OB #4 (Ch. 5-6, 26-27)

8) A 16-year-old girl asks, "Do I need to have a Pap smear just because I'm sexually active?" What is the nurse's correct response? 1. "No, you do not need to be screened for cervical cancer until you are 21 years old." 2. "Yes, all sexually active females should be screened for both cervical cancer and human papilloma virus (HPV)." 3. "Yes, all women under the age of 29 should be screened for both cervical cancer and human papilloma virus (HPV)." 4. "No, but you will need to begin your screenings for both cervical cancer and human papilloma virus (HPV) when you are 18 years old."

1 Explanation: 1. 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating cervical cancer screening at age 21. 2. Engaging in sexual activity is not an indication for routine cervical cancer or for HPV screening. 3. 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend cervical cancer screening without HPV cotesting in women ages 21 to 29. 4. 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating cervical cancer screening at age 21. Page Ref: 95

7) Which statement indicates that client teaching about vaginal infections has been effective? 1. "The fishy vaginal odor I have is caused by a bacterial infection." 2. "I can use this antiyeast medication weekly to prevent another infection." 3. "My diabetes is unrelated to the frequency of my vaginal yeast infections." 4. "I should douche weekly to prevent a recurrence of my bacterial vaginosis."

1 Explanation: 1. Bacterial vaginosis is characterized by a fishy vaginal odor and greenish discharge with a vaginal pH over 4.5. 2. Medication for vaginal yeast infections should be used as treatment, not prophylaxis. Using medication as prescribed is important client education. Medication should not be saved for future use. 3. Yeast vaginitis is more common in diabetic and pre-diabetic women. Four episodes or more per year of yeast vaginitis are an indication to screen a woman for diabetes. 4. Douching disrupts normal flora by washing out desirable bacteria; douching is not recommended. Page Ref: 110

12) The nurse is preparing a brochure that compares and contrasts cystitis and pyelonephritis. Which information should be included in the brochure? 1. Urine culture is included in the evaluation of both cystitis and pyelonephritis. 2. Dysuria, especially at the end of urination, is often the initial symptom of both conditions. 3. Both conditions usually present with sudden onset of chills, high temperature, and flank pain. 4. Both conditions are associated with pregnancy complications including increased risk of preterm birth and of intrauterine growth restriction.

1 Explanation: 1. Diagnosis of cystitis is made with a urine culture. Women with acute pyelonephritis should have a urine culture and sensitivity done to determine the appropriate antibiotic. 2. The initial symptom of cystitis is often dysuria, specifically at the end of urination. 3. Acute pyelonephritis has a sudden onset, with chills, high temperature, and flank pain (either unilateral or bilateral). 4. Pyelonephritis during pregnancy is associated with an increased risk of preterm birth and intrauterine growth restriction. Page Ref: 119-120

13) The day after a vaginal delivery, a client develops painful vesicular lesions on the perineum and vulva which are diagnosed as a primary herpes type 2 infection. What care should the newborn receive? 1. Intravenous acyclovir (Zovirax) and contact precautions 2. Cultures of blood and cerebrospinal fluid and serial chest x-rays every 12 hours 3. Parental rooming-in and four intramuscular injections of penicillin 4. Meticulous hand washing and antibiotic eye ointment administration

1 Explanation: 1. For a herpes type 2 infection, intravenous acyclovir (Zovirax) is indicated. Contact precautions should be implemented. 2. These cultures are appropriate, but chest x-rays are not indicated. Chest x-rays are obtained if the neonate is thought to have group B streptococcal pneumonia. 3. Parental rooming-in is encouraged, but penicillin does not treat viral illness. Penicillin is the drug of choice for syphilitic infections. 4. Although meticulous hand washing by staff and parents is important, antibiotic eye ointment is used for conjunctivitis of gonorrhea or Chlamydia. Page Ref: 635

11) A 63-year-old female client requests information about complementary and alternative therapies that promote wellness during menopause. Which therapy should the nurse recommend? 1. Soy for reducing insomnia symptoms 2. Non-weight-bearing exercise, such as swimming 3. Calcium intake of 600 mg per day to help prevent osteoporosis 4. Increased consumption of phytoestrogens for women with a history of endometriosis or fibroids

1 Explanation: 1. Research suggests that isoflavones, which are found in soy, are effective in reducing symptoms of insomnia in postmenopausal women. 2. Weight-bearing exercises such as walking, jogging, tennis, and low-impact aerobics are encouraged in order to increase bone mass and decrease the risk of osteoporosis. 3. Perimenopausal and postmenopausal women are advised to have a calcium intake of at least 1200 mg per day. Most women require supplements to achieve this level. 4. Women who have endometriosis or fibroids should be cautioned about the use of phytoestrogens. Page Ref: 97

1) The nurse is reviewing clients scheduled for prenatal care. Which client should the nurse identify as being most likely to have a newborn at risk for mortality or morbidity? 1. 37-year-old G8 P2323, works in a chemical factory 2. 16-year-old primipara, began prenatal care at 30 weeks 3. 28-year-old G2 P1001, history of gestational diabetes 4. 23-year-old primipara, low socioeconomic status, unmarried

1 Explanation: 1. This client is at greatest risk because she has multiple risk factors: age over 35, high parity, history of preterm birth, and exposure to chemicals that might be toxic. 2. This client has two risk factors: young age and late onset of prenatal care. 3. This client has gestational diabetes history as the only risk factor. 4. The main risk factor for this client is a low socioeconomic status. Page Ref: 566

2) A client asks, "Is it okay for me to use a vaginal douche each day when I'm on my period?" How should the nurse respond? 1. "Douching should be avoided when you're on your period." 2. "Regular douching is necessary in order to promote good hygiene." 3. "Using a douche each day will help prevent vaginal infections from occurring." 4. "During your period, douching will help promote the flow of menstrual secretions."

