Test

12. When developing a presentation for a local community organization on violence, the nurse is planning to include statistics on intimate partner violence and its effects on children. When addressing these statistics, what is the rate of the cases involving a parent and the children being abused? A. 1 in 8 B. 1 in 3 C. 1 in 5 D. 1 in 10

Answer A Rationale: In many cases when a parent is abused, the children are abused as well. Approximately 1 in 8 children are abused annually in the United States.

2. To assist the woman in regaining control of the urinary sphincter after bladder surgery, the nurse should teach the client to perform which action? A. Perform Kegel exercises daily. B. Void every hour while awake. C. Limit the intake of fluid. D. Take a laxative every night.

Answer: A Rationale: After bladder surgery, the client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.

28. A woman who gave birth to a healthy newborn several hours ago asks the nurse, "Why am I perspiring so much?" The nurse integrates knowledge that a decrease in which hormone plays a role in this occurrence? A. estrogen B. hCG C. hPL D. progesterone

Answer: A Rationale: Although hCG, hPL, and progesterone decline rapidly after birth, decreased estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy.

6. A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn? A. infection B. hemorrhage C. trauma D. hypovolemia

Answer: A Rationale: Although hemorrhage, trauma, and hypovolemia may be problems, the prolonged labor with the prolonged premature rupture of membranes places the client at high risk for a postpartum infection. The rupture of membranes removes the barrier of amniotic fluid, so bacteria can ascend.

19. A nurse is conducting an in-service program for a group of staff nurses. After teaching the group about ovarian cysts, the nurse determines that the teaching was successful when the group identifies which type of cyst as being associated with hydatidiform mole? A. theca-lutein cyst B. corpus luteum cyst C. follicular cyst D. polycystic ovarian syndrome

Answer: A Rationale: Although rare, theca-lutein cysts, which develop from prolonged abnormally high levels of human chorionic gonadotropin, are associated with hydatiform mole, choriocarcinoma, polycystic ovarian syndrome, and clomiphene therapy. Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Follicular cysts are caused by the failure of the ovarian follicle to rupture at the time of ovulation. Both types typically require no treatment. Polycystic ovarian syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function.

20. A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which disorder? Select all that apply. A. rectocele B. fecal incontinence C. cystocele D. urinary incontinence E. enterocele

Answer: A, C, E Rationale: The four most common types of pelvic or genital prolapse are cystocele, rectocele, enterocele, and uterine prolapse. Urinary and fecal incontinence along with pelvic organ and genital prolapse are classified as pelvic support disorders.

21. A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which procedure? A. CA-125 testing B. transvaginal ultrasound C. Papanicolaou test D. mammography

Answer: B Rationale: A transvaginal ultrasound would be used to evaluate endometrial thickness to determine if an endometrial biopsy is needed. CA-124 testing is a nonspecific blood test used as a tumor marker. A Papanicolaou test is used to screen for cervical cancer. A mammography is used to screen for breast cancer.

3. A woman comes to the clinic for a routine checkup. After obtaining the client's history, the nurse identifies that the client is at increased risk for cervical cancer based on her history of exposure to which virus? A. hepatitis B. human papillomavirus C. cytomegalovirus D. Epstein-Barr virus

Answer: B Rationale: Human papillomavirus is a major causative factor for cervical cancer. Hepatitis, cytomegalovirus, and Epstein-Barr virus are not associated with the development of cervical cancer.

27. A nurse is observing a postpartum woman and her partner interact with the their newborn. The nurse determines that the parents are developing parental attachment with their newborn when they demonstrate which behavior? Select all that apply. A. frequently ask for the newborn to be taken from the room B. identify common features between themselves and the newborn C. refer to the newborn as having a monkey-face D. make direct eye contact with the newborn E. refrain from checking out the newborn's features

Answer: B, D Rationale: Positive behaviors that indicate attachment include identifying common features and making direct eye contact with the newborn. Asking for the newborn to be taken out of the room, referring to the newborn as having a monkey-face, and refraining from checking out the newborn's features are negative attachment behaviors.

17. A group of nurses are preparing a program about rape and sexual assault for a community health center. Which information would the nurses include as being most accurate? Select all that apply. A. Most victims of rape tell someone about it. B. Few people falsely cry "rape." C. Women have rape fantasies desiring to be raped. D. A rape victim feels vulnerable and betrayed afterwards. E. Medication and counseling can help a rape victim cope.

Answer: B, D, E Rationale: The majority of victims never tell anyone about a rape. Almost two-thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few women falsely cry "rape." Reality and fantasy are different, and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed.

28. A nurse suspects that a client is experiencing intimate partner violence and uses a screening protocol to gather additional information from the client. When asking the client direct questions, which behavior by the nurse would be appropriate to elicit accurate information? Select all that apply. A. Look away from the client when asking any questions. B. Avoid the use of technical language. C. Minimize what the client says. D. Use leading questions. E. Wait patiently for the client to answer.

Answer: B, E Rationale: When asking the client direct questions using the SAVE model, the nurse should maintain continuous eye contact with the client, avoid the use of technical or medical language, not dismiss or minimize what the client says, even if the client does so, use direct, to the point questions, not leading questions, and wait for each answer patiently.

23. A woman comes to the clinic and asks the nurse about when she should have her first mammogram. The woman is at low risk and has no family history of breast cancer. Using the recommendations of the American Cancer Society, the nurse would suggest the woman have her first mammogram at which age? A. 30 years B. 35 years C. 40 years D. 45 years

Answer: C Rationale: The American Cancer Society still recommends annual mammograms and clinical breast exams for women starting at age 40.

4. A client is scheduled to have a Papanicolaou test. After the nurse teaches the client about the Papanicolaou test, which client statement indicates successful teaching? A. "I need to douche the night before with a mild vinegar solution." B. "I will take a bath first thing that morning to make sure I'm clean." C. "I will not engage in sexual intercourse for 48 hours before the test." D. "I will get a clean urine specimen when I first wake up the morning of the test."

Answer: C Rationale: The woman should refrain from sexual intercourse for 48 hours before the test because sperm can obscure the specimen. Douching should be avoided for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Although a bath is an appropriate hygiene measure, it is not required before a Papanicolaou test. Collecting a urine specimen also is not necessary.

20. A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? A. Administer the drug as an IV bolus injection. B. Give as a vaginal or rectal suppository. C. Piggyback the IV infusion into a primary line. D. Withhold the drug if the woman is hypertensive.

Answer: C Rationale: When giving oxytocin, it should be diluted in a liter of IV solution and the infusion set up to be piggy-backed into a primary line to ensure that the medication can be discontinued readily if hyperstimulation or adverse effects occur. It should never be given as an IV bolus injection. Oxytocin may be given if the woman is hypertensive. Oxytocin is not available as a vaginal or rectal suppository.

10. A postpartum client comes to the clinic for her 6-week postpartum checkup. When assessing the client's cervix, the nurse would expect the external cervical os to appear: A. shapeless. B. circular. C. triangular. D. slit-like.

Answer: D Rationale: After birth, the external cervical os is no longer shaped like a circle but instead appears as a jagged slit-like opening, often described as a "fish mouth."

8. A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis? A. transvaginal ultrasound B. colposcopy C. Papanicolaou test D. endometrial biopsy

Answer: D Rationale: An endometrial biopsy is the procedure of choice to make the diagnosis of endometrial cancer. A transvaginal ultrasound may be used to evaluate the endometrial cavity and measure the endometrial thickness to detect endometrial hyperplasia, but it does not confirm the diagnosis. Colposcopy is used to diagnose cervical cancer. A Papanicolaou test screens for abnormal cervical cells.

9. A woman with breast cancer is undergoing chemotherapy. Which side effect would the nurse interpret as being most serious? A. vomiting B. hair loss C. fatigue D. myelosuppression

Answer: D Rationale: Chemotherapy typically causes side effects of nausea, vomiting, hair loss, fatigue, and myelosuppression. Of these, myelosuppression would be the most serious because it increases the risk for infection, bleeding, and a reduced red blood cell count, which can lead to anemia.

1. A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find? A. sporadic vaginal bleeding accompanied by chronic pelvic pain B. heavy leukorrhea with vulvar pruritus C. menstrual irregularities and hirsutism on the chin D. stress incontinence with feeling of low abdominal pressure

Answer: D Rationale: Cystocele and rectocele are examples of pelvic organ prolapse. Manifestations typically include stress incontinence and lower abdominal pressure or pain. Complaints of sporadic vaginal bleeding and chronic pelvic pain are associated with uterine fibroids. Leukorrhea and vulvar pruritus commonly are associated with an infection. Menstrual irregularities and hirsutism are associated with polycystic ovarian syndrome.

24. A client is diagnosed with a leiomyoma. The client asks the nurse what this is. The nurse describes this as a: A. cyst. B. pelvic organ prolapse. C. fistula. D. fibroid.

Answer: D Rationale: Leiomyomas are also called uterine fibroids. Cysts are fluid-filled sac-like structures. A fistula is an abnormal opening. Pelvic organ prolapse is an abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.

2. The nurse is conducting a class for postpartum women about mood disorders. The nurse describes a transient, self-limiting mood disorder that affects mothers after birth. The nurse determines that the women understood the description when they identify the condition as postpartum: A. depression. B. psychosis. C. bipolar disorder. D. blues.

Answer: D Rationale: Postpartum blues are manifested by mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, feelings of being overwhelmed, and fatigue. They are usually self-limiting and require no formal treatment other than reassurance and validation of the woman's experience as well as assistance in caring for herself and her newborn. Postpartum depression is a major depressive episode associated with birth. Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. Bipolar disorder refers to a mood disorder typically involving episodes of depression and mania.

13. After teaching a local woman's group about incontinence, the nurse determines that the teaching was successful when the group identifies which characteristic of stress incontinence? A. feeling a strong need to void B. passing a large amount of urine C. developing most often in women in their 30s D. sneezing as an initiating stimulus

Answer: D Rationale: Stress incontinence is characterized by the involuntary passage of a small amount of urine in response to an increase in intra-abdominal pressure, such as with sneezing, coughing, laughing, or physical exertion. It develops commonly in women in their 40s and 50s due to the weakening of the muscles and the ligaments in the pelvis after birth.

9. A woman who is experiencing postpartum hemorrhage is extremely apprehensive and diaphoretic. The woman's extremities are cool and her capillary refill time is increased. Based on this assessment, the nurse suspects that the client is experiencing approximately how much blood loss? A. 20% B. 30% C. 40% D. 60%

Answer: D Rationale: The client's assessment indicated mild shock, which is associated with a 20% blood loss. Moderate shock occurs with a blood loss of 30 to 40%. Severe shock is associated with a blood loss greater than 40%.

11. When performing a clinical breast examination, which would the nurse do first? A. Palpate the axillary area. B. Compress the nipple for a discharge. C. Palpate the breasts. D. Inspect the breasts.

Answer: D Rationale: The first step in the clinical breast exam is to inspect the woman's breasts. The nurse then palpates the breasts, compresses the nipple to check for a discharge, and finally palpates the axillary area.

2. A woman is to have a Papanicolaou test. When teaching the woman about this test, the nurse would emphasize which instruction to the client? A. "Refrain from sexual intercourse for 1 week before the test." B. "Wear cotton panties on the day of the test." C. "Avoid taking any medications for 24 hours." D. "Do not douche for 48 hours before the test."

Answer: D Rationale: The nurse should instruct the woman not to douche for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Sexual intercourse should be avoided for 48 hours before the test. Wearing cotton panties is unrelated to preparation for a Papanicolaou test. Medications do not need to be withheld before the test.

25. A nurse is working with a woman who has been diagnosed with severe fibrocystic breast disease. After describing the medications that can be used as treatment, the nurse determines that additional teaching is needed when the client identifies which drug as being used? A. tamoxifen B. bromocriptine C. danazol D. penicillin

Answer: D Rationale: Treatment of severe fibrocystic breast disease may include the use of tamoxifen, bromocriptine, or danazol. Penicillin would be used to treat an infection such as mastitis.

10. A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? A. increased vaginal discharge B. urinary tract infection C. vaginitis D. vaginal ulceration

Answer: D Rationale: Use of a pessary can lead to pressure necrosis. Postmenopausal women with thin vaginal mucosa are highly susceptible to vaginal ulceration. Increased vaginal discharge, urinary tract infections, and vaginitis are possible side effects that could be seen in any woman fitted with a pessary.

29. A nurse is working with a victim of intimate partner violence. Which intervention would be most important for this client? A. providing for the client's safety B. reassuring the client he or she is not alone C. documenting the violence D. educating about the cycle of violence

Answer: A Rationale: Although reassurance, documentation, and education are important for the client experiencing intimate partner violence, ensuring safety is the most important.

4. The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which finding would the nurse expect when assessing the client's fundus? A. cannot be palpated B. 2 cm below the umbilicus C. 6 cm below the umbilicus D. 10 cm below the umbilicus

Answer: A Rationale: By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

8. A nurse is providing care to a postpartum woman. The nurse determines that the client is in the taking-in phase based on which finding? A. The client states, "He has my eyes and nose." B. The client shows interest in caring for the newborn. C. The client performs self-care independently. D. The client confidently cares for the newborn.

Answer: A Rationale: During the taking-in phase, new mothers when interacting with their newborns spend time claiming the newborn and touching him or her, commonly identifying specific features in the newborn such as "he has my nose" or "his fingers are long like his father's." Independence in self-care and interest in caring for the newborn are typical of the taking-hold phase. Confidence in caring for the newborn is demonstrated during the letting-go phase.

24. A nurse is conducting an in-service program on sexual abuse and violence for a group of nurses working at the community clinic. After teaching the group, the nurse determines that the teaching was successful when the group describes incest as involving which action? A. sexual exploitation by blood or surrogate relatives B. sexual abuse of individuals over age 18 C. violent aggressive assault on a person D. consent between perpetrator and victim.

Answer: A Rationale: Incest is any type of sexual exploitation between blood relatives or surrogate relatives before the victim reaches 18 years of age. Rape is a violent, aggressive assault on the victim's body and integrity. Rape is a legal rather than a medical term. It denotes penile penetration of the vagina, mouth, or rectum of the female or male without consent. It may or may not include the use of a weapon.

12. When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure? A. early parent-infant contact following birth B. expert medical care for the labor and birth C. good nutrition and prenatal care during pregnancy D. grandparent involvement in infant care after birth

Answer: A Rationale: Optimal bonding requires a period of close contact between the parents and newborn within the first few minutes to a few hours after birth. Expert medical care, nutrition and prenatal care, and grandparent involvement are not associated with the promotion of bonding.

13. A nurse is making a home visit to a postpartum client. Which finding would lead the nurse to suspect that a woman is experiencing postpartum psychosis? A. delirium B. feelings of guilt C. sadness D. insomnia

Answer: A Rationale: Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. It is manifested by depression that escalates to delirium, hallucinations, anger toward self and infant, bizarre behavior, mania, and thoughts of hurting herself and the infant. Feelings of guilt, sadness, and insomnia are associated with postpartum depression.

