NURS 247--PrepU Questions--Final Chapters

The nurse gave a presentation about intimate partner violence (IPV) to a local community group. The nurse determines more teaching is needed when a member makes which statement?

"For the victim's safety, the victim has to learn to be careful to not set off the abuser."

The clinic nurse is treating a client diagnosed with HIV. Which statement made by the client indicates an understanding of the diagnosis?

"If my T-cell count drops below 200 cells/mm3 (0.2 × 109/l), my HIV has progressed to AIDS."

As part of an education program for pregnant women and their partners, the nurse illustrates the various settings available for birth. The nurse determines that the program was successful when the group correctly chooses which statement about home births?

"Women giving birth at home have control over every part of labor."

A client is receiving ceftriaxone as treatment for gonorrhea. What would be most important for the nurse to emphasize to the client?

Avoid alcohol consumption.

Which finding would the nurse most likely find in a male diagnosed with a chlamydia trachomatis infection?

dysuria

The nurse instructs a pregnant client who is at home on bed rest to drink at least eight glasses of fluid each day. What would be the best method to encourage the client to drink this amount?

Keep a pitcher of fluid readily available on a bedside table.

A nurse is presenting a program for a local women's group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge?

candidiasis

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply.

- weight fluctuation - erosion of teeth - menstrual irregularity

Which medication is used to suppress viral load of the HSV-2 infection?

acyclovir

During a prenatal assessment, the nurse observes that the client is quiet and withdrawn. The client keeps asking if her partner can come into the examination room, because the partner does not like to be kept waiting. Which question would be most important for the nurse to ask before the partner comes into the examination room?

"Do you feel safe in your home?"

A woman seen in the emergency department is diagnosed with primary syphilis. What finding is most likely?

chancres at the vaginal site

What makes the area of family nursing a difficult arena in which to provide care at times?

family members who might not agree on treatments and a plan of care

Pelvic infection is most commonly caused by:

sexual transmission.

A female sex trade worker has been diagnosed with secondary syphilis. Which findings would most likely correlate with this diagnosis?

sore throat and flu-like symptoms

The nurse educator has completed a presentation on caring for babies born to mothers with a substance use disorder. Which statement by a participant would indicate the need for further education?

"Babies born to a mother with a substance use disorder don't have any difficulty eating."

The nurse is caring for a client suspected of being a victim of human trafficking. Which question, when given priority by the nurse during the admission interview, demonstrates a need for additional training?

"Are you working toward achieving American citizenship?"

The nurse is caring for a client diagnosed with trichomoniasis. The health care provider has prescribed a single dose of metronidazole. Which information will the nurse provide this client?

"Avoid alcohol consumption for at least 24 hours after you take this medication."

A child is seen in the pediatric clinic for update of immunizations prior to starting middle school. During the intake process the nurse asks the parents if the family is involved in any neighborhood or community activities. The parents ask the nurse, "What does that have to do with immunizations?" What is an accurate response by the nurse?

"Based on research, our physician feels that better connection to community leads to better health in many ways."

The public health nurse is teaching young adolescents in a sexual health class the proper use of a condom. Which statements made by the students indicate teaching was successful? Select all that apply.

- Only use latex condoms. - Place the condom on an erect penis. - Store the condoms in a cool, dry place.

Which of the 2020 National Health Goals should a maternal child health nurse working in a developed nation focus on for the betterment of clients? Select all that apply.

- reduction of child mortality - improvement of primary education - environmental sustainability - gender equality

A woman comes to the local women's health clinic for an evaluation. The woman is diagnosed with chlamydia. Which action(s) by the nurse would be important? Select all that apply.

- report the condition to public health authorities - discuss the need for treatment for gonorrhea as well

During the assessment of an 86-year-old client, the nurse notes multiple bruises on the torso, arms, and back. The client tells the nurse, "My child is my caretaker. My child is rough with me and very controlling." How will the nurse respond?

"Tell me what you have done in the past to resolve this mistreatment?"

The nurse is caring for a pregnant client who states her spouse verbally abuses her. Which response by the nurse is a priority?

"Intimate partner violence often gets worse during pregnancy and stress. Do you have a safety plan in place?"

A 16-year-old pregnant client presents to the office for the third time this week. While completing the client's admission, the nurse screens for intimate partner violence. The client responds, "I have already told you twice this week I am not being abused. Why do you keep asking me these questions?" Which response by the nurse is best?

"It is protocol to screen all clients for intimate partner violence at every visit."

A female client, who has been newly diagnosed with herpes simplex virus (HSV) ask the nurse how long it will take for the "sores" to go away. How should the nurse respond?

"It will take about 2 weeks for the outbreak to fully heal."

After teaching a group of college-aged students about condom use, the nurse determines that additional teaching is needed when the students make which statement?

"It's okay to use petroleum jelly with a latex condom."

The nurse suspects a client is a victim of intimate partner violence (IPV). Which statement by the client supports the nurse's suspicion?

"My spouse refuses to let me go out to find a job."

A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse?

"OK, great. I will let the physician know."

The nurse has completed teaching on total parenteral nutrition therapy for the parents of a 3-year-old client who will be receiving therapy at home. Which statement by the mother indicates that reteaching is necessary?

"She can still take her bubble baths every day just like normal."

A nurse is uncomfortable caring for a pregnant client who is married to her female life partner. The best advice another nurse can give her would include which statement?

"Spend some time self-reflecting why this family difference might be bothering you."

A woman with candidiasis is prescribed fluconazole. When teaching the woman about this medication, which instruction would the nurse include?

"Take 1 dose of the drug by mouth."

A client with genital herpes asks the nurse about what to expect with the infection. Which response by the nurse is appropriate?

"You have to be extremely careful in the future. Even if you do not have symptoms, you could still spread the infection to others."

A nurse is conducting a teaching session on sudden infant death syndrome (SIDS) for expectant parents. Which information should the nurse include? Select all that apply.

- Sharing a room allows for monitoring of the infant. - Place the infant on his or her back to sleep. - Maintain neutral temperatures and avoid overheating.

A client is diagnosed with pediculosis infection. When teaching the client about measures to treat and minimize the transmission, which measures would the nurse include? Select all that apply.

- following the manufacturer's instructions for the medication - not sharing any personal items with others - removing any nits with a fine toothed comb

The nursing instructor is teaching about violence and informs the students about which of its distinct phases? Select all that apply.

- tension-building phase - acute battering phase - honeymoon phase

Place the three phases of intimate partner violence in the order in which they occur. Use all options.

- tension-building phase - acute violence phase - honeymoon phase

The maternal-child health nurse is providing care to the following clients. Which client would the nurse assess as being in the health restoration phase?

