Final
. A mother who is 3 days postpartum calls the clinic and complains of "night sweats" she is afraid that she is going into early menopause. The nurse should base her answer on the fact that:
Diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother
36. A neonate at 34 weeks' gestation is admitted to the neonatal intensive care unit. The nurse reviews the medical record and obtains the neonate's vital signs. What objective should the nurse designate as the priority? Medical Record Vital Signs Born at 34 week's gestation Temperature: 98° F Weighs 6 pounds, 10 ounces Apical Heart Rate: 130 Apgar: 4 and 8 Respirations: 58 Blood Pressure: 60/20
a. Oxygenation will remain adequate
15. A client using a diaphragm should be instructed to:
a. Refrain from keeping the diaphragm in longer than eight hours.
40. A newborn is being treated with phototherapy for hyperbilirubinemia. What is the nurse's role when providing phototherapy?
a. Turning the infant every 2 hours
33. A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." The nurse knows that these signs indicate the client is in the
c. Transition phase of labor
5. The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to
c. Wart removal options.
20. A nurse is teaching a class about the female reproductive system. The nurse asks participants in class to state the purpose of the labia minora. Which statement, by a participant indicates that teaching has been effective?
d. The labia minora has numerous sebaceous glands that lubricate the entrance to the vagina.
During The second postpartum day, a woman asks the nurse, "Why are my after pains so much worse this time than after the birth of my other child?" The best answer by the nurse would be
. "After pains are more severe for women that have already had babies"
Which finding would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum?
. Pain in left calf with dorsiflexion of left foot
28. Josie is currently pregnant at 19 weeks, 2 miscarriages, one at 14 weeks and one at 18 weeks. One son born at 38 weeks. One daughter born at 41 weeks. A set of twins born at 39 weeks. LMP = May 1, 2011. a. Gravida = b. Para = c. Term/Full-term = d. Preterm = e. Abortion = f. Living = g. EDD =
28. Gravida = 6 Para = 3 Term/Fullterm = 4 Preterm = 0 Abortion = 2 Living = 4 EDD = February 8, 2012
26. A physician has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy and the client asks a nurse about the procedure. The nurse tells the client that:
d. The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel.
30. A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light- headed while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to:
d. Turn the woman on her side.
On a clients 1st postpartum day, nursing assessment reveals vital signs within normal limits, a boggy uterus, a saturation of the perineal pad with lochia rubra. Which nursing intervention takes highest priority?
Massaging the uterus gently
As part of the postpartum assessment, the nurse examines the breast of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be:
Soft, nontender, colostrum present.
21. The nurse is teaching expectant parents about the basics of genetics. Which of the following concepts about genetics is correct? Select all that apply.
a. Life starts as a single cell but the developed human body is made up of trillions of cells b. All human cells, except mature red blood cells, contain a complete set of deoxyribonucleic acids (DNA) molecules d. Mitosis and meiosis are the 2 types of cell division in human cells e. Alterations in chromosomes often occur during conception and are classified as either structural alterations or alterations in the number of chromosomes
3. A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate?
a. "Inform all potential sexual partners about the infection, even if it is inactive."
41. Within 3 minutes after birth the normal heart rate of the infant may range between:
a. 100 and 180
42. What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge?
a. Apical heart rate of 90 beats/min, slightly irregular, when awake and active
27. A nurse is caring for a client who has a diagnosis of gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe?
a. Ceftriaxone (Rocephin
23. A young couple comes to the OB's office prior to attempting to conceive. They have concerns regarding possible genetic defects from a long family history in both families. Which of the following topics should the nurse explore with the couple in order to prepare them for genetic evaluation?
a. Communication should include an assessment of the positive and negative outcomes of the test
9. A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate teaching the patient about
a. Endometrial biopsy.
34. Which of the following nurse's actions is required before a client in labor receives an epidural?
a. Give a fluid bolus of 500 mL.
19. The nurse is teaching a class on infertility. Which of the following statements correctly describes infertility?
a. Infertility is the lack of conception despite unprotected sexual intercourse for at least 12 months.
1. A nurse is caring for a client diagnosed with a Chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, Chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
b. Educate the client about why it's important to inform sexual contacts so they can receive treatment.
