OB Exam 2 TB

The nurses in a postnatal unit are aware of the fears of new parents with regard to infant abduction. Which interventions by the nurse will alleviate the concerns of the parents? SELECT ALL THAT APPLY. A. Allow only visitors with identification to enter the unit. B. Use the hospital abduction alarm systems. C. Require unit personnel to wear specific name tags. D. Footprints and a photo of the neonate are taken for identification purposes. E Encourage parents to accompany persons transporting the newborn.

A, B, C, D, E

The nurse is providing care for the 34-year-old patient diagnosed with polycystic ovarian syndrome. Which interventions would correlate to the common symptoms of this syndrome? SELECT ALL THAT APPLY. A. The patient has been unsuccessful with the ability to conceive. B. The patient has a history of painful and irregular menstrual cycles. C. The patient has noticed a drastic weight loss and dry skin. D. The patient has chronic back pain and gastrointestinal issues. E. The patient has heart palpitations and hypertension.

A, B, D Due to abnormal hormonal levels, the patient may have fertility issues. Due to abnormal hormonal levels, the patient may have issues with menstrual cycles. The patient may experience cardiac issues related to the hormonal fluctuations associated with polycystic ovarian syndrome.

The nurse is preparing to teach a class on the benefits of breastfeeding for infants. Which benefits will the nurse include in the presentation? Select all that apply. A. Decreased incidence of SIDS B. Fewer cases of necrotizing enterocolitis C. Less likely to become obese adults D. Decreased risk for developing otitis media E. Immunity to respiratory syncytial virus

A, B, D There is a decreased incidence of SIDS in infants who are breastfed. Breastfed infants have fewer cases of necrotizing enterocolitis. Breastfed infants have a decreased risk for developing otitis media

The nurse is arranging education for the menopausal support group regarding the approaches to treat the symptoms. Which of the following would be components of current treatments? SELECT ALL THAT APPLY. A. Moderately intense exercises B. Balanced diet, rich in calcium C. Alternative medicine such as black cohosh D. Over-the-counter sleep aid E. Hormone therapy

A, B, E Moderately intense exercise will promote overall health. A balanced diet rich in calcium will help maintain bone strength (due to the risk of osteoporosis). Studies have shown that hormone therapy can decrease the symptoms of menopause effectively.

The nurse is teaching new parents about the Period of PURPLE Crying Program aimed at the prevention of shaken baby syndrome. At the end of the program, the nurse evaluates the program successful if parents select which fact? Select all that apply. A. Your baby may not stop crying no matter what you do. B. Your baby may cry more in the late afternoon and evening. C. A serious condition exists if crying last 5 hours a day or more. D. Your baby will cry less each week, the least during the first 2 months. E. A crying baby may look to be in pain, even when he or she is not.

A, B, E Parents who understand -the baby may not stop crying no matter what they do -the baby may cry more in the late afternoon and evening -the baby may look to be in pain, even when he or she is not indicates a successful program.

The nurse is providing care to the 35-year-old female patient at the family practice clinic who is in the office for her annual physical examination. Which tests should the nurse recommend are the most appropriate for this patient? SELECT ALL THAT APPLY. A. Papanicolaou test every 5 years B. Mammogram every 2 years C. DEXA screen every 2 years D. HPV every 5 years E. HIV testing every 5 years.

A, D According to Healthy People 2020, the Pap test along with the HPV is recommended every 5 years for women ages 30 to 65.

The postnatal nurse is making a newborn visit to the parents who are from a different country. The nurse finds the newborn swaddled in a heavy blanket and wearing a knitted cap. The newborn has wet hair and is restless with rapid breathing. Which initial comment from the nurse is appropriate? A. "Your baby is exhibiting some concerning symptoms." B. "Share with me how babies are cared for in your country." C. "I would like to explain how to dress your baby correctly." D. "Let me explain the baby's symptoms of being overheated."

B When the nurse asks the parents to share how babies are cared for in their country, the nurse is showing interest and respect to the parents' culture. The nurse needs to understand the motivation behind dressing the baby in the current manner.

Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding? A. Why breastfeeding delays the need for solid foods B. When and what order solid foods are introduced C. When growth spurts and dietary increases are expected D. Why the babies are most likely to prefer food over milk

C. Mothers need to be aware of probable growth spurts regardless of the method of feeding. Infants experience growth spurts at 3 to 5 days, 1 week, 6 weeks, 3 months, and 6 months and require more frequent feedings during these time periods.

What is the common risk factor for hypertension, abnormal menstrual cycles, osteoarthritis, and high-risk pregnancies? A. Polycystic ovarian syndrome B. Diabetes mellitus C. Body mass index over 32 D. Sedentary lifestyle

C. A BMI of >30 indicates obesity, which could cause the listed symptoms.

The nurse is developing a plan of care for the 65-year-old obese female patient who states she wishes she could lose the weight but has no stamina for activity. Which nursing intervention would best correlate with the patient's statements? A. Provide information on local gyms and exercise groups. B. Provide information on choosemyplate.gov. C. Provide information on the overall health risks of obesity. D. Provide guidelines on how to increase daily activity as tolerated.

D. By facilitating an incremental increase in activity, the patient's stamina may increase, which was the statement made by the patient.

The nurse is assessing a 70-year-old female patient in the family practice clinic. The patient states that she has been experiencing sudden heavy vaginal bleeding the past 3 months. What is the expected diagnostic procedure for this patient? A. Cervical conization B. Colposcopy C. Dilation and curettage D. Endometrial biopsy

D. The patient will need to have an endometrial biopsy to determine the cause of postmenopausal bleeding. The patient's age is past the average age of menopause.