30. On a follow-up visit to the clinic, a nurse suspects that a postpartum client is experiencing postpartum psychosis. Which finding would most likely lead the nurse to suspect this condition? A. delusional beliefs B. feelings of anxiety C. sadness D. insomnia

Answer: A Rationale: Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. It is manifested by depression that escalates to delirium, hallucinations, delusional beliefs, anger toward self and infant, bizarre behavior, mania, and thoughts of hurting herself and the infant. Feelings of anxiety, sadness, and insomnia are associated with postpartum depression.

1. A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 66 beats per minute. Which of these actions should the nurse take? A. Document the finding, as it is a normal finding at this time. B. Contact the primary care provider, as it indicates early DIC. C. Contact the primary care provider, as it is a first sign of postpartum eclampsia. D. Obtain a prescription for a CBC, as it suggests postpartum anemia.

Answer: A Rationale: Pulse rates of 60 to 80 beats per minute at rest are normal during the first week after birth. This pulse rate is called puerperal bradycardia.

5. A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? A. dyspnea, diaphoresis, hypotension, and chest pain B. dyspnea, bradycardia, hypertension, and confusion C. weakness, anorexia, change in level of consciousness, and coma D. pallor, tachycardia, seizures, and jaundice

Answer: A Rationale: Sudden unexplained shortness of breath and reports of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.

11. When the nurse is alone with a client, the client says, "It was all my fault. The house was so messy when my partner got home, and I know my partner hates that." Which response would be most appropriate? A. "It is not your fault. No one deserves to be hurt." B. "What else did you do to make your partner so angry with you?" C. "You need to start to clean the house early in the day." D. "Remember, your partner works hard and you need to meet your partner's needs."

Answer: A Rationale: The nurse needs to communicate nonjudgmental support and explain that no one deserves to be abused. Doing so helps to establish trust and rapport. Asking the victim what he or she did to make the partner so angry, telling the victim to clean the house earlier in the day, and telling the victim to meet the partner's needs all shift the blame to the victim and are thus inappropriate.

7. When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage because: A. these measurements may not change until after the blood loss is large. B. the body's compensatory mechanisms activate and prevent any changes. C. they relate more to change in condition than to the amount of blood lost. D. maternal anxiety adversely affects these vital signs.

Answer: A Rationale: The typical signs of hemorrhage do not appear in the postpartum woman until as much as 1,800 to 2,100 ml of blood has been lost. In addition, accurate determination of actual blood loss is difficult because of blood pooling inside the uterus and on perineal pads, mattresses, and the floor.

19. Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? A. hematoma B. laceration C. bladder distention D. uterine atony

Answer: A Rationale: The woman most likely has a hematoma based on the findings: firm uterus with bright-red bleeding; localized bluish bulging area just under the skin surface in the perineal area; severe perineal or pelvic pain; and difficulty voiding. A laceration would involve a firm uterus with a steady stream or trickle of unclotted bright-red blood in the perineum. Bladder distention would be palpable along with a soft, boggy uterus that deviates from the midline. Uterine atony would be noted by a uncontracted uterus.

15. The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which action would be a priority? A. placing the call light within her reach B. teaching her how the sitz bath works C. telling her to use the sitz bath for 30 minutes D. cleaning the perineum with the peri-bottle

Answer: A Rationale: Tremendous hemodynamic changes are taking place within the woman, and safety must be a priority. Therefore, the nurse makes sure that the emergency call light is within her reach should she become dizzy or lightheaded. Teaching her how to use the sitz bath, including using it for 15 to 20 minutes, is appropriate but can be done once the woman's safety is ensured. The woman should clean her perineum with a peri-bottle before using the sitz bath, but this can be done once the woman's safety needs are met.

15. A postpartum woman is diagnosed with endometritis. The nurse interprets this as an infection involving which area? Select all that apply. A. endometrium B. decidua C. myometrium D. broad ligament E. ovaries F. fallopian tubes

Answer: A, B, C Rationale: Endometritis is an infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus. Extension of endometritis can result in parametritis, which involves the broad ligament and possibly the ovaries and fallopian tubes, or septic pelvic thrombophlebitis.

30. After teaching a group of young adults about sexual violence, the nurse determines that the teaching was successful when the group identifies which acts as a type of sexual violence? Select all that apply. A. female genital mutilation B. bondage C. infanticide D. human trafficking E. prostitution

Answer: A, B, C, D Rationale: Sexual violence includes IPV, human trafficking, incest, female genital cutting, forced prostitution, bondage, exploitation, neglect, infanticide, and sexual assault.

26. While obtaining a history from a woman at a regularly scheduled physical, the nurse notices various bruises on the client's upper extremity. The client dismisses the bruising and changes the subject. Which additional information about the woman as a victim would the nurse discuss with the healthcare provider when relaying the physical assessment data? Select all that apply. A. A dysfunctional family system B. A low academic achievement C. A victim of childhood violence D. Limited alcohol consumption E. Economic stress

Answer: A, B, C, E Rationale: Victims often will not describe themselves as abused. In battered woman syndrome, the woman has experienced deliberate and repeated physical or sexual assault by an intimate partner over an extended period of time. She is terrified and feels trapped, helpless, and alone. She reacts to any expression of anger or threat by avoidance and withdrawal behavior. Some women believe that the abuse is caused by a personality flaw or inadequacy in themselves (e.g., inability to keep the partner happy). These feelings of failure are reinforced and exploited by their partners. After being told repeatedly that they are "bad," some women begin to believe it. Many victims were abused as children and may have poor self-esteem, poor health, posttraumatic stress disorder (PTSD), depression, insomnia, low education achievement, or a history of suicide attempts, injury, or drug and alcohol abuse.

21. A nurse is working with a victim of intimate partner violence, helping the client develop a safety plan. Which items would the nurse suggest that the client take when leaving? Select all that apply. A. driver's license B. Social Security number C. cash D. phone cards E. health insurance cards

Answer: A, B, C, E Rationale: When leaving an abusive relationship, the victim should take a driver's license or photo ID, Social Security number or green card/work permit, birth certificates, any court papers or orders, credit cards, cash, and health insurance cards. The victim should avoid phone cards because they leave a trail to follow.

30. A nurse is providing care to a woman of Latin American culture who delivered a healthy neonate 6 hours ago. When developing a plan of care that is culturally congruent for this client, which information would be important for the nurse to obtain initially? Select all that apply. A. Meanings associated with touch and gestures B. Woman's beliefs about the postpartum period C. Plans for care of the newborn after discharge D. Amount of help the partner is expected to provide E. Preferences for measures to relieve discomforts

Answer: A, B, D, E Rationale: Although childbirth and the postpartum period are unique experiences for each woman, how the woman perceives and makes meaning of them is culturally defined. Nurses caring for childbearing families should consider all aspects of culture, including health beliefs, communication, space, and family roles. To ensure culturally congruent care, the nurse needs to gather initial information about the woman's health beliefs about the postpartum period because different cultures view the postpartum period differently, such as the need to balance hot and cold substances. This belief can influence the woman's preferences for relieving discomforts. The meaning of touch and gestures is also important to determine. The concept of personal space and the dimensions of comfort zones differ from culture to culture. Nurses must be sensitive to how people respond when being touched and should refrain from touching if the client's response indicates it is unwelcome. In addition, cultural norms also have an impact on family roles, expectations, and behaviors associated with a member's position in the family. For example, culture may influence whether a male partner actively participates in the woman's pregnancy and childbirth. In the Western countries, partners are expected to be involved, but this role expectation may conflict with that of many of the diverse groups now living in the countries. Plans for care of the newborn can be addressed at a later time.

22. A nurse is providing a refresher class for a group of postpartum nurses. The nurse reviews the risk factors associated with postpartum hemorrhage. The group demonstrates understanding of the information when they identify which risk factors associated with uterine tone? Select all that apply. A. rapid labor B. retained blood clots C. hydramnios D. operative birth E. fetal malpostion

Answer: A, C Rationale: Risk factors associated with uterine tone include hydramnios, rapid or prolonged labor, oxytocin use, maternal fever, or prolonged rupture of membranes. Retained blood clots are a risk factor associated with tissue retained in the uterus. Fetal malposition and operative birth are risk factors associated with trauma of the genital tract.

25. A nurse is teaching a group of college students about rape and sexual assault. The nurse determines that additional teaching is necessary based on which statements by the group? Select all that apply. A. Most victims of rape tell someone about it. B. Few individuals falsely cry "rape." C. Women have rape fantasies desiring to be raped. D. A rape victim feels vulnerable and betrayed afterwards. E. Medication and counseling can help a rape victim cope.

Answer: A, C Rationale: The majority of victims never tell anyone about a rape. Almost two-thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few individuals falsely cry "rape." Reality and fantasy are different, and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed.

26. The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which measures would the nurse most likely include in this teaching plan? Select all that apply. A. taking the prescribed antibiotic until it is finished B. checking temperature once a week C. washing hands before and after perineal care D. handling perineal pads by the edges E. directing peribottle to flow from back to front

Answer: A, C, D Rationale: Teaching should address taking the prescribed antibiotic until finished to ensure complete eradication of the infection; checking temperature daily and notifying the practitioner if it is above 100.4° F (38° C); washing hands thoroughly before and after eating, using the bathroom, touching the perineal area, or providing newborn care; handling perineal pads by the edges and avoiding touching the inner aspect of the pad that is against the body; and directing peribottle so that it flows from front to back.

21. Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which finding would the nurse expect to assess? Select all that apply. A. diaphoresis B. tachycardia C. oliguria D. cool extremities E. confusion

Answer: A, D Rationale: Signs and symptoms of mild shock include diaphoresis, increased capillary refill, cool extremities, and maternal anxiety. Tachycardia and oliguria suggest moderate shock. Confusion suggests severe shock.

16. A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for a postpartum infection based on which information? Select all that apply. A. history of diabetes B. labor of 12 hours C. rupture of membranes for 16 hours D. hemoglobin level 10 mg/dL E. placenta requiring manual extraction

Answer: A, D, E Rationale: Risk factors for postpartum infection include history of diabetes, labor over 24 hours, hemoglobin less than 10.5 mg/dL, prolonged rupture of membranes (more than 24 hours), and manual extraction of the placenta.

17. A home health care nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels "lousy." Which finding would lead the nurse to suspect endometritis? Select all that apply. A. lower abdominal tenderness B. urgency C. flank pain D. breast tenderness E. anorexia

Answer: A, E Rationale: Manifestations of endometritis include lower abdominal tenderness or pain on one or both sides, elevated temperature, foul-smelling lochia, anorexia, nausea, fatigue and lethargy, leukocytosis, and elevated sedimentation rate. Urgency and flank pain would suggest a urinary tract infection. Breast tenderness may be related to engorgement or suggest mastitis.

22. A nurse is presenting a discussion on sexual violence at a local community college. When describing the incidence of sexual violence, the nurse would identify that a woman has which chance of experiencing a sexual assault in her lifetime? A. 1 in 3 B. 1 in 5 C. 2 in 15 D. 3 in 20

Answer: B Rationale: According to the National Sexual Violence Resource Center (NSVRC), nearly one in five women and one in 9 men in the United States have experienced rape, physical violence, and/or stalking by a partner with IPV-related impact in their lifetimes.

4. A nurse is developing a program to help reduce the risk of late postpartum hemorrhage in clients in the labor and birth unit. Which measure would the nurse emphasize as part of this program? A. administering broad-spectrum antibiotics B. inspecting the placenta after delivery for intactness C. manually removing the placenta at birth D. applying pressure to the umbilical cord to remove the placenta

Answer: B Rationale: After the placenta is expelled, a thorough inspection is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

29. After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify which concept as reflecting the enduring nature of their relationship, one that involves placing the infant at the center of their lives and finding their own way to assume the parental identity? A. reciprocity B. commitment C. bonding D. attachment

Answer: B Rationale: Commitment refers to the enduring nature of the relationship. The components of this are twofold: centrality and parent role exploration. In centrality, parents place the infant at the center of their lives. They acknowledge and accept their responsibility to promote the infant's safety, growth, and development. Parent role exploration is the parents' ability to find their own way and integrate the parental identity into themselves. The development of a close emotional attraction to the newborn by parents during the first 30 to 60 minutes after birth describes bonding. Reciprocity is the process by which the infant's capabilities and behavioral characteristics elicit a parental response. Engrossment refers to the intense interest during early contact with a newborn. Attachment refers to the process of developing strong ties of affection between an infant and significant other.

10. In addition to providing privacy, which action would be most appropriate initially in situations involving suspected intimate partner violence? A. Allow the client to have a good cry over the situation. B. Tell the client, "Injuries like these don't usually happen by accident." C. Call the police immediately so they can question the victim. D. Ask the abuser to describe his side of the story first.

Answer: B Rationale: Communicating support through a nonjudgmental attitude and telling the victim that no one deserves to be abused are the first steps in establishing trust and rapport. Allowing the client to cry is appropriate after the client is safe, the client's privacy is protected, and the nurse has emphasized that there is a problem. Notifying the police is done once the assessment reveals suspicion or actual indications of intimate partner violence. Asking the abuser to describe the story is inappropriate because asking the abuser about the situation may trigger an abusive episode.

23. A nurse is reading a journal article about sexual abuse. Which age range would the nurse expect to find as the peak age for such abuse? A. 7 to 10 years B. 8 to 12 years C. 14 to 18 years D. 18 to 22 years

Answer: B Rationale: Current estimates indicate that 1 of 5 girls is sexually assaulted, and the peak ages of such abuse are from 8 to 12 years of age. At every age in the life span, females are more likely to be victims of sexual violence by father, brother, family member, neighbor, boyfriend, husband, partner or ex-partner than by a stranger or anonymous assailant.

16. When assessing a postpartum woman, the nurse suspects the woman is experiencing a problem based on which finding? A. elevated white blood cell count B. acute decrease in hematocrit C. increased levels of clotting factors D. pulse rate of 60 beats/minute

Answer: B Rationale: Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable and may even increase. An acute decrease is not an expected finding. Red blood cell production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours. During the next 2 weeks, both levels rise slowly. The white blood count, which increases in labor, remains elevated for first 4 to 6 days after birth but then falls to 6,000 to 10,000/mm3. The WBC count remains elevated for the first 4 to 6 days and clotting factors remain elevated for 2 to 3 weeks. Bradycardia (50 to 70 beats per minute) for the first two weeks reflects the decrease in cardiac output. The increase in cardiac output and stroke volume during pregnancy begins to diminish after birth once the placenta has been delivered. This decrease in cardiac output is reflected in bradycardia (40 to 60 bpm) for up to the first 2 weeks postpartum.

11. A nurse is preparing a couple and their newborn for discharge. Which instructions would be most appropriate for the nurse to include in discharge teaching? A. introducing solid foods immediately to increase sleep cycle B. demonstrating comfort measures to quiet a crying infant C. encouraging daily outings to the shopping mall with the newborn D. allowing the infant to cry for at least an hour before picking him or her up

Answer: B Rationale: Discharge teaching typically would focus on several techniques to comfort a crying newborn. The nurse needs to emphasize the importance of responding to the newborn's cues, not allowing the infant to cry for an hour before being comforted. Information about solid foods is inappropriate for a newborn because solid foods are not introduced at this time. The mother and newborn need rest periods. Therefore, daily outings to a shopping mall would be inappropriate. Information about newborn sleep-wake cycles and measures for sensory enrichment and stimulation would be more appropriate.

