PrepUs FINAL EXAM

During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate?

"It can take up to 2 years once she starts for the periods to become regular." Once menarche has occurred, cycles may take up to 2 years to become regular, ovulatory cycles (pg 114).

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate?

"There is no cure, but drug therapy helps to reduce symptoms and recurrences." (pg 186)

A nurse is providing care to a pregnant client at 9 weeks' gestation. The client reports that her breasts have become quite tender. She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply.

- estrogen - progesterone An increase in estrogen and progesterone that occurs with pregnancy causes the fat layer of the breasts to thicken and the number of milk ducts and glands to increase during the first trimester (pg 408).

Which sign(s) and symptom(s) can be associated with cytomegalovirus (CMV) infection in an infant? Select all that apply.

- microcephaly - hearing impairment leading to deafness - chronic liver disease (pg 383).

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate that the client is at how many weeks' gestation?

28 weeks' gestation (pg 396)

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks' gestation, a 2-year-old son born at 39 weeks' gestation, and a spontaneous abortion (miscarriage) 1 year ago at 6 weeks' gestation. Using the GTPAL method, the nurse would document her obstetric history as:

4 1 1 1 3 Using the GTPAL method, the woman's history would be documented as 4 (her fourth pregnancy), 1 (number of term pregnancies), 1 (number of pregnancies ending in preterm birth), 1 (number of pregnancies ending before 20 weeks or viability), and 3 (number of living children).

The pediatrician prescribes morphine sulphate 0.2 mg/kg orally q 4 hour for a neonate suffering from drug withdrawal. The neonate weighs 3,800 grams. How much of drug will the nurse give in 24 hours? Record your answer using two decimal places.

4.56 mg 3800 grams = 3.8 kg 3.8 kg/kg x 0.20 mg x 6 doses = 4.56 mg in 24 hours

A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?

Eat small meals frequently rather than large meals (pg 406).

At her prenatal visit a client reports that she cannot find any shoes that are comfortable. Assessment of her legs reveals dependent edema. The nurse suggests that the client attempt which actions to help reduce the edema? Select all that apply.

Elevate feet and legs when sitting or lying. Avoid foods high in sodium, sugar, and fats. Drink 6 to 8 glasses of water each day (pg 412).

The sexual health nurse is presenting to a group of adolescents the government initiative that proposes to reduce the numbers of adolescents with sexually transmitted infections (STIs). What is the name of this initiative?

Healthy People 2030 (pg 173)

The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which suggestions should the nurse include in the teaching plan? Select all that apply.

Increase water consumption. Use heating pads or take warm baths. Increase exercise and physical activity. (pg 119)

A nurse who is conducting sessions on preventing the spread of sexually transmitted infections (STIs) discovers that there is a very high incidence of hepatitis B in the community. Which measure should the nurse take to ensure the prevention of the disease?

Instruct people to get vaccinated for hepatitis B (pg 194).

When interacting with parents caring for their newborn in opioid withdrawal, which nursing action is most essential?

Instruct the parents with a nonjudgmental, caring attitude. It is essential to approach the parents with a nonjudgmental and caring attitude. If the parents feel that the nurse cares, they will be open to the instruction being provided (pg 899).

Which information would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice?

Pathologic jaundice appears within 24 hours after birth. Pathologic jaundice appears within 24 hours after birth whereas physiologic jaundice commonly appears around the third or fourth days of life. Acute bilirubin encephalopathy (kernicterus) is more commonly associated with pathologic jaundice (pg 901).

The nurse is assessing the neonate shown. From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticipate performing care?

Spina bifida with myelomeningocele The neonate shown was born with spina bifida myelomeningocele, which is a sac containing the spinal cord and meninges with nerves roots embedded in the wall.

Which of these findings should a nurse investigate first when assessing a female client who has been unable to conceive for 14 months?

The client was diagnosed with thyroid cancer 2 years ago. The nurse should further assess the extent of the thyroid cancer as endocrine dysfunction can be a significant source for infertility (pg 129)

A nurse is caring for a client positive for human immunodeficiency virus (HIV). The client is on triple-combination highly active antiretroviral therapy (HAART). What should the nurse include in the teaching plan when educating the client about the treatment? Select all that apply.

Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Ensure that the client understands the dosing regimen and schedule. The nurse should ensure that the client understands the dosing regimen and schedule. The client should be informed that unpleasant side effects such as nausea and diarrhea are common. The nurse should provide written material describing diet, exercise, and medications to promote compliance and ensure a healthy lifestyle (pg 197).

The nurse is caring for a new infant and notes on assessment the newborn is small for gestational age and also has indications of intrauterine growth restriction. Which assessments should the nurse prioritize about the mother as a potential cause for the infant's condition?

blood glucose levels Uncontrolled maternal diabetes can be a contributing factor for the infant with intrauterine growth restriction (pg 886).

