*OB Quiz 1 Possible Questions- Chapters 1-5

The nurse instructs a nursing student to administer clomiphene (Clomid) to a patient in order to conduct a clomiphene citrate challenge test (CCCT). What instruction should the nurse give to the nursing student before giving this medication to the patient? To administer: 1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. 2 A 500-mg initial dose of clomiphene (Clomid) to the patient. 3 Clomiphene (Clomid) to the patient on the 12th day of the menstrual cycle. 4 Clomiphene (Clomid) to the patient on the 15th day of the menstrual cycle.

1 A 100-mg dose of clomiphene (Clomid) to the patient immediately. The clomiphene citrate challenge test is used to assess follicle-stimulating hormone (FSH) levels. From this test, the nurse can determine whether the patient has an adequate ovarian reserve. The nurse instructs the student nurse to administer a 100-mg dose of clomiphene (Clomid) to the patient, as it is the standard dosage. Administering 500 mg may lead to an overdose and side effects in the patient. Therefore, the nurse should not instruct the nursing student to administer 500 mg of clomiphene (Clomid) as the initial dosage. Administering clomiphene (Clomid) on the 12th or 15th day of the menstrual cycle may not be effective and does not affect the levels of follicle-stimulating hormone

4 If a patient is not given the standard level of care, and some kind of harm to the patient results, then she can make a case for negligence. Inconsistent fetal heart rate is not a case for negligence by itself; negligence occurs if care was not provided even after the findings. Not providing care because of cultural differences is a case of racial discrimination, not negligence. If the patient does not understand the care instructions, then the responsibility for negligence lies with the patient.

An infant born to a 38-year-old Hispanic patient dies 3 days after birth due to sepsis. On what grounds could the patient have a legitimate case for negligence? 1 The fetal heart rate was inconsistent. 2 The patient was neglected because of her Hispanic origins. 3 The patient could not understand care instructions. 4 The patient was not given the standard level of care.

The process by which people retain some of their own culture while adopting the practices of the dominant society is known as: A) Acculturation. B) Assimilation. C) Ethnocentrism. D) Cultural relativism.

A) Acculturation.

38. Many pregnant teens wait until the second or third trimester to seek prenatal care. The nurse should understand that the reasons behind this delay include: a. Lack of realization that they are pregnant. b. Uncertainty as to where to go for care. c. Continuing to deny the pregnancy. d. A desire to gain control over their situation. e. Wanting to hide the pregnancy as long as possible.

A, B, C, E

16. Recent trends in childbirth practices in the United States indicate that: a. More than 15% of mothers had late or no prenatal care. b. The percentage of Hispanics, non-Hispanic African Americans, and Caucasians who received prenatal care was essentially the same. c. Births occurring in the hospital accounted for 99% of births. d. Cesarean births have been declining as a percentage of live births.

c. Births occurring in the hospital accounted for 99% of births.

7. What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

c. Identifying researchable problems

23. To ensure patient safety, the practicing nurse must have knowledge of the current Joint Commission's "Do Not Use" list of abbreviations. Which of the following is acceptable for use? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero

c. International Unit

12. With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility.

c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.

8. Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are: a. Ovaries. b. Breast milk. c. Menstrual blood. d. The vagina.

c. Menstrual blood.

3. The role of the professional nurse caring for childbearing families has evolved to emphasize: a. Providing care to patients directly at the bedside. b. Primarily hospital care of maternity patients. c. Practice using an evidence-based approach. d. Planning patient care to cover longer hospital stays.

c. Practice using an evidence-based approach.

11. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established.

c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms.

11. A 38-year-old Hispanic woman delivered a 9-pound, 6-ounce girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds would the woman potentially have a legitimate legal case for negligence? a. She is Hispanic. b. She delivered a girl. c. The standards of care were not met. d. She refused fetal monitoring.

c. The standards of care were not met.

13. The term used to describe legal and professional responsibility for practice for maternity nurses is: a. Collegiality. b. Ethics. c. Evaluation. d. Accountability.

d. Accountability.

22. The stimulated release of gonadotropin-releasing hormone and follicle-stimulating hormone is part of the: a. Menstrual cycle. c. Ovarian cycle. b. Endometrial cycle. c. Ovarian cycle. d. Hypothalamic-pituitary cycle.

d. Hypothalamic-pituitary cycle.

6. When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman's: a. Age. b. Minority status. c. Educational level. d. Inability to pay.

d. Inability to pay.

10. The long-term treatment plan for an adolescent with an eating disorder focuses on: a. Managing the effects of malnutrition. b. Establishing sufficient caloric intake. c. Improving family dynamics. d. Restructuring perception of body image.

d. Restructuring perception of body image.

16. The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors.

d. Risky sexual behaviors and inadequate preventive health behaviors.

Which statement about family systems theory is inaccurate? A) A family system is part of a larger suprasystem. B) A family as a whole is equal to the sum of the individual members. C) A change in one family member affects all family members. D) The family is able to create a balance between change and stability.

B) A family as a whole is equal to the sum of the individual members.

12. A newly graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Her research finds that these costs are much higher compared with other developed countries as a result of: a. A higher rate of obesity among pregnant women. b. Limited access to technology. c. Increased usage of health care services along with lower prices. d. Homogeneity of the population.

a. A higher rate of obesity among pregnant women.

39. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.

a. Diuretic administration.

41. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. b. Intraductal papilloma. c. Chronic cystic disease. d. Fibroadenoma.

a. Ductal ectasia.

20. A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

a. Fluconazole

25. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

a. Herpes simplex virus (HSV)-2

29. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely.

a. Strategies to enhance condom use.

24. Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and providing care across the perinatal continuum. Therefore it is important for the nurse to be aware that significant progress has been made in: a. The reduction of fetal deaths and use of prenatal care. b. Low birth weight and preterm birth. c. Elimination of health disparities based on race. d. Infant mortality and the prevention of birth defects.

a. The reduction of fetal deaths and use of prenatal care.

27. A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" Your best response is: a. "It's just a little lump on your cervix. We can freeze it off." b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." c. "HPV is a type of early human immunodeficiency virus (HIV). You will die from this." d. "You probably caught this from your current boyfriend. He should get tested for this."

b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer."

21. To detect human immunodeficiency virus (HIV), most laboratory tests focus on the: a. virus. b. HIV antibodies. c. CD4 counts. d. CD8 counts.

b. HIV antibodies.

18. The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).

b. Human papillomavirus (HPV).

19. Maternity nursing care that is based on knowledge gained through research and clinical trials is: a. Derived from the Nursing Intervention Classification. b. Known as evidence-based practice. c. At odds with the Cochrane School of traditional nursing. d. An outgrowth of telemedicine.

b. Known as evidence-based practice.

23. Certain fatty acids classified as hormones that are found in many body tissues and that have roles in many reproductive functions are known as: a. Gonadotropin-releasing hormone (GnRH). b. Prostaglandins (PGs). c. Follicle-stimulating hormone (FSH). d. Luteinizing hormone (LH).

b. Prostaglandins (PGs).

6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days.

b. She describes her flow as very heavy.

19. The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client-applied: a. Miconazole ointment. b. Topical podofilox 0.5% solution or gel. c. Penicillin given intramuscularly for two doses. d. Metronidazole by mouth.

b. Topical podofilox 0.5% solution or gel.

5. Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is: a. 5 to 7 days after menses ceases. b. Day 1 of the endometrial cycle. c. Midmenstrual cycle. d. Any time during a shower or bath.

a. 5 to 7 days after menses ceases

Which contraceptive method provides protection against sexually transmitted infections? 1 Oral contraceptives 2 Tubal ligation 3 Male or female condoms 4 Intrauterine device (IUD)

3 Male or female condoms Because condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted infection. Only the barrier methods provide some protection from sexually transmitted infections. A tubal ligation is considered a permanent contraceptive method but does not offer any protection against sexually transmitted infections. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted infections.

1, 3, 4, 5 Healthy People 2020 promotes healthy behaviors across all life stages. Healthy People provides science-based 10-year national objectives for improving the health of all Americans. It has four overarching goals: (1) attaining high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieving health equity, eliminating disparities, and improving the health of all groups; (3) creating social and physical environments that promote good health for all; and (4) promoting quality of life, healthy development, and healthy behaviors across all life stages (www.healthypeople.gov/2020/about/default.aspx). The goals of Healthy People 2020 are based on assessments of major risks to health and wellness, changes in public health priorities, and issues related to the health preparedness and prevention of our nation.

Healthy People 2020 goals include: Select all that apply. 1 promoting quality of life. 2 promoting healthy behaviors in middle adulthood. 3 attaining high-quality, longer lives. 4 eliminating health disparities. 5 creating social and physical environments that promote health.

1 Pregnancy-related hypertension and diabetes-related hypertension are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of increased health care services and longer hospital stays. Both drug and alcohol use continue to increase in the maternal population. These are associated with low-birth-weight infants, cognitive impairment, and birth defects. The number of these patients is increasing; however, these are not the most common risks. Behavior and lifestyle choices contribute to the health of the mother and fetus.

The most frequently reported maternal medical risk factors are: 1 pregnancy-related hypertension and diabetes-related hypertension. 2 drug use and alcohol abuse. 3 homelessness and lack of insurance. 4 behaviors and lifestyles

1, 2, 3, 5 It is imperative that nurses put questions to the patient to elicit cultural expectations about childbearing. Knowledge about the cultural issues related to childbirth will allow the nurse to provide better and informed care. Asking patients about their perceptions of maintaining health, and how they plan to maintain their health helps the nurse spot any unhealthy choices. Asking what foods the patient plans to give to the child also helps the nurse identify foods, which may be inappropriate. Asking about the labor support person helps the nurse ensure adequate preparation for the procedure.

The nurse is asking patient questions to elicit cultural expectations about childbearing. What is an appropriate question to be asked by the nurse? Select all that apply. 1 What do you and your family believe is healthy during pregnancy? 2 What can you do to improve your health and the health of your baby? 3 What foods do you believe will help make a healthy baby? 4 How stressful do you expect the birth of the baby to be? 5 How can your labor support person make you comfortable during labor?

1 Initiate health-screening programs for community members. 2 Participate in immunization or vaccination clinics. 3 Work with community leaders to develop or clean up playgrounds. Lack of community programs and the presence of gangs are a risk for the health status of the community. Working with community leaders to develop or clean up playgrounds is done to provide a safe place for children to play. This is an essential intervention to improve the health status of the community. The nurse also initiates health-screening programs for community members to identify effects of environmental hazards in the community. The nurse participates in immunization or vaccination clinics to reduce risk in the community of infectious diseases. Such measures are aimed at improving the health status of the community. Monitoring or surveillance systems are developed to ensure that progress will continue and new problems will be identified. Preparing patient education materials in a variety of languages is done to enhance understanding of community members.

The nurse is teaching students about the interventions required if there are no community programs to guide youth groups and there are gangs present in the community. What is an appropriate intervention by the nurse? Select all that apply: 1 Initiate health-screening programs for community members. 2 Participate in immunization or vaccination clinics. 3 Work with community leaders to develop or clean up playgrounds. 4 Develop monitoring or surveillance system. 5 Prepare patient education materials in a variety of languages

3 The Joint Commission has issued a "Do Not Use" list that contains abbreviations and acronyms that should not be used while writing instructions. MS can mean morphine sulphate or magnesium sulphate. Therefore, the nurse needs to consult with the primary health care provider and obtain the proper drug name. The nurse should not obtain the drug from the pharmacy without verifying that it is the right drug. The nurse should not ask colleagues because they may not give the correct answer.

The nurse receives a prescription that includes the abbreviation MS. What action does the nurse take? 1 Obtains morphine sulphate from the pharmacy 2 Obtains magnesium sulfate from the pharmacy 3 Consults the primary health care provider 4 Consults a colleague for explanation

2. The uterus is a muscular, pear-shaped organ that is responsible for: a. Cyclic menstruation. b. Sex hormone production. c. Fertilization. d. Sexual arousal.

a. Cyclic menstruation.

