurse is best?

Assess the woman's diet for adequate iron and protein.

A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Calling the doctor right away for dark, tarry stools B. Drinking at least one glass of orange juice a day C. Stopping the prenatal vitamins while taking iron D. Taking the medication between meals and with milk

B. Drinking at least one glass of orange juice a day Vitamin C enhances the absorption of iron, and a nonsmoking woman should be able to get sufficient iron from a glass of citrus juice daily. Iron tablets should be taken between meals, using a beverage other than tea, coffee, or milk. Dark, tarry stools are a known side effect of iron. Women on iron should also be on prenatal vitamins.

Which of the following women would the nurse advise to use a back-up contraceptive in addition to their birth control pills?

Being treated for tuberculosis

A woman has given birth to a child with a cleft lip. What action by the patient would best indicate that goals for the diagnosis of dysfunctional grieving have been at least partially met?

Birth announcements include photo and wording to explain cleft lip.

A 24-year-old pregnant woman at 26 weeks' gestation is experiencing her third pregnancy. The patient's obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate? A. "Can you ask your manager about light-duty work at your job?" B. "See if you can take more breaks at work to rest and drink water." C. "With your previous premature birth, you might need to reduce your working hours." D. "You can continue to work as long as you want to and feel able to."

C. "With your previous premature birth, you might need to reduce your working hours." Although many women do continue to work throughout their pregnancies, certain medical problems and pregnancy complications are a red flag for the woman to reduce her work hours. Examples of these conditions include back problems, preterm labor (both of which this woman has), diabetes, kidney disease, heart disease, hypertension, and a history of spontaneous abortion. Light duty may be an option in addition to decreasing the work hours. Taking more breaks might be advised as well, but with this woman's history and current health complaints she should consider decreasing her working hours. Other factors the nurse should discuss with the patient are the amount of heavy physical labor she does and her exposure to chemotherapeutic agents, both of which are possible environmental hazards to the pregnancy

The nursing instructor explains to a class that important effects of estrogen in the proliferative phase of the uterine cycle include which of the following?

Causes changes in cervical mucus to facilitate sperm penetration

A neonate whose mother is a drug addict is listless and sweating. What action by the nurse takes priority?

Check the baby's blood sugar.

A nurse is assessing a woman for TORCH infections. What diseases are included in this acronym? (Select all that apply.)

Cytomegalovirus Hepatitis B Toxoplasmosis Varicella zoster

A woman in her third trimester in complaining of constipation. Which instruction by the nurse is best?

Drink 8 glasses of water and increase your fiber daily

A student reviewing the anatomy and physiology of fetal circulation learns that fetal blood enters the aorta through which structure?

Ductus arteriosus

A pregnant woman in the perinatal clinic complains of a diffuse, reddish discoloration of her palms. What action by the nurse is most appropriate?

Explain that this is a normal finding.

Which hormone is responsible for regulating oogenesis?

Follicle-stimulating hormone (FSH)

A student has read that fetal development progresses in a cephalocaudal fashion and asks the faculty member for clarification. What explanation by the faculty member is best?

From head to feet

The nurse teaching a course in human reproduction informs the class that which reproductive structure is the first to form in the embryo?

Gonad

In providing anticipatory guidance to a 12-year-old female who has developed breast buds, what information should the nurse provide?

Growth of pubic hair will occur next.

A 17-year-old female is brought to the family practice clinic by her mother, who is worried that her daughter has not yet developed secondary sex characteristics. Which action by the nurse is best?

Inform them that the daughter will be tested for estrogen deficiency.

A patient inquires why ibuprofen (Motrin) and not acetaminophen (Tylenol) is usually prescribed for menstrual discomfort. Which response by the nurse is best?

Inhibits prostaglandins

A family planning nurse is working with an 18-year-old female who has been treated for gonorrhea in the past. In addition, the patient has a previous sexual partner who has tested positive for HIV. Which contraceptive method would probably work best for this patient?

Latex male condom

The nurse discussing fetal development describes the hormone responsible for suppressing the maternal immunological response to the fetus, thereby facilitating physiological acceptance of the pregnancy. Which hormone is the nurse describing?

Progesterone

The nurse has learned that which hormone is primarily responsible for maintaining a pregnancy?

Progresterone

A woman who is 22 weeks pregnant calls the clinic to report painless irregular contractions. Which action by the nurse is best?

Teaches the woman that this is a normal occurrence

1A pregnant woman in the perinatal clinic complains of occasional fainting. Which action by the nurse is best?

Tell her to lie down on her left side if she has warning signs.

A pregnant woman tells the perinatal nurse that she stopped abusing other drugs when she learned that she was pregnant but kept using marijuana because "it is so harmless." What response by the nurse is best?

Tell the mother that marijuana use can affect language and cognitive development.

A family practice nurse is providing anticipatory guidance to an 11-year-old boy. What information about puberty should the nurse plan to include?

The first sign of puberty is testicular enlargement.

A nurse is assessing a 40-year old primigravida who is an insulin-dependent diabetic and who smokes. What does the nurse understand about these conditions related to prenatal screening tests?

The woman will have an overall effect of a higher inhibin level.

A student asks the nurse why so many pregnant women get cholecystitis. Which response by the nurse is best?

"Inefficient emptying leads to stasis of bile and inflammation, or cholecystitis."

A woman is asking the family health nurse if she needs to use contraception while she is breastfeeding. Which response by the nurse is best?

"It can be very effective for a short time while you are exclusively nursing"

A couple has undergone prenatal testing and their fetus has an identified congenital anomaly. What action by the nurse is best?

"It is normal for both of you to be afraid, sad, or angry."

A new nurse is attempting to catheterize a female patient. The nurse has a difficult time and after three attempts, finally inserts the catheter into the bladder and has urine output. What suggestion by the more experienced nurse is best?

"Leave the incorrectly placed catheters where they are while inserting a fresh one."

A woman who is postmenopausal is in the clinic complaining of urinary incontinence and wants to know why this is occurring. Otherwise she has no other complaints. What response by the nurse is best?

"Low estrogen levels after menopause causes the urinary tissues to atrophy."

A woman complains of irregular menstrual periods and wonders if she is in perimenopause or menopause. Her laboratory work shows high levels of follicle-stimulating hormone (FSH) and low levels of estradiol. What response by the nurse is best?

"These laboratory findings usually indicate menopause or perimenopause."

A perimenopausal woman complains to the nurse about the new onset of urinary stress incontinence. Which statement by the nurse is best?

"This is probably related to decreased estrogen."

A nurse is assessing a couple who are in the clinic complaining of an inability to get pregnant. Which questions are most important at this time? (Select all that apply.)

-"Do you get up right after intercourse?" -"Do you know how to track your cycle?" -"How do you know when you ovulate?" -"What sexual positions do you use?"

A woman comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. Which of the following are appropriate statements by the nurse? (Select all that apply.)

-"Do you have questions before I begin your prenatal history and information sharing?" -"I am interested in hearing about your life and what prompted you to begin your prenatal care today." -"It is nice to meet you and I will try to help you get caught up in your prenatal care."

A woman in the OB clinic complains of multiple, fluid-filled blisters in her genital area that make walking extremely painful. What information should the nurse provide this patient? (Select all that apply.)

-"There are serious adverse fetal effects of this disease." -"There is no cure for herpes simplex virus infection."

A nurse is running for public office and plans to fund a comprehensive program to prevent teen pregnancy. When asked how to justify the cost of such a venture, what information could the nurse provide? (Select all that apply.)

-A quarter of teen mothers give birth to a second child within 2 years of the first child. -Fifty percent of teen mothers go on welfare within 5 years of the birth of their first child. -Only a small percentage of teen mothers will complete any education beyond high school. -The rate of teen pregnancy in America is double that of other developed countries.

The nurse teaches a patient the acronym "ACHES" for the serious symptoms that must be reported immediately when taking oral contraceptive pills. Which manifestations does this include? (Select all that apply.)

-Abdominal pain -Chest pain -Headaches -Eye pain

A nurse is instructing a man on the correct procedure for semen analysis. Which instructions should the nurse include? (Select all that apply.)

-Abstain for 2-3 days before collecting the sample. -Collect the sperm sample through masturbation. -Store the sample on your body during transport.

The nurse recognizes that a pregnant adolescent must successfully complete developmental tasks to be an effective mother. Which tasks does the nurse understand this to include? (Select all that apply.)

-Accepting this pregnancy and telling parents/friends -Growing up and accepting responsibility -Seeing herself as a mother -Setting reasonable goals for herself

The perinatal nurse explains to a student the different mechanisms by which substances are transported across the placenta. Which mechanisms are included? (Select all that apply.)

-Active diffusion -Bulk flow -Endocytosis -Pinocytosis

The perinatal nurse mentor teaches the new nurse about the functions of cervical mucus. What information should the nurse include? (Select all that apply.)

-Acts as a bacteriostatic agent -Provides a barrier to sperm during nonfertile phases -Provides an easy-flowing pathway during fertile phases -Forms an operculum to protect the pregnancy

A perinatal nurse is assessing a woman who is approximately 10 weeks pregnant. The woman smells like cigarette smoke. What actions by the nurse are best? (Select all that apply.)

-Advise her to stop smoking now so that the baby can be of normal weight. -Ask the woman if either she or her partner smokes. -Explain that nicotine deprives the fetus of oxygen.

A nursing instructor informs the class of the many benefits of prenatal care. What benefits does the instructor include? (Select all that apply.)

-Allows women informed decision making -Decreased pregnancy-related maternal death -Improved pregnancy outcomes -Increased early identification of abnormal findings

A nurse is teaching a group of middle school girls about the complications associated with teen pregnancy. What topics should the nurse include? (Select all that apply.)

-Anemia -Hypertensive problems -Preeclampsia -Preterm birth

The OB nurse knows the menstrual cycle is controlled by the complex interplay of hormones that are secreted by which physiological structures? (Select all that apply.)

-Anterior pituitary -Hypothalamus -Ovaries

A nurse is counseling a woman who wishes to undergo an elective medication abortion. The nurse should assess the woman for what psychosocial considerations? (Select all that apply.)

-Availability of a close friend who can stay with the woman -Feeling that medication pregnancy termination is a natural, less stressful process -Potential for trauma at seeing or handling the products of conception

A woman has decided to have an elective abortion. What information can the nurse provide to make the experience less stressful and to better prepare her? (Select all that apply.)

-Average waiting time to be seen -Cost and range of services provided -Potential for protesters to be present

The nurse provides increased support to a woman during her first prenatal visit for her current pregnancy. The patient's first pregnancy ended in a miscarriage. The nurse understands that the reasons the patient may be ambivalent about this baby include which of the following? (Select all that apply.)

-Awareness of a new 24-hour responsibility -Potential role/relationship changes -Previous perinatal loss -Unresolved grief and mourning

A nurse is counseling women about the lactational amenorrhea method of contraception. Which of the following women would the nurse advise to use another method of contraception if pregnancy is not desired? (Select all that apply.)

-Baby is 5 months old and started on cereals. -Baby is 8 months old; menses have not resumed.

A nurse is providing anticipatory guidance to a pregnant woman regarding normal changes in the nose and nasal passages. What information should the nurse provide? (Select all that apply.)

-Blow your nose gently. -Increase your fluid intake. -Stuffiness is common.

A nurse is planning an educational program for middle school boys focused on physical changes they can expect with puberty. Which topics should the nurse plan to include? (Select all that apply.)

-Changes in patterns of hair -Deepening of the voice -Growth spurt -Narrowing waist

A nurse is educating a woman who is 38 years old and experiencing her first pregnancy. When planning care for this woman, what information does the nurse take into consideration? (Select all that apply.)

-Chronic health conditions are more likely in this age group. -Gestational diabetes is seen more frequently in this age group. -Older primigravidas are at higher risk for cesarean birth.

A student nurse asks the OB clinic nurse why a pregnancy test is needed if a woman has missed several menstrual periods in a row. The nurse explains that amenorrhea can be caused by several conditions other than pregnancy, including which of the following? (Select all that apply.)

-Chronic illness -Endocrine disorders -Infections -Psychological factors

The nurse advocates for smoking cessation during pregnancy and teaches pregnant women about the effects of tobacco exposure. Which of the following are potential harmful effects of prenatal tobacco use that the nurse should plan to include in the teaching? (Select all that apply.)

-Continued childhood respiratory problems -Preterm labor and birth -Small-for-gestational-age infant

The family planning clinic nurse reviews the signs and symptoms of toxic shock syndrome (TSS) with a patient who is being fitted for a diaphragm. The nurse explains that the patient should promptly seek medical attention if she develops which of the following manifestations? (Select all that apply.)

-Develops a generalized red rash -Develops a fever over 101.1°F (38.4°C) -Feels lightheaded, is dizzy, or has chills

The nurse explains to a newly diagnosed pregnant woman at 10 weeks' gestation that her rubella titer indicates that she is not immune. Which of the following should the nurse teach the patient? (Select all that apply.)

-Do not become pregnant for 4 weeks after you receive the vaccination. -Receive the rubella vaccine during the postpartum period.

A pregnant woman had several urinary tract infections (UTIs) in her last pregnancy and wants to avoid them during this pregnancy. What advice by the nurse is best? (Select all that apply.)

-Drink 8 to 10 glasses of water daily. -Void every 2 to 3 hours while awake.

A patient is complaining of constipation. What teaching should the nurse plan to provide? (Select all that apply.)

-Drink 8 to 10 glasses of water each day. -Don't strain to move your bowels. -Increase your fiber intake.

A nurse is planning an educational seminar focused on changes associated with perimenopause and postmenopause. Which topics should the nurse plan to include? (Select all that apply.)

-Eating foods high in calcium -Getting plenty of rest and sleep -Keeping the room cool at night -Using vaginal lubricants

A nurse assesses the pregnant woman for recreational drug use as part of the first prenatal visit. What harmful effects of recreational drugs does the nurse teach the woman about? (Select all that apply.)

-Ecstasy: cleft palate -Marijuana: intrauterine growth restriction -Methamphetamine: spontaneous abortion

A pregnant woman in the perinatal clinic is a commercial sex worker and states that she frequently has unprotected sexual intercourse. The nurse should educate this woman about which complications of sexually transmitted diseases (STDs)? (Select all that apply.)

-Ectopic pregnancy -Preterm labor -Spontaneous abortion

Masters and Johnson described the four phases of human sexual response. Which phases did they include? (Select all that apply.)

-Excitement -Orgasm -Plateau -Resolution

A nurse is caring for a woman who is positive for hepatitis B. What other screening tests does the nurse facilitate for this patient? (Select all that apply.)

-Hepatitis B for household members -Hepatitis B for intimate contacts -Hepatitis C

The nurse is explaining to students in the perinatal clinic that some adolescents are at higher risk of teen pregnancy than others. Which teens does the nurse include in these high-risk groups? (Select all that apply.)

-Homeless teens -Incarcerated teens

In providing anticipatory guidance to a couple expecting their first child, which tasks and activities does the nurse discuss with the parents? (Select all that apply.)

-Honing communication and listening skills -Negotiating household roles and daily tasks -Reorganizing the house for a new member -Reviewing patterns of money management

A nurse is explaining contraceptive options to a young woman. What benefits of an IUD does the nurse describe? (Select all that apply.)

-No interference with spontaneity -No daily attention required -No hormonal side effects associated with the Copper T 380A -One-time expense

The perinatal nurse understands that the functions of the vagina include which of the following? (Select all that apply.)

-Produces lubrication for intercourse -Provides a receptacle for sperm -Serves as a lower portion of the birth canal -Stimulates the penis during intercourse

1. Match the types of play with their characteristics. _____ Assume roles in games; games have goals _____Playing with the same items, but not really playing together _____ Plays alone, no regard for those in the area _____ Play together, but little organization _____ Observes other children while playing alone a. Solitary play b. Onlooker play c. Parallel play d. Associative play e. Cooperative play

ANS: e, c, a, d, b There are five types of play: solitary play (child plays alone without regard for those around him or her), onlooker play (child observes others playing and may talk to them, may alter his or her own play, or may continue playing as he or she was doing), parallel play (playing with the same materials and items, but not playing together), associative play (play together in a peer group, but in a loosely organized manner), and cooperative play (assume roles in games, games have goals, and rely on each other to continue and progress).

