Chapter 10: Promoting a Healthy Pregnancy, Unit 6, 10, & 16 - Care of Family Ch. 4, Care of Family Ch. 2, 3

6. The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. Gonorrhea C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

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

27. A nurse wishes to assess how often members of a family consume alcohol or use drugs during a typical week. What type of family assessment tool would this nurse choose? A. Ecomap B. Genogram C. Qualitative D. Quantitative

ANS: D A quantitative tool measures the frequency at which problems or behaviors occur. An ecomap is a tool that displays the outside systems used by the family. A genogram illustrates the family structures and compares generations within the same family. Qualitative tools measure the descriptions and depth of family experiences.

40. The nurse notes that a patient's chart contains the results of an MMSE. What can the nurse surmise about this patient? A. Behind on recommended immunizations B. Concerns about cognitive functioning C. Tracking changes in bone density D. Worried about cardiovascular health

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

44. A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test? A. At age 19 B. At age 21 C. Before sexual activity D. No specific age

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

1. The nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. What does the nurse tell the mothers about breast milk? (Select all that apply.) A. Fewer nutrients B. Less casein C. Less protein D. More calories E. More carbohydrates

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

32. A nurse is reviewing the results of several patients' cholesterol and lipid screenings. For which patient is the action appropriate? A. HDL cholesterol 66 mg/dL: Evaluate patient for cardiovascular risk. B. LDL cholesterol 98 mg/dL: Instruct patient to take fish oil 3 gm daily. C. Total cholesterol 240 mg/dL: Teach heart-healthy lifestyle changes. D. Triglycerides 132 mg/dL: Refer to dietician for comprehensive diet education.

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

41. A 65-year-old patient is in the clinic for an annual influenza vaccination. What other health promotion activity should the nurse encourage specifically for this patient? A. Heart-healthy eating B. Participating in social activities C. Pneumococcal vaccination D. Regular exercise

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

A perinatal clinic nurse educated a pregnant woman about basic prenatal exercises. On a return visit, which statement by the patient indicates that teaching goals have been met? A. "I have learned to isolate the right muscle for Kegel exercises." B. "It's hard to find 30 minutes a day for exercise, but I have done it." C. "Jumping rope is great exercise and keeps my weight in control." D. "When I get fatigued with these exercises, I just push through it."

A. "I have learned to isolate the right muscle for Kegel exercises." Kegel exercises are among the basic prenatal exercises taught to all pregnant women. In order to do them correctly, the woman needs to learn to isolate the pubococcygeal (PC) muscle. Women can obtain benefits from exercising as little as 10 minutes a day; jumping rope should be avoided because it involves too much bouncing; and when the pregnant woman is fatigued, she should rest.

A nurse is explaining childbirth education choices to an expectant couple. The nurse explains that although each method is different, all methods emphasize some similar concepts. Which concepts does the nurse describe as similar across different methodologies? (Select all that apply.) A. Biological B. Financial C. Psychosocial D. Relational E. Social

A. Biological C. Psychosocial E. Social Although they are different, all childbirth preparation classes incorporate a holistic approach to childbearing, which encompasses the biological, psychological, and social factors related to the experience.

A nurse is educating a pregnant woman who has a history of pica about healthier eating. Which nutrients should the nurse include in the teaching plan? (Select all that apply.) A. Calcium B. Folic acid C. Iron D. Vitamin C E. Vitamin D

A. Calcium C. Iron D. Vitamin C E. Vitamin D Specific nutritional deficiencies associated with pica include deficiencies in iron, calcium zinc, thiamine, niacin, vitamin C, and vitamin D.

The perinatal nurse would assess which newborn system as a priority after birth if a woman admitted to cocaine use during her pregnancy? A. Cardiovascular system B. Endocrine system C. Integumentary system D. Respiratory system

A. Cardiovascular system Although it is difficult to assess for complications from cocaine because of the likelihood of multi-drug abuse, common complications seen from its use include congenital abnormalities in the skull, brain, face, eyes, intestines, heart, limbs, genitals, and urinary tract.

A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit. Which statement by the patient would indicate that teaching objectives for this problem have been met? A. "I have been supporting my uterus with a pillow when resting." B. "I have been trying all sorts of over-the-counter medications." C. "I haven't had any black, tarry stools at all since I was here." D. "That black cohosh has really helped with my abdominal pain."

A. I have been supporting my uterus with a pillow when resting Round ligament pain is a common discomfort of pregnancy and the nurse can teach self-care measures such as supporting the uterus with a pillow when resting, warm baths, applying heat, and wearing a pregnancy girdle. Pregnant women should be taught to avoid all medications (both prescription and over the counter) without consulting with their health-care provider. Black, tarry stools are not related to round ligament pain. Black cohosh is a uterine stimulant and should be avoided during pregnancy.

A woman is admitted to the hospital with a birth plan that specifies the Bradley method of childbirth. Which actions by the nurse are most appropriate for this patient? (Select all that apply.) A. Assist the woman in conserving energy for childbirth. B. Call the anesthesiologist to place an epidural. C. Ensure the patient has a quiet environment. D. Establish a relationship with the husband-coach. E. Turn the lights down in the patient's room.

A. assist the woman in conserving energy for childbirth C. Ensure the patient has a quiet environment D. Establish a relationship with the husband/coach E. Turn the lights down in the patient's room The Bradley method emphasizes inward relaxation, allowing the woman to conserve energy for the impending birth. There is an emphasis on darkness, solitude, and quiet in order to reduce stimulation and enhance the calm and comfort needed by the woman. The Bradley method is also known as "husband-coached childbirth." The nurse will need to establish a professional, caring relationship with both the woman and her partner. Medication is discouraged in this method.

4. The community health nurse is aware that the goals of Healthy People 2020 include which of the following? (Select all that apply.) A. Creating physical environments that promote health B. Developing healthy behaviors in children and teens C. Eliminating health disparities and increasing equity D. Improving the health of all groups in the country E. Increasing the average life span for all adults

ANS: A, C, D Goals of the Healthy People 2020 document include the following: (1) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) to achieve health equity, eliminate disparities, and improve the health of all groups; (3) to create social and physical environments that promote good health for all; and (4) to promote quality of life, healthy development, and healthy behaviors across all life stages. The blueprint does not call for developing healthy behaviors only in children and teens, nor does it call for simply increasing the average life span.

2. The clinic nurse understands that children who come for well-child visits at age 10 are in the process of developing which of the following attributes? A. Attachment B. Coordination C. Personal values D. Self-identity

ANS: D During the school-aged and adolescent/teenage developmental stage, personal values are shaped and clarified and ethical development occurs. This stage provides the optimal opportunity for teaching about drugs, sex, and health promotion.

25. One goal of the Healthy People 2020 initiative is to increase the number of people who have some form of health insurance. What percentage of the population is the target? A. 25% B. 35% C. 55% D. 100%

ANS: D Healthy People 2020 has the ambitious goal of increasing the proportion of people with health insurance to 100%.

A woman comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. She is very concerned about her changing body shape. What disorder does the nurse suspect? A. Anemia B. Anorexia nervosa C. Gestational diabetes D. Gestational hypertension

B. Anorexia nervosa Anorexia nervosa is characterized by a distorted body image and an intense fear of becoming obese. Patients with anorexia nervosa lose weight either by excessive dieting or by purging themselves of calories they have ingested. Because this woman has gained very little weight and has concerns about her body shape, the nurse should suspect anorexia and assess the patient further. Anemia, gestational diabetes, and gestational hypertension do not manifest with these symptoms.

A nurse is assessing a woman pregnant with her third child. She has a history of pregnancy-related varicosities. Which action by the nurse takes priority? A. Advising the woman not to cross her legs while pregnant B. Assessing the woman's pedal pulses and circulation C. Having the woman rate her leg pain on a 1-to-10 scale D. Teaching the woman to wear knee-high stockings

B. Assessing the woman's pedal pulses and circulation Assessment is the first step of the nursing process, and issues related to airway, breathing, and circulation are priorities for all patients. The nurse should first assess the patient's circulation, including pedal pulses, warmth, skin color, and capillary refill. After a circulatory assessment is complete, the nurse should assess pain. After a thorough assessment, the nurse can plan teaching. Self-care measures include not crossing the legs, not wearing constrictive clothing such as knee-high stockings, and elevating the legs at least twice a day.

A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Calling the doctor right away for dark, tarry stools B. Drinking at least one glass of orange juice a day C. Stopping the prenatal vitamins while taking iron D. Taking the medication between meals and with milk

B. Drinking at least one glass of orange juice a day Vitamin C enhances the absorption of iron, and a nonsmoking woman should be able to get sufficient iron from a glass of citrus juice daily. Iron tablets should be taken between meals, using a beverage other than tea, coffee, or milk. Dark, tarry stools are a known side effect of iron. Women on iron should also be on prenatal vitamins.

A pregnant woman has been brought to the emergency department by the rescue squad with symptoms of heat exhaustion after competing in an outdoor race on a hot day. Before discharge, the nurse teaches about appropriate exercise during pregnancy. The husband asks if the woman's having heat exhaustion will harm the baby. Which response by the nurse is most accurate? A. "Definitely; that's why pregnant women should not do aerobic exercise." B. "Fetal temperature depends on mom's temperature, so the fetus may be affected." C. "The baby is in a fluid environment and won't get overheated." D. "Yes, but if we rapidly cool mom down, there won't be any problems."

B. Fetal temperature depends on mom's temperature, so the fetus may be affected The fetus is unable to reduce body temperature through perspiration or other means and instead must rely on the mother's body for temperature regulation. Possible complications of maternal hyperthermia include spontaneous abortion, preterm labor, and fetal distress. The nurse should educate the couple about exercise that won't increase the maternal temperature too much. Complications are possible, not definite; the baby being in a fluid environment does not regulate its temperature, and women who are pregnant can engage in aerobic activity following safety guidelines.

The clinic nurse is assessing a woman in her 30th week of pregnancy. Her fundal height is 23 centimeters. What other assessment finding would the nurse correlate with this condition? A. Blood glucose 112 mg/dL B. Hemoglobin 9.2 g/dL C. Leukorrhea D. Platelet count elevated

B. Hemoglobin 9.2 g/dL True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction and preterm birth. The patient's lower-than-expected fundal height measurement could also be indicative of intrauterine growth restriction. The blood glucose, although slightly high, is not related, nor is leukorrhea (a common finding in pregnancy) or an elevated platelet count.

A patient in the prenatal clinic had a negative rubella titer. Which action by the nurse is most appropriate? A. Have the laboratory draw rubella titers as a double-check. B. Instruct the woman to avoid anyone who may have the disease. C. Prepare to administer a rubella vaccination to the woman. D. Reassure the woman that rubella has few fetal consequences.

B. Instruct the woman to avoid anyone who may have the disease Rubella (German measles) can cause fetal abnormalities if the pregnant woman contracts it during the first trimester, so all pregnant women are screened for immunity. A positive test means the woman is immune to the disease, whereas a negative test indicates susceptibility to it. The woman needs to avoid people who may be ill with rubella and be immunized after her delivery. There is no need for a double check of the results.

A nurse is describing various childbirth options to an expectant couple. The woman states "I want to do Lamaze because I hear you will have no pain with this method." Which response by the nurse is best? A. "If done right, you will have no childbirth pain." B. "Lamaze empowers you to cope with the pain." C. "No, Lamaze emphasizes epidural pain control." D. "Pain is a natural and normal part of childbirth."

B. Lamaze empowers you to cope with the pain Although Lamaze does teach that pain is a natural and normal part of childbirth, it also empowers the woman with strategies to cope with the pain in positive ways that facilitate the labor and birth process. It does not promise a pain-free childbirth and decisions about medications are left to the woman who has been educated about their effect on childbirth. Stating simply that pain is a normal part of childbirth without elaborating on how it is managed will not alleviate the patient's concern.

A woman admitted in labor asks if she can have a doula present with her. The nurse understands that a doula is which of the following? A. A massage therapist with a specialty in labor massage B. A trained labor coach standing in for the woman's partner C. A woman who is experienced in labor and provides support to the woman D. Someone who is trained and licensed to deliver babies in the hospital

C. A woman who is experienced in labor and provides support to the woman A doula is a woman who is experienced in childbirth and who provides physical and emotional support to the mother during labor, birth, and the postpartum period. A doula is not a massage therapist, nor a trained labor coach, and a doula is not licensed to deliver babies.

A nurse is reviewing the care plan for a woman in the third trimester of her first pregnancy. Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood? A. Attended three prenatal classes with her partner to learn about labor B. Continues to exercise, maintains a healthy diet, quit smoking recently C. Educated about pregnancy, fetal growth and development, and motherhood D. Has prepared a well-stocked nursery complete with stimulating toys

C. Educated about pregnancy, fetal growth and development, and motherhood Attending prenatal classes, maintaining a healthy lifestyle, and having a prepared space for the baby are all tasks that indicate some degree of positive adaptation to a pregnancy. However, the best indicator of positive adaptation is when the woman can be described as well educated on pregnancy, growth and development of the fetus, and motherhood. This is much more inclusive than the other individual tasks

The nurse in a family practice clinic is working with a woman of childbearing age who recently was married and has no plans to have children yet. Which action by the nurse is most important? A. Asking the woman when the couple plans to get pregnant B. Encouraging the woman to review her birth control plan C. Instructing the woman to get 0.4 mg of folic acid daily D. Reviewing the woman's family history for genetic defects

C. Instruct the woman to get 0.4 mg of folic acid daily Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day (0.4 mg/day). Because the woman may not realize that she is pregnant early in her pregnancy when neural tube defects occur, prophylactic supplementation is recommended. The other options may be applicable too, but they are not as important as educating the woman about the importance of folic acid.