1 Explanation: 1. Women should avoid douching during menstruation because the cervix is dilated to permit the downward flow of menstrual fluids from the uterine lining. 2. Douching as a hygiene practice is unnecessary because the vagina cleanses itself. 3. Douching washes away the natural mucus and upsets the vaginal flora, which can make the vagina more susceptible to infection. 4. During menstruation, douching may interfere with downward flow of menstrual fluids from the uterine lining. Page Ref: 79

9) A nurse provides a client with instructions regarding breast self-examination (BSE). Which client statements indicate an understanding of detecting lumps in the breast? Select all that apply. 1. "I should inspect my breasts in a circular manner." 2. "Knowing the texture and feel of my breasts is important." 3. "I should perform BSE 1 week prior to the start of my period." 4. "When I reach menopause, I will perform BSE every 2 months." 5. "I should inspect my breasts while in a supine position, with my arms at my sides."

1, 2 Explanation: 1. Checking breasts in a circular manner, feeling all parts of the breast, provides adequate palpation and possible detection of lumps. 2. A woman who knows the texture and feel of her own breasts is far more likely to detect changes that develop. 3. BSE should be performed 1 week after the start of each menstrual period because hormonal levels are lowest and allow closer examination of softer breast tissue. 4. BSE should be performed monthly, on the same day each month, during menopause. 5. The breasts should be inspected while standing with arms at sides. Page Ref: 93

23) During an assessment the nurse suspects that a client is at risk for developing a cystocele. What findings did the nurse use to come to this conclusion? Select all that apply. 1. Age 68 2. Body mass index (BMI) 32 3. Pregnant seven times 4. History of diabetes 5. Takes hormone replacement therapy

1, 2, 3 Explanation: 1. Advanced age is a risk factor for the development of a cystocele. 2. Obesity is a risk factor for the development of a cystocele. 3. Childbearing is a risk factor for the development of a cystocele. 4. History of diabetes is not a risk factor for the development of a cystocele. 5. Hormone replacement therapy is not a risk factor for the development of a cystocele. Page Ref: 121

18) During a home visit the nurse suspects that a newborn is experiencing chlamydial conjunctivitis. What did the nurse assess to make this clinical determination? Select all that apply. 1. Eyelid swelling 2. Yellow discharge 3. Eye inflammation 4. Purulent discharge 5. Corneal ulcerations

1, 2, 3 Explanation: 1. Manifestations of chlamydial conjunctivitis include eyelid swelling 5 to 14 days after birth. 2. Manifestations of chlamydial conjunctivitis include yellow discharge. 3. Manifestations of chlamydial conjunctivitis include eye inflammation. 4. Purulent discharge is a manifestation of ophthalmia neonatorum caused by gonorrhea. 5. Corneal ulceration is a manifestation of ophthalmia neonatorum caused by gonorrhea. Page Ref: 635

12) The nurse is caring for a newborn born to a client who abused drugs while pregnant. Which assessment findings would be common for this newborn? Select all that apply. 1. Hyperirritability 2. Transient tachypnea 3. Exaggerated reflexes 4. Decreased muscle tone 5. Depressed respiratory effort

1, 2, 3 Explanation: 1. The newborn of a woman who abused drugs during her pregnancy is predisposed to hyperexcitability. 2. The newborn of a woman who abused drugs during her pregnancy is predisposed to transient tachypnea. 3. The newborn of a woman who abused drugs during her pregnancy is predisposed to exaggerated reflexes. 4. The newborn of a woman who abused drugs during her pregnancy will not routinely demonstrate decreased muscle tone. 5. The newborn of a woman who abused drugs during her pregnancy will not routinely demonstrate depressed respiratory effort. Page Ref: 597

13) What should be considered as potentially infectious when providing care to a newborn of a client who is HIV positive? Select all that apply. 1. Feces 2. Urine 3. Blood 4. Soiled linens 5. Feeding bottle

1, 2, 3, 4 Explanation: 1. Body fluids such as feces are considered potentially infectious. 2. Body fluids such as urine are considered potentially infectious. 3. Body fluids such as blood are considered potentially infectious. 4. Because body fluids are considered potentially infectious, soiled linens are also potentially infectious. 5. A feeding bottle is not identified as being potentially infectious. Page Ref: 603

17) A newborn is admitted to the neonatal intensive care unit with suspected meconium aspiration. What care should the nurse expect to provide to this client? Select all that apply. 1. Dopamine infusion 2. High-pressure ventilation 3. High-level oxygen therapy 4. Surfactant replacement therapy 5. High-volume intravenous fluids

1, 2, 3, 4 Explanation: 1. For meconium aspiration, dopamine may be prescribed to maintain systemic blood pressure. 2. High-pressure ventilation may be needed to cause sufficient expiratory expansion of obstructed terminal airways or to stabilize airways that are weakened by inflammation. 3. Treatment of meconium aspiration usually involves delivery of high levels of oxygen. 4. Surfactant replacement therapy is most effective when given as a prophylactic measure. 5. Fluids may be restricted in the first 48 to 72 hours because of the risk of cerebral edema. Page Ref: 622

14) A newborn is diagnosed with tetralogy of Fallot. What findings indicate that this client is experiencing heart failure? Select all that apply. 1. Tachypnea 2. Diaphoresis 3. Tachycardia 4. Hepatomegaly 5. Splenomegaly

1, 2, 3, 4 Explanation: 1. Manifestations of heart failure in a newborn include tachypnea. 2. Manifestations of heart failure in a newborn include diaphoresis. 3. Manifestations of heart failure in a newborn include tachycardia. 4. Manifestations of heart failure in a newborn include hepatomegaly. 5. Splenomegaly is not a manifestation of heart failure in a newborn. Page Ref: 604