1. A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected? A. two fingerbreadths above the umbilicus B. at the level of the umbilicus C. two fingerbreadths below the umbilicus D. four fingerbreadths below the umbilicus

Answer: B Rationale: During the first 12 hours postpartum, the fundus of the uterus is located at the level of the umbilicus. Over the first few days after birth, the uterus typically descends from the level of the umbilicus at a rate of 1 cm (one fingerbreadth) per day. By 3 days, the fundus lies two to three fingerbreadths below the umbilicus (or slightly higher in multiparous women). By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

18. A nurse is making a home visit to a postpartum woman who gave birth to a healthy newborn 4 days ago. The woman's breasts are swollen, hard, and tender to the touch. The nurse documents this finding as: A. involution. B. engorgement. C. mastitis. D. engrossment.

Answer: B Rationale: Engorgement is the process of swelling of the breast tissue as a result of an increase in blood and lymph supply as a precursor to lactation (Figure 15.4). Breast engorgement usually peaks in 3 to 5 days postpartum and usually subsides within the next 24 to 36 hours (Chapman, 2011). Engorgement can occur from infrequent feeding or ineffective emptying of the breasts and typically lasts about 24 hours. Breasts increase in vascularity and swell in response to prolactin 2 to 4 days after birth. If engorged, the breasts will be hard and tender to touch. Involution refers to the process of the uterus returning to its prepregnant state. Mastitis refers to an infection of the breasts. Engrossment refers to the bond that develops between the father and the newborn.

10. A nurse is reviewing the policies of a facility related to bonding and attachment with newborns. Which practice would the nurse identify as needing to be changed? A. allowing unlimited visiting hours on maternity units B. offering round-the-clock nursery care for all infants C. promoting rooming-in D. encouraging infant contact immediately after birth

Answer: B Rationale: Factors that can affect attachment include separation of the infant and parents for long times during the day, such as if the infant was being cared for in the nursery throughout the day. Unlimited visiting hours, rooming-in, and infant contact immediately after birth promote bonding and attachment.

7. A postpartum client who is bottle feeding her newborn asks, "When should my period return?" Which response by the nurse would be most appropriate? A. "It's difficult to say, but it will probably return in about 2 to 3 weeks." B. "It varies, but you can estimate it returning in about 7 to 9 weeks." C. "You won't have to worry about it returning for at least 3 months." D. "You don't have to worry about that now. It'll be quite a while."

Answer: B Rationale: For the nonlactating woman, menstruation resumes 7 to 9 weeks after giving birth, with the first cycle being anovulatory. For the lactating woman, menses can return anytime from 2 to 18 months after birth.

9. A nurse is observing the interaction between a new father and his newborn. The nurse determines that engrossment has yet to occur based on which behavior? A. demonstrates pleasure when touching or holding the newborn B. identifies imperfections in the newborn's appearance C. is able to distinguish his newborn from others in the nursery D. shows feelings of pride with the birth of the newborn

Answer: B Rationale: Identifying imperfections would not be associated with engrossment. Engrossment is characterized by seven behaviors: visual awareness of the newborn, tactile awareness of the newborn, perception of the newborn as perfect, strong attraction to the newborn, awareness of distinct features of the newborn, extreme elation, and increased sense of self-esteem.

27. A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? A. "I just feel so overwhelmed and tired." B. "I'm feeling so guilty and worthless lately." C. "It's strange, one minute I'm happy, the next I'm sad." D. "I keep hearing voices telling me to take my baby to the river."

Answer: B Rationale: Indicators for postpartum depression include feelings related to restlessness, worthlessness, guilt, hopeless, and sadness along with loss of enjoyment, low energy level, and loss of libido. The statements about being overwhelmed and fatigued and changing moods suggest postpartum blues. The statement about hearing voices suggests postpartum psychosis.

25. A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? A. "I will use a soft toothbrush to brush my teeth." B. "I can take ibuprofen if I have any pain." C. "I need to avoid drinking any alcohol." D. "I will call my health care provider if my stools are black and tarry."

Answer: B Rationale: Individuals receiving anticoagulant therapy need to avoid use of any over-the-counter products containing aspirin or aspirin-like derivatives such as NSAIDs (ibuprofen) to reduce the risk for bleeding. Using a soft toothbrush and avoiding alcohol are appropriate measures to reduce the risk for bleeding. Black, tarry stools should be reported to the health care provider.

5. After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention? A. presence of lochia serosa B. frequent scant voidings C. fundus firm, below umbilicus D. milk filling in both breasts

Answer: B Rationale: Infrequent or insufficient voiding may be a sign of infection and is not a normal finding on the second postpartum day. Lochia serosa, a firm fundus below the umbilicus, and milk filling the breasts are expected findings.

23. A nurse is visiting a postpartum woman who gave birth to a healthy newborn 5 days ago. Which finding would the nurse expect? A. bright red discharge B. pinkish brown discharge C. deep red mucus-like discharge D. creamy white discharge

Answer: B Rationale: Lochia serosa is pinkish brown and is expelled 3 to 10 days postpartum. Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. Lochia alba is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content and occurs from days 10 to 14 but can last 3 to 6 weeks postpartum.

10. A postpartum client is prescribed medication therapy as part of the treatment plan for postpartum hemorrhage. Which medication would the nurse expect to administer in this situation? A. Magnesium sulfate B. methylergonovine C. Indomethacin D. nifedipine

Answer: B Rationale: Methylergonovine, along wiht oxytocin and carboprost are drugs used to manage postpartum hemorrhage. Magnesium sulfate, indomethecin, and nifedipine are used to control preterm labor.

4. A nurse is observing a new mother interacting with her newborn. Which statement would alert the nurse to the potential for impaired bonding between mother and newborn? A. "You have your daddy's eyes." B. "He looks like a frog to me." C. "Where did you get all that hair?" D. "He seems to sleep a lot."

Answer: B Rationale: Negative comments may indicate impaired bonding. Pointing out commonalities such as "daddy's eyes" and expressing pride such as "all that hair" are positive attachment behaviors. The statement about sleeping a lot indicates that the mother is assigning meaning to the newborn's actions, another positive attachment behavior.

26. A postpartum woman who is bottle-feeding her newborn asks the nurse, "About how much should my newborn drink at each feeding?" The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding? A. 1 to 2 ounces B. 2 to 4 ounces C. 4 to 6 ounces D. 6 to 8 ounces

Answer: B Rationale: Newborns need about 108 cal/kg or approximately 650 cal/day (Dudek, 2010). Therefore, a newborn will need to 2 to 4 ounces to feel satisfied at each feeding.

28. A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition? A. "Postpartum blues is a long-term emotional disturbance." B. "Getting some outside help for housework can lessen feelings of being overwhelmed." C. "The mother loses contact with reality." D. "Extended psychotherapy is needed for treatment."

Answer: B Rationale: Postpartum blues require no formal treatment other than support and reassurance because they do not usually interfere with the woman's ability to function and care for her infant. Nurses can ease a mother's distress by encouraging her to vent her feelings and by demonstrating patience and understanding with her and her family. Suggest that getting outside help with housework and infant care might help her to feel less overwhelmed until the blues ease. Provide telephone numbers she can call when she feels down during the day. Making women aware of this disorder while they are pregnant will increase their knowledge about this mood disturbance, which may lessen their embarrassment and increase their willingness to ask for and accept help if it does occur.

14. A woman who gave birth 24 hours ago tells the nurse, "I've been urinating so much over the past several hours." Which response by the nurse would be most appropriate? A. "You must have an infection, so let me get a urine specimen." B. "Your body is undergoing many changes that cause your bladder to fill quickly." C. "Your uterus is not contracting as quickly as it should." D. "The anesthesia that you received is wearing off and your bladder is working again."

Answer: B Rationale: Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production. All these factors contribute to rapid filling of the bladder within 12 hours of birth. Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum.

27. As part of an education program for a group of pregnant women, the nurse teaches them about the changes that occur in the respiratory system during the postpartum period. The women demonstrate understanding of the information when they identify which occurrence as a postpartum adaptation? A. continued shortness of breath B. relief of rib aching C. diaphragmatic elevation D. decrease in respiratory rate

Answer: B Rationale: Respirations usually remain within the normal adult range of 16 to 24 breaths per minute. As the abdominal organs resume their nonpregnant position, the diaphragm returns to its usual position. Anatomic changes in the thoracic cavity and rib cage caused by increasing uterine growth resolve quickly. As a result, discomforts such as shortness of breath and rib aches are relieved.

26. A postpartum woman who has experienced diastasis recti asks the nurse about what to expect related to this condition. Which response by the nurse would be most appropriate? A. "You'll notice that this will fade to silvery lines." B. "Exercise will help to improve the muscles." C. "Expect the color to lighten somewhat." D. "You'll notice that your shoe size will increase."

Answer: B Rationale: Separation of the rectus abdominis muscles, called diastasis recti, is more common in women who have poor abdominal muscle tone before pregnancy. After birth, muscle tone is diminished and the abdominal muscles are soft and flabby. Specific exercises are necessary to help the woman regain muscle tone. Fortunately, diastasis responds well to exercise, and abdominal muscle tone can be improved. Stretch marks (striae gravidarum) fade to silvery lines. The darkened pigmentation of the abdomen (linea nigra), face (melasma), and nipples gradually fades. Parous women will note a permanent increase in shoe size.

18. A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which finding? A. nonpalpable fundus B. moderate lochia serosa C. bruising on arms and legs D. fever

Answer: B Rationale: Subinvolution is usually identified at the woman's postpartum examination 4 to 6 weeks after birth. The clinical picture includes a postpartum fundal height that is higher than expected, with a boggy uterus; the lochia fails to change colors from red to serosa to alba within a few weeks. Normally, at 4 to 6 weeks, lochia alba or no lochia would be present and the fundus would not be palpable. Thus evidence of lochia serosa suggests subinvolution. Bruising would suggest a coagulopathy. Fever would suggest an infection.

19. A nurse is caring for a recent rape victim. The nurse would expect this client to experience which phase first? A. denial B. disorganization C. reorganization D. integration

Answer: B Rationale: The acute phase of rape recovery is disorganization characterized by shock, fear, disbelief, anger, shame, guilt and feelings of uncleanliness. This is followed by denial (outward adjustment), reorganization, and finally integration and recovery.

18. The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse interprets this finding as indicating which amount of blood loss? A. 10 mL B. 10 to 25 mL C. 25 to 50 mL D. over 50 mL

Answer: B Rationale: The amount of lochia is described as light or small for an approximately 4-inch stain and indicates a blood loss of 10 to 25 mL. Scant refers to a 1- to 2-inch stain of lochia and approximately 10 mL of blood loss; moderate refers to a 4- to 6-inch stain, suggesting a 25 to 50 mL blood loss; and large or heavy refers to a pad that is saturated within 1 hour after changing, indicating over 50 mL blood loss.

19. The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse documents this finding as which description? A. scant B. light C. moderate D. large

Answer: B Rationale: The amount of lochia is described as light or small for an approximately 4-inch stain. Scant refers to a 1- to 2-inch stain of lochia; moderate refers to a 4- to 6-inch stain; and large or heavy refers to a pad that is saturated within 1 hour after changing.

31. A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next? A. Apply warm soaks to the area. B. Notify the health care provider. C. Massage the uterine fundus. D. Encourage the client to void.

Answer: B Rationale: The client is experiencing postpartum hemorrhage secondary to a perineal hematoma. The nurse needs to notify the health care provider about these findings to prevent further hemorrhage. Applying warm soaks to the area would do nothing to control the bleeding. With a perineal hematoma, the uterus is firm, so massaging the uterus or encouraging the client to void would not be appropriate.

21. A nurse is observing a postpartum client interacting with her newborn and notes that the mother is engaging with the newborn in the en face position. Which behavior would the nurse be observing? A. mother placing the newborn next to bare breast B. mother making eye-to-eye contact with the newborn C. mother gently stroking the newborn's face D. mother holding the newborn upright at the shoulder

Answer: B Rationale: The en face position is characterized by the mother interacting with the newborn through eye-to-eye contact while holding the newborn. Bonding is a vital component of the attachment process and is necessary in establishing parent-infant attachment and a healthy, loving relationship. During this early period of acquaintance, mothers touch their infants in a characteristic manner. Mothers visually and physically "explore" their infants, initially using their fingertips on the infant's face and extremities and progressing to massaging and stroking the infant with their fingers. This is followed by palm contact on the trunk. Eventually, mothers draw their infant toward them and hold the infant. Kangaroo care refers to skin-to-skin contact between the mother and newborn.

12. A father of a newborn tells the nurse, "I may not know everything about being a dad, but I'm going to do the best I can for my son." The nurse interprets this as indicating the father is in which stage of adaptation? A. expectations B. transition to mastery C. reality D. taking-in

Answer: B Rationale: The father's statement reflects transition to mastery because he is making a conscious decision to take control and be at the center of the newborn's life regardless of his preparedness. The expectations stage involves preconceptions about how life will be with a newborn. Reality occurs when fathers realize their expectations are not realistic. Taking-in is a phase of maternal adaptation.

14. A nurse is reviewing a journal article on the causes of postpartum hemorrhage. Which condition would the nurse most likely find as the most common cause? A. labor augmentation B. uterine atony C. cervical or vaginal lacerations D. uterine inversion

Answer: B Rationale: The most common cause of postpartum hemorrhage is uterine atony, failure of the uterus to contract and retract after birth. The uterus must remain contracted after birth to control bleeding from the placental site. Labor augmentation is a risk factor for postpartum hemorrhage. Lacerations of the birth canal and uterine inversion may cause postpartum hemorrhage, but these are not the most common cause.

16. A group of nurses are reviewing information about mastitis and its causes in an effort to develop a teaching program on prevention for postpartum women. The nurses demonstrate understanding of the information when they focus the teaching on ways to minimize risk of exposure to which organism? A. E. coli B. S. aureus C. Proteus D. Klebsiella

Answer: B Rationale: The most common infectious organism that causes mastitis is S. aureus, which comes from the breast-feeding infant's mouth or throat. E. coli is another, less common cause. E. coli, Proteus, and Klebsiella are common causes of urinary tract infections.

23. A nurse is massaging a postpartum client's fundus and places the nondominant hand on the area above the symphysis pubis based on the understanding that this action: A. determines that the procedure is effective. B. helps support the lower uterine segment. C. aids in expressing accumulated clots. D. prevents uterine muscle fatigue.

Answer: B Rationale: The nurse places the nondominant hand on the area above the symphysis pubis to help support the lower uterine segment. The hand, usually the dominant hand that is placed on the fundus, helps to determine uterine firmness (and thus the effectiveness of the massage). Applying gentle downward pressure on the fundus helps to express clots. Overmassaging the uterus leads to muscle fatigue.