32. To comfort a woman who is tensing her muscles with contractions, the nurse should guide the labor coach to do which of the following?
b. Encourage the patient to pant.
37. A neonate born at 39 weeks' gestation is small for gestational age (SGA). What commonly occurring problem should the nurse anticipate when planning care for this infant?
b. Hypoglycemia
25. A nursing student is questioning her instructor as the relevance of gene knowledge for herself as a beginning practitioner. Which of the following statements by the nursing instructor depicts the significance of genetic advances on health care delivery?
b. Knowledge of how gene alterations are inherited is important for nursing interventions and teaching
11. A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients. Which of the following statements by an adolescent requires clarification?
b. Spermicide is applied once when using a diaphragm.
38. What should the nurse do when an apnea monitor sounds an alarm 10 seconds after cessation of respirations?
b. Use tactile stimuli on the chest and extremities
2. A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe?
b. b) Ceftriaxone
16. A couple who has been trying to conceive for two years is consulting with a fertility specialist about fertility testing. The specialist realizes that the husband understands the teachings when he states:
c. "We will need to abstain from intercourse 2-5 days before we do the post coital test."
10. A female patient experienced a pelvic fracture in a motor vehicle accident several months earlier and her recovery has been slow. Among the challenges presented by event is the fact that sexual activity causes a dull ache in her pelvis. What diagnosis is most important for this patient?
c. Alteration in comfort: Pain
12. Which of the following instruction should be included in the nurse's teaching regarding oral contraceptives?
c. An alternate method of birth control is needed when taking antibiotics.
17. Fertilization occurs in which structure?
c. Fallopian tubes
8. Which information will the nurse include when teaching a 51-year-old woman who is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause?
c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.
14. You have been asked to conduct a sex education class at a college fraternity and have just completed teaching about contraception. Which statement below indicates a lack of understanding?
c. If a girl I'm hooking up with is on the pill, I don't need to worry about wearing a condom.
39. The parents of a preterm infant are preparing to take their baby home. What should the nurse do to evaluate the parents' competency in infant care?
c. Observe the parents while they are giving care to their infant
24. The nurse is present with the physician when genetic testing results are revealed to expectant parents. Which of the following actions would be an important role of the nurse in this process?
c. Parents are tested to confirm their genotype and non-paternity may be an issue
31. A nurse is caring for a client in labor. The nurse determines that the client is beginning the second stage of labor when which of the following assessments is noted?
c. The cervix is dilated completely.
45. A new mother told the nurse, "I've been told that the milk I have right after the baby is born is not good for the baby." The nurse should base her answer on the fact that:
c. The colostrum is high in immunoglobulin
22. Parents of a newborn are confused when their child is diagnosed with a genetic disorder because neither of them has a defect. Testing is done and it is determined that both parents are carriers of the disorder even though they are asymptomatic. Understanding the principles of inheritance what condition is the likely reason for this disorder?
d. Autosomal recessive condition
13. A nurse is instructing a client who has been prescribed oral contraceptives about the danger signs. The nurse evaluates that the client understands the teaching regarding side effects when she states the need to report:
d. Chest pain or shortness of breath.
43. When performing nursing care for a newborn after birth, which of the following nursing interventions is the highest priority?
d. Covering the newborn's head with a cap
7. A systemic disease which is most frequently associated with impotence is
d. Diabetes Mellitus
4. A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding?
d. Genital chancres
29. An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. What should the nurse tell the couple?
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor
44. The nurse is preparing to care for a newborn receiving phototherapy. Which interventions are appropriate? Select all that apply.
d. Monitor skin temperature closely. e. Reposition the newborn every 2 hours. f. Cover the newborn's eyes with eye shields or patches.
6. A holistic approach to nursing care of the client with sexual disorders requires the nurse to have which of the following?
d. Proficiency in the use of the nursing process and ability to assess the client's sexual health
35. A fetus is an occipitoposterior position. The woman is complaining of back labor and the labor is prolonged. The nurse can best assist the mother with this problem by:
a. Placing her in hands and knees position.
18. You are the nurse caring for a couple undergoing fertility testing. The husband is being scheduled for a semen analysis. What information should you provide when he asks what to expect?
c. You will need to make two separate appointments to provide two semen samples, and you must refrain from ejaculating 2-5 days before each appointment.