23. A nurse working with a married couple notes that both parties seem to try to be dominant in their sessions. According to Bowen's family systems theory, which question asked by the nurse would yield the most useful information? A. "Are you each a first-born, middle child, or youngest sibling?" B. "How demonstrative were each of your parents when you were growing up?" C. "How many children were in each of your families?" D. "What socioeconomic classes did you both grow up in?"

ANS: A According to this family theory, birth order plays an important role in predicting certain patterns of behavior. Spouses who occupy the same birth order may have difficulty functioning together. In this case, both spouses probably are first-borns with a need for control. The other questions may yield helpful information as part of a thorough assessment, but are not related to this theory.

38. A nurse is preparing to dismiss a woman and her infant from the hospital. The woman is Rh(D)-negative and the infant is Rh(D)-positive. This was her first pregnancy. Which nursing action is most appropriate? A. Administer Rho(D) immune globulin (RhoGAM) and document accurately. B. Assess the father to see if he has ever received an injection of RhoGAM. C. Educate the woman on the need for RhoGAM if she delivers an Rh(D)-negative baby. D. Instruct the woman to get RhoGAM with her next pregnancy, not for this one.

ANS: A Administering RhoGAM correctly and documenting it is a critical nursing action when indicated. An unsensitized Rh(D)-negative woman should be given RhoGAM within 72 hours of delivery of an Rh(D)-positive baby. RhoGAM is not administered to the father or to the baby. If an Rh(D)-negative woman gives birth to an Rh(D)-negative baby, she does not need RhoGAM. The woman should be tested for sensitivity during her next, and all subsequent, pregnancies.

33. A patient in the high-risk OB unit has suffered a seizure and is now postictal. She is on oxygen at 2L/minute. Which assessment by the nurse warrants immediate intervention? A. Fetal heart rate is 98 beats/minute on electronic fetal monitor strip. B. Maternal oxygen saturation is 94% by pulse oximetry. C. Mother is sleeping soundly and is difficult to arouse. D. Mother's respiratory rate is 12 breaths/minute.

ANS: A After a seizure, all fetuses must be checked and accounted for. Fetal heart rate may show variability or bradycardia. A fetal heart rate of 98 is bradycardic, and the nurse should intervene immediately. Oxygen saturation of 94% is normal, a postictal patient will be drowsy and difficult to arouse, and a respiratory rate of 12 breaths/minute is normal.

33. A 17-year-old high school senior is resentful about caring for younger siblings so the parents can have a "date night" once every 2 weeks. The teen often "forgets" and schedules work or social activities that override the parents' plans. The parents are angry that the teen is so indifferent to their needs. What action by the family indicates that goals for the diagnosis of impaired family processes have been met? A. Parents and teen mutually plan date nights in advance. B. Parents consistently discipline teen for "forgetting." C. Teen acknowledges "forgetting" date night on purpose. D. Teen expresses feelings about being made to babysit.

ANS: A All the outcomes show some positive resolution, but the most optimal response is the parents and teen jointly planning the parents' nights out. This shows collaboration, communication, and mutual respect. In the end, everyone's needs are taken into consideration, and the teen will be more willing to adapt the current role to include watching the siblings. Consistent consequences delivered without anger is a hallmark of healthy discipline. The teen is taking responsibility when he or she acknowledges that the forgetting occurs on purpose. The lines of communication are open when the teen is allowed to verbalize feelings.

A new patient is being assessed by the perinatal nurse. For exercise, the woman practices yoga five times a week, walks her dog, and swims. What action should the nurse do first? A. Ask if any yoga positions involve arching the back. B. Explain that swimming is a great exercise for all women. C. Instruct the woman to stop exercising if she gets fatigued. D. Tell her that no extra water is needed if she is swimming.

A. Ask if any yoga positions involve arching the back Women should adhere to some basic safety guidelines when formulating an exercise program. These guidelines include monitoring the breathing rate; ensuring that the ability to walk and talk comfortably is maintained during the physical activity; stopping the exercise when tired; avoiding exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle; and maintaining an adequate fluid intake. Because yoga involves different positions, the nurse should assess whether the patient engages in positions that involve arching the back. Swimming is good exercise and she should stop exercising if she gets fatigued, but asking about positions involves an immediate possible threat to the safety of the fetus. Extra water is needed no matter what type of exercise is being done.

An expectant father seems to be ambivalent about the impending birth of his child. Which actions by the nurse are most important? (Select all that apply.) A. Ask the father if he has fears for his partner. B. Assess the woman for intimate partner violence (IPV). C. Call the social worker to assess the father's financial situation. D. Give the father written information about childbirth. E. Reassure the father that conflicting emotions are normal.

A. Ask the father if he has fears for his partner E. Reassure the father that conflicting emotions are normal Expectant fathers can experience fears and ambivalence about the woman's pregnancy. Some common concerns include fear for the woman's safety and health, financial concerns, and worry that he is not ready for this responsibility. The nurse should reassure the father that these feelings are normal and can further the discussion by assessing for these common emotions. There is no indication that either partner suffers from IPV, it is premature to call the social worker before a problem has been identified, and giving the father written information on childbirth may not address his concerns. In addition, the nurse should assess literacy prior to giving written information and should be prepared to discuss it.

18. A nurse is working with a patient who misses appointments frequently and doesn't always fill prescriptions for herself or her children. On reviewing the patient's chart, the nurse sees that the patient has insurance. What action by the nurse would be the most helpful? A. Ask the patient to describe her health insurance coverage. B. Educate the patient about the consequences of skipping medicines. C. Find out if the patient is seeing other health-care providers. D. Remind the patient that she is responsible for her children's health.

ANS: A An important factor in access to health care is insurance. Employer-provided plans are becoming more uncommon, and even those with insurance often have gaps in their coverage, which leads to missed appointments, unfilled prescriptions, and other services being underutilized. The other actions might be useful, although it probably will sound judgmental if the nurse merely tells the patient that she is responsible for her children's health.

22. A nurse ensures that a patient does not have questions regarding the upcoming surgical procedure and verifies that the signature on the consent form is the patient's signature. Which ethical principle is this nurse demonstrating? A. Autonomy B. Beneficence C. Fidelity D. Justice

ANS: A Autonomy is the right to make decisions and to have the information necessary to make such decisions. Beneficence is doing good. Fidelity is keeping promises. Justice is treating everyone fairly.

21. A nurse considers beneficence as the guiding ethical principle for nursing practice. Working within that framework, which action by the nurse best demonstrates that concept? A. Administering a pain medication before therapy so that the patient can participate B. Allowing the patient to make informed choices as to his or her plan of care C. Promising a pain medication in 1 hour and returning with it on time D. Turning patients to prevent pressure sores, despite causing temporary discomfort

ANS: A Beneficence means acting for the patient's benefit, or doing good. Giving a pain medication before a therapy session helps the patient fully participate, improving his or her recovery. Allowing the patient to make informed choices demonstrates autonomy. Returning when promised is an example of fidelity. Turning patients, even though it causes temporary discomfort, is non-maleficence.

3. A new mother with a 2-month-old daughter tells the family clinic nurse that she is experiencing a lack of sleep because of infant night feedings and her husband's shift work and excessive overtime. Which of the following is the best description of this family concern? A. Caregiver strain B. Coping stress C. Lack of support D. Parental maladaptation

ANS: A Caregiver strain occurs when the main caregiver becomes overwhelmed and feels "underhelped" regarding the tasks concerned with the care of the family member. In this situation, mounting bitterness and withdrawal from other family members may cause caregivers to push away any potential helpers.

2. The prenatal clinic nurse assesses a woman at 15 weeks' gestation. The patient's blood pressure, measured twice at intervals 1 hour apart with a cuff that fits appropriately, is 146/96 mm Hg. The nurse understands the patient has which condition? A. Chronic hypertension B. Gestational hypertension C. Preeclampsia D. Transient hypertension

ANS: A Chronic hypertension is defined as hypertension that is present and observable prior to pregnancy, or hypertension that is diagnosed before the 20th week of gestation. Hypertension is defined as a blood pressure greater than 140/90 mm Hg. Hypertension for which a diagnosis is confirmed for the first time during pregnancy and that persists beyond the 84th day postpartum is also classified as chronic hypertension. Gestational hypertension occurs after 28 weeks without proteinuria and is a temporary diagnosis used until more diagnostic testing can be accomplished. Preeclampsia is an increased blood pressure seen after 20 weeks' gestation accompanied by proteinuria. Transient hypertension describes women who develop gestational hypertension but have no preeclampsia and whose blood pressure returns to normal within 12 weeks postpartum. This diagnosis is used only after pregnancy.

29. A nurse is caring for a woman receiving continuous electronic fetal monitoring. Which action by the nurse is most important? A. Educate the woman and her partner about the importance of electronic fetal monitoring. B. Ensure clearly readable monitoring strips are placed in the patient's chart per protocol. C. Offer diversionary activities for the woman and partner while they are in the hospital. D. Restrict visitors in order to decrease the chance of being exposed to infectious illness.

ANS: B Fetal monitoring strips (along with other documentation) can show that the standard of care was met if questions arise. An important nursing responsibility in caring for women with electronic fetal monitoring is to ensure strips are clear enough to be interpreted and strips are placed in the patient's chart according to facility policy. Education and diversionary activities are important actions, but do not take priority over this legal responsibility. Restricting visitors may or may not be appropriate.

20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most appropriate? A. Ask if she knows how overweight she is. B. Assess the woman for stress-related problems. C. Caution her about related chronic illnesses. D. Encourage the woman to exercise more.

ANS: B In young adulthood, women especially begin to manifest stress-related disorders, including comfort eating. The nurse's best action is to assess the woman for this problem. The nurse can encourage her to exercise and can caution her about the relationship between poor nutrition and chronic illness, but if stress is causing the woman to overeat, she probably will not be able to make significant changes without addressing the cause. Asking the woman if she knows how heavy she is right now is disrespectful and will likely end the therapeutic relationship.

3. A nurse working with an after-school program is concerned about the lack of health literacy in the students' parents. What action would best address this need? A. Conduct a monthly health-related seminar for parents. B. Investigate grants or other funding for a computer bank. C. Invite parents to healthy cooking demonstrations. D. Provide brochures on a variety of health problems.

ANS: B The disparity between people who have access to technology and those who do not is directly related to health literacy and knowledge. The amount of information doubles every 6 years, so it is not possible to keep track of all the latest health news by accessing brochures, books, or periodicals. Having access to computers would greatly increase health literacy. The other options are certainly helpful, but would not be as far-reaching as providing access to online material.

45. A nurse manager on the OB unit is auditing patient charts. One record documents the care of a patient having a seizure. The record describes the time and length of the seizure, medications given, maternal and fetal vital signs, and outcome of treatment. Which action by the manager is best? A. Compare the chart with charts of similar patients. B. Educate the staff on better documentation practices. C. Have the nurse rewrite the documentation. D. No action is needed; continue with chart audits.

ANS: B The elements of complete documentation include what was charted plus associated symptoms, presence (or absence) of uterine contractions, and the presence of other obstetrical complications (e.g., rupture of membranes). The manager should educate all nurses in the unit about complete documentation needed for patients having a seizure. There is no need to compare this chart with others, and the nurse should not rewrite the documentation (although the nurse may need to use an addendum, depending on how old the record is).

24. A nurse has heard of the "digital divide" between people who have access to technology and those who don't. The nurse asks a mentor how this can affect health care. What response by the mentor is most accurate? A. "It's just easier and faster to make appointments online." B. "Much health-care information is available only digitally." C. "The so-called digital divide really doesn't have much impact." D. "You can chat with your doctor on social media sites."

ANS: B The explosion in information makes digital access to health-care resources vital. There are even applications for smart phones that have a health-care function. Not all clinics and physician offices have online appointment scheduling. Most people surveyed would like to connect with their physicians via email but not on social networking sites.

3. Which of the following does the nurse recognize as complications of premature birth? (Select all that apply.) A. Osteoporosis B. Cerebral palsy and mental retardation C. Diabetes mellitus type 1 D. Intraventricular hemorrhage E. Retinopathy of prematurity

ANS: B, D, E Some short-term neonatal morbidities associated with preterm birth include respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and patent ductus arteriosus. Long-term morbidities include cerebral palsy, mental retardation, and retinopathy of prematurity. Osteoporosis and diabetes are not known complications of premature birth.

4. A nurse is teaching a woman the actions to take in the event the woman believes she is in preterm labor. Which of the following should the nurse include in the teaching plan? (Select all that apply.) A. "Come to the hospital immediately if you don't feel contractions." B. "Drink 2 to 3 glasses of a non-caffeinated beverage after emptying your bladder." C. "Feel for uterine contractions for the next 2 to 3 hours." D. "Lie down on your back with pillows under your knees." E. "Seek additional health care if you have 4 or more contractions in 1 hour."

ANS: B, E The nurse should instruct the woman to empty her bladder, lie down on her side, drink 2 to 3 non-caffeinated beverages, feel for uterine contractions, and either go to the hospital or call the health-care provider if she feels 4 or more contractions in 1 hour. She should not lie down on her back or assess for contractions for over an hour.

13. A woman is being dismissed after undergoing placement of a cerclage. The woman is married with a husband who travels frequently and the couple has two other children. Which action by the nurse is most helpful? A. Arrange for the visiting nurse to administer IV antibiotics. B. Educate the woman on the need for strict bedrest. C. Enlist the services of a social worker to help her plan care for her other children. D. Teach the woman about the side effects of metachlopramide (Reglan).

ANS: C After cerclage placement, bedrest is necessary. It is often difficult for a woman to maintain bedrest, especially if she has other children. A social worker can be helpful in assisting the woman to make contact with support organizations and in developing a working plan to care for the other children and household obligations. IV antibiotics are not routinely needed. Education on bedrest is important, but without acknowledging and acting on the profound disruptions that it can cause for a family, education alone is likely to be unsuccessful in promoting bedrest. Metachlopramide is used for nausea.

44. A nurse is caring for a pregnant woman on the high-risk OB unit who is anticipating a long stay on bedrest. Which action by the nurse would be most helpful to help diminish the physical complications associated with imposed bedrest? A. Arrange a social work consult for coping assessment. B. Assess and document the woman's skin each shift. C. Consult physical therapy for in-bed exercises. D. Help the woman select high-protein foods from the menu.

ANS: C All activities are appropriate for a woman who is confined to bed prior to childbirth. However, to mitigate the possible physical complications from bedrest, encouraging activity and exercise to her limits is desirable. A physical therapist can design an exercise routine the patient can do in bed. A coping assessment would help with psychosocial complications. Assessing and documenting skin condition does not diminish complications. Nutrition is important and selecting appropriate foods is helpful, but the major complications from bedrest occur in the cardiovascular system.

4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age? A. 1 month B. 2 months C. 3 months D. 4 months

ANS: C At 3 months, infants begin to roll over from the stomach to the back and to turn toward loud sounds. These activities can pose a safety hazard related to the changing tables used for changing diapers, and parents should be told to keep a hand on their infant at all times.

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best? A. Compliment the mother on her parenting skills. B. Document that the baby is eating finger foods now. C. Stop the mother from feeding the hot dog to the baby. D. Teach the mother that hot dogs are poor nutrition.

ANS: C At this age, examples of appropriate finger foods include small pieces of lightly toasted bagel, small pieces of ripe bananas, well-cooked pasta, teething crackers, and low-sugar "O" shaped cereal. Protein sources such as meat should be pureed to avoid choking. The nurse should gently stop the mother from feeding the hot dog to the baby. Hot dogs are not the most nutritional food, but safety comes first, so this is not the best answer. Documentation is always important but can be done later. The nurse should find something to compliment the mother on to help establish a trusting relationship.

17. A pregnant patient in the second trimester is in the emergency department after a motor vehicle crash. She has a severe laceration of her arm resulting in a large blood loss. Which assessment should the nurse perform first? A. Blood pressure B. Fetal heart tones C. Pulse D. Respiratory rate

ANS: C Because a woman's blood volume can increase dramatically during pregnancy, blood pressure is an unreliable indicator of a volume deficit. Maternal pulse and fetal heart rate are much more accurate indicators. Because the priority in care of the pregnant trauma patient is care of the mother, the nurse should assess the mother's blood pressure first.