20. The partner of a woman who has given birth to a healthy newborn says to the nurse, "I want to be involved, but I'm not sure that I'm able to care for such a little baby." The nurse interprets this as indicating which stage? A. expectations B. reality C. transition to mastery D. taking-hold

Answer: B Rationale: The partner's statement reflects stage 2 (reality), which occurs when fathers or partners realize that their expectations in stage 1 are not realistic. Their feelings change from elation to sadness, ambivalence, jealousy, and frustration. Many wish to be more involved in the newborn's care and yet do not feel prepared to do so. New fathers or partners pass through stage 1 (expectations) with preconceptions about what home life will be like with a newborn. Many men may be unaware of the dramatic changes that can occur when this newborn comes home to live with them. In stage 3 (transition to mastery), the father or partner makes a conscious decision to take control and be at the center of his newborn's life regardless of his preparedness. Taking-hold is a stage of maternal adaptation.

16. A nurse is assessing a rape survivor for posttraumatic stress disorder. The nurse asks the survivor, "Do you feel as though you are reliving the trauma?" The nurse is assessing for which effect of the trauma? A. physical symptoms B. intrusive thoughts C. avoidance D. hyperarousal

Answer: B Rationale: The question is used to assess the survivor for intrusive thoughts that reflect the client reexperiencing the trauma. Physical symptoms would be assessed with questions about sleeping, eating, palpitations and other problems. Avoidance would be reflected in questions involving withdrawal socially, avoiding situations that remind the survivor of the rape. Hyperarousal would be noted by irritability and an exaggerated startle response.

30. A woman gave birth to a healthy term neonate today at 1330. It is now 1430 and the nurse has completed the client's assessment. At which time would the nurse next assess the client? A. 1445 B. 1500 C. 1530 D. 1830

Answer: B Rationale: The woman is in her second hour postpartum. Typically, the nurse would assess the woman every 30 minutes. In this case, this would be 1500. During the first hour, assessments are usually completed every 15 minutes. After the second hour, assessments would be made every 4 hours for the first 24 hours and then every 8 hours.

12. After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? A. "I need to call my doctor if my temperature goes above 100.4° F (38° C)." B. "When I put on a new pad, I'll start at the back and go forward." C. "If I have chills or my discharge has a strange odor, I'll call my doctor." D. "I'll point the spray of the peri-bottle so it the water flows front to back."

Answer: B Rationale: The woman needs additional teaching when she states that she should apply the perineal pad starting at the back and going forward. The pad should be applied using a front-toback motion. Notifying the health care provider of a temperature above 100.4° F (38° C), aiming the peri-bottle spray so that the flow goes from front to back, and reporting danger signs such as chills or lochia with a strange odor indicate effective teaching.

7. The nurse administers Rho(D) immune globulin to an Rh-negative client after birth of an Rhpositive newborn based on the understanding that this drug will prevent her from: A. becoming Rh positive. B. developing Rh sensitivity. C. developing AB antigens in her blood. D. becoming pregnant with an Rh-positive fetus.

Answer: B Rationale: The woman who is Rh-negative and whose infant is Rh-positive should be given Rho(D) immune globulin within 72 hours after birth to prevent sensitization.

25. After teaching a postpartum woman about breastfeeding, the nurse determines that the teaching was successful when the woman makes which statement? A. "I should notice a decrease in abdominal cramping during breast-feeding." B. "I should wash my hands before starting to breastfeed." C. "The baby can be awake or sleepy when I start to feed him." D. "The baby's mouth will open up once I put him to my breast."

Answer: B Rationale: To promote successful breastfeeding, the mother should wash her hands before breast feeding and make sure that the baby is awake and alert and showing hunger signs. In addition, the mother should lightly tickle the infant's upper lip with her nipple to stimulate the infant to open the mouth wide and then bring the infant rapidly to the breast with a wide-open mouth. The mother also needs to know that her afterpains will increase during breastfeeding.

27. A nurse is working with a victim of violence to develop a safety plan. The nurse teaches the client about the necessary items to take when leaving. The nurse determines that additional teaching is needed when the client identifies which items? Select all that apply. A. photo ID B. phone cards C. most of her clothing D. cash E. health insurance cards

Answer: B, C Rationale: When leaving an abusive relationship, the victim should take the following items: driver's license or photo ID; Social Security number or green card/work permit; birth certificates for oneself and one's children; phone numbers for social services or shelter; deed or lease to the home or apartment; any court papers or orders; a change of clothing for oneself and one's children; pay stubs, checkbook, credit cards, and cash; and health insurance cards. Phone cards should not be used because they leave a trail to follow.

20. A group of nurses is preparing a violence prevention program. The group is researching information about risk factors for intimate partner violence related to the individual. Based on their research, which risk factors would the nurses expect to address? Select all that apply. A. dysfunctional family system B. low academic achievement C. victim of childhood violence D. heavy alcohol consumption E. economic stress

Answer: B, C, D Rationale: Individual risk factors associated with intimate partner violence include young age, heavy drinking, low academic achievement, and experience of or witnessing of violence as a child. Dysfunctional family system and economic stress are risk factors associated with the relationship.

25. A nurse is preparing a presentation about changes in the various body systems during the postpartum period and their effects for a group of new mothers. The nurse explains which event as influencing a postpartum woman's ability to void? Select all that apply. A. use of an opioid anesthetic during labor B. generalized swelling of the perineum C. decreased bladder tone from regional anesthesia D. use of oxytocin to augment labor E. need for an episiotomy

Answer: B, C, D Rationale: Many women have difficulty feeling the sensation to void after giving birth if they received an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they received oxytocin to induce or augment their labor (antidiuretic effect). These women will be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention. In addition, urination may be impeded by perineal lacerations; generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus; hematomas; decreased bladder tone as a result of regional anesthesia; and diminished sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor.

24. A nurse is developing a teaching plan about sexuality and contraception for a postpartum woman who is breastfeeding. Which information would the nurse most likely include? Select all that apply. A. resumption of sexual intercourse about two weeks after birth B. possible experience of fluctuations in sexual interest C. use of a water-based lubricant to ease vaginal discomfort D. use of combined hormonal contraceptives for the first three weeks E. possibility of increased breast sensitivity during sexual activity

Answer: B, C, E Rationale: Typically, sexual intercourse can be resumed once bright-red bleeding has stopped and the perineum is healed from an episiotomy or lacerations. This is usually by the third to the sixth week postpartum. Fluctuations in sexual interest are normal. In addition, breastfeeding women may notice a let-down reflex during orgasm and find that breasts are very sensitive when touched by the partner. Precoital vaginal lubrication may be impaired during the postpartum period, especially in women who are breastfeeding. Use of water-based gel lubricants can help. The Centers for Disease Control and Prevention recommend that postpartum women not use combined hormonal contraceptives during the first 21 days after birth because of the high risk for venous thromboembolism (VTE) during this period.

22. After teaching a group of nurses during an in-service program about risk factors associated with postpartum hemorrhage, the nurse determines that the teaching was successful when the group identifies which risk factors? Select all that apply. A. prolonged labor B. placenta previa C. null parity D. hydramnios E. labor augmentation

Answer: B, D, E Rationale: Risk factors for postpartum hemorrhage include precipitous labor less than 3 hours, placenta previa or abruption, multiparity, uterine overdistention such as with a large infant, twins, or hydramnios, and labor induction or augmentation. Prolonged labor over 24 hours is a risk factor for postpartum infection.

29. A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? A. severe uterine pain B. board-like abdomen C. appearance of petechiae D. inversion of the uterus

Answer: C Rationale: A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with DIC and placental abruption.

3. A postpartum client has a fourth-degree perineal laceration. The nurse would expect which medication to be prescribed? A. ferrous sulfate B. methylergonovine C. docusate D. bromocriptine

Answer: C Rationale: A stool softener such as docusate may promote bowel elimination in a woman with a fourth-degree laceration, who may fear that bowel movements will be painful. Ferrous sulfate would be used to treat anemia. However, it is associated with constipation and would increase the discomfort when the woman has a bowel movement. Methylergonovine would be used to prevent or treat postpartum hemorrhage. Bromocriptine is used to treat hyperprolactinemia.

20. When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which area? A. superficial structures above the muscle B. through the perineal muscles C. through the anal sphincter muscle D. through the anterior rectal wall

Answer: C Rationale: A third-degree laceration extends through the anal sphincter muscle. A first-degree laceration involves only the skin and superficial structures above the muscle. A second-degree laceration extends through the perineal muscles. A fourth-degree laceration continues through the anterior rectal wall.

24. A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which measure would the nurse include as the most cost-effective method for prevention? A. prophylactic heparin administration B. compression stockings C. early ambulation D. warm compresses

Answer: C Rationale: Although compression stockings and prophylactic heparin administration may be appropriate, the most cost-effective preventive method is early ambulation. It is also the easiest method. Warm compresses are used to treat superficial venous thrombosis.

2. A client who has just given birth to a healthy newborn required an episiotomy. Which action would the nurse implement immediately after birth to decrease the client's pain from the procedure? A. Offer warm blankets. B. Encourage the woman to void. C. Apply an ice pack to the site. D. Offer a warm sitz bath.

Answer: C Rationale: An ice pack is the first measure used after a vaginal birth to provide perineal comfort from edema, an episiotomy, or lacerations. Warm blankets would be helpful for the chills that the woman may experience. Encouraging her to void promotes urinary elimination and uterine involution. A warm sitz bath is effective after the first 24 hours.

21. A nurse is reviewing information about maternal and paternal adaptations to the birth of a newborn. The nurse observes the parents interacting with their newborn physically and emotionally. The nurse documents this as: A. puerperium. B. lactation. C. attachment. D. engrossment.

Answer: C Rationale: Attachment is a formation of a relationship between a parent and her/his newborn through a process of physical and emotional interactions. Puerperium refers to the postpartum period. Lactation refers to the process of milk secretion by the breasts. Engrossment refers to the bond that develops between the father and the newborn.

29. A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus and documents which finding as normal? A. two fingerbreadths above the umbilicus B. at the level of the umbilicus C. two fingerbreadths below the umbilicus D. four fingerbreadths below the umbilicus

Answer: C Rationale: During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by day 2, it is about 2 fingerbreadths below the umbilicus.

15. During a follow-up visit to the clinic, a victim of sexual assault reports changing jobs and moving to another town. The client tells the nurse, "I pretty much stay to myself at work and at home." The nurse interprets these findings to indicate that the client is in which phase of rape recovery? A. disorganization B. denial C. reorganization D. integration

Answer: C Rationale: During the reorganization phase, the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. The disorganization phase is characterized by shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During the denial or outward adjustment phase, the survivor appears outwardly composed and returns to work or school and refuses to discuss the assault and denies the need for counseling. During the integration and recovery phase, the survivor begins to feel safe and starts to trust others.

6. A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction by the nurse would be most appropriate to aid in relieving her discomfort? A. "Express some milk from your breasts every so often to relieve the distention." B. "Remove your bra to relieve the pressure on your sensitive nipples and breasts." C. "Apply ice packs to your breasts to reduce the amount of milk being produced." D. "Take several warm showers daily to stimulate the milk let-down reflex."

Answer: C Rationale: For the woman with breast engorgement who is bottle feeding her newborn, encourage the use of ice packs to decrease pain and swelling. Expressing milk from the breasts and taking warm showers would be appropriate for the woman who was breastfeeding. Wearing a supportive bra 24 hours a day also is helpful for the woman with engorgement who is bottle feeding.

14. A postpartum woman is having difficulty voiding for the first time after giving birth. Which action would be least effective in helping to stimulate voiding? A. pouring warm water over her perineal area B. having her hear the sound of water running nearby C. placing her hand in a basin of cool water D. standing her in the shower with the warm water on

Answer: C Rationale: Helpful measures to stimulate voiding include placing her hand in a basin of warm water, pouring warm water over her perineal area, hearing the sound of running water nearby, blowing bubbles through a straw, standing in the shower with the warm water turned on, and drinking fluids.

6. When the nurse is assessing a postpartum client approximately 6 hours after birth, which finding would warrant further investigation? A. deep red, fleshy-smelling lochia B. voiding of 350 cc C. blood pressure 90/50 mm Hg D. profuse sweating

Answer: C Rationale: In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of the compensatory increase in heart rate. Thus, a decrease in blood pressure and cardiac output are not expected changes during the postpartum period. Early identification is essential to ensure prompt intervention. Deep red, fleshy-smelling lochia is a normal finding 6 hours postpartum. Voiding in small amounts such as less than 150 cc would indicate a problem, but 350 cc would be appropriate. Profuse sweating also is normal during the postpartum period.

11. A nurse is teaching a postpartum client how to do muscle-clenching exercises for the perineum. The client asks the nurse, "Why do I need to do these exercises?" Which reason would the nurse most likely incorporate into the response? A. reduces lochia B. promotes uterine involution C. improves pelvic floor tone D. alleviates perineal pain

Answer: C Rationale: Muscle clenching perineal exercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing, ultimately helping to prevent urinary incontinence later in life. Kegel exercises have no effect on lochia, involution, or pain.

23. A postpartum woman who is breastfeeding tells the nurse that she is experiencing nipple pain. After teaching the woman about possible suggestions, the nurse determines that more teaching is needed when the woman makes which statement? A. "I use a mild analgesic about 1 hour before breastfeeding." B. "I apply expressed breast milk to my nipples." C. "I apply glycerin-based gel to my nipples." D. "My baby latches on."

Answer: C Rationale: Nipple pain is difficult to treat, although a wide variety of topical creams, ointments, and gels are available to do so. This group includes beeswax, glycerin-based products, petrolatum, lanolin, and hydrogel products. Many women find these products comforting. Beeswax, glycerin-based products, and petrolatum all need to be removed before breastfeeding. These products should be avoided in order to limit infant exposure because the process of removal may increase nipple irritation. Mild analgesics such as acetaminophen or ibuprofen are considered relatively safe for breastfeeding mothers. Applying expressed breast milk to nipples and allowing it to dry has been suggested to reduce nipple pain. Usually the pain is due to incorrect latch-on and/or removal of the nursing infant from the breast. Early assistance with breastfeeding to ensure correct positioning can help prevent nipple trauma. In addition, applying expressed milk to nipples and allowing it to dry has been suggested to result in less nipple pain for many women.

15. The nurse develops a teaching plan for a postpartum client and includes teaching about how to perform pelvic floor muscle training or Kegel exercises. The nurse includes this information for which reason? A. reduce lochia B. promote uterine involution C. improve pelvic floor tone D. alleviate perineal pain

Answer: C Rationale: Pelvic floor muscle training or Kegel exercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing, ultimately helping to prevent urinary incontinence later in life. Kegel exercises have no effect on lochia, involution, or pain.

14. A nurse is preparing a teaching plan for victims who are recovering from intimate partner violence. The nurse would focus the teaching on ways to: A. enhance their personal appearance and hairstyle. B. develop their creativity and work ethic. C. improve their communication skills and assertiveness. D. plan more nutritious meals to improve their own health.

Answer: C Rationale: Providing reassurance and support to victims of intimate partner violence is key if the violence is to end. Appropriate actions can help victims express their thoughts and feelings in constructive ways and strengthen their control over their lives. Although interventions related to personal appearance and creativity can enhance the victim's self-esteem, they are not helpful in dealing with intimate partner violence. Planning nutritious meals helps to promote a healthy lifestyle but is ineffective in dealing with intimate partner violence.

8. Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage? A. multiparity, age of mother, operative birth B. size of placenta, small baby, operative birth C. uterine atony, placenta previa, operative procedures D. prematurity, infection, length of labor

Answer: C Rationale: Risk factors for postpartum hemorrhage include a precipitous labor less than three hours, uterine atony, placenta previa or abruption, labor induction or augmentation, operative procedures such as vacuum extraction, forceps, or cesarean birth, retained placental fragments, prolonged third stage of labor greater than 30 minutes, multiparity, and uterine overdistention such as from a large infant, twins, or hydramnios.

9. When teaching parents about their newborn, the nurse describes the development of a close emotional attraction to a newborn by the parents during the first 30 to 60 minutes after birth. The nurse refers to this process by which term? A. reciprocity B. engrossment C. bonding D. attachment

Answer: C Rationale: The development of a close emotional attraction to the newborn by parents during the first 30 to 60 minutes after birth describes bonding. Reciprocity is the process by which the infant's capabilities and behavioral characteristics elicit a parental response. Engrossment refers to the intense interest during early contact with a newborn. Attachment refers to the process of developing strong ties of affection between an infant and significant other.

19. A nurse is assessing a postpartum woman's adjustment to her maternal role. Which event would the nurse expect to occur first? A. reestablishing relationships with others B. demonstrating increasing confidence in care of the newborn C. assuming a passive role in meeting her own needs D. becoming preoccupied with the present

Answer: C Rationale: The first task of adjusting to the maternal role is the taking-in phase in which the mother demonstrates dependent behaviors and assumes a passive role in meeting own basic needs. During the taking-hold phase, the mother becomes preoccupied with the present. During the letting-go phase, the mother reestablishes relationships with others and demonstrates increased responsibility and confidence in caring for the newborn.

13. A nurse is working with a group of clients who are victims of intimate partner violence. The nurse focuses interventions on which area as the primary goal? A. convincing them to leave the abuser soon B. helping them cope with their life as it is C. empowering them to regain control of their life D. arresting the abuser so he or she cannot abuse again

Answer: C Rationale: The goal of interventions is to enable the victim to gain control over life. Although the nurse can encourage a victim to leave an abuser, the choice to leave must be made by the victim. The nurse can provide support and assistance with coping, but the ultimate goal is for the victim to become empowered. Arresting the abuser does not necessarily stop the abuse.

13. Which method would be most effective in evaluating the parents' understanding about their newborn's care? A. Demonstrate all infant care procedures. B. Allow the parents to state the steps of the care. C. Observe the parents performing the procedures. D. Routinely assess the newborn for cleanliness.

Answer: C Rationale: The most effective means to evaluate the parents' learning is to observe them performing the procedures. Parental roles develop and grow through interaction with their newborn. The nurse would involve both parents in the newborn's care and praise them for their efforts. Demonstrating the procedures to the parents and having the parents state the steps are helpful but do not guarantee that the parents understand them. Assessing the newborn for cleanliness would provide little information about parental learning.

11. A client is experiencing postpartum hemorrhage, and the nurse begins to massage her fundus. Which action would be most appropriate for the nurse to do when massaging the woman's fundus? A. Place the hands on the sides of the abdomen to grasp the uterus. B. Use an up-and-down motion to massage the uterus. C. Wait until the uterus is firm to express clots. D. Continue massaging the uterus for at least 5 minutes.

Answer: C Rationale: The uterus must be firm before attempts to express clots are made because application of firm pressure on an uncontracted uterus could lead to uterine inversion. One hand is placed on the fundus and the other hand is placed on the area above the symphysis pubis. Circular motions are used for massage. There is no specified amount of time for fundal massage. Uterine tissue responds quickly to touch, so it is important not to overmassage the fundus.

1. Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition? A. retained placental fragments B. hypertension C. thrombophlebitis D. uterine subinvolution

Answer: C Rationale: The woman is at risk for thrombophlebitis due to the prolonged second stage of labor, necessitating an increased amount of time in bed, and venous pooling that occurs when the woman's legs are in stirrups for a long period of time. These findings are unrelated to retained placental fragments, which would lead to uterine subinvolution, or hypertension.

17. A nurse is completing a postpartum assessment. Which finding would alert the nurse to a potential problem? A. lochia rubra with a fleshy odor B. respiratory rate of 16 breaths per minute C. temperature of 101° F (38.3° C) D. pain rating of 2 on a scale from 0 to 10

Answer: C Rationale: Typically, the new mother's temperature during the first 24 hours postpartum is within the normal range. Some women experience a slight fever, up to 100.4º F (38º C), during the first 24 hours. A temperature above 100.4º F (38º C) at any time or an abnormal temperature after the first 24 hours may indicate infection and must be reported. Foul-smelling lochia or lochia with an unexpected change in color or amount, shortness of breath, or respiratory rate below 16 or above 20 breaths per minute would also be a cause for concern. The goal of pain management is to have the woman's pain scale rating maintained between 0 to 2 points at all times, especially after breast-feeding.

2. When caring for a mother who has had a cesarean birth, the nurse would expect the client's lochia to be: A. greater than after a vaginal birth. B. about the same as after a vaginal birth. C. less than after a vaginal birth. D. saturated with clots and mucus.

Answer: C Rationale: Women who have had cesarean births tend to have less flow because the uterine debris is removed manually along with delivery of the placenta.

24. A nurse teaches a postpartum woman about her risk for thromboembolism. The nurse determines that additional teaching is required when the woman identifies which as a factor that increases her risk? A. increase in clotting factors B. vessel damage C. immobility D. increase in red blood cell production

Answer: D Rationale: Clotting factors that increased during pregnancy tend to remain elevated during the early postpartum period. Giving birth stimulates this hypercoagulability state further. As a result, these coagulation factors remain elevated for 2 to 3 weeks postpartum (Silver & Major, 2010). This hypercoagulable state, combined with vessel damage during birth and immobility, places the woman at risk for thromboembolism (blood clots) in the lower extremities and the lungs. Red blood cell production ceases early in the puerperium, which leads to mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly over the next 2 weeks.

13. A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which factor would the nurse identify as being a significant contributor to this condition? A. early ambulation B. short duration of labor C. breastfeeding D. use of anesthetics

Answer: D Rationale: Factors that inhibit involution include prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution include complete expulsion of amniotic membranes and placenta at birth, complication-free labor and birth process, breastfeeding, and early ambulation.

3. The nurse is developing a teaching plan for a client who has decided to bottle-feed her newborn. Which information would the nurse include in the teaching plan to facilitate suppression of lactation? A. encouraging the woman to manually express milk B. suggesting that she take frequent warm showers to soothe her breasts C. telling her to limit the amount of fluids that she drinks D. instructing her to apply ice packs to both breasts every other hour

Answer: D Rationale: If the woman is not breastfeeding, relief measures for engorgement include wearing a tight supportive bra 24 hours daily, applying ice to her breasts for approximately 15 to 20 minutes every other hour, and not stimulating her breasts by squeezing or manually expressing milk. Warm showers enhance the let-down reflex and would be appropriate if the woman was breastfeeding. Limiting fluid intake is inappropriate. Fluid intake is important for all postpartum women, regardless of the feeding method chosen.

22. The nurse is providing an in-service education program to a group of home health care nurses who provide care to postpartum women. After teaching the group about the process of involution, the nurse determines that additional teaching is needed when the group identifies which process as being involved? A. catabolism B. muscle fiber contraction C. epithelial regeneration D. vasodilation

Answer: D Rationale: Involution involves three retrogressive processes: contraction of muscle fibers to reduce those previously stretched during pregnancy; catabolism, which reduces enlarged myometrial cells; and regeneration of uterine epithelium from the lower layer of the deciduas after the upper layers have been sloughed off and shed during lochial discharge. Vasodilation is not involved.

32. A nurse is providing education to a woman who is experiencing postpartum hemorrhage and is to receive a uterotonic agent. The nurse determines that additional teaching is needed when the woman identifies which drug as possibly being prescribed as treatment? A. oxytocin B. methylergonovine C. carboprost D. magnesium sulfate

Answer: D Rationale: Magnesium sulfate is during labor as a tocolytic agent to slow or halt preterm labor. It is not be used to treat postpartum hemorrhage. Oxytocin, methylergonovine, and carboprost are drugs used to manage postpartum hemorrhage.

3. A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would question the woman about which symptom? A. an inverted nipple on the affected breast B. no breast milk in the affected breast C. an ecchymotic area on the affected breast D. hardening of an area in the affected breast

Answer: D Rationale: Mastitis is characterized by a tender, hot, red, painful area on the affected breast. An inverted nipple is not associated with mastitis. With mastitis, the breast is distended with milk, the area is inflamed (not ecchymotic), and there is breast tenderness.

17. A nurse is teaching a new mother about breastfeeding. The nurse determines that the teaching was successful when the woman identifies which hormone as responsible for milk let-down? A. prolactin B. estrogen C. progesterone D. oxytocin

Answer: D Rationale: Oxytocin is released from the posterior pituitary to promote milk let-down. Prolactin levels increase at term with a decrease in estrogen and progesterone; estrogen and progesterone levels decrease after the placenta is delivered. Prolactin is released from the anterior pituitary gland and initiates milk production.

28. As part of an in-service program to a group of home health care nurses who care for postpartum women, a nurse is describing postpartum depression. The nurse determines that the teaching was successful when the group identifies that this condition becomes evident at which time after birth of the newborn? A. in the first week B. within the first 2 weeks C. in approximately 1 month D. within the first 6 weeks

Answer: D Rationale: PPD usually has a gradual onset and becomes evident within the first 6 weeks postpartum. Postpartum blues typically manifests in the first week postpartum. Postpartum psychosis usually appears about 3 months after birth of the newborn.

18. After teaching a class at a local college campus on date rape, the nurse determines that the teaching was successful when the class identifies which substance as the most common date rape drug? A. gamma hydroxybutyrate B. liquid ecstasy C. ketamine D. rohypnol

Answer: D Rationale: Rohypnol is the most common date rape drug. Others include gamma hydroxybutyrate (or liquid ecstasy) and ketamine.

8. A nurse is assessing a postpartum client. Which finding would the cause the nurse the greatest concern? A. leg pain on ambulation with mild ankle edema B. calf pain with dorsiflexion of the foot C. perineal pain with swelling along the episiotomy D. sharp, stabbing chest pain with shortness of breath

Answer: D Rationale: Sharp, stabbing chest pain with shortness of breath suggests pulmonary embolism, an emergency that requires immediate action. Leg pain on ambulation with mild edema suggests superficial venous thrombosis. Calf pain on dorsiflexion of the foot may indicate deep vein thrombosis or a strained muscle or contusion. Perineal pain with swelling along the episiotomy might be a normal finding or suggest an infection. Of the conditions, pulmonary embolism is the most urgent.

5. A client who is breastfeeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate? A. "Your uterus is still shrinking in size; that's why you're feeling this pain." B. "Let me check your vaginal discharge just to make sure everything is fine." C. "Your body is responding to the events of labor, just like after a tough workout." D. "The baby's sucking releases a hormone that causes the uterus to contract."

Answer: D Rationale: The woman is describing afterpains, which are usually stronger during breastfeeding because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains are associated with uterine involution, but the woman's description strongly correlates with the hormonal events of breastfeeding. All women experience afterpains, but they are more acute in multiparous women secondary to repeated stretching of the uterine muscles.

6. A woman is scheduled for an anterior and posterior colporrhaphy as treatment for a cystocele. When the nurse is explaining this treatment to the client, which description would be most appropriate to include? A. "This procedure helps to tighten the vaginal wall in the front and back so that your bladder and urethra are in the proper position." B. "Your uterus will be removed through your vagina, helping to relieve the organ that is putting the pressure on your bladder." C. "This is a series of exercises that you will learn to do so that you can strengthen your bladder muscles." D. "These are plastic devices that your primary care provider will insert into your vagina to provide support to the uterus and keep it in the proper position."

Answer: A Rationale: An anterior and posterior colporrhaphy tightens the anterior and posterior vaginal wall, and the supportive tissue between the vagina and bladder is folded and sutured to bring the bladder and urethra into proper position. Removal of the uterus through the vagina refers to a vaginal hysterectomy. Exercises to strengthen the bladder muscles are called Kegel exercises. Plastic devices inserted to provide support are called pessaries.

19. The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the client's statement that she is worried that she will not be the same. Which outcome would be appropriate for this client? A. Client will verbalize positive statements about self and sexuality. B. Client will demonstrate understanding of the condition and associated treatment. C. Client will exhibit positive coping strategies related to diagnosis. D. Client will identify misconceptions related to her diagnosis.

Answer: A Rationale: An appropriate outcome for disturbed body image would be that the client verbalizes positive statements about herself and her sexuality. Demonstrating understanding of the condition and treatment and identifying misconceptions would be appropriate for a nursing diagnosis of deficient knowledge. Exhibiting positive coping strategies would be appropriate for a nursing diagnosis of anxiety.

2. The nurse determines that a woman has implemented prescribed therapy for her fibrocystic breast disease when the client reports that she has eliminated which from her lifestyle? A. caffeine B. cigarettes C. dairy products D. sweets

Answer: A Rationale: Caffeine is a stimulant and eliminating it will help reduce symptoms of fibrocystic breast disease. Cigarettes, dairy products, and sweets are not associated with symptoms of fibrocystic breast disease.

29. A client is diagnosed with fibrocystic breast disease. After teaching the client about this condition, the nurse determines that the teaching was successful based on which client statement? A. "I need to cut out drinking coffee like I'm used to doing." B. "It's important that I stop smoking or my condition will get worse." C. "I guess I'll have to find a replacement for milk and cheese." D. "No more cookies and baked goods for me."

Answer: A Rationale: Caffeine is a stimulant, and eliminating it will help reduce symptoms of fibrocystic breast disease. Thus cutting out coffee from the client's intake indicates understanding of the situation. Although smoking cessation is important for anyone, cigarettes, along with dairy products such as milk and cheese, and sweets, such as cookies and baked goods, are not associated with symptoms of fibrocystic breast disease.

6. A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method? A. freezing B. cutting C. burning D. irradiating

Answer: A Rationale: Cryosurgery destroys abnormal cervical tissue by freezing. Conization involves cutting out a cone-shaped section of tissue. Laser therapy destroys cervical tissue by using highenergy light to burn it off. Radiation therapy involves irradiating the tissue for destruction.

11. The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate? A. "Currently there is no reliable screening test for ovarian cancer." B. "A Papanicolaou test is almost always helpful in identifying this type of cancer." C. "There's a blood test for a marker, CA-125, that if elevated indicates cancer." D. "A genetic test for two genes, if positive, will identify the ovarian cancer."

Answer: A Rationale: Currently there are no adequate screening tests for ovarian cancer. A Papanicolaou test is used to screen for cervical cancer. The CA-125 marker may be elevated in women with ovarian cancer, but it is not specific for this cancer and may be elevated in other malignancies. Genetic testing via BRCA-1 and BRCA-2 provides information about a woman's risk but does not predict if the woman will develop cancer.

