Exam 5

Which is a preferred treatment for candidiasis?

Mycostatin

What is Chandelier sign?

Pain on movement of the cervix

A 50 year old patient informs the nurse that she is experiencing some of the symptoms of menopause. She has not had a menstrual period in 8 months and states that she is having hot flashes. What other methods can the nurse inform her are available to treat the hot flashes?

Problematic hot flashes have been treated with low-dose venlafaxine (Effexor) and other meds. Vit. B6 and Vit. E may also be effective. Black cohosh, ginseng, dong quai, soy, and other herbal preparations have also been tried by some women, although few data exist about the safety or effectiveness.

Maryanne, a 19 year old college student, has recently noticed increased vaginal discharge that is grey to yellowish-white in color and comes into the clinic for treatment. The nurse will educate her on reducing the risk factors that cause bacterial vaginosis. What risk factors does the nurse include when educating?

The following increase risk of developing bacterial vaginosis: - Smoking - Multiple sex partners - Douching after menstruation - Having other active STI's

When the nurse places the patient in the stirrups for a pelvic exam she observes a bulge caused by rectal cavity protrusion. What does the nurse know this protrusion is called? a. Cystocele b. Rectocele c. Uterine prolapse d. Hemorrhoids

b. Rectocele

What is premenstrual syndrome?

A cluster of physical, emotional, and behavioral symptoms that are usually related to the luteal phase of the menstrual cycle.

Charlotte is a 21 year old college student and has recently noticed increased vaginal discharge that is grey to yellowish-white in color and comes into the clinic for treatment. The nurse suspects bacterial vaginosis. What does the nurse recognize is a diagnostic sign of bacterial vaginosis?

A pH over 4.7

Define Cystocele:

Bladder protruding into the vagina

What is another name for benign tumors of the uterus?

Fibroids

What is endometriosis?

Implantation of endometrial tissue in other areas of the pelvis

A woman comes to the clinic frequently with reports of chronic pelvic pain. What does the nurse understand can be associated with this issue?

In women, chronic pelvic pain is often associated with physical violence, emotional neglect, and sexual abuse in childhood.

What is the term used to describe the beginning of menstruation?

Menarche

Menopause usually begins at age ______ to ______ years with a median age of ______ years. Perimenopause can begin as early as age _______ years.

Menopause usually begins at age 45 to 52 years with a median age of 51 years. Perimenopause can begin as early as age 35 years.

What is the recommended treatment for trichomoniasis?

Metronidazole

What is probably the most significant form of menstrual dysfunction because it may signal cancer, benign tumors of the uterus, or other gynecologic problems?

Metrorrhagia

Define Adnexa:

Pain on movement of the cervix

Which of the following people are at increased risk for vulvovaginal candidiasis? (select all that apply) a. Pregnant woman b. a diabetic woman c. a woman living with HIV d. A young woman taking oral contraceptives e. A middle aged woman taking corticosteroids

a,b,c,d,e all these people would be at an increased risk for developing vulvovaginal candidiasis.

HPV can be found in lesions of which of the following? (Select all that apply) a. Skin b. Cervix c. Vagina d. Anus e. Penis f. Oral Cavity

a,b,c,d,e,f. HPV can be found in lesions of all of the choices.

The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient? a. Calcium b. Iron c. Salt d. Vit. K

a. Calcium

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend to diminish the discomfort? a. ibuprofen b. petroleum jelly c. water-based lube d. Aspirin

c. water-based lube

The nurse is assisting a patient in preparing for a pelvic exam. What position will the nurse place the patient in for exam? a. left lateral b. prone c. jackknife d. lithotomy

d. Lithotomy

What is dyspareunia?

painful intercourse

What is dysmenorrhea?

painful menstruation

The nurse is assessing a male client for clinical manifestations of gonorrhea. Which data support the diagnosis? 1. Presence of a chancre sore on the penis. 2. No symptoms. 3. A CD4 count of less than 200. 4. Pain in the testes and scrotal edema.

1. A chancre sore is a symptom of syphilis, not gonorrhea. 2. Gonorrhea is more likely to be asymptomatic in females. 3. A CD4 count of less than 200 is a diagnostic indicator for AIDS. 4. Pain in the testes and scrotal edema can indicate epididymitis, an inflammatory process of the epididymis. This and urethritis are the most common presenting symptoms in a male with gonorrhea. TEST-TAKING HINT: Two answer options mention male anatomy. If the test taker did not know the information, then choosing between these two options might be the appropriate method of elimination.

The client is diagnosed with primary syphilis. Which clinical manifestations should the nurse observe? 1. A chancre sore in the perineal area. 2. A rash on the trunk and extremities. 3. Blistering of the palms of the hands. 4. Confusion and disorientation.

1. A chancre sore on the perineal area is a symptom of primary syphilis. 2. A rash on the trunk and extremities occurs in secondary syphilis. 3. Blistering of the palms of the hand occurs in secondary syphilis. 4. Tertiary syphilis occurs over a prolonged period and includes clinical manifestations of dementia, psychosis, paresis, stroke, and meningitis.

The emergency department nurse is caring for a client diagnosed with HHNS and a blood glucose of 680 mg/dL. Which question should the nurse ask the client to determine the cause of this acute complication? 1. "When is the last time you took your insulin?" 2. "When did you have your last meal?" 3. "Have you had some type of infection lately?" 4. "How long have you had diabetes?"

1. A client diagnosed with type 2 diabetes usually is prescribed oral hypoglycemic medications, not insulin. 2. The client could not eat enough food to cause a 680 mg/dL blood glucose level; therefore, this question does not need to be asked. 3. The most common precipitating factor is infection. The manifestations may be slow to appear, with onset ranging from 24 hours to 2 weeks (Hoffman & Sullivan, 2020). 4. This does not help determine the cause of this client's HHNS. TEST-TAKING HINT: If the test taker does not know the answer to this question, the test taker could possibly relate to the phrase "acute complication," realizing a medical problem might cause this, and thus select infection, option "3."

The client is diagnosed with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? 1. Reports of extreme fatigue and hair loss. 2. Exophthalmos and reports of nervousness. 3. Reports of profuse sweating and flushed skin. 4. Tetany and reports of stiffness of the hands.

1. A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss. 2. These are clinical manifestations of hyperthyroidism. 3. These are clinical manifestations of hyperthyroidism. 4. These are clinical manifestations of parathyroidism. TEST-TAKING HINT: Often, if the test taker does not know the specific clinical manifestations of the disease but knows the function of the system affected by the disease, some possible answers can be ruled out. Tetany and stiffness of the hands are related to calcium, the level of which is influenced by the parathyroid gland, not the thyroid gland; therefore, option "4" can be ruled out.

The outpatient clinic nurse is working with clients diagnosed with STIs. Which long-term complication should the nurse discuss with the clients about STIs? 1. Stress the need for clients to finish all antibiotic prescriptions completely. 2. Inform the clients that, legally, many STIs must be reported to the health department. 3. Sexually transmitted infections can result in reproductive problems. 4. Discuss the myth that acquired immunodeficiency syndrome is an STI.

1. A general rule when discussing antibiotics is to teach clients to finish all of the prescription, but this is not specific information related to STIs. 2. Most STIs must be reported to comply with public health laws, but this is not a long-term complication of having an STI. 3. Because of the scarring of reproductive tissue, infertility may be an issue resulting from STI infection. 4. AIDS is a sexually transmitted infection and can also be transmitted by non-sexual blood and body fluid exposure. TEST-TAKING HINT: The test taker can rule out option "1" because of the generalized nature of the option; it is not specific to STIs. Option "2" does not address a long-term complication for the client. And option "4" requires the test taker to know the transmission of the disease.

The nurse is teaching the client diagnosed with type 2 diabetes mellitus about diet. Which diet selection indicates the client understands the teaching? 1. A submarine sandwich, potato chips, and diet cola. 2. Four slices of a supreme thin-crust pizza and milk. 3. Smoked turkey sandwich, celery sticks, and unsweetened tea. 4. A roast beef sandwich, fried onion rings, and a cola.

1. A submarine sandwich is on a bun-type bread and is usually 6 to 12 inches long, and potato chips add fat and more carbohydrates to the meal. 2. Four slices of pizza contain excessive numbers of carbohydrates, plus cheese and meats, and whole milk is high in fat. 3. Turkey is a low-fat meat. A sandwich usually means normal slices of bread, and the client needs at least 50% carbohydrates in each meal. Celery sticks are not counted as carbohydrates. 4. The roast beef sandwich is high in carbohydrates, fried onion rings are high in fat, and a regular cola is high in carbohydrates.

The nurse is caring for a 30-year-old nulliparous client reporting severe dysmenorrhea. Which diagnostic test should the nurse prepare the client to undergo to determine the diagnosis? 1. A bimanual vaginal exam. 2. A pregnancy test. 3. An exploratory laparoscopy. 4. An ovarian biopsy.

1. A vaginal examination does not provide a definitive diagnosis to determine the cause of the pain. 2. A pregnancy test is not usually ordered unless the client has a reason to think she may be pregnant. Pregnancy temporarily alleviates the symptoms of endometriosis because neither ovulation nor menses occur during pregnancy. 3. There is a high incidence of endometriosis among women with no biological children (nulliparity) and those having children later in life. The most common way to diagnose this condition is through an exploratory laparoscopy. 4. The ovaries lie deep within the pelvic cavity. Some form of abdominal procedure must be performed, such as laparoscopy, to reach the ovaries. However, the symptoms are not those of an ovarian cyst. TEST-TAKING HINT: The test taker could eliminate answer option "1" because "diagnosis" is in the stem. The stem is asking for a procedure providing a definitive diagnosis. Option "2" could be eliminated because, if the client is menstruating (dysmenorrhea means "painful menstruation"), then the client is usually not pregnant.