3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her? A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age

ANS: C Between 8 and 11 years of age, children begin to focus on their own development and to contrast it with their friends' development. At this time, parents should begin to educate their children about the names and functions of the male and female sexual organs, puberty, the menstrual cycle, sexual intercourse, pregnancy, pregnancy prevention, same-sex relationships, masturbation, and the spread of sexually transmitted infections, and encourage dialogue about personal expectations and values regarding sexual activity.

41. A pregnant woman who has diabetes mellitus is in the high-risk OB clinic for a checkup. The nurse notes that her hemoglobin A1C (HbAIC) is 5%. Which action by the nurse is most appropriate? A. Arrange a referral to the diabetic nurse educator. B. Assess for factors leading to noncompliance. C. Document the findings in the patient's chart. D. Schedule another HbAIC in 4 weeks.

ANS: C Control of maternal glucose levels (7.0% in overtly diabetic women) is an important factor in determining fetal outcome. The glycosylated hemoglobin A1c (HbA1c) level is commonly assessed to guide adjustments in the treatment plan throughout pregnancy. Because the maternal serum HbA1c reflects the degree of glycemic control during the preceding 5 to 6 weeks, the test is repeated every trimester. Good diabetic control is reflected by an HbA1c value of 2.5% to 5.9%; an HbA1c value greater than 8% is indicative of poor diabetic control. Because the patient's value indicates good control, the most appropriate action is documentation. The patient may need to see the diabetic nurse educator, depending on other nursing assessments or patient desire.

The perinatal nurse explains to a childbirth class that which of the following are the primary functions of the placenta? (Select all that apply.)

-Protects the fetus from pathogens -Provides hormones that maintain the pregnancy -Removes waste products from the fetus -Transfers nutrients to the fetus

What information does the nurse understand about the labia minora? (Select all that apply.)

-Provide lubrication and protective bacteriocidal secretions -Resemble mucous membrane and do not have hair follicles

The nurse schedules a patient for her first prenatal appointment with the certified nurse-midwife (CNM) in the clinic. About what topics does the nurse help the patient formulate questions to ask the CNM? (Select all that apply.)

-The CNM's beliefs and practices concerning epidural anesthesia and episiotomies -Use of complementary and alternative methods during labor and birth -What happens if the patient gives birth when the CNM is not available -Whether the CNM will be available by phone or Internet to answer questions

A teenager is asking questions about her hymen. Which of the following are correct responses by the nurse? (Select all that apply.)

-The hymen can widen or perforate with tampon use, vulvar injury, or intercourse. -It is a small portion of tissue around the vaginal opening in young girls.

Match the hormones and their functions. a. Gonadotropin-releasing hormone 1. ____ Controls the development and function of the adrenal cortexb. Somatostatin 2. _____ Stimulates the maturation of the mammary glands during pregnancyc. Adrenocorticotropic hormone 3. _____ Regulates thyroid hormonesd. Oxytocin 4. _____ Also known as growth hormone-inhibiting hormone; inhibits the release of growth hormonee. Prolactin 5. Among other things, it is responsible for developing muscle mass and protein synthesisf. Corticotropin-releasing hormone 6. _____ Appears to provide a protective action by minimizing a maternal immunological rejection that could cause miscarriageg. Thyrotropin-releasing hormone 7. _____ Stimulates the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitaryh. Growth hormone 8. _____ Stimulates uterine contractions and the release of milk from milk ducts during lactation

1:c; 2: e; 3: g; 4:b; 5:h; 6: f; 7:a; 8:dGonadotropin-releasing hormone stimulates the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. Somatostatin is also known as growth hormone- inhibiting hormone; it inhibits the release of growth hormone. Adrenocorticotropic hormone controls the development and function of the adrenal cortex. Oxytocin stimulates uterine contractions and the release of milk from milk ducts during lactation. Prolactin stimulates the maturation of the mammary glands during pregnancy. Corticotropin-releasing hormone appears to provide a protective action by minimizing a maternal immunological rejection that could cause miscarriage. Thyrotropin-releasing hormone regulates thyroid hormones. Growth hormone is responsible for developing muscle mass and protein synthesis, among other things.

Match each TORCH disease with its possible effects on the newborn or characteristics. Diseases may be used more than once or not at all. a. Toxoplasmosis 1. _____ Without intervention, maternal transmission to the fetus is about 25%b. Rubella 2. _____ The most common viral infection in the fetusc. Cytomegalovirus 3. _____ Bullae, microcephaly, hydrencephaly, and encephalitis can occurd. Herpes simplex virus 4. _____ No known risks if infection occurs after 20 weeks' gestatione. Human immunodeficiency virus (HIV) 5. _____ Late manifestations include keratitis, snuffles, deafness, and bowing of the shinsf. Varicella zoster virus 6. _____ Symptoms in the mother seem to be "flu-like"g. Syphilis 7. _____ Maternal infection in the first trimester can lead to spontaneous abortion8._____Maternal infection during the first trimester leads to a 20% chance of fetal infection

1e, 2c, 3d, 4f, 5g, 6a, 7c, 8b Toxoplasmosis has symptoms often referred to as "flu-like." Maternal infection with rubella in the first trimester leads to a 20% chance of the fetus being infected. Cytomegalovirus is the most common viral infection in the fetus, and spontaneous abortion may result from maternal CMV infection in the first trimester. Herpes simplex infection leads to manifestations such as bullae, microcephaly, hydrencepahly, and encephalitis. Without medical intervention, vertical (maternal-to-child) transmission of HIV is about 25%. Varicella zoster virus carries no known risk to the fetus after 20 weeks' gestation. Late syphilis symptoms include keratitis, snuffles, deafness, and bowing of the shins.

A perinatal clinic nurse educated a pregnant woman about basic prenatal exercises. On a return visit, which statement by the patient indicates that teaching goals have been met? A. "I have learned to isolate the right muscle for Kegel exercises." B. "It's hard to find 30 minutes a day for exercise, but I have done it." C. "Jumping rope is great exercise and keeps my weight in control." D. "When I get fatigued with these exercises, I just push through it."

A. "I have learned to isolate the right muscle for Kegel exercises." Kegel exercises are among the basic prenatal exercises taught to all pregnant women. In order to do them correctly, the woman needs to learn to isolate the pubococcygeal (PC) muscle. Women can obtain benefits from exercising as little as 10 minutes a day; jumping rope should be avoided because it involves too much bouncing; and when the pregnant woman is fatigued, she should rest.

A nurse is conducting a class on the Lamaze method of childbirth. Which core values does this nurse plan to teach? (Select all that apply.) A. A woman's ability to give birth can be diminished by the care provider. B. Conscious breathing is the main coping strategy in Lamaze. C. Lamaze birthing is medication free and epidurals are not given. D. The birth coach is only present to provide comfort to the laboring woman. E. Women are capable of and have the wisdom to give birth.

A. A woman's ability to give birth can be diminished by the care provider. B. Conscious breathing is the main coping strategy in Lamaze. E. Women are capable of and have the wisdom to give birth. The woman's innate ability to give birth, the use of conscious breathing as the main coping strategy, and the fact that the woman's confidence and ability to give birth can be either enhanced or diminished by the care provider and place of birth are some of the core concepts of the Lamaze method. Lamaze educators provide information on pain control and stress that each woman needs to make the decision about pain management that is best for her. Birth partners are taught to assess the woman for hyperventilation during the transition period of labor.

The nurse teaches the prenatal class attendees about herbal medications that may cause uterine contractions and preterm labor. Which of the following herbal preparations should be avoided because they act as uterine stimulants? (Select all that apply.) A. Black cohosh B. Dong quai C. Ephedra D. Mugwort E. Senna

A. Black cohosh D. Mugwort During preconception counseling and pregnancy, nurses should educate couples to avoid the following common uterine stimulants that may cause preterm labor: barberry, black cohosh, feverfew, goldenseal, mugwort, pennyroyal leaf, and yarrow root. Dong quai is an anticoagulant, ephedra is a cardiac stimulant, and senna can overstimulate digestion and metabolism, causing fluid and electrolyte imbalances.

A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit. Which statement by the patient would indicate that teaching objectives for this problem have been met? A. "I have been supporting my uterus with a pillow when resting." B. "I have been trying all sorts of over-the-counter medications." C. "I haven't had any black, tarry stools at all since I was here." D. "That black cohosh has really helped with my abdominal pain."

A. I have been supporting my uterus with a pillow when resting Round ligament pain is a common discomfort of pregnancy and the nurse can teach self-care measures such as supporting the uterus with a pillow when resting, warm baths, applying heat, and wearing a pregnancy girdle. Pregnant women should be taught to avoid all medications (both prescription and over the counter) without consulting with their health-care provider. Black, tarry stools are not related to round ligament pain. Black cohosh is a uterine stimulant and should be avoided during pregnancy.

A nurse is reviewing a patient's chart and finds the following documentation: a 28 year old woman complains of nausea and vomiting, breast tenderness, and frequent urination. A physical exam reveals a positive hegar's and chadwick's signs. The nurse interprets these findings as?

All probable signs of pregnancy

Match each term with its definition or description. a. Autosome 1. _____ Large female chromosomeb. X chromosome 2. _____ Gene pair in which the gene pairs are differentc. Y chromosome 3. _____ Genetic makeup of an individuald. Homozygous 4. _____ Observable expression of a person's genotypee. Heterozygous 5. _____ Non-sex chromosome common to both males and femalesf. Genotype 6. _____ Smaller male chromosomeg. Genome 7. _____ Gene pair in which both genes are identicalh. Phenotype 8. _____ Complete set of genes present in a person

An autosome is a non-sex chromosome common to both males and females. The X chromosome is the larger female chromosome, whereas the Y chromosome is the smaller male chromosome. Homozygous gene pairs have identical genes, whereas heterozygous gene pairs have differing genes. A genotype is the genetic makeup of an individual. The genome is the complete set of genes present in each person. The phenotype is the observable genetic differences expressing a person's genotype, such as hair and eye color.

The prenatal nurse has reviewed a patient's 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog, chips, and an apple for lunch. Breakfast consists of cereal, milk, and juice; and dinner contains meat, a starch, vegetables, and a salad. What action by the nurse is most important? . A. Advise the woman to obtain more calories from protein. B. Assess the woman's knowledge of proper food handling. C. Discuss adding fish such as tuna or swordfish to the diet. D. Weigh the woman and document her weight in the chart.

B. Assess the woman's knowledge of proper food handling Pregnant women should be taught proper food handling to prevent foodborne illnesses. Deli meats, hot dogs, and luncheon meats should be stored at 40° or less, heated before eating, and consumed within 4 days. Tuna should be eaten in moderation and fish such as shark, swordfish, king mackerel, and tilefish should be avoided in pregnancy because of mercury poisoning. Promoting safety is a priority. The woman may or may not need more calories from protein. Obtaining the patient's weight and documentation are important prenatal activities, but are not the best answer because the nurse needs to assess the woman's knowledge and practice of safe food handling first.

A woman admitted in labor asks if she can have a doula present with her. The nurse understands that a doula is which of the following? A. A massage therapist with a specialty in labor massage B. A trained labor coach standing in for the woman's partner C. A woman who is experienced in labor and provides support to the woman D. Someone who is trained and licensed to deliver babies in the hospital

C. A woman who is experienced in labor and provides support to the woman A doula is a woman who is experienced in childbirth and who provides physical and emotional support to the mother during labor, birth, and the postpartum period. A doula is not a massage therapist, nor a trained labor coach, and a doula is not licensed to deliver babies.

A nurse is helping a pregnant woman prepare for a planned home birth. What action by the nurse takes priority? A. Advising the woman to get a prescription for pain medication filled beforehand B. Attempting to convince the woman that giving birth at the hospital is a better choice C. Ensuring the woman has safe, rapid, and available transportation to a nearby hospital D. Giving the woman a list of local obstetricians who will assist at a home birth

C. Ensuring the woman has safe, rapid, and available transportation to a nearby hospital Home births are an option for women who have low-risk pregnancies and no labor complications. However, according to a position statement by the American College of Obstetrics and Gynecology (ACOG), women who choose to deliver at home should be well- informed and should ensure access to rapid and timely transportation to the closest hospital in case of emergency (ACOG, 2011). Obstetricians will not deliver babies at home. Although pain management may be an important consideration, this is not as important as ensuring the safety of both mother and baby. Trying to convince the woman to go against her beliefs is disrespectful

A pregnant woman in her third trimester presents to the emergency department after fainting upon rising from a supine position. Which activity should the nurse perform first? A. Call the cardiology department for an EKG. B. Determine the fetal heart rate. C. Obtain a blood glucose reading. D. Teach her to rise slowly from a reclining position

C. Obtain a blood glucose reading Supine hypotension is caused by the pressure of the enlarging uterus on the inferior vena cava while the woman is in a supine position. Vena caval compression impedes venous blood flow, reduces the amount of blood in the heart, and decreases cardiac output, causing dizziness and syncope. Pathological causes of supine hypotension include cardiac or respiratory disorders, anemia, hypoglycemia, dehydration, anxiety, and stress. Hypoglycemia can be treated rapidly if that is the cause. The other actions are appropriate as well, but the priority action would be to identify a condition that is readily treatable

The nurse working in a family practice clinic assesses women for sexual dysfunction. Which woman would the nurse assess as having a sexual dysfunction?

Complains about lack of arousal but still has intercourse

Which patient would the perinatal nurse assess as being most at risk for maternal attachment problems? A. 18 year-old married woman with a supportive family who lives nearby B. 20-year-old woman with remote history of chlamydia and gonorrhea C. 22-year-old alcoholic who has been sober for 10 years D. 52-year-old unemployed divorced woman who thought she was in menopause

D. 52 year old unemployed divorced woman who thought she was in menopause Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors (Youngkin et al., 2012). The nurse should assess for indicators such as unintended pregnancy, intimate partner violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, and the presence of mental conditions that might interfere with the patient's ability to bond with and care for the infant. The divorced, unemployed woman experiencing an unexpected pregnancy has the most risk factors.

The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting, fatigue, and weight gain. Which action by the nurse is most appropriate? A. Ask the woman's health-care provider to prescribe the man anti-nausea medication. B. Assess for cancer risk factors, as weight gain and vomiting are unusual together. C. Encourage the man to make an appointment with his primary health-care provider. D. Explain that these symptoms are normal and often seen in men with pregnant partners.

D. Explain that these symptoms are normal and often seen in men with pregnant partners Couvade syndrome is when a male partner experiences the same maternal signs and symptoms as the woman. The nurse should reassure the man that this is an often-occurring finding. The nurse would not need to encourage the man to make an appointment with his health-care provider unless the symptoms became severe. The woman's primary health-care provider does not need to prescribe anti-emetics, nor does the nurse need to assess the man further for cancer risk factors.

An expectant couple complains of dyspareunia. Which action by the nurse is best? A. Assess the woman's family history and genetic background. B. Explain that this condition is a normal finding during pregnancy. C. Instruct the couple that sex during pregnancy is not advised. D. Suggest sexual positions that might be more comfortable.

D. Suggest sexual positions that might be more comfortable Dyspareunia is painful intercourse that may result from pelvic congestion and impaired circulation caused by the enlarging uterus during pregnancy. The nurse should reassure the couple that having sex during pregnancy is acceptable (unless there are medical reasons to contraindicate it) and suggest positions for sex that might be more comfortable for the woman. There is no reason to assess the woman's family history and genetic background. Simply explaining that dyspareunia is normal is dismissive of the couple's concern, although they should be reassured that this does sometimes happen and then they should be offered education on ways to alleviate it.

A perinatal nurse is assessing a pregnant woman's medications and finds that one of them is categorized as Category D. What information should the nurse provide this patient? A. "Studies have not found human fetal risk, although animal fetuses are harmed by it." B. "There are no associated fetal risks with this drug and it is safe to take in pregnancy." C. "There haven't been any studies of this drug in human fetuses; I wouldn't take it." D. "We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus."