5. A nurse is developing a plan of care for a victim of intimate partner violence. Which intervention would be least appropriate for the nurse to include? A. assisting the client to project anger B. providing information about a safe home and crisis line C. teaching the client about the cycle of violence D. discussing the client's legal and personal rights

Answer: A Rationale: The goal of intervention is to enable the victim to gain control by providing sensitive, predictable care in an accepting setting. Assisting the client to project anger would not be helpful when the client needs support and education.

11. When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which information would the nurse include? A. care of the indwelling catheter at home B. emphasis on coughing to prevent complications C. return to usual activity level in a few days D. daily douching with dilute vinegar solution

Answer: A Rationale: Following surgery to repair a pelvic organ prolapse, the nurse would teach the woman about caring for the indwelling catheter, which will remain in place for approximately 1 week. Activities that increase intra-abdominal pressure, such as straining, sneezing, or coughing, should be avoided. The woman also should avoid heavy lifting or straining for several weeks. Pelvic rest is prescribed until the operative area is healed in 6 weeks. Douching is indicated if the woman had a pessary inserted, not surgery.

4. A nurse is conducting a presentation for a local women's group about pelvic floor disorders. Which instruction would the nurse include about preventing pelvic support disorders? A. performing Kegel isometric exercises B. consuming low-fiber diets C. using hormone replacement D. voiding every 2 hours

Answer: A Rationale: Kegel exercises are an effective preventive measure for pelvic support disorders. They may limit the progression of a mild prolapse and alleviate mild prolapse symptoms. High-fiber rather than low-fiber diets are appropriate to reduce straining associated with constipation. Hormone replacement therapy must be highly individualized and is not an appropriate option for every woman. Normal voiding patterns typically are every 3 to 5 hours. Too frequent or too infrequent voiding can lead to problems.

25. The nurse is caring for a client with polycystic ovarian syndrome (PCOS) who is receiving oral contraceptives as part of her treatment plan. The nurse teaches the client about the drug therapy and how it will help her. The nurse determines that the teaching was successful when the client states which reason for the drug? A. "It will help regulate my menstrual cycle." B. "It will help me to ovulate." C. "My body will be able to use insulin better." D. "It will help decrease my hair growth."

Answer: A Rationale: Oral contraceptives are used as treatment for PCOS to restore menstrual irregularities and treat acne. Ovulation induction agents such as clomiphene are used to induce ovulation. Metformin is used to improve insulin uptake. Mechanical hair removal methods are used to treat hirsutism.

8. A client with polycystic ovarian syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. When discussing this treatment with the client, the nurse would discuss which rationale for this therapy? A. restore menstrual regularity B. induce ovulation C. improve insulin uptake D. alleviate hirsutism

Answer: A Rationale: Oral contraceptives are used as treatment for PCOS to restore menstrual irregularities and treat acne. Ovulation induction agents such as clomiphene are used to induce ovulation. Metformin is used to improve insulin uptake. Mechanical hair removal methods are used to treat hirsutism.

8. As part of discharge planning, the nurse refers a woman to Reach to Recovery. The nurse initiates this referral to facilitate which goal? A. help support women who have undergone mastectomies B. raise funds to support early breast cancer detection programs C. provide all supplies needed after breast surgery for no cost D. collect statistics for research for the American Cancer Society

Answer: A Rationale: Reach for Recovery is an organization that gives women and their families opportunities to express their feelings, verbalize their fears, and get answers. Reach to Recovery volunteers provide living proof that people can survive breast cancer and lead productive lives. Reach to Recovery helps raise funds, provide supplies, and collect statistics, but these are not the program's primary purpose.

27. A client with advanced breast cancer, who has had both chemotherapy and radiation therapy, is to start hormonal therapy using a selective estrogen receptor modulator (SERM). Which agent would the nurse expect the client to receive? A. tamoxifen B. letrozole C. exemestane D. cortisone

Answer: A Rationale: Tamoxifen is an example of a SERM used as adjunctive treatment for breast cancer. Letrozole and exemestane are aromatase inhibitors used to treat advanced breast cancer. Cortisone is a steroid and would not be used.

6. During a clinical breast examination, the nurse palpates a well-defined, firm, mobile lump in a 60-year-old woman's left breast. The nurse notifies the primary care provider. What would the nurse anticipate the care provider to prescribe next? A. mammogram B. hormone receptor status C. fine-needle aspiration D. genetic testing for BRCA

Answer: A Rationale: The characteristics of the palpated mass suggest that it is a benign mass, most likely a fibroadenoma. However, since other breast lesions have similar characteristics, the lump needs to be evaluated via mammography. Hormone receptor status is used to determine if a malignant mass is stimulated to grow by estrogen or progesterone. A fine-needle aspiration may be done later on if there is reason to suspect a malignancy. Genetic testing for the BRCA genes would be done to determine a woman's risk for breast cancer, but this would not be done next.

26. A client is experiencing urinary incontinence. The nurse is teaching the client measures to regain control of the urinary sphincter. The nurse determines that the teaching was effective when the client states she will perform which action? A. Perform Kegel exercises daily. B. Urinate every hour while awake. C. Limit the intake of fluids. D. Use a laxative every night.

Answer: A Rationale: The client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.

29. A client is diagnosed with urinary incontinence. The nurse teaches the client about the condition and ways to manage it. The nurse determines that the teaching was successful based on which client statement? A. "I will limit my daily fluid intake to about 1.5 liters." B. "I can continue to drink coffee, but I must avoid drinking tea." C. "I can use a feminine deodorant spray to help control the odor." D. "I should perform Kegel exercises about once a week."

Answer: A Rationale: The client with urinary incontinence must avoid drinking too much fluid, typically limiting fluid intake to about 1.5 liters/day. The client also should avoid caffeine which includes tea as well as coffee. The client should use a mild soap and water for perineal care. Feminine hygiene sprays are not indicated and can be irritating. Kegel exercises should be done at least 5 times each day.

14. When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area? A. labia majora B. labia minora C. clitoris D. prepuce

Answer: A Rationale: The diagnosis of vulvar cancer is made by biopsy of the suspicious lesion, which is most commonly found on the labia majora.

8. When a nurse suspects that a client may be a victim of intimate partner violence, the first action should be to: A. ask the client about the injuries and if they are related to intimate partner violence. B. encourage the client to leave the abuser immediately. C. set up an appointment with an intimate partner violence counselor. D. ask the suspected abuser about the victim's injuries.

Answer: A Rationale: The first step is to screen for intimate partner violence and identify the connection between the client's injuries and that abuse. Once intimate partner violence is detected, the nurse should immediately isolate the client to provide privacy and prevent retaliation by the abuser. Encouraging the client to leave the abuser immediately is not realistic. Setting up an appointment with a counselor would be appropriate once intimate partner violence is detected and the client is safe. Questioning the suspected abuser might worsen the situation.

30. A laboratory technician arrives to draw blood for a complete blood count (CBC) for a client who had a left-sided mastectomy 8 hours ago. The client has an intravenous line with fluid infusing in her right antecubital space. The nurse enters the room and sees the technician beginning to place a tourniquet on the client's right arm. Which response by the nurse would be most appropriate? A. Stop the technician immediately. B. Have the technician come back later on. C. Notify the surgeon to obtain the specimen via a cut-down procedure. D. Tell the technician to obtain the specimen from the client's left arm.

Answer: A Rationale: The nurse should immediately stop the technician from obtaining the specimen. The left arm cannot be used because the mastectomy was performed on that side. The right arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Telling the technician to come back later on does not address the situation at present. Notifying the surgeon may be appropriate, but a cut-down procedure is invasive, and other less invasive options should be attempted first before considering such a procedure.

12. A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head, but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would the nurse identify as the priority? A. situational low self-esteem related to masculinization effects of the disease B. social isolation related to feelings about appearance C. risk for suicide related to effects of condition and fluctuating hormone levels D. ineffective peripheral tissue perfusion related to effects of disease on vasculature

Answer: A Rationale: The woman is verbalizing how she sees herself in light of the manifestations of PCOS. She is exhibiting a negative self-image. Therefore, the nursing diagnosis of situational low self-esteem would be a priority. There is no information about the woman's participation in social activities. Her statements do not reflect that she might hurt herself. PCOS is associated with long-term health problems, but this is not evidenced by the scenario.

16. A woman diagnosed with breast cancer is to receive trastuzumab. What information would the nurse incorporate into the explanation about how this drug works? A. It blocks the effect of the HER-2/neu protein inhibiting the growth of cancer cells. B. The drug blocks the conversion of androgens to estrogens. C. It interferes with hormone receptors that allow estrogen to enter a cell. D. The drug ultimately attacks areas where micrometastasis has occurred.

Answer: A Rationale: Trastuzumab is immunotherapy approved for breast cancer. Breast cancers that overexpress the protein HER-2/neu are associated with a more aggressive form of disease and a poorer prognosis. Trastuzumab target the HER2 pathway to inhibit the growth of cancer cells. The aromatase inhibitors work by inhibiting the conversion of androgens to estrogens. SERMs Interfere with the hormone receptors that allow estrogen to enter the cell and stimulate it to divide. The goal of any chemotherapeutic regimen is to perform a system sweep of the body to reduce the chances that distant tumors will grow or micrometastasis will occur.

28. A woman who has undergone a right modified-radical mastectomy returns from surgery. The nurse would focus immediate interventions on which area as the priority? A. respiratory function B. body image C. lymphedema prevention D. incisional care

Answer: A Rationale: Upon return from surgery, the nurse's priority would be on the client's respiratory function, encouraging the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Body image and prevention of lymphedema would be priorities later on in the client's course of care. The client will most likely have a surgical dressing in place that most likely would not be removed in the immediate postoperative period.

16. Vulvar cancer is suspected in a client. When reviewing the client's history which report would the nurse most likely find? Select all that apply. A. dyspareunia B. persistent vulvar itching C. history of herpes simplex D. lesion on the cervix E. abnormal Papanicolaou test result

Answer: A, B, C Rationale: Leading presenting reports of women with vulvar cancer include dyspareunia, long history of pruritis, ulcers on the "outside" genitalia, vulvar swelling, vulvar bleeding, and urinary problems. In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Papanicolaou test result are not associated with vulvar cancer.

28. A client comes to the clinic for an evaluation. After assessing the client, the nurse suspects that the client may be experiencing uterine prolapse. Which findings would the nurse report when notifying the primary care provider about the suspicion? Select all that apply. A. urge to defecate B. nocturnal urinary frequency C. abdominal pressure D. low back pain on sitting E. dyspareunia

Answer: A, B, C, E Rationale: Symptoms associated with pelvic organ prolapse including urgency of defecation, diurnal and nocturnal frequency, abdominal pressure and pain, low back pain on standing for long periods and dyspareunia.

29. A nurse is conducting a class for a group of young adult women at a local women's health clinic. The nurse is describing ovarian cancer and ways to reduce the risk. The nurse determines that the teaching was successful based on which statement(s) from the group? Select all that apply. A. "We should avoid using any kind of talc near our genitals." B. "Breastfeeding is better than bottle feeding to lower our risk." C. "We should eat foods that have a higher fat content." D. "Keeping our weight fairly even and at a healthy level is important." E. "Birth control with diaphragms is better than using birth control pills."

Answer: A, B, D Rationale: Ways to reduce the risk of ovarian cancer include getting pregnant, using oral contraceptives (for 3 years or longer), breastfeeding (before the age of 30), and avoiding the use of talc and hygiene sprays on the genitals. It is also important to maintain healthy lifestyles, including maintaining a healthy weight and eating a low-fat diet.

20. A woman comes to the clinic and tells the nurse that she has read an article about certain foods that have anticancer properties and help boost the immune system. During the discussion, the nurse would expect the client to identify which foods? Select all that apply. A. garlic B. soybeans C. milk D. leeks E. flax seed

Answer: A, B, D, E Rationale: Phytochemical-rich foods include green tea and herbal teas; garlic; whole grains and legumes; onions and leeks; soybeans and soy products; tomato products (cooked tomatoes); fruits (citrus, apricots, pumpkin, berries); green leafy vegetables (spinach, collards, romaine); colorful vegetables (carrots, squash, tomatoes); cruciferous vegetables (broccoli, cabbage, cauliflower); and flax seeds.

17. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as a risk factor for this cancer? Select all that apply. A. 55 years of age B. history of breast cancer C. monogamous sexual partner D. HSV-type 2 exposure E. obesity

Answer: A, B, D, E Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HSV type 2, history of breast cancer, multiple sex partners, obesity, hypertension, and diabetes.

27. A nurse is reading a journal article about treatment options for fibroids. Which information would the nurse most likely find as a disadvantage associated with uterine artery embolization? Select all that apply. A. The procedure often causes pain. B. It can negatively affect fertility. C. The fibroids can regrow after the procedure. D. The procedure is noninvasive. E. Radiation and contrast dye are used.

Answer: A, B, E Rationale: Uterine artery embolization is frequently painful, minimally invasive, and requires the use of radiation and contrast dye. In addition, although future fertility is possible, there is a possibility of a negative effect on fertility. Fibroids can regrow after treatment with hormones, a noninvasive treatment.

22. A nurse is conducting a class for a local woman's group about recommendations for a Papanicolaou test. One of the participants asks, "At what age should a woman have her first test?" The nurse responds by stating that a woman should have her first Papanicolaou test at which age? A. 18 B. 21 C. 25 D. 28

Answer: B Rationale: Although professional medical organizations disagree as to the recommended frequency of screening for cervical cancer, ACOG (2018b) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history), since women younger than age 21 are at very low risk of cancer.

23. A nurse is teaching a client how to perform Kegel exercises. Which directives would the nurse include? Select all that apply. A. "Squeeze your rectal muscles as if you are trying to avoid passing flatus." B. "Tighten your pubococcygeal muscles for a count of 10." C. "Contract and relax your pubococcygeal muscles rapidly 10 times." D. "Try bearing down for about 10 seconds for no more than 5 times." E. "Do these exercises at least 5 times every hour."

Answer: A, C Rationale: To perform Kegel exercises, the nurse would tell the client to squeeze the muscles in her rectum as if she is trying to prevent passing flatus. Then the nurse would tell the client to stop and start urinary flow to help identify the pubococcygeus muscle. Once this is accomplished, the nurse would tell the client to tighten the pubococcygeus muscle for a count of 3, and then relax it. Next the nurse would tell the woman to contract and relax the pubococcygeus muscle rapidly 10 times and try to bring up the entire pelvic floor and bear down 10 times. Finally, the nurse would tell the client to repeat these exercises at least 5 times daily.

9. Which description would the nurse include when teaching a client about a scheduled colposcopy? A. "A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas." B. "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument." C. "Scrapings of tissue will be obtained and placed on slides to be examined under the microscope." D. "After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples."

Answer: B Rationale: A colposcopy is a microscopic examination of the lower genital tract using a magnifying instrument. Use of a microphone-like device over the abdomen describes an ultrasound. Obtaining tissue scrapings that are examined under a microscope describes a Papanicolaou test. Insertion of a device under anesthesia near the umbilicus describes a biopsy obtained via laparoscopy.

5. A 42-year-old woman is scheduled for a mammogram. Which statement would the nurse include when teaching the woman about the procedure? A. "The room will be darkened throughout the procedure." B. "Each breast will be firmly compressed between two plates." C. "Make sure to refrain from eating or drinking after midnight." D. "A dye will be injected to highlight the breast tissue and its ducts."