A 29-year-old G1P1L1 is assessed for ongoing complications from eclampsia, one week postpartum. Blood pressure is 128/92 mm Hg, heart rate 78 bpm, respiratory rate 22 breaths/min, temperature 98.8°F (37°C). Client states no headaches, no vision changes, and no seizure activity.

The nurse is providing education on the prevention of sexually transmitted infections (STIs) to clients. The nurse understands which client is at the highest risk of contracting an STI?

A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution.

A woman is in the second stage of labor, 8-cm dilated and 90% effaced. She keeps very quiet without expressing any outward signs of pain. Which intervention by the nurse would be most appropriate in this situation?

Allow the woman to labor according to her cultural beliefs.

The nurse is preparing a prenatal seminar for young mothers. Which type of information should the nurse gather to ensure success of the program?

Approximate education level of the participants

A 13-year-old client who is newly diagnosed with type 1 diabetes is being discharged home with home care follow-up. What is the most appropriate goal for the nurse to select related to the nursing diagnosis of Health-Seeking Behaviors related to Skills Needed to Continue Home Care?

Client will self-administer insulin injections using appropriate technique.

To properly assist a victim of intimate partner violence, which action would be most appropriate for the nurse to do?

Document the details.

Morbidity rates among children are most highly associated with which cause?

Environmental factors

A nurse is assisting a client who does not speak the dominant language with breastfeeding. What action will the nurse take when engaging the services of an interpreter?

Establish a rapport with the interpreter.

When orienting a new home health nurse on safety policies, which should the nurse include?

Keep the agency informed of your visit schedule.

The home health nurse enters the gated front yard of the client. A large aggressive dog appears on the front porch. What is the most appropriate action by the nurse?

Leave the yard and return to the car.

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care?

They were convinced that setting would improve birth outcomes.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

a painless genital ulcer that appeared about 3 weeks after unprotected sex

The nurse is caring for a pregnant woman and her family who are immigrants. Which intervention would be the priority for helping to achieve a successful outcome?

communicating using understandable terms

A program designed to decrease the infant mortality rate in the United States would probably make the greatest impact if it focused on which aspect of care?

increasing the number of women receiving prenatal care

Childhood morbidity produces a large amount of disability in children. What factor has the highest impact on childhood disability?

missed days of school

Which finding would alert the nurse to suspect that a client has a yeast infection?

vulvar burning and itching

Which physician is known as the "Father of Pediatrics"?

Abraham Jacobi

A nurse who specializes in maternal and child health care performs many varied functions in diverse settings over the course of a year. Which action would be outside the nurse's scope of practice?

Assist in the treatment and recovery of a woman with ovarian cancer.

A nurse is trying to reduce a mother's anxiety about her child being in the hospital. What would be the best way to accomplish this?

Include the mother in the medical decision-making.

A young female client is pregnant for the first time and is uncertain who to seek prenatal care from. The nurse should point out which health care provider as the likely choice?

Obstetrician

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.

The nurse is preparing to teach a drug education class at a local elementary school. The nurse is focused on providing which type of care to the community?

Primary prevention

The community health nurse is seeing a mother and newborn for the first home visit. Which information best indicates an understanding of visiting clients in their home?

The home visit is a way of monitoring the well-being of all family members.

A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection?

gonorrhea

What is the medication of choice for early syphilis?

penicillin G benzathine

Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection?

trichomoniasis

The nurse is caring for a client diagnosed with candida vaginitis. The nurse knows additional teaching is needed when the client makes which statement?

"Douching is an effective way to cleanse the vaginal area after intercourse."

A nurse is teaching a new mother about self-care measures. Which action would the nurse do as the final step in this process?

Document the teaching and effectiveness.

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby?

Instill a prophylactic agent in the eyes of the newborn.

An infant at 33 weeks' gestation dies after 1 week of life in the neonatal intensive care unit. This infant's death rate would be classified under which statistical category?

neonatal death

A nurse is assessing a victim of rape. Further assessment reveals that the client received rohypnol. The nurse understands that this drug can lead to memory loss for up to how many hours?

8

A nurse is preparing to teach a class to high school students on the risks of teenage birth and the various methods of contraception. The nurse recognizes that enhanced provisions of sex education to adolescents have had a positive influence on which measurement in the past 10 years in the United States?

Birth rate

The nursing instructor is discussing the infant mortality rate with a group of students. The instructor determines the discussion is successful when the students correctly choose which action as a priority to help decrease infant mortality in the United States?

Improving accessibility to postnatal health care for infants

A client who is currently 30 weeks' gestation with three small children is placed on bed rest at home due to preeclampsia. Which is the priority nursing diagnosis for this client?

Ineffective role performance

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?

Teach injury prevention and proper safety practices.

A nurse is addressing a group of women on the issue of women's health during their reproductive years. Which reason does the nurse provide regarding the need for comprehensive, community-centered care to women during this time period?

Women's health care needs change with their reproductive goals.

A nurse is providing care to several clients at the clinic. The nurse would obtain legal consent for care from the parent or legal guardian for which client?

a 15-year-old adolescent who is a high school student

Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent?

Telephone consent with two witnesses listening simultaneously.

Which factor in a client's history indicates she is at risk for candidiasis?

use of corticosteroids

The nurse is teaching a group of middle school students about sexually transmitted infections (STIs). Which statement by the students indicates a need for additional teaching about condom use?

"I will put the condom on just before orgasm."

The nurse suspects a pregnant client is a victim of intimate partner violence (IPV). When the nurse asks the client if her partner abuses her, the client responds, "Oh no, my partner does not hit me." Which response by the nurse is most appropriate?

"There are many types of intimate partner violence beyond physical abuse."

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking?

"We had to sign the form right away so the surgery could get scheduled."

The nursing instructor is discussing culture with a group of nursing students. Which aspects should be included in the discussion of this topic? Select all that apply.

- a sense of personal space - primary language spoken by the family - religious beliefs of the individuals

While taking a health history, the nurse finds out that the pregnant woman of Japanese descent comes from a culture that does not eat meat. Which foods will indicate sufficient protein intake? Select all that apply.

- beans and rice eaten every day - stir-fried carrots and beans regularly - egg drop soup 2 to 3 times per week

A nurse is conducting a monthly chart audit in the newborn nursery. Which finding could indicate an ethical consideration of practice?

200% increase in IV cath attempts

A pregnant woman arrives in the L & D unit following premature rupture of membranes along with her spouse who insists on being present and demands only female nurses assess his wife. When obtaining history and assessment data, the spouse provides all the answers. What is the best approach for the nurse to handle this situation?

Act as an advocate for the woman who has a male dominant partner.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for children from various cultures. Which action by the UAP will cause the RN to intervene?

Following the traditions of the UAP's own culture with each client

A nursing student is exploring community-based nursing as a career focus. The nurse is prepared to prioritize which activity as a primary focus?