D. We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus There are five categories of drugs based on fetal risk: Category A: no associated fetal risk, safe to take during pregnancy; Category B: no associated fetal risk in animals, fetal risk in humans not identified; Category C: evidence of adverse effects in animal fetuses, fetal risk in humans not identified; Category D: evidence of adverse effects and fetal risk in humans, benefits and risks must be considered before prescribing; and Category X: evidence of fetal risk and congenital anomalies in humans, risks outweigh the benefits, should not be prescribed during pregnancy.

A nurse is assessing a pregnant woman who says she drinks 5 to 7 alcoholic drinks per week. What action by the nurse is best?

Explain that during pregnancy, alcohol in any amount can harm the fetus.

A pregnant woman in her first trimester is having her first prenatal visit. She tells the nurse that she takes red raspberry leaf regularly. What response by the nurse is best?

Explain that it is safe to use during pregnancy.

A woman undergoing her first prenatal visit for a current pregnancy is reluctant to discuss her past obstetrical history with the nurse. Which action by the nurse is best?

Explain that past obstetrical experiences frequently recur in later pregnancies.

An obstetrical nurse is taking a medication history from a pregnant woman. One of the woman's medications is classified as category D. What action by the nurse is best?

Have her call her primary care provider immediately.

A nurse is examining a patient's Skene's glands. What action is best to visualize these structures?

Pull the urethral margins apart.

A woman who gave birth 2 months ago calls the perinatal clinic crying because her hair is falling out in large amounts. What action by the nurse is most appropriate?

Reassure the woman that her hair will grow back within a year.

A woman calls the clinic to ask about taking a home pregnancy test because she has missed her last period by 2 weeks. The nurse advises her to use a home pregnancy test?

That is specific to the beta subunit of hCG

A pediatric nurse has assessed a 13-year-old girl and notices that she is in thelarche. What situation does this term refer to?

The appearence of breast buds

A nurse is planning to teach a prenatal class on the Dick-Read method of childbirth. Which information should the nurse plan to include?A. After birth, the newborn is placed in a tub of warm water.B. Consciously controlled breathing is the main coping strategy.C. Relaxation is vital because pain is caused by fear and tension.D. The Dick-Read method means a totally medication-free birth.

The founder of the Dick-Read method of childbirth was convinced that the pain associated with labor and birth was caused by tension and fear. These conditions stimulate the woman's sympathetic nervous system, decrease blood flow to the uterus, and lead to uterine hypoxia. Relaxation restores the blood flow. Placing the baby in a warm tub of water is a component of the LeBoyer method; consciously controlled breathing as the main coping strategy is part of the Lamaze method; and although Dick-Read did not advocate for the use of pain medication, he did approve it when the woman was unable to relax or was experiencing complications.

A faculty member explains the Human Genome Project to a class of nursing students. Which information about this project is correct?

The goal is to identify exact DNA sequences and genes occurring in humans.

Match the pelvic types with their descriptions. Pelvic types may be used more than once. a. Gynecoid _____ Best suited for childbirthb. Android _____ Fetal descent more likely to be in a posterior presentationc. Anthropoid _____Fetal descent is often in a transverse presentationd. Platypelloid _____ Triangular or heart-shaped_____ Only found in 3% of women_____ Traditional form found in about 50% of women_____Oval shaped at the inlet but in the anterior-posterior plane_____ Characteristics cause difficulty during fetal descent

a, c, d, b, d, a, c, bThe gynecoid pelvis is the typical female pelvis best suited for vaginal delivery. The android pelvis is triangular (or heart-shaped) and the shape can cause difficulty during fetal descent. The anthropoid pelvis is more likely to result in a posterior fetal presentation due to its oval shape at the inlet that is in the anterior-posterior plane. The platypelloid pelvis usually prevents vaginal delivery owing to the fetus descending in a transverse presentation.

44. A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test? A. At age 19 B. At age 21 C. Before sexual activity D. No specific age

ANS: B Women should have their first Pap test at age 21.

A preterm infant is jittery and has an oxygen saturation of 88%. After stabilizing the newborn, what action by the nurse is most important?

Assess the mother for opioid use during pregnancy.

A nursing instructor is planning to teach students about the process of oogenesis. Which information does the nurse plan to include?

It is regulated by follicle-stimulating hormone (FSH).

A woman who is 10 weeks pregnant is being counseled by the nurse regarding her upcoming elective abortion. What information should the nurse provide?

"They may use a seaweed product to dilate your cervix."

A pregnant woman has the nursing diagnosis of risk for ineffective role performance. What statement by the patient indicates that she is meeting a maternal task associated with the second trimester?

"This baby seems so real to me since I feel him move."

A nurse working with a couple in the infertility clinic notes the diagnosis of cryptorchidism on the man's chart. What assessment question by the nurse is most important?

"Did you have surgery for your undescended testes?"

A nurse working in the infertility clinic counsels a couple about male fertility. What assessment question to a male by the nurse would yield the most important information?

"Do you wear boxer shorts or briefs?"

A 14-year-old girl asks the school nurse why her periods are so irregular. What is the best response by the nurse?

"Estrogen levels are still pretty low."

A nurse is counseling a couple about fertility prior to the husband beginning chemotherapy for cancer. The couple wish to delay childbirth until the husband is in remission. What information from the nurse is most accurate?

"Have you considered cryopreservation of your sperm?"

A patient has been taught about her Depo-Provera contraceptive injection. Which statement by the patient indicates that education has not been effective?

"I can become pregnant right after stopping the shots."

A nurse has taught a woman about the physical signs that accompany ovulation. Which statement by the patient indicates that teaching has been effective?

"I can still conceive for up to 48 hours after ovulation."

A woman who was recently fitted for a diaphragm is in the clinic for a follow-up visit. Which statement by the patient indicates that teaching was effective?

"I leave the diaphragm in place for 6 hours after intercourse."

A woman is in the clinic for a checkup 4 weeks after elective surgical abortion and has the nursing diagnosis of spiritual distress related to discrepancy between religious beliefs and reproductive choices. Which statement by the patient indicates that goals for this diagnosis have been met?

"I talked to my minister and feel better about my choice."

A pregnant woman is complaining of frequent heartburn. What statement by the patient indicates to the nurse that teaching has been effective?

"I will not lie down for 1 hour after eating."

A woman who desires a second-trimester medical abortion has been educated about the procedure, side effects, and follow-up. What statement by the patient indicates that additional teaching is needed?

"If I get a fever with chills, I should go to the emergency department."

A patient has been taught about the vaginal contraceptive ring. Which statement by the patient indicates that further teaching is needed?

"If it comes out at all, I need back-up contraception for a week."

A 26-year-old woman has come for preconception counseling and asks about caring for her cat, because she has heard that she "should not touch the cat during pregnancy." Which of the following is the nurse's best response?

"If someone else changes the litter box you should be okay."

A patient who is 28 weeks pregnant calls the obstetrical clinic and complains of irregular, painless contractions that last for 10 to 15 seconds. What response by the nurse is best?

"If they last more than 60 seconds or become regular, come in."

A woman in the prenatal clinical is concerned because her partner, who was supportive and excited about becoming pregnant, has suddenly become more withdrawn and seems ambivalent toward the pregnancy. What response by the nurse is best?

"This is a normal reaction to the reality of the pregnancy."

A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease, but don't know how the child got it, as neither of them is affected. What response by the nurse is best?

"This is a recessive disorder, meaning that each of you is just a carrier."

A woman calls the prenatal clinic to inquire if she should have the seasonal influenza vaccination. What advice should the nurse provide?

"Yes, you should get the flu vaccination."

A woman sustained a moderate blow to the lower pelvic region in an occupational accident. She is surprised to find out that no bones were broken. What explanation by the nurse is best?

"You have a fat pad in front of your pelvis."

32. A nurse is working with a family that has the nursing diagnosis of altered family processes. When formulating goals, whom does the nurse include? A. Entire family B. No one else C. Parents D. Physician

ANS: A The most effective goals are those that include the entire family. The entire family agrees upon the goals and commits to working on them.

The perinatal nurse would assess which newborn system as a priority after birth if a woman admitted to cocaine use during her pregnancy? A. Cardiovascular system B. Endocrine system C. Integumentary system D. Respiratory system

A. Cardiovascular system Although it is difficult to assess for complications from cocaine because of the likelihood of multi-drug abuse, common complications seen from its use include congenital abnormalities in the skull, brain, face, eyes, intestines, heart, limbs, genitals, and urinary tract.

A nurse is educating a pregnant woman who has a history of pica about healthier eating. Which nutrients should the nurse include in the teaching plan? (Select all that apply.) A. Calcium B. Folic acid C. Iron D. Vitamin C E. Vitamin D

A. Calcium C. Iron D. Vitamin C E. Vitamin D Specific nutritional deficiencies associated with pica include deficiencies in iron, calcium zinc, thiamine, niacin, vitamin C, and vitamin D.

1. Match the terms on the left with the statements on the right. Answers may be used once, more than once, or not at all. a. Placenta previa b. Abruptio placentae c. Vasa previa 1. _____ Can be described as complete, partial, or marginal 2. _____ Condition in which the umbilical cord is implanted in the membranes rather than in the placenta 3. _____ May be associated with previous cesarean birth 4. _____ One risk factor is closely spaced pregnancies 5. _____ Premature separation of the normally implanted placenta from the lining of the uterus 6. _____ Can resolve as the uterus enlarges in the third trimester 7. _____ Maternal abdominal trauma is one risk factor 8. _____ Classic sign is vaginal bleeding and severe abdominal pain in the third trimester

ANS: 1. a, 2. c, 3. a, 4. a, 5. b, 6. a, 7. b, 8. b

2. Match each description with the correct disorder. Disorders may be used more than once. Descriptions may have more than one answer. 1. _____Rectum presses into vagina 2. _____Symptoms include constipation 3. _____ Bladder herniates into vagina 4. _____Difficulty completing a bowel movement 5. _____ Damaged muscles appear higher in the colon 6. _____ Symptoms include difficulty in voiding, incontinence, and dyspareunia a. Cystocele b. Rectocele c. Enterocele

ANS: 1: b; 2: b, c; 3: a; 4: b, c; 5: c; 6: a

43. A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations? A. Annual screening after age 40 B. MRI to replace mammography C. No routine screening after age 65 D. Periodic screening if high risk

ANS: A Breast cancer screening is the subject of controversy. The American College of Obstetricians and Gynecologists (ACOG) recommends annual screening with mammography and clinical breast examinations every year starting at age 40.

4. A patient describes her spouse's dependence on oxycodone terephthalate (Percocet), which began following knee surgery last year. Although the prescription was finished some time ago, the spouse continues to obtain and take Percocet. Because of the spouse's "need" for the medication, the patient "has to" do all the yard work, child care, and meal preparation. How would the nurse describe the patient's behavior? A. Enabler B. Impaired caregiver C. Inadequate dyad partner D. Overstressed parent

ANS: A An enabler is a common role in families with addictions. The enabler makes excuses for the addicted person's behavior. The patient's behavior allows the spouse to continue with the addiction without being held accountable.

9. A patient tells the nurse about living in a commune. What does the nurse understand about this family structure? A. Family with distant relatives included B. Group of men, women, and children C. Kinship care provided to children D. Unmarried man and woman living together

ANS: B A commune is a group of men, women, and children all living together. Families with relatives beyond the nuclear family are called extended families. Kinship care provided to children constitutes a no-parent family. An unmarried man and woman living together is called cohabitation.

14. The nurse manager in a perinatal clinic is reviewing research related to care of patients with cervical insufficiency and preterm birth. What practice change might result from this review of the literature? A. Administering fewer doses of Rho(D) immune globulin (RhoGAM) B. Decreased utilization of cerclage placement in women with preterm labor C. Measuring serial cervical lengths in all women pregnant with singletons D. Providing betamethasone (Celestone) as long-term therapy

ANS: B According to a meta-analysis by Berghella and Mackeen (2011), singleton gestations in women with prior preterm birth might be monitored safely with transvaginal ultrasound cervical length screening, and they suggested that cerclage placement be reserved for the minority of women who actually develop a short cervical length. Administration of RhoGAM is not related. Only women with a history of preterm birth need cervical length measurement according to current practice. Celestone is not used for long-term therapy.

40. An immigrant family is working with a nurse on improving family dynamics. The nurse notes that the teenage children do not subscribe to their parent's social and cultural mores and identify more with their native-born American friends. What description of the children is most accurate to record in the family's chart? A. Acculturated B. Assimilated C. Disconnected D. Lost children

ANS: B Assimilation is the process whereby a family or individual loses its unique cultural identity and identifies more with the dominant culture. The teens appear to be assimilated. Acculturation is the changes in cultural patterns within a group to match those of the host society. Connectedness relates to with whom the family identifies and relates as a family unit. Lost children are often seen in substance-abusing families.

25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil vaccination. After giving the shot, what instruction does the nurse provide to her? A. Return in 1 month for the next shot. B. Return in 2 months for the next shot. C. Return in 6 months for the next shot. D. Return in 1 year for the next shot.

ANS: B Gardasil is given in a series of three injections. The second shot is 2 months after the first. The third shot is 6 months after the first. The other options are incorrect.

28. A pregnant patient is brought to the emergency department after a roll-over motor vehicle crash. After assessing and stabilizing the patient's airway, breathing, and circulation, which of the following actions should the nurse perform next? A. Assess the woman for further injuries. B. Attach continuous fetal monitoring leads. C. Determine the date of the patient's last tetanus booster. D. Prepare to transfer the woman to the delivery suite.

ANS: B Maternal trauma accounts for about 50% of fetal deaths. Seemingly minor injuries to the woman may cause serious injury or death to the fetus. Because the fetal heart rate is one of the first signs to change in fetal distress, all pregnant trauma patients need continuous fetal monitoring. Assessing the woman for further injuries and determining the date of the woman's last tetanus booster are both appropriate actions; however, they do not take priority over fetal monitoring. The woman may or may not need to be transferred to the delivery suite.

18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for violence. Which statement by a participant indicates understanding? A. "Friends of mine have said they would be willing to help in a crisis." B. "If good communication doesn't solve the problem, I will leave." C. "If we can't settle our differences, we will have to start talking all over again." D. "My mother can help my boyfriend and me resolve a conflict."

ANS: B Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message.

40. The nurse notes that a patient's chart contains the results of an MMSE. What can the nurse surmise about this patient? A. Behind on recommended immunizations B. Concerns about cognitive functioning C. Tracking changes in bone density D. Worried about cardiovascular health

ANS: B The MMSE (Mini-Mental State Examination) is a screening test for cognitive function. The other options are not related.

23. A 45-year-old woman presents to the emergency department complaining of chest pain and feeling anxious. She asks to have an electrocardiogram (EKG) but is told that "heart disease is a man's disease" and is given a prescription for lorazepam (Ativan). What can the nurse conclude? A. If the woman were older, she may have received an EKG. B. Sex hormones play a powerful role in determining heart disease. C. Stereotyping seriously impacted the care the woman received. D. Women under the age of 45 are at low risk of having heart disease.

ANS: C A stereotype is a mental image that portrays members of a specific group with the same attributes. Believing that heart disease is a "man's disease" is an example of a stereotype. Because the practitioner held this view, the woman's health care was compromised. The other statements cannot be justified from this example.

11. A nurse is working with family members who have been striving to improve their functioning as a family unit. What behavior would suggest to the nurse that the family is meeting its goals? A. The children are in multiple activities to develop talents. B. The desire to be understood guides most communication. C. Family members gave up some activities in order to eat dinner together on most nights. D. The parents have a strong desire for the children to succeed.

ANS: C Effective tools for families include ways to enhance family performance. One very effective tool is to put the family first in this very chaotic world. Giving up some activities in order to eat dinner together shows the family is putting the unit as a whole first over individual desires. This is the opposite of children being in multiple activities, which often cuts into family time and can be disruptive. Communication should be guided by the desire to understand the other first, then to be understood. A strong desire for the children's success does not guarantee successful family functioning.

38. A nurse is working with an older adult who has never exercised despite understanding the health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen? A. Ask the patient if dancing sounds like fun. B. Encourage the patient to join a fitness club. C. Explain how exercise increases independence. D. Have the family talk with the patient about it.