A pregnant woman in her third trimester presents to the emergency department after fainting upon rising from a supine position. Which activity should the nurse perform first? A. Call the cardiology department for an EKG. B. Determine the fetal heart rate. C. Obtain a blood glucose reading. D. Teach her to rise slowly from a reclining position

C. Obtain a blood glucose reading Supine hypotension is caused by the pressure of the enlarging uterus on the inferior vena cava while the woman is in a supine position. Vena caval compression impedes venous blood flow, reduces the amount of blood in the heart, and decreases cardiac output, causing dizziness and syncope. Pathological causes of supine hypotension include cardiac or respiratory disorders, anemia, hypoglycemia, dehydration, anxiety, and stress. Hypoglycemia can be treated rapidly if that is the cause. The other actions are appropriate as well, but the priority action would be to identify a condition that is readily treatable

The perinatal nurse recommends muscle-strengthening exercises to a woman who is pregnant for the first time. The woman states that she does not want to be "muscle-bound and masculine." What response by the nurse is best? A. "As long as you use lighter weights, you won't get muscle-bound." B. "OK, what do you think about swimming for exercise then?" C. "Strengthening muscles will decrease risks of ligament and joint injury." D. "Stronger muscles will make the labor process much easier on you."

C. Strengthening muscles will decrease risks of ligament and joint injury Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle-strengthening exercises also help to decrease the risk of ligament and joint injury. The other options do not explain this information, making it much less likely she will participate in these exercises.

A 21-year-old pregnant woman smokes 8 to 10 cigarettes per day. The clinic nurse reviews the patient's diet with her and notes that she does not eat fruits or vegetables. Which action should the nurse recommend to this patient? A. Cut down on smoking and eventually quit. B. Eat non-produce sources of vitamin C. C. Take an over-the-counter vitamin C supplement. D. Try to drink one glass of orange juice daily.

C. Take on over-the-counter vitamin C supplement Food sources rich in vitamin C include produce such as red and green sweet peppers, oranges, kiwi fruit, grapefruit, strawberries, Brussels sprouts, cantaloupe, broccoli, sweet potatoes, tomato juice, cauliflower, pineapple, and kale. Most pregnant women are able to meet the recommended daily allowance (80 to 85 mg) by including at least one daily serving of citrus fruit or juice or vitamin C-rich food source, but women who smoke need more (NIH, 2011). Although it is important for the woman to quit smoking, this alone will not help her meet her dietary need for Vitamin C. Because she does not eat the primary sources of this vitamin, an over-the-counter supplement would be her best option.

Which patient would the perinatal nurse assess as being most at risk for maternal attachment problems? A. 18 year-old married woman with a supportive family who lives nearby B. 20-year-old woman with remote history of chlamydia and gonorrhea C. 22-year-old alcoholic who has been sober for 10 years D. 52-year-old unemployed divorced woman who thought she was in menopause

D. 52 year old unemployed divorced woman who thought she was in menopause Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors (Youngkin et al., 2012). The nurse should assess for indicators such as unintended pregnancy, intimate partner violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, and the presence of mental conditions that might interfere with the patient's ability to bond with and care for the infant. The divorced, unemployed woman experiencing an unexpected pregnancy has the most risk factors.

The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting, fatigue, and weight gain. Which action by the nurse is most appropriate? A. Ask the woman's health-care provider to prescribe the man anti-nausea medication. B. Assess for cancer risk factors, as weight gain and vomiting are unusual together. C. Encourage the man to make an appointment with his primary health-care provider. D. Explain that these symptoms are normal and often seen in men with pregnant partners.

D. Explain that these symptoms are normal and often seen in men with pregnant partners Couvade syndrome is when a male partner experiences the same maternal signs and symptoms as the woman. The nurse should reassure the man that this is an often-occurring finding. The nurse would not need to encourage the man to make an appointment with his health-care provider unless the symptoms became severe. The woman's primary health-care provider does not need to prescribe anti-emetics, nor does the nurse need to assess the man further for cancer risk factors.

A patient on the postpartum floor of the hospital has a body mass index (BMI) of 38 and just gave birth to a healthy baby girl by Cesarean section. Which action by the nurse takes highest priority? A. Administering pain medication promptly when requested B. Assisting the woman to begin breastfeeding the infant C. Educating the woman about healthy weight loss D. Monitoring the incision site and using strict hand-washing technique

D. Monitoring the incision site and using strict hand washing technique All of these interventions are appropriate for this patient. However, patient safety is the priority. Women with Level 2 obesity (BMI 35-39.9) are at higher risk of wound infection and breakdown. The nurse should place a priority on hand hygiene and close monitoring of the incision.

The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following? A. Blood, uterine, and breast tissue B. Fetal tissue C. Maternal reserves D. Placental fluid

D. Placental fluid During early pregnancy, maternal weight gain is related to an increased blood volume, which is necessary to supply the enlarging uterus and to support fetal growth and development. As the pregnancy progresses, enlargement of the placenta and fetal body add to the woman's increase in weight. By term, maternal extracellular fluid, blood, uterine tissue, and breast tissue comprise 35% of the gestational weight gain; the maternal reserves comprise 27%; fetal tissue comprises 27%; and placental fluid comprises 11% of the total maternal weight gain (Cunningham et al., 2010).

An expectant couple complains of dyspareunia. Which action by the nurse is best? A. Assess the woman's family history and genetic background. B. Explain that this condition is a normal finding during pregnancy. C. Instruct the couple that sex during pregnancy is not advised. D. Suggest sexual positions that might be more comfortable.

D. Suggest sexual positions that might be more comfortable Dyspareunia is painful intercourse that may result from pelvic congestion and impaired circulation caused by the enlarging uterus during pregnancy. The nurse should reassure the couple that having sex during pregnancy is acceptable (unless there are medical reasons to contraindicate it) and suggest positions for sex that might be more comfortable for the woman. There is no reason to assess the woman's family history and genetic background. Simply explaining that dyspareunia is normal is dismissive of the couple's concern, although they should be reassured that this does sometimes happen and then they should be offered education on ways to alleviate it.

A woman in her second trimester wants to continue her weight-lifting and exercise plan. Which exercise would the nurse advise against participating in? A. Calf stretches B. Weight lifting C. Pelvic tilts D. Walking lunges

D. Walking lunges Lunges may injure connective tissue in the pelvic area and should be avoided. The other exercises are acceptable, but the woman should be cautioned to use resistance bands instead of free weights.

A perinatal nurse is assessing a pregnant woman's medications and finds that one of them is categorized as Category D. What information should the nurse provide this patient? A. "Studies have not found human fetal risk, although animal fetuses are harmed by it." B. "There are no associated fetal risks with this drug and it is safe to take in pregnancy." C. "There haven't been any studies of this drug in human fetuses; I wouldn't take it." D. "We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus."

D. We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus There are five categories of drugs based on fetal risk: Category A: no associated fetal risk, safe to take during pregnancy; Category B: no associated fetal risk in animals, fetal risk in humans not identified; Category C: evidence of adverse effects in animal fetuses, fetal risk in humans not identified; Category D: evidence of adverse effects and fetal risk in humans, benefits and risks must be considered before prescribing; and Category X: evidence of fetal risk and congenital anomalies in humans, risks outweigh the benefits, should not be prescribed during pregnancy.

2. Match each description with the correct disorder. Disorders may be used more than once. Descriptions may have more than one answer. 1. _____Rectum presses into vagina 2. _____Symptoms include constipation 3. _____ Bladder herniates into vagina 4. _____Difficulty completing a bowel movement 5. _____ Damaged muscles appear higher in the colon 6. _____ Symptoms include difficulty in voiding, incontinence, and dyspareunia a. Cystocele b. Rectocele c. Enterocele

ANS: 1: b; 2: b, c; 3: a; 4: b, c; 5: c; 6: a

1. Match the types of play with their characteristics. _____ Assume roles in games; games have goals _____Playing with the same items, but not really playing together _____ Plays alone, no regard for those in the area _____ Play together, but little organization _____ Observes other children while playing alone a. Solitary play b. Onlooker play c. Parallel play d. Associative play e. Cooperative play

ANS: e, c, a, d, b There are five types of play: solitary play (child plays alone without regard for those around him or her), onlooker play (child observes others playing and may talk to them, may alter his or her own play, or may continue playing as he or she was doing), parallel play (playing with the same materials and items, but not playing together), associative play (play together in a peer group, but in a loosely organized manner), and cooperative play (assume roles in games, games have goals, and rely on each other to continue and progress).

1. The clinic nurse is taking a history from a woman who came to the clinic to get test results. The patient brought a coworker with her because she is worried. The patient asks to have her coworker remain in the exam room when the doctor describes the test findings. The patient states that the friend is "like a sister." The nurse would most correctly identify the two women as which of the following? A. Extended family B. Family C. Family of choice D. Family of origin

ANS: A A family consists of two or more members who self-identify as a "family" and interact and depend on one another socially, emotionally, and financially. Because the patient self-identifies the friend as "like a sister," the patient and friend consider themselves a family.

29. A nurse explains the benefits of a strengths-and-problems list to a student. Which is the best explanation? A. Can use their strengths to work on identified priority problems B. Demonstrates that each family has both strengths and problems C. Forces people to be accountable and take responsibility for problems D. Lets families see which members have problems affecting them

ANS: A A strengths-and-problems list requires the family members to list their strengths as well as what each member brings to the group that is positive. The problems list helps the family prioritize problems to work on. By seeing this information in writing, the family members can capitalize on their strengths to work on the problems. It does demonstrate that each family has both strengths and problems, but that is not the main purpose. It does not force families to take responsibility, although it does encourage this. Its purpose is not to point out who has which problems.

2. A nurse wishing to be an advocate for access to health care would most likely choose to participate in which of the following activities? A. Lobby for improved insurance access for all individuals, whether or not they are employed. B. Help establish fast-track or minor illness areas in local emergency rooms. C. Partner with medical centers to provide free services for low-income patients. D. Work with visiting nurses associations to create on-site clinics at day-care centers.

ANS: A The biggest determinant of access to and quality of health care is one's insurance status. The other actions might help improve access too, but would not be as effective as lobbying for improved ability for all individuals to get insurance.

19. A nurse is providing anticipatory guidance to a mother of a toddler. Using communication theory, which information is the most appropriate? A. "Don't nod your head 'yes' when you say 'no.'" B. "Explain things in several different ways." C. "There is no need to see if a toddler understands." D. "You shouldn't yell at such a young child."

ANS: A According to communication theory, verbal and nonverbal messages should be congruent. A verbal "no" accompanied by nodding the head "yes" is sending inconsistent messages. Messages should be clear, so explaining things in many different ways would not be recommended. Good communicators determine if the listener has understood. Good communication demonstrates love and support clearly, but the advice to not yell is vague and seems to send the message that yelling at an older child would be more acceptable.

23. A nurse working with a married couple notes that both parties seem to try to be dominant in their sessions. According to Bowen's family systems theory, which question asked by the nurse would yield the most useful information? A. "Are you each a first-born, middle child, or youngest sibling?" B. "How demonstrative were each of your parents when you were growing up?" C. "How many children were in each of your families?" D. "What socioeconomic classes did you both grow up in?"

ANS: A According to this family theory, birth order plays an important role in predicting certain patterns of behavior. Spouses who occupy the same birth order may have difficulty functioning together. In this case, both spouses probably are first-borns with a need for control. The other questions may yield helpful information as part of a thorough assessment, but are not related to this theory.

38. A patient has just been admitted to the hospital in critical condition. In caring for the entire family, what action by the nurse is most important? A. Assessing who in the family will make decisions B. Determining if the family needs financial resources C. Ensuring each member understands the situation D. Orienting the family to visiting hours on the unit

ANS: A All options are important activities to keep the family engaged fully with the patient. However, for a patient who is critically ill, determining who makes medical decisions (and if there are advance directives) is crucial. The other actions can occur later.

17. A school nurse is increasingly concerned with a growing absentee problem. To best address this issue, which of the following actions should the nurse take? A. Begin a structured follow-up program for asthmatic children. B. Hold informational meetings on the importance of childhood vaccines. C. Partner with providers on continuity plans for kids with chronic illness. D. Work with law enforcement to develop a truancy response team.

ANS: A All plans sound like they could be innovative strategies for dealing with school absenteeism. But because asthma is the most common reason for a child to miss school (and the primary reason for visits to pediatric emergency rooms), the nurse's best response is to develop a structured follow-up program for kids with asthma.

33. A 17-year-old high school senior is resentful about caring for younger siblings so the parents can have a "date night" once every 2 weeks. The teen often "forgets" and schedules work or social activities that override the parents' plans. The parents are angry that the teen is so indifferent to their needs. What action by the family indicates that goals for the diagnosis of impaired family processes have been met? A. Parents and teen mutually plan date nights in advance. B. Parents consistently discipline teen for "forgetting." C. Teen acknowledges "forgetting" date night on purpose. D. Teen expresses feelings about being made to babysit.

ANS: A All the outcomes show some positive resolution, but the most optimal response is the parents and teen jointly planning the parents' nights out. This shows collaboration, communication, and mutual respect. In the end, everyone's needs are taken into consideration, and the teen will be more willing to adapt the current role to include watching the siblings. Consistent consequences delivered without anger is a hallmark of healthy discipline. The teen is taking responsibility when he or she acknowledges that the forgetting occurs on purpose. The lines of communication are open when the teen is allowed to verbalize feelings.

4. A patient describes her spouse's dependence on oxycodone terephthalate (Percocet), which began following knee surgery last year. Although the prescription was finished some time ago, the spouse continues to obtain and take Percocet. Because of the spouse's "need" for the medication, the patient "has to" do all the yard work, child care, and meal preparation. How would the nurse describe the patient's behavior? A. Enabler B. Impaired caregiver C. Inadequate dyad partner D. Overstressed parent

ANS: A An enabler is a common role in families with addictions. The enabler makes excuses for the addicted person's behavior. The patient's behavior allows the spouse to continue with the addiction without being held accountable.

32. A nurse is working with a family that has the nursing diagnosis of altered family processes. When formulating goals, whom does the nurse include? A. Entire family B. No one else C. Parents D. Physician

ANS: A The most effective goals are those that include the entire family. The entire family agrees upon the goals and commits to working on them.