A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply.

bradycardia hypotension reduced subcutaneous fat (pg 114)

A client is being prepared for intrauterine (artificial) insemination. Which finding is the most suggestive to determine if the client is ovulating?

change in the cervical mucus (pg 139)

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?

condoms (pg 141)

The nurse should carefully screen a client who insists on using only oral contraceptive pills (OCPs) for which contraindication?

deep vein thrombosis (pg 146) The nurse should screen the client for deep vein thrombosis (DVT), migraine headaches, neurological symptoms, coronary artery disease or cerebral vascular disease, severe diabetes, hypertension, liver disease, breast or endometrial cancer, and unexplained vaginal bleeding when oral contraceptive pills (OCPs) are used.

A newborn is suspected of developing persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which procedure to confirm the suspicion?

echocardiogram An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension (pg 882).

The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which measure would the nurse be sure to include as effective in reducing the risk for osteoporosis?

engaging in daily weight-bearing exercise (pg 161)

A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment?

feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour A woman should report vaginal bleeding, no matter how slight, because some of the serious bleeding complications of pregnancy begin with only slight spotting (pg 409).

When obtaining the health history from an adolescent client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)?

five different sexual partners (pg 172)

One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it?

folic acid (pg 383)

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)?

gonorrhea To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states (pg 184).

A nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply

hot flashes increased abdominal fat vaginal dryness decreased bone density (pg 159)

If constipation is a problem for a woman during pregnancy, which measure would be best to recommend?

increased fiber intake (pg 405)

A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which evaluatory method to confirm this suspicion?

laparoscopy The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis (pg 126).

A nurse is providing care to a client diagnosed with genital/vulvovaginal candidiasis. As part of the client's plan of care, the nurse would teach the client about which medication?

miconazole Genital/vulvovaginal candidiasis is most commonly treated with topical azoles, such as miconazole (pg 179).

The perinatal nurse is assessing a large-for-gestational age infant born by breech birth and notes that the infant is irritable and does not move the right arm. For what would the nurse assess?

midclavicular fracture Midclavicular fractures most often occur during births of newborns with macrosomia (pg 890).

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?

newborn who is type A, mother who is type O Hemolytic disease of the newborn may develop when a mother and the unborn fetus have different blood types. The disease occurs when the immune system of the mother sees the fetus's red blood cells as foreign. Antibodies then develop against the fetus's red blood cells. These antibodies attack the red blood cells beginning at birth, causing them to break down too early. There is more than one way in which the fetus's blood type may not match the mother's. Commonly, it is the result of ABO incompatibility. It also occurs with Rh factor incompatibility. Of the options provided, the newborn with type A and the mother with type O will result in hemolytic disease of the newborn (pg 902).

A nurse is assessing a preterm newborn for possible sepsis. The nurse suspects an early onset infection based on which risk factors? Select all that apply.

preterm labor prolonged rupture of membranes maternal fever (pg 906)

In the preterm newborn, the most critical complications are related to which system?

respiratory (pg 877)

The nurse was teaching a college student how to properly take the prescribed oral contraceptive pills (OCPs). The nurse determines the session is successful when the client correctly chooses which instruction to follow when taking the OCP?

same time of day, each day (pg 145)

The estrogen content in the contraceptive pill performs which action?

suppresses follicle-stimulating hormone (FSH) Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation (pg 145).

A client comes to the prenatal clinic for her first visit. When determining the client's estimated date of delivery/birth, the nurse understands that which method is the most accurate?

ultrasound Although there are several methods for determining the EDD, the ultrasound is considered the most accurate method for dating the pregnancy (pg 390).

A nurse is describing the various birth methods to pregnant couples. Which information would the nurse include as part of the Lamaze method?

use of specific breathing and relaxation techniques Lamaze is a psychoprophylactic ("mind prevention") method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques (pg 421).

The nurse is scheduled to see four clients. Which client is at highest risk for depression?

A 17-year-old at 32 weeks' gestation, living with a 22-year-old man who is not the father of her baby, because her parents made her move out when she got pregnant Risk factors for depression are young age, lack of social support, and unintended pregnancy (pg 387).

The nurse is caring for clients in a community health clinic. Which clients does the nurse recognize need screening for sexually transmitted infections? Select all that apply.

An incarcerated 28-year-old client. A pregnant woman in the third trimester. Initial examination after a sexual assault. Annual exam for a 24-year-old sexually active woman (pg 188).

The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?

Arrange for Rho(D) immune globulin at 28 weeks' gestation (pg 403).

A pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client?

Kegel exercises (pg 406)

A nurse is caring for a newborn with meconium aspiration syndrome. Which interventions should the nurse perform when caring for this newborn? Select all that apply.

Place the newborn under a radiant warmer or in a warmed isolette. Administer oxygen therapy. Administer broad-spectrum antibiotics (pg 882).

A sex trade worker is seen at the sexual health clinic reporting dysuria, mucopurulent vaginal discharge with bleeding between periods, conjunctivitis, and a painful rectal area. What sexually transmitted infection would the nurse suspect?

chlamydia Chlamydial symptoms include dysuria, mucopurulent vaginal discharge, and dysfunctional uterine bleeding. It can cause inflammation of the rectum and conjunctiva (pg 183).