ANS: C Maintaining physical fitness in later years contributes to health, well-being, and independence. If the patient already understands the health benefits of exercising, asking about dancing and joining fitness clubs is not likely to get the desired response. However, if the nurse can show the patient how being physically fit may mean more years of independent living, the patient might be willing to make some small changes. Asking the family to talk with the patient is not showing the nurse in action.

14. A nurse enjoys working with patients who have chronic illnesses. What group of people would this nurse enjoy working with most? A. Ethnic minorities B. Men and boys C. Older adults D. Women and girls

ANS: C The older adult population is growing steadily and rapidly and will have a huge impact on health care in the future, due to the prevalence of chronic illness in this group. Chronic illness occurs in all groups, but for the older adult population, it is a special concern.

7. The nurse observes a woman and her sister who live together. They are trying to support one another and provide extended care to their mother who has recently been diagnosed with Alzheimer's disease. The two sisters describe their experience with a homemaker who visits their home to help bathe their mother. They say she is "humorous and cheerful" and absorbs their mother's attention for the whole time she is present. This is a positive description of which component of Bowen's family systems theory? A. Communication B. Family relationship building C. Family rituals D. Triangulation

ANS: D According to Bowen, triangulation occurs when a dyad (the sisters) focuses on a third person who draws attention away from their conflicts. The homemaker is serving this function in this family. Bowen's theory looks at family problems that are rooted in family processes, such as communication. Relationship building and rituals are not part of this theory.

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide? A. Brush the baby's teeth with special baby toothpaste. B. The child should see a dentist before the age of 2. C. All teeth should be in by age 2. D. Wipe the baby's gums with moist gauze.

ANS: D Dental hygiene should be started early. Even before a child has teeth, the gums can be wiped with a damp cloth or gauze. Toothpaste cannot be used before age 2 (because of the risks associated with swallowing it). A dentist should examine a baby's teeth within 6 months of the eruption of the first tooth, but no later than the first birthday. Children should have all 20 primary teeth by the third birthday.

27. A new nurse is caring for a woman previously diagnosed with preeclampsia who was admitted to the high-risk OB unit after suffering a seizure in the perinatal clinic. The new nurse is preparing to administer a dose of magnesium sulfate (Sulfamag). Which action by the nurse warrants intervention by the unit manager? A. Explains to the patient that her vital signs and EKG will be monitored frequently B. Piggybacks the Sulfamag into a main line using an infusion pump C. Places 10% calcium gluconate in a secure location in the patient's room D. Runs the Sulfamag as the main IV line through an infusion pump

ANS: D Magnesium sulfate should be infused on an infusion pump piggybacked into the main line, not as the primary IV line. The other actions are appropriate.

39. An older patient has never exercised, but wants to begin now. What response by the nurse is best? A. "At your age, exercise will not benefit you." B. "Good for you! I am so proud of you!" C. "Remember to stretch before exercising." D. "Start with exercising for only 5 minutes a day."

ANS: D Older adults who are beginning to exercise for the first time in their lives (or for the first time in a long time) should begin with only 5 minutes per day. Exercise is beneficial at any age. Reminders about stretching and praising the patient are also good options, but safety comes first.

16. A nurse is working with a parent-teacher association to combat school bullying. What action can the nurse suggest that would best help to decrease this form of interpersonal violence? A. Advise that victims' parents call law enforcement and press charges. B. Begin offering martial arts classes in the school for bullied children. C. Encourage the school to adopt no-tolerance policies for bullying. D. Suggest limiting television viewing, especially for younger children.

ANS: D Some research has shown that violent media exposure is linked to violent behavior. Included in media are computer games, which can also be violent. Younger children may not be able to distinguish between real and fantasy and may be overly influenced by violent images. No-tolerance policies can be helpful, as can a social environment in which children and their parents are held accountable legally. Offering martial arts classes may send the wrong message and would most likely not diminish the incidence of bullying.

8. A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticity E. Vaginal dryness

ANS: D, E Physical changes in the older woman that increase susceptibility to HIV infection include loss of vaginal elasticity and vaginal dryness. Increased promiscuity is not a physical factor (and is not known to be a characteristic of the older adult). Mild isotonic dehydration is often seen in older adults, but is not related. Vaginal pH is not related.

A patient being seen for the first time in the perinatal clinic has multiple complaints, such as fatigue, anger outbursts, chronic pelvic pain, and feelings of anxiety. What action by the nurse is best?

Assess the woman for a history of sexual assault.

The clinic nurse talks with a patient about her possible pregnancy. The patient has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. She is convinced she is pregnant and is reluctant to pay for a pregnancy test. Which action by the nurse is best?

Explain that these symptoms can be caused by other conditions.

A patient in the emergency department is complaining of fever, burning with urination, bloody urine, and amenorrhea for 1 month. To evaluate her symptoms, what action by the nurse is best?

Instruct her in obtaining a midstream urine sample.

A nurse is teaching a class about gender maturation. What information is most accurate?

It is a lengthy process that spans from the embryonic stage through puberty.

A student asks the faculty member to explain why the fetus has such a low PO2. What explanation by the faculty member is most accurate?

It keeps the ductus arteriosus open.

The nurse explains to the student that the development of the lining of the uterus is mediated by which hormone?

Progesterone

The perinatal nurse knows that which of the following hormones is most responsible for maintaining pregnancy?

Progesterone

A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nurse recommends an oral contraceptive formulated with which ingredients?

Progestin only

A nurse is teaching a prenatal class about placental development and functions. Which information about the placenta is best?

Provides oxygenation nutrition, hormones, and waste removal

A woman who is 22 weeks pregnant calls the clinic worried that her last hCG test had a lower level than the results from her initial prenatal visit. Which response by the nurse is best?

Reassure the woman that this is a normal finding

A young woman is being educated on the risks related to er contraceptive sponge. What symptom should the nurse advise the patient to report immediately?

Sudden onset of fever over 101.1*F (38.4*C)

A 40-year old primigravida has undergone nuchal translucency screening. The results show a finding of 3.3 mm. What information should the nurse provide the parents?

The fetus has an increased risk for genetic disorders.

A couple has been told that there is a problem with their pregnancy. They only remember the term "ductus venosus." The nurse explains that there is a problem in the circulation between which two structures?

Umbilical cord and inferior vena cava

A nurse works with many women who self-identify as lesbian or bisexual. What action by the nurse would best address this population's needs?

Using questions that do not assume sexual orientation

An infertility clinic nurse explains to the student that the process of sperm washing has several benefits. Which benefits should the nurse explain to the student? (Select all that apply.)

-Improves chances of fertilization -Increases sperm motility -May correct sperm clumping

A nurse is teaching a couple about the postcoital test. What information should the nurse provide about the test? (Select all that apply.)

-It assesses the quality and quantity of cervical mucus at ovulation. -It assesses the quality of sperm function at the time of ovulation. -The woman should return to the clinic 6 to 12 hours after intercourse.

An 18-year-old woman at 18 weeks' gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurse's best approach to care at this visit? A. Ask the patient to complete a 3-day dietary recall while she is in the clinic. B. Explain the possible concerns related to excessive weight gain in pregnancy C. Explain to the patient that weight gain is not a concern in pregnancy. D. Teach the patient about the expected normal weight gain during pregnancy.

A. Ask the patient to complete a 3-day dietary recall while she is in the clinic This woman has gained much more than the average weight gain in the first trimester (1-2.5 kg). Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. The nurse should facilitate this process while the woman is at her appointment. After assessment and mutually planning nutritional goals, the nurse can educate the woman about the possible concerns related to excessive weight gain and teach about the normal trajectory of weight gain during pregnancy. This series of actions follows the nursing process best.

A woman in her second trimester continues to smoke a pack of cigarettes a day despite stating that she understands why smoking is bad for her and for her fetus. Which action by the nurse is best? A. Assess the patient for past trauma and abuse. B. Document the information in the patient's chart. C. Review prior teaching done regarding smoking. D. Show photos of babies born with abnormalities.

A. Assess the patient for past trauma and abuse Research shows that women who continue to smoke during pregnancy often report high levels of trauma and abuse and higher levels of PTSD symptoms. Women who smoke as a coping mechanism are even more likely to smoke during pregnancy (Lopez, Konrath, & Seng, 2011). The nurse should assess for these factors. Documentation is important, but is not the best answer because the nurse does not do anything to assist the patient; documentation alone is the answer only when the data are normal. Reviewing prior teaching may be helpful, but if the nurse does not help the patient address the core issue of smoking, this review will be unhelpful and a waste of time. Showing babies born with abnormalities is demeaning and could be interpreted as threatening.

A woman in her third trimester is complaining of numbness and tingling in her fingers. Which action should the nurse take first? A. Assess the woman for hyperventilation. B. Educate her about a thermoskin carpal tunnel glove. C. Facilitate an appointment for a nerve conduction study. D. Reassure her that the condition is temporary

A. Assess the woman for hyperventilation Carpal tunnel syndrome is commonly seen in pregnancy and can be caused by either hyperventilation or from nerve compression of the median and ulnar nerves in the arm. If the woman is hyperventilating, the nurse can educate her about conscious control of breathing, which would provide relief quickly and easily. If hyperventilation does not seem to be the causative factor, the nurse can educate her about strategies for symptom control. These methods include maintaining good posture, elevating the hands on pillows when sleeping, wearing a wrist brace, and/or using a thermoskin carpal tunnel glove. Simply reassuring the woman that the condition is temporary does nothing to increase her comfort. A nerve conduction study is not needed at this time, but if the condition persists after childbirth, it could be an option.

A nurse is explaining childbirth education choices to an expectant couple. The nurse explains that although each method is different, all methods emphasize some similar concepts. Which concepts does the nurse describe as similar across different methodologies? (Select all that apply.) A. Biological B. Financial C. Psychosocial D. Relational E. Social

A. Biological C. Psychosocial E. Social Although they are different, all childbirth preparation classes incorporate a holistic approach to childbearing, which encompasses the biological, psychological, and social factors related to the experience.

30. A nurse working with a pregnant woman who is a recent immigrant to the United States notes that her husband rarely accompanies her to prenatal visits, and when he does, he sits in the waiting room. What action by the nurse is best? A. Ask the patient what role men in her culture play in pregnancy. B. Ask the woman why her husband doesn't seem involved. C. Encourage the man to participate in order to support his wife. D. Research the couple's cultural background and health beliefs.

ANS: A Culture affects the roles family members assume during times of illness, pregnancy and childbirth, and death. The best option is to ask the woman what role men in her culture play during pregnancy and childbirth. This can open a discussion of how the woman is coping and if she is getting enough support, either from her mate or friends and family. Asking why the man doesn't seem involved is judgmental. Encouraging the man to participate may not be desired by the woman and may be seen as an intrusion by the man. The nurse could research the culture but this would not lead to a discussion until the next visit. It is also important to be aware that there are variations in how people of the same culture behave and believe.

26. A woman who is 28 weeks pregnant is admitted to the high-risk OB unit with preterm premature rupture of the membranes. Four hours after admission, the nurse notes the following: temperature: 38.5°C (101.5°F), maternal pulse: 122 beats/minute, and white blood cell count: 23,000 mm3. Which action by the nurse takes priority? A. Document the findings and notify the health-care provider. B. Facilitate fern testing or Nitrazine testing on vaginal fluid. C. Prepare to administer a prn dose of acetaminophen (Tylenol). D. Reassure the woman that these are expected findings.

ANS: A Delivery for a woman with premature rupture of membranes should be accomplished immediately for signs of maternal infection, advanced labor, vaginal bleeding, or nonreassuring fetal signs. This patient's vital signs and WBC indicate infection. The nurse should document the findings and notify the health-care provider so that arrangements can proceed. Fern testing or Nitrazine testing is done to help diagnose rupture of the membranes and is not needed at this time. Giving acetaminophen at this time is not a priority and may be contraindicated if the woman needs to be placed on NPO status.

16. A nurse has admitted a patient with hyperemesis gravidarum and is reviewing the physician's orders. Which order should the nurse question? A. Betamethasone (Celestone) 100 mg IV every 8 hours B. Dimenhydrinate (Dramamine) 75 mg rectally every 4-6 hours C. Metoclopramide (Reglan) 10 mg IV every 8 hours D. Promethazine (Phenergan) 25 mg IV every 4 hours

ANS: A Dimenhydrinate, metoclopramide, promethazine, and pyridoxine are all used to treat nausea and vomiting of pregnancy. Betamethasone is used to decrease the chance of respiratory distress syndrome in premature infants. It is given in 2 doses, 12 hours apart, at a dose of 12 mg.

4. A nurse is caring for a patient near the end of life whose wishes regarding care are not known. The two sons disagreed with the two daughters about future medical plans for the patient during a recent family conference, and now the sons and daughters are not talking to one another. What action by the nurse would be best to help resolve this dilemma? A. Call the facility's ethics committee and request a formal consultation. B. Have social work coordinate another family meeting to discuss the issue. C. Meet with the sons and daughters separately to discuss their wishes. D. Request that the physician tell the family what is in the patient's best interests.

ANS: A Ethical principles in health care are often in conflict, and it takes a skilled person to negotiate and mediate these situations. Ethics committees exist in most health-care facilities that are experienced in confronting these difficult situations. The best response would be for the nurse to request a consultation from the ethics committee. Another family meeting may not work, as the family already disagrees and tensions are high. The other options may be helpful, but are not as vital as a formal ethics committee consultation. Meeting privately with the sons and daughters might give the nurse some insight into their positions, but would not be as effective as utilizing the expertise on the committee. The physician should not decide what is in the patient's best interests, as this is paternalistic and violates the principle of autonomy.

6. The nurse managing a pediatric clinic often sees single mothers with children. What action by the nurse would best help this population of women access health care? A. Arrange to have evening and weekend hours. B. Offer sample medications instead of prescriptions. C. Provide a play center for waiting children. D. Provide bus tokens for transportation to the clinic.

ANS: A Single mothers with children constitute 82% of the poverty population. "Welfare to work" programs are now compulsory, and women must work in order to receive aid. Offering evening and weekend hours could accommodate more women who cannot afford to miss time off from work. The other options might be helpful for some patients and families, but to have the greatest impact on the largest group of people, accommodating work schedules is important for this population of women.

12. A practicing nurse tells a student nurse that beyond the World Health Organization's definition of health, providers must also consider which of the following factors when determining the health of a community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention

ANS: A The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration.

24. A woman at 32 weeks' gestation is admitted to the high-risk OB unit with a diagnosis of preterm labor. On assessment the nurse finds the following: blood pressure, 182/96 mm Hg; pulse, 106 beats/minute; respirations, 16 breaths/minute; regular uterine contractions of 5 in 10 minutes; and fetal heart rate of 145 beats/minute. She is dilated to 8 cm. Which action by the nurse is best? A. Administer the ordered dose of betamethasone (Celestone). B. Call for an immediate electrocardiogram (EKG). C. Document the findings and prepare for emergent delivery. D. Prepare to administer magnesium sulfate (Sulfamag).

ANS: A The administration of antenatal corticosteroids (betamethasone) is the most beneficial intervention for improvement of neonatal outcomes among women who give birth preterm. A single course of corticosteroids is recommended for pregnant women between 24 and 34 weeks of gestation who are at risk of preterm delivery within 7 days. Although the woman is mildly tachycardic, there is no need for an EKG without further information. There is no indication that delivery is imminent. Magnesium sulfate is a tocolytic drug used to stop labor, but it is contraindicated in women with advanced cervical dilation.

4. A 17-year-old girl comes to the health department clinic to renew her oral contraceptive pills. During the physical examination, the nurse observes that the girl has broken blood vessels on her face and her lips are cracked and chapped and her fingers are callused. What further actions will the nurse perform? (Select all that apply.) A. A weight assessment B. Assessment for depression C. Draw blood for electrolytes D. Discussion about anorexia nervosa E. Discussion about bulimia

ANS: A, B, C, E Bulimia nervosa is a syndrome that consists of a cycle of binge eating and purging. Physically, the adolescent with bulimia nervosa may exhibit physical changes related to forced, excessive vomiting: cracked and damaged lips, tooth damage, callused fingers and hands, and broken blood vessels in the face. Other findings that may not be readily apparent include throat irritation, esophageal inflammation, and parotitis from vomiting, as well as rectal bleeding from overuse of laxatives. Bulimia is also associated with depression. The nurse should assess the teen's weight, screen her for depression, draw blood for electrolyte imbalances, and discuss bulimia.