18. A nurse is working with a patient who misses appointments frequently and doesn't always fill prescriptions for herself or her children. On reviewing the patient's chart, the nurse sees that the patient has insurance. What action by the nurse would be the most helpful? A. Ask the patient to describe her health insurance coverage. B. Educate the patient about the consequences of skipping medicines. C. Find out if the patient is seeing other health-care providers. D. Remind the patient that she is responsible for her children's health.

ANS: A An important factor in access to health care is insurance. Employer-provided plans are becoming more uncommon, and even those with insurance often have gaps in their coverage, which leads to missed appointments, unfilled prescriptions, and other services being underutilized. The other actions might be useful, although it probably will sound judgmental if the nurse merely tells the patient that she is responsible for her children's health.

22. A nurse ensures that a patient does not have questions regarding the upcoming surgical procedure and verifies that the signature on the consent form is the patient's signature. Which ethical principle is this nurse demonstrating? A. Autonomy B. Beneficence C. Fidelity D. Justice

ANS: A Autonomy is the right to make decisions and to have the information necessary to make such decisions. Beneficence is doing good. Fidelity is keeping promises. Justice is treating everyone fairly.

21. A nurse considers beneficence as the guiding ethical principle for nursing practice. Working within that framework, which action by the nurse best demonstrates that concept? A. Administering a pain medication before therapy so that the patient can participate B. Allowing the patient to make informed choices as to his or her plan of care C. Promising a pain medication in 1 hour and returning with it on time D. Turning patients to prevent pressure sores, despite causing temporary discomfort

ANS: A Beneficence means acting for the patient's benefit, or doing good. Giving a pain medication before a therapy session helps the patient fully participate, improving his or her recovery. Allowing the patient to make informed choices demonstrates autonomy. Returning when promised is an example of fidelity. Turning patients, even though it causes temporary discomfort, is non-maleficence.

3. A new mother with a 2-month-old daughter tells the family clinic nurse that she is experiencing a lack of sleep because of infant night feedings and her husband's shift work and excessive overtime. Which of the following is the best description of this family concern? A. Caregiver strain B. Coping stress C. Lack of support D. Parental maladaptation

ANS: A Caregiver strain occurs when the main caregiver becomes overwhelmed and feels "underhelped" regarding the tasks concerned with the care of the family member. In this situation, mounting bitterness and withdrawal from other family members may cause caregivers to push away any potential helpers.

25. A family with a loud, disobedient child has been working with a nurse. Which action observed by the nurse indicates that goals for the diagnosis of impaired parenting have been met? A. The father delivers consequence to the child calmly. B. The father only asks the child twice not to do something. C. The mother doesn't cry when disciplining her child. D. The mother states that the child is still testing the limits.

ANS: A Consistency in setting and enforcing rules is critical. Consequences should be delivered immediately, without anger, and consistently. The father's disciplining the child without getting mad is demonstrating that goals have been (or are being) met. The other options do not show consistent, calm, immediate consequences.

30. A nurse working with a pregnant woman who is a recent immigrant to the United States notes that her husband rarely accompanies her to prenatal visits, and when he does, he sits in the waiting room. What action by the nurse is best? A. Ask the patient what role men in her culture play in pregnancy. B. Ask the woman why her husband doesn't seem involved. C. Encourage the man to participate in order to support his wife. D. Research the couple's cultural background and health beliefs.

ANS: A Culture affects the roles family members assume during times of illness, pregnancy and childbirth, and death. The best option is to ask the woman what role men in her culture play during pregnancy and childbirth. This can open a discussion of how the woman is coping and if she is getting enough support, either from her mate or friends and family. Asking why the man doesn't seem involved is judgmental. Encouraging the man to participate may not be desired by the woman and may be seen as an intrusion by the man. The nurse could research the culture but this would not lead to a discussion until the next visit. It is also important to be aware that there are variations in how people of the same culture behave and believe.

14. A nurse who works with families uses Duvall's family developmental theory as the core of nursing practice. What action by this nurse takes priority? A. Assessing the developmental stage of the family B. Determining how the family interacts with society C. Observing what roles each family member assumes D. Tailoring teaching to the specific needs of the family

ANS: A Developmental theory has as its core the idea that every person moves through developmental stages with tasks that must be mastered before they can move on to the next stage. Family developmental theory assumes the same progression for families as a unit. Duvall's theory identifies eight family stages. The nurse using Duvall's family developmental theory must first assess the stage the family is in, because teaching and all other interventions must be tailored to that stage. Only tailoring the teaching to specific needs does not necessarily require assessment of the family using a developmental approach. Determining how the family interacts with society is more in line with systems theory. Observing roles is part of structural-functional theory.

4. A nurse is caring for a patient near the end of life whose wishes regarding care are not known. The two sons disagreed with the two daughters about future medical plans for the patient during a recent family conference, and now the sons and daughters are not talking to one another. What action by the nurse would be best to help resolve this dilemma? A. Call the facility's ethics committee and request a formal consultation. B. Have social work coordinate another family meeting to discuss the issue. C. Meet with the sons and daughters separately to discuss their wishes. D. Request that the physician tell the family what is in the patient's best interests.

ANS: A Ethical principles in health care are often in conflict, and it takes a skilled person to negotiate and mediate these situations. Ethics committees exist in most health-care facilities that are experienced in confronting these difficult situations. The best response would be for the nurse to request a consultation from the ethics committee. Another family meeting may not work, as the family already disagrees and tensions are high. The other options may be helpful, but are not as vital as a formal ethics committee consultation. Meeting privately with the sons and daughters might give the nurse some insight into their positions, but would not be as effective as utilizing the expertise on the committee. The physician should not decide what is in the patient's best interests, as this is paternalistic and violates the principle of autonomy.

39. A hospice nurse is making the initial home visit to a patient who just returned home after a lengthy hospitalization. What action by the nurse is most appropriate to help the family continue to function? A. Assess the degree of comfort in family caregiving. B. Ensure the family understands the hospice concept. C. Provide information about available hospice services. D. Refer the family to a community counseling center.

ANS: A In the at-home hospice setting, family members must find a balance between direct caregiving activities and their own needs for personal time. The nurse must assess this to help the family avoid caregiver strain and resentment and to maintain roles necessary for family functioning. Ensuring the family understands the hospice concept and providing information are also important, but are not directly related to family functioning. The family may or may not need counseling.

7. A community health nurse explains to the nursing student that the best health-related programming includes which of the following elements? A. Has both individual and societal components B. Is directed toward individual responsibility C. Provides incentives to compensate healthy choices D. Requires legislation to truly be effective

ANS: A Intervention programs must be multi-tiered and oriented to the broader social context in which they occur, because that is where patients are located. Programs directed toward only individuals are less successful. Programs and interventions do not need to include legislation or incentives.

6. The nurse managing a pediatric clinic often sees single mothers with children. What action by the nurse would best help this population of women access health care? A. Arrange to have evening and weekend hours. B. Offer sample medications instead of prescriptions. C. Provide a play center for waiting children. D. Provide bus tokens for transportation to the clinic.

ANS: A Single mothers with children constitute 82% of the poverty population. "Welfare to work" programs are now compulsory, and women must work in order to receive aid. Offering evening and weekend hours could accommodate more women who cannot afford to miss time off from work. The other options might be helpful for some patients and families, but to have the greatest impact on the largest group of people, accommodating work schedules is important for this population of women.

12. A practicing nurse tells a student nurse that beyond the World Health Organization's definition of health, providers must also consider which of the following factors when determining the health of a community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention

ANS: A The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration.

11. The jail nurse is interviewing a woman who has been brought to the clinic for prenatal care. Which of the following are appropriate actions for the nurse to perform? (Select all that apply.) A. Assess the woman for drug and alcohol abuse and possible withdrawal. B. Assess the woman's health knowledge and health literacy. C. Ask if the woman has other children and who is caring for them. D. Determine if the woman has risk factors for pregnancy complications. E. Inquire about the woman's criminal history and background.

ANS: A, B, C, D A nurse who is able to deliver culturally competent care to incarcerated women quickly becomes cognizant of the challenges of caring for this population. These women tend to have many health problems, including substance abuse and dependency. They frequently have not had access to health-related knowledge. Because nearly 1.3 million children of incarcerated women have no mother figure in their lives, women in prison or jail are often deeply concerned about their welfare. This demonstrates caring and can often be the motivation for making changes. The nurse needs to complete a thorough obstetrical history, including determining risk factors for high-risk pregnancy. The nurse does not need to know about the woman's criminal history.

8. The clinic nurse keeps resource numbers and contacts for assistance with situations in which family members may potentially require assistance to restore balance and function to the family. These developmental crises may include which of the following situations? (Select all that apply.) A. Home fire requiring a lengthy hotel stay B. Hospitalization of a family member C. Identification of domestic violence D. Postpartum depression in a young family E. The anticipated birth of a new baby

ANS: A, B, C, D Sometimes families are in special need of nursing intervention due to situational or developmental crises that go beyond the family's internal resources. Developmental crises occur as part of expected growth events that can take place during any developmental stage of the family or its individual members and include such situations as being displaced, hospitalization of a family member, domestic violence, and serious depression. Childbirth is a normal event that does not generally require special nursing intervention unless complications occur.

1. A nurse working in a women's health clinic has several patients who are from a minority culture, live in the inner city, lack employment that offers benefits, have large families, and often lack transportation to health care. Which of these factors are considered broad determinants of health? (Select all that apply.) A. Access to health care B. Employment C. Environment D. Family size E. Race

ANS: A, B, C, E Broad determinants of health care are personal, community, and societal systems and include environment, employment, insurance, class, race, social support, access to health services, genetic endowment, and personal histories. Family size itself is not a broad determinant of health care; however, it could be included in the larger category of personal history.

3. A nurse working in the community understands that health is often affected by social stressors. Which of the following are examples of societal pressures having a negative impact on the health of today's families? (Select all that apply.) A. Economic trends affecting access to health care B. Increased HIV/AIDS in women and children C. Loss of resources in public schools D. Restricted health-care access for adult males E. Violence and increased teen suicides

ANS: A, B, C, E Many social pressures have negative effects on the health of our families. Some of these trends include the economic situation, HIV and AIDS in women and children who are vulnerable due to barriers to health care, a loss of resources in schools, and an increase in all types of violence. As a group, adult males do not have restricted access to health care.

10. A visiting nurse is seeing an older woman with the nursing diagnosis of risk for trauma related to decreased bone density secondary to osteoporosis. Which assessment findings would indicate to the nurse that a priority goal for this diagnosis has been met? (Select all that apply.) A. All scatter rugs have been removed. B. Burned-out light bulbs have been replaced. C. Hot water heater temperature is set to 110°F. D. Patient wears non-skid shoes or slippers. E. Pets have been given away to friends.

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

14. A nurse enjoys working with patients who have chronic illnesses. What group of people would this nurse enjoy working with most? A. Ethnic minorities B. Men and boys C. Older adults D. Women and girls

ANS: C The older adult population is growing steadily and rapidly and will have a huge impact on health care in the future, due to the prevalence of chronic illness in this group. Chronic illness occurs in all groups, but for the older adult population, it is a special concern.

11. The reproductive care clinic nurse teaches young women about their risk for sexually transmitted infections (STIs). Which factors does the nurse include? (Select all that apply.) A. Alkaline pH of the vagina B. Increased genital mucosal surface area C. Increased number of pubic hair follicles D. Prolonged exposure to semen E. Temperature of the vaginal area

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

14. A nurse has helped organize and staff a free vaccination clinic for underserved populations in a central location of the city. The nurse is unhappy that so few people came to the clinic. In evaluating this outcome, what factors does the nurse recognize as potentially leading to the problem? (Select all that apply.) A. Clinic hours B. Inability to miss work C. Lack of insurance D. Lack of transportation E. Language barriers

ANS: A, B, D, E Underserved, typically poor, populations face multiple obstacles to obtaining health care that need to be considered when organizing events. If the clinic hours were during the day, parents might be reluctant to pull children out of school for fear of being labeled as truant. Parents participating in "welfare to work" programs or who have low-skill, low-wage jobs might not be able to miss work, or would forfeit pay by doing so. Participants need transportation to the clinic, which is located in one area of town. Language barriers could lead to confusion or misunderstanding or lack of awareness of the clinic. The lack of insurance shouldn't be a concern because the vaccinations are free, but it is possible this was a point that some misunderstood.

9. The nurse working with older women knows that risk factors for osteoporosis include which of the following? (Select all that apply.) A. Asian ethnicity B. Excessive consumption of caffeine C. Large frame D. Regular physical activity E. Cigarette smoking

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

2. The community health nurse knows that the public health intervention model is focused on which of the following intervention levels? (Select all that apply.) A. Community B. Family C. Government D. Hospitals E. Patient

ANS: A, B, E The public health intervention model is an inclusive framework that encompasses three levels at which interventions can be initiated, from the micro-level of the individual to the macro-level environment. Interventions are targeted toward individuals/families, communities, and larger institutional and societal systems. Government and hospitals are not one of the three levels.

10. A nurse is assessing a family whose patriarch died recently. Using Kübler-Ross's stages of grieving, what stages should the nurse assess for? (Select all that apply.) A. Bargaining B. Dealing C. Denial D. Remorse E. Shock

ANS: A, C Kübler-Ross's stages of grieving include denial, anger, bargaining, and acceptance. Dealing is one of Rodebaugh's stages. Remorse is one of Epperson's stages. Shock is one of Harvey's phases.

4. A nurse using family systems theory to work with patients and their families would do which of the following? A. Assess how school, work, and church impact the family. B. Describe the developmental stage the family is in. C. Determine if there are any family secrets or taboos. D. Listen to how information is shared with providers. E. Observe how family members interact with each other.

ANS: A, C, D, E Family systems theory considers family boundaries (how the family interacts with the outside world) and looks at interaction among all the members, as the family unit itself is considered more important than the individuals within it. Boundaries can also be assessed in part by determining if there are family secrets or taboos (closed boundaries) or if information is shared too freely (open boundaries). Developmental stages of the family are not considered in family systems theory, but are part of Duvall's family developmental stages and theory.