A patient arrives to the family practice clinic for her annual examination. The nurse's assessment data includes thin, 35-year-old female, history of weight loss surgery and total hysterectomy, BMI is 19, patient has been taking corticosteroids for severe asthma. Which of the following is an expected diagnostic screening for a potential health problem? A. Dual-energy x-ray absorptiometry scan B. Serum electrolyte levels and vitamin D C. Serum cholesterol and diabetic screening. D. Papanicolaou (Pap) Smear

A The dual-energy x-ray absorptiometry (DXA) is indicated for this patient because she has the following risk factors: corticosteroid use, low BMI, and surgical menopause.

The nurse is providing care for a neonate during the fourth stage of labor. Which action does the nurse take during this stage? A. Dry the neonate immediately B. Complete neonate assessment within 1 hour C. Obtain neonate blood glucose levels D. Perform APGAR screening until scores are 7

A The fourth stage of labor is from the birth of the neonate for 4 hours postpartum. The nurse will dry the neonate immediately to aid with thermoregulation and to prevent cold stress.

Which nursing interventions would best correlate with the nursing diagnosis of "At risk for disturbed sleep patterns related to night sweats"? A. Take a cool shower before bedtime. B. Avoid medications such as fluoxetine. C. Eat a consistent carbohydrate prior to bedtime. D. Avoid liquid intake 2 hours prior to bedtime.

A This would facilitate a cooler body core prior to going to bed and may decrease hot flashes.

The nurse is concerned about the number of infants in the community who die from SIDS even with teaching about "back to sleep" being provided. On which additional preventive measures will the nurse focus? Select all that apply. A. During pregnancy, women should not smoke, drink alcohol, or use illegal drugs. B. Infants need to be dressed to prevent infants from overheating during sleep. C. Mothers need to be informed that breastfeeding reduces the risk for SIDS. D. Parents should not smoke or allow smoking around their baby. E. Parents need to avoid products that claim to reduce the risk of SIDS.

A, B, C, D, E

The nurse is explaining to a mother that her newborn's blood test indicates a high level of bilirubin, which causes jaundice. Which information does the nurse present to the mother? SELECT ALL THAT APPLY A. The blood test does not indicate a pathological disease. B. The newborn's liver converts bilirubin to a water-soluble substance. C. An abundance of RBCs and RBC short life span contributes to the condition. D. The newborn's condition is also referred to as hyperbilirubinemia. E. Elevated bilirubin can be excreted in the urine and stool.

A, B, C, E The newborn's blood test is indicative of a type of physiological condition (jaundice). Unconjugated bilirubin, a fat-soluble substance, is produced from the breakdown of red blood cells (RBCs). It is converted to conjugated bilirubin, a water-soluble substance, by liver enzymes. Newborns are born with an abundance of RBCs, which have a shorter life span. These factors contribute to a proportionally greater amount of bilirubin production. Unconjugated bilirubin is eventually excreted in the urine and stool.

The nurse is providing education on the prevention of heart disease for adult females ages 35 to 44 years old. Which of the following would be most appropriate for this disease process? SELECT ALL THAT APPLY. A. Taking a brisk walking for 50 minutes three times a week B. Consuming a diet rich in vegetables, fruits, and whole grains C. Obtaining a varicella vaccine, if no evidence of immunity D. Recognizing the importance of smoking cessation E. Taking calcium supplements, if lactose intolerant

A, B, D Getting at least 150 minutes of moderate intensity physical activity per week helps reduce risk potential for heart disease. Consuming a nutrient rich diet helps reduce the risk potential for heart disease, as well as other disease processes, such as cancer. Smoking cessation is another risk factor for many disease processes, including cardiac disease. It is a leading cause of heart disease and cancer.

A college-aged female patient states that she understands the risk of sexual assault with overdrinking. She asks the nurse what health risks are associated with excessive alcohol intake for her age. What diseases or conditions should the nurse include in her response? SELECT ALL THAT APPLY. A. Infertility B. Cancer of mouth C. Hypertension D. Brain shrinkage E. Osteoporosis

A, B, D Per the CDC, excessive alcohol intake at this age can increase a woman's risk for infertility, cancer of the mouth, memory loss and brain shrinkage.

The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply. A. Menopausal women with an intact uterus who receive hormonal therapy B. Women who have undergone treatment for breast cancer C. Women who have many pregnancies and nursed their infants D. Women who smoke and have many sexual partners E. Women with a long-standing history of polycystic ovarian syndrome

A, B, E Unopposed estrogen therapy in women with a uterus can cause endometrial hyperplasia in the lining of the uterus. The second most common cancer of the female reproductive system is endometrial cancer. Tamoxifen is indicated for reducing risk for breast cancer in women or as a treatment of breast cancer. The medication competes with estrogen for binding sites in the breast but increases the risk for endometrial cancer. Polycystic ovarian syndrome increases the risk for endometrial cancer.

The nurse is assessing a 42-year-old patient who presents to the gynecology office with complaints of pelvic pressure, backaches, menorrhagia, and urinary frequency. The health care provider has diagnosed the patient with leiomyoma of the uterus. What are the treatment options for this condition? Select all that apply. A. Routine pelvic examinations to assess rate of disease process B. Oral contraceptives to control the bleeding and pain C. Myomectomy for women who desire pregnancy D. Hysterectomy for women who do not desire pregnancy E. Antibiotic therapy with NSAIDS for symptom management

A, C, D Routine pelvic examinations may be performed to assess the rate of growth of the leiomyomas (fibroids). A pelvic ultrasound to confirm the diagnosis of tumors and rule out pregnancy is another option of diagnosis. A myomectomy may be a surgical intervention to remove the fibroids, while leaving the uterus intact for those that desire pregnancy. Hysterectomy is recommended for women who do not desire pregnancy and who are experiencing excessive bleeding. Leiomyomas are the main indicator for hysterectomy.