3. A nurse working in the community understands that health is often affected by social stressors. Which of the following are examples of societal pressures having a negative impact on the health of today's families? (Select all that apply.) A. Economic trends affecting access to health care B. Increased HIV/AIDS in women and children C. Loss of resources in public schools D. Restricted health-care access for adult males E. Violence and increased teen suicides

ANS: A, B, C, E Many social pressures have negative effects on the health of our families. Some of these trends include the economic situation, HIV and AIDS in women and children who are vulnerable due to barriers to health care, a loss of resources in schools, and an increase in all types of violence. As a group, adult males do not have restricted access to health care.

2. A community health nurse is packing a kit of play items for the families who will be visited today. One family has an infant and a preschooler. Which toys should the nurse include in the kit? (Select all that apply.) A. Blocks B. Coloring books C. Ride-on train D. Simple board game E. Stuffed animals

ANS: A, B, D An infant is in the stage of solitary play. Appropriate toys include blocks, books, rattles, push-pull toys, and musical toys. The preschooler is in the stage of associative play. Appropriate toys for this child include imitative games, simple arts and crafts, simple board games, interactive games, alphabet or color games, coloring and drawing, and simple computer games. The ride-on train and the stuffed animals are more appropriate for a toddler.

11. The perinatal nurse describes risk factors for placenta previa to the student nurse. Which of the following risk factors does the nurse include? (Select all that apply.) A. Cocaine use B. Previous cesarean birth C. Previous use of medroxyprogesterone (Depo-Provera) D. Tobacco use E. Young maternal age

ANS: A, B, D Placenta previa may be associated with conditions that cause scarring of the uterus such as prior cesarean birth, multiparity, or increased maternal age. Placenta previa may also occur with a large placental mass, as seen in multiple gestations and erythroblastosis. Other risk factors for placenta previa include smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years (Clark, 2004).

3. A nurse is preparing to educate a group of parents about injury prevention in adolescents. Which topics should the nurse plan to include as priorities? (Select all that apply.) A. Bicycle safety B. Gun safety C. Home safety D. Driving safety E. Water safety

ANS: A, B, D, E In adolescents, the most common causes of injury are motor vehicle crashes, bicycles (includes skateboarding and skating), firearms, and water activities. Home safety, although always important, is a topic more appropriate to families with younger children.

14. A nurse has helped organize and staff a free vaccination clinic for underserved populations in a central location of the city. The nurse is unhappy that so few people came to the clinic. In evaluating this outcome, what factors does the nurse recognize as potentially leading to the problem? (Select all that apply.) A. Clinic hours B. Inability to miss work C. Lack of insurance D. Lack of transportation E. Language barriers

ANS: A, B, D, E Underserved, typically poor, populations face multiple obstacles to obtaining health care that need to be considered when organizing events. If the clinic hours were during the day, parents might be reluctant to pull children out of school for fear of being labeled as truant. Parents participating in "welfare to work" programs or who have low-skill, low-wage jobs might not be able to miss work, or would forfeit pay by doing so. Participants need transportation to the clinic, which is located in one area of town. Language barriers could lead to confusion or misunderstanding or lack of awareness of the clinic. The lack of insurance shouldn't be a concern because the vaccinations are free, but it is possible this was a point that some misunderstood.

9. The nurse working with older women knows that risk factors for osteoporosis include which of the following? (Select all that apply.) A. Asian ethnicity B. Excessive consumption of caffeine C. Large frame D. Regular physical activity E. Cigarette smoking

ANS: A, B, E Risk factors for osteoporosis can be found in Box 4-9 and include Asian (and Caucasian) ethnicity, excessive caffeine or alcohol use, and smoking. A small frame, not a large one, is a risk factor due to decreased stress on the bones. Regular activity (particularly weight-bearing exercise) is a preventative factor.

4. A nurse using family systems theory to work with patients and their families would do which of the following? A. Assess how school, work, and church impact the family. B. Describe the developmental stage the family is in. C. Determine if there are any family secrets or taboos. D. Listen to how information is shared with providers. E. Observe how family members interact with each other.

ANS: A, C, D, E Family systems theory considers family boundaries (how the family interacts with the outside world) and looks at interaction among all the members, as the family unit itself is considered more important than the individuals within it. Boundaries can also be assessed in part by determining if there are family secrets or taboos (closed boundaries) or if information is shared too freely (open boundaries). Developmental stages of the family are not considered in family systems theory, but are part of Duvall's family developmental stages and theory.

2. The nurse explains to the student that television and movies have often portrayed families in certain ways, depending on the decade. Which of the following statements about this trend are correct? (Select all that apply.) A. 1950s-1960s: nuclear family, simple issues, father dominated B. 1960s-1970s: extended families, lower income, divorced parents C. 1980s-1990s: exploring social issues, stressed family closeness D. 1990s: single parents, social issues including poverty and abuse E. New millennium: alternative family structures, extended family

ANS: A, C, D, E In the 1950s and 1960s, families were father-dominated and nuclear in structure and shows focused on problems that were simple and easily solved. In the 1960s and 1970s, the trend was toward blended families (with widowhood being the reason for remarriage) that were mostly in an upper-income bracket. In the 1980s and 1990s, social issues such as class and politics became popular. The shows may not have shown resolution of the problem at hand, but emphasized the closeness of the family unit. In the 1990s, shows brought increased awareness of the challenges facing families dealing with a host of problems such as alcoholism, poverty, and abuse. In the new millennium, shows present alternative and extended family formats.

8. A mother brings her 6-month-old infant and 18-month-old child to the health clinic for a routine visit. The nurse counsels the mother about lead exposure testing. Which information should the nurse include? (Select all that apply.) A. "About one-fourth of all homes where kids under 6 live are contaminated by lead." B. "Both of your children should have testing for lead at this time." C. "Lead exposure may cause anemia, seizures, and mental retardation if not treated." D. "Lead testing for children is recommended by the American Academy of Pediatrics." E. "We can test your older child for lead exposure, but it is too early for the 6-month-old."

ANS: A, C, D, E The American Academy of Pediatrics recommends that all children between the ages of 1 and 2 years receive testing for lead exposure, as 25% of homes presently occupied by children under the age of 6 have known lead contamination. Lead exposure has been linked to a number of medical and developmental problems, including anemia, seizures, and mental retardation.

13. A nurse is working with a patient determined to have low health literacy and has taught the patient vital self-care measures for a chronic illness. How will the nurse best determine if the patient has understood the information? (Select all that apply.) A. Ask for a return demonstration of the skills taught. B. Assess if the patient will take brochures written for this illness. C. Encourage the patient to explain how the information fits into his or her daily life. D. Give the patient a written quiz at the end of the teaching session. E. Have the patient repeat the information in her or his own words.

ANS: A, C, E Communicating with people who have low health literacy can be challenging. Some strategies the nurse can employ are: specific training, asking open-ended questions, asking patients to restate information or provide a return demonstration of skills, using plain and culturally sensitive language, and developing health information tailored to specific populations. To assess for cultural congruency, the nurse can ask the patient to explain how the self-care measures fit into the patient's life. Simply giving the patient brochures does not guarantee that the patient understands or will use them, or even whether the patient can read. Giving a quiz might be seen as intimidating.

5. What does the nursing student understand about health disparities in the United States? (Select all that apply.) A. African American babies die by age 1 at a rate times that of European Americans. B. Asian American babies have the highest rate of preterm birth of any other group. C. Despite large expenditures, health resources are unevenly distributed. D. European Americans have double the number of low-birth-weight babies than other groups. E. Sudden infant death syndrome is most prevalent in American Indian and Alaska native babies.

ANS: A, C, E Many health disparities exist in America, despite huge outlays of money. A major problem is that health resources are not distributed evenly across demographic and geographic groups. This leads to such problems as the high rate at which African American babies die before age 1, and the high incidence of sudden infant death syndrome in American Indian and Alaska Native populations. Asian American babies do not have the highest rate of preterm birth, and European American women do not have double the number of low-birth-weight babies of other groups.

5. The clinic nurse talks with parents about the signs and symptoms of substance use because their 12-year-old twins will be attending a new school in the fall and they wish to be prepared. The nurse correctly describes the potential symptoms of substance abuse, including which of the following? (Select all that apply.) A. Chronic cough B. Euphoria C. Irritability D. Nausea and vomiting E. Red and glazed eyes

ANS: A, C, E There are many warning signs to alert parents to adolescent substance abuse. Physical signs include fatigue, red and glazed eyes, chronic cough, and health complaints. Emotional signs include personality changes, sudden mood swings, irritability, poor judgment and decision making, depression, and lack of interest in things that were of previous interest.

1. A nurse is explaining to a student why it is so important to consider the entire family as the patient. What explanation for this is best? (Select all that apply.) A. Families are a rich source of information and support. B. Families will have to take over the caregiving role at home. C. If they are not included, families tend to interfere in care. D. The patient has to reintegrate into the family upon discharge. E. The patient's background context includes the family.

ANS: A, D, E The patient's family should be welcomed into nursing experiences. The family is a rich source of support and information about the patient. The patient will have to reintegrate into the family upon discharge. The patient's family represents the context from which he or she comes. Families may or may not have to assume the caregiving role. It is stereotypical to assume that families will interfere in patient care.

5. The nurse using developmental theory offers anticipatory guidance on preventing injuries to the family of a preschooler. What concepts guide this information? A. Coordination lagging behind activity B. Development of personal values and ethics C. Impact of friends and peer group D. Poor judgment about safety risks E. Toddler's increasing physical abilities

ANS: A, D, E The toddler is in a stage where rapid physical development occurs but coordination and judgment are lagging behind. Thus the toddler is prone to accidents and injury. The nurse should offer anticipatory guidance so the parents can keep their child safe. Development of personal values and ethics occurs in the school-age and adolescent stage. Impact of peer group increases in this stage as well.

A woman's birth plan specifies the Odent method of childbirth. Early in her admission, the woman asks about having an epidural for pain control. Which action by the nurse is best?A. Advise the woman that this will change her birth planB. Ask why she wants pain control with natural childbirthC. Facilitate having the epidural catheter placedD. Review the breathing techniques for managing pain

ANS: AThe Odent method involves the woman's giving birth in a warm water bath. Not every woman is a candidate for this method, including women who have rupture of the membranes or other complications that require continuous fetal monitoring. Epidural anesthesia requires continuous fetal monitoring, so if she chooses an epidural, she will not be able to use the Odent method. The nurse should advise her of this so that the woman is well informed before making a final decision. Asking why she wants pain control sounds judgmental. Breathing techniques are the primary method of coping with pain in the Lamaze method. If the woman decides to go ahead with the epidural, then by all means the nurse should facilitate its placement.

17. A patient has been dismissed from the hospital after a serious illness and needs several weeks of home care and rehabilitation. When the visiting nurse comes to the house, it is apparent that the family is not functioning. The house is dirty, there is little food available, and one parent and an older child are arguing about picking up a younger sibling from school. What action by the nurse is most appropriate? A. Ask the parents if they need financial resources for the basic necessities. B. Assess each family member for the roles he or she plays in the family. C. Contact child protective services or social work to assess the home environment. D. Provide referrals for family and couples counseling in the community.

ANS: B According to structural-functional theory, each person in a family unit occupies a specific role. Sometimes roles are shared. A problem can occur when one member of the family is unable to fill his or her role and no one else is doing it. That appears to be the situation here. The nurse should assess what roles each family member plays and assist them to see how they can fulfill the role formerly held by the patient. The family may need financial resources if the patient was the breadwinner. There is no need to conduct an environmental assessment, as it does not appear that any family member is in danger. The family may or may not need counseling at this time.

29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily.

ANS: B Alcohol intake, smoking, and weight maintenance all affect breast health. However, this woman's highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

15. A nurse would like to improve the health of the community. Which action by the nurse would have the greatest impact? A. Blood glucose screening at the local Korean church B. Blood pressure screening at a predominantly black church C. Teaching immigrants heart-healthy cooking for traditional foods D. Teaching men the signs and symptoms of heart attacks

ANS: B Although all activities are good nursing interventions for specific communities, more than half of black women aged 45-64 years have hypertension, so a blood pressure screening at a predominantly black church could have the greatest impact.

17. A school nurse is preparing educational activities for all high school students on reproductive health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate? A. Argue that abstinence-only programs do not work and are not valuable. B. Discuss the need to have information appropriate to the teens' experience. C. Plan the program but encourage questions not related to the prepared material. D. Prepare an abstinence-only program because teens should not have sex.

ANS: B Education on sexual health should take into consideration the age and sexual experience of the audience. For teens who have not yet had sexual intercourse, an abstinence-only program might make sense. However, if the teens have already engaged in sexual intercourse, they are likely to continue this behavior, and the program should focus on using condoms in order to avoid unprotected sex and its risks. Abstinence-only programs cannot be characterized as being of no value. Encouraging teens to ask questions off the prepared topic is a passive-aggressive action. It is not up to the nurse to decide if teens should have sex or not.

10. A nurse is assessing a child with very poor social skills. What conclusion can the nurse make about the child's family? A. Emotional or mental illness B. Not filling socialization needs C. Poorly educated, poor job skills D. Probably lower-income status

ANS: B Families should fulfill five functions: physical needs, economic needs, reproductive needs, affective and coping needs, and socialization needs. A child with poor social skills probably (but not necessarily) comes from a family that is not fulfilling the child's socialization needs. Assuming that the child has an emotional or mental illness without further assessment is unhelpful. Assuming that the family is lower income, is poorly educated, and has poor job skills is stereotypical.

13. A patient is dismissed from the hospital and is receiving nursing care at home to help in the recovery from a serious illness and operation. The visiting nurse notes that the family is in a state of disarray and members are disorganized and not communicating. The patient is trying to direct everyone's actions. The nurse calls a family meeting. What action by the nurse is best? A. Encourage family members to make "to do" lists and assign chores. B. Explain that changes in one person require changes in the others. C. Make a referral to a counselor or mental health nurse practitioner. D. Tell the family members that for the patient to recover, they have to assume his or her role.

ANS: B Family systems theory recognizes that changes in one member of a family affect every other member of the family. In order for the family to function effectively, all members need to adapt to the major changes in one of the members. Making lists and assigning chores are simple tasks that might help with organization, but this does not go far enough in solving the problem. The family may or may not need a referral for counseling. Simply telling the family members a fact does not give them enough information to adapt.

6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information? A. High risk: Call the school district counselor. B. High risk: Contact 911 immediately. C. Low risk: Send a referral home with the student. D. Moderate risk: Call the parents to come get the teen.

ANS: B Individuals who have suicidal thoughts should be assessed for a specific plan, the means to carry out the plan, and previous suicide attempts. This student has two of the three high-risk identifiers, so the teen should be seen by a mental health professional immediately. The safest way to ensure this occurs is to access the emergency medical system. The district counselor may not be prepared to deal with this situation and may not be available. The student is not low risk, so a referral should not be sent home. The student is not moderate risk, and the burden of ensuring immediate access to a health-care professional should not be placed on the parents, who also may be unavailable.

23. A woman who is 36 weeks pregnant presents to the perinatal clinic with complaints of backache, pelvic fullness, and uterine contractions. Which action by the nurse is most appropriate? A. Arrange admission to the hospital. B. Obtain a clean-catch, midstream urine sample. C. Obtain blood for a type and screen. D. Prepare to administer a tocolytic agent.

ANS: B Infection is a predisposing factor for preterm labor, so the nurse would be wise to collect a urine sample, which may be obtained via clean-catch or catheterized specimen. Arranging admission to the hospital is premature. Also, there is no indication that the patient will need blood imminently, and tocolytic agents to stop preterm labor are not used after the 34th week of gestation.