1. When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is: a. Diabetes mellitus. b. Mitral valve prolapse (MVP). c. Chronic hypertension. d. Anemia.

a. Diabetes mellitus.

18. A 20-year-old patient calls the clinic to report that she has found a lump in her breast. The nurse's best response is: a. "Don't worry about it. I'm sure it's nothing." b. "Wear a tight bra, and it should shrink." c. "Many women have benign lumps and bumps in their breasts. However, to make sure that it's benign, you should come in for an examination by your physician." d. "Check it again in 1 month and call me back if it's still there."

c. "Many women have benign lumps and bumps in their breasts. However, to make sure that it's benign, you should come in for an examination by your physician."

42. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman b. A 50-year-old woman c. A 16-year-old girl d. A 27-year-old woman

c. A 16-year-old girl

38. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. b. Lipoma. c. Intraductal papilloma. d. Mammary duct ectasia.

c. Intraductal papilloma.

21. A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the _____ phase of the endometrial cycle. a. Menstrual b. Proliferative c. Secretory d. Ischemic

c. Secretory

32. A pregnant woman who abuses cocaine admits to exchanging sex for her drug habit. This behavior places her at a greater risk for: a. Depression of the central nervous system b. Hypotension and vasodilation c. Sexually transmitted diseases d. Postmature birth

c. Sexually transmitted diseases

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

d. Using a heating pad on the abdomen to relieve cramping

24. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. b. Ofloxacin. c. Podophyllin. d. Zidovudine.

d. Zidovudine.

19. The female reproductive organ(s) responsible for cyclic menstruation is/are the: a. Uterus. b. Ovaries. c. Vaginal vestibule. d. Urethra.

a. Uterus.

10. With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women. b. It is more common in leaner women who exercise strenuously. c. Symptoms can begin at any point in the ovulatory cycle. d. Pain usually occurs in the suprapubic area or lower abdomen.

d. Pain usually occurs in the suprapubic area or lower abdomen.

4. The hormone responsible for maturation of mammary gland tissue is: a. Estrogen. b. Testosterone. c. Prolactin. d. Progesterone.

d. Progesterone.

30. The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

d. The exact cause of breast cancer is unknown.

While working in the prenatal clinic, you care for a very diverse group of patients. When planning interventions for these families, you realize that acceptance of the interventions will be most influenced by: A) Educational achievement. B) Income level. C) Subcultural group. D) Individual beliefs.

D) Individual beliefs.

20. The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: a. Perineum. b. Bony pelvis. c. Vaginal vestibule. d. Fourchette.

b. Bony pelvis

A patient wants to have an abortion during the 18th week of pregnancy. What abortion technique should the nurse suggest to the patient? 1 Dilation and evacuation 2 A surgical (aspiration) abortion 3 Administration of methotrexate (Trexal) 4 Administration of mifepristone (Mifeprex)

1 Dilation and evacuation The patient is in her second trimester of pregnancy. Therefore, the nurse should suggest the dilation and evacuation method of abortion. This method is safe and can be used until 20 weeks of gestation. Surgical (aspiration) methods and use of medications such as methotrexate (Trexal), mifepristone (Mifeprex), and misoprostol (Cytotec) are effective for abortion during the first trimester of pregnancy. These methods are not suitable as the patient is in the 18th week of pregnancy.

The procedure in which ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus is: 1 In vitro fertilization 2 Tubal embryo transfer 3 Therapeutic insemination 4 Gamete intrafallopian transfer

1 In vitro fertilization In vitro fertilization is a procedure used to bypass blocked or absent fallopian tubes. Tubal embryo transfer places the conceptus into the fallopian tube. Therapeutic insemination uses the partner's sperm or that of a donor and places it directly into the woman. Gamete intrafallopian transfer involves placing the sperm and ova in the fallopian tube.

Which medication should the nurse expect to find in the patient's medication profile for the treatment of uterine fibroid tumors? 1 Leuprolide acetate (Lupron) 2 Ganirelix acetate (Antagon) 3 Progesterone (Prometrium) 4 Clomiphene citrate (Clomid)

1 Leuprolide acetate (Lupron) Gonadotropin-releasing hormone (GnRH) agonists like leuprolide acetate (Lupron) are used for the treatment of uterine fibroids. These medications desensitize the GnRH agonist receptors and decrease the production of follicle-stimulating hormone (FSH) and ovarian function. Ganirelix acetate (Antagon) is a GnRH antagonist and is used for infertility treatment. Progesterone (Prometrium) is used for treatment of luteal phase inadequacy. Clomiphene citrate (Clomid) is used for ovulation induction and treatment of luteal phase inadequacy.

What are the side effects of gonadotropin-releasing hormone (GnRH) agonists? Select all that apply. 1 Myalgia 2 Arthralgia 3 Lactic acidosis 4 Vaginal dryness 5 Liver dysfunction

1 Myalgia 2 Arthralgia 4 Vaginal dryness Gonadotropin-releasing hormone (GnRH) agonists are used for the treatment of endometriosis and uterine fibroids. Myalgia, arthralgia, and vaginal dryness are the side effects of gonadotropin-releasing hormone (GnRH) agonists. These side effects are usually reversible within 12 to18 months after the treatment. Lactic acidosis and liver dysfunction are side effects of metformin, which is an oral hypoglycemic agent.

A woman calls the clinic asking the nurse what to do for one missed combined oral contraceptive pill. Which instructions should the nurse give the woman? Select all that apply. 1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. 4 Take two pills then resume one tablet daily. 5 Use a backup contraceptive for the next seven days.

1 No backup method is needed. 2 Take the next dose at the usual time. 3 Take one active pill as soon as possible. For one missed combined oral contraceptive pill the nurse instructs the woman to continue the pack as usual, take the next dose at the usual time and take one active pill as soon as possible. Two pills should not be taken and no backup contraceptive is necessary.

The nurse is reviewing the laboratory results for a patient who has undergone semen testing. The nurse notices that the patient is in the subfertile stage. What is the next step that the nurse should take? 1 Plan to have the test repeated 2 Arrange for hormone level tests 3 Schedule a scrotal ultrasound 4 Counsel about infertility issues

1 Plan to have the test repeated A minimum of two seminal analyses are recommended before determining the cause of infertility or referring for further testing. If abnormalities are found during the first test, the nurse should plan for a second seminal analysis after a sufficient interval. If the second semen test also finds the patient to be in the subfertile range, then further investigation is needed. This can include assessing hormonal levels and sending the patient for an ultrasound. The nurse should proceed to counsel the patient only after all the diagnostic tests reveal infertility, not after the initial semen examination.

A man and a woman who have not achieved a successful pregnancy are scheduled to meet with a fertility specialist. Which simple evaluation is usually the first test to be performed? 1 Semen analysis 2 Testicular biopsy 3 Endometrial biopsy 4 Hysterosalpingogram

1 Semen Analysis Semen analysis is usually the first test to be performed because it is least costly and noninvasive. A testicular biopsy is an invasive examination using a local anesthetic. Endometrial biopsy determines whether the endometrium is responding to ovarian stimulation. Hysterosalpingogram uses contrast medium to evaluate the structure and patency of the uterus and tubes.

After having a discussion with a patient, the nurse finds that the patient has regular menstrual cycles every 28 days. What instructions should the nurse give to the patient to prevent conception? 1 The couple should abstain from sexual intercourse from days 10 through 17. 2 The couple should abstain from sexual intercourse from days 6 through 19. 3 It is safe to have unprotected sexual intercourse from days 11 through 17. 4 It is safe to have unprotected sexual intercourse from days 12 through 16.

1 The couple should abstain from sexual intercourse from days 10 through 17 The patient has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11 = day 17). Therefore, the nurse should advise the patient to abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual intercourse between days 11 and 17 and days 12 through 16 because it is a fertile period.

The nurse is assessing a patient who is taking oral contraceptives and reports severe pain in the legs. What symptoms should the nurse primarily assess for in the patient? 1 Thrombus formation 2 Severe muscle spasms 3 High creatinine levels 4 Hyperglycemic events

1 Thrombus Formation Patients who take oral contraceptives are at a high risk of developing thromboembolism or blood clots. Therefore the nurse would primarily assess for calf pain warmth and tenderness which indicates thromboembolism. Muscle spasms are not side effects that develop with oral contraceptives. Although the pain is severe in the case of muscle spasms, it can be resolved easily with the help of analgesics. Creatinine levels increase when the kidneys fail to function properly. Oral contraceptives have no effect on kidney function. Oral contraceptives have no effect on blood glucose levels

A patient approaches the primary health care provider due to ovulation problems. The nurse instructs the patient to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? 1 To assess the levels of progesterone in the patient 2 To determine the thickness of the uterine lining 3 To evaluate the viscosity of the cervical mucus 4 To assess the follicle-stimulating hormone (FSH) level

1 To assess the levels of progesterone in the patient Serum progesterone levels are tested seven days before the onset of the next estimated menstrual cycle. This test would help identify the progesterone levels in the patient. It helps to assess the corpus luteum and midluteal-phase progesterone levels as progesterone plays a role in ovulation and the menstrual cycle. The uterine cavity is observed by using an X-ray film during a hysterosalpingogram. This test does not need to be conducted at a particular time. The viscosity of the cervical mucus is assessed to determine if it is conducive for the penetration of the sperm. This can be checked at any point in time. Follicle-stimulating hormone (FSH) levels are determined on day 3 of menstruation to determine ovarian reserve.

The nurse is counseling a patient who has had multiple miscarriages. The nurse explains to the patient that she has developed endometriosis. In which category would this be placed as a cause of infertility? 1 Tubal factors 2 Ovarian factors 3 Uterine factors 4 Cervical factors

1 Tubal factors A series of steps are required for successful conception. Interference in any one of the steps may result in infertility. Tubal factors would be the cause of this patient's infertility. The fertilized embryo was unable to reach the uterus by passing through the fallopian tubes because of the patient's endometriosis. Ovarian factors that cause infertility impair the process of production of healthy oocytes during the menstruation cycle. A successfully formed fertilized embryo signifies that oocytes are healthy. This patient does not have uterine factors that cause infertility since the patient is able to successfully conceive. The uterine factors may affect the process of implantation and nourishment of the embryo in the uterus. The fertilized egg is unable to reach the uterus. Any change in the anatomy of the cervix that affects the movement of the sperm into the uterus indicates a cervical factor. In this patient, the embryo was fertilized. This indicates that the sperm were able to pass through the uterus and fertilize the egg. Therefore it is not a cervical factor.

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: 1 "The lubricant prevents vaginal irritation." 2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." 3 "The additional lubrication improves sex." 4 "Nonoxynol-9 improves penile sensitivity."

2 "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 does not provide protection against sexually transmitted infections. Nonoxynol-9 may cause vaginal irritation. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

A patient is administered progestins (Depo-Provera) through the intramuscular route. What should the nurse suggest to the patient to prevent complications? The patient should increase: 1 Iron intake. 2 Calcium intake. 3 Protein intake. 4 Potassium intake.

2 Calcioum intake Patients who take progestins such as depot medroxyprogesterone acetate (Depo-Provera) may lose significant bone mineral density, which may cause osteoporosis in time. Therefore, the nurse should recommend increasing the daily calcium intake for patients who are on progestins. Iron intake is encouraged in the patients who are anemic; progestins do not cause anemia. Progestins do not affect the protein and potassium levels in the body. Therefore, the nurse need not suggest that the patient eat a diet rich in protein or potassium.