The home health nurse is completing the admission assessment for a 76-year-old client diagnosed with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included in the plan of care? 1. Assess the client's ability to read the small print. 2. Monitor the client's serum prothrombin time (PT) level. 3. Teach the client how to perform a hemoglobin A1c test daily. 4. Instruct the client to check the feet weekly.

1. Age-related visual changes and diabetic retinopathy could cause the client to have difficulty in reading and drawing up insulin dosage accurately. 2. The PT level is monitored for clients receiving warfarin (Coumadin), an anticoagulant, which is not ordered for clients diagnosed with diabetes, type 1 or 2. 3. Glycosylated hemoglobin is a serum blood test usually performed in a laboratory, not in the client's home. The hemoglobin A1c is performed every 3 months. Self-monitoring blood glucose should be taught to the client. 4. The client's feet should be checked daily, not weekly. In a week, the client could develop gangrene from an unnoticed injury. TEST-TAKING HINT: Always notice the age of a client if it is provided because this is important when determining the correct answer for the question. Be sure to note the adverbs, such as "weekly" instead of "daily."

The nurse is caring for a young adult client diagnosed with gonorrhea. Which statement reflects an understanding of the transmission of STIs? 1. Only lower socioeconomic income people are at risk for gonorrhea and syphilis. 2. The longer a client waits to become sexually active, the greater the risk for an STI. 3. Females can transmit infectious diseases more rapidly than males. 4. If a client is diagnosed with an STI, the client should be evaluated for other STIs.

1. All socioeconomic levels of clients contract STIs. 2. The longer the client abstains from sexual activity and the fewer partners the client has, the less the risk of an STI. 3. Females and males can spread STIs equally. Specific diseases may be asymptomatic in the sexes (in females, gonorrhea; in males, chlamydia) and they can transmit them unknowingly. 4. If the client has one STI, there is a great likelihood the client has another disease also. If one STI is found, the client should be monitored for others. TEST-TAKING HINT: Option "2" does not make sense: If sexual activity is put off, there cannot be an increased risk. Socioeconomic reasons may be a reason for delaying the treatment of a disease, but diseases are not financially based and occur in all socioeconomic levels.

The nurse is admitting a client diagnosed with trichomoniasis. Which assessment data support this diagnosis? 1. Odorless, white, curdlike vaginal discharge. 2. Strawberry spots on the vaginal surface and itching. 3. Scant white vaginal discharge and dyspareunia. 4. Purulent discharge from the endocervix and pelvic pain.

1. An odorless, white, curdlike vaginal discharge is a symptom of Candida albicans, a vaginal yeast infection. 2. A strawberry spot on the vaginal wall or cervix, a fishy smelling vaginal discharge, and itching are clinical manifestations of trichomonas. 3. Scant white vaginal discharge and dyspareunia are clinical manifestations of atrophic vaginitis. 4. Purulent discharge from the endocervix and pelvic pain are clinical manifestations of cervicitis. TEST-TAKING HINT: When studying for a test covering similar diseases, the test taker should concentrate on the information that makes one different from another. Only one STI has a characteristic strawberry spot.

The nurse is discharging a client diagnosed with PID. Which statement by the client indicates an understanding of the discharge instructions? 1. "I should expect pelvic pain after intercourse." 2. "I need to douche every day to prevent PID." 3. "I will have a vaginal examination every 2 years." 4. "My partner should use a condom if he is infectious."

1. Any pelvic pain after sexual exposure, childbirth, or pelvic surgery should be evaluated as soon as possible. 2. Douching reduces the natural flora, which combats infecting organisms and may help infecting bacteria move upward into the uterus, but douching will not prevent PID. 3. The client should have a vaginal examination at least once a year. 4. The client and partner should consistently use a condom if there is any chance of transmission of any organism.

The client is diagnosed with benign uterine fibroid tumors. Which question should the nurse ask to determine if the client is experiencing a complication? 1. "How many periods have you missed?" 2. "Do you get short of breath easily?" 3. "How many times have you been pregnant?" 4. "Where is the location of the pain you are having?"

1. Benign fibroid tumors in the uterus cause the client to bleed longer with a heavier flow, not miss periods. 2. Many women delay surgery until anemia has occurred from the heavy menstrual flow. A symptom of anemia is shortness of breath. 3. The number of pregnancies does not matter at this time; the client has a different problem. 4. The pain is in the pelvic region to the low back, where the uterus lies. TEST-TAKING HINT: This is a high-level question requiring the test taker to make several judgments before arriving at the answer. First, the test taker must decide what happens when a client has fibroid tumors and then which symptoms the client will exhibit.

The young female client is admitted with pelvic inflammatory disease secondary to a chlamydia infection. Which discharge instruction should be taught to the client? 1. The client will develop antibodies to protect against future infection. 2. This infection will not have any long-term effects for the client. 3. Both the client and the sexual partner must be treated simultaneously. 4. Once the infection subsides, the pain will go away and not be a problem.

1. Chlamydia does not cause an antigen-antibody reaction. 2. There are long-term problems associated with any STI. Chlamydia may have the long-term effects of chronic pain and increased risk for ectopic pregnancy, postpartum endometritis, and infertility. 3. If both the client and the sexual partner are not treated simultaneously, the sexual partner can reinfect the client. 4. The client may develop chronic pelvic pain as a result of the infection. TEST-TAKING HINT: Options "2" and "4" have a form of absolute. The words "any," "will," or "will not" are absolutes, and in health care, there are very few absolutes.

The client is diagnosed with a rectovaginal fistula to be managed medically. Which information should the nurse teach the client before discharge? 1. Douche with normal saline. 2. Eat a low-residue diet. 3. Keep ice packs on the area. 4. Use an abdominal binder.

1. Cleansing douches are prescribed with tepid water, not normal saline. 2. Measures to assist the client in healing without surgical interventions include proper nutrition with a low-residue diet to minimize contamination of the tissues with feces, cleansing douches, enemas, and rest. 3. Warm perineal irrigations and controlled heat-lamp applications promote healing; ice vasoconstricts the area and delays wound healing. 4. The client should wear perineal pads but not an abdominal binder.

The nurse is assessing the feet of a client diagnosed with long-term type 2 diabetes. Which assessment data warrant immediate intervention by the nurse? 1. The client has crumbling toenails. 2. The client has athlete's foot. 3. The client has a necrotic big toe. 4. The client has thickened toenails.

1. Crumbling toenails indicate tinea unguium, which is a fungus infection of the toenail. 2. Athlete's foot is not a life-threatening fungal infection. 3. A necrotic big toe indicates "dead" tissue. The client does not feel pain, does not realize the injury, and does not seek treatment. Increased blood glucose levels decrease the oxygen supply needed to heal the wound and increase the risk of developing an infection. 4. Big, thick toenails are fungal infections and do not require immediate intervention by the nurse. TEST-TAKING HINT: The test taker should select the option indicating this is possibly a life-threatening complication or some type of assessment data the health-care provider should be informed of immediately. Remember, "warrants immediate intervention."

Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism? 1. "I just don't seem to have any appetite anymore." 2. "I have a bowel movement about every 3 to 4 days." 3. "My skin is really becoming dry and coarse." 4. "I have noticed all my collars are getting tighter."

1. Decreased appetite is a symptom of hypothyroidism, not hyperthyroidism. 2. Constipation is a symptom of hypothyroidism. 3. Dry, coarse skin is a sign of hypothyroidism. 4. The thyroid gland (in the neck) enlarges as a result of the increased need for thyroid hormone production; an enlarged gland is called a goiter. TEST-TAKING HINT: If the test taker does not know the answer, sometimes thinking about the location of the gland or organ causing the problem may help the test taker select or rule out specific options.

The nurse is planning the care of a client diagnosed with pelvic inflammatory disease secondary to an STI. Which collaborative diagnosis is appropriate for this client? 1. Risk for infertility. 2. Knowledge deficit. 3. Fluid volume deficit. 4. Noncompliance.

1. Determining and diagnosing the risk for infertility problems requires collaboration between the nurse and the HCP. 2. The nurse is required to teach a client. This is an independent action. 3. Fluid volume deficit is not an appropriate nursing diagnosis for this client. 4. Noncompliance is an independent nursing problem. TEST-TAKING HINT: The question requires the test taker to determine which are autonomous functions of the nurse. The nurse does not have the capability to prescribe fertility medications or treatments.

Which client would the nurse identify as being at risk for developing diabetes? 1. The client with a diet of mostly candy and potatoes. 2. The 22-year-old client taking birth control pills. 3. The client having a cousin diagnosed with diabetes 2 years ago. 4. The 38-year-old female after delivering a 10-pound infant.

1. Eating sweets and high-carbohydrate foods can lead to obesity, but eating candy does not cause diabetes. 2. Birth control pills do not increase the risk of developing diabetes. 3. Type 2 diabetes can be more prevalent in families, but having one cousin with diabetes does not increase the risk of diabetes for the client. 4. Research shows that women are at greater risk of developing diabetes after delivering a large infant. TEST-TAKING HINT: The test taker must know the antecedents of developing disease processes.

The occupational health nurse is preparing a class regarding sexually transmitted infections (STIs) for employees at a manufacturing plant. Which high-risk behavior information should be included in the class information? 1. Engaging in oral or anal sex decreases the risk of getting an STI. 2. Using a sterile needle guarantees the client will not get an STI. 3. The more sexual partners, the greater the chance of developing an STI. 4. If a condom is used, the client will not get a sexually transmitted infection.

1. Engaging in oral and anal sex increases the risk of contracting an STI. 2. Using a sterile needle for drug abuse ensures the client will not get an STI from needle sharing, but the client can still contract an STI from other risky behaviors. 3. The more sexual partners, the greater the risk of contracting an STI. 4. Condom use provides a barrier to contracting an STI, but it is not a guarantee. The condom can break or come off during intercourse. TEST-TAKING HINT: In option "2" the word "guarantees" appears, and the nurse cannot guarantee anything in dealing with healthcare issues. Option "4" is an absolute statement—"will not get"—and can be eliminated on this basis.

