OB Final

33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best?

. You have to go 1 year without a menstrual period to be sure that menopause has occurred. Rational: Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a womans cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 3560 years.

11. A nurse is examining a patients Skenes glands. What action is best to visualize these structures?

.C. Pull the urethral margins apart. Rational: The Skenes glands are located on each side of the urethra. To examine them, the nurse should gently pull the margins of the urethra apart and evert the mucous membranes.

18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for violence. Which statement by a participant indicates understanding?

A If good communication doesnt solve the problem, I will leave. Rational: Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message.

23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication?

A. 20-lb weight gain Rational: Depo-Provera is used to treat endometriosis, but one undesirable side effect is weight gain. Danazol (Danocrine) is also used to treat this condition, but side effects of acne and facial hair growth cause this medication to be prescribed less often. Cold intolerance is not a common side effect of medications used to treat endometriosis.

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

A. A trial of a selective serotonin reuptake inhibitor Rational: Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft), have been used to reduce vasomotor symptoms such as hot flashes. The anticonvulsant gabapentin (Neurontin) has also been used. This woman is not a candidate for estrogen-only hormone replacement therapy for two reasons: she has not had a hysterectomy and she has a history of DVT. She is not a candidate for estrogen-progestin therapy because of her previous history of DVT.

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

A. Absence of androgens Rational: The external female genitalia develop in the absence of androgens. The paramesonephric ducts are dominant in females, but this does not lead directly to the development of external genitalia. Ovaries are created when the medulla of the first primitive gonad regresses as the outer cortex becomes the ovary at around 10 weeks of gestation. Oogonia are underdeveloped fetal egg cells; it is not a process.

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide?

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

36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness, heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman?

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

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

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

11. The reproductive care clinic nurse teaches young women about their risk for sexually transmitted infections (STIs). Which factors does the nurse include? (Select all that apply.)

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

10. A visiting nurse is seeing an older woman with the nursing diagnosis of risk for trauma related to decreased bone density secondary to osteoporosis. Which assessment findings would indicate to the nurse that a priority goal for this diagnosis has been met? (Select all that apply.)

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

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

A. An ovum can be fertilized for 12 to 24 hours after ovulation. Rational: An ovum is capable of being fertilized by a sperm cell for approximately 12 to 24 hours after ovulation. Pregnancy occurs during ovulation, which marks the end of the follicular phase and the beginning of the luteal phase. There are physiological signs of ovulation, such as changes in cervical mucus and body temperature. Women with irregular cycles can get pregnant.

43. A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations?

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

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

A. Around age 10, girls will get interested in shaving their underarms. Rational: Adrenarche (the time when androgen secretion leads to axillary and pubic hair) occurs at an average age of 10, so girls around that time will start noticing this change and thinking about shaving. The adolescent growth spurt is not completed for girls until an average age of 11.8, but in calculating an average, older and younger ages are included. Feminine supplies should be on hand for a girl to use earlier than age 14, because the average age of menarche is 12.8. Breast budding begins on average at 9.8 years.

9. The nurse working with older women knows that risk factors for osteoporosis include which of the following? (Select all that apply.)

A. Asian ethnicity B. Excessive consumption of caffeine E. Cigarette smoking Rational: Risk factors for osteoporosis can be found in Box 4-9 and include Asian (and Caucasian) ethnicity, excessive caffeine or alcohol use, and smoking. A small frame, not a large one, is a risk factor due to decreased stress on the bones. Regular activity (particularly weight-bearing exercise) is a preventative factor.

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

A. Assess the level of the womans spinal cord injury. Rational: Women with SCI above the level of T6 may be able to deliver vaginally because the uterus may retain enough intrinsic motility to create effective contractions. The nurse manager should ask about the level of the SCI. The nurse should not assure the office nurse that vaginal delivery is possible without this information. A woman with an SCI probably would not do well in a water birth due to impaired mobility. The nurse should also not tell the office nurse that vaginal birth is impossible without further information.

2. A community health nurse is packing a kit of play items for the families who will be visited today. One family has an infant and a preschooler. Which toys should the nurse include in the kit? (Select all that apply.)