Wellness

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which symptoms would the nurse expect the client to exhibit?

heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin

A homeless client diagnosed with human papillomavirus (HPV) is seen in the maternity clinic requesting a pregnancy test. Which nursing action would be the best example of the secondary level of prevention?

Suggest she have a Papanicolaou test.

The obstetrical nurse notes that a Muslim client has not been eating any of the meals supplied to her. Which actions performed by the nurse best demonstrate cultural competence?

The nurse becomes familiar with the Muslim client's meal practices.

A group of nursing students are comparing the various changes in maternity care over the course of history and discover that the development of what medical treatment was most influential in moving birth from the home into the hospital setting?

Anesthesia and analgesic therapy

Which instruction should be given to a woman newly diagnosed with genital herpes?

Limit stress and emotional upset as much as possible.

A clinical nurse specialist is conducting a review class for a group of nurses about cultural competence and cultural diversity. Which term reflects the view of the world and set of traditions of a specific social group passed down through generations?

culture

A pregnant woman with premature ruptured membranes is trying to decide whether home care might be the best option for her. Which advantage should the nurse mention to the client that is most pertinent to her condition?

decreased exposure to infection

The nurse is preparing to make a home visit to admit a new client to services. Which actions should the nurse take to ensure personal safety? Select all that apply.

- Keeping the gas tank of the car full - Parking the car in a well-lighted area - Using a map to avoid getting lost in a strange neighborhood - Informing the agency of the estimated arrival time and expected return

A nursing instructor is teaching the class about community-based nursing. The instructor determines the session is successful when the students correctly choose which activity as an example of tertiary prevention?

Ensuring the client attends physical therapy after orthopedic surgery

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children.

A 7-year-old client on a ventilator who is being cared for at home is admitted to the hospital for the fourth time in a 6-week period for respiratory complications. What might be the priority nursing diagnosis for this client?

Deficient knowledge

When implementing an intervention for a client experiencing intimate partner violence, what is the primary goal?

The client will regain a sense of control in life.

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

yeast infections

The nurse is caring for a victim of intimate partner violence who needs emotional support. What nursing actions are appropriate for this client? Select all that apply.

- Allow the client to make as many decisions as possible. - Encourage the client to attend support groups. - Teach strategies for problem-solving and stress management.

The nurse completes a focused assessment on a client complaining of migraine headaches. Which items identified during the assessment would the nurse recommend the client change in an attempt to decrease the incidence of migraine headaches?

- Uses an oral contraceptive pill (OCP) - Drinks 3-4 glasses of wine in the evening - Consumes large quantities of aged cheeses and salty foods

The mother of a child who has been diagnosed with a chronic lung condition has asked what the implications are for her child's future. After providing education to the parent, which statements indicate the need for additional teaching? Select all that apply.

- "Since this condition is not related to my child's level of intelligence, it will not impact her performance in school." - "Social maturity is not likely to be impacted with a chronic lung condition."

The nurse is interviewing a client who has experienced intimate partner violence. Which nursing intervention will likely be most effective in assuring the client that the interview will be kept confidential?

Assure the client agrees before any information can be released

A client who is a rape survivor has appeared to cope very well. However, at a routine visit several months later, the client describes a new onset of nightmares and flashbacks. Which action by the nurse is most appropriate for this client?

Refer the client to a psychologist for psychotherapy treatment.

A nurse is working with a client who is anticipating the possibility of leaving a relationship with intimate partner violence. In helping the client make the decision to leave or to stay in the abusive situation, which action would be most important for the nurse to take?

Explain to the client how to develop a safety plan for leaving the relationship.

A client who is a victim of intimate partner violence fails to report the violence primarily because of which reason?

The client feels responsible for causing the incident.

The nurse is caring for several families enrolled in Medicaid in the prenatal setting. Which statement by an expectant mother would alert the nurse to assess the family further?

"My sister-in-law is due to have her baby the same month as our baby is due."

When teaching a group of young adults about the cycle of violence, the nurse would describe which behavior as eventually disappearing as the violence becomes accelerated over time?

apologies for the pain and abuse

The nurse is working with the parents of an infant and a toddler in the clinical setting. What statement by the parent would alert the nurse to assess the children further?

"We live in an old house, and we are planning to renovate it when the kids are older."

A client is receiving treatment for injuries sustained during a fight with a partner. The nurse observes the partner visit the client daily in the hospital and appears very solicitous and contrite. The client states, "My partner always apologizes and brings gifts after a fight." Which response by the nurse is appropriate?

"Although your partner seems sorry, often an abuser will continue to repeat the behavior in the future."

The nurse is teaching a prenatal class about yeast infections during pregnancy. Which statement made by the class indicates the teaching has been effective?

"Eating less baked goods, white rice and honey may help prevent yeast infections."

The nurse is teaching a client about sexually transmitted infections. The nurse determines the teaching was successful when the client makes which statement?

"Genital ulcers are a sign of genital herpes simplex."

As part of a local college awareness program, a nurse is interviewing several of the participants about their views on rape. Which statement by a participant will lead the nurse to determine teaching about rape is needed?

"Health care providers can prevent pregnancy and sexually transmitted infection transmission after a rape."

A pregnant woman recently diagnosed with the genital herpes virus asks the nurse for more information on the virus. Which responses by the nurse would be appropriate? Select all that apply.

- "The virus remains quiet until a stressful event occurs to reactivate it." - "Infections may be transmitted by individuals unaware that they have it." - "Transmission is through contact of infected mucous membranes."

The nurse is working with a same-sex couple, both of whom have children from previous relationships. Although the couple have no plans of marrying, they view their relationship as monogamous and long-term. Which family structure would apply to this family? Select all that apply.

- Gay or lesbian family - Cohabitation family - Blended family

A nurse is conducting an AIDS awareness program for women. Which instructions should the nurse include in the teaching plan to empower women to develop control over their lives in a practical manner so that they can prevent becoming infected with the HIV? Select all that apply.

- Give opportunities to practice negotiation techniques. - Encourage women to develop refusal skills. - Encourage women to use female condoms.

A nurse is caring for a pregnant client and discovers signs of bruises near her neck. On questioning, the nurse learns that the bruises were caused by her spouse. The client tells the nurse that the spouse had stopped hitting her some time ago, and that this was the first time during the pregnancy that she was assaulted. The client blames herself because she admits to not paying enough attention to her spouse. Which facts about intimate partner violence during pregnancy should the nurse tell the client to convince her that the violence was not her fault? Select all that apply.

- Intimate partner violence is a result of resentment toward the interference of the growing fetus and change in the woman's shape. - Intimate partner violence is a result of the perception of the partner that the baby will be a competitor after he or she is born. - Intimate partner violence is a result of insecurity and jealousy of the pregnancy and the responsibilities it brings.