A neonate is born after 37 weeks gestation, and the nurse is concerned about avoiding cold stress after discharge. Which suggestions does the nurse give the mother to keep the baby safe? SELECT ALL THAT APPLY. A. Keep the baby wrapped in a warm blanket. B. Perform the daily bath in a warm location. C. Position the baby away from vents and drafts. D. Place a stocking cap on the neonate's head. E. Change wet clothing immediately.

A, C, D, E

The nurse is preparing a talk with new parents about immunity and their newborns. Which factual information will the nurse present? SELECT ALL THAT APPLY A. A vaccination is an example of acquired immunity. B. Antigens are produced as part of natural immunity. C. Placental transfer is how newborns get natural passive immunity. D. Gamma globulin is an example of artificial active immunity. E. Natural passive immunity protects the baby for a few months after birth.

A, C, E A vaccination is an example of how acquired immunity is produced. Placental transfer of antibodies from mother to fetus is the manner in which the neonate acquires natural passive immunity. Natural passive immunity protects the baby for only a few months after birth.

The nurse is providing postoperative care to a patient who underwent a total abdominal hysterectomy 12 hours ago. Which of the following are appropriate nursing interventions? Select all that apply. A. Assist the patient with ambulation. B. Maintain the Foley catheter for 48 to 72 hours postoperatively. C. Monitor intake and output and characteristics of urine. D. Maintain bedrest while taking narcotic pain medications. E. Initiate antiembolism therapy as ordered.

A, C, E Ambulation decreases the risk for deep vein thrombosis and facilitates return of peristalsis, which decreases the amount of gas buildup. Monitoring intake and output, as well as the characteristics of the urine, will facilitate monitoring for signs/symptoms of fluid imbalances and injury to the ureters or bladder. A risk related to surgical procedures is deep vein thrombosis or venous thromboembolism. This may include antiembolism stockings, ambulation, and/or anti-coagulant therapy.

The nurse is assessing a 25-year-old female patient when the patient becomes tearful. The patient states that she has thin milky discharge from her nipples and two small masses on her left breast. She has lost over 40 pounds in the past year due to intensive exercises and finds that she needs to wear a sports bra during her sessions. The patient states that she is afraid that she will become the first member of her family to have breast cancer. Besides a negative mammogram, what other symptoms would correlate with this being a benign finding? Select all that apply. A. Milky discharge from nipples B. Extensive weight loss C. Painful masses D. Mood swings E. Multiple masses

A, C, E Discharge from nipples that are milky may be due to the elicited response from compression (resulting from the sports bra). Fewer than 10% of women with breast cancer will present with pain. The two masses are painful, and fewer than 10% of women with breast cancer will present with pain.

During the fourth stage of labor, which actions by the nurse will promote parent-newborn attachment? SELECT ALL THAT APPLY A. Delay administration of eye ointment until parents have held newborn. B. Stay close with the couple and the neonate in case of an emergency. C. Space out necessary assessments to prevent prolonged interruptions. D. Initiate skin-to-skin contact with a warm blanket over the neonate and parent. E. Explain expected neonatal characteristics such as molding, milia, and lanugo.

A, D, E Once ointment is administered, the neonate is less likely to open his or her eyes and make eye contact with parents. The administration can be delayed. The nurse can initiate skin-to-skin contact with a warm blanket over the neonate and parent. The nurse can point out and explain expected neonatal characteristics such as molding, milia, and lanugo. Understanding the characteristics of their neonate will aid in bonding. The parents may be reluctant to ask about physical characteristics.

The nurse is providing care to the 24-year-old patient in the OB/GYN clinic. The patient states that she thinks she may be pregnant because she has missed three menstrual cycles. The patient says, "This couldn't be happening at a worse time. I have been training heavily for a triathlon in 4 months." Which response by the nurse is most appropriate? A. "Secondary amenorrhea, or no menses for 3 months, is not always a sign of pregnancy; it may be due to your heavy athletic activity." B. "Pregnancy during times of stress such as heavy athletic activity can occur when precautions are not followed." C. "If the pregnancy test is negative, the physician will need to perform a diagnostic laparoscopy to rule out a neoplasm." D. "Amenorrhea may occur at times of nutritional disturbances. Are you eating a well-balanced diet?"

A. Heavy athletic activity may cease ovulation and menstrual cycles.

The nurse is teaching newborn care to an adolescent mother. When the nurse attempts to teach how to swaddle the newborn, the mother states, "What's the big deal about how to wrap up a baby?" The nurse needs to convey which reason as being most important for proper swaddling? A. Improper swaddling can cause hip dysplasia. B. Correct swaddling will increase the neonate's comfort. C. Neonates are swaddled only until they can turn from front to back. D. Two to three fingers need to fit between the infant's chest and the swaddle.

A. Improper swaddling can cause hip dysplasia. It is especially important to allow the hips to spread apart and bend up. In the womb, the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. This is the most important information for the nurse to convey.

The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment? A. This condition is often associated with use of oral contraceptives and may subside upon discontinuation. B. This condition is often associated with type 2 diabetes and must be controlled with a different type of birth control. C. This condition is often associated with hyperplasia of the endometrial tissue, which is exacerbated with oral contraceptives. D. This condition is often associated with ovarian cysts, which are exacerbated with the use of oral contraceptives.

A. Metrorrhagia is the most significant form of menstrual disorder. If not caused by endometrial cancer, it is typically associated with use of an IUD and use of oral contraceptives.