2. The nurse explains to the student that television and movies have often portrayed families in certain ways, depending on the decade. Which of the following statements about this trend are correct? (Select all that apply.) A. 1950s-1960s: nuclear family, simple issues, father dominated B. 1960s-1970s: extended families, lower income, divorced parents C. 1980s-1990s: exploring social issues, stressed family closeness D. 1990s: single parents, social issues including poverty and abuse E. New millennium: alternative family structures, extended family

ANS: A, C, D, E In the 1950s and 1960s, families were father-dominated and nuclear in structure and shows focused on problems that were simple and easily solved. In the 1960s and 1970s, the trend was toward blended families (with widowhood being the reason for remarriage) that were mostly in an upper-income bracket. In the 1980s and 1990s, social issues such as class and politics became popular. The shows may not have shown resolution of the problem at hand, but emphasized the closeness of the family unit. In the 1990s, shows brought increased awareness of the challenges facing families dealing with a host of problems such as alcoholism, poverty, and abuse. In the new millennium, shows present alternative and extended family formats.

8. A mother brings her 6-month-old infant and 18-month-old child to the health clinic for a routine visit. The nurse counsels the mother about lead exposure testing. Which information should the nurse include? (Select all that apply.) A. "About one-fourth of all homes where kids under 6 live are contaminated by lead." B. "Both of your children should have testing for lead at this time." C. "Lead exposure may cause anemia, seizures, and mental retardation if not treated." D. "Lead testing for children is recommended by the American Academy of Pediatrics." E. "We can test your older child for lead exposure, but it is too early for the 6-month-old."

ANS: A, C, D, E The American Academy of Pediatrics recommends that all children between the ages of 1 and 2 years receive testing for lead exposure, as 25% of homes presently occupied by children under the age of 6 have known lead contamination. Lead exposure has been linked to a number of medical and developmental problems, including anemia, seizures, and mental retardation.

6. The family nurse completes a genogram map when conducting a family assessment. Appropriate information the nurse should include in the genogram map includes which of the following? (Select all that apply.) A. Congenital diseases in the family B. Country of origin for family members C. Dates of birth for all family members D. Dates of divorce and deaths for family members E. Three or more generations

ANS: A, C, D, E The genogram may be used to highlight generational influences of behaviors, illnesses, vocational information, or any other pertinent information that provides a larger picture of patterns that exert influence on the family's current situation. The genogram should include at least three family generations and should list dates of births, divorces, deaths, stillbirths, and other pertinent elements of family information.

13. A nurse is working with a patient determined to have low health literacy and has taught the patient vital self-care measures for a chronic illness. How will the nurse best determine if the patient has understood the information? (Select all that apply.) A. Ask for a return demonstration of the skills taught. B. Assess if the patient will take brochures written for this illness. C. Encourage the patient to explain how the information fits into his or her daily life. D. Give the patient a written quiz at the end of the teaching session. E. Have the patient repeat the information in her or his own words.

ANS: A, C, E Communicating with people who have low health literacy can be challenging. Some strategies the nurse can employ are: specific training, asking open-ended questions, asking patients to restate information or provide a return demonstration of skills, using plain and culturally sensitive language, and developing health information tailored to specific populations. To assess for cultural congruency, the nurse can ask the patient to explain how the self-care measures fit into the patient's life. Simply giving the patient brochures does not guarantee that the patient understands or will use them, or even whether the patient can read. Giving a quiz might be seen as intimidating.

5. What does the nursing student understand about health disparities in the United States? (Select all that apply.) A. African American babies die by age 1 at a rate times that of European Americans. B. Asian American babies have the highest rate of preterm birth of any other group. C. Despite large expenditures, health resources are unevenly distributed. D. European Americans have double the number of low-birth-weight babies than other groups. E. Sudden infant death syndrome is most prevalent in American Indian and Alaska native babies.

ANS: A, C, E Many health disparities exist in America, despite huge outlays of money. A major problem is that health resources are not distributed evenly across demographic and geographic groups. This leads to such problems as the high rate at which African American babies die before age 1, and the high incidence of sudden infant death syndrome in American Indian and Alaska Native populations. Asian American babies do not have the highest rate of preterm birth, and European American women do not have double the number of low-birth-weight babies of other groups.

1. A nurse is explaining to a student why it is so important to consider the entire family as the patient. What explanation for this is best? (Select all that apply.) A. Families are a rich source of information and support. B. Families will have to take over the caregiving role at home. C. If they are not included, families tend to interfere in care. D. The patient has to reintegrate into the family upon discharge. E. The patient's background context includes the family.

ANS: A, D, E The patient's family should be welcomed into nursing experiences. The family is a rich source of support and information about the patient. The patient will have to reintegrate into the family upon discharge. The patient's family represents the context from which he or she comes. Families may or may not have to assume the caregiving role. It is stereotypical to assume that families will interfere in patient care.

5. The nurse using developmental theory offers anticipatory guidance on preventing injuries to the family of a preschooler. What concepts guide this information? A. Coordination lagging behind activity B. Development of personal values and ethics C. Impact of friends and peer group D. Poor judgment about safety risks E. Toddler's increasing physical abilities

ANS: A, D, E The toddler is in a stage where rapid physical development occurs but coordination and judgment are lagging behind. Thus the toddler is prone to accidents and injury. The nurse should offer anticipatory guidance so the parents can keep their child safe. Development of personal values and ethics occurs in the school-age and adolescent stage. Impact of peer group increases in this stage as well.

9. A patient tells the nurse about living in a commune. What does the nurse understand about this family structure? A. Family with distant relatives included B. Group of men, women, and children C. Kinship care provided to children D. Unmarried man and woman living together

ANS: B A commune is a group of men, women, and children all living together. Families with relatives beyond the nuclear family are called extended families. Kinship care provided to children constitutes a no-parent family. An unmarried man and woman living together is called cohabitation.

A mother is worried about her three children developing an inherited medical condition because many members of her family have died from this disease. To start an assessment of this family, which tool should the nurse choose? A. Ecomap B. Genogram C. Problem list D. Quantitative tool

ANS: B A genogram is a diagram of at least three generations that illustrates the present family structures and compares past generations with the present ones. To determine the prevalence of this inherited disorder in the family, the nurse would use a symbol to denote each family member with this disease. An ecomap displays the outside systems with which the family interacts. A problem list helps family members identify difficulties or negative characteristics. A quantitative tool assesses the frequency of a behavior or problem. A genogram has a quantitative influence, as it documents how many people in the family have the characteristic being studied, but a genogram is more specific.

17. A patient has been dismissed from the hospital after a serious illness and needs several weeks of home care and rehabilitation. When the visiting nurse comes to the house, it is apparent that the family is not functioning. The house is dirty, there is little food available, and one parent and an older child are arguing about picking up a younger sibling from school. What action by the nurse is most appropriate? A. Ask the parents if they need financial resources for the basic necessities. B. Assess each family member for the roles he or she plays in the family. C. Contact child protective services or social work to assess the home environment. D. Provide referrals for family and couples counseling in the community.

ANS: B According to structural-functional theory, each person in a family unit occupies a specific role. Sometimes roles are shared. A problem can occur when one member of the family is unable to fill his or her role and no one else is doing it. That appears to be the situation here. The nurse should assess what roles each family member plays and assist them to see how they can fulfill the role formerly held by the patient. The family may need financial resources if the patient was the breadwinner. There is no need to conduct an environmental assessment, as it does not appear that any family member is in danger. The family may or may not need counseling at this time.

15. A nurse would like to improve the health of the community. Which action by the nurse would have the greatest impact? A. Blood glucose screening at the local Korean church B. Blood pressure screening at a predominantly black church C. Teaching immigrants heart-healthy cooking for traditional foods D. Teaching men the signs and symptoms of heart attacks

ANS: B Although all activities are good nursing interventions for specific communities, more than half of black women aged 45-64 years have hypertension, so a blood pressure screening at a predominantly black church could have the greatest impact.

16. A family practice nurse is working with a patient who is asking for anti-anxiety medications to deal with the stress and frustration of an adult child who won't leave the home. Based on knowledge of the tasks of launching children, which resource should the nurse suggest first? A. Anger management counseling B. Contact numbers for vocational training C. Information on a parenting workshop D. Marriage and couples counseling

ANS: B An adult child who still lives at home is either using home base as a temporary arrangement while continuing education or as a "nonaction" until more permanent ties have been established elsewhere. With the parent's frustration and anxiety, this situation of incomplete launching needs to be addressed. The first suggestion should be about vocational assessment and training for the adult child. There is no indication the patient needs anger management, a parenting workshop, or marriage counseling.

40. An immigrant family is working with a nurse on improving family dynamics. The nurse notes that the teenage children do not subscribe to their parent's social and cultural mores and identify more with their native-born American friends. What description of the children is most accurate to record in the family's chart? A. Acculturated B. Assimilated C. Disconnected D. Lost children

ANS: B Assimilation is the process whereby a family or individual loses its unique cultural identity and identifies more with the dominant culture. The teens appear to be assimilated. Acculturation is the changes in cultural patterns within a group to match those of the host society. Connectedness relates to with whom the family identifies and relates as a family unit. Lost children are often seen in substance-abusing families.

10. A nurse is assessing a child with very poor social skills. What conclusion can the nurse make about the child's family? A. Emotional or mental illness B. Not filling socialization needs C. Poorly educated, poor job skills D. Probably lower-income status

ANS: B Families should fulfill five functions: physical needs, economic needs, reproductive needs, affective and coping needs, and socialization needs. A child with poor social skills probably (but not necessarily) comes from a family that is not fulfilling the child's socialization needs. Assuming that the child has an emotional or mental illness without further assessment is unhelpful. Assuming that the family is lower income, is poorly educated, and has poor job skills is stereotypical.

13. A patient is dismissed from the hospital and is receiving nursing care at home to help in the recovery from a serious illness and operation. The visiting nurse notes that the family is in a state of disarray and members are disorganized and not communicating. The patient is trying to direct everyone's actions. The nurse calls a family meeting. What action by the nurse is best? A. Encourage family members to make "to do" lists and assign chores. B. Explain that changes in one person require changes in the others. C. Make a referral to a counselor or mental health nurse practitioner. D. Tell the family members that for the patient to recover, they have to assume his or her role.

ANS: B Family systems theory recognizes that changes in one member of a family affect every other member of the family. In order for the family to function effectively, all members need to adapt to the major changes in one of the members. Making lists and assigning chores are simple tasks that might help with organization, but this does not go far enough in solving the problem. The family may or may not need a referral for counseling. Simply telling the family members a fact does not give them enough information to adapt.

37. A grade school nurse is conducting vision screening before school and notes the student is accompanied by an older sister who has also brought a middle school child. The older child states that time is a problem because middle school starts in a few minutes and tells the younger child to go right to the classroom after the screening, then leaves. What question by the nurse would be most appropriate to ask the youngest child during the screening? A. "Do you feel safe at home or is someone hurting you there?" B. "Does your sister always bring you and your sibling to school?" C. "Have you ever seen your parents drinking a lot or using drugs?" D. "Why aren't your parents available to bring you to school?"

ANS: B In substance-abusing families, one child often takes the role as the responsible person, allowing the family to continue functioning. The fact that a sibling was bringing the children to school is a little unusual, and the nurse should assess the reason behind it. However, substance-abusing families often keep secrets for both social and legal reasons. The nurse should not ask directly about substance abuse, but rather open a line of discussion by introducing a nonthreatening question. There is no indication of abuse, so asking if the child is safe is not appropriate at this time. In a secret-keeping family, asking directly about drinking or drug use would most likely elicit a negative response. Asking "why" questions is confrontational.

20. A nurse working with the elderly population is distressed that in order to obtain public funding for long-term care, the elderly must expend nearly all of their resources. When considering bioethical principles, which principle should the nurse choose to act from to make the biggest difference in this situation? A. Autonomy B. Fidelity C. Justice D. Veracity

ANS: C The principle of justice means treating everyone fairly. Requiring the elderly to divest themselves of their resources in order to obtain funding for housing could be seen as a justice issue. Autonomy is having free will and acting according to one's own wishes when making decisions. Fidelity is keeping promises. Veracity is truth telling.

1. The clinic nurse is working with a mother and her 3-year-old child who have arrived for the child's routine checkup. The nurse encourages the mother to return for her child's measles-mumps-rubella immunization prior to the child's entering school. This intervention is an example of what type of care? A. Mandatory health care B. Primary health prevention C. Secondary health prevention D. Tertiary health prevention

ANS: B Of the three levels of prevention, the most desirable level is primary prevention. This encompasses health promotion and activities specifically meant to prevent disease from occurring—in this case, scheduling vaccinations. Secondary prevention refers to early identification and prompt treatment of a health problem before it has an opportunity to spread or become more serious. Tertiary prevention is intended to restore health to the highest functioning state that is possible.

10. A nurse wants to work in the community providing secondary prevention activities. Which action would this nurse choose to do? A. Educate teenage girls about birth control options. B. Provide STD/STI testing at the local youth center. C. Staff the county health department flu shot clinic. D. Volunteer to drive cancer patients to receive their treatments.

ANS: B Secondary prevention is screening, early detection, and prompt treatment for health problems. Testing youths for STD/STIs is an example of secondary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Educating teenage girls about birth control options will (hopefully) prevent unintentional pregnancies and is an example of primary prevention. Likewise, staffing the flu shot clinic is also an example of primary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Driving cancer patients to their treatments is an example of tertiary prevention.

36. A nurse is working with a family in which one member has schizophrenia. Using systems theory, for which concern should the nurse specifically assess this family? A. Balance B. Boundaries C. Children's ages D. Subsystems

ANS: B Systems theory looks at boundaries, balance and homeostasis, and subsystems. An important concern in the family whose member is diagnosed with a mental illness is social isolation, which is related to boundaries. Some families view mental illness as shameful and try to keep the information secret. The nurse should work to ensure the family understands the importance of healthy interaction with outside systems. Children's ages would be assessed using developmental theories.