A home care nurse is planning care for a 29-week gestation client pregnant with triplets on bed rest to reduce the chance for preterm labor. Which tasks can the nurse delegate to the home care assistant? Select all that apply.

- Prepare lunch for the client. - Assist the client with a bed bath.

The nurse is working with a client who is in a relationship with a man who controls her activities, calls her names, and occasionally hits her. What are the goals in the treatment of this client? Select all that apply.

- Provide support to the client - Empower the client to take control - Maximize the client's safety

The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply.

- Spontaneous abortion (miscarriage) - Placental abruption (abruptio placentae) - Uterine rupture - Preterm labor

A gay couple asks their health care provider about how they can begin a family. Which method(s) will be discussed to accomplish their goal of a family? Select all that apply.

- The couple can find a female surrogate and then donate sperm to allow for artificial insemination. - The nurse can give the couple a list of area adoption agencies that might be helpful to use to grow their family. - One or both partners can donate sperm to a surrogate gestational carrier.

The nurse who counsels clients who suffer from intimate partner violence (IPV) understands that IPV can come in which form(s) of abuse? Select all that apply.

- emotional abuse - physical abuse - financial abuse - sexual abuse

The nurse is reviewing health records to collect information regarding infant mortality. Which data, when noted, would alert the nurse to further assess the client's chart for evidence of the child dying during infancy? Select all that apply.

- female infant born at 31 weeks' gestation in a hospital setting - male infant diagnosed with low birth weight of 2400 grams - Male infant diagnosed with a congenital abnormality soon after birth.

What aspects of care play an essential role in the health of a woman and fetus during pregnancy? Select all that apply.

- financial support - prenatal care - emotional support - maternal nutrition

A nurse is working in a local community health care facility where many clients are victims of intimate partner violence. For which sign(s) will the nurse assess to determine if a client is a victim? Select all that apply.

- mental health disorders such as depression, anxiety, or substance use disorder - injuries on the face, head, and neck - reported history of the injury inconsistent with the presenting problem

The case manager is looking over the inpatient census on the floor to determine which client would be the best candidate for discharge with home health care follow-up. Which client would the case manager recommend to the practitioner for discharge?

10-year-old boy with an infected laceration on his leg who has been treated with IV antibiotics for 3 days.

In which age range are women most vulnerable for intimate partner violence?

16 to 24 years

The nursing student is studying violence and mistreatment against the older woman. While researching it, the student learns that laws require health care professionals to report elder or vulnerable person mistreatment. How many states currently have these laws?

50

The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate?

Check the medical record for written client approval with whom to share information.

The home care nurse is visiting a client and family for the first time. Which initial action can the nurse take to build trust with the client and family?

Communicate in an organized and professional manner.

A client at 34 weeks' gestation comes to the clinic with her partner and reports neck and back pain. During the assessment, the nurse notes multiple contusions in various stages of healing on the client's torso and weight gain of 3 lb (1.36 kg) during the course of the pregnancy. Which action will the nurse take next?

Have the client's partner leave the room during the examination.

Cost containment in the health care field has become a sought-after necessity because of rising costs and the influence of managed care. Nurses are instrumental in assisting with cost containment of health care by prioritizing which strategy?

Health promotion

The nurse is beginning an assessment with a pregnant client from a non-English-speaking culture. The interpreter is having difficulty understanding what the client is trying to say and the client is becoming frustrated. Which nursing diagnosis would be most appropriate for this situation?

Impaired verbal communication

A nurse is preparing a presentation for a local community group about intimate partner violence. Which statement would be most appropriate for the nurse to include in the presentation?

Intimate partner violence in lesbian, gay, bisexual, transgender, queer (LGBTQ) relationships may go unreported for fear of harassment.

The nursing instructor is teaching a session outlining the necessary skills of a community nurse. The instructor determines the session is successful when the students correctly choose which factor as the foundation of all nursing care?

Nursing process

A nurse is doing a literature search on maternal mortality and finds that direct causes comprise the majority of maternal deaths. Direct causes are noted to be unpredictable reasons. Which action would be most appropriate to implement that would have the greatest impact on reducing these numbers?

Practicing high standards of infection control.

The nursing instructor is teaching a session on the increase of health care costs associated with the advancement of modern technology. The instructor determines the session is successful when the students correctly choose which focus of community-based health care that has been implemented to combat the increased cost?

Preventing disease and its sequelae

The nurse notes injuries indicating intimate partner violence (IPV) when assessing a client. When questioned, the client confirms the nurse's suspicions. Which nursing action is a priority?

Provide the client information on resources for IPV victims.

A pregnant woman comes to the clinic with a head injury. She tells the nurse that her partner came home drunk and she made him angry by not having dinner ready. He lashed out, she got in the way, and her head hit the corner on the table. What action should the nurse take in this situation?

Provide the client with contact information for a 24-hour shelter and social worker on discharge.

A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse?

Pull the nurse aside and inquire as to the content of the conversation.

A family is seeking sources for payment of health care costs. When talking with the family, the nurse determines that the family makes too much money to qualify for the federal program. Which source would the nurse likely recommend?

State Child Health Insurance Program

The nurse instructs a client who is at 28 weeks' gestation on the correct use of the fetal heart monitor at home. Which observation indicates that teaching has been effective?

The client has a log with the date, time, and number of fetal heart beats counted.

A nurse is developing a plan of care for a client of Muslim faith. Which action demonstrates an understanding of providing culturally competent care?

The client is asked if there are any meal preferences to be included in the care plan.

The nurse is admitting a client to the emergency clinic and notes that the client's gender expression is different than the gender noted in the driver's license and insurance documentation. What is the nurse's best response?

The nurse should communicate with the client based on the client's preferred pronoun.

A nurse admits a young boy who lives in a homeless shelter with his pregnant teenage mother. What would the nurse realize is a priority when planning this boy's case management?

The toddler's situation puts him at risk for higher incidence of disease and limited access to appropriate care.

A client who does not speak the dominant language becomes upset when the nurse brings in an interpreter, rather than using a family member as the translator. Which would be the best reason for using an official interpreter in this case? There may be cultural limitations that change how the information is being interpreted by the family.

There may be cultural limitations that change how the information is being interpreted by the family.

A nurse is engaged in primary prevention activities for human papillomavirus (HPV). The nurse would be most likely involved with which activity?

administering HPV vaccine

A nurse is conducting a discussion group at a local women's health center about violence and women. The nurse would include that women are at a higher risk for violence at which time?

during pregnancy

The nurse is organizing health information to teach a client basic principles that will help maintain wellness in the family. Which actions should the nurse prioritize in this teaching?

encouraging yearly checkups for all clients.