A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother? A. There are at least eight wet diapers and several stools per day. B. The mother is physically and emotionally comfortable during feedings. C. The newborn suckles and the mother can hear and/or see swallowing. D. The newborn spontaneously releases the grip on the breast when satiated.

A. The most concrete indicator that the breastfeeding baby is receiving enough milk is at least eight wet diapers and several stools per day

A patient in the second trimester of pregnancy is discussing breastfeeding and other options with the nurse. Which question is most important for the nurses to ask? A. "How does your partner feel about you breastfeeding?" B. "Do you have family members who have breastfed their babies?" C. "What are the reasons why you are considering breastfeeding?" D. "At what point after childbirth do you plan to return to work?"

A. The woman's partner plays a significant role in her choice to breastfeed and to continue breastfeeding. Her feelings about and success at breastfeeding are enhanced by her partner's support.

The nurse is assessing a 72-year-old female patient in the women's health clinic. The mildly obese patient's history includes 7 vaginal births, 2 of which necessitated forceps deliveries, type 2 diabetes, and hypertension. The patient states that she has become incontinent of urine, has a history of frequent urinary tract infections (UTIs), and has a sense of fullness "down there." What would be an appropriate nursing intervention to help the patient with her symptoms? A. Instruct the patient to stop urinating midstream at least twice a day. B. Instruct the patient to eat a high-fiber diet and increase fluid intake. C. Instruct the patient to add probiotics to their diet while taking antibiotics. D. Instruct the patient to bear down effectively while having a bowel movement.

A. This is the Kegel exercise, which helps improve pelvic muscle strength for a mild cystocele. Key words in this question are frequent UTIs, urinary incontinence, multiple births, two of which were forceps deliveries, which further traumatizes the pelvic floor.

A 48-year-old female patient presents to the OB/GYN clinic for her annual examination. She states that she has had the following symptoms: mood swings, irregular menstrual cycles, forgetfulness, food cravings, and a decrease in libido. Which of the following does the nurse suspect the patient is experiencing? A. Menopause B. Perimenopause C. Postmenopause D. Pregnancy

B Given the patient's age and current symptoms, the patient is experiencing perimenopause.

The nurse is providing care to the adult female patient who presents to the emergency department with a suspected myocardial infarction (MI). Which symptom indicates a possible MI for the female patient? A. Chest pain that radiates to the right arm and jaw B. Episodic nausea/indigestion and palpitations C. Sudden onset of trouble walking, and loss of balance D. Swelling of the feet and shortness of breath

B Often, the female patient will experience gastrointestinal issues as a sign of a MI and will often ignore these symptoms, believing them to be heartburn.

The nurse is assessing the 19-year-old female patient in the women's health clinic. She reports that for the past several months, she has had lower abdominal pain, elimination issues, and mood swings, and her acne is worse the week before menstruation. The health care provider has prescribed oral contraceptives. The patient asks the nurse for the reason for the prescription. Which response by the nurse is appropriate? A. "Pregnancy should be avoided because the hormonal shift would place the fetus at risk for birth defects." B. "The hormones in the oral contraceptives can maintain estrogen-progesterone hormones to alleviate discomfort." C. "Oral contraceptives may provide an increase in the hormones to help with your possible infertility issues." D. "Oral contraceptives may balance the chemical changes in your brain to alleviate the depression symptoms."

B PMS may be controlled, with oral contraceptives, as PMS might be related to hormonal changes related to the menstrual cycle. Estrogen-progesterone hormones found in oral contraceptives may provide relief from the symptoms.

The nurse in the neonate nursery notices a neonate, born 45 minutes ago, is unresponsive to external stimuli, and has a respiratory and heart rate below normal range. Which action does the nurse take? A. Picks up the neonate and tries to get a response. B. Allows the neonate to naturally continue deep sleep. C. Asks another nurse to assist with reassessment. D. Notifies the caregiver of the neonate's condition.

B The nurse needs to allow the neonate to continue to sleep deeply, which will last for approximately 2 hours

A 55-year-old postmenopausal female patient presents to the family practice clinic for her annual examination. The nurse notes that the patient has lost inch in height. Upon further investigation, the nurse discovers that the patient has a slow-healing fracture of the left radius. What screening will most likely be initiated at this time for the patient? A. Assessment for domestic violence B. Dual-energy x-ray absorptiometry scan C. Follicle-stimulating hormone D. Serum levels of calcium and vitamin D

B The postmenopausal patient has experienced height loss and has a fracture. This indicates a need to screen for osteoporosis.

The nurse is collecting information from a parent whose infant has frequent diaper dermatitis. Which comment by the parent indicates a possible cause of the condition? Select all that apply. A. "I use disposable wipes to clean the diaper area." B. "I buy an antibiotic ointment specified for skin rashes." C. "I leave the diaper off while the baby is sleeping." D. "I treat any sign of a rash immediately with zinc oxide." E. "I even get up and change the baby's diaper during the night."

B When an infant has diaper dermatitis, the use of antibiotic ointments, which can increase the risk of allergic skin reactions, should be avoided. This statement alerts the nurse to a possible cause of the infant's diaper dermatitis.

The postpartum nurse-manager wants the unit to become active as a supporter of the Baby-Friendly Hospital Initiative. Which nursing actions will be initiated? Select all that apply. A. Give pacifiers to infants on demand. B. Help mothers initiate breastfeeding within 1 hour of birth. C. Teach breastfeeding and promote lactation to mothers separated from infants. D. Refer mothers to support group resources on discharge. E. Provide infants with water until a milk supply is established.