Which symptom in a woman who is using oral contraceptives should be reported to the physician immediately? 1. 5-lb weight gain in a month 2 Leg pain and edema 3 Decrease in menstrual flow 4 Increased pigmentation of the face

2 Leg pain and edema Oral contraceptives increase clotting factors that may place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain in the first month is a common finding. A decrease in menstrual flow is an expected finding. An increased pigmentation of the face is a common finding.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse tells him to: 1 ejaculate into a sterile container. 2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. 3 transport specimen with container packed in ice. 4 ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

2 obtain the specimen after a period of abstinence from ejaculation of 2 to 7 days. An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

A woman undergoing evaluation of infertility states, "At least when we're through with all of these tests, we will know what is wrong." The nurse's best response is: 1 "I know the test will identify what is wrong." 2 "I'm sure that once you finish these tests your problem will be resolved." 3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples." 4 "Once you've identified your problem, you may want to look at the option of adoption."

3 "Even with diagnostic testing, infertility remains unexplained in about 20% of couples" Problems with infertility must be approached realistically. Nurses should not make judgments or give false reassurance. Providing accurate information to the couple is the best response. The nurse should not make statements indicating that problems will be resolved, because this gives a false impression. The tests are not always definitive, so the nurse should not give false reassurance. The nurse should not offer her opinion but instead should state the facts.

Which symptom should the nurse expect in a female patient who presents with elevated androgen levels? 1 Skin rashes and acne 2 Loss of body hair 3 Pigmentation changes 4 Decreased body weight

3 Pigmentation changes An increase in androgen (male sexual hormone) levels causes pigmentation changes in the patient. This is because the epidermis becomes coarse and thick. Increased androgen levels do not cause hypersensitivity or acne breakouts. Therefore, the patient may have neither skin rashes nor acne. Due to an increase in androgen levels, the patient may have an excessive growth in body hair. Androgen levels do not affect body weight.

What factors should the nurse assess in the patient with anovoluation? Select all that apply. 1 Endometriosis 2 Vaginal infections 3 Thyroid disorders 4 Pituitary gland disorders 5 Pancreatic gland disorders

3 Thyroid disorders 4 Pituitary gland disorders Thyroid disorders and pituitary gland disorders are the primary factors causing anovulation. Abnormal activity of these glands could restrict the formation of ova. Endometriosis is the condition that affects peritoneal factors. This condition does not affect the formation of ova, nor does it restrict it. Vaginal infections are treated with medications and have no relation to the ovaries or their functioning. The pancreas secretes insulin and glucagon, which is not related to ovarian activity either.

A 26-year-old woman is considering Depo-Provera as the contraception that is best for her because she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse should tell her that Depo-Provera: 1 is a combination of progesterone and estrogen. 2 is a small adhesive hormonal birth control patch that is applied weekly. 3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. 4 has an effectiveness rate in preventing pregnancy of 96% when used correctly.

3 thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. The effectiveness rate is 99% or greater over 5 years.

Which response by the nurse is most appropriate when a woman asks, "What contraceptive do you think I should use?" 1 "Your health care provider will know what is best for you." 2 "The male condom is probably the easiest for you to use." 3 "Because you are younger than 40, you should use oral contraceptives." 4 "I can discuss the various methods so you can decide what is best for you."

4 "I can discuss the various methods so you can decide what is best for you." The nurse should provide the woman with all the necessary information to make an informed decision, but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

After checking the laboratory report of a patient, the nurse reports to the primary health care provider findings that the patient has developed insulin resistance and anovulation. What should the nurse expect to be prescribed for the patient? 1 Danazol (Danocrine) and glipizide (Glucotrol) 2 Bromocriptine (Parlodel) and glyburide (Diabeta) 3 Progesterone (Prometrium) and acarbose (Precose) 4 Clomiphene (Clomid) and metformin (Glucophage)

4 Clomiphene (Clomid) and metformin (Glucophage) The patient has anovulation and insulin resistance. Therefore, the primary health care provider may prescribe a combination of clomiphene to promote ovulation and metformin to control blood sugar levels. Clomiphene increases pituitary production and increases the production of follicle-stimulating hormone. Insulin resistance causes hyperinsulinemia, which is a feature of polycystic ovary syndrome. This causes anovulation and leads to infertility in the patient. Danazol (Danocrine) is used for the treatment of endometriosis. Glipizide (Glucatrol) and glyburide (Diabeta) are oral hypoglycemic agents but do not work on patients with insulin resistance. Bromocriptine (Parlodel) is used for patients who have excess prolactin. Progesterone (Prometrium) is used for the treatment of endometriosis. Acarbose (Precose) works in the gastrointestinal tract on carbohydrates for diabetes mellitus.

What is the significance of the clomiphene citrate challenge test (CCCT)? To assess: 1 If the fallopian tubes are open and patent 2 for the presence of uterine abnormalities 3 The amount of progesterone production 4 Follicle-stimulating hormone (FSH) levels

4 Follicle-stimulating hormone (FSH) levels The clomiphene citrate challenge test (CCCT) is used to assess follicle-stimulating hormone (FSH) levels. In this test, 100 mg of clomiphene (Clomid) is administered to the patient from day 3 to day 10 of the menstrual cycle. Follicle-stimulating hormone (FSH) levels are assessed on the 3rd day and the 10th day after clomiphene (Clomid) is administered. FSH levels greater than 20 indicate that the pregnancy will not occur with the woman's own eggs. FSH levels less than 15 suggest an adequate ovarian reserve in the patient. Patency in the fallopian tubes is assessed by hysterosalpingogram, hysterosalpingo-contrast sonography, and chlamydia immunoglobulin G antibodies. Uterine abnormalities are assessed by hysterosalpingogram and hysterosalpingo-contrast sonography. Progesterone production is assessed by the serum progesterone test.

7. Individual irregularities in the ovarian (menstrual) cycle are most often caused by: a. Variations in the follicular (preovulatory) phase. b. An intact hypothalamic-pituitary feedback mechanism. c. A functioning corpus luteum. d. A prolonged ischemic phase.

a. Variations in the follicular (preovulatory) phase

The nurse administers leuprolide acetate (Eligard) followed by gonadotropin therapy to a patient and schedules the patient for daily ultrasounds. What is the rationale for this referral? To check for: 1 Fibrocystic breast tissue changes. 2 Stimulation of the endometrium. 3 Blockage in the fallopian tubes. 4 Hyperstimulation of both ovaries.

4 Hyperstimulation of both ovaries. Leuprolide acetate (Eligard) followed by gonadotropin is the most powerful medication to induce ovulation. These medications require daily ovarian ultrasounds and checking of estradiol levels in order to assess for hyperstimulation of the ovaries. Breast tissue changes, endometrial stimulation, and fallopian tube blockage are not side effects related to gonadotropin drugs. Progesterone may cause breast enlargement and endometrial stimulation. Fallopian tube blockage must be corrected surgically.

On reviewing the laboratory report of the patient, the nurse finds that the patient is subfertile. Which nursing advice is helpful for the patient to resolve this condition? 1 Start taking cold baths or showers daily. 2 Take flaxseed oil in order to stimulate fertility. 3 Add periwinkle powder to your tea once a day. 4 Use water-soluble lubricants during intercourse.

4 Use water-soluble lubricants during intercourse. Commonly used lubricants contain spermicides or have spermicidal properties that can kill sperm. Therefore the nurse should advise the patient to use water-soluble lubricants during intercourse. The nurse should advise the patient to take hot baths or use saunas instead of cold baths and showers. This increases the basal body temperature, which helps in increasing spermatogenesis. Flaxseed and periwinkle herbal products should not be used, as most herbal remedies are not clinically proven. Hence, they may not be safe

The nurse is caring a patient who is pregnant as a surrogate mother. What condition would the biological mother have in order to need to use a gestational surrogate? 1 Ovarian failure 2 Tubal blockage 3 Early menopause 4 Uterine myoma

4 Uterine Myoma The patient who carries the fetus for another couple is referred to as a surrogate mother. In conditions like uterine myomas, the fertilized ova cannot be impregnated in the uterus of the biological mother. Therefore, the couple would need a surrogate mother to carry the fetus. A female with ovarian failure can still carry the fetus after in vitro fertilization of the donor oocyte. The genetic investment from the male parent can possibly be observed in the embryo when the oocyte is donated and fertilized with the parent sperm. In conditions like tubal blockage, a female can carry the fetus after it is fertilized in vitro. Genetic investment is possible from both the parents for the embryo. Early menopause is the condition where a female may require a donor oocyte to conceive and can still carry the embryo in her own uterus.

The nurse is assessing a couple for infertility problems. After reviewing the patient's history and laboratory results, the nurse finds that the patient is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help the patient to increase the sperm count? 1 Bromocriptine (Parlodel) 2 Progesterone (Prometrium) 3 Depot medroxyprogesterone acetate (DMPA) 4 Intracytoplasmic sperm injection (ICSI)

4 intracytoplasmic sperm injection The patient may require intracytoplasmic sperm injection (ICSI). This treatment is preferred for treating patients who have a low sperm count or reduced spermatogenesis. In this process, one sperm cell is selected and injected directly into the egg to achieve fertilization. Bromocriptine (Parlodel) is used to reduce excess prolactin levels. Progesterone (Prometrium) is used for the treatment of endometriosis. Progestin (DMPA) injections are used to impair fertility by inhibiting ovulation. These medications are not prescribed for infertility problems in males.

4 Native Americans often use cradle boards and avoid handling their newborn often; they believe that the infant should not be fed colostrum. Delayed attachment is a cultural belief, not a delay in attachment. Embarrassment is a cultural belief, not an expression of embarrassment. This cultural belief does not indicate that there is disappointment regarding the sex of the baby.

A Native American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: 1 delayed attachment. 2 embarrassment. 3 disappointment that the baby is a girl. 4 a belief that babies should not be fed colostrum.

2 Acculturation refers to the changes that occur within one group or among several groups when people from different cultures interact with one another. People may retain some of their own culture while adopting some cultural practices of the dominant society. Assimilation occurs when a cultural group loses its cultural identity and becomes part of the dominant culture. Ethnocentrism is the view that one's own way of doing things is the best way. Cultural relativism refers to learning about and applying the standards of another's culture to one's own culture.

A group of students of Latin American origin was quite influenced by others of Indian origin, and adopted their practices. What is this phenomenon called? 1 Assimilation 2 Acculturation 3 Ethnocentrism 4 Cultural relativism

3, 2, 1, 4, 5 The Situation-Background-Assessment-Recommendation (SBAR) technique provides a specific framework for communication among health care providers. SBAR is an easy-to-remember, useful, and concrete mechanism for communicating information that requires a clinician's immediate attention. Failure to communicate adequately is one of the major reasons for health care errors. In this particular case the Situation that the nurse identified was bleeding and a change in vital signs. Background included recent medications and her multiparous status. Assessment included the finding of a boggy uterus. Last, the nurse clearly articulated the need for the physician to come immediately in her Recommendation.

A nurse is concerned that her newly delivered patient is experiencing a postpartum hemorrhage. She is calling the physician to provide a report regarding this critical situation. Using SBAR as a communication tool, in which order should the nurse provide information? 1. I would like you to come and examine the patient immediately. 2. I have just assessed Mrs. Smith; she has saturated a sanitary pad in 1 hour and her BP is 112/62 mm Hg. 3. Mrs. Smith is a gravida 6 patient who delivered 12 hours ago. 4. The I.V. with Pitocin was discontinued 2 hours ago. 5. The patient's fundus is boggy.

3 Married-blended families are those formed because of divorce and remarriage. They consist of unrelated family members such as stepparents, stepchildren, and stepsiblings. No-parent families are those in which children live independently in foster or kinship care such as living with a grandparent. Married-parent families (biologic or adoptive parents) make up the majority-about 48.4% of American families. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults.