34. A pregnant patient with a long-standing history of cardiovascular disease is admitted to the high-risk OB unit. The patient will have internal continuous electronic fetal monitoring until delivery. Which action by the nurse takes priority? A. Assess the woman's vital signs every hour until delivery. B. Consult with the physician about prophylactic antibiotics. C. Educate the woman and partner about this modality. D. Prepare an infusion of magnesium sulfate (Sulfamag).

ANS: B Internal electronic fetal monitoring is an invasive procedure that carries the risk of infection. Because the patient has a history of cardiac disease, the nurse should consult with the physician about antibiotics in case the woman is at risk for endocarditis. If the patient is stable and not in labor, hourly vital signs are not needed. Education is always an important responsibility, but patient safety and infection control are higher priorities. There is no indication that the woman needs magnesium sulfate.

1. A woman presents to the perinatal clinic with abdominal pain. She has missed one period and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The nurse prepares the patient for which therapy? A. Laparoscopic salpingostomy B. Methotrexate C. Partial salpingectomy D. Salpingectomy by laparotomy

ANS: B Methotrexate, a chemotherapeutic drug and folic acid inhibitor that stops cell production and destroys remaining trophoblastic tissue, is used in the management of uncomplicated, non-life-threatening ectopic pregnancies. Patients are considered to be eligible for methotrexate therapy if the ectopic mass is unruptured and measures 4 cm or less on ultrasound examination. The other options would not be needed.

1. The clinic nurse is working with a mother and her 3-year-old child who have arrived for the child's routine checkup. The nurse encourages the mother to return for her child's measles-mumps-rubella immunization prior to the child's entering school. This intervention is an example of what type of care? A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention

ANS: B Of the three levels of prevention, the most desirable level is primary prevention. This encompasses health promotion and activities specifically meant to prevent disease from occurring—in this case, scheduling vaccinations. Secondary prevention refers to early identification and prompt treatment of a health problem before it has an opportunity to spread or become more serious. Tertiary prevention is intended to restore health to the highest functioning state that is possible.

10. A nurse wants to work in the community providing secondary prevention activities. Which action would this nurse choose to do? A. Educate teenage girls about birth control options. B. Provide STD/STI testing at the local youth center. C. Staff the county health department flu shot clinic. D. Volunteer to drive cancer patients to receive their treatments.

ANS: B Secondary prevention is screening, early detection, and prompt treatment for health problems. Testing youths for STD/STIs is an example of secondary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Educating teenage girls about birth control options will (hopefully) prevent unintentional pregnancies and is an example of primary prevention. Likewise, staffing the flu shot clinic is also an example of primary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Driving cancer patients to their treatments is an example of tertiary prevention.

36. A nurse is working with a family in which one member has schizophrenia. Using systems theory, for which concern should the nurse specifically assess this family? A. Balance B. Boundaries C. Children's ages D. Subsystems

ANS: B Systems theory looks at boundaries, balance and homeostasis, and subsystems. An important concern in the family whose member is diagnosed with a mental illness is social isolation, which is related to boundaries. Some families view mental illness as shameful and try to keep the information secret. The nurse should work to ensure the family understands the importance of healthy interaction with outside systems. Children's ages would be assessed using developmental theories.

24. A nurse reads in a patient's chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this woman's treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron)

ANS: B The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation.

8. A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate dark-brown vaginal bleeding. On physical exam, her uterus is large for dates. Which action by the nurse is most appropriate? A. Assess the woman's diet for folic acid intake. B. Facilitate an ultrasound examination. C. Instruct the woman on a fetal kick count. D. Prepare the woman for pelvic cultures.

ANS: B The incidence of gestational trophoblastic disease (GTD), including hydatidiform mole, increases in women of advanced age (especially over 50). Dark-brown vaginal bleeding is one symptom of this condition, and the nurse should be cognizant of its possibility. Because hydatidiform mole is diagnosed with ultrasound, the nurse should facilitate this testing. A diet low in folic acid is a risk factor, but the nurse should delay assessing for risk factors until after he or she has facilitated the ultrasound. Because molar pregnancies are either associated with no fetus or one that is generally spontaneously aborted, instructing the woman on fetal kick counts is not appropriate. The patient does not need pelvic cultures for this condition.

6. A woman in her second trimester of pregnancy presents to the perinatal clinic with complaints of scant vaginal bleeding, abdominal pain, and shoulder pain. What action should the nurse perform first? A. Assess her for a history of preterm labor. B. Obtain a blood sample for a -hCG test. C. Prepare the woman for a pelvic exam. D. Request an order for methotrexate (Rheumatrex).

ANS: B This woman is displaying symptoms of a possible ruptured ectopic pregnancy (vaginal bleeding, abdominal pain, shoulder pain). Shoulder pain can occur from nerve irritation due to the presence of blood in the pelvic cavity. A -hCG test finding will be lower than expected for the gestational age. The woman will most likely need a pelvic exam. However, to facilitate a rapid diagnosis, the nurse should first obtain and send a blood sample for -hCG test. The nurse can then assess the woman for risk factors for ectopic pregnancy. However, preterm labor is not a risk factor. Methotrexate is used for uncomplicated, non-life-threatening ectopic pregnancies. It would not be indicated in this patient because she has manifestations of rupture.

14. A nurse is caring for a pregnant 16-year-old who is homeless and occasionally spends time in a homeless shelter. She has been seen in the clinic before for sexually transmitted infections (STIs). She weighs 92 lb (41.8 kg) and occasionally uses crack cocaine. Which risk factors does this patient have for a negative pregnancy outcome? (Select all that apply.) A. Age of 16 years B. Being homeless C. Crack cocaine use D. History of STIs E. Low weight

ANS: B, C, D, E According to Barry (2011) and Porter and Holness (2011), prenatal medical and behavioral risks for the adolescent population include preterm labor and birth—especially when combined with low socioeconomic status, being a single parent, being a smoker, using illicit drugs, prepregnant weight less than 100 lb (45.5 kg), poor weight gain during pregnancy, and inadequate prenatal care. Other factors include anemia; preeclampsia-eclampsia; repeated exposure to sexually transmitted infections; chronic or asymptomatic urinary tract infections; acute pyelonephritis; intrauterine growth restriction/low-birth-weight infants (< 2,500 g); and social issues such as poverty, unmarried status, low educational levels, smoking, and drug use. After age 15 years, the adolescent does not experience any more problems than does the general population.

6. A nurse is conducting a nonstress test on a pregnant woman. The nurse understands that which of the following conditions can lead to loss of fetal heart rate reactivity? A. Central nervous system irritability B. Certain congenital abnormalities C. Fetal acid-base disturbance D. Fetal hypoxia E. Fetal sleep cycle

ANS: B, C, D, E The most common cause of loss of fetal heart rate reactivity is a fetal sleep cycle. Other causes are related to central nervous system depression (not irritability) and can include fetal acidosis, hypoxia, and certain congenital abnormalities.

1. The nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. What does the nurse tell the mothers about breast milk? (Select all that apply.) A. Fewer nutrients B. Less casein C. Less protein D. More calories E. More carbohydrates

ANS: B, C, E Human breast milk contains more carbohydrates, less protein, and less casein than cow's milk or infant formulas. Commercially prepared formulas have the same essential nutrients for growth and development and do not have fewer calories.

7. The nurse assesses the communication in a family that includes a single mother, a teenage son and daughter, and a grandmother. During the family interview, the daughter answers many questions while the son and mother are quiet and the grandmother is absent. What conclusions can the nurse make about this family? (Select all that apply.) A. The communication patterns are healthy. B. The daughter may have a lot of power. C. The grandmother does not want to be involved. D. The grandmother may have little power. E. The mother and son may have a coalition.

ANS: B, D, E Communication theory asserts that patterns of communication within a family reveal much about the way the family functions, the structure of the family, the power base, decision making, affection, trust, and affiliation. Preliminary conclusions the nurse can make about this family are that the daughter may have a lot of power because she answers many questions without input from anyone else, the grandmother may not have much power because she is not even present, and the mother and son may have a coalition opposed to the daughter. The nurse will need to confirm these conclusions with further assessment. These communication patterns are not healthy. The nurse should not assume that the grandmother does not want to be involved but should assess the reason for her absence.

5. A nurse is caring for a woman on a continuous IV of magnesium sulfate. Which actions are appropriate for patient safety? (Select all that apply.) A. Administer the bolus from the main bag, then change to the maintenance rate. B. Double-check each new bag and dose/rate change with another nurse. C. Ensure that a supply of romazicon (Flumazenil) is available in the patient's room. D. Perform handoff report at the bedside, verifying the dose and orders by both nurses. E. Place color-coded tags on each IV line, bag, and pump to label them clearly.

ANS: B, D, E Magnesium sulfate is a high-risk, high-alert drug and the nurse must be cautious about administering this drug safely. Some appropriate actions include double-checking any rate or dose changes with a second nurse, performing the handoff report at the bedside so that both nurses can verify the orders and compare them to the IV bag and pump rate, and color-coding IV lines, bags, and pumps for easy identification. The nurse should ensure that a supply of the antidote (calcium gluconate 10%) is available. However, romazicon is the antidote for benzodiazepine overdose. The nurse should use a small-volume IV piggyback for the bolus dose instead of using the main bag to give the bolus to the patient, and then change the infusion rate to the maintenance setting.

15. A nurse is working with a blended family of 1 year with five children aged 3, 7, 13 (twins), and 19. The parents seem overly stressed and anxious and do not seem to work well as a unit. What can the nurse conclude about this family? A. Communication problems are the core of the parents' stress. B. Economic stressors are impacting the parental dyad. C. The family is in too many developmental stages to master any of them. D. There are too many children to give each one adequate attention.

ANS: C In family developmental theory, the age of the child determines the stage the family is in. If there is more than one child, the family is probably in multiple developmental stages at the same time. The family is probably in a combination of beginning families, preschool, school-aged and adolescent, and launching stages. The competing priorities of all of these stages pave the way for chaos. Without further information, the nurse cannot conclude that economic stressors or communication problems are the root cause of the issue. Simply concluding that the family has too many children is judgmental and does not leave any room for interventions.

20. A woman with a history of previous abruptio placentae with fetal demise is being seen in the perinatal clinic. She is now pregnant again in her early second trimester. She tells the nurse she is a Jehovah's Witness and she wants her chart to reflect her refusal to accept blood products if she hemorrhages again. Which action by the nurse is best? A. Ask the woman to consider an exception in order to save her baby's life if needed. B. Document the information on the chart and inform the health-care provider. C. Encourage the woman and provider to discuss appropriate delivery sites. D. Tell the woman a court can order the transfusion to save the baby.

ANS: C Jehovah's Witnesses do not accept blood products or their derivatives as part of their medical care. Because this woman is at high risk for a complicated pregnancy (another abruptio placentae) and hemorrhage, she should be advised to deliver in a tertiary care center that is prepared to manage catastrophic hemorrhage. The nurse should facilitate this discussion as part of providing holistic care. Asking the woman to reconsider (and go against her religious beliefs) is disrespectful. The nurse should document the information and inform the care provider, but this action in itself is incomplete. Telling the woman that a court can order her to have transfusions, although a true statement, is likely to be perceived as threatening and disrespectful, and certainly does not allow the nurse to provide care in a holistic manner.

8. A nurse is assessing a single person at a clinic visit. How would the nurse classify this patient's family? A. Family of choice B. Family of origin C. Not in a family D. Nuclear family

ANS: C Most definitions of family require at least two people who self-define as being part of that family. Thus, a single individual cannot be a family. A family of choice is the family adopted through marriage or cohabitation. A family of origin includes the individuals who reared the person of interest. A nuclear family consists of a male partner, a female partner, and their children.

20. A nurse working with the elderly population is distressed that in order to obtain public funding for long-term care, the elderly must expend nearly all of their resources. When considering bioethical principles, which principle should the nurse choose to act from to make the biggest difference in this situation? A. Autonomy B. Fidelity C. Justice D. Veracity

ANS: C The principle of justice means treating everyone fairly. Requiring the elderly to divest themselves of their resources in order to obtain funding for housing could be seen as a justice issue. Autonomy is having free will and acting according to one's own wishes when making decisions. Fidelity is keeping promises. Veracity is truth telling.

15. The school nurse wants to create a safe driving program for the high school students. In order to have the greatest impact on safety, on which issue should the nurse focus? A. Female driving B. Late-night driving C. Seat-belt use D. Sleep deprivation

ANS: C The risk for motor vehicle accidents is greater among adolescents than for any other age group. Factors associated with this include the inability to assess hazardous situations while driving, speeding, driving under the influence of drugs and/or alcohol, and a low compliance with seat-belt use. Females are actually less likely to be in a motor vehicle crash than males. Late-night driving does not appear to increase risk. Although teens are often sleep deprived, this does not appear to be related.

18. A nurse who uses the structural-functional theory would assess which of the following when working with families? A. Communication patterns B. How things get done C. If goals are being met D. Looseness of boundaries

ANS: C The structural-functional theory focuses on the outcomes, not the processes, within the family. The nurse using this theory would assess if the family goals are being met. Communication patterns are critical to communication theory. Processes are important to family developmental theory, and boundaries are important in family systems theory.

9. A woman who recently had a miscarriage is in the clinic for follow-up. She sees the diagnosis "spontaneous abortion" on her chart and becomes visibly upset, stating, "I did not have an abortion!" Which response by the nurse is best? A. "Don't be upset; that is just a medical term used commonly." B. "I can come back and talk to you when you are not so upset." C. "I see you are upset. Does it help to know this means miscarriage?" D. "No one is accusing you of having an abortion."

ANS: C The term "spontaneous abortion" is the medical term for miscarriage before 20 weeks' gestation. Medical terms are often confusing to laypeople, and it is the nurse's duty to inform patients of their meaning. Nurses should also be aware that the term "abortion" is politically and emotionally laden, so it should not be surprising that an uninformed layperson might become upset at its use. The nurse should acknowledge the woman's feelings and explain the term. Telling the woman not to be upset is paternalistic and does nothing to educate her. Offering to come back later would be a useful option after the nurse has acknowledged the woman's feelings and discovered that she does not want to talk right now; otherwise, this statement might seem like rejection. Stating that no one is accusing the woman of having an abortion is defensive.

19. A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV line, which action should the nurse do next? A. Administer betamethasone (Celestone) just prior to delivery. B. Discuss pros and cons of continuous fetal monitoring. C. Facilitate laboratory work, including blood type and screen. D. Obtain informed consent for emergent delivery.

ANS: C Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae. Bleeding accompanied by abdominal pain is the classic sign of placental abruption. Care includes obtaining maternal vital signs, assessing fetal heart rate, and starting an IV for fluid resuscitation or transfusion if needed. Blood work should be obtained for CBC, type and screen, coagulation studies, and a Kleihauer Betke determination, Betamethasone is given if delivery is not imminent. Continuous electronic fetal monitoring is the standard of care, and although the nurse should educate the patient on its use, this discussion does not take priority over obtaining diagnostic laboratory studies. An emergent delivery is a possible (not certain) outcome, but obtaining consent does not take priority over the diagnostic blood work.

6. The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. Gonorrhea C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

ANS: C, D, E Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

10. A nurse in the perinatal clinic explains to a student nurse that which of the following patients are at highest risk of developing gestational diabetes? (Select all that apply.) A. A17-year-old in her second pregnancy B. A 24-year-old pregnant woman with placenta previa C. A 32-year-old woman with a BMI of 40 D. A woman whose first baby weighed 10.5 lb (4.7 kg) E. A woman whose mother and sister had gestational diabetes

ANS: C, D, E The risk factors for developing gestational diabetes include age older than 25; obesity; insulin resistance; polycystic ovary syndrome; history of pregnancy-related diabetes mellitus; history of a large-for-gestational age infant; hydramnios, stillbirth, miscarriage, or an infant with congenital anomalies during a previous pregnancy; family history of type 2 diabetes (first-degree relative); and ethnicity. Being young does not confer additional risk, nor does placenta previa. The 32-year-old is obese, the 10.5-lb baby is large for gestational age, and the mother and sister are first-degree relatives.

45. A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls? A. Blood draw B. Limited pelvic exam C. No alternative D. Urine collection

ANS: D A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 13-18. The other options are incorrect.