20) The nurse is concerned that a new mother is going to have difficulty caring for her newborn once the baby is discharged from the neonatal intensive care unit. What client behaviors are consistent with nonadaptive responses? Select all that apply. 1. Refusing to touch the infant 2. Grimacing when holding the infant 3. Expressing fear of taking the infant home 4. Asking staff questions about the infant's care 5. Blaming spouse for the infant's health problems

1, 2, 3, 5 Explanation: 1. Nonadaptive responses include a lack of interaction with the infant during hospitalization. 2. Nonadaptive responses include a negative view of the infant. 3. Nonadaptive responses include a fear of going home with the infant. 4. Asking staff questions about the infant's care is an adaptive response. 5. Nonadaptive responses include blaming others for the infant's condition. Page Ref: 640

10) The nurse is caring for a newborn born to a client who experienced abruptio placentae. Which assessment findings suggest that the infant is experiencing anemia? Select all that apply. 1. Pallor 2. Tachypnea 3. Tachycardia 4. Elevated blood pressure 5. Capillary refill 6 seconds

1, 2, 3, 5 Explanation: 1. Pallor is a manifestation of anemia in a newborn. 2. Tachypnea is a manifestation of anemia that is compromised in a newborn. 3. Tachycardia is a manifestation of anemia in a newborn. 4. Low blood pressure is a manifestation of anemia in a newborn. 5. Capillary refill greater than 3 seconds is an indication of anemia in a newborn. Page Ref: 634

14) A middle school student comes to the nurse's office concerned about her menstrual flow. What should the nurse include when discussing menstruation with this student? Select all that apply. 1. A tub bath is helpful to promote blood flow and reduce cramping. 2. Show a variety of pads and tampons available for the student to use. 3. A fishy odor experienced during menstruation is expected and normal. 4. Demonstrate that the volume of blood lost during menstruation is about 1 to 2 ounces. 5. Wash the hands before and after using any feminine hygiene products for menstruation.

1, 2, 4, 5 Explanation: 1. A long, leisurely soak in a warm tub promotes menstrual blood flow and relieves cramps by relaxing the muscles. 2. If working with teens and preteens, keeping a variety of pads and tampons on hand helps these young girls become familiar with the options available for dealing with menstruation. 3. Conditions such as vaginitis produce a foul-smelling discharge that women often describe as having a "fishy" odor. This is not expected or normal. 4. The average flow is approximately 25 to 60 mL per period. 5. Because of the potential for developing an infection, a woman should wash her hands before inserting a fresh tampon and should avoid touching the tip of the tampon when unwrapping it or before insertion. Hand washing should also occur after using the commode.

15) During a health interview the nurse determines that a client contemplating pregnancy would benefit from teaching on preconception health measures. What information did the nurse use to make this clinical determination? Select all that apply. 1. Smokes one half of a pack per day of cigarettes 2. Works in an industrial plant 3. Drinks decaffeinated coffee 4. Drinks 4 ounces red wine every evening 5. Takes over-the-counter antacids as needed

1, 2, 4, 5 Explanation: 1. One preconception health measure is smoking cessation. 2. One preconception health measure is identifying environmental hazards. 3. Avoiding caffeine several months before conception is a preconception health measure. 4. One preconception health measure is alcohol intake. 5. One preconception health measure is the use of over-the-counter medications. Page Ref: 92

16) A newborn has just been admitted to the special care nursery. What criteria should the nurse use to determine this newborn's classification and neonatal mortality risk? Select all that apply. 1. Length 2. Birth weight 3. Gestational age 4. Amount of lanugo 5. Occipital-frontal head circumference

1, 2,3, 5 Explanation: 1. A newborn is assigned to a category depending on length. 2. A newborn is assigned to a category depending on birth weight. 3. A newborn is assigned to a category depending on gestational age. 4. Amount of lanugo is not used to determine the newborn's classification and neonatal mortality risk 5. A newborn is assigned to a category depending on occipital-frontal head circumference. Page Ref: 566

22) A female client with infertility is suspected as having a problem with patent fallopian tubes and ovum motility. For which health problems should the nurse expect that this client will be evaluated? Select all that apply. 1. Endometriosis 2. Cervical stenosis 3. Ectopic pregnancy 4. Peritubal adhesions 5. Pelvic inflammatory disease

1, 3, 4, 5 Explanation: 1. Fallopian tube function and motility can be affected by endometriosis. 2. Cervical stenosis affects cervical mucus. 3. Fallopian tube function and motility can be affected by an ectopic pregnancy. 4. Fallopian tube function and motility can be affected by peritubal adhesions. 5. Fallopian tube function and motility can be affected by pelvic inflammatory disease. Page Ref: 122

24) A client is diagnosed with a uterine prolapse. Which treatments should the nurse prepare to discuss with this client? Select all that apply. 1. Hysterectomy 2. Kegel exercises 3. Vaginal pessary 4. Topical estrogen 5. Systemic estrogen

1, 3, 4, 5 Explanation: 1. Surgery for uterine prolapse often involves hysterectomy and repair of the prolapsed vaginal walls. 2. Kegel exercises are indicated in the treatment of a cystocele. 3. Conservative treatment for a uterine prolapse includes a vaginal pessary. 4. Conservative treatment for a uterine prolapse includes topical estrogen. 5. Conservative treatment for a uterine prolapse includes systemic estrogen. Page Ref: 121

9) The nurse is assessing a 36-week gestational age newborn. What assessment findings indicate that a cardiac defect is present? Select all that apply. 1. Cyanosis 2. Abdominal bruit 3. Peripheral pulses 4. Signs of heart failure 5. Presence of a heart murmur

1, 4, 5 Explanation: 1. The primary goal of the neonatal nurse is to identify cardiac defects early and initiate referral to the healthcare provider. One of the most common manifestations of a cardiac defect is cyanosis. 2. An abdominal bruit is not a sign of a cardiac defect in a newborn. 3. Peripheral pulses are not assessed to determine the presence of a cardiac defect in a newborn. 4. The primary goal of the neonatal nurse is to identify cardiac defects early and initiate referral to the healthcare provider. One of the most common manifestations of a cardiac defect is signs of heart failure. 5. The primary goal of the neonatal nurse is to identify cardiac defects early and initiate referral to the healthcare provider. One of the most common manifestations of a cardiac defect is the presence of a heart murmur. Page Ref: 604

5) The nurse is planning a group session for parents who are beginning infertility evaluation. Which statements should be included in this session? Select all that apply. 1. "Infertility can be stressful for a marriage." 2. "Taking a vacation usually results in pregnancy." 3. "Your insurance will pay for the infertility treatments." 4. "The doctor will be able to tell why you have not conceived." 5. "Keep communicating with one another through this process."