Answer: B Rationale: A mammogram involves taking X-ray pictures of the breasts while they are compressed between two plastic plates. There is no need to darken the room or to refrain from eating or drinking after midnight. A ductography involves the injection of dye to highlight the breast ducts.

3. When developing the plan of care for a woman who has had an abdominal hysterectomy, the nurse would identify which action as contraindicated? A. ambulating the client B. massaging the client's legs C. applying elasticized stockings D. encouraging range-of-motion exercises

Answer: B Rationale: After an abdominal hysterectomy, massaging the client's legs would be contraindicated because the woman is at risk for venous stasis, thrombophlebitis, and thromboembolism. Ambulation, elasticized stockings, and range-of-motion exercises would be appropriate to reduce the woman's risk for thrombophlebitis.

1. A 58-year-old client comes to the clinic for evaluation. After obtaining the client's history, the nurse suspects endometrial cancer. Which information would lead the nurse to this suspicion? A. use of oral contraceptives between ages 18 and 25 B. onset of painless, bright red postmenopausal bleeding C. menopause occurring at age 46 D. use of intrauterine device for 3 years

Answer: B Rationale: Any episode of bright red painless bleeding occurring after menopause needs to be investigated. Abnormal uterine bleeding in postmenopausal women should be regarded with suspicion. Oral contraceptive use is associated with cervical cancer. Late menopause (after age 52) is associated with endometrial cancer. Use of an intrauterine device is not associated with endometrial cancer.

17. When describing programs for breast cancer screening, the nurse includes breast selfexamination (BSE). Which statement most accurately reflects the current thinking about breast self-examination? A. BSE is essential for early breast cancer detection. B. A woman performing BSE has breast awareness. C. BSE plays a minimal role in detecting breast cancer. D. A clinical breast exam has replaced BSE.

Answer: B Rationale: Breast self-examination (BSE) is a technique that enables a woman to detect any changes in her breasts. Breast self-exams, once thought essential for early breast cancer detection, are now considered optional. Instead, breast awareness is stressed. Breast awareness refers to a woman being familiar with the normal consistency of both breasts and the underlying tissue. This emphasis is now on awareness of breast changes, not just discovery of cancer. Research has shown that breast self-examination plays a small role in detecting breast cancer compared with self-awareness. However, doing breast self-examination is one way for a woman to know how her breasts normally feel so that she can notice any changes that do occur. Clinical breast examination has not replaced BSE.

15. The nurse is developing a plan of care for a woman with breast cancer who is scheduled to undergo breast-conserving surgery. The nurse interprets this as which procedure? A. removal of nipple and areolar area B. lump removal followed by radiation C. entire breast removal without lymph nodes D. axillary lymph node removal

Answer: B Rationale: Breast-conserving surgery is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue. A lumpectomy is often used for early-stage localized tumors and is followed by radiation to eradicate residual microscopic cancer cells. A simple mastectomy is the removal of all breast tissue, the nipple, and the areola. The axillary nodes and pectoral muscles are spared. A modified radical mastectomy involves removal of breast tissue, the axillary nodes, and some chest muscles, but not the pectoralis major, thus avoiding a concave anterior chest.

13. A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which information about the cancer? A. spread to the uterine muscle wall B. found on the endometrial surface C. spread to the cervix D. invaded the bladder

Answer: B Rationale: Carcinoma in situ is found only on the endometrial surface. In stage I, the cancer has spread to the uterine muscle wall. In stage II, it has spread to the cervix. In stage IV, it has invaded the bladder mucosa with distant metastases to the lungs, liver, and bone.

17. After undergoing diagnostic testing, a woman is diagnosed with a corpus luteum cyst. The nurse anticipates that the woman will require: A. biopsy. B. no treatment. C. oral contraceptives. D. metformin.

Answer: B Rationale: Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Typically these cysts appear after ovulation and resolve without intervention. Biopsy would be indicated if a malignancy was suspected. Oral contraceptives and metformin would be used to treat polycystic ovarian syndrome.

9. A nurse is listening to a client who is a victim of intimate partner violence. The client is describing how events would unfold with the partner. The nurse interprets the client's statements and identifies which action as characteristic of the second phase of the cycle of violence? A. The batterer is contrite and attempts to apologize for the behavior. B. The physical battery is abrupt and unpredictable. C. Verbal assaults begin to escalate toward the victim. D. The victim accepts the anger as legitimately directed at him or her.

Answer: B Rationale: During the second phase of the cycle of violence, the violence explodes and the batterer loses control physically and emotionally. During the honeymoon or third phase, the batterer is contrite and attempts to apologize for the behavior. During the first phase or tensionbuilding phase, verbal or minor battery occurs and the victim often accepts the partner's building anger as legitimately directed toward him or her.

7. A client is diagnosed with uterine fibroids. When reviewing the client's health history, the nurse would identify which finding as associated with the client's condition? A. diarrhea B. chronic pelvic pain C. amenorrhea D. upper back pain

Answer: B Rationale: Findings associated with uterine fibroids include chronic pelvic pain, constipation, dysmenorrhea, and lower back pain.

14. After teaching a woman with pelvic organ prolapse about dietary and lifestyle measures, which statement would indicate the need for additional teaching? A. "If I wear a girdle, it will help support the muscles in the area." B. "I should take up jogging to make sure I exercise enough." C. "I will try to drink at least 64 oz of fluid each day." D. "I need to increase the amount of fiber I eat every day."

Answer: B Rationale: High-impact aerobics, jogging, or jumping repeatedly should be avoided to reduce the risk of increasing intra-abdominal pressure. Wearing a girdle or abdominal support helps to support the muscles surrounding the pelvic organs. The woman should consume at least eight 8- oz glasses of fluid daily and replace refined low-fiber foods with high-fiber foods.

31. A client is being discharged after having a right-sided modified radical mastectomy. After teaching the client about ways to minimize lymphedema, the nurse determines that the teaching was successful based on which client statement? A. "I should use lotion on my hands after working in my garden." B. "I need to avoid wearing tops that have elastic in the sleeves." C. "I should have my blood pressure taken in my right arm." D. "I need to limit my driving to once a week."

Answer: B Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. However, wearing a well-fitted compression sleeve would promote drainage return. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema.

15. When describing the various types of reproductive tract cancers to a local women's group, the nurse would identify which cancer as the least common type? A. vulvar B. vaginal C. endometrial D. ovarian

Answer: B Rationale: Of the cancers listed, vaginal cancer is the rarest. Only about one of every 1,100 women will develop vaginal cancer in her lifetime. Vulvar cancer represents approximately 4% of female genital cancers. Endometrial cancer is the fourth most common gynecologic malignancy in the United States and sixth most common cancer globally. It accounts for 7% of all cancers in women in the United States (one in 40 women). Ovarian cancer is the fifth most common cancer among women and the most common cause of cancer deaths for women in the United States.

5. Which finding obtained during a client history would the nurse identify as increasing a client's risk for ovarian cancer? A. multiple sexual partners B. consumption of a high-fat diet C. underweight D. grand multiparity (more than five children)

Answer: B Rationale: Risk factors for ovarian cancer include a high-fat diet, obesity, nulliparity, early menarche, late menopause, and increasing age. Having multiple sexual partners is a risk factor for cervical cancer.

4. A physically abused pregnant woman reports to the nurse that her spouse has stopped hitting her and promises never to hurt her again. Which response by the nurse would be most appropriate? A. "That's great. I wish you both the best." B. "Remember, the cycle of violence often repeats itself." C. "He probably didn't mean to hurt you." D. "You need to consider leaving him."

Answer: B Rationale: The cycle of violence typically increases in frequency and severity as it is repeated over and over again. The woman needs to understand this.

6. A nurse is describing the cycle of violence to a community group. When explaining the first phase, the nurse would include which description? A. somehow triggered by the victim's behavior B. characterized by tension-building and minor battery C. associated with loss of physical and emotional control D. like a honeymoon that lulls the victim

Answer: B Rationale: The cyclic behavior begins with a time of tension-building arguments, progresses to violence, and settles into a making-up or calm period.

14. A laboratory technician arrives to draw blood for a complete blood count (CBC) for a client who had a right-sided mastectomy 8 hours ago. The client has an intravenous line with fluid infusing in her left antecubital space. To obtain the blood specimen, the technician places a tourniquet on the client's right arm. Which action by the nurse would be most appropriate? A. Assist in holding the client's arm still. B. Suggest a finger stick be done on one of the client's left fingers. C. Tell the technician to obtain the blood sample from the client's left arm. D. Call the surgeon to perform a femoral puncture.

Answer: B Rationale: The most appropriate action would be to suggest that a finger stick be done. The right arm cannot be used because the mastectomy was performed on that side. The left arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Holding the client's arm still is inappropriate because neither arm should be used. Less invasive options should be attempted first before considering a femoral puncture.

7. A client with advanced breast cancer, who has had both chemotherapy and radiation therapy, is to start endocrine therapy. Which agent would the nurse expect the client to receive? A. trastuzumab B. tamoxifen C. cortisone D. estrogen

Answer: B Rationale: The objective of endocrine therapy is to block or counter the effect of estrogen in the pathogenesis of cancer. The best-known agent is tamoxifen. Use of estrogens in postmenopausal women increases a woman's risk for breast cancer. In addition, estrogen is a considered to play a major role in the development of breast cancer and as such would not be used. Cortisone is a steroid and would not be used. Trastuzumab is an immunotherapeutic agent.

12. After teaching a woman how to perform breast self-examination, which statement would indicate that the nurse's instructions were successful? A. "I should lie down with my arms at my side when looking at my breasts." B. "I should use the fingerpads of my three middle fingers to apply pressure to my breast." C. "I don't need to check under my arm on that side if my breast feels fine." D. "I need to work from left to right down my breast towards my ribs."

Answer: B Rationale: When performing breast self-examination, the client should use the pads of the middle three fingers to palpate the breast. When performing the visual part of the procedure, the woman should look at her breasts with her arms up behind the head, with arms down at the sides, and while bending forward. When palpating the breast, the woman should check the breasts as well as the area between the breast and the axilla, the axilla itself, and the area above the breast up to the clavicle and across the shoulder. When palpating, the woman should use a spiral, pie wedge, or vertical strip approach.

1. The nurse is presenting a class at a local community health center on violence during pregnancy. Which possible complication would the nurse include? A. gestational hypertension B. chorioamnionitis C. placenta previa D. postterm labor

Answer: B Rationale: Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Gestational hypertension is not associated with violence during pregnancy.

25. When assessing a female client for the possibility of vulvar cancer, the nurse would most likely expect the client to report which symptoms? Select all that apply. A. abnormal vaginal bleeding B. persistent vulvar itching C. history of herpes simplex D. lesion on the cervix E. abnormal Papanicolaou test result

Answer: B, C Rationale: In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Papanicolaou test result are not associated with vulvar cancer.

20. During a routine health check-up, a young adult woman asks the nurse about ways to prevent endometrial cancer. Which actions would the nurse most likely include? Select all that apply. A. eating a high-fat diet B. having regular pelvic exams C. engaging in daily exercise D. becoming pregnant E. using estrogen contraceptives

Answer: B, C, D Rationale: Measures to prevent endometrial cancer include eating a low-fat diet, having regular pelvic exams after the age of 21, engaging in daily exercise, becoming pregnant (pregnancy serves as a protective factor), and asking the practitioner about the use of combination estrogen and progestin pills.

21. During a wellness visit to the clinic, a 30-year-old woman asks the nurse if there is anything she can do to reduce her risk for developing breast cancer. Which suggestions would be appropriate? Select all that apply. A. "Eat three servings of fruit daily." B. "Keep your weight gain under 11 pounds (5 kilograms)." C. "Eat at least seven portions of complex carbohydrates daily." D. "Limit your intake of refined sugar products." E. "Use salt liberally when cooking"

Answer: B, C, D Rationale: The American Institute for Cancer Research (AICR), which conducts extensive research, made the following recommendations to reduce a woman's risk for developing breast cancer: engaging in daily moderate exercise and weekly vigorous physical activity; consuming at least five servings of fruits and vegetables daily; not smoking or using any tobacco products; keeping a maximum body mass index (BMI) of 25 and limiting weight gain to no more than 11 pounds (5 kilograms) since age 18; consuming seven or more daily portions of complex carbohydrates, such as whole grains and cereals; limiting intake of processed foods and refined sugar; restricting red meat intake to approximately 3 ounces (.08 kilograms) daily; limiting intake of fatty foods, particularly those of animal origin; and restricting intake of salted foods and use of salt in cooking.

21. A nurse is reviewing the medical record of a client. Which finding would lead the nurse to suspect that the client is experiencing polycystic ovarian syndrome? Select all that apply. A. decreased androgen levels B. elevated blood insulin levels C. anovulation D. waist circumference of 32 inches E. triglyceride level of 175 mg/dL F. high-density lipoprotein level of 40 mg/dL

Answer: B, C, E Rationale: Polycystic ovarian syndrome is a multifaceted disorder, and central to its pathogenesis are hyperandrogenemia and hyperinsulinemia. PCOS is associated with obesity, hyperinsulinemia, elevated luteinizing hormone levels (linked to ovulation), elevated androgen levels (virilization), hirsutism (male-pattern hair growth), follicular atresia (ovarian growth failure), ovarian growth and cyst formation, anovulation (failure to ovulate), infertility, type 2 diabetes, sleep apnea, amenorrhea (absence of menstruation or irregular periods) and metabolic syndrome, which is characterized by abdominal obesity (waist circumference >35 in.), dyslipidemia (triglyceride level >150 mg/dL, high-density lipoprotein cholesterol [HDL-C] level <50 mg/dL), elevated blood pressure, a pro-inflammatory state characterized by an elevated Creactive protein level, and a prothrombotic state characterized by elevated PAI-1 and fibrinogen levels.

22. A nurse is conducting a refresher program for a group of nurses about chemotherapy used for breast cancer. After teaching the group about the different types of chemotherapeutic agents used to treat breast cancer, the nurse determines that the teaching was successful when the group identifies which agent as an example of an aromatase inhibitor? Select all that apply. A. tamoxifen B. letrozole C. raloxifene D. exemestane E. anastrozole

Answer: B, D, E Rationale: Letrozole, exemestane, and anastrozole are examples of aromatase inhibitors. Examples of SERMs include tamoxifen and raloxifene.

26. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as risk factors for this cancer? Select all that apply. A. age under 40 years B. HPV 16 exposure C. monogamous sexual partner D. hypertension E. diabetes

Answer: B, D, E Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HPV 16, multiple sex partners, hypertension, and diabetes.

30. A woman diagnosed with uterine fibroids is scheduled for a myomectomy. After reviewing this procedure with the client, the nurse determines that the client understands this procedure based on which statement? A. "This will help to reduce the size of my fibroids." B. "I will have tiny particles put in to shrink the fibroids." C. "The fibroid will be removed but new ones may grow." D. "I will not be able to have any more children."