The nurse identifies the client problem "risk for imbalanced body temperature" for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? 1. Discourage the use of an electric blanket. 2. Assess the client's temperature every 2 hours. 3. Keep the room temperature cool. 4. Plan activity intervals to promote rest.

1. External heat sources (heating pads, electric or warming blankets) should be discouraged because they increase the risk of peripheral vasodilation and vascular collapse. 2. Assessing the client's temperature every 2 hours is not needed because the temperature will not change quickly. The client needs thyroid hormones to help increase the client's temperature. 3. The room temperature should be kept warm because the client will report of being cold. 4. The client is fatigued, and this is an appropriate intervention but is not applicable to the client problem of "risk for imbalanced body temperature." TEST-TAKING HINT: The test taker must always know exactly what the question is asking. Option "4" can be ruled out because it does not address body temperature. If the test taker knows the normal function of the thyroid gland, this may help identify the answer; decreased metabolism will cause the client to be cold.

The client diagnosed with gestational diabetes delivered a 10-pound 5-ounce infant. Which is a priority for the nursery nurse to monitor? 1. Failure to latch on to the breast during feeding. 2. Jaundice and clay-colored stools. 3. Parchment-like skin and lack of lanugo. 4. Low blood glucose readings.

1. Failure of the baby to latch onto the breasts is not the priority for the nurse to assess. 2. There is nothing that indicates this baby will have jaundice and clay-colored stools. 3. The baby would have parchment-like skin and lack lanugo if the baby were over 40 weeks gestation. This is not stated in the stem. 4. The neonate is a high birth weight, and the mother had gestational diabetes. This infant had a high glucose content passing through the placenta in utero, and the infant's pancreas has been producing insulin to take care of the glucose content of the blood. The infant's pancreas must adjust to lower levels of glucose in the system. TEST-TAKING HINT: The test taker could eliminate option "2" because this is associated with liver or gallbladder issues, and basic knowledge of the pathophysiology of post-maturity gestation could eliminate option "3."

Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1,000 mL/day. 4. Provide six small, well-balanced meals a day.

1. Fiber should be increased in the client diagnosed with hypothyroidism because the client experiences constipation secondary to decreased metabolism. 2. The client diagnosed with hyperthyroidism should have a high-calorie, high-protein diet. 3. The client's fluid intake should be increased to replace fluids lost through diarrhea and excessive sweating. 4. The client diagnosed with hyperthyroidism has an increased appetite; therefore, well-balanced meals served several times throughout the day will help with the client's constant hunger. TEST-TAKING HINT: If the test taker knows the metabolism is increased with hyperthyroidism, then increasing the food intake is the most appropriate choice.

Which electrolyte replacement should the nurse anticipate being ordered by the HCP for the client diagnosed with diabetic ketoacidosis (DKA) just admitted to the ICU? 1. Glucose. 2. Potassium. 3. Calcium. 4. Sodium

1. Glucose is elevated in DKA; therefore, the HCP would not be replacing glucose. 2. The client diagnosed with DKA loses potassium from increased urinary output, acidosis, catabolic state, and vomiting. Replacement is essential for preventing cardiac dysrhythmias secondary to hypokalemia. 3. Calcium is not affected in the client diagnosed with DKA. 4. The prescribed IV for DKA—0.9% normal saline—has sodium, but it is not specifically ordered for sodium replacement. This is an isotonic solution. TEST-TAKING HINT: Option "1" should be eliminated because the problem with DKA is elevated glucose, so the HCP would not be replacing it. The test taker should use physiology knowledge and realize potassium is in the cell.

The client diagnosed with type 2 diabetes, controlled with biguanide medication, and a history of liver disease, is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? 1. Provide a high-fat diet 24 hours before the test. 2. Hold the biguanide medication for 48 hours before the test. 3. Obtain an informed consent form for the test. 4. Administer pancreatic enzymes before the test.

1. High-fat diets are not recommended for clients diagnosed with diabetes, and food does not have an effect on a CT scan with contrast. 2. According to the Food and Drug Administration (FDA), biguanides, oral diabetic medications such as metformin, must be held for a test with contrast medium in clients with a glomerular filtration rate below 60 mL/min/1.73 m2 or a history of liver disease, alcoholism, or heart failure. In these clients, biguanides combined with contrast mediums increase the risk of lactic acidosis, which leads to renal problems. Before 2016, the FDA required metformin to be discontinued for all clients, regardless of medical history (Lipska, Flory, Hennessy, & Inzucchi, 2016). 3. Informed consent is not required for a CT scan. The admission consent covers routine diagnostic procedures. 4. Pancreatic enzymes are administered when the pancreas cannot produce amylase and lipase, not when the beta cells cannot produce insulin. TEST-TAKING HINT: The test taker could eliminate option "1" because high-fat diets are not recommended for any client. Because the stem specifically refers to the biguanide medication and CT contrast, a good choice addresses both of these. Option "2" discusses both the medication and the test.

The client is admitted to the ICU diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.

1. Hypoglycemia is expected in a client diagnosed with myxedema; therefore, a 74 mg/dL blood glucose level is expected. 2. A pulse oximeter reading of less than 93% is significant. A 90% pulse oximeter reading indicates a Pao2 of approximately 60 on an ABG gas test; this is severe hypoxemia and requires immediate intervention. 3. The client diagnosed with myxedema coma is in an exaggerated hypothyroid state; a low pulse is expected in a client diagnosed with hypothyroidism. 4. Lethargy is an expected symptom in a client diagnosed with myxedema; therefore, this does not warrant immediate intervention. TEST-TAKING HINT: The words "warrant immediate intervention" means the test taker should select an option that is abnormal for the disease process or a life-threatening clinical manifestation.

The nurse administered 28 units of insulin isophane to a client diagnosed with type 1 diabetes at 1600. Which intervention should the nurse implement? 1. Ensure the client eats the bedtime snack 2. Determine how much food the client ate at lunch 3. Perform a glucometer reading at 0700 4. Offer the client protein after administering insulin

1. Insulin isophane (Humulin N), intermediate-acting insulin, peaks in 4 to 6 hours (Vallerand & Sanoski, 2019). The client will be at risk for hypoglycemia before midnight, which is why the client should receive a bedtime snack. This snack will prevent nighttime hypoglycemia. 2. The food intake at lunch will not affect the client's blood glucose level at midnight. 3. The client's glucometer reading should be done around 2100 to assess the effectiveness of insulin given at 1600. 4. The onset of insulin isophane (Humulin N), intermediate-acting insulin, is 2 to 4 hours, but it does not peak until 4 to 6 hours. TEST-TAKING HINT: The test taker must be familiar with the five types of insulins (rapid-acting, short-acting, intermediate-acting, long-acting, and combinations); the peak, onset, and duration of the five types of insulins; and the generic names of the insulins in each category. In this case, memorization is required.

Which clinical manifestations should the nurse expect to assess in the client diagnosed with an insulinoma? 1. Nervousness, jitteriness, and diaphoresis. 2. Flushed skin, dry mouth, and tented skin turgor. 3. Polyuria, polydipsia, and polyphagia. 4. Hypertension, tachycardia, and feeling hot.

1. Insulinoma is a tumor of the islet cells of the pancreas that produces insulin. The clinical manifestations of an insulinoma are signs of hypoglycemia. 2. These are clinical manifestations of hyperglycemia. 3. These are clinical manifestations of hyperglycemia. 4. These are clinical manifestations of hyperthyroidism.

The client diagnosed with type 2 diabetes is admitted to the intensive care unit (ICU) with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) coma. Which assessment data should the nurse expect the client to exhibit? 1. Kussmaul's respirations. 2. Diarrhea and epigastric pain. 3. Dry mucous membranes. 4. Ketone breath odor

1. Kussmaul's respirations occur with diabetic ketoacidosis (DKA) as a result of the breakdown of fat, resulting in ketones. 2. Diarrhea and epigastric pain are not associated with HHNS. 3. Dry mucous membranes are a result of the hyperglycemia and occur with both HHNS and DKA. 4. This occurs with DKA as a result of the breakdown of fat, resulting in ketones. TEST-TAKING HINT: The test taker must be able to differentiate between HHNS (type 2 diabetes) and DKA (type 1 diabetes), which primarily is the result of the breakdown of fat and results in an increase in ketones causing a decrease in pH, resulting in metabolic acidosis.

Which question should the nurse ask when assessing the client for an endocrine dysfunction? 1. "Have you noticed any pain in your legs when walking?" 2. "Have you had any unexplained weight loss?" 3. "Have you noticed any change in your bowel movements?" 4. "Have you experienced any joint pain or discomfort?"

1. Leg pain when walking indicates intermittent claudication, which occurs with peripheral vascular disease. 2. Weight loss with normal appetite may indicate hyperthyroidism. 3. Changes in bowel movements may indicate colon cancer. 4. Joint pain indicates a musculoskeletal or degenerative joint disease.

The client is diagnosed with tertiary syphilis. Which clinical manifestations should the nurse expect the client to exhibit? 1. Lymphadenopathy and hair loss. 2. Warts in the genital area. 3. Dementia and psychosis. 4. Raised rash covering the body.

1. Lymphadenopathy and hair loss are clinical manifestations of secondary syphilis, not tertiary syphilis. 2. Genital warts are not signs of tertiary syphilis. 3. Aortitis and neurosyphilis (dementia, psychosis, stroke, paresis, and meningitis) are the most common manifestations of tertiary syphilis. 4. A rash covering the body is a symptom of gonorrhea. TEST-TAKING HINT: The keyword in this question is "tertiary." The test taker must decide which disease has three distinct phases and then which clinical manifestations accompany each phase.