1, 5 Explanation: 1. Infertility is often stressful on a marriage, as a result of the need to schedule intercourse and pay for treatments and the societal expectation to have children. 2. A common myth is that taking a vacation or just relaxing will result in conception. 3. Insurance often does not pay for infertility treatment. 4. Some infertility cannot be explained, despite extensive treatments. 5. Communication is important to help cope with stress. A nurse should always encourage clients to ask questions. Page Ref: 131

16) An infant weighing 1500 g is prescribed intravenous normal saline 10 mL/kg. How many milliliters of fluid should the nurse expect to provide this infant? (Calculate to the nearest whole number.)

100 mL Explanation: First convert this infant's weight in grams to kilograms by dividing the weight in grams by 1000, or 1500 g/1000 = 1.5 kg. Then multiply the prescribed dose of 10 mL of fluid by the weight in kilograms, or 10 mL × 10 = 100 mL. The nurse should prepare to administer 100 mL of fluid to this infant. Page Ref: 611

6) An infant with type O Rh-positive blood becomes visibly jaundiced at 12 hours of age. The mother with type O Rh-negative blood asks why this has occurred. How should the nurse respond? 1. "The RhoGAM you received at 28 weeks' gestation did not prevent alloimmunization." 2. "Your body has made antibodies against the baby's blood that are destroying her red blood cells." 3. ""The red blood cells of your baby are breaking down because you both have type O blood." 4. "Your baby's liver is too immature to eliminate the red blood cells that are no longer needed."

2 Explanation: 1. Although this statement is true, the term "alloimmunization" is not likely to be understood by the client. It is better to explain what is happening using more understandable terminology. 2. Alloimmune hemolytic disease, also known as erythroblastosis fetalis, occurs when an Rh-negative mother is pregnant with an Rh-positive fetus and maternal antibodies cross the placenta. Maternal antibodies enter the fetal circulation, then attach to and destroy the fetal RBCs. The fetal system responds by increasing RBC production. Jaundice is the result. 3. Mother and baby's both having type O blood is not a problem. ABO incompatibility occurs if the mother is O and the baby is A or B. 4. The infant's liver is indeed too immature to eliminate red blood cells, but the hemolysis from the maternal antibodies is the cause of the jaundice. Page Ref: 626

12) The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further education? 1. "The 'honeymoon period' follows an episode of violence." 2. "Everyone experiences anger and hitting in a relationship." 3. "Abusers can be either husbands or boyfriends or wives or girlfriends." 4. "My daughter is not to blame for the violence in her marriage."

2 Explanation: 1. An acute episode of battering is followed by the tranquil phase, or honeymoon period, when the abuser is often repentant and promising never to abuse the victim again. In some cases, the honeymoon period is the only time there is a lack of building tension. 2. Violence is not a normal part of intimate relationships. This statement indicates that the client has likely been a victim of domestic violence. 3. Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be experienced in any intimate relationship, regardless of whether the couple is straight, gay, or lesbian, and both within marriage and outside of marriage. 4. The victims of violence are not the cause of the violence. Abusers are responsible for their violent behavior. Avoiding blaming and shaming of victims of domestic violence is important to establish a therapeutic relationship. Page Ref: 98

15) The newborn of a mother with type 2 diabetes mellitus is experiencing tremors. What nursing action has the highest priority? 1. Obtain a bilirubin level. 2. Obtain a blood calcium level. 3. Measure the newborn's temperature. 4. Place a pulse oximeter on the newborn.

2 Explanation: 1. Bilirubin level also might be necessary to monitor, but will not cause tremors in the newborn. 2. Tremors are the classic sign for hypocalcemia. Clients with diabetes who deliver newborns tend to have decreased serum magnesium levels at term. This could cause secondary hypoparathyroidism in the infant. 3. Body temperature also might be necessary to monitor, but will not cause tremors in the newborn. 4. Oxygen saturation also might be necessary to monitor, but will not cause tremors in the newborn. Page Ref: 574

13) When a woman who has been raped is admitted to the emergency department, which nursing intervention has priority? 1. Contact family members. 2. Create a safe, secure atmosphere for the woman 3. Assure the woman that everything will be all right. 4. Explain exactly what will need to be done to preserve legal evidence.

2 Explanation: 1. Contacting family members is not the top priority and can wait until a safe environment is established. 2. The first priority in caring for a survivor of a sexual assault is to create a safe, secure atmosphere that will allow the woman to process what has happened. 3. Assuring the woman that everything will be all right is not the top priority and is giving false promise. 4. Explaining exactly what will need to be done to preserve legal evidence is not the top priority. Page Ref: 101

3) What should the gynecology clinic nurse recommend for the client experiencing premenstrual syndrome (PMS)? 1. "Increase your consumption of red meat when you feel symptoms, and eat three large meals per day." 2. "Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin." 3. "Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of bleeding." 4. "Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding should begin."

2 Explanation: 1. Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating several small meals per day rather than three large meals. 2. Regular aerobic activity helps to decrease PMS symptoms. 3. 1200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come from supplements or be obtained through dietary intake of dairy and soy products. 4. Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and colas should be limited throughout the month.