A school health nurse is presenting information on sexually transmitted infections (STIs) to a high school class. The nurse feels confident that learning has taken place when the students report:

female adolescents are more susceptible to STIs due to their anatomy.

A nurse is reviewing the statistical outcomes related to fetal deaths nationwide and notes that the numbers have changed over the last several decades. The best explanation would be:

improved prenatal care has reduced the numbers of fetal deaths.

What nursing intervention by the maternity nurse is the most important in providing family-centered care?

promoting uninterrupted infant bonding

A nurse is providing teaching to a parenting class on childhood mortality prevention. Which topic would be the priority for the nurse to include?

seat belt safety

A nurse is screening a client for intimate partner violence using indirect questions. Which question would the nurse most likely ask?

"Clients with your injuries are often abused. Is anything like this happening now?"

A community health nurse is conducting an educational session at a local community center on sexually transmitted infections (STIs). The nurse considers the session successful when participants identify which statement as correct?

"Human papillomavirus is the cause of essentially all cases of cervical cancer."

A home care nurse is visiting with a teenage client on home care during cancer treatments. Which statement by the client's mother warrants intervention by the home care nurse?

"I don't let her drink too many fluids since the bathroom is downstairs."

A nurse is teaching an 18-year-old client about circumcision care for her second baby. Which statement made by the nurse would be most appropriate to assess the client's learning ability?

"I notice you're having problems with reading the information. Will you tell me about this?"

A nurse informs a 19-year-old client that she is pregnant. The client immediately states that she plans to have an abortion. What would be the most appropriate response from the nurse to this client?

"I'll put together the information that you will need."

Which statement made by a new nurse demonstrates an understanding of the prevalence of sexual assault and related violence among the population?

"I've come to realize that I need to include questions related to sexual assault and related violence into the assessment of all my clients."

While performing an assessment on a female client, the nurse notes signs of sexual assault. When questioned, the client states, "I am married, so I have not been raped or abused." What statement by the nurse is most appropriate?

"If you do not consent, it is still assault when you are married."

A nurse is conducting an in-service program for a group of nurses on the health of women and their families, incorporating information from Healthy People 2030. The nurse determines that additional discussion and clarification is needed when the group makes which statement?

"Immunizations may be the cause of some illnesses being seen currently."

Which statement made by a male client who has a history of perpetrating intimate partner violence reflects a known factor that is characteristic of this behavior?

"My classmates always called me a bully."

While talking to the nurse, a client states that every time she has a serious fight with her spouse, the client is forced to have intercourse. The client appears very disturbed when revealing this to the nurse. Which is an appropriate response by the nurse?

"This behavior is called intimate partner violence."

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching?

"This drug will help to suppress any symptoms of the infection."

The nurse is caring for a child who says, "I'm tired of being in the hospital and I miss my own home." Which response by the nurse is most appropriate?

"What can we do to make your room seem more like home?"

The nurse is caring for a female client newly diagnosed with gonorrhea. The client's current male sexual partner tested negative. The client asked the nurse how this is possible. Which response by the nurse is most appropriate?

"Women are actually more prone to contract sexually transmitted infections than men."

A woman arrives at the prenatal clinic and is accompanied by her partner. Which behaviors would be suggestive of intimate partner violence (IPV)? Select all that apply.

- The partner answers questions for the pregnant client. - The partner is overly protective of the pregnant client. - Poor weight gain during the pregnancy and low-birth-weight infant

A nurse is teaching a parenting class about key issues that threaten children's health today. Which statements by the participants would indicate comprehension of those key issues? Select all that apply.

- Unintentional injuries are a leading cause of injury after 1 year of age. - Childhood obesity is a continuing threat to children's health. - Allergies are a serious threat to childhood health.

A nurse is conducting a presentation on violence and abuse for a community health program. When describing this concept, which information would the nurse include? Select all that apply.

- Violence against women often goes unrecognized and unreported. - In some countries, violence against women is considered acceptable behavior.

A group of nurses are working to provide quality care for their clients within the current health care environment of cost containment. Which strategy(ies) would be appropriate for the nurses to use? Select all that apply.

- educating clients about seeking help for problems early on - urging clients to participate in screening programs - creating easy access programs for clients to receive immunizations

The nurse has completed an assessment and interview on a client being treated for lacerations and abrasions. What acquired data support the nurse's suspicion that the client may be a victim of human trafficking? Select all that apply.

- female - 16 years of age - acting fearful and submissive

The nurse who has experience in caring for victims of intimate partner violence knows that goals for a victim may fall into which categories? Select all that apply.

- primary prevention - secondary prevention - tertiary prevention

The nurse knows which client is at the highest risk for contracting a sexually transmitted infection (STI)?

21-year-old client who tested positive for cocaine use and was treated for trichomoniasis twice in the past 3 years

A nurse is working as part of a research team evaluating children for participation in a research study. The nurse demonstrates respect when the nurse obtains assent from children over which age?

7

A client at 36 weeks' gestation presents in the emergency department with a broken arm. The client states, "I fell while cooking dinner." During the assessment, the nurse notes no prenatal care for this pregnancy, as well as bruises in multiple stages of healing on the client's abdomen, arms, and chest. What action will the nurse perform next?

Ask the client how she acquired the bruises

The nurse is assessing a client whose partner is present. The nurse notes the partner swears and yells, makes lavish promises, and threatens to hit the client. Which nursing intervention is a priority?

Ask the partner to leave the room.

A client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by a partner. During the admission process, which action is a priority for the nurse to complete?

Assess the client for suicide risk.

The home care nurse visits a client who is 32 weeks' gestation on bed rest and reporting a severe headache. Which intervention should the nurse implement first?

Assess the client's vital signs and conduct a quick, focused assessment.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention?

Assessing the diet of the child and family

Advocacy for the client is an important aspect of community-based nursing. What is one way a nurse can advocate for a pediatric client?

Assist the family to apply for Medicaid or other forms of health care reimbursement.

A client has been seen and treated in the emergency room several times for injuries that are deemed suspicious. The client is reluctant to participate in a screening process. How best can the nurse provide reassurance to this client?

Being nonjudgmental

A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment?

Avoid alcohol.

Which instruction should the nurse give to a client with genital herpes to help control the infection?

Avoid sexual contact until sores heal.

Today, families come in a variety of structures. Which statement best describes a blended family?

Both adults are custodial parents and bring their children to the family structure.

When initiating care for a client suspected of being a victim of human trafficking, what is the nurse's primary responsibility?

Building trust

A home care nurse has just completed a home assessment for a client and notes that there are no working smoke detectors in the upstairs of the home. The client states that her husband just lost his job and they cannot afford to purchase them. Which is the most appropriate referral for the nurse to initiate?

Call the local fire department.