The nurse identified a concept of metabolism for a client diagnosed with diabetes. Which antecedent would be identified as placing the client at risk for diabetes? 1. Nutrition. 2. Sensory perception. 3. pH regulation. 4. Medication.

1. Nutrition encompasses obesity, and obesity is a risk factor for developing diabetes mellitus type 2. 2. Sensory perception may be a problem for clients diagnosed with diabetes because ophthalmological issues occur as a result of high blood glucose levels for a prolonged period of time but are not antecedents. 3. The concept of pH is a situation that can occur as a result of DM1 but not DM2 because acidosis results from lactic acid buildup from no insulin production from the pancreas. Type 2 diabetes clients still produce some insulin. Insulin resistance is an issue in type 2 diabetes. 4. Medication is given to treat diabetes but not to cause it. TEST-TAKING HINT: The test taker must know risk factors for developing a disease process.

The nurse is working in a health clinic. Which condition is required to be reported to the public health department? 1. Pelvic inflammatory disease. 2. Epididymitis. 3. Syphilis. 4. Ectopic pregnancy

1. Pelvic inflammatory disease (PID) does not have to be reported, but the cause of the PID may need to be reported. 2. There are causes for epididymitis other than an STI. 3. Syphilis is an STI and therefore must be reported to the appropriate health department. 4. An ectopic pregnancy may have numerous causes. TEST-TAKING HINT: Only one answer option is an STI. The other diseases and conditions may be caused by STIs, but they all have other causes as well.

The concepts of nutrition and metabolism have been identified for the client. Which referral should the nurse include in the plan of care? 1. Physical therapy. 2. Social work. 3. Speech therapy. 4. Dietary.

1. Physical therapy is not indicated. 2. Social work is not indicated. 3. Speech therapy is not indicated. 4. Metabolism involves the intake and utilization of nutrients; the dietitian should be consulted. TEST-TAKING HINT: As a coordinator of care, the nurse must be aware of each discipline and how it affects the client's care.

The client is 1 hour postoperative thyroidectomy. Which intervention should the nurse implement? 1. Check the posterior neck for bleeding. 2. Assess the client for Chvostek's sign. 3. Monitor the client's serum calcium level. 4. Change the client's surgical dressing.

1. The incision for a thyroidectomy allows the blood to drain dependently by gravity to the back of the client's neck. Therefore, the nurse should check this area for hemorrhaging, which is a possible complication of any surgery. 2. Chvostek's sign indicates hypocalcemia, which is too early to assess for in this client. 3. Accidental removal of or damage to the parathyroid glands will not decrease the calcium level for at least 24 hours. 4. Surgeons often prefer to remove the surgical dressing for the first time.

The client in the gynecology clinic asks the nurse, "What are the risk factors for developing cancer of the cervix?" Which statement is the nurse's best response? 1. "The earlier the age of sexual activity and the more partners, the greater the risk." 2. "Eating fast foods high in fat and taking birth control pills are risk factors." 3. "A Chlamydia trachomatis infection can cause cancer of the cervix." 4. "Having yearly Pap smears will protect you from developing cancer."

1. Risk factors for cancer of the cervix include sexual activity before the age of 20 years; multiple sexual partners; early childbearing; exposure to the human papillomavirus; HIV infection; smoking; and nutritional deficits of folates, beta carotene, and vitamin C. 2. High-fat diets place clients at risk for some cancers but not for cervical cancer. The use of birth control pills may allow increased sexual freedom because of the protection from pregnancy, but it does not increase the risk for cancer of the cervix. 3. Infections with the human papillomavirus are a risk factor for cancer of the cervix. 4. Having a yearly Pap smear increases the chance of detecting cellular changes early, but it does not decrease the risk of developing cancer. TEST-TAKING HINT: The test taker could discard option "4" as a possible answer because it is a yearly test for the early detection of cervical cancer, not a risk factor.

The nurse is administering morning medications. Which medications should the nurse question administering? 1. The oral sucralfate to a client before the breakfast meal. 2. The subcutaneous insulin to a client refusing blood glucose checks. 3. The levothyroxine PO to a client diagnosed with hypothyroidism. 4. The sliding scale insulin to a client with a 320 mg/dL blood glucose level.

1. Sucralfate (Carafate) is a mucosal barrier agent and should be administered on an empty stomach so the medication can coat the mucosa. The nurse would not question administering this medication. 2. The nurse cannot administer sliding-scale insulin without knowing the current blood glucose. The nurse should talk with the client to try and obtain the client's cooperation and, if not, then notify the HCP that the medication cannot be administered. 3. Levothyroxine is an appropriate treatment for hypothyroidism. 4. The sliding scale usually begins at 150 mg/dL; the nurse would not question administering this medication. TEST-TAKING HINT: The test taker must know normal and abnormal diagnostic laboratory values. Medications are administered per sliding scale in response to blood glucose levels. The nurse must also recognize accepted treatments for diseases.

The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed with type 1 diabetes. Which instruction is most important to discuss with the client? 1. Refer the client to the American Diabetes Association. 2. Do not take any over-the-counter (OTC) medications. 3. Take the prescribed insulin even when unable to eat because of illness. 4. Explain the need to get the annual flu and pneumonia vaccines.

1. The American Diabetes Association is an excellent referral, but the nurse should discuss specific ways to prevent DKA. 2. The client should be careful with OTC medications, but this intervention does not help prevent the development of DKA. 3. Illness increases blood glucose levels; therefore, the client must take insulin and consume high-carbohydrate foods such as regular Jell-O, regular popsicles, and orange juice. 4. Vaccines are important to help prevent illness, but regardless of whether the client gets these vaccines, the client can still develop diabetic ketoacidosis. TEST-TAKING HINT: The words "most important" in the stem of the question indicate one or more options may be appropriate instructions, but only one is the priority intervention.

The client diagnosed with diabetes reports a curtain being drawn across the eyes. Which should the nurse implement first? 1. Assess the eyes using an ophthalmoscope. 2. Tell the client to keep the eyes closed. 3. Notify the health-care provider (HCP). 4. Call the rapid response team (RRT).

1. The HCP and not the nurse should perform this assessment. The nurse has an unusual and potentially life-changing issue identified. 2. Keeping the eyes closed will not change the outcome of retinal detachment. This is an ophthalmological emergency. 3. This is an emergency; this indicates retinal detachment. The nurse should notify the HCP. 4. The RRT will help to prevent cardiac or respiratory arrest. The HCP should be notified to arrange for an ophthalmologist consult. TEST-TAKING HINT: The test taker should recognize life-changing or life-threatening complications of a disease process. Failure to intervene immediately can result in a "failure to rescue" situation.

The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1c) of 8.1%. Which interpretation should the nurse make based on this result? 1. This result is below normal levels 2. This result is within acceptable levels 3. This result is above the recommended levels 4. This result is dangerously high

1. The acceptable level for an A1c for a client diagnosed with diabetes is less than 7%, which corresponds to a 154 mg/dL average blood glucose level. 2. This result is not within acceptable levels for the client diagnosed with diabetes, which is less than 7%. 3. This result parallels a serum blood glucose level of approximately 185 mg/dL. An A1c is a blood test reflecting average blood glucose levels over a period of 3 months; clients with elevated blood glucose levels are at risk for developing long-term complications (American Diabetes Association, 2020). 4. An A1c of 13% is dangerously high; it reflects a 326-mg/dL average blood glucose level over the past 3 months. TEST-TAKING HINT: The test taker must know normal and abnormal diagnostic laboratory values. Laboratory values may vary depending on which laboratory performs the test.

The client received 10 units of regular insulin at 0700. At 1030 the UAP tells the nurse the client has a headache and is really acting "funny." Which intervention should the RN implement first? 1. Instruct the UAP to obtain the blood glucose level. 2. Have the client drink 8 ounces of orange juice. 3. Go to the client's room and assess the client for hypoglycemia. 4. Prepare to administer one ampule 50% dextrose intravenously

1. The blood glucose level should be obtained, but it is not the first intervention. 2. If it is determined the client is having a hypoglycemic reaction, orange juice is appropriate. 3. Regular insulin (Humulin R), fast-acting insulin, peaks in 2 to 4 hours. Therefore, the registered nurse (RN) should think about the possibility the client is having a hypoglycemic reaction and should assess the client. The nurse should not delegate nursing tasks to a UAP if the client is unstable. 4. Dextrose 50% is only administered if the client is unconscious, and the nurse suspects hypoglycemia. TEST-TAKING HINT: When answering a question requiring the nurse to decide which intervention to implement first, all four options are plausible for the situation, but only one answer should be implemented first. The test taker must apply the nursing process; assessment is the first step of the nursing process.

The client is diagnosed with hypothyroidism. Which assessment data support this diagnosis? 1. The client's vital signs are T 99.0, P 110, R 26, and BP 145/80. 2. The client reports constipation and being constantly cold. 3. The client has an intake of 780 mL and an output of 256 mL. 4. The client reports a headache and has projectile vomiting

1. The client diagnosed with hypothyroidism has slowed body processes, so the temperature, pulse, and BP would be lower. 2. All body processes slow as a result of decreased thyroid production. The client will be constipated, cold, have thicker skin, low temperature, and bradycardia. 3. The intake and output would not be affected. 4. Hypothyroidism does not cause headaches or projectile vomiting. TEST-TAKING HINT: The test taker must know basic clinical manifestations. The word "hypo" in the name of the disease would help the test taker eliminate option "1."

The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes? 1. Eat a simple carbohydrate snack before exercising. 2. Carry peanut butter crackers when exercising. 3. Encourage the client to walk 20 minutes three times a week. 4. Perform warm-up and cool-down exercises.