3. A nurse working with an after-school program is concerned about the lack of health literacy in the students' parents. What action would best address this need? A. Conduct a monthly health-related seminar for parents. B. Investigate grants or other funding for a computer bank. C. Invite parents to healthy cooking demonstrations. D. Provide brochures on a variety of health problems.

ANS: B The disparity between people who have access to technology and those who do not is directly related to health literacy and knowledge. The amount of information doubles every 6 years, so it is not possible to keep track of all the latest health news by accessing brochures, books, or periodicals. Having access to computers would greatly increase health literacy. The other options are certainly helpful, but would not be as far-reaching as providing access to online material.

24. A nurse has heard of the "digital divide" between people who have access to technology and those who don't. The nurse asks a mentor how this can affect health care. What response by the mentor is most accurate? A. "It's just easier and faster to make appointments online." B. "Much health-care information is available only digitally." C. "The so-called digital divide really doesn't have much impact." D. "You can chat with your doctor on social media sites."

ANS: B The explosion in information makes digital access to health-care resources vital. There are even applications for smart phones that have a health-care function. Not all clinics and physician offices have online appointment scheduling. Most people surveyed would like to connect with their physicians via email but not on social networking sites.

26. A nurse is working with a woman who is 4 months pregnant. The woman has had a series of temporary housing, has no job, and is wearing clothing that is obviously way too big for her. What action can the nurse take to most improve the health of this woman and child? A. Arrange transportation for her to get to a community food bank. B. Consult a social worker to help her apply for the WIC program. C. Encourage the woman to make her return appointment before leaving.

ANS: B WIC, or the Women, Infants, and Children Program, targets pregnant women, infants, and children up to age 5 who are nutritionally at risk. WIC provides supplemental nutritious foods and nutrition counseling. Forty-five percent of infants born in this country participate in the WIC program. Helping with transportation needs and facilitating return appointments is helpful too, but not to the degree that improving this woman's nutrition will be. The woman might be eligible for Medicaid, but not Medicare, which is for the elderly.

7. Which of the following activities should the perinatal nurse encourage women who come for preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation E. Ensuring iron supplementation

ANS: B, C, D Folic acid supplementation helps to prevent certain birth defects. A fetus's exposure to harm could potentially be prevented if a woman were counseled prior to pregnancy about the adverse effects of alcohol, tobacco, toxoplasmosis, and other teratogens in her home or workplace. During the preconception period, it is too early for the woman to take iron supplements (unless she is anemic), and debating infant feeding methods is not the priority at this time

9. A nurse assessing a family includes which components in the assessment? (Select all that apply.) A. Dietary habits B. Family size and structure C. Parenting style D. Religious affiliation E. Socioeconomic status

ANS: B, C, D, E A family assessment includes family size and structure; parenting style; and religious, cultural, and socioeconomic orientation. Dietary habits are not specifically assessed, although this information may be part of a cultural assessment.

3. A nurse working in the community uses the public health intervention model to combat diabetes mellitus type 2. Using this model, which interventions are appropriate? (Select all that apply.) A. Community: Encourage high-risk patients to have glucose screening. B. Community: Lobby for funds to build walking and biking trails. C. Community: Subsidize community gardens in areas where produce is expensive. D. Individual/family: Educate about the benefits of daily exercise. E. Societal: Pressure Congress for laws requiring insurance incentives for health promotion.

ANS: B, C, D, E The public health intervention model, also known as the Intervention Wheel, is a framework that contains three levels for health-care interventions, from the micro-level of the individual to the macro-level of the environment. Interventions are aimed at individuals/families, communities, and larger institutional and social systems. Lobbying to build walking/biking trails and assisting with community gardens are examples of community-level interventions. Encouraging high-risk individuals to have glucose screening is at the individual/family level, as is education about the benefits of daily exercise. An example of an institutional or societal intervention would be lobbying Congress to pass laws requiring insurance companies to provide incentives for health promotion activities.

10. The clinic nurse explains to a student that an appropriate nursing action is screening all children for child abuse. What other information does the nurse give the student about child abuse? (Select all that apply.) A. It is frequently carried out by a stranger. B. The most common form is neglect. C. It is most often perpetrated by a parent. D. Only 1 out of 1,000 girls is sexually abused. E. It is part of an ongoing cycle of violence.

ANS: B, C, E The National Child Abuse and Neglect Data System reports that three children die of child abuse in the home each day. Children are most commonly abused by someone they know, and in 79% of cases, the perpetrator is a parent. Child abuse can set up a perpetuating cycle of suffering and more violence later in life, potentially reaching to future generations. Neglect is the most common form of child abuse. One out of every four girls will be sexually abused by the time she reaches 18.

6. The public health nurse explains to students that diversity is an increasing phenomenon in this country. What facts about this phenomenon does the nurse share with the students? (Select all that apply.) A. As immigrants acculturate, their unique cultural care needs will diminish. B. By 2050, the minority population in America is estimated to be 50%. C. Hispanics, blacks, and Asians are the historically designated minority groups. D. One in five people in this country will be over the age of 65 by the year 2030. E. Racial differences are rooted in biological factors that explain illness trends.

ANS: B, D The population of ethnic minorities is expected to reach 50% by the year 2050, which increases the need for culturally competent health care. One in five people will be over the age of 65 by 2030, increasing the impact of chronic illnesses. Hispanics, blacks, Asians, and Native Americans are the historically designated minority groups. There is no biologic basis for race; racial and ethnic categories are socially created.

7. The nurse assesses the communication in a family that includes a single mother, a teenage son and daughter, and a grandmother. During the family interview, the daughter answers many questions while the son and mother are quiet and the grandmother is absent. What conclusions can the nurse make about this family? (Select all that apply.) A. The communication patterns are healthy. B. The daughter may have a lot of power. C. The grandmother does not want to be involved. D. The grandmother may have little power. E. The mother and son may have a coalition.

ANS: B, D, E Communication theory asserts that patterns of communication within a family reveal much about the way the family functions, the structure of the family, the power base, decision making, affection, trust, and affiliation. Preliminary conclusions the nurse can make about this family are that the daughter may have a lot of power because she answers many questions without input from anyone else, the grandmother may not have much power because she is not even present, and the mother and son may have a coalition opposed to the daughter. The nurse will need to confirm these conclusions with further assessment. These communication patterns are not healthy. The nurse should not assume that the grandmother does not want to be involved but should assess the reason for her absence.

12. Which childhood illnesses are the subject of a Healthy People initiative regarding vaccinations? (Select all that apply.) A. Asthma B. Measles C. Meningitis D. Mumps E. Pertussis

ANS: B, D, E One goal of the Healthy People initiative is to reduce vaccine-preventable illnesses such as measles, mumps, and rubella to zero cases and to reduce pertussis in children under 7 to no more than 2,000 cases/year. Asthma and meningitis are not included in this goal.

34. A nurse is working with a family with the diagnosis of impaired family processes. Although both parties worked, one person worked part time and had the main responsibility for the household. The other spouse retired recently and has not taken on more of this role. Both people are angry and resentful. What goal would be best for this couple? A. Adapt to role changes positively within 2 months. B. Divide up household duties between spouses more evenly. C. Express feelings using "I" statements within 1 month. D. Learn to discuss anger and other negative emotions.

ANS: C A good goal or outcome is specific, measurable, and has a time element. The goal that best meets that description is expressing feelings using "I" statements within 1 month. Adapting to role changes is vague and not measurable. Dividing duties more evenly is not measurable and has no time element. Learning to discuss negative emotions does not mean using what is learned, so it is not as specific as the correct answer.

23. A 45-year-old woman presents to the emergency department complaining of chest pain and feeling anxious. She asks to have an electrocardiogram (EKG) but is told that "heart disease is a man's disease" and is given a prescription for lorazepam (Ativan). What can the nurse conclude? A. If the woman were older, she may have received an EKG. B. Sex hormones play a powerful role in determining heart disease. C. Stereotyping seriously impacted the care the woman received. D. Women under the age of 45 are at low risk of having heart disease.

ANS: C A stereotype is a mental image that portrays members of a specific group with the same attributes. Believing that heart disease is a "man's disease" is an example of a stereotype. Because the practitioner held this view, the woman's health care was compromised. The other statements cannot be justified from this example.

12. A nurse works a great deal with refugees and is frustrated because, as a group, they don't seem to want to implement desired health behaviors. What action by the nurse would be most helpful? A. Conduct a health screening and educational event each month. B. Provide written information in the group's native language. C. Teach selected group representatives to be lay health educators. D. Try to establish relationships within the refugee community.

ANS: C According to family systems theory, each family system contains boundaries that affect how the outside world interacts with the family. Families that have recently immigrated to the United States might have closed boundaries and may only be receptive to health information provided by extended family members or members of their community. Establishing a lay health educator program in which community members can be taught health information with the intent of delivering it to their communities would be a good way to work with these families while respecting their boundaries. Regularly occurring health events might improve the nurse's standing in the community. Written information may or may not be helpful; many refugees are illiterate in their native languages and some languages do not have a written form. Establishing relationships within the community is advisable, but does not go far enough to solve the problem.

11. A nurse is working with family members who have been striving to improve their functioning as a family unit. What behavior would suggest to the nurse that the family is meeting its goals? A. The children are in multiple activities to develop talents. B. The desire to be understood guides most communication. C. Family members gave up some activities in order to eat dinner together on most nights. D. The parents have a strong desire for the children to succeed.

ANS: C Effective tools for families include ways to enhance family performance. One very effective tool is to put the family first in this very chaotic world. Giving up some activities in order to eat dinner together shows the family is putting the unit as a whole first over individual desires. This is the opposite of children being in multiple activities, which often cuts into family time and can be disruptive. Communication should be guided by the desire to understand the other first, then to be understood. A strong desire for the children's success does not guarantee successful family functioning.

31. A family has weekly game nights and monthly family together days. The nurse documents these events as examples of which of the following? A. Family beliefs B. Family bonding C. Family building D. Family rituals

ANS: C Family-building activities are an extension of family rituals and center on recreation and leisure. They do contribute to family bonding, but the most specific answer is family building. Family activities are influenced by family beliefs.

15. A nurse is working with a blended family of 1 year with five children aged 3, 7, 13 (twins), and 19. The parents seem overly stressed and anxious and do not seem to work well as a unit. What can the nurse conclude about this family? A. Communication problems are the core of the parents' stress. B. Economic stressors are impacting the parental dyad. C. The family is in too many developmental stages to master any of them. D. There are too many children to give each one adequate attention.

ANS: C In family developmental theory, the age of the child determines the stage the family is in. If there is more than one child, the family is probably in multiple developmental stages at the same time. The family is probably in a combination of beginning families, preschool, school-aged and adolescent, and launching stages. The competing priorities of all of these stages pave the way for chaos. Without further information, the nurse cannot conclude that economic stressors or communication problems are the root cause of the issue. Simply concluding that the family has too many children is judgmental and does not leave any room for interventions.

13. A nurse wants to know the trend concerning death due to cardiovascular disease. What source should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data

ANS: C Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education.

8. A nurse is assessing a single person at a clinic visit. How would the nurse classify this patient's family? A. Family of choice B. Family of origin C. Not in a family D. Nuclear family

ANS: C Most definitions of family require at least two people who self-define as being part of that family. Thus, a single individual cannot be a family. A family of choice is the family adopted through marriage or cohabitation. A family of origin includes the individuals who reared the person of interest. A nuclear family consists of a male partner, a female partner, and their children.

5. A mother and her 12-year-old daughter visit the clinic often because of the daughter's asthma. The clinic nurse recognizes that one of the most important nursing actions in this situation is which of the following? A. Continue to schedule regular clinic visits for the child to follow her condition. B. Give the mother time to talk about her daughter's illness while she is present. C. Listen patiently to the child as she talks about her illness, letting her tell her story. D. Regulate and modify the child's medications in response to her asthma symptoms.

ANS: C Research shows that children feel that health-care providers don't really listen to them. It is important to advocate for the child and to develop a therapeutic relationship characterized by a caring attitude. The nurse should encourage the child to discuss her asthma and modify interventions accordingly.

35. A patient is being discharged from a psychiatric facility after a suicide attempt. The family consists of the patient, two parents, and two other teenage children. What action should the nurse teach the entire family as a priority? A. Assess for drugs or alcohol in the patient's room. B. Encourage the patient to take medications. C. Monitor the patient for signs of suicidal thoughts. D. Plan menus that contain nutritious food items.

ANS: C Safety is a priority concern in every family and all members should be made aware that the patient could have continued suicidal thoughts. If the siblings notice this, they should be taught to tell the parents immediately and could also be taught some effective communication to use. Looking for drugs or alcohol in the patient's room, encouraging medication use, and planning menus are all actions more appropriate for the parents.

11. A nurse is interested in providing tertiary prevention activities. Which of the following activities would this nurse choose to do? A. Assist with low-cost swimming lessons at the YMCA. B. Conduct monthly educational seminars at a church. C. Join the county pandemic outbreak response team. D. Provide glucose and cholesterol screening at the mall.

ANS: C Tertiary prevention attempts to restore health to its highest level of functioning. Working with a county response team in the event of a pandemic outbreak would be an example of tertiary prevention. Primary prevention includes activities designed to keep health problems from happening. It often includes education. Assisting with swimming lessons and conducting monthly seminars will educate the target audiences in order to prevent a health problem. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing glucose and cholesterol screening is an example of secondary prevention.

18. A nurse who uses the structural-functional theory would assess which of the following when working with families? A. Communication patterns B. How things get done C. If goals are being met D. Looseness of boundaries

ANS: C The structural-functional theory focuses on the outcomes, not the processes, within the family. The nurse using this theory would assess if the family goals are being met. Communication patterns are critical to communication theory. Processes are important to family developmental theory, and boundaries are important in family systems theory.