B, C, D Initiating breastfeeding early is helpful in establishing breastfeeding. The ideal time line is to initiate breastfeeding within the first hour after birth. Even if separated from their infants for a period of time, mothers are offered information about breastfeeding and maintaining lactation. If the separation is related to a medical condition, the mother can pump and supply her infant with breastmilk unless it is medically contraindicated. For continuing care, breastfeeding mothers need to be offered the support of other breastfeeding mothers.

The nurse is providing education to the patient that is receiving a bisphosphate medication for osteoporosis. Which instructions should the nurse include in the teaching plan to reduce side effects and enhance absorption while taking bisphosphates? SELECT ALL THAT APPLY. A. Take the medication with a small meal at the same time. B. Take the medication with at least 8 oz. of water. C. Remain upright for at least 30 minutes after taking a dose. D. Take the medication on an empty stomach. E. Take the medication with a calcium supplement.

B, C, D This medication should be given on an empty stomach 30 minutes before breakfast. The patient must follow it with at least 8 oz. of only water and remain upright for 30 minutes.

The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply. A. Bathing is best after a feeding when newborn is relaxed. B. Daily bathing with soap is not necessary for the newborn. C. Use a mild preservative-free soap with a neutral pH. D. Avoid the use of soap on the face of the newborn. E. Genital and rectal areas should be cleaned at each diaper change.

B, C, D, E Daily bathing of a newborn with soap is not necessary and can contribute to skin irritation. Between baths with soap, the newborn can be cleaned with clear water. When bathing with soap, a mild preservative-free soap with a neutral pH is used to prevent skin irritation. The use of soap on the face is not recommended. The face and neck areas should be cleaned after feedings with plain water. Genital and rectal areas should be cleaned at each diaper change with water or diaper wipes.

The nurse is educating a 24-year-old female patient who was newly diagnosed with polycystic ovary syndrome (PCOS). The patient was prescribed an antidiabetic medication. Which medication effects should the nurse educate the patient about? Select all that apply. A. A period of initial weight gain B. A change in her integumentary system C. Low blood sugar until her hormones stabilize D. Decreased likelihood of pregnancy E. A decrease in abdominal obesity and weight

B, C, E The patient may notice loss of hirsutism and acne while taking the antidiabetic medication. This is because this medication decreases testosterone levels. The nature of the antidiabetic medication can cause lower blood sugar, and the patient will need to take the proper precautions. This may lower the testosterone level, which may decrease the degree of acne, hirsutism, and abdominal obesity.

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide? A. Frozen breast milk can be defrosted in a microwave. B. Breast milk can be kept in a deep freezer for 6 to 12 months. C. The freezer door shelf decreases the chance of milk contamination. D. Breast milk can only be frozen in special plastic freezer bags.

B. Breast milk can be safely kept in a deep freezer for 6 to 12 months; in a freezer attached to a refrigerator, it can be safely stored for 3 to 6 months.

The parents of a newborn male are concerned about providing care for the baby's new circumcision performed with a Plastibell. Which information will the nurse include in the teaching plan for the parents? A. Apply lubricants to the penis to keep the diaper from sticking. B. Report if penis is red, warm, and swollen and/or there is surgical site drainage. C. Remove the plastic ring gently on the fifth day after surgery. D. Contact the health care provider if newborn does not void for 36 hours.

B. The nurse will include information to the parents that if the entire penis is red, warm, and swollen and/or there is drainage from the surgical site (signs of infection), it should be reported immediately to the health care provider.

The nurse is assembling data for an education session at the local women's shelter. The majority of the guests at the shelter are 25- to 35-year-old American Indian women with young children. What is the leading cause of death for this population? A. Situational depression B. Risk-taking behaviors C. Poor prenatal care D. Poor dietary choices

B. This could increase the likelihood for accidents, such as not wearing seat belts. Native American women have a high risk for death from accidents at this age.

The telephone triage nurse receives a call from a patient who is 5 days postoperative total abdominal hysterectomy. The patient states that her pain is not relieved with the medications and that she has noticed blood in her urine. The nurse instructs the patient to report immediately to the emergency department. What does the nurse suspect as the surgical complication? A. Possible complication related to the anesthesia B. Possible injury to the ureters or bladder C. Possible hemorrhage from the internal incision D. Possible peritoneal venous thromboembolism

B. Bloody urine and unmanaged pain could indicate a ureter injury from the surgery.

The nurse is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection and now reports a milky discharge from her vagina and has a fishy odor. After microscopic examination of the vaginal discharge, the health care provider prescribed metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient? A. The patient has gonorrhea due to lowered immunity after antibiotic therapy. B. The patient has bacterial vaginosis due to recent disruption of normal vaginal flora. C. The patient has genital condylomas due to the recent UTI treatment. D. The patient has candida vaginitis due to recent disruption of normal vaginal flora.

B. Disruption of normal vaginal flora can increase the likelihood of bacterial vaginosis, and the symptoms are often described as milky vaginal discharge with a distinct "fishy" odor.

The nurse is providing care to a 72-year-old female patient. While providing care, the nurse instructs the patient to slowly rise from a sitting or prone position. What is the pathophysiological reason for this instruction? A. The patient is at higher risk for fractures due to postmenopausal osteoporosis. B. The patient is at higher risk for hypotension due to decreased baroreceptor sensitivity. C. The patient is at higher risk for falls due to decreased muscle strength and balance. D. The patient is at higher risk for adverse drug reactions due to decreased hepatic function.

B. The normal physiological changes of aging include decreased baroreceptor sensitivity, thus increasing the risk for falls due to hypotension.