A healthy client without a primary care provider is exploring the options available for a health care provider to assist with her pregnancy. Which health care provider can the nurse point out as a best option?

Certified nurse midwife

A home care nurse is visiting a pregnant client from the Arab culture. During the health history the husband frequently answers questions for the client. How should the nurse respond?

Continue with the health history.

A nurse is reviewing a labor plan with a client who has been admitted to the labor and birth unit. The client states that she has been drinking a significant amount of herbal teas lately to help with uterine contractions. Which is the priority action by the nurse?

Determine the type of herbal teas recently consumed.

A nurse working in a community health education program is assigned to educate community members about sexually transmitted infections (STIs). Which nursing strategy should be adopted to prevent the spread of STIs in the community?

Discuss limiting the number of sex partners.

A client is being discharged from the gynecological unit after treatment for acute pelvic inflammatory disease (PID). What priority instruction regarding disease management should the nurse include?

Discuss the necessity of completing the antibiotic therapy

Which statement is false regarding emergency contraception (EC)?

EC will disrupt an established pregnancy if taken within 72 hours.

The nurse is preparing to teach a class on cultural differences to a group of clients from the community. Which principle of culture will the nurse consider while planning the class information?

Each generation learns about culture from family and the community.

A client reports feeling increased levels of stress and anxiety before a routine ultrasound. What is an appropriate action by the nurse?

Encourage the client to meditate for a few minutes.

The nursing instructor is teaching a group of students about the history of maternity and family care. The instructor determines the session is successful when the students correctly choose which major change resulting from research by Klaus and Kennell?

Family-centered care of today

The nurse is caring for a client believed to be a victim of human trafficking. What action is most important for the nurse to perform?

Gain the client's trust.

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.

Which statement best describes the pattern of maternal mortality since World War II?

It has steadily decreased.

When describing sexually transmitted infections and testing, the nurse explains that a client is typically tested for chlamydia, gonorrhea, and syphilis at the same time for which reason?

It is not unusual for clients to have concurrent infections with more than one sexually transmitted infection (STI).

A nurse is using the SAVE model to assess a client for possible violence. When validating the client, which action would the nurse most likely perform?

Tell the client that the nurse believes the story.

In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?

Low birth weight

The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.

Which concept characterizes transcultural nursing?

Planning care compatible with the client's health belief system

The charge nurse overhears another nurse state, "I do not like caring for clients from a culture different from my own." Which action by the charge nurse is appropriate?

Privately discuss the comment with the nurse.

The nurse is caring for a client who is seeking care after being raped. What is the primary reason the nurse does not leave the client alone during the emergency room stay?

Promotes the client's sense of safety

A client has recently been treated in the emergency department for trauma to the head as a result of intimate partner violence (IPV). The client states to the nurse the desire to go back home to the partner upon discharge. Which action will the nurse take first?

Provide the client with components of an IPV safety plan.

A nurse is working to develop cultural competence. Which aspect would the nurse need to incorporate as the foundation for this concept?

Respect

A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection?

Safety of antiviral therapy during pregnancy has not been established.

Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor?

Seek assistance from another health care professional who can converse in sign language.

A client at 25 weeks' gestation and her partner are at their first prenatal visit. While performing the admission history, the nurse notes several contusions in multiple stages of healing on the client's body. The client's partner answers all of the nurse's questions. Based on these observations, which is the most appropriate nursing intervention at this time?

Take the client to an isolated room to continue the assessment.

A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. What action would be most appropriate?

Take the issue to the Institutional Ethics Committee for advice.

During a prenatal examination the nurse observes bruises on the client's arms and a black eye. When asked about the bruises, the client states, "It was an accident. My spouse just had a bad day at work, and I was late getting dinner prepared. But my spouse is being so kind now; my spouse brought me flowers yesterday. My spouse is looking for a new job, so it will not happen again." This client is in which phase of the cycle of violence?

The honeymoon phase

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group?

The importance of crossing streets safely

When describing birth during the 18th century, which description would be most accurate regarding maternal care during pregnancy and birth?

The majority of births occurred in the home with female midwives in attendance.

The nurse is caring for several clients in the prenatal clinic. Which action by the nurse demonstrates cultural competency?

The nurse asks each client about dietary restrictions and preferences during the postpartum period.

The emergency nurse is providing care for a pregnant woman admitted with a broken femur, blackened eye, and multiple contusions. She admits her partner is abusive. Which activity would be considered at the tertiary level of prevention?

The nurse contacts the crisis social worker for assistance.

After completing an assessment, the nurse examines the information to develop a wellness diagnosis for the client to identify which potential goal?

The potential for improvement in health

A client who does not speak the dominant language becomes upset when the nurse brings in an interpreter, rather than using a family member as the translator. Which would be the best reason for using an official interpreter in this case?

There may be cultural limitations that change how the information is being interpreted by the family.

An 11-year-old boy was raised in a home where his father beat his mother on a regular basis. Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?

They are at increased risk for being abused.

A young couple are very excited to learn they are expecting their first child and question the nurse about which test they need to discover its gender. Which procedure will best provide this information to the couple?

Ultrasound

A nurse is caring for a client who was raped at gunpoint. The client does not want any photos taken of the injuries. The client also does not want the police to be informed about the incident even though state laws require reporting life-threatening injuries. Which intervention should the nurse perform to document and report the findings of the case?

Use direct quotes and specific language.

The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother?

WIC

A 15-year-old client has just given birth and states that she does not want her infant to receive any newborn vaccines. What is the appropriate action for the nurse to take?

Withhold the vaccines

Which statement is false regarding screening for intimate partner violence in women?

Women tend to fit a profile for intimate partner violence, and victims tend to share similar physical characteristics.

The nurse is caring for four clients. Which client will the nurse suspect is a victim of intimate partner violence?

a client whose partner does not leave the client's side or hospital room at any point of the day or night

A community health nurse is actively involved in various community projects. The nurse is providing a secondary prevention activity by organizing which event?

a skin cancer screening fair

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

an azole antifungal agent

A community-based nurse has a different set of skills than those of counterparts who work in a hospital. Community-based nurses also face unique issues and challenges. What is one of the unique aspects of community-based nursing?

autonomous action

A nurse is conducting a presentation for a group of pregnant women about appropriate health promotion strategies to address issues related to infant mortality. Which strategy would the nurse encourage to reduce the infant's risk for infection after birth?

breastfeeding

A client is being treated for gonorrhea. Which agent would the nurse expect the primary care provider to prescribe?

ceftriaxone

A nurse is required to assess a client reporting unusual vaginal discharge for bacterial vaginosis. For which classic manifestation of this condition should the nurse assess?

characteristic "stale fish" odor

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common STI in the United States would the nurse expect to include?

chlamydia

A woman of Chinese descent feels that it is her duty to abort pregnancies after giving birth to one healthy infant, whereas a woman of Catholic faith considers all children a blessing from God and refuses to abort a fetus with a severe birth defect. Which concept would best describe the actions in these different cultures?

controversial taboo

What is the gold standard for herpes simplex virus (HSV) diagnosis?

culture

A chronically ill child attends school regularly. The parents have signed a do not resuscitate (DNR) order for the child and presented it to the school nurse. What action should the school nurse take first?

determine the parents' wishes if death should occur at school

A nurse is conducting a class for high school students on preventing sexually transmitted infections (STIs). Which information would the nurse emphasize as the sole method for not contracting STIs?

engaging in abstinence

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

facilitating return to school by working with the school nurse

In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the:

family.