A patient has a stepfather and a couple of stepsons. The patient asks the nurse, "What kind of family category does my family belong to according to classification?" What is an appropriate response by the nurse? 1 "No-parent families" 2 "Married-parent families" 3 "Married-blended families" 4 "Single-parent families"

2 Members of some cultural groups tend to speak more loudly when they are excited, with great emotion and with vigorous and animated gestures. This is true whether their excitement is due to positive or negative events. It is important for the nurse to avoid rushing to judgment regarding a person's intent when the patient is speaking, especially in a language not understood by the nurse. Instead, the nurse should withhold an interpretation of what has been expressed until it is possible to clarify the patient's intent. To conclude that the patient is disturbed would be a rushed judgment as the nurse should rule out other options first. Manic patients switch between extremely happy and extremely depressed states. A depressed patient is unlikely to speak loudly and animatedly.

A patient of German origin speaks quite fast, and is very loud and excited most of the time. What is an appropriate interpretation by the nurse? The patient is: 1 disturbed. 2 from a different culture. 3 manic. 4 depressed.

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? A) "I feel irritable and moody a week before my period is supposed to start." B) "I have lower abdominal pain beginning the third day of my menstrual period." C) "I have nausea and headaches after my period starts, and they last 2 to 3 days." D) "I have abdominal bloating and breast pain after a couple days of my period."

A) "I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

To provide competent care to an Asian-American family, the nurse should include which of the following questions during the assessment interview? A) Do you prefer hot or cold beverages? B) Do you want milk to drink? C) Do you want music playing while you are in labor? D) Do you have a name selected for the baby?

A) Do you prefer hot or cold beverages?

A mothers household consists of her husband, his mother, and another child. She is living in a(n): A) Extended family. B) Single-parent family. C) Married-blended family. D) Nuclear family.

A) Extended family.

A pictorial tool that can assist the nurse in assessing aspects of family life related to health care is the: A) Genogram. B) Family values construct. C) Life cycle model. D) Human development wheel.

A) Genogram.

The nurse is preparing for a home visit to complete a newborn wellness checkup. The neighborhood has a reputation for being dangerous. Identify which precautions the nurse should take to ensure her safety (Select all that apply). A) Having access to a cell phone at all times. B) Visiting alone due to the agency's staffing model. C) Carrying an extra set of car keys. D) Avoiding groups of strangers hanging out in doorways. E) Wearing her usual amount of jewelry.

A) Having access to a cell phone at all times. C) Carrying an extra set of car keys. D) Avoiding groups of strangers hanging out in doorways.

A married couple lives in a single-family house with their newborn son and the husbands daughter from a previous marriage. On the basis of the information given, what family form best describes this family? A) Married-blended family B) Extended family C) Nuclear family D) Same-sex family

A) Married-blended family

The woman's family members are present when the home care maternal-child nurse arrives for a postpartum and newborn visit. What should the nurse do? A) Observe the family members interactions with the newborn and one another. B) Ask the woman to meet with her and the baby alone. C) Do a brief assessment on all family members present. D) Reschedule the visit for another time so that the mother and infant can be assessed privately.

A) Observe the family members interactions with the newborn and one another.

The CDC-recommended medication for the treatment of chlamydia would be: A) doxycycline. B) podofilox. C) acyclovir. D) penicillin.

A) doxycycline. Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: A) it is most commonly caused by anovulation. B) it most often occurs in middle age. C) the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. D) the most effective medical treatment involves steroids.

A) it is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

46. Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (Select all that apply): a. Fellatio. b. Unprotected anal intercourse. c. Multiple sex partners. d. Dry kissing. e. Abstinence.

A, B, C

25. Which interventions would help alleviate the problems associated with access to health care for maternity patients (Select all that apply)? a. Provide transportation to prenatal visits. b. Provide childcare so that a pregnant woman may keep prenatal visits. c. Mandate that physicians make house calls. d. Provide low-cost or no-cost health care insurance. e. Provide job training.

A, B, D

45. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.

A, B, D, E

47. The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

A, D, E

37. A common effect of both smoking and cocaine use in the pregnant woman is: a. Vasoconstriction b. Increased appetite c. Changes in insulin metabolism d. Increased metabolism

a. Vasoconstriction

Which statement about cultural competence is not accurate? A) Local health care workers and community advocates can help extend health care to underserved populations. B) Nursing care is delivered in the context of the clients culture but not in the context of the nurses culture. C) Nurses must develop an awareness of and sensitivity to various cultures. D) A cultures economic, religious, and political structures influence practices that affect childbearing.

B) Nursing care is delivered in the context of the clients culture but not in the context of the nurses culture.

The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on family: A) Rituals and customs. B) Values and beliefs. C) Boundaries and channels. D) Socialization processes.

B) Values and beliefs.

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: A) it probably is the result of a hormone deficiency that can be treated with medication. B) it may be caused by stress or excessive exercise or both. C) it likely will require the client to eat less and exercise more. D) it often goes away on its own.

B) it may be caused by stress or excessive exercise or both. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: A) point out that inappropriate sexual behavior caused the infection. B) position the woman in a semi-Fowler position. C) explain to the woman that infertility is a likely outcome of this type of infection. D) tell her that antibiotics need to be taken until pelvic pain is relieved.

B) position the woman in a semi-Fowler position. Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.

26. Which of the following statements indicate that the nurse is practicing appropriate family-centered care techniques (Select all that apply)? a. The nurse commands the mother to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the patient's sister, who is a nurse, that she cannot be in the room during the delivery.

B, C

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? (Select all that apply) A) Bone loss from hypoestrogenism is not reversible. B) Side effects from the steroid danazol include masculinizing traits. C) Surgical intervention often is needed for severe or acute symptoms. D) Women without pain and who do not want to become pregnant need no treatment. E) Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

B, C, D B) Side effects from the steroid danazol include masculinizing traits, C) Surgical intervention often is needed for severe or acute symptoms and D) Women without pain and who do not want to become pregnant need no treatment. Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation.

The nurse should include which information when teaching a 15-year-old about genital tract infection prevention? (Select all that apply.) A) Wear nylon undergarments. B) Avoid tight-fitting jeans. C) Use floral scented bath salts. D) Decrease sugar intake. E) Do not douche. F) Limit time spent wearing a wet bathing suit

B, D, E, F B) Avoid tight-fitting jeans, D) Decrease sugar intake, E) Do not douche & F) Limit time spent wearing a wet bathing suit Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche.

Several noted health risks are associated with menopause. These risks include all except: A) osteoporosis. B) coronary heart disease. C) breast cancer. D) obesity.

C) Breast Cancer Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.

In which culture is the father more likely to be expected to participate in the labor and delivery? A) Asian-American B) African-American C) European-American D) Hispanic

C) European-American

Health care functions carried out by families to meet their members needs include: A) Developing family budgets. B) Socializing children. C) Meeting nutritional requirements. D) Teaching family members about birth control.

C) Meeting nutritional requirements.

A traditional family structure in which male and female partners and their children live as an independent unit is known as a(n): A) Extended family. B) Binuclear family. C) Nuclear family. D) Blended family.

C) Nuclear family.

Using the family stress theory as an intervention approach for working with families experiencing parenting, the nurse can help the family change internal context factors. These include: A) Biologic and genetic makeup. B) Maturation of family members. C) The family's perception of the event. D) The prevailing cultural beliefs of society.

C) The family's perception of the event.

The nurses care of a Hispanic family includes teaching about infant care. When developing a plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic families: A) Breastfeeding is encouraged immediately after birth. B) Male infants typically are circumcised. C) The maternal grandmother participates in the care of the mother and her infant. D) Special herbs mixed in water are used to stimulate the passage of meconium.

C) The maternal grandmother participates in the care of the mother and her infant.

An effective relief measure for primary dysmenorrhea would be to: A) reduce physical activity level until menstruation ceases. B) begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C) decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D) use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

C) decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

Self-care instructions for a woman following a modified radical mastectomy would include that she: A) wears clothing with snug sleeves to support her affected arm. B) use depilatory creams instead of shaving the axilla of her affected arm. C) expect a decrease in sensation or tingling in her affected arm as her body heals. D) empty surgical drains once a day or every other day.

C) expect a decrease in sensation or tingling in her affected arm as her body heals. Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary.

14. As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids.

a. It is most commonly caused by anovulation.

34. A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

a. Nausea, hot flashes, and vaginal bleeding

35. Despite warnings, prenatal exposure to alcohol continues to exceed by far exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which is category is not associated with a diagnosis of FAS? a. Respiratory conditions b. Impaired growth c. CNS abnormality d. Craniofacial dysmorphologies

a. Respiratory conditions

The nurse should be aware that during the childbearing experience an African-American woman is most likely to: A) Seek prenatal care early in her pregnancy. B) Avoid self-treatment of pregnancy-related discomfort. C) Request liver in the postpartum period to prevent anemia. D) Arrive at the hospital in advanced labor.

D) Arrive at the hospital in advanced labor.

When attempting to communicate with a patient who speaks a different language, the nurse should: A) Respond promptly and positively to project authority. B) Never use a family member as an interpreter. C) Talk to the interpreter to avoid confusing the patient. D) Provide as much privacy as possible.

D) Provide as much privacy as possible.

In what form do families tend to be most socially vulnerable? A) Married-blended family B) Extended family C) Nuclear family D) Single-parent family

D) Single-parent family

The patients family is important to the maternity nurse because: A) They pay the bills. B) The nurse will know which family member to avoid. C) The nurse will know which mothers will really care for their children. D) The family culture and structure will influence nursing care decisions.

D) The family culture and structure will influence nursing care decisions.

33. The nurse must watch for what common complications in a patient who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap? a. Axillary edema and tissue necrosis b. Delayed wound healing and muscle contractions c. Delayed wound healing and axillary edema d. Delayed wound healing and hematoma

d. Delayed wound healing and hematoma

1 The nurse anticipates that the parents of the newborn will return for a follow-up visit. This indicates that the parents are focused on long-term goals and exhibit time orientation toward the future. Parents who are focused on past experiences tend to remain stagnant and show no motivation for long-term activities. Parents who are focused on the present live life for the moment and concentrate on day-to-day survival. People living for the present moment are less likely to plan a follow-up visit in advance. The parents who are focused on the past tend to strive to maintain traditions.

The nurse gives home care instructions to the parents of a newborn at the time of discharge. The nurse anticipates that the parents will return with the child for a follow-up visit. What does this indicate about the parents' attitude? 1 The parents are focused on long-term goals. 2 The parents are focused on past experiences. 3 The parents are focused on day-to-day survival. 4 The parents are focused on maintaining traditions.

4 According to the Family Stress Theory, the internal and external contexts in which the family is living help assess the family's stress. The family has no control over aspects of the external context. Therefore, asking about the culture of the larger society in which the family lives gives an idea about the external context. The family's religious beliefs, structure, and psychological defense mechanisms of coping with stress such as the loss of a family member give an insight into the internal context. The family has direct control over elements of the internal context.

The nurse is assessing a family's reaction to the sudden death of their child in a car accident. The nurse helps ascertain the external context in which the family is living. Which question is most appropriate in this situation? 1 "What are your religious beliefs?" 2 "What does your family structure look like?" 3 "How is the family psychologically coping with the loss?" 4 "What is the predominant culture of the society in which your family lives?"

C, D According to Bronfenbrenner's Human Developmental Ecology theory, every individual is embedded within a microsystem, which comprises aspects such as the person's role and relations in the family, and a macrosystem, which comprises the cultural identity, values, and status. The patient's exosystem comprises external settings that do not include the patient. The interrelation between different settings forms the mesosystem. The chronosystem accounts for change over time.

The nurse is assessing the role a patient plays as the breadwinner in his family and how that role aligns with cultural norms and expectations. What aspects of Human Developmental Ecology is the nurse assessing? Select all that apply. A The patient's exosystem B The patient's mesosystem C The patient's microsystem D The patient's macrosystem E The patient's chronosystem

37. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the woman's side.

a. The blood pressure (BP) cuff should not be applied to the affected arm.