A 32-year-old female patient arrives to the emergency department with heavy uterine bleeding. The nurse finds that the patient had a positive pregnancy test 1 month prior to the visit. What is the potential medical management for this patient's issue? A. Endometrial biopsy B. Dilation and curettage C. Colposcopy D. Laparoscopy

B. The patient may be experiencing an incomplete abortion and will need the remnants of the pregnancy removed.

The nurse is providing care to a 35-year-old female patient who complains of low back pain, pain with defecation, pelvic pressure, and premenstrual spotting. The health care provider has prescribed the hormonal therapy Lupron for this condition. What is the goal of this prescription? A. To prevent pregnancy at this time to promote healing B. To suppress menstruation and further growth of the tissue C. To prevent retrograde menstruation outside the uterine cavity D. To increase blood flow to decrease the endometrial lining

B. This is the goal of GnRH agonists, which suppresses menstruation and further growth of tissue.

A patient delivers a term neonate and expresses concern about the reason for giving the neonate an injection. Which info from the nurse is accurate? A. Neonates will hemorrhage without vitamin K B. Vitamin K is needed to activate clotting factors C. Mothers are unable to supply vitamin K to the fetus D. Breastfeeding is an excellent source of vitamin K

B. Vitamin K is given to the neonate in order to activate coagulation factors II, VII, IX, and X, which are synthesized in the liver

The nurse is teaching the mother of a neonate the benefits of kangaroo care. Which action is explained to the mother regarding the procedure? A. The neonate is tucked into the front of a parent's shirt. B. A bare-chested neonate is held against a bare-chested parent. C. A pouch is formed from a blanket for carrying the neonate. D. The neonate is placed in a sling and placed on a parent's side.

B. When the nurse teaches a mother the benefit of initiating kangaroo care, a bare-chested neonate is held against a bare-chested parent and both the neonate and parent are covered with a warm blanket.

The nurse is providing education for disease prevention to the adult female patient. Which factor puts the patient at a higher risk for multisystem disease processes such as cardiac issues, gynecological issues, and cancers? A. Consuming two glasses of wine a week B. Smoking two packs of cigarettes a day C. Having a body mass index of over 32 D. Having poor intake of calcium and vegetables

C A BMI of over 30 indicates obesity, which increases the risks for many disease processes, such as cardiac, endocrine, musculoskeletal issues, and gynecological disorders.

The nurse is assisting a newborn's primary care provider with the performance of a circumcision. Which intervention is used to manage the neonate's pain? A. A velcro tourniquet is loosely wrapped around the penis B. The neonate is breastfed to promote a sense of calmness C. A sucrose-dipped pacifier is offered during the nerve block D. The foreskin is numbed with ice before the nerve block

C A sucrose-dipped pacifier is offered during the nerve block as a procedure for pain management. The sucrose entices the neonate to suck, which is a comforting activity.

The nurse is assessing a newborns reflexes. Which response will cause the nurse concern? A. A fencing position when the head is turned B. strong Babinski reflex C. Asymmetrical Moro reflex D. Absence of rooting or sucking reflexes

C The nurse is concerned if an asymmetrical response is noted when checking for a Moro reflex. This response may be related to temporary or permanent birth injury to clavicle, humerus, or brachial plexus. This reflex disappears by age 6 months.

During the nurse's assessment of a 44-year-old female patient in the family medicine clinic, the patient becomes tearful and states she may be pregnant, as she has some unintentional weight gain, mood swings, and irregular menstrual cycles. The urine hCG reveals that the patient is not pregnant. What is the possible reason for her symptoms at this time? A. The patient has a false pregnancy. B. The patient is menopausal. C. The patient is perimenopausal. D. The patient may be pregnant

C The patient's age and symptoms are indicative of perimenopause.

Postnatal nurses expressed concern about neonatal pain management during painful interventions. Using evidence-based practice from research performed by Thakkar, Arora, Das, Javadekar, and Panigrahi (2016), which method of pain control will be used for heel sticks? A. An anesthetic gel will be applied 20 minutes before the stick. B. The stick will be administered while the neonate is breastfeeding. C. A combination of stimulated sucking and receiving sucrose orally. D. The neonate is stuck while the mother and neonate are en face.

C The study concluded that pain was decreased the most with a combined intervention of having sterile gauze held gently in the neonate's mouth and the palate tickled to stimulate sucking, and administering 30% sucrose solution PO by sterile syringe.

A new mother states, "I don't want anyone around my baby. I need to protect him from getting sick." Which statement by the nurse will help the mother to understand neonatal immunity? SELECT ALL THAT APPLY. A. "I agree with you; the baby's sterile environment is gone." B. "The baby will have acquired immunity soon from vaccinations." C. "The baby has natural passive immunity from you for a few months." D. "We will give the baby gamma globin for short-term immediate protection." E. "Your baby was exposed to some pretty serious pathogens in your birth canal."

C, D The neonate does have natural passive immunity from the mother for the first few months. Natural passive immunity is the placental transmission of antibodies from the mother to the fetus. An example of artificial passive immunity is gamma globulin, which provides immediate protection for a short time.

A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply. A. Hold the infant and sway from side to side or walk around with the infant. B. Place the infant in a car seat and take him or her for a ride in the car. C. Place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. D. Do simple household chores, such as vacuuming or washing the dishes. E. Place the infant (abdomen down) over the knees and gently rub or pat the back.

C, D When a mother expresses severe frustration with a colicky baby, she needs to place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. The mother can check on the baby when she has calmed down. A mother who expresses severe frustration with a colicky baby needs to find a distraction. Doing simple household chores, such as vacuuming or washing the dishes can be effective and allow the mother time to calm down.