1. The client diagnosed with type 2 diabetes, not taking insulin or oral agents, does not need extra food before exercise. 2. The client diagnosed with diabetes at risk for hypoglycemia when exercising should carry a simple carbohydrate, but this client is not at risk for hypoglycemia. 3. Clients with diabetes controlled by diet and exercise must exercise daily at the same time and in the same amount to control the glucose level. 4. All clients should perform warm-up and cool-down routines to help prevent muscle strain and injury while exercising. TEST-TAKING HINT: Options "1" and "2" apply directly to clients diagnosed with diabetes, and options "3" and "4" do not directly address clients diagnosed with diabetes. The reader could narrow the choices by either eliminating or including the two similar options.

The UAP on the medical floor tells the nurse the client diagnosed with DKA wants something else to eat for lunch. Which intervention should the RN implement? 1. Instruct the UAP to get the client some additional food. 2. Notify the dietitian about the client's request. 3. Request the HCP to increase the client's caloric intake. 4. Tell the UAP the client cannot have anything else.

1. The client is on a special diet and should not have any additional food. 2. The client will not be compliant with the diet if still hungry. Therefore, the nurse should request that the dietitian talk with the client and adjust the meals so the client will adhere to the diet. 3. The nurse does not need to notify the HCP for an increase in caloric intake. The appropriate referral is to the dietitian. 4. The client is on a special diet. The nurse needs to help the client maintain compliance with the medical treatment and should refer the client to the dietitian. TEST-TAKING HINT: The test taker should select the option attempting to ensure the client maintains compliance. The test taker should remember to work with members of the multidisciplinary health-care team.

The client diagnosed with endometriosis experiences pain rated a "5" on a 1-to-10 pain scale during her menses. Which intervention should the nurse teach the client? 1. Teach the client to take a stool softener when taking morphine. 2. Instruct the client to soak in a tepid bath for 30 to 45 minutes when the pain occurs. 3. Explain the need to take NSAIDs with food. 4. Discuss the possibility of a hysterectomy to help relieve the pain.

1. The client taking a narcotic medication should be placed on a bowel regimen, but this client would not be prescribed morphine, a narcotic medication. 2. A tepid bath for 30 to 45 minutes is not appropriate because the lukewarm water gets cold. A heating pad to the abdomen sometimes helps with the pain. 3. The medication of choice for mild to moderate dysmenorrhea is an NSAID. NSAIDs cause gastrointestinal upset and should be taken with food. 4. This may be an option eventually, but the stem did not give an age nor state the client has decided she does not want to get pregnant. TEST-TAKING HINT: The test taker should not read into the question. Option "4" is only correct when more information is provided. The test taker must know about the scales used to rate pain, nausea, or depression. The client's report of midrange symptoms does not indicate the need for routine narcotic administration.

The older client is admitted to the intensive care unit diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care? 1. Infuse 0.9% normal saline intravenously. 2. Administer intermediate-acting insulin. 3. Perform blood glucometer checks daily. 4. Monitor arterial blood gas (ABG) results.

1. The initial fluid replacement is 0.9% normal saline (an isotonic solution) intravenously, followed by 0.45% saline. The rate depends on the client's fluid volume status and physical health, especially of the heart. 2. Regular insulin, not intermediate, is the insulin of choice because of its quick onset and peak in 2 to 4 hours. 3. Blood glucometer checks are done every 1 hour or more often for clients diagnosed with HHNS and receiving regular insulin drips. 4. ABGs are not affected in HHNS because there is no breakdown of fat, resulting in ketones leading to metabolic acidosis. TEST-TAKING HINT: The test taker should eliminate option "3" based on the word "daily." In the ICU with a very ill client, most checks are more often than daily. Remember to look at adjectives; "intermediate" in option "2" is the word eliminating this as a possible correct answer.

The HCP has prescribed two IV antibiotics for the female client diagnosed with diabetes and pneumonia. Which order should the nurse request from the HCP? 1. Request written information on antibiotic-caused vaginal infections. 2. Request yogurt to be served on the client's meal trays. 3. Request a change of one of the antibiotics to an oral route. 4. Request Lactobacillus acidophilus three times a day.

1. The nurse does not require an order to teach. Teaching is an independent nursing function. 2. The nurse can request the dietitian to include yogurt in the client's calorie restrictions without an order. 3. If the HCP has ordered an IV antibiotic, then there is no reason to request a change to an oral route. 4. Female clients on antibiotics are at risk for killing the good bacteria, which keep yeast infections in check. This is especially true in clients diagnosed with diabetes. L. acidophilus, a probiotic, is a yeast replacement medication. TEST-TAKING HINT: The test taker must be aware of independent nursing functions. This eliminates options "1" and "2."

The client diagnosed with type 1 diabetes is found lying unconscious on the floor of the bathroom. Which intervention should the nurse implement first? 1. Administer 50% dextrose (IVP). 2. Notify the health-care provider. 3. Move the client to the ICU. 4. Check the serum glucose level.

1. The nurse should assume the client is hypoglycemic and administer IVP dextrose, which will rouse the client immediately. If the collapse is the result of hyperglycemia, this additional dextrose will not further injure the client. 2. The health-care provider may or may not need to be notified, but this is not the first intervention. 3. The client should be left in the client's room, and 50% dextrose should be administered first. 4. The serum glucose level requires a venipuncture, which will take too long. A blood glucometer reading may be obtained, but the nurse should first treat the client, not the machine. The glucometer only reads "low" after a certain point, and a serum level is needed to confirm the exact glucose level. TEST-TAKING HINT: The question is requesting the test taker to select which intervention should be implemented first. All four options could be possible interventions, but only one intervention should be implemented first. The test taker should select the intervention directly treating the client; do not select a diagnostic test.

The client diagnosed with hyperthyroidism is reporting being hot and cannot sit still. Which should the RN do based on the assessment? 1. Continue to monitor the client. 2. Have the UAP take the client's vital signs. 3. Request an order for a sedative. 4. Insist the client lie down and rest.

1. The nurse should continue to monitor the client. The behavior is expected for a client diagnosed with hyperthyroidism. 2. The client's vital signs are not indicated because of the symptoms. 3. This behavior is expected for a client diagnosed with hyperthyroidism. A sedative is not needed. 4. The nurse cannot insist the client do anything. TEST-TAKING HINT: The test taker must know expected clinical manifestations for disease processes.

The client has failed to conceive after many attempts over a 3-year time period and says to the nurse, "I have tried everything. What should I do now?" Which statement is the nurse's best response? 1. "By 'everything' do you mean you have consulted an infertility specialist?" 2. "You have tried everything. This must be hard for you. Would you like to talk?" 3. "You should get on an adoption list because it can take a long time." 4. "You need to relax and not try so hard. It is your nerves preventing conception."

1. The nurse should investigate which fertility measures have been attempted. There are many reasons for infertility, and only a specialist in the area can identify the cause. 2. This is a therapeutic response, but the client is asking for information. 3. This is advising and not answering the client's question. 4. The nurse cannot know this to be true, and this does not address the client's concern.

Which statement best describes the responsibility of the public health nurse regarding STIs? 1. Notify the sexual partners of clients diagnosed with an STI. 2. Determine the course of treatment for clients diagnosed with an STI. 3. Explain the legal aspects of STI reporting to a client diagnosed with an STI. 4. Analyze the statistics regarding STI transmission and reporting the findings.

1. The public health nurse is responsible for attempting to notify the sexual partners of a client diagnosed with an STI of potential infection and urging the partner to be tested for the disease and to receive treatment. Health departments offer confidential testing and treatment. 2. An HCP will determine the course of treatment for a client diagnosed with an STI. 3. The nurse can teach some information about reporting, but the nurse is not qualified to discuss all the legal aspects of reporting an STI. 4. The nurse is not responsible for analyzing statistics. TEST-TAKING HINT: Answer options "2," "3," and "4" ask the nurse to take on roles not within the nurse's expertise. The nurse must know the Nurse Practice Act of the state where the nurse practices. No state allows the nurse to give legal or medical advice.

The client diagnosed with HHNS was admitted yesterday with a blood glucose level of 780 mg/dL. The client's blood glucose level is now 300 mg/dL. Which intervention should the nurse implement? 1. Increase the regular insulin IV drip. 2. Check the client's urine for ketones. 3. Provide the client with a therapeutic diabetic meal. 4. Notify the HCP to obtain an order to decrease insulin.

1. The regular intravenous insulin is continued because ketosis is not present, as with DKA. 2. The client diagnosed with type 2 diabetes does not excrete ketones in HHNS because there is enough insulin to prevent fat breakdown but not enough to lower blood glucose. 3. The client may or may not feel like eating, but it is not the appropriate intervention when the blood glucose level is reduced to 300 mg/dL. 4. When the glucose level is decreased to around 300 mg/dL, the regular insulin infusion therapy is decreased. Subcutaneous insulin will be administered per sliding scale. TEST-TAKING HINT: When two options are the opposite of each other, they can either be eliminated or can help eliminate the other two options as incorrect answers. Options "2" and "3" do not have insulin in the answer; therefore, they should be eliminated as possible answers.

The nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperglycemia related to noncompliance with the medication regimen." Which statement is an appropriate short-term goal for the client? 1. The client will have a blood glucose level between 90 and 140 mg/dL. 2. The client will demonstrate an appropriate insulin injection technique. 3. The nurse will monitor the client's blood glucose levels four times a day. 4. The client will maintain normal kidney function with 30 mL/hr urine output.

1. The short-term goal must address the response part of the nursing diagnosis, which is "high risk for hyperglycemia," and this blood glucose level is within acceptable ranges for a noncompliant client. 2. This is an appropriate goal for a knowledge-deficit nursing diagnosis. Noncompliance is not always the result of a knowledge deficit. 3. The nurse is implementing an intervention, and the question asks for a goal that addresses the problem of "high risk for hyperglycemia." 4. The question asks for a short-term goal, and this is an example of a long-term goal. TEST-TAKING HINT: Remember, the nursing diagnosis consists of a problem related to an etiology. The goals must address the problem, and the interventions must address the etiology. The test taker should always remember a short-term goal is usually a goal met during the hospitalization, and the long-term goal may take weeks, months, or even years.