A. Blocks B. Coloring books D. Simple board game Rational: An infant is in the stage of solitary play. Appropriate toys include blocks, books, rattles, push-pull toys, and musical toys. The preschooler is in the stage of associative play. Appropriate toys for this child include imitative games, simple arts and crafts, simple board games, interactive games, alphabet or color games, coloring and drawing, and simple computer games. The ride-on train and the stuffed animals are more appropriate for a toddler. 3. A nurse is preparing to educate a group of parents about injury prevention in adolescents. Which topics should the nurse plan to include as priorities? (Select all that apply.) A. Bicycle safety B. Gun safety C. Home safety D. Driving safety E. Water safety ANS: A, B, D, E In adolescents, the most common causes of injury are motor vehicle crashes, bicycles (includes skateboarding and skating), firearms, and water activities. Home safety, although always important, is a topic more appropriate to families with younger children. 4. A 17-year-old girl comes to the health department clinic to renew her oral contraceptive pills. During the physical examination, the nurse observes that the girl has broken blood vessels on her face and her lips are cracked and chapped and her fingers are callused. What further actions will the nurse perform? (Select all that apply.) A. A weight assessment B. Assessment for depression C. Draw blood for electrolytes D. Discussion about anorexia nervosa E. Discussion about bulimia ANS: A, B, C, E Bulimia nervosa is a syndrome that consists of a cycle of binge eating and purging. Physically, the adolescent with bulimia nervosa may exhibit physical changes related to forced, excessive vomiting: cracked and damaged lips, tooth damage, callused fingers and hands, and broken blood vessels in the face. Other findings that may not be readily apparent include throat irritation, esophageal inflammation, and parotitis from vomiting, as well as rectal bleeding from overuse of laxatives. Bulimia is also associated with depression. The nurse should assess the teens weight, screen her for depression, draw blood for electrolyte imbalances, and discuss bulimia.

5. The clinic nurse talks with parents about the signs and symptoms of substance use because their 12-year-old twins will be attending a new school in the fall and they wish to be prepared. The nurse correctly describes the potential symptoms of substance abuse, including which of the following? (Select all that apply.)

A. Chronic cough C. Irritability E. Red and glazed eyes Rational: There are many warning signs to alert parents to adolescent substance abuse. Physical signs include fatigue, red and glazed eyes, chronic cough, and health complaints. Emotional signs include personality changes, sudden mood swings, irritability, poor judgment and decision making, depression, and lack of interest in things that were of previous interest.

31. A nurse in a family practice clinic sees several generations of the same family. For which family members should the nurse arrange routine screening colonoscopies?

A. Daughter, age 52 Rational: Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 7585 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening.

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

A. Did you have surgery for your undescended testes? Rational: Cryptorchidism is a condition in which the testes fail to descend, and if they are not surgically placed into the scrotum, infertility can result. The other questions are not related to this condition.

16. The parents of a 16-year-old boy are frustrated because the teen is always participating in risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful?

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

30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What action by the nurse takes priority?

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

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

A. Explain that the pain is from stretching of the ligaments. Rational: The uterus is supported by several ligaments. The round ligaments expand in diameter and length during pregnancy and may be associated with sharp pain if they are stretched tight during sudden movement, such as with sneezing, coughing, or position changes. The nurse should reassure the woman that this is not concerning and explain the phenomenon. There is no need for the woman to count contractions, be placed on bedrest, or come in to the clinic that day.

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

A. Gonad Rational: The first reproductive structure formed in the embryo is a gonad. This early reproductive tissue arises from the mesoderm, which is the embryos middle layer. The mesonephric ducts are a set of primitive reproductive ducts. Oocytes are eggs.

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

A. Human chorionic gonadotropin. Rational: Human chorionic gonadotropin may play a role in limiting the maternal immune response to the pregnancy. Prostaglandins modulate hormonal activity and have an effect on ovulation, fertility, and cervical mucus viscosity. Relaxin aids in the softening and lengthening of the uterine cervix and works on the myometrial smooth muscle to promote uterine relaxation. Progesterone functions to create a highly vascular secretory endometrium that will be suitable for implantation of a fertilized ovum.