14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What statement by the teen indicates that goals for this diagnosis have been met? A. "I don't want to cut out any more evening activities." B. "I sleep until about noon on Saturdays to catch up." C. "I take a long nap when I get home from school each day." D. "I try to keep the same sleep and wake times all week."

ANS: D Adolescents are commonly sleep deprived and often try to make up for their sleep deficit by sleeping more on weekends. This is actually detrimental, as the body has difficulty adapting to changing sleep routines. The teen who is keeping consistent sleep and wake times during the entire week has learned this fact and is probably getting better sleep than before. The other statements do not show understanding of sleep deprivation and ways to improve it.

15. A woman is hospitalized with hyperemesis gravidarum. Which other member of the health-care team should the nurse ensure is involved in this patient's care as a priority? A. Chaplain B. Diabetic educator C. Mental health nurse practitioner D. Registered dietician

ANS: D Although all members of the health-care team have important roles to play and may be needed in the care of this patient, the dietician is the priority. Patients with hyperemesis gravidarum have extreme nausea and vomiting unrelated to other causes. They demonstrate weight loss and measures of starvation such as ketosis. Serious complications arise if the woman cannot maintain her weight despite antiemetics. The dietician will be helpful in assisting the woman to plan appropriate meals and snacks or, if the woman needs enteral or parenteral feedings, in providing nutritional information to guide therapy.

24. A nurse working in a pediatric clinic is attempting to assess a school-age child who is disrespectful of the nurse and parent and tears up a magazine when asked to sit down. What conclusion can the nurse make about this family? A. The child is not getting enough attention from the parents. B. The family is from an underserved community group. C. Financial stress has caused family strife and fighting. D. The parental disciplinary approach is inconsistent.

ANS: D Children whose parents have a laissez-faire disciplinary style tend to be disrespectful, aggressive, and disobedient. A laissez-faire disciplinary style includes inconsistent use of discipline, allowing children (rather than the parents) control over the environment, few rules, and children making their own decisions rather than being guided by parents. The other options may be true, but without further assessment, the nurse cannot make those conclusions.

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight? A. "Are you willing to talk about your weight gain this year?" B. "Do you realize your weight puts you into an obese category?" C. "Do you participate in any activities or exercise?" D. "What do you think about your weight right now?"

ANS: D During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. The other questions may put the teen on the defensive and close communication. Answer choice 1 particularly is an example of poor communication, as it is a "yes-no" question. The teen could simply answer "no" and the nurse would have no recourse other than to end that line of discussion.

2. The clinic nurse understands that children who come for well-child visits at age 10 are in the process of developing which of the following attributes? A. Attachment B. Coordination C. Personal values D. Self-identity

ANS: D During the school-aged and adolescent/teenage developmental stage, personal values are shaped and clarified and ethical development occurs. This stage provides the optimal opportunity for teaching about drugs, sex, and health promotion.

33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best? A. "No, at your age, fluctuations in your menstrual cycle are normal findings." B. "No, menopause only begins in women after the age of 55." C. "Yes, not having a period for more than 6 months is diagnostic of menopause." D. "You have to go 1 year without a menstrual period to be sure that menopause has occurred."

ANS: D Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a woman's cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 35-60 years.

3. The perinatal nurse is assessing a woman who is at 35 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats/minute. A vaginal examination performed by the health-care provider reveals no cervical changes since her last examination. Ultrasound examination reveals the presence of V-shaped cervical funneling. Which action by the nurse is most appropriate? A. Educate the woman on benefits of corticosteroids. B. Facilitate admission to the high-risk OB unit. C. Prepare to administer a dose of magnesium sulfate. D. Reassure the woman that she is not in preterm labor.

ANS: D Preterm labor is defined as regular uterine contractions and cervical changes before the end of the 37th week of gestation. Many patients present with preterm contractions but only those who demonstrate changes in the cervix are diagnosed with preterm labor. Because this woman has no demonstrated cervical changes, she does not have the diagnosis. Also reassuring is the infrequency of her contractions; a defining characteristic of preterm labor is persistent uterine contractions (4 every 20 minutes or 8 per hour). Another reassuring finding is the presence of V-shaped cervical funneling ; a change to U-shaped cervical funneling in a woman with a shortened cervix is associated with preterm labor in high-risk women with a prior spontaneous preterm birth. The woman does not require corticosteroids or magnesium sulfate or admission to the high-risk OB unit.

26. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching should the nurse plan for this patient? A. Avoid sexual intercourse during your period. B. Take prophylactic antibiotics daily. C. Void every 4 hours while awake. D. Wipe from front to back after using the bathroom.

ANS: D Preventative measures for UTIs include drinking plenty of water, voiding when the urge is felt, wiping from front to back, taking showers instead of baths, not using perfumes or bath oil if baths are taken, wearing cotton underwear, and avoiding feminine hygiene sprays and scented douches. The other options are not related.

13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula. The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best? A. Ask the student if she had pain medication this morning. B. Document the findings and send the student to classes. C. Have the student lie down and call 911 immediately. D. Question the student about eating and exercising patterns.

ANS: D Signs of anorexia nervosa include weakness, dizziness, excessive weight loss, intolerance to cold, bradycardia, hypotension, bone loss with fractures, constipation, and the development of lanugo. The nurse should assess the student for the restricted eating and excessive exercise that is characteristic of this disorder. The lower blood pressure and pulse might be the result of pain medication, but the student should not have been allowed to return to school on these medications, and this does not explain why the student appears to feel cold. Documenting the findings is important, but the school nurse has an excellent opportunity to assess and intervene if needed. Calling 911 immediately is not warranted.

6. The clinic nurse notices that each time a child with leukemia is brought in to see the doctor, her mother and aunt accompany her. The mother states that she finds her daughter's illness to be very traumatic and is having difficulty coping. The child's aunt encourages the child's mother and distracts the child while her blood work is being drawn. The child's aunt could be described as taking on which of the following roles? A. Child-caregiver role B. Kinship role C. Socializer role D. Therapist role

ANS: D Structural-functional theory focuses on the functioning of the family and the roles assumed by each family member to promote family function. Necessary roles include provider, housekeeper, child caregiver, socializer, sexual partner, therapist, recreational organizer, and kinship member. The therapist role is assumed when one family member expresses concern for another's health or emotional well-being. The aunt does not appear to be the primary caregiver (child-caregiver role). There is no indication that the aunt fills the socializer role by organizing family social activities. The kinship role includes maintaining family and social ties by things like remembering important dates, and the aunt does not appear to function in that role either.

40. A patient on the high-risk OB unit is receiving magnesium sulfate. The nurse notes that her magnesium level is 14 mEq/L. Which of the following actions by the nurse is most appropriate? A. Bring the crash cart to the patient's room. B. Document the findings in the woman's chart. C. Order another blood level in 6 hours. D. Prepare to administer calcium gluconate.

ANS: D This woman's magnesium level has nearly reached the level associated with respiratory arrest. The nurse should prepare to administer the antidote, 10% calcium gluconate. The nurse should have someone else bring the crash cart into the room in case respiratory arrest does occur. Documentation is important, but this needs to be done after the woman is cared for. Additional magnesium levels will be drawn, but ordering them now instead of treating the patient is an inappropriate action.

10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention? A. A cat is sitting on the kitchen counter by the stove. B. Roaches are evident in the kitchen and in the pantry. C. The baby is on a carpet that is stained and worn out. D. The crib has dirty bumper pads and a dirty comforter.

ANS: D To prevent sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that all babies be put to sleep on their backs and that cribs be free of toys, comforters, and bumpers. Vaccinations and breastfeeding are also recommended. The other options show a house that is dirty but does not rise to the level of needing immediate intervention.

7. The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.) A. Aspirin prophylaxis B. Breast cancer screen C. Colorectal cancer screen D. Influenza vaccine E. Tobacco and alcohol screen

ANS: D, E Priority health services for the young adult population include influenza vaccination and tobacco, alcohol, and drug screens, among other things. Aspirin prophylaxis and breast cancer screen are more appropriate for middle-aged adults.

A 22-year-old woman is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. The patient is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. Which of the following should the nurse include in the patient's dietary teaching plan? (Select all that apply.) A. Consuming red meat B. Eating foods high in zinc C. Increasing calcium intake D. Restricting sodium E. Taking an iron supplement

B. Eating foods high in zinc E. Taking an iron supplement Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Most women cannot consume enough iron through their diets while pregnant, so an iron supplement should be suggested. The nurse can also educate the patient about foods high in zinc so that she can increase her intake. Although red meat does contain iron, consuming meat goes against the woman's chosen lifestyle and it would be disrespectful of the nurse to suggest this. Increasing calcium and restricting sodium intake are not helpful advice in this situation.

A pregnant woman has been brought to the emergency department by the rescue squad with symptoms of heat exhaustion after competing in an outdoor race on a hot day. Before discharge, the nurse teaches about appropriate exercise during pregnancy. The husband asks if the woman's having heat exhaustion will harm the baby. Which response by the nurse is most accurate? A. "Definitely; that's why pregnant women should not do aerobic exercise." B. "Fetal temperature depends on mom's temperature, so the fetus may be affected." C. "The baby is in a fluid environment and won't get overheated." D. "Yes, but if we rapidly cool mom down, there won't be any problems."

B. Fetal temperature depends on mom's temperature, so the fetus may be affected The fetus is unable to reduce body temperature through perspiration or other means and instead must rely on the mother's body for temperature regulation. Possible complications of maternal hyperthermia include spontaneous abortion, preterm labor, and fetal distress. The nurse should educate the couple about exercise that won't increase the maternal temperature too much. Complications are possible, not definite; the baby being in a fluid environment does not regulate its temperature, and women who are pregnant can engage in aerobic activity following safety guidelines.

The clinic nurse is assessing a woman in her 30th week of pregnancy. Her fundal height is 23 centimeters. What other assessment finding would the nurse correlate with this condition? A. Blood glucose 112 mg/dL B. Hemoglobin 9.2 g/dL C. Leukorrhea D. Platelet count elevated

B. Hemoglobin 9.2 g/dL True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction and preterm birth. The patient's lower-than-expected fundal height measurement could also be indicative of intrauterine growth restriction. The blood glucose, although slightly high, is not related, nor is leukorrhea (a common finding in pregnancy) or an elevated platelet count.

The nurse understands that the genetic possibility of a woman having a male or a female child is based on the single sex chromosome provided by each parent (mother is XX, father is XY, and each contributes one chromosome). Fill in the boxes below with the possibilities based on the single chromosome that is contributed by each parent in these four possible combinations. For the purpose of this exercise, the mother's chromosomes are designated X(m1) and X(m2), and the father's are designated X(f) and Y(f). The result of any XX chromosome pair yields a girl, and XY a boy. 1. Mother's sex chromosome _____Father's sex chromosome _____Child is a _____________ 2. Mother's sex chromosome _____Father's sex chromosome _____Child is a _____________3. Mother's sex chromosome _____Father's sex chromosome _____Child is a _____________ 4. Mother's sex chromosome _____Father's sex chromosome _____Child is a _____________

Box 1:Mother's sex chromosome X(m1)Father's sex chromosome X(f)Child is a girl Box 2:Mother's sex chromosome X(m1)Father's sex chromosome Y(f)Child is a boy Box 3:Mother's sex chromosome X(m2)Father's sex chromosome X(f)Child is a girl Box 4:Mother's sex chromosome X(m2)Father's sex chromosome Y(f)Child is a boy

The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patient's quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important? A. Call the social worker for a consultation. B. Document the findings in the woman's chart. C. Facilitate a referral to a genetics counselor. D. Prepare the woman for intrauterine death

C. Facilitate a referral to a genetics counselor All women should be offered screening with maternal serum markers. The triple-marker screen and the quadruple-marker screen test for the presence of alpha-fetoprotein, estradiol, human chorionic gonadotropin, and other markers. These tests screen for potential neural tube defects, Down syndrome, and trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling and further testing, such as chorionic villus sampling or amniocentesis, should be performed (ACOG, 2007). There is no indication that the woman needs a social work consult or that she will experience intrauterine death. Documentation should be complete, but is not the most important action for the nurse to take

The nurse in a family practice clinic is working with a woman of childbearing age who recently was married and has no plans to have children yet. Which action by the nurse is most important? A. Asking the woman when the couple plans to get pregnant B. Encouraging the woman to review her birth control plan C. Instructing the woman to get 0.4 mg of folic acid daily D. Reviewing the woman's family history for genetic defects

C. Instruct the woman to get 0.4 mg of folic acid daily Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day (0.4 mg/day). Because the woman may not realize that she is pregnant early in her pregnancy when neural tube defects occur, prophylactic supplementation is recommended. The other options may be applicable too, but they are not as important as educating the woman about the importance of folic acid.

A student nurse is working in the OB clinic as part of a preceptorship. The student is counseling a woman in her first trimester who complains of insomnia due to nasal congestion. Which action by the student warrants intervention by the student's preceptor? A. Advises the woman to use over-the-counter nasal saline spray B. Assesses the patient for other allergy and cold symptoms C. Instructs the woman to use decongestants and antihistamines D. Suggests the woman take a hot, steamy bath at bedtime

C. Instructs the woman to use decongestants and anti histamines Congestion is a common complaint in pregnancy. Self-care measures include occasional saline drops; hot, steamy showers; increasing fluids;, and using a vaporizer or humidifier. It is important to rule out upper respiratory infections such as colds or allergies when a woman complains of nasal congestion. Women should avoid decongestants in the first trimester.

A 21-year-old pregnant woman smokes 8 to 10 cigarettes per day. The clinic nurse reviews the patient's diet with her and notes that she does not eat fruits or vegetables. Which action should the nurse recommend to this patient? A. Cut down on smoking and eventually quit. B. Eat non-produce sources of vitamin C. C. Take an over-the-counter vitamin C supplement. D. Try to drink one glass of orange juice daily.

C. Take on over-the-counter vitamin C supplement Food sources rich in vitamin C include produce such as red and green sweet peppers, oranges, kiwi fruit, grapefruit, strawberries, Brussels sprouts, cantaloupe, broccoli, sweet potatoes, tomato juice, cauliflower, pineapple, and kale. Most pregnant women are able to meet the recommended daily allowance (80 to 85 mg) by including at least one daily serving of citrus fruit or juice or vitamin C-rich food source, but women who smoke need more (NIH, 2011). Although it is important for the woman to quit smoking, this alone will not help her meet her dietary need for Vitamin C. Because she does not eat the primary sources of this vitamin, an over-the-counter supplement would be her best option.

A pregnant woman is complaining of urinary frequency and is worried about incontinence. Which teaching strategy should the nurse use when counseling this woman? A. Minimize fluid intake during the day. B. Perform sit-ups to strengthen the abdomen. C. Teach the woman how to perform Kegel exercises. D. Void infrequently to train the bladder.

C. Teach the woman how to perform Kegel exercises There are several physiological factors that cause urinary frequency and possible incontinence during pregnancy. Kegel exercises can improve both symptoms. The patient should remain well hydrated and void frequently. Sit-ups will not help with urinary frequency.

A woman in the perinatal clinic is upset that her impending childbirth will cause her to lose her job. What assessment question by the nurse would yield the most important information regarding this situation? A. "After you give birth, you will probably want to quit your job anyway." B. "Can you make an appointment with human resources to discuss this?" C. "Where do you work and how long have you been there?" D. "Why do you think you will be fired after your baby is born?"

C. Where do you work and how long have you been there? The Family Medical Leave Act of 1993 guarantees most women (and men) 12 weeks of unpaid family leave following the birth or adoption of a child. The employee has the right to return to the job without loss of seniority, pay, or benefits. This act applies to federal, state, or local government organizations and any other organization that has 50 or more employees working within 75 miles of the workplace. The employee must have worked at this job at least 12 months or for at least 1,250 hours in the previous year to be eligible. By asking the woman where she works and how long she has been there, the nurse is assessing if the workplace must adhere to this act. Telling the woman she will probably want to quit her job is dismissive of her concerns. Making an appointment with human resources might be a good suggestion, but only after the nurse has assessed the patient's eligibility for the Family Medical Leave Act. Asking "why" questions is considered a communication barrier, as many people become defensive when questions are worded this way.