4 The patient in labor is unwilling to accept the nurse's instructions due to her cultural beliefs about the birth process. The nurse can exhibit cultural relativism by understanding that the patient's behavior is unintentional and is based on her cultural belief system. Cultural relativism reaffirms the patient's cultural uniqueness. Cultural relativism does not mean that the nurse blindly accepts the patient's belief; however, it involves an understanding of the value of different cultures. Ethnocentrism is the view that one's own belief is the best and may involve an attempt to impose one's belief on others. Labeling the patient's behavior as inappropriate is an example of ethnocentrism, which is the opposite of cultural relativism.

The nurse is caring for a patient in labor. The patient is uncooperative and doesn't follow the instructions given by the nurse. The patient believes that birth is a normal process that requires minimal intervention from the health care team. Which action by the nurse indicates cultural relativism? 1 Acceptance of the patient's belief 2 Imposing the nurse's belief as the best 3 Labeling the patient's behavior as inappropriate 4 Understanding the patient's cultural uniqueness

2 Culture may influence whether a man actively participates in pregnancy and childbirth. However, maternity care practitioners working in the Western health care system expect fathers to be involved. This can create a significant conflict between the nurse and the role expectations of very traditional Mexican or Arab families, who usually view the birthing experience as a female affair. The husband will not attempt to participate. The husband will not attempt to interfere in the care of the patient as the husband cares. It is unlikely for the husband to prevent the nurse from the birthing experience, as the nurse will assist the patient during childbirth.

The nurse is caring for a pregnant patient of Mexican origin. What will the nurse likely expect from the Mexican husband of the patient? The husband: 1 will actively participate in the birthing experience. 2 will stay away from the birthing experience. 3 will be extremely interfering in the care of the patient. 4 may not want the nurse to be present during childbirth.

1 Presence of churches, synagogues, mosques 2 Presence of clubs, bars, fraternal organizations 3 How safe the community is and the level of crime rate 5 Presence of cultural groups A community walkthrough includes a number of observations. The nurse checks the presence of churches, synagogues, and mosques to identify the religious affiliations of the community. Presence of clubs, bars, and fraternal organizations help the nurse assess community involvement. Safety of the community and the crime rate helps the nurse assess if safety interventions are required. Identifying which cultural groups are present helps the nurse understand the culture. The nurse does not note the dressing styles of the community members, as it has no relevance to the health of the community.

The nurse is conducting a community walkthrough. What findings does the nurse include? Select all that apply. 1 Presence of churches, synagogues, mosques 2 Presence of clubs, bars, fraternal organizations 3 How safe the community is and the level of crime rate 4 How the community members dress 5 Presence of cultural groups

1, 2, 4, 5 Women and teenagers receiving postabortion care are less likely to develop infections and complications. Access to family planning services prevents unwanted pregnancies. Having access to skilled attendants at birth ensures a safe birthing process. Providing adolescents with better reproductive health services improves safe and supportive environments, preventing unintended pregnancies and other health risks. The nurse does not instruct obese women to delay pregnancy but informs patients about the risks associated with obesity, such as miscarriage or fetal death, so that the patient can make an informed decision.

The nurse is discussing strategies to decrease maternal mortality in a health care facility that has high maternal mortality rates. What strategies does the nurse suggest during this discussion? Select all that apply. 1 Provide postabortion care. 2 Improve family planning services. 3 Instruct obese women to delay pregnancy. 4 Improve access to skilled attendants at birth. 5 Provide adolescents with better reproductive health services.

2, 4 The goal of developmental assessment is to describe the life cycle or the typical trajectory that most families experience. So questions such as "When you think back, what do you most enjoy about your life?" and "Have you made plans for your care as your health declines?" are included. Questions such as "Which one of the family is responsible for making sure Grandma takes her medicine?" are part of functional assessment. Questions such as "Who are the members of your family?" and "Has anyone moved in or out lately?" are part of structural assessment.

The nurse is doing the developmental assessment of a patient. What is an appropriate question to be asked by the nurse during the assessment? Select all that apply. 1 "Who are the members of your family?" 2 "When you think back, what do you most enjoy about your life?" 3 "Which one of the families is responsible for making sure Grandma takes her medicine?" 4 "Have you made plans for your care as your health declines?" 5 "Has anyone moved in or out lately?"

2 An ecomap is a graphic portrayal of social relationships of the woman and family, may also help the nurse understand the social environment of the family and identify support systems available to them. A family genogram is a family tree format depicting relationships of family members over at least three generations. A genealogy map is not a medical term used in nursing. A life-cycle map talks about the stages of life and not family generations.

The nurse is teaching a group of students about the graphic representation of families. The nurse is talking about a graphic portrayal of social relationships of the woman and family. About which graphical representation is the nurse teaching? 1 A genogram 2 An ecomap 3 A genealogy map 4 A lifecycle map

2, 3, 4, 5 Obesity during pregnancy increases the risk of miscarriage, hypertension, diabetes, and congenital anomalies. Such patients may need increased health care services and longer hospital stays. Septicemia is a pregnancy complication and is not associated with obesity.

The nurse is teaching pre-pregnancy planning to a borderline obese patient. Which maternal risk factors associated with obesity does the nurse caution the patient about? Select all that apply. 1 Septicemia 2 Miscarriage 3 Hypertension 4 Gestational diabetes 5 Congenital anomalies

1 Assimilation is the process by which groups "melt" into the mainstream. Cultural relativism refers to learning about and applying the standards of another person's culture to activities within that culture. Acculturation refers to changes that occur within one group or among several groups when people from different cultures come in contact with one another. Ethnocentrism is a belief in the rightness of one's culture's way of doing things.

The term used to describe a situation in which a cultural group loses its identity and becomes part of the dominant culture is called: 1 assimilation. 2 cultural relativism. 3 acculturation. 4 ethnocentrism

1, 2, 4, 5 Communication is not merely the exchange of words. Instead, it involves understanding the individual's language, including subtle variations in meaning and distinctive dialects. It involves appreciating individual differences in interpersonal style, and accurately interpreting the volume of speech as well as the meanings of touch and gestures. Getting close to the individual's values and beliefs occurs when people imbibe the culture of another community.

The nurse is teaching students about communication. What statements do the students identify as a component of communication? Select all that apply. 1 Understanding the individual's language, including subtle variations 2 Appreciating individual differences in interpersonal style 3 Getting close to the individual's values and beliefs 4 Accurately interpreting the volume of speech 5 Accurately interpreting the meanings of touch and gestures

4 Many models and frameworks of community assessment are available. The actual process often depends on the extent and nature of the assessment to be performed, the time and resources available, and the way the information is to be used. In a community health assessment, data are collected and analyzed. This data is then used to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve public health.

The nurse is teaching students about community health assessment. Which statement by the student indicates a need for additional teaching? 1 Data are collected and analyzed. 2 It educates and mobilizes communities. 3 It is used to develop priorities. 4 A universal model is followed

1 Cultural knowledge includes beliefs and values about each facet of life and is passed from one generation to the next. Language and arts are a part of cultural knowledge. Cultural beliefs and traditions also relate to food, religion, health and healing practices, kinship relationships, and all other aspects of community, family, and individual life. A group within a larger cultural system is called a subculture. Relationships with family and peers influence culture; they alone do not form culture.

The nurse is teaching students about culture. How does the nurse define cultural knowledge for the students? 1 "Beliefs and values" 2 "All about language and arts-related concepts" 3 "Group within a larger cultural system" 4 "Relationships with family and peers"

2 The nurse should integrate folk and Western treatments. Such integration can improve patient care. Breaking down language barriers enables easy communication. Enlisting the family caregiver and others helps in the treatment of the patient. Providing language-appropriate materials helps with efficient communication and makes implementation easier.

The nurse is teaching students about strategies for care delivery. Which statement by the student indicates a need for additional teaching? 1 Break down the language barriers. 2 Keep folk and Western treatment separate. 3 Enlist the family caregiver and others. 4 Provide language-appropriate materials.

1 The nurse should take care to avoid making stereotypic assumptions about any person based on sociocultural-spiritual affiliations. Nurses should exercise sensitivity in working with every family. The nurse should keep an appropriate distance from the patient to avoid making the patient uncomfortable. The nurse should ask about the woman's fears and the family's so they can be resolved. The nurse provides language-appropriate materials for efficient communication.

The nurse is teaching students about the care of pregnant patients of Arab origin. What statement made by a student indicates a need for additional teaching? 1 "Make assumptions about the culture." 2 "Keep an appropriate distance from the patient." 3 "Ask about the woman's fears and the family's." 4 "Provide language-appropriate materials."

1 The nurse interacts with the interpreter informally. When meeting the interpreter the first time, the nurse should find out how well the interpreter speaks English. No matter how proficient or what age the interpreter is, the nurse should be respectful. No matter what the language is, if in relating information to the patient, the interpreter uses far fewer or far more words than you do, something else is going on. The nurse should identify cultural issues that may conflict with those of the interpreter. The interview is collaboration between the nurse and the interpreter, so the nurse should listen as well as speak.

The nurse is teaching students about working with an interpreter. Which statement by the student indicates a need for additional teaching? 1 Speak formally and carefully with the interpreter. 2 Interrupt if the interpreter uses few words. 3 Identify cultural conflict. 4 Balance listening with speaking.

4 The Family Life Cycle theory states that families move through stages. Relationships among family members go through transitions. Although families have roles and functions, a family's main value lies in relationships that are irreplaceable. Family Stress Theory puts the spotlight on how families react to stressful events. The goal of the Health Belief Model is to reduce cultural and environmental barriers that interfere with access to health care. A family system is part of a larger suprasystem and is composed of many subsystems. The family is viewed as a unit, and interactions among family members are studied rather than studying individuals.

The nurse tells students, "Although families have roles and functions, a family's main value is in relationships that are irreplaceable." Which theory relevant to family nursing practice is the nurse teaching the students? 1 Family Stress Theory 2 Health Belief Model 3 Family Systems Theory 4 Family Life Cycle

3, 5, 1, 2, 4 Step 1: Before the interview: Outline your statements and questions and list the key pieces of information that you want to know. Learn something about the culture. Step 2: Meeting with the interpreter: Introduce yourself and converse informally. Emphasize that you do want the patient to ask question, as this may be inappropriate in the patient's culture. Step 3: During the interview: Stop now and then and ask the interpreter how things are going. Identify cultural issues that may conflict with your requests. Step 4: After the interview: Speak to the interpreter to get an idea of how things went. Make notes as to what you could use in future situations.

The patient you are caring for is postpartum day 2, after a normal spontaneous vaginal delivery of a 7 lb 8 oz male infant. She is a newly arrived refugee from Burundi and speaks no English. Her husband speaks very limited English. To prepare the patient adequately for discharge, you have determined that it is necessary to contact an interpreter who speaks the same native language and is of the same religion. Please place in order the correct steps when working with an outside translator. 1. Emphasize that you want the patient to ask questions. 2. Identify cultural issues that may conflict with your requests. 3. Outline your statements and questions. 4. Speak to the interpreter to get ideas of what went well. 5. Introduce yourself and converse informally to find out how well the person speaks English.

1, 2, 5 The Cochrane Database contains reviews of randomized controlled trials, which helps the nurse understand the effects of care. The nurse refers to well-designed primary studies such as randomized controlled trials to understand and implement best practices. The nurse can adapt practice recommendations published by the AHRQ. It may not be feasible to consult specialists and health care providers during emergencies, so the nurse needs to refer to journals and reference books and be prepared in advance. The nurse uses notes to document events and interventions that are implemented during patient care. Therefore, they are not a good source of evidence.

What actions does the nurse take to ensure that nursing practice is based on evidence-based practice? Select all that apply. 1 Refer to the Cochrane Database. 2 Obtain results of randomized clinical trials that pertain to the clinical area in question. 3 Consult specialists and health care providers. 4 Refer to the notes of experienced nurses. 5 Refer to Agency for Healthcare Research and Quality (AHRQ) guidelines.