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

A. I can still conceive for up to 48 hours after ovulation. Rational: The womans basal body temperature increases 24 to 48 hours after ovulation, and it is still possible to become pregnant at this point. Thin, watery cervical mucus creates a pathway for sperm to readily swim through the cervix. Sticky cervical mucus does not aid in fertilization.

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

B. It is regulated by follicle-stimulating hormone (FSH). Rational: Oogenesis begins in the ovaries and is regulated by follicle-stimulating hormone (FSH). For each primary oocyte that undergoes meiosis, only one functional egg is produced; the other cells (termed polar bodies) deteriorate. The graafian follicle is a mature ovarian follicle and does not secrete prolactin. Oogenesis occurs in utero.

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

A. Leave the incorrectly placed catheters where they are while inserting a fresh one. Rational: Because the clitoris often resembles the urinary meatus, nurses sometimes try to insert a catheter in it instead of the real meatus. Leaving the incorrectly placed catheter while attempting another insertion shows the nurse where not to insert it. The patient should be in a low semi-Fowlers or supine position with the legs abducted (or frog-legged). To maintain infection control, never use a catheter for more than one catheterization attempt.

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

A. Maturing sperm are stored in the epididymis. Rational: Maturing sperm are stored in both epididymi, which also convey the sperm to the vas deferens and secrete seminal fluid. Spermatogenesis occurs in the testicles. The prostate has several functions, one of which is to secrete an alkaline fluid that protects sperm from the acidic environment of the vagina and the male urethra.

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

A. Pelvic outlet Rational: Inferiorly, the lowest portion of the true pelvis is termed the pelvic outlet. Superiorly, the true pelvis is bounded by the sacral promontory (anterior projecting portion of the base of the sacrum) and the sacral alae (broad bilateral projections from the base of the sacrum), the linea terminalis, and the upper margins of the pubic bones. The false pelvis and the true pelvis are divided by the linea terminalis, or pelvic brim.

42. A nurse is educating a woman on the use of denosumab (Prolia). What information should the nurse provide?

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

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

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

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

B. Acts as a bacteriostatic agent C. Provides a barrier to sperm during nonfertile phases D. Provides an easy-flowing pathway during fertile phases E. Forms an operculum to protect the pregnancy Rational: The cervix secretes mucus, which serves several functions: (1) lubricates the vaginal canal, (2) forms a barrier to sperm penetration into the uterus during nonfertile periods, (3) provides an easy-flowing pathway to facilitate sperm passage into the uterus during fertile periods, (4) provides an alkaline environment to facilitate the viability of sperm that have been deposited in the acidic vagina, (5) forms a solid plug called an operculum to protect a pregnancy from outside pathogens, and (6) functions as a bacteriostatic agent.

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

B. Assess the woman for previous vaginal infections and their treatment. Rational: Anatomically, there is a continuous passage from the vagina into the uterus and on into the fallopian tubes and ovaries. A vaginal infection can lead to residual scarring of the tubes from the inflammatory process. This puts the woman at increased risk for ectopic pregnancies and infertility. Not all vaginal infections are sexually transmitted infections (STIs), and to specifically ask about STIs sounds judgmental in addition to not providing adequate information. There are several treatment options for this woman. Genetic defects may play a role in this womans problem, but the higher likelihood is that her scarred tubes are due to a vaginal infection.

20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most appropriate?

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

44. A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test?

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

27. The nurse prepares to offer health screening and promotion activities for women aged 4060. Which activity does the nurse plan to include as a priority for this group?

B. Breast cancer screening Rational: Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 4055. The priority screening activity is for breast cancer. Alzheimers disease screening is typically done in the older patient. Gardasil is recommended for females aged 926. Influenza vaccinations are important for all ages.

1. The nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. What does the nurse tell the mothers about breast milk? (Select all that apply.)

B. Less casein C. Less protein E. More carbohydrates rational: Human breast milk contains more carbohydrates, less protein, and less casein than cows milk or infant formulas. Commercially prepared formulas have the same essential nutrients for growth and development and do not have fewer calories.