A nurse is caring for clients who have a history of genital herpes infection. The client most at risk for an outbreak of genital herpes is the client who reports:

genital pruritus and paresthesia.

A nurse is working as part of a larger community group to develop programs to address current barriers to health care being experienced by women. The community is in the city with a large population of low-income families. On which factor should the group focus their efforts to address a main barrier to access to care?

health insurance

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive.

A nurse is speaking with a client who has just learned that she is pregnant with her first child. The nurse reads in the client's chart that she does not drink alcohol on a regular basis. However, the nurse decides to go ahead and warn the client about the dangers of drinking alcohol while pregnant. Which phase of health care would this action be classified as?

health promotion

A nurse is providing care to a client who has undergone a mastectomy. The nurse provides the woman with information about where to obtain a breast prosthesis. This is an example of which type of community-based nursing intervention?

health system referral

The nurse in the sexual health clinic is obtaining a health history of a client who is addicted to heroin, reporting chronic flu-like symptoms accompanied by pruritis, fatigue, anorexia, and constant upper right quadrant pain. Which sexually transmitted infection would the nurse suspect?

hepatitis A

A primary care provider tells a pregnant woman with slightly elevated blood pressure to return home on bed rest until her next scheduled checkup. This is an example of which type of care?

home care

A group of students is reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which cause of condylomata?

human papillomavirus

The nurse explains to a client diagnosed with trichomoniasis that the disease is caused by the parasitic protozoan Trichomonas vaginalis. What would the nurse say is a factor that triggers growth of trichomoniasis?

irritation of vaginal walls

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?

learning the mother is not the custodial parent

Morbidity data indicates that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues?

mental health and behavioral disorders

A male client appears in the walk-in clinic and requests treatment for trichomoniasis as his girlfriend was recently diagnosed with it. What medication would the health care provider most likely prescribe?

metronidazole

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

metronidazole

A woman who just gave birth tells the obstetrical nurse that her mother has noticed that so much has changed in maternity care in recent years. One change she could likely be referring to is:

newborns stay at the mother's bedside as long the infant is well.

The pediatric nurse knows that the state of children's health in the United States is evaluated by specific determinants and measures of health status. These determinants include:

race and ethnicity.

A nurse is conducting a program about genital herpes infection at a community clinic. The nurse determines that additional discussion is needed when the group identifies which activity as a means of transmission?

sharing contaminated needles

Which nursing plan is a good example of how to incorporate cultural diversity preferences into the labor and delivery unit?

supplying long-sleeved gowns and head scarves for a woman who requests them

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?

syphilis

A nurse is describing the cycle of violence to a group at a community clinic. The nurse determines that the attendees have understood the information when they identify which phase as usually lasting the longest?

tension building

The United States lags behind other industrialized countries regarding infant mortality. The main factor that contributes to this is:

the large number of preterm births in the U.S.

The term used to guide the cultural aspects of nursing care and respect individual differences is:

transcultural nursing.

A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis?

vaginal odor smelling of fish

The generation-to-generation continuum of violence refers to the fact that:

violence is a learned behavior, and children who witness intimate partner violence are more likely to become abusers themselves.

A woman comes to the clinic reporting intense pruritus and a thick curd-like vaginal discharge. On examination, white plaques are observed on the vaginal wall. The nurse suspects which condition?

vulvovaginal candidiasis

A group of women are attending a community presentation regarding the leading health concerns of women. Which interventions should the nurse recommend to have the greatest impact on the leading cause of death?

weight control and being knowledgeable about family history of cardiovascular disease

A 4-year-old child is brought to the clinic by his parents for evaluation of a cough. Which action by the nurse would be least appropriate in promoting atraumatic care for the child?

wrapping the child tightly in a blanket to prevent him from moving around

Which initial interview technique would be least effective in gathering information from a suspected abuse victim?

· Ask the client to strip down and show you where she

A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing?

· transcultural nursing

Nurses sometimes have difficulty assessing clients for intimate partner violence. Which screening protocol is most thorough when assessing for violence?

the SAVE model

A victim of rape is prescribed emergency contraception. After teaching the client about this therapy, the nurse determines that the teaching was effective based on which client statement?

"It contains high doses of a typical birth control pill."

The nurse is presenting to a shelter for women and children who experienced intimate partner violence and is asked by a participant, "What does the No Child Left Behind Act mean?" How should the nurse best respond?

"It is a federal program that will ensure all children in classrooms receive up-to-date, research-based curriculum."

A school health nurse is providing education to a group of adolescents regarding the proper procedure for male condom use. The nurse knows the teaching has been effective when which statement is made by a student?

"Withdraw the penis erect, holding the condom firmly against the penis."

A nursing student asks an experienced nurse to explain the role of evidence-based practice on the maternal child unit. Which statement by the experienced nurse is most appropriate?

"Women have been able to be successful at having a natural birth after a cesarean birth."

When a pregnant client explains to the nurse that strawberries cause birthmarks, what is the nurse's best response?

"Wow, that's very interesting. Where did you learn that?"

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age?

25

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance?

Allow the client to adopt a position that is comfortable for him or her.

What is a key element of providing family-centered care?

Communicate specific health information.

An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response?

Tell the couple to seek information directly from the child's parents.

The nurse is assessing a client who was a previous victim of rape. The nurse believes the client is in the integration and recovery phase following the rape. Which action will the nurse recommend to the client for continued recovery?

joining a rape survivor group

The nurse is teaching a birthing class to expectant fathers. A father wants to know how he can directly help his partner. How should the nurse respond? Select all that apply.

- "Providing a back rub helps with pain and provides relaxation." - "Be aware that hormonal changes may make your partner have some behavior changes temporarily." - "You can be supportive by encouraging your partner during labor." - "Involving yourself in infant care provides for better family bonding."

A community health nurse is conducting a class on sexually transmitted infections (STIs). She states that "STIs are discriminatory." What would the nurse most likely use to support this statement?

- "Women are diagnosed with two thirds of the new cases of STIs annually." - "After only a single exposure, women are twice as likely as men to acquire STIs."