The client diagnosed with hypothyroidism is prescribed levothyroxine. Which assessment data indicate the medication has been effective? 1. The client has a 3-pound weight gain. 2. The client has a decreased pulse rate. 3. The client's temperature is WNL. 4. The client denies any diaphoresis.

1. The thyroid hormone levothyroxine (Synthroid) will help increase the client's metabolic rate. A weight gain indicates not enough medication is being taken to put the client in a euthyroid (normal thyroid) state. 2. A decreased pulse rate indicates there is not enough thyroid hormone level; therefore, the medication is not effective. 3. The client diagnosed with hypothyroidism frequently has a subnormal temperature, so a temperature WNL indicates the thyroid hormone levothyroxine (Synthroid) is effective. 4. Diaphoresis (sweating) occurs with hyperthyroidism, not hypothyroidism. TEST-TAKING HINT: One way of determining the effectiveness of a medication is to determine if the clinical manifestations of the disease are no longer noticeable.

The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. The thyroid hormone to the client without a T3, T4 level. 2. The regular insulin to the client with a blood glucose level of 210 mg/dL. 3. The loop diuretic to the client with a potassium level of 3.3 mEq/L. 4. The cardiac glycoside to the client with a digoxin level of 1.4 mg/dL.

1. The thyroid hormone must be administered daily, and thyroid levels are drawn every 6 months or so. 2. A blood glucose level of 210 mg/dL requires insulin administration; therefore, the nurse should not question administering this medication. 3. This potassium level is below normal, which is 3.5 to 5.5 mEq/L. Therefore, the nurse should question administering this medication because loop diuretics cause potassium loss in the urine. 4. The digoxin level is within therapeutic range—0.5 to 2 mg/dL; therefore, the nurse should administer this medication. TEST-TAKING HINT: When administering medication, the nurse must know when to question the medication, how to know it is effective, and what must be taught to keep the client safe while taking the medication. The test taker may want to turn the question around and say, "I should give this medication."

The nurse is providing an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the United States get goiters as often as those in other countries?" Which statement by the nurse is the best response? 1. "It is because of the screening techniques used in the United States." 2. "It is a genetic predisposition rare in North Americans." 3. "The medications available in the United States decrease goiters." 4. "Iodized salt helps prevent the development of goiters in the United States."

1. There is no screening for thyroid disorders, just serum thyroid levels. 2. This is not a true statement. 3. Medications do not decrease the development of goiters. 4. Almost all of the iodine entering the body is retained in the thyroid gland. A deficiency in iodine will cause the thyroid gland to work hard and enlarge, which is called a goiter. Goiters are commonly seen in geographical regions having an iodine deficiency. Most table salt in the United States has iodine added. TEST-TAKING HINT: The nurse must know about disease processes. There is no test-taking hint to help with knowledge.

Which clinical manifestations should make the nurse suspect the client is experiencing a thyroid storm? 1. Obstipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.

1. These are clinical manifestations of myxedema (hypothyroidism) coma. Obstipation is extreme constipation. 2. Hyperpyrexia (high fever) and heart rate above 130 beats per minute are clinical manifestations of thyroid storm, a severely exaggerated hyperthyroidism. 3. Decreased blood pressure and slow heart rate are clinical manifestations of myxedema coma. 4. These are clinical manifestations of myxedema coma. TEST-TAKING HINT: If the test taker does not have the knowledge to answer the question, the test taker should look at the options closely. Options "1," "3," and "4" all have clinical manifestations of "decrease"—hypoactive, hypotension, and hypoxia. The test taker should select the option that does not match.

The male client presents to the public health clinic reporting joint pain and malaise. On assessment, the nurse notes a rash on the trunk, palms of the hands, and soles of the feet. Which action should the nurse implement next? 1. Determine if the client has had a chancre sore within the last 2 months. 2. Ask the client how many sexual partners he has had in the past year. 3. Refer the client to a dermatologist for a diagnostic work-up. 4. Have the client provide a clean, voided midstream urine specimen.

1. These are clinical manifestations of second-stage syphilis. The nurse should ask about the development of a chancre sore, one of the first signs of a syphilis infection. 2. This may be required of the public health nurse for notification of the partners, but it is not required to assess this problem. 3. This client does not need a dermatologist to determine an STI infection. The HCP can treat this infection. 4. A urine culture will not diagnose this disease. TEST-TAKING HINT: If the test taker is aware the clinical manifestations are those of an STI, options "3" and "4" can be eliminated.

The charge nurse is making client assignments in the ICU. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with type 2 diabetes and a blood glucose level of 348 mg/dL. 2. The client diagnosed with type 1 diabetes experiencing hypoglycemia. 3. The client diagnosed with DKA having multifocal premature ventricular contractions. 4. The client diagnosed with HHNS and a plasma osmolarity of 290 mOsm/L.

1. This blood glucose level is elevated, but not life-threatening, in the client diagnosed with type 2 diabetes. Therefore, a less experienced nurse could care for this client. 2. Hypoglycemia is an acute complication of type 1 diabetes, but it can be managed by frequent monitoring, so a less experienced nurse could care for this client. 3. Multifocal PVCs, which are secondary to hypokalemia and can occur in clients diagnosed with DKA, are a potentially life-threatening emergency. This client needs an experienced nurse. 4. A plasma osmolarity of 275 to 295 mOsm/kg is within normal limits; therefore, a less experienced nurse could care for this client. TEST-TAKING HINT: The test taker must select the client with an abnormal, unexpected, or a life-threatening clinical manifestation for the disease process and assign this client to the most experienced nurse.

The postmenopausal client reveals it has been several years since her last gynecological examination and states, "Oh, I don't need examinations anymore. I am beyond having children." Which statement should be the nurse's response? 1. "As long as you are not sexually active, you don't have to worry." 2. "You should be taking hormone replacement therapy now." 3. "You are beyond bearing children. How does that make you feel?" 4. "There are situations other than pregnancy that should be checked."

1. This client is at risk for cancer of the ovary and uterus because of advancing age, regardless of sexual activity, and should see an HCP yearly. 2. Hormone replacement therapy (HRT) is not recommended for most postmenopausal clients because research has shown HRT increases the risk of myocardial infarctions and cerebrovascular accidents (strokes). 3. This is a therapeutic response, and the client did not state a feeling. 4. The client should have a yearly clinical examination of the breasts and pelvic area for the detection of cancer. TEST-TAKING HINT: If the stem is not asking for a therapeutic response, then factual information should be provided to the client. This eliminates option "3" as a possible answer.

Which assessment data indicate the client diagnosed with diabetic ketoacidosis is responding to medical treatment? 1. The client has tented skin turgor and dry mucous membranes. 2. The client is alert and oriented to date, time, and place. 3. The client's ABG results are pH 7.29, Pco2 44, HCO3 15. 4. The client's serum potassium level is 3.3 mEq/L.

1. This indicates the client is dehydrated, which does not indicate the client is getting better. 2. The client's level of consciousness can be altered because of dehydration and acidosis. If the client's sensorium is intact, the client is getting better and responding to medical treatment. 3. These ABGs indicate metabolic acidosis; therefore, the client is not responding to treatment. 4. This potassium level is low and indicates hypokalemia, which shows the client is not responding to medical treatment. TEST-TAKING HINT: The phrase "responding to medical treatment" is asking the test taker to determine which data indicate the client is getting better. The correct answer will be normal data, and the other three options will be clinical manifestations of the disease process or condition.

The female client diagnosed with human papillomavirus (HPV) asks the nurse, "What other problems can HPV lead to?" Which statement is the most appropriate response by the nurse? 1. "HPV is transmitted during sexual intercourse." 2. "HPV infection can cause cancer of the cervix." 3. "It has been known to lead to ovarian problems." 4. "Regular Pap smears can help prevent problems."

1. This is a true statement, but it does not answer the client's question. 2. An untreated HPV infection is a cause for developing cancer of the cervix. 3. HPV infection does not invade the abdominal cavity and therefore does not cause ovarian cancer. 4. The Pap test was developed to note early cell changes in the cervix. It indirectly monitors the effects of HPV, but it does not help prevent problems. TEST-TAKING HINT: The test taker should choose the answer for the question the client is asking. Option "1" discusses transmission and option "4" discusses prevention; therefore, these two options could be eliminated based on the stem of the question.

The nurse at a freestanding health-care clinic is caring for a homeless 56-year-old male client diagnosed with type 2 diabetes controlled with insulin. Which action is an example of client advocacy? 1. Ask the client if he has somewhere he can go and live. 2. Arrange for someone to give him insulin at a local homeless shelter. 3. Notify Adult Protective Services about the client's situation. 4. Ask the HCP to take the client off insulin because he is homeless.

1. This is an example of interviewing the client; it is not an example of client advocacy. 2. Client advocacy focuses support on the client's autonomy. Even if the nurse disagrees with his living on the street, it is the client's right. Arranging for someone to give him his insulin provides for his needs and allows his choices. 3. Adult Protective Services is an organization investigating any actual or potential abuse in adults. This client is not being abused by anyone. 4. The client needs the insulin to control diabetes, and talking to the HCP about taking him off a needed medication is not an example of advocacy. TEST-TAKING HINT: Remember, the test taker must understand what the question is asking and the definition of the terms.

The nurse is teaching a community class to people with type 2 diabetes mellitus. Which best explains the development of type 2 diabetes? 1. The islet cells in the pancreas stop producing insulin. 2. The client eats too many foods high in sugar. 3. The pituitary gland does not produce vasopressin. 4. The cells become resistant to circulating insulin.