5. A mother brings her 8-year-old daughter to the clinic for the third time in 2 months. The mother states that her daughter is very active and often falls down. The mother states that her daughter eats well, but the child's weight falls below the 10th percentile. The clinic record shows the child had multiple bruises on her arms at the time of the last two visits. Today the nurse notes that the child has areas of ecchymosis on her left leg and ankle. Which action by the nurse is best? A. Ask the child and her mother again about the child's bruises. B. Question the child about her accident-prone behaviors. C. Speak with the child alone, asking if she feels safe at home. D. Teach the mother to keep a diary of what her child is eating.

ANS: C This child's presentation is suspicious. If child abuse is suspected, the nurse should question the child privately. In all situations the nurse is legally obligated to report the abuse to the proper investigating agency.

22. A student observes as an adult brother and sister lash out at the nurse caring for their hospitalized parent. The parent lives at home but is dependent on the children for care and is obviously neglected. The nurse has informed the children that social work will be involved in their father's case. How does the nurse explain this interaction? A. "Don't worry; they will calm down eventually." B. "Families often get emotional in these situations." C. "They are focusing attention on me, not the problem." D. "This family is obviously highly dysfunctional."

ANS: C This family is dysfunctional, but that does not go far enough to explain the situation. This behavior is known as triangulation, and occurs when a dyad diverts attention away from their problems and chooses instead to focus on a third party, in this case the nurse. Reassuring the student they will calm down is neither helpful nor accurate as the family members may choose to continue to lash out. Families often do get emotional, but again, this information is not really helpful.

26. A female patient from a refugee community is in the emergency department and needs urgent surgery. The patient defers making a choice on the operation, preferring to wait for a cultural elder to arrive. What action by the nurse is most appropriate? A. Encourage the patient's family to talk her into having the operation. B. Explain kindly to the patient that her situation cannot wait. C. Respect the patient's choice and wait for the elder to arrive. D. Take the patient to surgery under the principle of implied consent.

ANS: C This is a difficult situation, but because the patient's wishes are known, the nurse has no choice other than to wait. In the emergency department, sometimes surgery is performed under the principle of implied consent (for instance, on an unconscious patient with no known family), but in this case, the patient has been clear as to her wishes, so doing that would be an ethics violation. The nurse must be careful to not be coercive. The nurse (and physician) would ensure that the patient understands the risks of waiting.

9. The clinic nurse is interviewing a woman and her daughter who describe their address as"temporary." The mother appears thin, pale, and tired. Her blood work confirms anemia and pregnancy. What actions by the nurse would be most helpful? (Select all that apply.) A. Call the Department of Children and Family Services. B. Discuss nutrition needs for pregnancy. C. Facilitate the woman's opportunity to return for prenatal care. D. Determine if the family is in a safe location. E. Provide shelter information for this family.

ANS: C, D, E A priority for this family is to provide information regarding shelters, to facilitate follow-up clinic visits for the mother to address her pregnancy and anemia, and to determine if the family is currently in a safe place or if the family is vulnerable to violence. Nutrition in pregnancy should be discussed, but it is not the priority intervention at this point. There is no reason to call the Department of Children and Family Services unless abuse is suspected.

7. The nurse observes a woman and her sister who live together. They are trying to support one another and provide extended care to their mother who has recently been diagnosed with Alzheimer's disease. The two sisters describe their experience with a homemaker who visits their home to help bathe their mother. They say she is "humorous and cheerful" and absorbs their mother's attention for the whole time she is present. This is a positive description of which component of Bowen's family systems theory? A. Communication B. Family relationship building C. Family rituals D. Triangulation

ANS: D According to Bowen, triangulation occurs when a dyad (the sisters) focuses on a third person who draws attention away from their conflicts. The homemaker is serving this function in this family. Bowen's theory looks at family problems that are rooted in family processes, such as communication. Relationship building and rituals are not part of this theory.

21. A clinic nurse is using group theory to assess a family whose youngest child recently moved back home after graduating from college and is unable to find a job. Which statement by a parent would indicate to the nurse that goals for norming have been met? A. "I'm glad my son stays in his room in the basement all day so he doesn't bother us." B. "It's hard to decide how much food to buy because we don't know where he's eating." C. "My son is gone a lot of the time, so we really don't notice that he moved back in." D. "We have agreed not to have a curfew as long as we know when he will be home."

ANS: D According to group theory, a healthy family adjusts to changes in its structure by resetting roles and norms. In this family, a launched child has moved back in, disrupting the patterns established when he left. Agreeing to new rules and roles is a sign of adaptation. The other responses do not show adaptation to the new situation.

20. A nurse is working with a woman who is newly married and pregnant and says she is distressed because she and her husband seem to be so different and they argue over petty issues. What action by the nurse using group theory would be best? A. Ask the woman if she can remember why she and her husband fell in love. B. Caution her that this level of disagreement will cause stress to the unborn baby. C. Offer the woman a referral to a community counseling center for couples therapy. D. Reassure her that this is normal and help her brainstorm ways to work cooperatively.

ANS: D According to group theory, groups evolve through the distinct stages of forming, storming, norming, performing, and adjourning. Storming often occurs when a group that has recently formed notices differences in members, leading to chaos or confusion. This couple is in this stage. At this point, the nurse's best action is to reassure the woman and help her brainstorm ways of working together cooperatively, which might include forming rules or procedures that both parties agree to follow. Asking about their early relationship does not give the woman information that will help the present situation. Warning the patient about the negative effects of stress on her unborn baby sounds judgmental and threatening. A referral for counseling might be needed at a future date.

24. A nurse working in a pediatric clinic is attempting to assess a school-age child who is disrespectful of the nurse and parent and tears up a magazine when asked to sit down. What conclusion can the nurse make about this family? A. The child is not getting enough attention from the parents. B. The family is from an underserved community group. C. Financial stress has caused family strife and fighting. D. The parental disciplinary approach is inconsistent.

ANS: D Children whose parents have a laissez-faire disciplinary style tend to be disrespectful, aggressive, and disobedient. A laissez-faire disciplinary style includes inconsistent use of discipline, allowing children (rather than the parents) control over the environment, few rules, and children making their own decisions rather than being guided by parents. The other options may be true, but without further assessment, the nurse cannot make those conclusions.

9. A nurse is interested in primary prevention programs. Which of the following activities would this nurse choose to do? A. Assist with blood pressure screening at the local mall. B. Collect and distribute used eyeglasses for poor people. C. Staff a mobile mammogram unit for underserved groups. D. Teach teenagers about the dangers of texting and driving.

ANS: D Primary prevention includes activities designed to keep health problems from happening. It often includes education. Teaching teens the dangers of texting and driving will (hopefully) prevent motor vehicle crashes. Secondary prevention is screening, early detection, and prompt treatment for health problems. Providing blood pressure screening and mammograms are examples of secondary prevention. Tertiary prevention attempts to restore health to its highest level of functioning. Providing eyeglasses for needy people with vision problems is an example of tertiary prevention.

16. A nurse is working with a parent-teacher association to combat school bullying. What action can the nurse suggest that would best help to decrease this form of interpersonal violence? A. Advise that victims' parents call law enforcement and press charges. B. Begin offering martial arts classes in the school for bullied children. C. Encourage the school to adopt no-tolerance policies for bullying. D. Suggest limiting television viewing, especially for younger children.

ANS: D Some research has shown that violent media exposure is linked to violent behavior. Included in media are computer games, which can also be violent. Younger children may not be able to distinguish between real and fantasy and may be overly influenced by violent images. No-tolerance policies can be helpful, as can a social environment in which children and their parents are held accountable legally. Offering martial arts classes may send the wrong message and would most likely not diminish the incidence of bullying.

6. The clinic nurse notices that each time a child with leukemia is brought in to see the doctor, her mother and aunt accompany her. The mother states that she finds her daughter's illness to be very traumatic and is having difficulty coping. The child's aunt encourages the child's mother and distracts the child while her blood work is being drawn. The child's aunt could be described as taking on which of the following roles? A. Child-caregiver role B. Kinship role C. Socializer role D. Therapist role

ANS: D Structural-functional theory focuses on the functioning of the family and the roles assumed by each family member to promote family function. Necessary roles include provider, housekeeper, child caregiver, socializer, sexual partner, therapist, recreational organizer, and kinship member. The therapist role is assumed when one family member expresses concern for another's health or emotional well-being. The aunt does not appear to be the primary caregiver (child-caregiver role). There is no indication that the aunt fills the socializer role by organizing family social activities. The kinship role includes maintaining family and social ties by things like remembering important dates, and the aunt does not appear to function in that role either.

8. A nursing student wishes to investigate national health goals. Where should the student research this information? A. Cochrane Database B. Cumulative Index of Nursing and Allied Health Literature C. Government websites D. Healthy People initiative

ANS: D The Healthy People initiative is the blueprint for the nation's health goals. Updated every 10 years, it lists national health priorities. Information related to the Healthy People initiative can be found on the other sites, but they are secondary sources. The student would do best to investigate the primary source.

19. A nurse reads in the paper that the death rate for women overall has declined substantially. To what does the nurse correlate this finding? A. Abundant new choices in contraception B. Better detection and treatment of breast cancer C. Greater access to sources of fresh produce D. Improved diagnosis of heart disease in women

ANS: D The leading cause of death in women overall is heart disease. Women face significant barriers to timely diagnosis and treatment of heart disease than do men. The nurse can conclude that this has improved, leading to the significant decrease in the female death rate. Contraception choices would not lead to a significant decrease in mortality, as childbirth is not a common fatal event, although the number of perinatal deaths has not declined in recent years. And even with multiple choices in contraception, at least half of all pregnancies are unintended or mistimed. Access to fresh produce could improve many health conditions for women. Cancer is the second leading cause of death in women.

8. A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticity E. Vaginal dryness

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

7. The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.) A. Aspirin prophylaxis B. Breast cancer screen C. Colorectal cancer screen D. Influenza vaccine E. Tobacco and alcohol screen

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

42. A nurse is educating a woman on the use of denosumab (Prolia). What information should the nurse provide? A. "Return in 6 months for another injection." B. "Take this medication on an empty stomach." C. "Take this medication with milk or food." D. "You may have increased night sweats."

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

A nurse is conducting a class on the Lamaze method of childbirth. Which core values does this nurse plan to teach? (Select all that apply.) A. A woman's ability to give birth can be diminished by the care provider. B. Conscious breathing is the main coping strategy in Lamaze. C. Lamaze birthing is medication free and epidurals are not given. D. The birth coach is only present to provide comfort to the laboring woman. E. Women are capable of and have the wisdom to give birth.

A. A woman's ability to give birth can be diminished by the care provider. B. Conscious breathing is the main coping strategy in Lamaze. E. Women are capable of and have the wisdom to give birth. The woman's innate ability to give birth, the use of conscious breathing as the main coping strategy, and the fact that the woman's confidence and ability to give birth can be either enhanced or diminished by the care provider and place of birth are some of the core concepts of the Lamaze method. Lamaze educators provide information on pain control and stress that each woman needs to make the decision about pain management that is best for her. Birth partners are taught to assess the woman for hyperventilation during the transition period of labor.

A pregnant woman lifts weights regularly with a partner. What modification to this activity should the nurse suggest? A. Adjust the weight bench so that it is tilted, not flat. B. Do fewer repetitions by using heavier weights. C. Do not hold your breath for more than 30 seconds. D. Use free weights instead of resistance bands.

A. Adjust the weight bench so that is tilted, not flat Lifting from a supine position can cause vena cava syndrome and decreased placental perfusion, so the woman should be instructed to adjust the weight bench to a tilted position. Heavy weights can overload the loosened joints, so using lighter weights with more repetitions is recommended. Holding the breath can cause a Valsalva maneuver, which decreases placental perfusion. Resistance bands are preferred to reduce the likelihood of abdominal injury.

A new patient is being assessed by the perinatal nurse. For exercise, the woman practices yoga five times a week, walks her dog, and swims. What action should the nurse do first? A. Ask if any yoga positions involve arching the back. B. Explain that swimming is a great exercise for all women. C. Instruct the woman to stop exercising if she gets fatigued. D. Tell her that no extra water is needed if she is swimming.

A. Ask if any yoga positions involve arching the back Women should adhere to some basic safety guidelines when formulating an exercise program. These guidelines include monitoring the breathing rate; ensuring that the ability to walk and talk comfortably is maintained during the physical activity; stopping the exercise when tired; avoiding exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle; and maintaining an adequate fluid intake. Because yoga involves different positions, the nurse should assess whether the patient engages in positions that involve arching the back. Swimming is good exercise and she should stop exercising if she gets fatigued, but asking about positions involves an immediate possible threat to the safety of the fetus. Extra water is needed no matter what type of exercise is being done.

An expectant father seems to be ambivalent about the impending birth of his child. Which actions by the nurse are most important? (Select all that apply.) A. Ask the father if he has fears for his partner. B. Assess the woman for intimate partner violence (IPV). C. Call the social worker to assess the father's financial situation. D. Give the father written information about childbirth. E. Reassure the father that conflicting emotions are normal.

A. Ask the father if he has fears for his partner E. Reassure the father that conflicting emotions are normal Expectant fathers can experience fears and ambivalence about the woman's pregnancy. Some common concerns include fear for the woman's safety and health, financial concerns, and worry that he is not ready for this responsibility. The nurse should reassure the father that these feelings are normal and can further the discussion by assessing for these common emotions. There is no indication that either partner suffers from IPV, it is premature to call the social worker before a problem has been identified, and giving the father written information on childbirth may not address his concerns. In addition, the nurse should assess literacy prior to giving written information and should be prepared to discuss it.

An 18-year-old woman at 18 weeks' gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurse's best approach to care at this visit? A. Ask the patient to complete a 3-day dietary recall while she is in the clinic. B. Explain the possible concerns related to excessive weight gain in pregnancy C. Explain to the patient that weight gain is not a concern in pregnancy. D. Teach the patient about the expected normal weight gain during pregnancy.