Answer: C Rationale: A myomectomy involves removing the fibroid alone and leaves the healthy areas of the uterus intact to preserve fertility. Fertility is not jeopardized because this procedure leaves the uterine muscle walls intact. Myomectomy relieves symptoms but does not affect the underlying process; thus, fibroids grow back and further treatment will be needed in the future. Hormones are used to reduce the size of fibroids. Uterine artery embolization (UAE) is an option in which polyvinyl alcohol pellets are injected into selected blood vessels via a catheter to block circulation to the fibroid, causing it to shrink and producing symptom resolution. This procedure can affect fertility. A hysterectomy involves the removal of the uterus and loss of fertility.

18. A nurse is assisting with the collection of a Papanicolaou test. When collecting the specimen, which action is done first? A. insertion of the speculum B. swabbing of the endocervix C. spreading of the labia D. insertion of the cytobrush

Answer: C Rationale: For a Papanicolaou test, the practitioner obtains a sample by spreading the labia; inserting the speculum; inserting the cytobrush and swabbing the endocervix; and inserting the plastic spatula and swabbing the cervix.

15. A nurse is conducting an in-service program for a group of staff nurses working at the women's health center. After teaching the group about genital fistulas, the nurse determines that the teaching was successful when the group identifies which as a major cause of genital fistulas? A. radiation therapy B. congenital anomaly C. female genital cutting D. Bartholin's gland abscess

Answer: C Rationale: Although genital fistulas may be due to radiation therapy, congenital anomaly, or Bartholin's gland abscess, the majority of fistulas are caused by obstetric trauma and female genital cutting.

5. A client is diagnosed with an enterocele. The nurse interprets this condition as: A. protrusion of the posterior bladder wall downward through the anterior vaginal wall. B. sagging of the rectum with pressure exerted against the posterior vaginal wall. C. bulging of the small intestine through the posterior vaginal wall. D. descent of the uterus through the pelvic floor into the vagina.

Answer: C Rationale: An enterocele occurs when the small intestine bulges through the posterior vaginal wall, especially when straining. A cystocele is a protrusion of the posterior bladder wall downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes against or into the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

27. A nurse is conducting an in-service program for a group of nurses about cervical cancer. The nurse determines that the teaching was successful when the group identifies which area as most commonly involved? A. internal cervical os B. junction of the cervix and fundus C. squamous-columnar junction D. external cervical os

Answer: C Rationale: Cervical cancer starts with abnormal changes in the cellular lining or surface of the cervix. Typically these changes occur in the squamous-columnar junction of the cervix. Here, cylindrical secretory epithelial cells (columnar) meet the protective flat epithelial cells (squamous) from the outer cervix and vagina in what is termed the transformation zone.

10. A woman comes to the clinic reporting a greenish-colored nipple discharge On examination, the area below the areola is red and slightly swollen, with tortuous tubular swelling. The nurse interprets these findings as suggestive of which disorder? A. fibrocystic breast disorder B. intraductal papilloma C. duct ectasia D. fibroadenoma

Answer: C Rationale: Duct ectasia is manifested by a greenish nipple discharge. Subareolar redness and swelling can be noted, along with tortuous tubular swellings beneath the areola. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papilloma is manifested by a wart-like growth in the mammary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur. Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast.

3. When describing an episode of intimate partner violence, the victim reports attempting to calm the partner down to keep things from escalating. The nurse interprets this behavior as reflecting which phase of the cycle of violence? A. battering B. honeymoon C. tension-building D. reconciliation

Answer: C Rationale: During the first phase of intimate partner violence, tension-building, the victim attempts to keep the situation from exploding based on the belief that the partner's anger is legitimately directed at him or her. The battering phase involves the explosion of violence. The honeymoon or reconciliation phase is manifested by a period of calm, loving, contrite behavior on the part of the batterer. The batterer may be genuinely sorry for the pain caused.

23. A client has an abnormal Papanicolaou test result that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which procedure? A. immediate colposcopy B. testing for human papillomavirus (HPV) C. repeat Papanicolaou test in 4 to 6 months D. cone biopsy

Answer: C Rationale: For the classification of ASC-US, the client would have a repeat Papanicolaou test in 4 to 6 months or be referred for a colposcopy. A referral for colposcopy with HPV testing is indicated if the results indicated ASC-H classification. An immediate colposcopy would be indicated for atypical glandular cells and adenocarcinoma in situ. A cone biopsy would be used to evaluate the lesion and may be used as treatment to remove any precancers and very early cancers.

9. When teaching a woman how to perform Kegel exercises, the client asks what muscles are being helped with these exercises. The nurse would include reference to which muscles in the response? A. gluteus B. lower abdominal C. pelvic floor D. diaphragmatic

Answer: C Rationale: Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse. They have no effect on the gluteal, lower abdominal, or diaphragmatic muscles.

1. The nurse is developing the discharge plan for a woman who has had a left-sided radical mastectomy. The nurse is including instructions for ways to minimize lymphedema. Which statement by the client indicates the need for additional instruction? A. "I need to wear gloves when doing any gardening." B. "Any blood pressures need to be taken in my right arm." C. "I should wear clothing with elasticized sleeves." D. "I need to avoid driving to and from work every day."

Answer: C Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema.

12. After teaching a group of young women how to reduce their risk for ovarian cancer, the nurse determines that additional teaching is needed when the group identifies which element as a way to reduce risk? A. pregnancy B. use of oral contraceptives C. use of feminine hygiene sprays D. breastfeeding

Answer: C Rationale: Risk reduction strategies include pregnancy, use of oral contraceptives, and breastfeeding. Women should avoid using talc and hygiene sprays on the genital area.

13. Evaluation of a woman with breast cancer reveals that her mass is approximately 1.25 inches in diameter. Three adjacent lymph nodes are positive. The nurse interprets this as indicating that the woman has which stage of breast cancer? A. 0 B. I C. II D. III

Answer: C Rationale: Stage II breast cancer is characterized by a tumor from 1 to 2 inches in diameter with spread to adjacent lymph nodes. Stage 0 cancer is an early stage in which the cancer is extremely localized. Stage I cancer involves a tumor that is localized and less than 1 inch in diameter. Stage III cancer involves a tumor that is 2 inches or larger with spread to other lymph nodes and tissues.

24. The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which practice would the nurse include? A. blood pressure evaluation every 6 months B. yearly Papanicolaou test starting at age 40 C. yearly cholesterol screening starting at age 45 D. consumption of two to three glasses of red wine per day

Answer: C Rationale: Staying healthy is a major way to reduce one's risk for cancer. Cholesterol should be checked annually starting at age 45. Blood pressure should be evaluated at least every 2 years. A Papanicolaou test is recommended every 1 to 3 years for sexually active women, starting at age 21. Alcohol should be consumed in moderation (not more than one drink per day), if at all.

10. The nurse is preparing a presentation for a local women's group about methods to reduce the risk of reproductive tract cancers. Which action should the nurse include? A. blood pressure evaluation every 6 months B. yearly Papanicolaou test starting at age 40 C. condom use with every sexual encounter D. consumption of two to three glasses of red wine per day

Answer: C Rationale: Staying healthy is a major way to reduce one's risk for cancer. Current recommendations include: using a condom with every sexual encounter; having blood pressure evaluated at least every 2 years; undergo a Papanicolaou test every 1 to 3 years, if sexually active, starting at age 21; and consuming alcohol in moderation (not more than one drink per day), if at all.

18. A breast biopsy indicates the presence of malignant cells, and the client is scheduled for a mastectomy. Which nursing diagnosis would the nurse most likely include in the client's preoperative plan of care as the priority? A. risk for deficient fluid volume B. activity intolerance C. disturbed body image D. impaired urinary elimination

Answer: C Rationale: The diagnosis of breast cancer and subsequent removal of the breast via surgery can affect all aspects of life for the woman, but most significantly her body image due to the loss of a body part. Therefore, the most important nursing diagnosis would be disturbed body image. Deficient fluid volume, activity intolerance, and impaired urinary elimination are possible due to the effects of surgery, but these are not as important preoperatively as the client's body image.

16. A nurse is providing care to a female client receiving treatment for a Bartholin cyst. The client has had a small loop of plastic tubing secured in place to allow for drainage. The nurse instructs the client that she will have a follow-up appointment for removal of the plastic tubing at which time? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks

Answer: C Rationale: The follow-up visit for removal of the plastic tubing is in approximately 3 weeks. After the Word catheter is inserted, the balloon tip is inflated, and it is left in place for 4 to 6 weeks.

4. A woman who has undergone a right-sided modified-radical mastectomy returns from surgery. Which nursing intervention would be most appropriate for the nurse to include in the client's plan of care at this time? A. Ask the client how she feels about having her breast removed. B. Attach a sign above her bed to have BP, IV lines, and lab work in her right arm. C. Encourage her to turn, cough, and deep breathe at frequent intervals. D. Position her right arm below heart level.

Answer: C Rationale: Upon return from surgery, the nurse should encourage the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Asking the client how she feels about her breast removal should be done at a later time, when she is more alert and oriented and has had time to think about what has happened. The sign should state that no BP, IV lines, and lab work should be done on the client's right arm. The right arm should be elevated on a pillow to promote lymph drainage.

28. A client is scheduled to undergo a cone biopsy. When explaining this procedure to the client, the nurse understands that the specimen will be obtained from which area? A. clitoris B. uterine fundus C. transformation zone D. ovarian follicle

Answer: C Rationale: When a cone biopsy is performed, a cone-shaped section of the cervix is removed. The base of the cone is formed by the ectocervix (outer part of the cervix) and the point or apex of the cone is from the endocervical canal. The transformation zone is contained within the cone sample. A cone biopsy is not obtained from the clitoris, uterine fundus, or ovarian follicle.

24. A nurse is preparing a presentation for a group of community nurses about benign and malignant breast masses. The nurses demonstrate understanding when they identify which as an indication of a benign breast mass? Select all that apply. A. absence of pain B. unilateral location C. firm consistency D. absence of dimpling E. fixed to the chest wall

Answer: C, D Rationale: Benign breast masses are typically painful, firm, and rubbery in consistency, often bilateral, no dimpling and mobile, without being affixed to the chest wall.

19. A nurse is conducting a class on breast cancer prevention. Which statement would the nurse include in the discussion? A. "Most often a lump is felt before it is seen." B. "Early breast cancer usually has some symptoms." C. "If the mass is not painful, it is usually benign." D. "If lump is palpable, it has been there for some time."

Answer: D Rationale: Early breast cancer has no symptoms. If a lump can be palpated, the cancer has been there for quite some time. The earliest sign of breast cancer is often an abnormality seen on a screening mammogram before the woman or the health care professional feels it. A healthy, asymptomatic presentation is typical.

22. A group of nurses are preparing a presentation about reproductive tract polyps for a local women's group. Which information would the nurses include in the presentation? A. Polyps are rarely the result of an infection. B. Endocervical polyps commonly appear after menarche. C. Cervical polyps are more common than endocervical polyps. D. Endocervical polyps are most common in women in their 50s.

Answer: D Rationale: Endometrial polyps are solitary, and they rarely occur in women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause. The exact cause of polyps is unknown, but they are frequently the result of infection. Cervical polyps often appear after menarche. Endocervical polyps are more common than cervical polyps and are commonly found in multiparous women ages 40 to 60.

26. A woman comes to the clinic. Assessment reveals a firm, rubbery, movable mass in the upper outer quadrant of the left breast. The edges of the mass are clearly delineated. The nurse interprets these findings as suggestive of which disorder? A. fibrocystic breast disorder B. duct ectasia C. intraductal papilloma D. fibroadenoma

Answer: D Rationale: Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast. Duct ectasia occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation. Periareolar infections consist of active inflammation around nondilated subareolar breast ducts— a condition termed periductal mastitis. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papilloma is manifested by a wart-like growth in the mammary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur.

2. Which approach would be most appropriate when counseling a client who is a suspected victim of intimate partner violence? A. Offer the client a pamphlet about the local shelter for victims of intimate partner violence. B. Call the client at home to ask some questions about the marriage. C. Wait until the client comes in a few more times to make a better assessment. D. Ask, "Have you ever been physically hurt by your partner?"

Answer: D Rationale: If intimate partner violence is suspected, the nurse must use direct or indirect questions to screen for abuse. Asking the client if he or she has ever been physically hurt by the partner is most appropriate. Offering the client a pamphlet, calling the client at home, or waiting until the client returns are inappropriate and do not validate the suspicion.

3. A nurse has completed the assessment of a client. The nurse suspects that the client may have a malignant breast mass based on which finding? A. painful lump B. absence of dimpling C. regularly shaped mass D. nipple retraction

Answer: D Rationale: Malignant breast masses typically are difficult to palpate, painless, irregularly shaped, and immobile, with nipple retraction and skin dimpling.

18. A nurse is assessing a female client and suspects that the client may have endometrial polyps based on which clinical manifestation? A. bleeding after intercourse B. vaginal discharge C. bleeding between menses D. irregular, acyclic bleeding

Answer: D Rationale: The most common clinical manifestation of endometrial polyps is irregular, acyclic uterine bleeding. Cervical and endocervical polyps are often asymptomatic, but they can produce mild symptoms such as abnormal vaginal bleeding (after intercourse or douching, between menses) or discharge.

7. A nurse is working with a victim of violence. Which statement would be most appropriate to empower the victim to take action? A. "Give your partner more time to come around." B. "Remember—children do best in two-parent families." C. "Change your behavior so as not to trigger the violence." D. "You are a good person, and you deserve better than this."

Answer: D Rationale: To help the victim gain control over his or her life, the nurse should emphasize that violence is never okay and that the victim did not deserve the violent attack or ask for it. Telling the victim to give the partner more time, saying that children need two parents, and suggesting that the client change his or her behavior do not promote control, rather they attempt to excuse the partner's behavior.

7. Which statement best indicates that a client has taken self-care measures to reduce her risk for cervical cancer? A. "I've really cut down on the amount of caffeine I drink every day." B. "I've thrown out all my bubble baths and just use soap and water now." C. "Every time I have sexual intercourse, I douche." D. "My partner always uses a condom when we have sexual intercourse."

Answer: D Rationale: Unprotected sexual intercourse is a risk factor for cervical cancer. Use of barrier methods of contraception such as condoms is a key measure for reducing the risk for cervical cancer. Cessation of smoking and drinking alcohol, not caffeine, also are effective measures for risk reduction. Eliminating irritants such as bubble baths is a general measure to reduce perineal irritation and urinary tract infections. Douching has no effect on risk reduction for cervical cancer.

30. A client is scheduled for a loop electrosurgical excision procedure (LEEP) to evaluate an abnormal Papanicolaou (Pap) test. After teaching the client about this procedure, the nurse determines that the teaching was successful based on which client statement? A. "I will have this procedure done in the outpatient surgery department." B. "I will need to get general anesthesia for this procedure." C. "I should expect the procedure to take about 1 to 2 hours." D. "I might have some mild cramping and bleeding for a few weeks."

Answer: D Rationale: With LEEP or LLETZ (large loop excision of the transformation zone), the abnormal cervical tissue is removed with a wire that is heated by an electrical current. For this procedure, a local anesthetic is used. It is performed in the health care provider's office in approximately 10 minutes. Mild cramping and bleeding may persist for several weeks after the procedure.