1. This is the cause of type 1 diabetes mellitus. 2. This may be a reason for obesity, which may lead to type 2 diabetes, but eating too much sugar does not cause diabetes. 3. This is the explanation for diabetes insipidus, which should not be confused with diabetes mellitus. 4. Normally insulin binds to special receptors sites on the cell and initiates a series of reactions involved in metabolism. In type 2 diabetes, these reactions are diminished primarily as a result of obesity and aging.

Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.

1. Thyroid hormones are the treatment of choice for the client diagnosed with hypothyroidism; therefore, the nurse should not question this medication. 2. In untreated hypothyroidism, medical management is aimed at supporting vital functions, so administering oxygen is an appropriate medication. 3. Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse should question this medication. 4. Clients with hypothyroidism become constipated as a result of decreased metabolism, so laxatives should not be questioned by the nurse. TEST-TAKING HINT: When a question asks which order the nurse should question, three of the options are medications the nurse expects to administer to the client. Sometimes saying, "The nurse administers this medication," may help the test taker select the correct answer.

The nurse is teaching the client diagnosed with diabetes. Which should the nurse teach to limit the complications of diabetes? 1. Teach the client to keep the blood glucose under 140 mg/dL. 2. Demonstrate how to test the urine for ketones. 3. Instruct the client to apply petroleum jelly between the toes. 4. Allow the client to eat meals as desired and then take insulin.

1. To limit the complications of diabetes, the client should keep the blood glucose levels under 140 mg/dL. This can be done with medications, diet, and exercise. Self-monitoring of glucose allows the client to monitor glucose levels. 2. Testing for urine ketones will not help to keep the blood glucose level controlled. 3. Petroleum jelly is rubbed on the feet but not between the toes. 4. The client should administer sliding-scale insulin when needed but not eat whatever the client wishes. The client should still attempt to control the number of carbohydrates. TEST-TAKING HINT: The nurse must recommend measures to control or treat disease processes.

An 18-year-old female client, 5'4" tall, weighing 113 kg, comes to the clinic for a nonhealing wound, which she has had for 2 weeks. Which disease process should the nurse suspect the client has deve1oped? 1. Type 1 diabetes 2. Type 2 diabetes 3. Gestational diabetes 4. Acanthosis nigricans

1. Type 1 diabetes usually occurs in young, underweight clients. In this disease, there is no production of insulin from the beta cells in the pancreas. People with type 1 diabetes are insulin-dependent with a rapid onset of symptoms, including polyuria, polydipsia, and polyphagia. 2. Type 2 diabetes is a disorder usually occurring around the age of 40, but it is now being detected in children and young adults as a result of obesity and sedentary lifestyles. Nonhealing wounds are a sign of type 2 diabetes (Salazar, Ennis, & Koh, 2016). This client weighs 248.6 pounds and is short. 3. Gestational diabetes occurs during pregnancy. 4. Acanthosis nigricans (AN), dark pigmentation and skin creases in the neck, is a sign of hyperinsulinemia. The pancreas is secreting excess amounts of insulin as a result of excessive caloric intake. It is identified in young children and is a precursor to the development of type 2 diabetes. TEST-TAKING HINT: The test taker must be aware of kilograms and pounds. The stem is asking about a disease process, and acanthosis nigricans is a clinical manifestation of a disease, not a disease itself. Therefore, the test taker should not select this as a correct answer.

Which laboratory test should the nurse expect for the client to rule out the diagnosis of syphilis? 1. Vaginal cultures. 2. Rapid plasma reagin card test (RPR-CT). 3. Gram-stained specimen of the urethral meatus. 4. Immunological assay.

1. Vaginal cultures are obtained to assess for gonorrhea and chlamydia. 2. The RPR-CT test and the Venereal Disease Research Laboratory (VDRL) test are diagnostic tests for syphilis. 3. Gram stains of the vagina or urethral meatus of a male may be done for gonorrhea but not for syphilis. 4. An immunological assay may be done for chlamydia but not for syphilis. TEST-TAKING HINT: The test taker must memorize the tests used to diagnose specific STIs and the clinical manifestations differentiating one STI from another.

Which clinical manifestations indicate the client diagnosed with hypothyroidism is not taking enough thyroid hormone? 1. Reports of weight loss and fine tremors. 2. Reports of excessive thirst and urination. 3. Reports of constipation and being cold. 4. Reports of delayed wound healing and belching.

1. Weight loss and fine tremors make the nurse suspect the client is taking too much thyroid hormone because these are clinical manifestations of hyperthyroidism. 2. Excessive thirst and urination are symptoms of diabetes. 3. If the client were not taking enough thyroid hormone, the client would exhibit symptoms of hypothyroidism such as constipation and being cold. 4. This indicates Cushing's disease.

Puberty usually begins at ages __________ to ___________ but may occur as early as age __________.

11-13 years, 10 years

A 22 year old woman was prescribed Metronidazole to be taken twice a day for 1 week for treatment of bacterial vaginosis. What should the nurse educate the patient on while she is taking this medication?

Abstain from alcohol while taking metronidazole and for 24 hours after stopping medication.

What is the drug of choice for herpes genitalis?

Acyclovir

Why would a hysteroscopy be indicated for a patient experiencing abnormal uterine bleeding?

Allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria is suspected to cause this disorder? a. Candida b. Eschar c. Trichomonas d. Escherichia coli

C. Trichomonas

The most common strains of HPV are 6 and 11. They usually cause what to occur on the vulva?

Condylomata (warts)

The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client? Select all that apply. 1. Explain that it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach that the iodine therapy will have to be tapered slowly over 1 week. 3. Discuss that the client will have to be hospitalized during the radioactive therapy. 4. Inform the client after therapy the client will not have to take any medication. 5. Tell the client they could experience a metallic taste in the mouth and nausea.

Correct answers are 1 and 5. 1. Radioactive iodine therapy is used to destroy overactive thyroid cells. After treatment, the client is followed closely for 3 to 4 weeks until the euthyroid state is reached. 2. A single dose of radioactive iodine therapy is administered; the dosage is based on the client's weight. 3. The colorless, tasteless radioiodine is administered by the radiologist, and the client may have to stay up to 2 hours after the treatment in the office. 4. If too much of the thyroid gland is destroyed by the radioactive iodine therapy, the client may develop hypothyroidism and have to take thyroid hormone indefinitely. 5. The client may experience side effects from the radioactive iodine, including a metallic taste in the mouth, nausea, and swollen salivary glands. The side effects last from a few days to a few weeks following treatment (Milas, 2020). TEST-TAKING HINT: Some questions require the test taker to have knowledge of the information, especially medical treatments, and there are no specific hints to help the test taker answer the question.

The nurse is instructing a group of workers at an industrial plant regarding the transmission of STIs. Which information should be included in the presentation? Select all that apply. 1. The same behaviors causing one STI could lead to another. 2. Once clients have had an STI, they develop immunity to it. 3. Infection with syphilis protects the client from being infected with HIV. 4. Herpes simplex 1 is a totally different disease from herpes simplex 2. 5. Condoms do not provide protection against all STIs.

Correct answers are 1 and 5. 1. The behaviors leading to the development of one STI could also lead to the development of another. 2. There is no antigen-antibody reaction development with STIs. A client can be reinfected multiple times. 3. There is no protection provided by one STI from developing another, and, frequently, clients will have more than one STI simultaneously. 4. Herpes simplex 1 and 2 are caused by the same virus. Herpes simplex 1 refers to orolabial lesions and herpes simplex 2 refers to genital lesions, which can be transferred from one area to the other. 5. Condoms are effective against most STIs if used correctly; however, some STIs can be spread from skin to skin contact (Centers for Disease Control and Prevention, 2013)

Which interrelated concepts could be identified as actual or potential for a 56-year-old male client diagnosed with diabetes mellitus type 2? Select all that apply. 1. Nutrition. 2. Metabolism. 3. Infection. 4. Male reproduction. 5. Skin integrity.

Correct answers are 1, 2, 3, 4, and 5. 1. Obesity is included in the concept of nutrition. Obesity is an antecedent of diabetes mellitus type 2. 2. Diabetes is a problem of glucose metabolism. 3. The client is at greater risk for developing infections resulting from the high circulating glucose levels. Bacteria utilize glucose for energy, as do mammals. 4. Diabetes affects the ability of the blood vessels to respond to the circulatory need. For a middle-aged male, this can result in erectile dysfunction. 5. Skin integrity is an issue if a pressure sore or a blister occurs on the feet. If not noted and treated early, then an infection can result in amputation. TEST-TAKING HINT: The test taker must know the disease process and potential complications.

The client is admitted to the ICU diagnosed with DKA. Which interventions should the nurse implement? Select all that apply. 1. Maintain adequate ventilation. 2. Assess fluid volume status. 3. Administer intravenous potassium. 4. Check for urinary ketones. 5. Monitor intake and output.

Correct answers are 1, 2, 3, 4, and 5. 1. The nurse should always address the airway when a client is seriously ill. 2. The client must be assessed for fluid volume deficit, and then for fluid volume excess after the fluid replacement is started. 3. The electrolyte imbalance of primary concern is the depletion of potassium. 4. Ketones are excreted in the urine; levels are documented from negative to a large amount. Ketones should be monitored frequently. 5. The nurse must ensure the client's fluid intake and output are equal. TEST-TAKING HINT: The test taker must select all answer options that apply. Do not try to outguess the item writer. In some instances, all options are correct.

The nurse is teaching the client diagnosed with hyperthyroidism. Which information should be taught to the client? Select all that apply. 1. Notify the HCP if a 3-pound weight loss occurs in 2 days. 2. Discuss ways to cope with emotional lability. 3. Notify the HCP if taking OTC medication. 4. Carry a medical identification card or bracelet. 5. Teach how to take thyroid medications correctly.