1, 2, 3, 5 The Patient Protection and Affordable Care Act aims to make insurance affordable and contain costs. It aims to reform the health care delivery system by reducing waste, fraud, and abuse. It also improves the quality of care for all Americans by promoting prevention and improving public health. It also strengthens and improves Medicare and Medicaid by reforming the insurance market. The act does not discriminate on the basis of age.

What are the provisions of the Patient Protection and Affordable Care Act? Select all that apply. 1 Make insurance affordable. 2 Reform the health care delivery system. 3 Improve the quality of care for all Americans. 4 Provide free health care for those over 70 years. 5 Strengthen and improve Medicare and Medicaid

2 Cultural traditions define the appropriate personal space for various social interactions. Although the need for personal space varies from person to person and with the situation, the actual physical dimensions of comfort zones differ from culture to culture. A distance of meter may be too far for some cultures. A distance of 0.5 meter could be uncomfortable for some people of Mexican or Arab culture. Hospitals typically do not define any personal space.

What distance is used to define personal space? 1 1 meter 2 Varies 3 0.5 meter 4 Hospital-defined

3 The Nursing Interventions Classification includes a comprehensive standardized language that describes interventions that are performed by generalist or specialist nurses. These interventions are commonly used by maternal child nurses to support the family and provide childbearing and after-birth care. The details of perinatal patients are documented in the medical records. The nurse can use reference books and journals to understand perinatal terms and complications. The Cochrane Pregnancy and Childbirth Database contains studies that evaluate beneficial and ineffective care practices.

What does the comprehensive standardized language developed by the nurses from University of Iowa describe? 1 Details of perinatal patients 2 Perinatal terms and complications 3 Interventions by specialist nurses 4 Beneficial and ineffective care practices

1 The improvements in perinatal care, particularly care of the mother-baby dyad before birth, have had the greatest impact. There has been a decrease in some congenital anomalies, such as spina bifida, but this has not had the greatest impact. Better maternal nutrition has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact.

What has had the greatest impact on reducing infant mortality in the United States? 1 Improvements in perinatal care 2 Decreased incidence of congenital abnormalities 3 Better maternal nutrition 4 Improved funding for health care

The family is viewed as the sum of individual members. The interactions are considered to be the problem, not the individual family members. Although the family is the sum of the individual members, the family systems theory focuses on the number of dyad interactions that can occur. The family systems theory describes an interactional model. Any change in one member will create change in others. Change in any family member will affect other members of the family.

What is descriptive of the family systems theory? 1 The family is viewed as the sum of individual members. 2 When the family system is disrupted, change can occur at any point in the system. 3 Change in one family member cannot create change in other members. 4 Individual family members are readily identified as the source of a problem

1 Multigenerational families, consisting of grandparents, children, and grandchildren, are becoming increasingly common. In 2010, they made up 4.4% of all households. This may create stress, as children must care for their parents as well as their own children. In other instances, either the grandparents support their grandchildren or maybe they are their sole caregivers. Multigenerational families are more likely to be closely knit. Such families may have conflicts but have greater resources of psychologic support. No developmental problems have been reported for multigenerational families.

What is the key disadvantage of multigenerational families? 1 They create stress for some members. 2 They are not closely knit. 3 They have psychologic problems. 4 They have developmental problems.

4 To obtain information through research and clinical trials is called evidence-based practice. Safe practice refers to a nursing practice that is implemented for efficient health care. Point-of-care testing is a diagnostic process. Performance appraisal is a standard of professional performance.

What is the process of obtaining information through research and clinical trials called? 1 Safe practice 2 Point-of-care testing 3 Performance appraisal 4 Evidence-based practice

2 Time orientation is a fundamental way in which culture affects health behaviors. People in cultural groups may be relatively more oriented to past, present, or future. Time orientation is not about how punctual people are, which may change with the stages of life. How much people miss their loved ones is not relevant to time orientation. How much people value time is not relevant to nursing care.

What is time orientation? 1 How punctual people are in their daily lives 2 How people relate to past present, or future 3 How fondly people remember loved ones 4 How much people value time

1, 3 During pregnancy, usually primary and secondary prevention are relevant. The goal is to maintain a healthy pregnancy by preventing illness and by screening those at risk for potential illnesses or complications that could arise during pregnancy. Tertiary prevention is not included during pregnancy. Priority prevention and temporary prevention are not among the three levels of disease prevention.

What levels of prevention of disease are most relevant during pregnancy? Select all that apply. 1 Primary prevention 2 Tertiary prevention 3 Secondary prevention 4 Priority prevention 5 Temporary prevention

3, 4, 5 The nurse uses simple words while providing instructions so that the patient understands the information. It is important to speak slowly and clearly so that the patient is not confused. The nurse needs to assess whether the patient understands the information correctly. For this purpose the nurse can ask for a return demonstration or encourage the patient to ask questions. The nurse avoids jargon because the patient may not be able to understand medical terms. Brief written instructions will not help if the patient is not able to read. It is important to assess the patient's literacy level before providing written instructions.

What precautions does the nurse take while providing instructions to a patient? Select all that apply. 1 Use jargon where necessary. 2 Provide brief written instructions. 3 Use simple words. 4 Speak slowly and clearly. 5 Assess whether the patient understands information.

1 The OASIS is an outcome system that measures the effectiveness of care by using quality indicators. It helps the nurse determine whether a patient benefits from the care provided. AHRQ is an organization that uses evidence-based practice to recommend best nursing practices for effective care. The NIC includes interventions for patient care that are performed by nurses. The ANA publishes standards for maternal-child health.

What resource does the nurse use to understand the effectiveness of care provided to a patient? 1 The Outcome and Assessment Information Set (OASIS) 2 The Agency for Healthcare Research and Quality (AHRQ) 3 The Nursing Interventions Classification (NIC) 4 The American Nurses Association (ANA) standards

B Give the patient the baby's first diaper. E Allow bathing to be delayed for 2 weeks Some Hispanic people follow the cultural practice of wiping the baby's first wet diaper on the mother's face. They believe that it removes the "mask of pregnancy." Bathing may also be delayed for 14 days postpartum. Some Native-American patients believe that drinking herbal tea during the postpartum period helps to stop bleeding. Some Koreans believe that the patient should be served seaweed soup and rice during the postpartum period. Some Chinese people believe that a postpartum patient should avoid fruits and vegetables in the diet.

What should the nurse keep in mind about cultural influences while providing postpartum care for a patient of Mexican origin who has just delivered a baby? Select all that apply. A Avoid herbal tea in the patient's diet. B Give the patient the baby's first diaper. C Give the patient seaweed soup with rice. D Avoid fruits and vegetables in the patient's diet. E Allow bathing to be delayed for 2 weeks

4 The nurse uses the SBAR technique to communicate critical information that warrants prompt attention by the primary health care provider. Telehealth is a communication technology that provides health care for patients who are separated by distance. TeamSTEPPS is a system that helps medical teams to improve their communication skills and teamwork. The NIC is a comprehensive standardized language describing interventions performed by a generalist or specialist nurse.

What technique is commonly used by the maternity nurse to communicate with the team of primary health care providers? 1 Telehealth 2 TeamSTEPPS 3 Nursing Intervention Classification (NIC) 4 The situation-background-assessment-recommendation (SBAR) technique

2 The first course of action is to call a warm line for advice from a nurse. Warm lines are telephone lines offered as a community service to provide new parents with support, encouragement, and basic parenting education. Visiting a pediatric screening clinic, calling the pediatrician, or requesting a home visit are not appropriate courses of action.

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful on the day after discharge? 1 Visiting a pediatric screening clinic at the hospital 2 Placing a call to the hospital nursery warm line 3 Calling the pediatrician for a lactation consult referral 4 Requesting a home visit

4 It is always best to follow the agency's policies and procedures manual when seeking information on correct patient procedures. These policies should reflect the current standards of care and state guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe patient care delivery. Physicians are responsible for their own patient care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies.

When a nurse is unsure about how to perform a patient care procedure, the best action is to: 1 ask another nurse. 2 discuss the procedure with the patient's physician. 3 look up the procedure in a nursing textbook. 4 consult the agency procedure manual and follow the guidelines for the procedure.

1 The United Nations MDGs aim to reduce child mortality and improve maternal health. These two goals pertain specifically to women and children. Combatting HIV/AIDS, malaria, and other diseases is one of the general goals of the United Nations MDG. Increasing abstinence from illicit drugs in pregnant women and reducing the proportion of breastfed newborns are included in the Healthy People 2020 maternal, infant, and child health objectives.

Which United Nations Millennium Development Goals (MDGs) specifically pertain to women and children? 1 Reduce child mortality and improve maternal health. 2 Combat human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria, and other diseases. 3 Increase abstinence from illicit drugs in pregnant women. 4 Reduce the proportion of breastfed newborns.

3 Understanding the distinctive dialect of the patient's language The nurse should understand the patient's language, including minor variations and distinctive dialects of the language. This ensures effective communication with the patient. The nurse should avoid rushing to judgment regarding the patient's intent, especially when the patient speaks limited English. When communicating with a patient with limited English proficiency, the nurse should engage the services of a good translator to translate written words, and an interpreter to translate spoken words. When used correctly, the services of a translator and interpreter can effectively bridge the communication gap between the nurse and the patient with limited English-speaking ability.

Which is the most appropriate action by the nurse to ensure effective communication with a patient who speaks limited English? 1 Judging the patient's intent as soon as possible 2 Involving a translator to translate spoken words to the patient 3 Understanding the distinctive dialect of the patient's language 4 Involving an interpreter to translate written words to the patient

4 With the help of an interpreter, the trainee nurse is conducting an interview session with a patient who does not understand English. The trainee nurse should understand that in certain cultures it is awkward for a younger female to talk about some sensitive topics with an elderly male patient. The nurse should understand the limitations and should not attempt to begin new gender relations in such situations. The nurse can use gestures such as fingers to point or count out body parts in case of a language problem. The nurse can converse informally with the interpreter, to ascertain how well the interpreter speaks and understands English. The nurse should occasionally stop the interpreter and find out if the conversation is going as intended. This helps the interpreter understand the need for focus.

Which action by the student nurse is beneficial when observing a younger female student nurse working with an interpreter and an elderly male patient who does not understand English? 1 Avoiding using fingers to point to body parts. 2 Not conversing informally with the interpreter. 3 Not stopping the interpreter during the session. 4 Not trying to pioneer new gender relations during the session

1, 4, 5 The nurse regularly assesses the patient for risks to be alert to any complications. This will help prevent a failure to rescue. In case of an obstetric emergency, the health care team needs to implement interventions quickly to minimize harm. This is possible with a timely identification of complications. Implementing interventions quickly for the patient's safety is more important than documenting the patient's condition. Telehealth services are used only when the patient is separated by distance from a health care provider.

Which actions does the perinatal nurse take to minimize harm or prevent a failure to rescue in an obstetric emergency? Select all that apply. 1 Assess the patient for risks. 2 Document the patient's condition. 3 Use telehealth services. 4 Identify complications immediately. 5 Implement interventions quickly.

1, 2, 3 Hypertensive disorders and infection have been the leading causes of maternal death in the last 50 years in the United States. Maternal mortality is also more likely if the patient is less than 20 years of age. Migraine is not a life-threatening disease and does not affect pregnancy. Maternal mortality rates have been higher in non-Caucasian races in the last 50 years.

Which assessment findings in a patient indicate a higher chance of maternal mortality? Select all that apply. 1 Hypertensive heart disease 2 Infection 3 18 years of age 4 Migraine 5 Caucasian race

3 A sentinel event is a serious or unexpected condition in an infant that warrants prompt intervention. Hyperbilirubinemia is a condition in which the child's bilirubin is greater than 30 mg/dL. It indicates an immediate need for neonatal phototherapy. Conditions such as malaria, urinary problems, and birth weight less than 2500 do not warrant phototherapy.