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

B. Causes changes in cervical mucus to facilitate sperm penetration Rational: During the proliferative phase of the uterine, or endometrial, cycle, increasing amounts of estrogen lead to changes in cervical mucus that facilitate sperm penetration at midcycle. During the ischemic phase, both estrogen and progesterone levels are low, and the uterine spiral arteries constrict, limiting blood flow to the endometrium. Eventually, the endometrial blood vessels rupture and menses begin. In the secretory phase, progesterone functions to create a highly vascular secretory endometrium that is suitable for implantation of a fertilized ovum.

40. The nurse notes that a patients chart contains the results of an MMSE. What can the nurse surmise about this patient?

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

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

B. Development of dominance in the primitive duct structure Rational: Differing male/female developmental changes in the mesonephric and paramesonephric ducts include the development of dominance in one set of the ducts. Mesonephric ducts become dominant in males; paramesonephric ducts become dominant in females. This is the first gender change that occurs. Gender is determined by the presence of an XX or XY pair of chromosomes; none are destroyed. External genitalia are usually not visible before 12 weeks of gestation, when androgens begin to stimulate their growth. Spermatogenesis occurs in puberty in boys; oogenesis begins sometime after 10 weeks of gestation when the ovaries begin to develop.

17. A school nurse is preparing educational activities for all high school students on reproductive health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate?

B. Discuss the need to have information appropriate to the teens experience. Rational: Education on sexual health should take into consideration the age and sexual experience of the audience. For teens who have not yet had sexual intercourse, an abstinence-only program might make sense. However, if the teens have already engaged in sexual intercourse, they are likely to continue this behavior, and the program should focus on using condoms in order to avoid unprotected sex and its risks. Abstinence-only programs cannot be characterized as being of no value. Encouraging teens to ask questions off the prepared topic is a passive-aggressive action. It is not up to the nurse to decide if teens should have sex or not.

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

B. Do you wear boxer shorts or briefs? Rational: Factors that influence male fertility include participation in active contact sports; smoking; and wearing tight, constrictive clothing. Brief-style underwear are tighter than boxer shorts, and this is one question the nurse could ask about clothing that might yield some useful information. Exercise does not specifically address active contact sports. Alcohol use and circumcision are not related.

11. A mother who has three older children now has a newborn. She complains to the physician that sleeping on his back has caused her baby to have a funny-shaped head that the other kids didnt have. She doesnt want to continue having the baby sleep on his back. Which action by the nurse is best?

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

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

B. First day of the menstrual cycle Rational: Day 1 of the menstrual cycle begins with the onset of bleeding.

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

B. Formation of the male genital tract Rational: The mesonephric ducts evolve into the male genital tract due to the influence of testosterone in the 7th or 8th week of gestation. A gonad is the first reproductive structure formed. Production of spermatozoa doesnt occur until puberty. The growth of external genitalia does not begin until the 12th week of gestation.

1.The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care?

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

6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information?

B. High risk: Contact 911 immediately. Rational:Individuals who have suicidal thoughts should be assessed for a specific plan, the means to carry out the plan, and previous suicide attempts. This student has two of the three high-risk identifiers, so the teen should be seen by a mental health professional immediately. The safest way to ensure this occurs is to access the emergency medical system. The district counselor may not be prepared to deal with this situation and may not be available. The student is not low risk, so a referral should not be sent home. The student is not moderate risk, and the burden of ensuring immediate access to a health-care professional should not be placed on the parents, who also may be unavailable.

29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best?

B. Lose weight. Rational: Alcohol intake, smoking, and weight maintenance all affect breast health. However, this womans highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

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

B. Low estrogen levels after menopause causes the urinary tissues to atrophy. Rational: During the perimenopausal and postmenopausal stages, lowered levels of estrogen can lead to atrophy of urinary tissues and incontinence. This is knowledge all nurses should have, so needing to ask the physician is not appropriate. Telling the woman that most older women have this problem does not give the patient any information about why this occurs, which was her question. Because she has no other complaints, a urinary tract infection is less likely.

24. A nurse reads in a patients chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this womans treatment?

B. Possible chemotherapy Rational: The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation.

25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil vaccination. After giving the shot, what instruction does the nurse provide to her?