Correct answers are 1, 2, 3, and 4. 1. Weight loss indicates the medication may not be effective and will probably need to be increased. 2. The client needs to know emotional highs and lows are secondary to hyperthyroidism. With treatment, this emotional lability will subside. 3. Any OTC medications (for example, alcohol-based medications) may negatively affect the client's hyperthyroidism or medications being used for treatment. 4. This will help any HCP immediately know of the client's condition, especially if the client is unable to tell the HCP. 5. The client diagnosed with hyperthyroidism will be on antithyroid medications, not thyroid medications. TEST-TAKING HINT: This alternate-type question instructs the test taker to select all the interventions that apply. The test taker must read and evaluate each option as to whether it applies or not.

The nurse identified a concept of metabolism for a client diagnosed with diabetes mellitus type 1. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Teach the client to perform self-glucose monitoring. 2. Instruct the client about complications of high glucose levels. 3. Instruct the client to inspect the feet daily. 4. Explain the need to carry a source of quick-acting proteins. 5. Encourage the client to have regular eye examinations.

Correct answers are 1, 2, 3, and 5. 1. The client diagnosed with diabetes should be taught to perform self-glucose monitoring. 2. In order to maintain a healthy lifestyle, the client should be aware of the consequences of not controlling blood glucose. 3. Diabetes affects all tissues in the body. The feet are particularly at risk for the development of foot sores. 4. The client should carry sources of quick-acting carbohydrates, not protein. 5. Diabetes can cause retinal changes and detachment. TEST-TAKING HINT: The nurse should be able to teach common information to the client.

The registered nurse (RN) and a UAP are caring for clients on a gynecology surgery floor. Which intervention can be delegated to the UAP? Select all that apply. 1. Empty the indwelling catheter on the 3-hour postoperative client. 2. Assist the client 2 days post-hysterectomy to the bathroom. 3. Monitor the peri-pad count on a client diagnosed with fibroid tumors. 4. Encourage the client refusing to get out of bed to walk in the hall. 5. Record the breakfast intake of the client preparing for discharge.

Correct answers are 1, 2, 4, and 5. 1. The UAP can empty the indwelling catheter and record the output. 2. This is an appropriate assignment. 3. Monitoring a peri-pad count is done to determine if the client is bleeding excessively; the nurse should do this as part of the assessment. 4. All personnel should encourage the client to ambulate. 5. This is an appropriate assignment. TEST-TAKING HINT: The RN cannot delegate assessment. The nurse must be aware of the tasks a UAP can perform.

The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply. 1. Take diabetic medication even if unable to eat the client's normal diabetic diet. 2. If unable to eat, drink liquids equal to the client's normal caloric intake. 3. It is not necessary to notify the health-care provider (HCP) if ketones are in the urine. 4. Test blood glucose levels and test urine ketones once a day and keep a record. 5. Call the HCP if glucose levels are higher than 180 mg/dL.

Correct answers are 1, 2, and 5. 1. The most important issue to teach clients is to take insulin, even if they are unable to eat. Glucose levels are increased with illness and stress. 2. The client should drink liquids such as regular cola or orange juice or eat regular gelatin, which provides enough glucose to prevent hypoglycemia when receiving insulin. 3. Ketones indicate a breakdown of fat and must be reported to the HCP because they can lead to metabolic acidosis. 4. Blood glucose levels and ketones must be checked every 3 to 4 hours, not daily. 5. The HCP should be notified if the blood glucose level is this high. Regular insulin may need to be prescribed to keep the blood glucose level within an acceptable range. TEST-TAKING HINT: This is an alternate-type question having more than one correct answer. The test taker should read all options and determine if each is an appropriate intervention.

The client had a total abdominal hysterectomy and tumor debulking for endometrial cancer. Which discharge instruction should the nurse teach? Select all that apply. 1. The client should take hormone replacement therapy every day to prevent bone loss. 2. The client should practice pelvic rest until seen by the HCP. 3. The client can drive a car as soon as she is discharged from the hospital. 4. The client should expect some bleeding after this procedure. 5. The client should notify the HCP of fever or severe pain.

Correct answers are 2 and 5. 1. Clients diagnosed with cancer of the uterus have the ovaries removed to reduce hormone production. The client will not be taking HRT. 2. Pelvic rest means nothing is placed in the vagina. The client does not need a tampon at this time, but sexual intercourse should be avoided until the vaginal area has healed. 3. The sitting position a client assumes when driving a vehicle places stress on the lower abdomen. The client should wait until the HCP releases her to drive. 4. The client should not have any vaginal bleeding. 5. Clients should be instructed about signs of complications that should be reported including fever, severe pain, and urinary burning or frequency. TEST-TAKING HINT: The test taker should apply basic postoperative concepts when answering questions and realize bleeding is not expected postoperatively and safety should always be addressed.

The nurse in the gynecology clinic is assessing a 14-year-old client reporting being sexually active. Which information should the nurse teach the client? Select all that apply. 1. Inform the client that the nurse must tell the parents of her being sexually active. 2. Teach the client about possible birth control options. 3. Instruct the client regarding sexually transmitted infections. 4. Demonstrate how a condom is applied correctly. 5. Tell the client about the importance of finishing all antibiotics. 6. Discuss the importance of attending parenting classes.

Correct answers are 2, 3, and 4. 1. The nurse does not have to inform the parents of the teenager's disclosure of information. 2. The nurse should discuss birth control and STIs with the client. She is at risk for pregnancy and STIs. 3. The nurse should discuss birth control and STIs with the client. She is at risk for pregnancy and STIs. 4. The male wears the most commonly used condoms, but both partners are responsible for contraception and prevention of STIs. This information will assist the client in knowing if the device is correctly applied and will have the best chance of preventing both pregnancy and STIs. 5. This would be information to provide if the client had an STI but is not needed at this time. 6. The client is not pregnant at this time. TEST-TAKING HINT: The test taker could eliminate options "5" and "6" because the client is not currently pregnant.

The client diagnosed with type 1 diabetes mellitus received regular insulin 2 hours ago. The client is reporting being jittery and nervous. Which interventions should the nurse implement? Rank in order of priority. 1. Call the laboratory to confirm the blood glucose level. 2. Administer a quick-acting carbohydrate. 3. Have the client eat a bologna sandwich. 4. Check the client's blood glucose level at the bedside. 5. Determine if the client has had anything to eat.

Correct order is 5, 2, 4, 1, 3. 5. Regular insulin peaks in 2 to 4 hours; therefore, the nurse should suspect a hypoglycemic reaction if the client has not eaten anything. 2. The antidote for insulin is glucose; therefore, the nurse should give the client some type of quick-acting food source. 4. The nurse should obtain the client's blood glucose level as soon as possible; this can be done with a glucometer at the bedside. 1. Most hospitals require a confirmatory serum blood glucose level. Do not wait for results to give food. 3. A source of long-acting carbohydrate and protein should be given to prevent a reoccurrence of hypoglycemia.

What is the term used to describe the downward displacement of the bladder toward the vaginal orifice?

Cystocele

In utero exposure to this drug increases the incidence of vaginal cancer?

Diethylstilbestrol (DES)

Donna is a 26 year old graduate student who has been sexually active with multiple partners for 5 years. Last year she experienced several incidences of cervicitis. She now comes to the clinic complaining of severe lower abdominal discomfort and is walking with a shuffling gait. The nurse suspects PID. What negative outcomes are possible for Donna to have if she is not treated immediately? What type of treatment does the nurse anticipate instructioning Donna about?

Donna faces pelvic peritonitis, abscesses, strictures, and fallopian tube obstruction if not treated immediately. There is also the potential for bacteremia with septic shock, chronic pelvic & abdominal pain; and recurring PID. A broad-spectrum antibiotic is prescribed, usually a combo of ceftriaxone, azithromycin, and doxycycline.

A 50 year old patient informs the nurse that she is experiencing some of the symptoms of menopause. She has not had a menstrual period in 8 months and states that she is having hot flashes. What does the nurse explain to her is the cause of the hot flashes?

The hot or warm flashes and night sweats reported by some women are thought to be caused by hormonal changes and denote vasomotor instability.

Why is Pap smear follow-up important if a woman has atypical cells from the first test?

To prevent cervical cancer.

Intense burning and inflammation of the vulva is documented as what?

Vulvodynia

An adolescent patient comes to the clinic reporting "terrible pain" during menstruation. What should the nurse document this subjective data as? a. dysmenorrhea b. amenorrhea c. menorrhagia d. metrorrhagia

a. Dysmenorrhea

Women with HPV should have annual Pap smears because of the potential of HPV to cause ________? a. dysplasia b. Fibroids c. FIstulas d. Prolapse

a. Dysplasia

In educating a patient with PMS about changing her dietary practices, what would the nurse recommend that she increase her intake of? a. magnesium b. vit. d c. Iron d. Zinc

a. Magnesium

A woman at an employee health fair informs the nurse that she has had vaginal bleeding for the past several days. She is postmenopausal and has not had a menstrual period for the past 4 years. What should the nurse instruct the woman to do? a. She should see her gynecologist or health-care provider as soon as possible. b. She should mention the bleeding episode to the HCP at the next appointment. c. She should disregard this bleeding episode, because it is probably normal. d. She should use a birth control method, because she may be fertile with her next ovulation.

a. She should see her gynecologist or HCP as soon as possible.

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? (Select all the apply) a. fluid retention b. low back pain c. fever d. headache e. hypotension

a. fluid retention b. low back pain d. headache

Which of the following is a potential complication of toxic shock syndrome? a. Septic shock b. Fibroids c. Cystocele d. Vulvodynia

a. septic shock

Define Amenorrhea:

absence of menstruation

The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as? a. Dysmenorrhea b. Dyspareunia c. Dysuria d. Dysthymia

b. Dyspareunia