7) A student nurse is caring for a neonate undergoing intensive phototherapy. Which action indicates that the student understands how to provide care for an infant undergoing intensive phototherapy? 1. Assesses temperature every 6 hours 2. Assesses urine specific gravity with each voiding 3. Removes eye coverings to help keep the baby calm 4. Removes the infant from the Isolette for diaper changes

2 Explanation: 1. Every 6 hours is too infrequent; the temperature should be assessed every 4 hours to assess for hyperthermia or hypothermia. 2. When excreted, the newborn's urine will be much darker in color/appearance because of the excreted higher conjugated bilirubin content. Darker urine can also indicate dehydration. Assessing the specific gravity will help differentiate the reason for the change in urine color. 3. Eyes should be covered at all times. 4. The infant's care should be clustered to keep the infant under the lights as much as possible. The diaper should have been changed while under the lights in the Isolette. Page Ref: 628

3) The nurse caring for a newborn on a ventilator for respiratory distress syndrome (RDS) informs the parents that the newborn is improving. Which of the following supports the nurse's assessment? 1. Increased PCO2 2. Increased urination 3. Decreased urine output 4. Increased pulmonary vascular resistance

2 Explanation: 1. Increased PCO2 results from alveolar hypoventilation. 2. In babies with respiratory distress syndrome (RDS) who are on ventilators, increased urination may be an early clue that the baby's condition is improving. As fluid moves out of the lungs into the bloodstream, alveoli open, and kidney perfusion increases; this results in increased voiding. 3. As fluid moves out of the lungs and into the bloodstream, alveoli open, and kidney perfusion increases, thereby increasing urine output. 4. Pulmonary vascular resistance increases with hypoxia. Page Ref: 615

3) A 38-week newborn is small for gestational age (SGA). Which nursing intervention should be included in the care of this newborn? 1. Assess for facial paralysis 2. Maintain a warm environment 3. Monitor for feeding difficulties 4. Monitor for signs of hyperglycemia

2 Explanation: 1. Large-for-gestational age (LGA) newborns often are prone to birth trauma, such as facial paralysis, due to cephalopelvic disproportion. 2. Hypothermia is a common complication of the SGA newborn; therefore, the newborn's environment must remain warm to decrease heat loss. 3. LGA newborns are more difficult to arouse to a quiet alert state and can have feeding difficulties. 4. SGA newborns are more prone to hypoglycemia. Page Ref: 568

19) A client calls his urologist's office to clarify instructions about semen analysis. What should the nurse instruct the client to do? 1. Use a lubricant while obtaining the semen specimen. 2. Remain abstinent for 3 days prior to collecting the specimen. 3. Immediately refrigerate the specimen for a maximum of 8 hours. 4. Deliver the specimen to the laboratory within 1 hour of collection.

2 Explanation: 1. Most lubricants also are spermicidal and should not be used unless approved by the andrology laboratory. 2. To obtain accurate results of a semen analysis, the specimen is collected after 3 days of abstinence. 3. If the specimen is obtained at home, it needs to be kept at body temperature and delivered to the laboratory within 1 hour so as not to impair motility. 4. If the specimen is obtained at home, it needs to be delivered to the laboratory within 1 hour so as not to impair motility. Page Ref: 126

3) The nurse is creating a care plan for a client who is unable to conceive as a consequence of endometriosis. Which statement accurately reflects a nursing diagnosis that may apply to the care of this client? 1. Acute pain related to dysuria and renal pain secondary to endometriosis 2. Compromised family coping related to depression secondary to infertility 3. Infertility related to endometrial inflammation and adhesions secondary to endometriosis 4. Hyperandrogenism related to elevated serum androgen levels secondary to endometriosis

2 Explanation: 1. Pelvic pain is a frequent symptom of endometriosis, while dysuria and renal pain are more commonly associated with conditions such as upper urinary tract infections (UTIs). 2. Infertility may lead to depression and subsequent compromised family coping, which is a nursing diagnosis. 3. Although associated with the medical condition of endometriosis, infertility is a medical diagnosis. 4. Hyperandrogenism is a medical diagnosis that pertains to elevated serum androgen levels. Hyperandrogenism is associated with polycystic ovarian syndrome (PCOS). Page Ref: 108

14) Which diagnostic test should the nurse question if prescribed for a client with pelvic inflammatory disease (PID)? 1. RPR (rapid plasma reagin) 2. Throat culture for streptococcus A 3. Vaginal culture for Neisseria gonorrhoeae 4. CBC (complete blood count) with differential

2 Explanation: 1. RPR is a test for syphilis, another cause of PID. 2. Streptococcal infection of the throat is not associated with PID. 3. Gonorrhea is a common cause of PID, and the client should be tested for this. 4. CBC with differential will give an indication of the severity of the infection. Page Ref: 116

11) Which client should be treated with ceftriaxone (Rocephin) IM and doxycycline (Vibramycin) by mouth? 1. A pregnant client with syphilis 2. A nonpregnant client with gonorrhea and chlamydial infection 3. A pregnant client with gonorrhea and a yeast infection 4. A nonpregnant client with chlamydial infection and trichomoniasis

2 Explanation: 1. Syphilis is treated with penicillin. 2. This combined treatment provides dual treatment for gonorrhea and chlamydial infection because the two infections frequently occur together. 3. Doxycycline is contraindicated during pregnancy. 4. Trichomoniasis is treated with metronidazole.

4) A client with type 2 diabetes mellitus delivered a fetus weighing 7 lb, 14 oz 2 hours ago. The infant's blood glucose is currently 45 mg/dL. What should the nurse do? 1. Begin an IV of 10% dextrose. 2. Document the findings in the chart. 3. Feed the baby 1 oz of formula. 4. Recheck the blood sugar in 4 hours.