A. Ask the patient to complete a 3-day dietary recall while she is in the clinic This woman has gained much more than the average weight gain in the first trimester (1-2.5 kg). Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. The nurse should facilitate this process while the woman is at her appointment. After assessment and mutually planning nutritional goals, the nurse can educate the woman about the possible concerns related to excessive weight gain and teach about the normal trajectory of weight gain during pregnancy. This series of actions follows the nursing process best.

A woman in her second trimester continues to smoke a pack of cigarettes a day despite stating that she understands why smoking is bad for her and for her fetus. Which action by the nurse is best? A. Assess the patient for past trauma and abuse. B. Document the information in the patient's chart. C. Review prior teaching done regarding smoking. D. Show photos of babies born with abnormalities.

A. Assess the patient for past trauma and abuse Research shows that women who continue to smoke during pregnancy often report high levels of trauma and abuse and higher levels of PTSD symptoms. Women who smoke as a coping mechanism are even more likely to smoke during pregnancy (Lopez, Konrath, & Seng, 2011). The nurse should assess for these factors. Documentation is important, but is not the best answer because the nurse does not do anything to assist the patient; documentation alone is the answer only when the data are normal. Reviewing prior teaching may be helpful, but if the nurse does not help the patient address the core issue of smoking, this review will be unhelpful and a waste of time. Showing babies born with abnormalities is demeaning and could be interpreted as threatening.

A woman in her third trimester is complaining of numbness and tingling in her fingers. Which action should the nurse take first? A. Assess the woman for hyperventilation. B. Educate her about a thermoskin carpal tunnel glove. C. Facilitate an appointment for a nerve conduction study. D. Reassure her that the condition is temporary

A. Assess the woman for hyperventilation Carpal tunnel syndrome is commonly seen in pregnancy and can be caused by either hyperventilation or from nerve compression of the median and ulnar nerves in the arm. If the woman is hyperventilating, the nurse can educate her about conscious control of breathing, which would provide relief quickly and easily. If hyperventilation does not seem to be the causative factor, the nurse can educate her about strategies for symptom control. These methods include maintaining good posture, elevating the hands on pillows when sleeping, wearing a wrist brace, and/or using a thermoskin carpal tunnel glove. Simply reassuring the woman that the condition is temporary does nothing to increase her comfort. A nerve conduction study is not needed at this time, but if the condition persists after childbirth, it could be an option.

The nurse teaches the prenatal class attendees about herbal medications that may cause uterine contractions and preterm labor. Which of the following herbal preparations should be avoided because they act as uterine stimulants? (Select all that apply.) A. Black cohosh B. Dong quai C. Ephedra D. Mugwort E. Senna

A. Black cohosh D. Mugwort During preconception counseling and pregnancy, nurses should educate couples to avoid the following common uterine stimulants that may cause preterm labor: barberry, black cohosh, feverfew, goldenseal, mugwort, pennyroyal leaf, and yarrow root. Dong quai is an anticoagulant, ephedra is a cardiac stimulant, and senna can overstimulate digestion and metabolism, causing fluid and electrolyte imbalances.

For which diseases does the prenatal nurse recommend a newly pregnant woman be screened? (Select all that apply.) A. Chlamydia B. Hepatitis A C. Mumps D. Rubella E. Varicella

A. Chlamydia D. Rubella E. Varicella Pregnant women should be screened for sexually transmitted infections, hepatitis B, HIV, rubella, and varicella. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella.

A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best? A. "It is the best time to find any conditions that could have a negative effect on a pregnancy." B. "It's a good time to educate women about birth control options before they need them." C. "Reproductive care is an important part of any woman's health care." D. "The Centers for Disease Control mandates that all women get preconception care."

A. It is the best tie to find any conditions that could have a negative effect on a pregnancy Preconception counseling is an ideal time to identify conditions (physical, psychosocial, environmental, or social) that could lead to a future negative pregnancy outcome. The patient can be educated about the risks and assist in developing a plan to mitigate or avoid them. Providing birth control options can be an important part of preconception care, but this answer is too limited to be the best choice. Stating that reproductive care is important is vague. A goal of Healthy People 2020 is to increase the number of women getting preconception and prenatal care.

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

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

30. A preoperative nurse is caring for a patient who will undergo an open breast biopsy. What action by the nurse takes priority? A. Ensure that an informed consent is signed and witnessed. B. Inventory and label all of the patient's belongings. C. Orient the patient's significant others to the waiting room. D. Premedicate the patient on arrival to the pre-op holding area.

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

43. A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations? A. Annual screening after age 40 B. MRI to replace mammography C. No routine screening after age 65 D. Periodic screening if high risk

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

23. A patient is in the clinic for an annual exam. Her past medical history includes endometriosis for which she takes medroxyprogesterone (Depo-Provera). What assessment finding would the nurse relate to the medical condition or medication? A. 20-lb weight gain B. Cold intolerance C. Facial acne D. Facial hair growth

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

31. A nurse in a family practice clinic sees several generations of the same family. For which family members should the nurse arrange routine screening colonoscopies? A. Daughter, age 52 B. Grandfather, age 80, no history of polyps or cancer C. Grandmother, age 72, history of polyps D. Grandson, age 30, no gastrointestinal symptoms

ANS: A Individuals aged 50 and older should have screening colonoscopies, so the daughter should be scheduled for this procedure. The CDC does not recommend routine screening for patients aged 75-85 and recommends no screening after age 85, so the grandparents do not need to be screened. For patients with family history of colon polyps or cancer, screening should begin in their 40s, so the grandson does not yet need screening.

16. The parents of a 16-year-old boy are frustrated because the teen is always participating in risky activities and getting hurt, and has a group of friends of whom the parents do not approve. What action by the nurse would be most helpful? A. Encourage an after-school program that includes rock climbing, rafting, and hiking. B. Reassure the parents that risk taking is just a normal part of adolescence. C. Show the teen statistics on preventable injuries and deaths among teenagers. D. Tell the teen his risky behavior can lead to injuries and worries his parents.

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

36. A nulliparous 53-year-old woman is in the clinic complaining of lower abdominal fullness, heavy menses, and severe menstrual cramping. What treatment does the nurse anticipate for this woman? A. Administration of leuprolide (Lupron) B. Hysterectomy and bilateral salpingo-oophorectomy C. None; issue will resolve spontaneously D. Surgical removal of the ovaries

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

4. A 17-year-old girl comes to the health department clinic to renew her oral contraceptive pills. During the physical examination, the nurse observes that the girl has broken blood vessels on her face and her lips are cracked and chapped and her fingers are callused. What further actions will the nurse perform? (Select all that apply.) A. A weight assessment B. Assessment for depression C. Draw blood for electrolytes D. Discussion about anorexia nervosa E. Discussion about bulimia

ANS: A, B, C, E Bulimia nervosa is a syndrome that consists of a cycle of binge eating and purging. Physically, the adolescent with bulimia nervosa may exhibit physical changes related to forced, excessive vomiting: cracked and damaged lips, tooth damage, callused fingers and hands, and broken blood vessels in the face. Other findings that may not be readily apparent include throat irritation, esophageal inflammation, and parotitis from vomiting, as well as rectal bleeding from overuse of laxatives. Bulimia is also associated with depression. The nurse should assess the teen's weight, screen her for depression, draw blood for electrolyte imbalances, and discuss bulimia.

2. A community health nurse is packing a kit of play items for the families who will be visited today. One family has an infant and a preschooler. Which toys should the nurse include in the kit? (Select all that apply.) A. Blocks B. Coloring books C. Ride-on train D. Simple board game E. Stuffed animals

ANS: A, B, D An infant is in the stage of solitary play. Appropriate toys include blocks, books, rattles, push-pull toys, and musical toys. The preschooler is in the stage of associative play. Appropriate toys for this child include imitative games, simple arts and crafts, simple board games, interactive games, alphabet or color games, coloring and drawing, and simple computer games. The ride-on train and the stuffed animals are more appropriate for a toddler.

3. A nurse is preparing to educate a group of parents about injury prevention in adolescents. Which topics should the nurse plan to include as priorities? (Select all that apply.) A. Bicycle safety B. Gun safety C. Home safety D. Driving safety E. Water safety

ANS: A, B, D, E In adolescents, the most common causes of injury are motor vehicle crashes, bicycles (includes skateboarding and skating), firearms, and water activities. Home safety, although always important, is a topic more appropriate to families with younger children.

5. The clinic nurse talks with parents about the signs and symptoms of substance use because their 12-year-old twins will be attending a new school in the fall and they wish to be prepared. The nurse correctly describes the potential symptoms of substance abuse, including which of the following? (Select all that apply.) A. Chronic cough B. Euphoria C. Irritability D. Nausea and vomiting E. Red and glazed eyes

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

29. A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily.

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

27. The nurse prepares to offer health screening and promotion activities for women aged 40-60. Which activity does the nurse plan to include as a priority for this group? A. Alzheimer's disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations

ANS: B Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40-55. The priority screening activity is for breast cancer. Alzheimer's disease screening is typically done in the older patient. Gardasil is recommended for females aged 9-26. Influenza vaccinations are important for all ages.

5. The family clinic nurse reviews nutritional information with a 15-year-old patient. The patient is concerned about being short and wonders if growth will continue. The nurse explains that the typical increase in height during adolescence is how much? A. 15% B. 25% C. 30% D. 35%

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

17. A school nurse is preparing educational activities for all high school students on reproductive health. The principal cautions that the program can only contain information about sexual abstinence. Which action by the nurse would be most appropriate? A. Argue that abstinence-only programs do not work and are not valuable. B. Discuss the need to have information appropriate to the teens' experience. C. Plan the program but encourage questions not related to the prepared material. D. Prepare an abstinence-only program because teens should not have sex.

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

25. A 21-year-old woman who has not been sexually active is in the clinic and requests a Gardasil vaccination. After giving the shot, what instruction does the nurse provide to her? A. Return in 1 month for the next shot. B. Return in 2 months for the next shot. C. Return in 6 months for the next shot. D. Return in 1 year for the next shot.

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

1. The clinic nurse knows that providing an influenza vaccination clinic for patients aged 65 years and older is best described as an example of what kind of health care? A. Disease prevention B. Health promotion C. Health screening D. Secondary prevention

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

20. The nurse is assessing a young woman who is overweight. Which action by the nurse is most appropriate? A. Ask if she knows how overweight she is. B. Assess the woman for stress-related problems. C. Caution her about related chronic illnesses. D. Encourage the woman to exercise more.

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

6. A school nurse is interviewing a high school student sent to the office for frequent crying episodes. The student admits to thinking of suicide and has made a previous attempt. The nurse determines that the teen has a suicide plan but does not yet have access to the materials needed to carry out the plan. How does the nurse interpret and act on this information? A. High risk: Call the school district counselor. B. High risk: Contact 911 immediately. C. Low risk: Send a referral home with the student. D. Moderate risk: Call the parents to come get the teen.

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

18. A nurse is teaching conflict-resolution strategies to a group of teen mothers at risk for violence. Which statement by a participant indicates understanding? A. "Friends of mine have said they would be willing to help in a crisis." B. "If good communication doesn't solve the problem, I will leave." C. "If we can't settle our differences, we will have to start talking all over again." D. "My mother can help my boyfriend and me resolve a conflict."

ANS: B Successful conflict resolution strategies enable the teen to remain calm and safe. If communication and respect do not work to resolve the conflict, the teen should remove herself from the situation. The other statements do not show that the teen has understood this message.

11. A mother who has three older children now has a newborn. She complains to the physician that sleeping on his back has caused her baby to have "a funny-shaped head" that the other kids didn't have. She doesn't want to continue having the baby sleep on his back. Which action by the nurse is best? A. Document the comments and alert the physician to the concern. B. Encourage her to put the baby on his stomach during the day. C. Explain that babies need to sleep on their sides at all times. D. Tell her that back-sleeping isn't important after 5 months of age.

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

24. A nurse reads in a patient's chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this woman's treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron)

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

21. A nurse is teaching a 24-year-old male about reproductive health. Which information should the nurse provide this patient about testicular cancer? A. Annual screening is recommended for testicular cancer. B. If the epididymis is tender to the touch, that is concerning. C. Perform a testicular self examination after a warm shower. D. Because testicular cancer is rare at this age, no action is needed.

ANS: C Although cancer of the epididymis is considered rare, it is still the most common cancer found in men aged 20-34. Men should be taught the technique of testicular self-examination, which is best performed after a warm shower when the scrotum is more relaxed. Annual screening is not recommended other than during a clinical exam. The epididymis is normally slightly tender to pressure.

4. The pediatric clinic nurse tells the parents that infants can roll over, presenting a safety hazard, at what age? A. 1 month B. 2 months C. 3 months D. 4 months

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

8. A nurse is observing a mother and her 10-month-old infant. The mother is interacting happily with the child while letting the baby eat pieces of hot dog. What action by the nurse is best? A. Compliment the mother on her parenting skills. B. Document that the baby is eating finger foods now. C. Stop the mother from feeding the hot dog to the baby. D. Teach the mother that hot dogs are poor nutrition.

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

3. The clinic nurse is working with a mother who wants to know the best age for teaching children about the names and functions of sexual organs. What should the nurse tell her? A. 5 to 6 years of age B. 6 to 7 years of age C. 8 to 9 years of age D. 9 to 11 years of age

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

34. A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin

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

38. A nurse is working with an older adult who has never exercised despite understanding the health benefits. What can the nurse do to improve the chances that this adult will begin an exercise regimen? A. Ask the patient if dancing sounds like fun. B. Encourage the patient to join a fitness club. C. Explain how exercise increases independence. D. Have the family talk with the patient about it.

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

47. The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching? A. "Are you sure your breasts are emptying?" B. "Does the baby put everything in his mouth?" C. "Does your baby sit in a high chair yet?" D. "Is your baby using the pincer grasp yet?"