The postpartum nurse notices that a new mother has her neonate unwrapped and undressed "to check out the baby". For which reason does the nurse conclude the neonate is at risk for cold stress? A. The neonate has an increased metabolic rate B. The neonate's respiratory rate has dropped C. The neonate is moving extremities about D. The neonate's skin is cool and clammy

C. A visible manifestation that indicates the neonate may be approaching cold stress is movement of the extremities in an effort to produce body heat.

The labor and delivery nurse understands that some neonates spontaneously take breath once the head and chest is delivered. Which understanding does the nurse have for the neonate that requires chemical stimuli to breathe? A. Oxygen is applied immediately to start respirations B. Carbon dioxide is administered in small doses C. Mild hypoxia and decreased pH stimulates the brain D. Suctioning is used to stimulate breathing efforts

C. The essence of chemical stimulation to initiate neonate breathing is the mild hypoxia that occurs when placental blood flow stops. Hypoxia causes an increase in carbon dioxide and decrease in blood pH, a chemical reaction that stimulates the respiratory center in the medulla.

The nurse is assessing a 64-year-old female patient. The patient states that she is able to reduce the risk of urinary tract infections (UTIs) by drinking a quart of cranberry juice a day. Which health condition, if present in this patient, contraindicates the use of cranberry juice? A. Hypertension, managed with lisinopril B. Diabetes type 1, managed with insulin C. Atrial fibrillation, managed with warfarin D. COPD, managed with inhaled steroids

C. Studies have shown that cranberry juice can affect the liver and interfere with warfarin (Coumadin) levels. Cranberry juice should not be taken with warfarin (Coumadin), aspirin, or medications that effect the liver.

The nurse is providing care to a 75-year-old female patient diagnosed with osteoporosis. Which of the following would be the priority nursing diagnosis? A. At risk for falls related to impaired balance B. Knowledge deficit related to new medication regimen C. Impaired physical mobility related to pain and skeletal changes D. Ineffective health maintenance related to continued immobility

C. The patient will experience skeletal changes, and often pain due to pathological fractures. In order to prevent further exacerbation of the disease process, the nurse will need to develop a plan of care that includes increasing physical mobility, especially weight-bearing exercises to increase bone density.

The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure? A. "I will use a mild douche solution to keep the surgical area clean." B. "I'm relieved that I won't have any visible scars on my abdomen." C. "I understand that there will be some light vaginal bleeding for several days." D. "I understand that I must remain on bedrest until cleared by the surgeon."

C. There will be some light bleeding for several days, and the patient should be instructed to notify the surgeon if bleeding increases.

The nurse is providing information to a postpartum mother about circumcision of her neonate. The neonate's father states, "We have never done that to any baby boy in my family." Which statement is best for the nurse to make? A. "Most families opt for the procedure for a variety of reasons." B. "I can leave information for you to read over and then decide." C. "I personally think that boys are cleaner and healthier if circumcised." D. "I understand that family culture and beliefs form our way of life."

D The nurse should always respect the patient's culture and beliefs, even if the nurse does not agree with or share the opinions.

The nurse is explaining to the new breastfeeding mother the types of neonatal stools the mother can expect. Which examples does the nurse provide? SELECT ALL THAT APPLY. A. Residual meconium is passed as loose watery stool. B. Sticky, thick, black stools indicate a presence of blood. C. Stools will eventually become drier and more formed. D. Golden yellow, a pasty consistency, and sour odor is expected. E. Neonate's first stool is passed within the first 24 to 48 hours.

D, E The stool of a breastfed baby later becomes a golden yellow with a pasty consistency and a sour odor. Meconium stool begins to form during the fourth gestational month and is the first stool eliminated by the neonate. It is first passed within 24 to 48 hours.

A mother who is 2 weeks postpartum asks the nurse lactation specialist how she knows if her baby is hungry. Which hunger indicator does the nurse discuss? A. Crying when all other physical needs are met B. If 2 to 3 hours have passed since feeding C. When the mother experiences a let-down sensation D. Opening the mouth in response to tactile stimulation

D. Opening the mouth in response to tactile stimulation is the best way to determine if a baby is hungry; the rooting reflex is not solicited in a baby who is not hungry.

The nurse is presenting information to new parents regarding screening of their newborn. Which information does the nurse identify as being most important to the parents? A. All babies born in the US are screened for specific conditions B. Newborn screenings consist of a blood test and a hearing test C. Each state has statutes or regulations on newborn screening D. Screenings are for infections, genetic diseases and inherited disorders.

D. The blood test screens for infections, genetic diseases, and inherited and metabolic disorders; this is the information the parents of a newborn will be most interested in. Parents are focused on the well-being of their newborn and will seek information that provides conditions and treatments if needed.

The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis? A. "I realize that this is not a cure for the issue, but I want to have more children within the next year." B. "I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy." C. "I realize that my type 2 diabetes will be cured now that I have those lesions removed." D. "I understand that I will not have to have a colostomy now that the growths were removed from my bowels."

A Endometriosis may recur after surgical interventions, but the laparoscopic surgery is used for women with severe symptoms who are infertile and desire pregnancy.

The nurse is preparing a teaching plan for a polycystic ovary syndrome (PCOS) support group. One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What is the reasoning for this rationale? A. Diet and exercise will promote weight loss, which will decrease hyperandrogenemia. B. Diet and exercise will decrease the risk of type 2 diabetes and gestational diabetes. C. Diet and exercise will decrease serum lipid levels and lower the risk for cardiovascular disease. D. Diet and exercise will increase the frequency of ovulation and menstruation and increase fertility.

A Hyperandrogenemia can lower testosterone levels, which can reduce the degree of acne and hirsutism.