2 Explanation: 1. The blood glucose of 45 mg/dL is considered a normal blood sugar reading for a neonate. No IV is needed. 2. A blood sugar of 45 mg/dL is a normal finding; documentation is an appropriate action. 3. Feeding would be appropriate if the infant's blood sugar were below 40, but this infant's reading is 45 mg/dL. 4. Infants of diabetic mothers should be fed frequently and should have their blood sugar assessed frequently. Four hours is too long a time frame. Page Ref: 574

26) The nurse learns that a client is being considered for a total abdominal hysterectomy. Which health problem should the nurse suspect this client is experiencing? Select all that apply. 1. Small fibroids 2. Ovarian cancer 3. Cervical cancer 4. Pelvic relaxation 5. Abnormal uterine bleeding - End of Ch 6 -

2, 3 Explanation: 1. Vaginal hysterectomy is generally done for small fibroids. 2. Abdominal hysterectomy is the usual treatment for cancer of the ovary. 3. Abdominal hysterectomy is the usual treatment for cancer of the cervix. 4. Vaginal hysterectomy is generally done for pelvic relaxation. 5. Vaginal hysterectomy is generally done for abnormal uterine bleeding. Page Ref: 121

17) The nurse suspects that a home care client is experiencing the tension-building phase within the cycle of violence. What observations caused the nurse to make this clinical determination? Select all that apply. 1. Spouse ignoring the client 2. Spouse yelling at the client 3. Client asking the nurse to leave 4. Client apologizing to the spouse 5. Spouse throwing items at the client

2, 3, 4 Explanation: 1. During the tension-building phase of the cycle of violence the batterer demonstrates power and control. Ignoring the client could occur during the tranquil loving phase. 2. During the tension-building phase of the cycle of violence the batterer demonstrates power and control which is characterized by anger and arguing. 3. During the tension-building phase of the cycle of violence the batterer demonstrates power and control; however, the woman may believe the escalation of anger can be controlled by her own actions. Asking the nurse to leave would be a controllable action. 4. During the tension-building phase of the cycle of violence the batterer demonstrates power and control; however, the woman may blame herself and apologize for her actions. 5. Throwing things at the client would occur during the acute battering incident. Page Ref: 98

5) Which issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply. 1. Age at menarche 2. Efficacy of the method 3. Future childbearing plans 4. Whether the client is a vegetarian 5. Cultural perspectives on menstruation and pregnancy

2, 3, 5 Explanation: 1. Age at menarche has no impact on contraceptive method use. 2. Efficacy of contraceptive methods varies and must be considered when discussing contraception with clients. When pregnancy is medically contraindicated, high-efficacy methods (such as an IUD, hormonal methods, or sterilization) should be discussed with the client. When the client would like to avoid pregnancy at this time, but pregnancy is not medically contraindicated, lower-efficacy methods (such as diaphragm, cervical cap, or Today sponge) could be discussed. 3. If a client desires children in the future, sterilization methods would be inappropriate to discuss. 4. Vegetarianism has no impact on contraceptive method use. 5. Cultural and religious beliefs, practices, and sanctions must be considered when discussing contraception with clients in order to avoid insulting a client for whom a particular type of contraceptive method is prohibited by her background. Page Ref: 82

20) The emergency room nurse is caring for a victim of sexual assault. What pharmacologic intervention should the nurse prepare to discuss with the victim? Select all that apply. 1. Prophylactic analgesics 2. Postcoital contraceptive therapy 3. Prophylactic immunizations for tetanus 4. Postexposure prophylaxis with HIV antiviral medications 5. Prophylactic treatment for sexually transmitted infections (STIs) - End of Ch 5 -

2, 4, 5 Explanation: 1. Pain medications are not routinely required for this situation. 2. Postcoital contraceptive therapy should be offered to the victim. 3. Prophylactic tetanus immunization is not routinely required for this situation. 4. Postexposure prophylaxis with HIV antiviral medications should be offered to the victim. 5. Prophylactic treatment for STIs should be offered to the victim. Page Ref: 101

7) The nurse is working with a family that just experienced the birth of their first child at 34 weeks. Which statements indicate that additional teaching is needed? Select all that apply. 1. "Our baby will be in an Isolette to keep him warm." 2. "The growth of our baby will be faster than if he were term." 3. "Breathing might be harder for our baby because he is early." 4. "Tube feedings will be required because his stomach is small." 5. "Because he came early, he will not produce urine for 2 days."

2, 4, 5 Explanation: 1. Preterm infants have little subcutaneous fat and have difficulty maintaining their body temperature. An Isolette or overhead warmer is used to keep the baby warm. 2. Preterm infants grow more slowly than do term infants. 3. Surfactant production might not be complete at 34 weeks, which leads to respiratory distress syndrome. In addition, respiratory effort is increased when the ductus arteriosus remains patent, which is common in preterm infants. 4. Although tube feedings might be required, it would be because preterm babies lack sufficient suck and swallow reflexes to prevent aspiration. 5. Although preterm babies have diminished kidney function due to incomplete development of the glomeruli, they will make urine. Page Ref: 578

20) A client undergoing infertility treatment states that her partner is angry all of the time since beginning treatment and is very negative in comments made about the likelihood of their achieving pregnancy. The client states, "I was angry and depressed, but now I am dedicated to following through with treatment and hoping we get pregnant." What statements best describe the partner's behavior? Select all that apply. 1. Showing that he will not be a good parent 2. In a different stage of grief than the client 3. Feeling guilty about not being able to father a child 4. Having difficulty accepting the reality of their infertility 5. Exhibiting signs of the anger stage of grieving the loss of their dreams of having children