Which condition in an infant is considered a sentinel event and necessitates neonatal phototherapy? 1 Malaria 2 Urinary problems 3 Hyperbilirubinemia 4 Birth weight less than 2500 g

4 The McGill Model of Nursing has a strength-based approach in clinical practice with families. Identification of family strengths and resources is the priority. Family Stress Theory puts the spotlight on how families react to stressful events. The goal of the Health Belief Model is to reduce cultural and environmental barriers that interfere with access to health care. A family system is part of a larger suprasystem and is composed of many subsystems. In the Family System Theory, the family is viewed as a unit, and interactions among family members are studied rather than studying individuals.

Which family theory involves the identification of family strengths and resources? 1 Family Stress Theory 2 Health Belief Model 3 Family Systems Theory 4 McGill Model of Nursing

3 Integrative health care combines conventional Western modalities of treatment with the complementary and alternative therapies that offer human-centered care. TeamSTEPPS is a teamwork system for health professionals to provide higher-quality, safer patient care. The Cochrane Database contains up-to-date, systematic reviews of randomized controlled trials. Evidence-based practice provides care based on the evidence gained through research and clinical trials.

Which health care system encompasses complementary and alternative therapies in combination with conventional Western modalities of treatment? 1 TeamSTEPPS 2 Cochrane Database 3 Integrative health care 4 Evidence-based practice

2 Obesity increases the risk for hypertension related to pregnancy and diabetes in pregnant women. Miscarriage and fetal death are also other risks that may result from obesity. Hence the nurse needs to inform the patient about these complications to prevent risks. The nurse needs to instruct the patient to increase fluid intake in case of dehydration. Aerobic exercises are prescribed for diabetic patients and not for pregnant women. The patient may choose to consult a nurse-midwife regarding childbirth decisions.

Which instruction does the nurse provide to an obese pregnant patient? 1 "You need to increase your fluid intake." 2 "There is an increased chance of complications." 3 "You need to learn aerobic exercises." 4 "You need to consult with a nurse-midwife."

2 The nurse who is on a perinatal home visit can observe the bathing, toileting, and laundry facilities at the patient's house. This gives an idea about the adequacy of resources at the patient's home. Identifying all family members who live with the patient helps the nurse assess the patient's social support. Determining how decisions are made within the family enables an assessment of the interpersonal relationships within the patient's family. Identifying in whom the patient confides during crises also helps the nurse assess the patient's social support.

Which is the most appropriate action by the nurse to effectively assess the adequacy of resources at the house of a pregnant patient while performing a perinatal home visit? 1 Identifying who lives with the patient 2 Observing the bathing, toileting, and laundry facilities 3 Determining how decisions are made within the family 4 Identifying in whom the patient confides during crises

1, 3, 5 A pregnant patient is at risk for complications such as uterine rupture, placental abruption, and hemorrhage after birth. Shoulder dystocia and prolapsed umbilical cord are fetal complications.

Which maternal complication is the perinatal nurse alert for while providing care for a pregnant patient? Select all that apply. 1 Uterine rupture 2 Shoulder dystocia 3 Placental abruption 4 Prolapsed umbilical cord 5 Hemorrhage after birth

15. The transition phase during which ovarian function and hormone production decline is called: a. The climacteric. b. Menarche. c. Menopause. d. Puberty.

a. The climacteric

20. The level of practice a reasonably prudent nurse provides is called: a. The standard of care. b. Risk management. c. A sentinel event. d. Failure to rescue.

a. The standard of care.

2, 4 The nurse must inform the patient about her rights as a research subject. This helps the patient determine whether the benefits of research outweigh the risks to the fetus. An informed consent must be obtained from the patient who participates in the research as it indicates the patient's willingness to participate. The nurse needs to inform the patient about the benefits and the adverse effects that may result from research so that the patient can make an informed decision. The nurse does not suggest the patient to collect research information online as some part of the information may be inaccurate.

Which nursing actions are necessary to prepare a perinatal patient for research? Select all that apply. 1 Conceal the benefits of the research. 2 Inform the patient about her rights. 3 Conceal the adverse effects of the research. 4 Obtain consent from the patient. 5 Suggest the patient read research information online

3 For the nurse's personal safety, all home visits should be conducted during daylight hours. The nurse should carry keys and a cell phone in the event the keys must be used for self-defense or the cell phone is needed to call for help. Making a visit in pairs is a good personal strategy for nurses visiting families with a history of violence or substance abuse. Dress should be casual but professional and should include a name tag.

Which personal safety precaution should guide the nurse working in home care? 1 Do not carry personal items, such as extra car keys or a cellular phone. 2 Avoid making a visit with another nurse. 3 Schedule visits during daylight hours. 4 Never wear a name tag.

2 Caucasians have lower infant morbidity and mortality rates than Hispanics, Asian Americans, African Americans, Native Americans, and Alaska Natives. This disparity results from different biological, environmental, and health factors such as birth defects, sexually transmitted infections, low educational attainment, and low income.

Which racial and ethnic group in the United States has lower infant morbidity and mortality rates than other groups? 1 Hispanics 2 Caucasians 3 Asian Americans 4 African Americans

2, 3, 4, 5 A sentinel event is an unexpected occurrence, death, or serious physical or psychologic injury that needs immediate response by health care personnel. An infant discharged to the wrong family is a harrowing experience for the mother, and a prompt response by the nurse is necessary. Leaving a foreign body in a patient after surgery may lead to serious injury to the patient. Hyperbilirubinemia in an infant must be treated promptly with phototherapy to prevent death. Maternal death related to the birth process is a sentinel event. Incessant crying of the newborn is not a serious event. It can be resolved by proper assessment and interventions. Perinatal death related to a congenital condition is not a sentinel event because the cause of congenital disease must be assessed in detail.

Which sentinel events in a perinatal setting does the nurse need to report immediately? Select all that apply. 1 Incessant crying of a newborn baby 2 Discharge of an infant to the wrong family 3 Foreign body left in a patient after surgery 4 Hyperbilirubinemia 5 Maternal death related to the birth process 6 Perinatal death due to a congenital condition

1, 2, 3, 4 The AWHONN has set standards of performance that delineate the roles and behaviors of the nurses in perinatal care. The nurse should participate in ongoing educational activities to maintain a current level of knowledge for practice. The nurse should perform a systemic evaluation of the nursing practice to ensure quality of care. The nurse should use resources in a cost-effective manner and at the same time consider safety and effectiveness while delivering care to the patient. The nurse should continuously evaluate and improve practice standards by comparing them to the standards and guidelines defined by AWHONN. Outcome identification is a standard that defines the nurse's responsibility to the patient.

Which standards of performance published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) define the role for which the nurse is accountable? Select all that apply. 1 Education 2 Quality of care 3 Resource utilization 4 Performance appraisal 5 Outcome identification

3 Alternative modalities of treatment provide human-centered care by taking into account the inputs, beliefs, values, and desires of the patient. Alternative modalities do not focus only on the disease but have a holistic approach to health. Alternative treatment modalities combine with Western modalities of treatment for greater effectiveness. Examples of alternative modalities include acupuncture, macrobiotics, herbal medicines, massage therapy, biofeedback, meditation, yoga, and chelation therapy.

Which statement by the student nurse about complementary and alternative treatment modalities indicates a need for further learning? Alternative modalities: 1 Have a holistic approach to health. 2 Combine with Western treatment modalities. 3 Limit the patient's independence in health care decisions. 4 Include herbal medicines, biofeedback, and yoga.

3 The Outcome and Assessment Information Set (OASIS) and the Nursing Outcomes Classification (NOC) are systems that can be used to evaluate patient care. Quality indicators are used to identify whether the patient benefits from the care provided. The Cochrane Pregnancy and Childbirth Database contains studies that evaluate beneficial care practices. The Nursing Interventions Classification includes a comprehensive standardized language that describes three levels of childbearing care interventions. Evidence-based practice includes interventions based on evidence.

Which statement by the student nurse about outcome-oriented practice indicates effective learning? 1 It lists the forms of care that are beneficial. 2 It lists three levels of childbearing care interventions. 3 It measures the value of nursing using quality indicators. 4 It lists interventions and practices based on evidence

1, 3, 4, 5 Cultural competence involves acknowledging, appreciating, and respecting ethnic, cultural, and linguistic diversity. It also involves educating and promoting healthy behaviors in a cultural context that has meaning for patients. Cultural competence is not concerned with the mental diversity of patients; it is a given that each patient will have a unique personality.

Which statements are appropriate for defining cultural competence? Select all that apply. 1 Acknowledging ethnic diversity 2 Appreciating diversity in personality 3 Respecting cultural diversity 4 Acknowledging linguistic diversity 5 Promoting healthy behaviors

9. From the nurse's perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further? a. Implementing programs to ensure women's early participation in ongoing prenatal care b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days c. Expanding the number of neonatal intensive care units (NICUs) d. Mandating that all pregnant women receive care from an obstetrician

a. Implementing programs to ensure women's early participation in ongoing prenatal care

2, 4, 5 Obstetricians provide fetal diagnostic testing and management of obstetric and medical complications in addition to providing basic care. Maternal-fetal medicine specialists provide subspecialty care such as genetic testing, advanced fetal therapies, and management of severe maternal and fetal complications. Obstetricians are specialists and can manage severe maternal and fetal complications. Doulas are trained and experienced labor attendants who provide care in a perinatal setting only for the labor and birth process. Basic perinatal care is provided by certified nurse-midwives and primary health care providers apart from obstetricians and other advanced practice clinicians approved by local governance.

Which statements by the student nurse about perinatal care indicate effective learning? Select all that apply. 1 "Doulas provide super-specialty care." 2 "Obstetricians provide specialty care." 3 "Certified nurse-midwives cannot provide basic care." 4 "Maternal-fetal specialists provide subspecialty care." 5 "Obstetricians can manage maternal complications."

1, 2, 4, 5 The standard of care reflects current knowledge and can be used for clinical benchmarking. The standard is agreed on by experts and leaders in a specialty. In legal terms, a standard of care is a level of practice that a nurse should provide in similar circumstances. The nurse can refer to the agency procedure book to understand the standard of care in a specific circumstance. Legal negligence is determined by comparing the care given to the standard of care. The ANA publishes standards of care for maternal-child health nursing.

Which statements by the student nurse indicate effective learning of the concept of the standard of care? Select all that apply. The standard of care: 1 Should reflect current knowledge. 2 Should be agreed on by experts. 3 Should be validated by the American Nurses Association (ANA). 4 Is a level of practice that a nurse provides in similar circumstances. 5 Helps to determine legal negligence.

4 The symbol "@" can be mistaken for the number "2." Therefore, the nurse uses at for documenting or writing instructions. For the same reason, the abbreviation Q.O.D. should not be used because it may be mistaken for Q.D. (daily) or Q.I.D. (four times daily). Instead, the nurse must use the term every other day to prevent errors. The symbol ">" should be written as greater than because ">" can be mistaken for the number "7." The nurse uses the term International Unit instead of I.U. because it could be easily misread as I.V. (intravenous) or the number "10."

Which term does the nurse use while documenting or writing out instructions to a patient? 1 Q.O.D. (every other day) 2 > (greater than) 3 IU (International Unit) 4 At (at)

1 Women need to be able to have 24-hour access to resources in the community in emergencies. Women and family members are also encouraged to learn how to perform CPR, especially for infants. Nurses also have to be skilled at performing various procedures such as venipuncture and administration of intravenous medications or fluids. Teachings about nutrition and discomforts of pregnancy are not required during an emergency.

Which topic will the nurse teach women to ensure that they are prepared for emergencies? 1 Cardiopulmonary resuscitation (CPR) 2 Venipuncture 3 Administration of intravenous fluids 4 Nutrition and discomforts during pregnancy

3 Risk management is the process that helps minimize the risk of injury in patients. Therefore, identifying potential for injury and establishing preventive practices is a risk management process because it helps minimize harm to the patient. Sentinel events such as maternal death or complications at delivery signal a need for an immediate investigation and response. Failure to rescue is a failure to act on the early signs of distress. Outcome-oriented care measures the effectiveness of care that is provided against benchmarks or standards.