A nurse is teaching a group of pregnant young women about sexually transmitted infections (STIs) and the possible effects that may occur in the fetus or newborn. Which STIs would the nurse describe as being transmitted to the newborn during birth? Select all that apply.

chlamydia gonorrhea genital herpes HIV Chlamydia, gonorrhea, and genital herpes can be transmitted to the fetus/newborn during birth. An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding. Syphilis can be transmitted to the fetus while in utero (pg 199).

An female adolescent is diagnosed with gonorrhea. When developing the plan of care for this adolescent, the nurse would expect that she would also receive treatment for:

chlamydia. Clients with gonorrhea usually receive treatment for chlamydia as well because they often are coinfected (pg 184).

A nurse in the sexual health clinic assesses a female client and notes wart-like lesions on the genital area and rectum. Which diagnosis best correlates with these findings?

human papillomavirus HPV presents itself with wart-like lesions that are soft, moist, or flesh colored and appear on the vulva and cervix, and inside and surrounding the vagina and anus (pg 177).

A 32 weeks' gestation newborn in the neonatal intensive care is being assessed for hyperbilirubinemia. Which diagnostic tests would the nurse expect to be done? Select all that apply.

- direct Coombs - blood type - hemoglobin - bilirubin levels Laboratory and diagnostic testing to assess for hyperbilirubinemia includes a direct Coombs test to identify hemolytic disease of the newborn. In addition, a hemoglobin concentration for evidence of anemia and the blood type is done to determine Rh status and any incompatibility of the newborn. A bilirubin level is assessed (pg 903).

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of:

deficiency of surfactant. A preterm newborn is at increased risk for respiratory distress syndrome (RDS) because of a surfactant deficiency. Surfactant helps to keep the alveoli open and maintain lung expansion. With a deficiency, the alveoli collapse, predisposing the newborn to RDS (pg 877).

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client?

vas deferens The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy.(pg 151)

Which strategies should the nurse utilize when attempting to awaken a potentially sleeping fetus? Select all that apply.

- Clap near the mother's abdomen. - Provide the mother a cold beverage. - Place hands on the abdomen to move the fetus. - Use vibroacoustic stimulation. The nurse is correct to arouse the fetus in a variety of ways. The nurse can use audio stimulation such as clapping near the abdomen or using vibroacoustic stimulation. Providing the mother a cold beverage can also arouse the fetus. Feeling the mother's abdomen for the location of the fetus and moving the body parts can also cause the fetus to move and/or kick.

A newborn with newly diagnosed hemolytic jaundice is being treated with phototherapy. Which actions should the nurse take? Select all that apply.

- Shield the newborn's genitals and eyes during phototherapy sessions. - Encourage the mother to breastfeed (8 to 12 feedings per day). - Supplement breast milk with formula. - Expose as much of the newborn's skin as possible (pg 903).

A couple who have been experiencing infertility have been prescribed clomiphene citrate. What information should be included in teaching about the medication therapy? Select all that apply.

- This medication therapy will promote ovulation in the woman. - The medication is usually used for no more than 3 cycles at a time. Clomiphene citrate is a nonsteroidal synthetic antiestrogen used to induce ovulation. It is typically discontinued after three cycles of use. After 5 days of therapy, the couple is encouraged to have sexual intercourse every other day (pg 132).

A nurse is providing follow-up teaching to a client regarding the medically induced termination of her pregnancy. Which assessment finding should the nurse tell the client to report to the health care provider? Select all that apply.

- Vaginal bleeding of more than two pads per hour - Severe depression or sadness - Severe abdominal pain The nurse should educate the client to notify the health care provider if there is vaginal bleeding of more than two pads an hour, severe abdominal pain or tenderness, and severe depression or sadness. The client should contact the health care provider if an oral temperature of greater than 102.4°F (39.1℃) or abdominal pain or tenderness occurs (pg 158).

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding?

Abnormal uterine shape Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall) (pg 156)

At a preconception counseling class, a client expresses concern and wonders how Healthy People 2030 will improve maternal-infant outcomes. Which response(s) by the nurse is appropriate? Select all that apply.

Healthy People 2030 aims to... - reduce the rate of fetal and infant deaths. - decrease the number of all infant deaths (within 1 year). - decrease the number of neonatal deaths (within the first year). - foster early and consistent prenatal care (pg 873).

A woman with diabetes has just given birth. While caring for this neonate, the nurse is aware that the child is risk for which complication?

hypoglycemia Neonates of mothers with diabetes are at risk for hypoglycemia due to increased insulin levels. During gestation, an increased amount of glucose is transferred to the fetus through the placenta. The neonate's liver can't initially adjust to the changing glucose levels after birth. This inability may result in an overabundance of insulin in the neonate, causing hypoglycemia (pg 886).

A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the:

placenta. The syphilis spirochete can cross the placenta after 9 weeks' gestation. It is not transmitted via amniotic fluid, passage through the birth canal, or breast milk (pg 188).

A client is using high-dose estrogen oral contraceptives. The nurse would assess the client for which finding?

yeast infections The nurse should closely monitor for yeast infections in a client who uses high-dose estrogen oral contraceptives. Hormonal changes when using high-dose estrogen oral contraceptives can change the environment of the vagina and make it conducive to the growth of yeast cells (pg 179).