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

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

B. Skin-covered region between the vagina and the anus Rational: The perineum, an anatomical landmark, is the skin-covered region between the vagina and the anus.

3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her?

C. 8 to 9 years of age Rational: Between 8 and 11 years of age, children begin to focus on their own development and to contrast it with their friends development. At this time, parents should begin to educate their children about the names and functions of the male and female sexual organs, puberty, the menstrual cycle, sexual intercourse, pregnancy, pregnancy prevention, same-sex relationships, masturbation, and the spread of sexually transmitted infections, and encourage dialogue about personal expectations and values regarding sexual activity.

4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age?

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

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

C. 40% Rational: In each millimeter of ejaculate, there are approximately 120 million sperm, 40% of which are motile.

46. At what age should the nurse prepare patients to begin thyroid function screening?

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

34. A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended?

C. 55 years old, history of hysterectomy 4 years ago, estrogen only Rational: Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy.

47. The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching?

C. Does your baby sit in a high chair yet? Rational: The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 810 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

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

C. Estrogen levels are still pretty low. Rational: As a girl begins menstruating, estrogen levels are usually insufficient to stimulate ovulation, and the menstrual periods are generally unpredictable and irregular. As the ovaries mature, regular ovulation and menses are established. Telling the student that all young girls have irregular periods and that her complaint is normal are both poor choices, because they do not give the girl adequate information. She does not need to be seen by her physician for this complaint.

38. A nurse is working with an older adult who has never exercised despite understanding the health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen?

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

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

C. Growth of pubic hair will occur next. Rational: Thelarche (breast budding) is followed by the growth of pubic hair. Breast self-exam is not vital until the breasts have developed, and then self-exam is taught as a component of breast awareness. Menarche, the first period, usually occurs 1 year after peak height velocity. It is not possible to state if maximum height has been obtained. Thelarche starts on average at age 9.8 years and is complete on average at age 14.6 years. The growth spurt starts on average at age 10 years and is complete on average by age 11.8.

19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best?

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

6. The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.)

C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection Rational: Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

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

C. Increased cardiovascular risk Rational: Decreased estrogen in a womans later years accompanied by low HDL and high LDL cholesterol levels increases the risk of cardiovascular disease. The nurse cannot conclude anything about the patients exercise or eating habits without further assessment. Older women are at risk of fractures due to osteoporosis, but that is not related to these laboratory values.

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

C. Inform them that the daughter will be tested for estrogen deficiency. Rational: Estrogen is the primary female hormone and is responsible for the development of secondary sex characteristics. Physical changes associated with puberty usually begin between ages 11 and 13. A 17-year-old female who has not yet developed these features may have an estrogen deficiency. A family pedigree may be beneficial, but not as the first step. A pregnancy test would not illustrate the cause of the problem.

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

C. Inhibits prostaglandins Rational: Prostaglandin release causes vasoconstriction and muscle contractions that lead to the tissue ischemia and pain felt with dysmenorrhea. Tylenols mechanism of action is not fully understood, but it is thought to raise the pain threshold. Ibuprofen is a prostaglandin inhibitor. Both drugs can be found in generic form for little money. All drugs have side effects. Oral medications take 3045 minutes to start working.

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

C. It is a lengthy process that spans from the embryonic stage through puberty. Rational: Gender maturation is a lengthy process that begins during embryonic development and is completed during late adolescence, at which time full maturity is achieved. The other statements are not correct.

35. A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best?

C. Mindbody, manipulative, or traditional Chinese medicine are safer than herbs. Rational: There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mindbody therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurses best answer is to explain this to the patient.

21. A nurse is teaching a 24-year-old male about reproductive health. Which information should the nurse provide this patient about testicular cancer?

C. Perform a testicular self examination after a warm shower. Rational: Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 2034. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure.

41. A 65-year-old patient is in the clinic for an annual influenza vaccination. What other health promotion activity should the nurse encourage specifically for this patient?