While providing care for a pregnant patient, the nurse identifies the potential for injuries and establishes preventive practices. Which process best describes these actions by the nurse? 1 Sentinel events 2 Failure to rescue 3 Risk management 4 Outcome-oriented practice

3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. "I feel irritable and moody a week before my period is supposed to start." b. "I have lower abdominal pain beginning the third day of my menstrual period." c. "I have nausea and headaches after my period starts, and they last 2 to 3 days." d. "I have abdominal bloating and breast pain after a couple days of my period."

a. "I feel irritable and moody a week before my period is supposed to start."

36. When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is: a. "No one deserves to be hurt. It's not your fault. How can I help you?" b. "What else do you do that makes him angry enough to hurt you?" c. "He will never find out what we talk about. Don't worry. We're here to help you." d. "You have to remember that he is frustrated and angry so he takes it out on you."

a. "No one deserves to be hurt. It's not your fault. How can I help you?"

16. Which statement would indicate that the client requires additional instruction about breast self-examination? a. "Yellow discharge from my nipple is normal if I'm having my period." b. "I should check my breasts at the same time each month, like after my period." c. "I should also feel in my armpit area while performing my breast examination." d. "I should check each breast in a set way, such as in a circular motion."

a. "Yellow discharge from my nipple is normal if I'm having my period."

23. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: a. Bacterial vaginosis (BV). b. Candidiasis. c. Trichomoniasis. d. Gonorrhea.

a. Bacterial vaginosis (BV)

18. The nurse caring for a pregnant client should be aware that the U.S. birth rate shows which trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years old are beginning to decline. c. Cigarette smoking among pregnant women continues to increase. d. The rates of maternal death owing to racial disparity are elevated in the United States.

a. Births to unmarried women are more likely to have less favorable outcomes.

4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. b. PMS. c. Primary dysmenorrhea. d. Secondary dysmenorrhea.

a. Endometriosis.

14. Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for patients. The most concerning pitfall for nurses using this technology is: a. Violation of patient privacy and confidentiality. b. Institutions and colleagues may be cast in an unfavorable light. c. Unintended negative consequences for using social media. d. Lack of institutional policy governing online contact.

a. Violation of patient privacy and confidentiality.

31. Which statement by the patient indicates that she understands breast self-examination? a. "I will examine both breasts in two different positions." b. "I will perform breast self-examination 1 week after my menstrual period starts." c. "I will examine the outer upper area of the breast only." d. "I will use the palm of the hand to perform the examination."

b. "I will perform breast self-examination 1 week after my menstrual period starts."

22. Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely would include: a. Oral antiviral therapy. b. Bed rest in a semi-Fowler position. c. Antibiotic regimen continued until symptoms subside. d. Frequent pelvic examination to monitor the progress of healing.

b. Bed rest in a semi-Fowler position.

15. An important development that affects maternity nursing is integrative health care, which: a. Seeks to provide the same health care for all racial and ethnic groups. b. Blends complementary and alternative therapies with conventional Western treatment. c. Focuses on the disease or condition rather than the background of the client. d. Has been mandated by Congress.

b. Blends complementary and alternative therapies with conventional Western treatment.

9. During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. b. Dysmenorrhea. c. Dyspareunia. d. Premenstrual syndrome (PMS).

b. Dysmenorrhea.

13. During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: a. Reassure the woman that the examination will not reveal any problems. b. Explain the process of vulvar self-examination to the woman and reassure her that she should become familiar with normal and abnormal findings during the examination. c. Reassure the woman that "bumps" can be treated. d. Reassure her that most women have "bumps" on their labia.

b. Explain the process of vulvar self-examination to the woman and reassure her that she should become familiar with normal and abnormal findings during the examination.

28. Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

26. During which phase of the cycle of violence does the batterer become contrite and remorseful? a. Battering phase b. Honeymoon phase c. Tension-building phase d. Increased drug-taking phase

b. Honeymoon phase

12. A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is going to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should: a. Remind the woman that she is long overdue for her examination and that she should come in annually. b. Listen carefully and allow extra time for this woman's health history interview. c. Reassure the woman that a nurse practitioner is just as good as her old doctor. d. Encourage the woman to talk about the death of her husband and her fears about her own death.

b. Listen carefully and allow extra time for this woman's health history interview.

9. Physiologically, sexual response can be characterized by: a. Coitus, masturbation, and fantasy. b. Myotonia and vasocongestion. c. Erection and orgasm. d. Excitement, plateau, and orgasm.

b. Myotonia and vasocongestion

27. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake because: a. A daily consumption of alcohol indicates a risk for alcoholism. b. She will be at risk for abusing other substances as well. c. The fetus is placed at risk for altered brain growth. d. The fetus is at risk for multiple organ anomalies.

b. She will be at risk for abusing other substances as well.

2. To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery, The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym? a. Situation, baseline assessment, response b. Situation, background, assessment, recommendation c. Subjective background, assessment, recommendation d. Situation, background, anticipated recommendation

b. Situation, background, assessment, recommendation

3. Unique muscle fibers make the uterine myometrium ideally suited for: a. Menstruation. b. The birth process. c. Ovulation. d. Fertilization.

b. The birth process.

21. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide her care during pregnancy and deliver her infant. What information would be most appropriate for the nurse to share with this patient? a. Midwifery care is available only to clients who are uninsured because their services are less expensive than an obstetrician. Costs are often lower than an obstetric provider. b. The client will receive fewer interventions during the birth process. c. The client should be aware that midwives are not certified. d. Delivery can take place only at the client's home or in a birth center.

b. The client will receive fewer interventions during the birth process.

17. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of intimate partner violence (IPV)? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions.

b. The woman has injuries on various parts of her body that are in different stages of healing.

30. As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old client for her first adult physical examination and Papanicolaou (Pap) test, the nurse is aware of excessiveness shyness. The young woman states that she will not remove her bra because, "There is something wrong with my breasts; one is way bigger." What is the best response by the nurse in this situation? a. "Please reschedule your appointment until you are more prepared." b. "It is okay; the provider will not do a breast examination." c. "I will explain normal growth and breast development to you." d. "That is unfortunate; this must be very stressful for you."

c. "I will explain normal growth and breast development to you."

11. The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, "I have special undergarments that I do not remove for religious reasons." The most appropriate response from the nurse would be: a. "You can't have an examination without removing all your clothes." b. "I'll ask the doctor to modify the examination." c. "Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably." d. "What? I've never heard of such a thing! That sounds different and strange."

c. "Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably."

26. The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. b. 2 to 4 weeks. c. 6 to 8 weeks. d. 6 months.

c. 6 to 8 weeks.

29. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called: a. Bimanual palpation. b. Rectovaginal palpation. c. A Papanicolaou (Pap) test d. A four As procedure.

c. A Papanicolaou (Pap) test

14. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection and she has been using an over-the-counter cream for the past 2 days to treat it. The nurse's initial response should be to: a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled. b. Reassure the woman that using vaginal cream is not a problem for the examination. c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection. d. Ask the woman to reschedule the appointment for the examination.

c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection.

43. The drug of choice for treatment of gonorrhea is: a. Penicillin G. b. Tetracycline. c. Ceftriaxone. d. Acyclovir.

c. Ceftriaxone.

17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. b. Syphilis. c. Chlamydia. d. Candidiasis.

c. Chlamydia.

31. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Fine-needle aspiration (FNA) d. CA 15.3

c. Fine-needle aspiration (FNA)

33. A woman who is older than 35 years may have difficulty achieving pregnancy primarily because: a. Personal risk behaviors influence fertility b. She has used contraceptives for an extended time c. Her ovaries may be affected by the aging process d. Prepregnancy medical attention is lacking

c. Her ovaries may be affected by the aging process

1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. b. Type 1 diabetes mellitus. c. Lack of exercise. d. Hysterectomy.

c. Lack of exercise.

44. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles

8. A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids increase in size during the perimenopausal period. c. Menorrhagia is a common finding. d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.

c. Menorrhagia is a common finding.

15. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin.

c. Nonsteroidal antiinflammatory drugs (NSAIDs).

7. When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. b. Excessive exercise. c. Pregnancy. d. Eating disorders.

c. Pregnancy.

10. Alternative and complementary therapies: a. Replace conventional Western modalities of treatment. b. Are used by only a small number of American adults. c. Recognize the value of clients' input into their health care. d. Focus primarily on the disease an individual is experiencing.

c. Recognize the value of clients' input into their health care.

6. Menstruation is periodic uterine bleeding: a. That occurs every 28 days. b. In which the entire uterine lining is shed. c. That is regulated by ovarian hormones. d. That leads to fertilization.

c. That is regulated by ovarian hormones.

24. Which statement regarding female sexual response is inaccurate? a. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. b. Vasocongestion is the congestion of blood vessels. c. The orgasmic phase is the final state of the sexual response cycle. d. Facial grimaces and spasms of hands and feet are often part of arousal.

c. The orgasmic phase is the final state of the sexual response cycle.

35. After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.

22. While obtaining a detailed history from a woman who has recently emigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation (FGM). The nurse's best response to this patient is: a. "This is a very abnormal practice and rarely seen in the United States." b. "Do you know who performed this so that it can be reported to the authorities?" c. "We will be able to restore your circumcision fully after delivery." d. "The extent of your circumcision will affect the potential for complications."

d. "The extent of your circumcision will affect the potential for complications."

32. A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. "Do you have transportation to the teaching hospital so that you can get your mammogram?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "It's very dangerous to skip your mammograms; your breasts need to be checked." d. "Would you like me to make an appointment for you to have your mammogram here?"

d. "Would you like me to make an appointment for you to have your mammogram here?"

36. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

d. A single lump in one breast that can be expected to shrink as the woman ages.

5. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic patient with limited English proficiency. It is important for the nurse to: a. Use maternity jargon in order for the patient to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the patient with handouts. d. Assess whether the patient understands the discussion.

d. Assess whether the patient understands the discussion.

5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness.

d. Can cause her to experience some hot flashes and vaginal dryness.

40. The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

d. Chlamydia

28. As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

d. Cocaine

8. When the nurse is unsure about how to perform a patient care procedure, the best action would be to: a. Ask another nurse. b. Discuss the procedure with the patient's physician. c. Look up the procedure in a nursing textbook. d. Consult the agency procedure manual and follow the guidelines for the procedure.

d. Consult the agency procedure manual and follow the guidelines for the procedure.

4. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments.

d. Explain to the woman the importance of keeping her prenatal care appointments.

25. As part of their participation in the gynecologic portion of the physical examination, nurses should: a. Take a firm approach that encourages the client to facilitate the examination by following the physician's instructions exactly. b. Explain the procedure as it unfolds and continue to question the client to get information in a timely manner. c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for cancer. d. Help the woman relax through proper placement of her hands and proper breathing during the examination.

d. Help the woman relax through proper placement of her hands and proper breathing during the examination.

34. The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is: a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

d. Intrauterine growth restriction

13. One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. b. Menorrhagia. c. Leiomyoma. d. Metrorrhagia.

d. Metrorrhagia.

17. Recent trends in childbirth practice indicate that: a. Delayed pushing is now discouraged in the second stage of labor. b. Episiotomy rates are increasing. c. Midwives perform more episiotomies than physicians. d. Newborn infants remain with the mother and are encouraged to breastfeed.

d. Newborn infants remain with the mother and are encouraged to breastfeed.

1. The two primary functions of the ovary are: a. Normal female development and sex hormone release. b. Ovulation and internal pelvic support. c. Sexual response and ovulation. d. Ovulation and hormone production.

d. Ovulation and hormone production.