2, 5 Explanation: 1. Being in the anger stage of grief is expected and normal and has no bearing on parenting ability. 2. The client is in the acceptance stage of grief, while the partner is in the anger stage. It is common and normal for families to be in different stages of the grieving process. 3. Guilt would manifest as feelings that it is his fault that pregnancy has not yet occurred. The client is describing anger. 4. The partner is in the anger stage of grief. Lack of acceptance would manifest as not believing that the diagnosis is correct. 5. The client's description of her partner correlates with the anger stage of grief. Couples often experience the stages of grief when infertility is diagnosed because childbearing is an expected outcome in marriage; the inability to become pregnant is the loss of the dream of parenthood. Page Ref: 131

25) A client asks about the difference between an abdominal hysterectomy and a laparoscopic-assisted vaginal hysterectomy (LAVH). What should the nurse explain to this client? Select all that apply. 1. Recovery will be quicker with an abdominal hysterectomy. 2. The results are nearly the same between the two surgical approaches. 3. An abdominal hysterectomy is indicated for uterine bleeding and small fibroids. 4. Hospitalization will be longer with a laparoscopic-assisted vaginal hysterectomy. 5. A laparoscopic-assisted vaginal hysterectomy does not have an abdominal incision.

2, 5 Explanation: 1. Recovery is quicker with a LAVH. 2. A benefit is that the surgeon can achieve results similar to those of a total abdominal hysterectomy when using LAVH, but without a large abdominal incision. 3. A vaginal hysterectomy is indicated for uterine bleeding and small fibroids. 4. Hospitalization will be longer with an abdominal hysterectomy. 5. A benefit is that a LAVH does not have a large abdominal incision. Page Ref: 121

12) A newborn delivered via cesarean birth at 32 weeks to a mother who experienced placenta previa has a low pulse rate, low blood pressure, and a capillary filling time of 3.6 seconds. Which interventions are indicated for the care of this newborn? Select all that apply. 1. Start the infant on phototherapy. 2. Start the infant on iron supplements. 3. Have isotonic saline ready for transfusion. 4. Draw several vials of blood for laboratory testing. 5. Monitor the infant's cardiac and respiratory status. 6. Have O-negative packed red cells ready for a transfusion.

2, 5, 6 Explanation: 1. Phototherapy should only be started if the infant has jaundice. 2. Iron supplements should be given to help increase red blood cell production. 3. Isotonic saline transfusion is not used to treat anemia. 4. Blood draws should be kept to a minimum for clients with anemia. 5. This is an appropriate nursing intervention. Monitoring the infant's cardiac and respiratory status will allow the nurse to detect symptoms of shock and assess the effectiveness of treatment. 6. Clients with severe anemia will need a blood transfusion. If the infant's blood type is not known, O-negative packed red cells can be used for transfusions. If the infant's blood type is known, the appropriate typed and cross-matched packed red cells should be used. Page Ref: 634

20) A full-term infant weighing 8.8 lb is delivered by a client who is HIV positive. The newborn is prescribed zidovudine (AZT) 2 mg/kg/dose every 6 hours for 6 weeks. Realizing that the newborn's weight is going to increase over the 6-week course of treatment, what is the total minimal amount of medication in milligrams that this infant will receive in 1 week? (Calculate to the nearest whole number.)

224 mg Explanation: First determine the infant's weight in kilograms by dividing the weight in pounds by 2.2, or 8.8/2.2 = 4 kg. Then multiply the prescribed dose of 2 mg by the weight in kilograms, or 2 × 4 = 8 mg. If the infant is to receive a dose every 6 hours, multiply the single dose amount of 8 mg × 4 = 32 mg of the medication each day. For 7 days, multiply the daily dose in milligrams by 7, or 32 × 7 = 224 mg. Page Ref: 603

17) A small-for-gestational-age (SGA) newborn weighing 2000 g is prescribed to receive 130 kcal/kg/day of oral feeding to achieve a daily weight gain of 30 g.What should this newborn weigh after 2 weeks of receiving these feedings? (Calculate to the nearest whole number.)

2420 g Explanation: If the newborn is to gain 30 g each day, for 14 days, multiply 30 g × 14 = 420 g of weight gain. After 2 weeks, the newborn should weigh 2420 g. Page Ref: 572

16) The nurse is preparing an education session for women on prevention of urinary tract infections (UTIs). Which statement should be included? 1. Lower urinary tract infections rarely occur in women. 2. Back pain often develops with a lower urinary tract infection. 3. The most common causative organism of cystitis is Escherichia coli. 4. Wiping from back to front after a bowel movement will help prevent a UTI.

3 Explanation: 1. About 60% of women will experience an episode of cystitis during their lifetime. 2. Low back or flank pain is a sign of pyelonephritis, which is an upper urinary tract infection. Signs of a lower UTI include dysuria, urinary frequency, and urinary urgency. 3. Because E. coli is a common bacterium in the bowel and the female urethra is short and close to the anus, cross-contamination of bowel bacteria into the female urinary tract is common. 4. Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being drawn toward the urethra. Women should be instructed always to wipe from front to back. Page Ref: 119

10) What is the best indicator that the client is experiencing menopause? 1. Hot flashes and night sweats 2. No menses for 8 consecutive months 3. High serum follicle-stimulating hormone (FSH) with low serum estrogen 4. Diagnosis of osteoporosis 4 months ago

3 Explanation: 1. Although hot flashes and night sweats are common in menopause, laboratory values or 12 months of amenorrhea are better indicators. 2. Menopause is defined as 12 months of amenorrhea. 3. Examining serum levels of the hormones FSH and estrogen is a very accurate indication of menopause. 4. Menopause is not the only cause of osteoporosis; therefore, the diagnosis of osteoporosis 4 months ago is not an indicator of menopause. Page Ref: 95

2) A client has delivered a small-for-gestational-age (SGA) infant. What long-term effect should the nurse recognize that this infant is at risk for experiencing? 1. Permanent disfiguration 2. Paralysis below the hips 3. Poor fine motor coordination 4. Thin and underweight as a child to overweight or obese as an adolescent