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

22. A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best?

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

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

C. Progesterone Rational: Estrogen and progesterone are responsible for mediating the development of the uterine lining. Follicle-stimulating hormone stimulates growth of the graafian follicle. Luteinizing hormone stimulates the development of the corpus luteum. Prostaglandins modulate hormonal activity and affect ovulation, fertility, and cervical mucus viscosity.

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

C. Provide lubrication and protective bacteriocidal secretions D. Resemble mucous membrane and do not have hair follicles Rational: The labia minora resemble mucus membrane and do not have hair follicles. They provide lubrication and protective bacteriocidal secretions. The Skenes and Bartholins glands are found in the vestibule of the vagina. The primary organ of sexual pleasure in women is the clitoris. The labia majora share an extensive network of lymphatics with other vulvar structures, leading to rapid spread of malignant disease.

15. The school nurse wants to create a safe driving program for the high school students. In order to have the greatest impact on safety, on which issue should the nurse focus?

C. Seat-belt use Rational The risk for motor vehicle accidents is greater among adolescents than for any other age group. Factors associated with this include the inability to assess hazardous situations while driving, speeding, driving under the influence of drugs and/or alcohol, and a low compliance with seat-belt use. Females are actually less likely to be in a motor vehicle crash than males. Late-night driving does not appear to increase risk. Although teens are often sleep deprived, this does not appear to be related.

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best?

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

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

C. The average age for breast budding is 9.8 years, so she is normal. Rational: The average age that breast budding begins is 9.8 years, so this child is normal. The other responses are not relevant for this situation.

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

C. The hymen can widen or perforate with tampon use, vulvar injury, or intercourse. D. It is a small portion of tissue around the vaginal opening in young girls. Rational: The hymen is a small portion of tissue forming a border around the entrance of the vagina in young girls. The hymen eventually widens through vulvar injury, use of tampons, or intercourse, sometimes accompanied by bleeding. It is a myth that the hymen must be intact for a female to be considered a virgin.

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

C. These laboratory findings usually indicate menopause or perimenopause. Rational: Elevated levels of FSH combined with low levels of estradiol usually indicate perimenopause or menopause.

32. A nurse is reviewing the results of several patients cholesterol and lipid screenings. For which patient is the action appropriate?

C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. Rational: A cholesterol below 200 mg/dL is desirable, so this patients level is high. The nurse should plan to teach this patient about heart-healthy lifestyle changes. The other laboratory values are in the desirable range, so no action is necessary.

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

D. 12 weeks Rational: It takes about 8 weeks of development before the reproductive system becomes differentiated as male or female, but external genitalia are not visible until after 12 weeks.

2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infants immune system. When does this occur?

D. 24 months Rational: Because an infants immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonates immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infants immune system.

14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What statement by the teen indicates that goals for this diagnosis have been met?

D. I try to keep the same sleep and wake times all week. Rational Adolescents are commonly sleep deprived and often try to make up for their sleep deficit by sleeping more on weekends. This is actually detrimental, as the body has difficulty adapting to changing sleep routines. The teen who is keeping consistent sleep and wake times during the entire week has learned this fact and is probably getting better sleep than before. The other statements do not show understanding of sleep deprivation and ways to improve it.

7. The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.)

D. Influenza vaccine E. Tobacco and alcohol screen Rational: Priority health services for the young adult population include influenza vaccination and tobacco, alcohol, and drug screens, among other things. Aspirin prophylaxis and breast cancer screen are more appropriate for middle-aged adults.

8. A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older womans risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.)

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

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

D. Obtain consent for possible cesarean delivery. Rational: Pelvimetry measurements demonstrate the feasibility of a vaginal birth. The minimum measurement for the midpelvis (which is the narrowest lateral portion of the female pelvis) is 4.7 inches (12 cm). Pelvimetry measurements may not be accurate for several reasons, and despite findings, in most situations, the woman is allowed a trial of labor. As the joints of the pelvis soften and become more mobile, a vaginal delivery might still be possible. The nurse should obtain consent for a possible cesarean delivery. All pregnant women should attend childbirth preparation classes. The nurse should not guarantee that a vaginal birth can occur. Drinking water is not related.