ANS: C The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 8-10 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

19. A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity.

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

15. The school nurse wants to create a safe driving program for the high school students. In order to have the greatest impact on safety, on which issue should the nurse focus? A. Female driving B. Late-night driving C. Seat-belt use D. Sleep deprivation

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

35. A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. "Acupuncture has been shown to work better than other body therapies." B. "Herbs are a great option as they do not typically have side effects." C. "Mind-body, manipulative, or traditional Chinese medicine are safer than herbs." D. "Research shows that black cohosh significantly reduces hot flashes."

ANS: C There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind-body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse's best answer is to explain this to the patient.

22. A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin).

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

46. At what age should the nurse prepare patients to begin thyroid function screening? A. 30 years B. 40 years C. 50 years D. 60 years

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

45. A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls? A. Blood draw B. Limited pelvic exam C. No alternative D. Urine collection

ANS: D A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 13-18. The other options are incorrect.

12. A clinic nurse is working with an extremely obese teen. Besides nutrition and related health effects, what else should the nurse assess the patient for? A. Alcoholism B. Hepatitis C C. Lanugo D. Seat-belt use

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

14. A nurse is assessing a teen who has the nursing diagnosis of sleep pattern disturbance. What statement by the teen indicates that goals for this diagnosis have been met? A. "I don't want to cut out any more evening activities." B. "I sleep until about noon on Saturdays to catch up." C. "I take a long nap when I get home from school each day." D. "I try to keep the same sleep and wake times all week."

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

2. The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant's immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months

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

9. A nurse is teaching new parents about dental care for their baby. Which information should the nurse provide? A. Brush the baby's teeth with special baby toothpaste. B. The child should see a dentist before the age of 2. C. All teeth should be in by age 2. D. Wipe the baby's gums with moist gauze.

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

7. The family clinic nurse initiates conversation with a 16-year-old adolescent male who is 5 feet 10 inches and weighs 250 pounds (113.6 kg). Which of the following is the most appropriate question for the nurse to ask the adolescent regarding his weight? A. "Are you willing to talk about your weight gain this year?" B. "Do you realize your weight puts you into an obese category?" C. "Do you participate in any activities or exercise?" D. "What do you think about your weight right now?"

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

37. A nurse notes that a woman's chart lists "dyspareunia" as a diagnosis. In planning education for the patient, which topics would the nurse include? A. Black cohosh and soy nuts B. Kegel exercises and use of a pessary C. Nonsteroidal anti-inflammatory medications D. Water-based vaginal lubricants

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

33. A 53-year-old woman is having her annual physical and tells the nurse she has not had a period for 7 months. She wants to know if she has undergone menopause. What response by the nurse is best? A. "No, at your age, fluctuations in your menstrual cycle are normal findings." B. "No, menopause only begins in women after the age of 55." C. "Yes, not having a period for more than 6 months is diagnostic of menopause." D. "You have to go 1 year without a menstrual period to be sure that menopause has occurred."

ANS: D Menopause can only be diagnosed with certainty after 1 year without menstrual periods. Although fluctuations in a woman's cycle are normal during the perimenopausal years, this answer is not correct, as it appears to signify that there is no relationship between the lack of periods and menopause, and so is misleading. The average age of menopause in the United States is 51.4 years, with a range of 35-60 years.

39. An older patient has never exercised, but wants to begin now. What response by the nurse is best? A. "At your age, exercise will not benefit you." B. "Good for you! I am so proud of you!" C. "Remember to stretch before exercising." D. "Start with exercising for only 5 minutes a day."

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

26. A young woman has had three urinary tract infections (UTIs) in the last year. What teaching should the nurse plan for this patient? A. Avoid sexual intercourse during your period. B. Take prophylactic antibiotics daily. C. Void every 4 hours while awake. D. Wipe from front to back after using the bathroom.

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

13. A school nurse is evaluating a teenager who is returning to school after breaking her fibula. The nurse notes the student has a blood pressure of 90/56 mm Hg, has a pulse of 58 beats/minute, and is wearing three layers of clothing. What action by the nurse is best? A. Ask the student if she had pain medication this morning. B. Document the findings and send the student to classes. C. Have the student lie down and call 911 immediately. D. Question the student about eating and exercising patterns.

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

10. A public health nurse is visiting a family home where there is a newborn. Which assessment finding by the nurse warrants immediate intervention? A. A cat is sitting on the kitchen counter by the stove. B. Roaches are evident in the kitchen and in the pantry. C. The baby is on a carpet that is stained and worn out. D. The crib has dirty bumper pads and a dirty comforter.

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

The prenatal nurse has reviewed a patient's 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog, chips, and an apple for lunch. Breakfast consists of cereal, milk, and juice; and dinner contains meat, a starch, vegetables, and a salad. What action by the nurse is most important? . A. Advise the woman to obtain more calories from protein. B. Assess the woman's knowledge of proper food handling. C. Discuss adding fish such as tuna or swordfish to the diet. D. Weigh the woman and document her weight in the chart.

B. Assess the woman's knowledge of proper food handling Pregnant women should be taught proper food handling to prevent foodborne illnesses. Deli meats, hot dogs, and luncheon meats should be stored at 40° or less, heated before eating, and consumed within 4 days. Tuna should be eaten in moderation and fish such as shark, swordfish, king mackerel, and tilefish should be avoided in pregnancy because of mercury poisoning. Promoting safety is a priority. The woman may or may not need more calories from protein. Obtaining the patient's weight and documentation are important prenatal activities, but are not the best answer because the nurse needs to assess the woman's knowledge and practice of safe food handling first.

A 22-year-old woman is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. The patient is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. Which of the following should the nurse include in the patient's dietary teaching plan? (Select all that apply.) A. Consuming red meat B. Eating foods high in zinc C. Increasing calcium intake D. Restricting sodium E. Taking an iron supplement

B. Eating foods high in zinc E. Taking an iron supplement Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Most women cannot consume enough iron through their diets while pregnant, so an iron supplement should be suggested. The nurse can also educate the patient about foods high in zinc so that she can increase her intake. Although red meat does contain iron, consuming meat goes against the woman's chosen lifestyle and it would be disrespectful of the nurse to suggest this. Increasing calcium and restricting sodium intake are not helpful advice in this situation.

After questioning a pregnant woman about her fluid intake, the nurse discovers that the patient is drinking four glasses of diet cola per day. Which response by the nurse is best? A. "As long as you get enough fluid, soda is all right to drink." B. "Less than two cups of caffeine a day is probably OK." C. "The major worry with soda is the sugar content." D. "You really should switch to decaffeinated colas."

B. Less than two cups of caffeine a day is probably OK The primary sources of caffeine for pregnant women are coffee, tea, and soda. Research shows that small amounts of caffeine (less than 2 cups a day) are probably safe; however, higher amounts cause central nervous system stimulation and can increase the chance of spontaneous abortions, stress the fetus's metabolic system, and decrease blood flow to the placenta. Women should be encouraged to restrict their intake of caffeinated beverages and taught that even decaffeinated beverages still contain some caffeine.

A 24-year-old pregnant woman at 26 weeks' gestation is experiencing her third pregnancy. The patient's obstetric history includes one full-term birth and one preterm birth; both children are alive and well. Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate? A. "Can you ask your manager about light-duty work at your job?" B. "See if you can take more breaks at work to rest and drink water." C. "With your previous premature birth, you might need to reduce your working hours." D. "You can continue to work as long as you want to and feel able to."

C. "With your previous premature birth, you might need to reduce your working hours." Although many women do continue to work throughout their pregnancies, certain medical problems and pregnancy complications are a red flag for the woman to reduce her work hours. Examples of these conditions include back problems, preterm labor (both of which this woman has), diabetes, kidney disease, heart disease, hypertension, and a history of spontaneous abortion. Light duty may be an option in addition to decreasing the work hours. Taking more breaks might be advised as well, but with this woman's history and current health complaints she should consider decreasing her working hours. Other factors the nurse should discuss with the patient are the amount of heavy physical labor she does and her exposure to chemotherapeutic agents, both of which are possible environmental hazards to the pregnancy

A nurse is helping a pregnant woman prepare for a planned home birth. What action by the nurse takes priority? A. Advising the woman to get a prescription for pain medication filled beforehand B. Attempting to convince the woman that giving birth at the hospital is a better choice C. Ensuring the woman has safe, rapid, and available transportation to a nearby hospital D. Giving the woman a list of local obstetricians who will assist at a home birth

C. Ensuring the woman has safe, rapid, and available transportation to a nearby hospital Home births are an option for women who have low-risk pregnancies and no labor complications. However, according to a position statement by the American College of Obstetrics and Gynecology (ACOG), women who choose to deliver at home should be well- informed and should ensure access to rapid and timely transportation to the closest hospital in case of emergency (ACOG, 2011). Obstetricians will not deliver babies at home. Although pain management may be an important consideration, this is not as important as ensuring the safety of both mother and baby. Trying to convince the woman to go against her beliefs is disrespectful

The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patient's quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important? A. Call the social worker for a consultation. B. Document the findings in the woman's chart. C. Facilitate a referral to a genetics counselor. D. Prepare the woman for intrauterine death

C. Facilitate a referral to a genetics counselor All women should be offered screening with maternal serum markers. The triple-marker screen and the quadruple-marker screen test for the presence of alpha-fetoprotein, estradiol, human chorionic gonadotropin, and other markers. These tests screen for potential neural tube defects, Down syndrome, and trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling and further testing, such as chorionic villus sampling or amniocentesis, should be performed (ACOG, 2007). There is no indication that the woman needs a social work consult or that she will experience intrauterine death. Documentation should be complete, but is not the most important action for the nurse to take

A student nurse is working in the OB clinic as part of a preceptorship. The student is counseling a woman in her first trimester who complains of insomnia due to nasal congestion. Which action by the student warrants intervention by the student's preceptor? A. Advises the woman to use over-the-counter nasal saline spray B. Assesses the patient for other allergy and cold symptoms C. Instructs the woman to use decongestants and antihistamines D. Suggests the woman take a hot, steamy bath at bedtime

C. Instructs the woman to use decongestants and anti histamines Congestion is a common complaint in pregnancy. Self-care measures include occasional saline drops; hot, steamy showers; increasing fluids;, and using a vaporizer or humidifier. It is important to rule out upper respiratory infections such as colds or allergies when a woman complains of nasal congestion. Women should avoid decongestants in the first trimester.

A woman who is 26 weeks pregnant has a blood pressure of 158/100 mm Hg. Which action by the nurse is most appropriate? A. Assess the woman's risk for other cardiovascular problems. B. Have her rest for 20 minutes, then reassess her blood pressure. C. Obtain a urine dipstick for proteinuria and assess for headache. D. Prepare to teach the woman about anti-hypertensive medication.

C. Obtain a urine dipstick for proteinuria and assess for a headache Preeclampsia is defined as a blood pressure greater than 140/90 mm Hg after 20 weeks' gestation accompanied by proteinuria. Other signs and symptoms include headache, visual changes, and edema. The nurse should suspect this condition and confirm it with a urine test for protein and by asking about the other symptoms. Assessing for other cardiovascular risk problems and teaching about anti-hypertensive medications are not warranted in this situation.

A pregnant woman is being discharged from the hospital after an episode of preterm labor that has resolved. She asks the nurse if she can now return to her low-impact aerobics class. Which response by the nurse is best? A. "As long as it's low impact, it should be OK to return." B. "Make sure you can talk while you are exercising." C. "Preterm labor is a contraindication for aerobic exercise." D. "Wait 72 hours; if you don't have more contractions, it's OK."

C. Preterm labor is a contraindication for aerobic exercise Premature labor, along with several other conditions, is an absolute contraindication to aerobic exercise during pregnancy. Although being able to talk while exercising is an important safety tip, this woman should not be engaging in any aerobics for the duration of this pregnancy.

A pregnant woman is complaining of urinary frequency and is worried about incontinence. Which teaching strategy should the nurse use when counseling this woman? A. Minimize fluid intake during the day. B. Perform sit-ups to strengthen the abdomen. C. Teach the woman how to perform Kegel exercises. D. Void infrequently to train the bladder.

C. Teach the woman how to perform Kegel exercises There are several physiological factors that cause urinary frequency and possible incontinence during pregnancy. Kegel exercises can improve both symptoms. The patient should remain well hydrated and void frequently. Sit-ups will not help with urinary frequency.

A woman in the perinatal clinic is upset that her impending childbirth will cause her to lose her job. What assessment question by the nurse would yield the most important information regarding this situation? A. "After you give birth, you will probably want to quit your job anyway." B. "Can you make an appointment with human resources to discuss this?" C. "Where do you work and how long have you been there?" D. "Why do you think you will be fired after your baby is born?"

C. Where do you work and how long have you been there? The Family Medical Leave Act of 1993 guarantees most women (and men) 12 weeks of unpaid family leave following the birth or adoption of a child. The employee has the right to return to the job without loss of seniority, pay, or benefits. This act applies to federal, state, or local government organizations and any other organization that has 50 or more employees working within 75 miles of the workplace. The employee must have worked at this job at least 12 months or for at least 1,250 hours in the previous year to be eligible. By asking the woman where she works and how long she has been there, the nurse is assessing if the workplace must adhere to this act. Telling the woman she will probably want to quit her job is dismissive of her concerns. Making an appointment with human resources might be a good suggestion, but only after the nurse has assessed the patient's eligibility for the Family Medical Leave Act. Asking "why" questions is considered a communication barrier, as many people become defensive when questions are worded this way.

The perinatal nurse notes that a patient has the diagnosis of ptyalism. What topic should the nurse include in the patient's teaching plan? A. The benefits of acupuncture B. The need to eat more red meat C. The importance of strict vulvar hygiene D. The suggestion to suck on hard candy

D. The suggestion to suck on hard candy Ptyalism is an excessive production of saliva. Possible helpful strategies include sucking on hard candy, brushing the teeth often, drinking plenty of water in small sips, and consuming small frequent meals with fewer starchy foods. Acupuncture can help with nausea and vomiting, vulvar hygiene would be recommended for leukorrhea, and eating more red meat may help with dietary insufficiencies.