The nurse works in a postnatal nursery and is required by hospital policy to perform a gestational age assessment on specified neonates. On which neonate is the nurse most likely to perform this assessment. A. The neonate with a birth weight of 4,100g B. The neonate born at 37 weeks gestation C. The neonate born after an 18 hour labor D. The neonate exposed to oxytocin in utero

A Neonates who weigh less than 2,500 g or more than 4,000 g are most likely to be assessed for gestational age. The nurse will determine if the neonate is post-term.

The nurse is assessing a 59-year-old female patient for her annual examination. The patient had a full hysterectomy, bilateral salpingo-oophorectomy 1 year ago for a noncancerous condition. The patient states that she wants to stop her menopausal hormone therapy at this time, and she will try black cohosh if the symptoms persist. Which response by the nurse is most appropriate? A. "Hormone therapy is the most effective treatment for menopausal symptoms." B. "Hormone therapy becomes less effective within 2 years of treatment." C. "Hormone therapy is most effective with alternative medicines use." D. "Hormone therapy is most effective when combined with lifestyle changes."

A Per the North American Menopause Society, hormone therapy is the most effective treatment for menopausal symptoms.

The nurse at a family practice clinic is providing care to a 47-year-old obese patient. The patient states that she realizes that she has put on extra weight but is reluctant to go to any exercise classes. She states that she often has to cross her legs when she sneezes and cannot do any exercises with her legs crossed. The health care provider has prescribed tolterodine (Detrol). What is the rationale for this medication? A. Tolterodine is used to treat overactive bladders and to decrease urinary frequency, urgency, and urge incontinence. B. Tolterodine is used to improve the tone and tissue in the urethral and vaginal areas. C. Tolterodine is used to facilitate weight loss by acting as an appetite suppressant. D. Tolterodine is used to improve blood flow to the pelvic muscles to decrease urinary tract infections.

A. Tolterodine (Detrol) inhibits cholinergic bladder contractions, thereby decreasing urinary frequency, urgency, and urge incontinence.

The nurse is providing care to a 46-year-old female patient. The patient appears hesitant when asked of her sexual history, and the nurse discovers that the patient is a lesbian. What education should the nurse provide to this patient pertaining to her health? A. Lesbians often are at higher risk for menstrual disorders, abnormal insulin production, and infertility. B. Lesbians often are at higher risk due to lower socioeconomic disparities than their heterosexual counterparts. C. Lesbians often refuse choices in health care such as the HPV vaccine as many feel they are not at risk. D. Lesbians often have fewer health issues than their heterosexual counterparts due to their strong support systems.

A. These are signs and symptoms of polycystic ovarian syndrome, which lesbians are at higher risk for than are their heterosexual counterparts.

The lactation nurse visits the room of a patient who is postpartum and being prepared for discharge. The nurse plans to provide breastfeeding information aimed at assisting the patient to continue breastfeeding her newborn. Which observation by the nurse indicates a possible disruption to the planned teaching? A. The patient is currently breastfeeding her baby. B. The patient is excited about taking her baby home. C. The patient's partner is in the patient's room. D. The patient states she has no questions or concerns.

B. When the patient is distracted by feelings and/or activities, there is the possibility for disruption of the nurse's teaching. The right time for teaching is imperative.

The nurse is assessing a 16-year-old sexually active patient in the family practice clinic. The patient's symptoms include breakthrough vaginal bleeding, abdominal pain, nausea, and fever. The health care provider obtains cultures of the cervical epithelial cells during a Pap smear and orders doxycycline 100 mg orally twice a day for 7 days for her and her partner. The nurse understands that this prescription is consistent with the treatment of which medical diagnosis? A. Herpes B. Condylomas C. Chlamydia D. Gonorrhea

C. Chlamydia is the most common bacterial STI in the United States and the leasing cause of preventable infertility. This is diagnosed by cultures of cervical epithelial cells and is treated with antibiotics. The partner needs to be treated to prevent reinfection.

A patient in the first stage of pregnancy is discussing the options for feeding her infant, and asks the nurse, "Which is the most important reason I should consider breastfeeding my baby?" Which is the most significant reason the nurse presents? A. Human milk proteins are easier to digest than protein in prepared formula. B. The amount of cholesterol in human milk is essential for the baby. C. Human milk contains multiple antibodies, enzymes, and immune factors. D. Vitamins and minerals are transferred to human milk from the mother.

C. Human milk contains multiple antibodies, enzymes, and immune factors that help protect the infant from common infections. It also stimulates the growth of healthy bacteria in the intestinal system, which inhibits growth of bacteria that can cause diseases. The factors are not found in formula, and this is the most significant reason for the nurse to recommend breastfeeding.

The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, if made by the mother, requires the nurse to provide patient teaching? A. "I wish that I had tried breastfeeding because formula is expensive." B. "At least I get a break every evening when my spouse feeds the baby." C. "Sometimes I will add a little water to the formula if I am running low." D. "I get frustrated if the last bottle is fed to the baby late at night."

C. If the mother states a practice of diluting the baby's formula if her supply is low, the nurse needs to provide teaching. Prolonged over-dilution of formulas can cause water intoxication, as well as decrease the caloric intake by the baby

The nurse is assessing a term neonate delivered to a mother with a history of drug and alcohol abuse. Which finding does the nurse relate to the mothers history? A. Chest circumference is less than the head circumference B. The neonates pulse rate increases when the neonate cries C. When crying, the neonate exhibits an absence of tear production D. Head circumference is below the 10th percentile of normal gestational age

D Head circumference below the 10th percentile of normal for gestational age is indicative of microcephaly, which is often related to congenital malformation, maternal drug or alcohol ingestion, or maternal infection during pregnancy.