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

D. Platypelloid Rational: The gynecoid pelvic type is the typical, traditional female pelvis (present in 50% of women) that is best suited for childbirth. Fetal descent through a platypelloid pelvis is usually in a transverse presentation and will not allow for a vaginal birth. Fetal descent through an anthropoid pelvis is more likely to be in a posterior (facing the womans front) rather than anterior (facing the womans back) presentation. The android pelvis resembles a typical male pelvis, and this pelvic shape can also cause difficulty during fetal descent.

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

D. Pregnant Rational: Human chorionic gonadotropin (hCG) is measured to diagnose pregnancy; it does not signify any of the other conditions.

13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula. The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best?

D. Question the student about eating and exercising patterns. Rational: Signs of anorexia nervosa include weakness, dizziness, excessive weight loss, intolerance to cold, bradycardia, hypotension, bone loss with fractures, constipation, and the development of lanugo. The nurse should assess the student for the restricted eating and excessive exercise that is characteristic of this disorder. The lower blood pressure and pulse might be the result of pain medication, but the student should not have been allowed to return to school on these medications, and this does not explain why the student appears to feel cold. Documenting the findings is important, but the school nurse has an excellent opportunity to assess and intervene if needed. Calling 911 immediately is not warranted.

12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health effects, what else should the nurse assess the patient for?

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

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

D. Secretory phase Rational: The secretory phase occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6. The proliferative phase is the end of menses through ovulation, approximately days 7 to 14. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation, approximately days 27 to 28.

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

D. Sexually mature Rational: Guidelines of secondary sexual characteristic development, termed Tanner stages, measure the predictable stages of pubertal body changes in both genders. A female in stage V (the last stage) would be sexually mature.

39. An older patient has never exercised, but wants to begin now. What response by the nurse is best?

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

10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention?

D. The crib has dirty bumper pads and a dirty comforter. Rational: To prevent sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that all babies be put to sleep on their backs and that cribs be free of toys, comforters, and bumpers. Vaccinations and breastfeeding are also recommended. The other options show a house that is dirty but does not rise to the level of needing immediate intervention.

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

D. The first sign of puberty is testicular enlargement. Rational: Testosterone secretion causes testicular enlargement, which is the first sign of pubertal changes in males. Girls start puberty about 2 years earlier than boys. Testosterone production causes the first signs of puberty, so saying that this is a late occurrence is incorrect. Breast enlargement usually does not occur in males despite the presence of circulating estrogen.

45. A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls?

D. Urine collection Rational: A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 1318. The other options are incorrect.

37. A nurse notes that a womans chart lists dyspareunia as a diagnosis. In planning education for the patient, which topics would the nurse include?

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

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight?,

D. What do you think about your weight right now? Rational During adolescence, body weight has a dramatic effect on the development of self-image and self-esteem and can be a sensitive issue for discussion. An important strategy in discussions about weight and weight loss with adolescents is to begin the conversation with expressions of respect that are sensitive to cultural differences related to food choices and eating patterns. Regardless of whether the patient is ready to begin a weight control program, he may still benefit from talking openly about healthy eating and exercise. To open the conversation, the nurse can begin with a simple question to determine if the patient is willing to talk about the issue. The other questions may put the teen on the defensive and close communication. Answer choice 1 particularly is an example of poor communication, as it is a yes-no question. The teen could simply answer no and the nurse would have no recourse other than to end that line of discussion.

. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching should the nurse plan for this patient?

D. Wipe from front to back after using the bathroom. Rational: Preventative measures for UTIs include drinking plenty of water, voiding when the urge is felt, wiping from front to back, taking showers instead of baths, not using perfumes or bath oil if baths are taken, wearing cotton underwear, and avoiding feminine hygiene sprays and scented douches. The other options are not related.

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

D. You have a fat pad in front of your pelvis. Rational: The mons pubis is a layer of subcutaneous tissue anterior to the genitalia in front of the symphysis pubis. It is essentially a protective fat pad, and although it will not prevent fracture of the pelvis in a serious trauma, the mons pubis does offer some protection to these tissues. Blunt force is the usual cause of fractures. The pelvis is often fractured, especially in motor vehicle crashes. Some fractures do not show up immediately, but this is not the best answer because most do.