A nurse is accepting a new position to provide care in the home. The nurse is prepared to utilize which skills or traits in this new position? Select all that apply.

- Acute care nursing skills - Great flexibility - Ability to teach family members how to give care - Ability to encourage frustrated family members

A nurse is providing care to a client who speaks little of the dominant language. The nurse enlists the aid of an interpreter. Which method(s) will the nurse include when working with the interpreter to educate this this client? Select all that apply.

- Ask an interpreter to translate material into the client's primary language. - Be certain that rooms in your health care agency, such as bathrooms, are labeled with international symbols. - Assess the client's reading level and rewrite information at an easier reading level if necessary. - Use hand gestures or draw a figure, if need be, to communicate better.

A nurse is caring for a client with vaginitis. What teaching(s) should the nurse provide to the client to prevent recurrent vaginal infections? Select all that apply.

- Avoid using deodorant tampons. - Avoid douching. - Wear only cotton panties and ventilated pantyhose.

What societal issues greatly influence delivery of maternal and pediatric health care? Select all that apply.

- Cost of health care - Low income of families - Increased cultural and ethnic diversity of clients

A 13-year-old adolescent is admitted to the health care facility with vaginal bleeding. A genital examination reveals unhealed wounds likely resulting from female genital cutting. The client has limited proficiency in the dominant language. The service of an interpreter is employed. What should the nurse keep in mind when interacting with this client?

Use pictures and diagrams to supplement the questions and answers of the client's understanding.

The nurse is caring for a client who has been a victim of intimate partner violence (IPV) for a few years. The client states, "My partner has been so sweet to me the last few days by telling me how special I am and bringing me flowers. I believe my partner is sorry and will not do this again." How will the nurse respond?

"It may seem better now, but over time, IPV typically becomes accelerated and more dangerous."

The nurse is caring for a teen who has been hospitalized after a motor vehicle accident. The accident is believed to have been caused by alcohol and drug use. The teen states, "I fit in when I use marijuana and, besides, it is legal in some states." Which response by the nurse is most therapeutic?

"Tell me how you feel when you use marijuana."

A new nurse in the emergency department is caring for a pregnant woman who was beaten by her partner. Which statement by the new nurse would require intervention from the supervising nurse?

"That woman must be doing something to get beaten like that."

A school nurse has discovered that one of the children has acquired a case of head lice. The school principal asks the nurse to write a letter that will be sent to parents explaining about head lice and measures to prevent infestation. What information is important for the nurse to include in the letter? Select all that apply.

- Children should avoid sharing personal items such as combs and hats. - Parents should inspect their child's head for nits with a fine tooth comb. - A second treatment one week after the first is recommended.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply.

- Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. - Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

Which are potential capabilities of umbilical cord blood? Select all that apply.

- If a family member develops a disease, umbilical cord blood can be used in treatment. - Umbilical cord blood is used for admission laboratory studies in newborns. - Transfusion therapies use umbilical cord blood in various treatments. - It can be used for bone marrow transplants if needed later in the child's life.

When assessing the home monitoring equipment of a pregnant client, which will the nurse need to further address? Select all that apply.

- Mercury thermometer - Automated blood pressure cuff - Electronic Doppler - Electronic uterine monitor

A nurse is caring for a female client who is undergoing treatment for genital warts due to human papillomavirus (HPV). Which information should the nurse include when educating the client about the risk for cervical cancer? Select all that apply.

- Obtaining a Papanicolaou test routinely helps early detection of cervical cancer. - Recurrence of genital warts increases risk of cervical cancer.

The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply.

- "Culture can impact who a client chooses to see for health care needs." - "Culture can impact the diet a client follows." - "A client's cultural beliefs can impact spirituality and/or religion." - "A client's cultural beliefs should be incorporated into the care a client receives.

The triage nurse receives a phone call from a client stating, "I was just raped and I need help. What should I do?" Which response by the nurse is a priority?

"Tell me if you are in a safe location away from the assailant now."

A nurse is caring for a 31-year-old pregnant client who is subjected to intimate partner violence. The client has developed a feeling of hopelessness and does not feel confident in dealing with the situation at home, which makes her feel suicidal. Which nursing intervention should the nurse offer to help the client deal with her situation?

Provide emotional support to empower the client to help herself.

A nurse is assessing a client who has come to the clinic for evaluation of an injury to the arm. This is the fourth visit by the client in the past several months. Previous visits also were for injuries that the client reported as due to being clumsy. During the assessment the nurse suspects that the client may be a victim of intimate partner violence. When talking with the client, which statements would the nurse identify as characteristic of the tension-building phase? Select all that apply.

- "My partner was out drinking and he got upset that dinner wasn't ready." - "It was my fault because I should have had the laundry done."

To assess the sociocultural aspects of the family of an adolescent being seen in an ambulatory clinic, the nurse would try to find out more about:

his family structure.

A client with hypertension tells her nurse that she would like to use an herbal substance (CAM) to lower her blood pressure instead of taking the antihypertensive medication. The nurse should:

advise the client to speak with her health care provider about combining herbal substances with her medication.

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection?

viral culture of vesicular fluid

The nurse is caring for a client who was raped 3 hours ago. Which intervention is a priority for the nurse to perform?

Administer prescribed emergency contraceptive pills.

A 20-year-old female comes to the sexual health clinic for follow up related to a positive test for the human papillomavirus (HPV). The client asks the nurse, "Is there anything I can do to get rid of this?" What is the nurse's best response?

"There is currently no medical treatment to cure HPV."

At a prenatal class, the nurse is told by a client that her mother advises her not raise her hands above her head during pregnancy in order to avoid umbilical cord problems. What is the nurse's best response?

"This is a belief from your mother's culture about what to avoid during pregnancy."

A client states "My spouse loves me. My spouse did not mean to hit me. My spouse felt so bad, I received flowers to show me how sorry my spouse was for hitting me. I know this will not happen again." How will the nurse respond?

"This is a common action of abusers. It does not mean you will not be hit again."

A 74-year-old client presents with depression, insomnia, and atypical chest pain. When asked about thoughts of suicide, the client states "Yes, I do think about ending all this." What will the nurse do next?

Ask the client if he or she is being mistreated.

The nurse is caring for a minor child who has voiced an interest in becoming emancipated. What information can the nurse provide to the client? Select all that apply.

- Emancipation requires a minor to live apart from his or her parents. - An emancipated minor needs to be self-supporting. - The courts will have to approve the request for emancipation.

A nursing instructor is teaching a session investigating infant mortality as a standard measurement of the quality of health care in the country. The instructor determines the session is successful when the students correctly choose which factors as contributing to the high numbers of deaths in the United States? Select all that apply.

- Preterm births - Maternal complications - Congenital deformities and chromosomal abnormalities