3 Explanation: 1. Although it may occur, disfiguration is not commonly associated with SGA infants. Instead, disfiguration is more likely to remain in infants with congenital anomalies such as cleft lip/cleft palate, even after corrective surgery. 2. Many infants with myelomeningocele will suffer life-long paralysis below the site of the cyst. Paralysis is not generally associated with SGA infants. 3. SGA infants are likely to develop cognitive disabilities such as poor fine motor coordination, hyperactivity, learning disabilities, and hearing loss. 4. This long-term effect is often seen in children with fetal alcohol syndrome, not SGA. Page Ref: 568

6) Which .client in the gynecology clinic should the nurse assess first? 1. 31-year-old, reports increasing dyspareunia 2. 15-year-old, no menses for past 4 months 3. 22-year-old, using tampons, T = 102°F, P = 122, BP = 70/55 4. 18-year-old seeking information on contraception methods

3 Explanation: 1. Although this client might have endometriosis, dyspareunia is not a life-threatening condition. 2. Secondary amenorrhea can be caused by pregnancy. Teen pregnancy is a high risk, but no indication is given that the client is exhibiting a life-threatening condition. 3. A client using tampons who is febrile, tachycardic, and hypotensive might have toxic shock syndrome. Hypotension is life threatening; this client should be seen immediately. 4. Unplanned pregnancy and sexually transmitted infections can be problematic in the future, but this client exhibits no signs or symptoms of a life-threatening condition at this time. Page Ref: 109

18) A 31-year-old woman with normal ovaries, a normal prolactin level, and an intact pituitary gland is undergoing initial pharmacologic treatment of anovulation. Which medication should the nurse anticipate being prescribed for this client? 1. Bromocriptine (Parlodel) 2. Metformin (Glucophage) 3. Clomiphene citrate (Clomid or Serophene) 4. Human menopausal gonadotropins (hMGs)

3 Explanation: 1. Bromocriptine (Parlodel) is used to treat hyperprolactinemia accompanied by anovulation. 2. Oral hypoglycemic agents such as metformin (Glucophage) are used for inducing ovulation in women with polycystic ovary disease (PCOS). 3. Clomiphene citrate (Clomid or Serophene) is a common first-line therapy for inducing ovulation in women with normal ovaries, normal prolactin level, and intact pituitary gland. 4. Human menopausal gonadotropins (hMGs) represent a second line of therapy in women who fail to ovulate or conceive with clomiphene citrate therapy. Page Ref: 127

15) The nurse is explaining a client's abnormal Pap smear results. Which statement should the nurse include? 1. "Your cervix needs to be treated with cryotherapy." 2. "The Pap smear is used to diagnose cervical cancer." 3. "Colposcopy to further examine your cervix is the next step." 4. "A loop electrosurgical excision procedure (LEEP) is needed."

3 Explanation: 1. Cryotherapy, or freezing of the cervix, is one treatment option for precancerous cervical lesions. However, this client does not yet have a diagnosis; she has only had an abnormal screening test. 2. The Pap smear is a screening tool for cervical abnormalities; it is not diagnostic. 3. Colposcopy is an examination of the cervix through a magnifying device. Solutions are often painted onto the cervix and surrounding tissue and observed for changes secondary to the application of the solution. Biopsy samples are taken of suspected abnormal tissue and sent for pathologic examination and diagnosis. Endocervical canal biopsy is often undertaken with colposcopy. 4. Although LEEP (the removal of the surface tissue of the cervix) might be performed to treat cervical dysplasia or carcinoma in situ, this client has not had a diagnostic examination yet. Page Ref: 117

19) The nurse is preparing teaching for the parents of a premature infant weighing 4.4 lb. How much urine in ounces should the nurse instruct the parents that the infant will produce in 1 day if the rate of production is 2 mL/kg/hr? (Calculate to the nearest whole number.)

3 oz Explanation: First determine the newborn's weight in kilograms by dividing the weight in pounds by 2.2, or 4.4/2.2 = 2 kg. Then determine the amount of urine produced in 1 hour by multiplying 2 mL × 2 kg = 4 mL/hr. Then multiple the amount of urine produced each hour by 24 hours, or 4 mL × 24 = 96 mL. To determine the amount of urine in ounces, divide the total amount of daily urine in milliliters by 30 mL, or 96/30 = 3.2. When rounding to the nearest whole number, the amount of urine that the infant will produce in 1 day is 3 oz. Page Ref: 578

1) The nurse is teaching a class to women who were recently diagnosed with benign breast disease (BBD), commonly known as fibrocystic breast disease. One of the participants reports increased swelling, pain, and pressure in her breasts just before menstruation. What is the best response by the nurse? 1. "It's best to make an appointment with an oncologist." 2. "The pain may be caused by thinning of the normal breast tissue." 3. "Consider asking your healthcare provider about adding a mild diuretic to your regimen." 4. "Breast swelling and pressure are expected symptoms, but pain is abnormal and should be evaluated by your physician."

3 Explanation: 1. Cyclic breast pain, swelling, and tenderness are common symptoms associated with BBD. Generally, fibrocystic changes are not a risk factor for breast cancer. 2. The pathology of BBD involves fibrosis, which is a thickening of the normal breast tissue. 3. Treatment of BBD may include taking a mild diuretic during the week prior to the onset of menses to counteract fluid retention, relieve pressure in the breast, and help decrease pain. 4. Common symptoms associated with BBD include cyclic breast pain, tenderness, and swelling. Page Ref: 106

11) A newborn is diagnosed with fetal alcohol syndrome (FAS). Which statement indicates that the parents require additional teaching about this health problem? 1. "He might be a fussy baby because of this." 2. "His face looks like it does due to this problem." 3. "Cuddling and rocking will help him stay calm." 4. "Our baby's heart murmur is from this syndrome."

3 Explanation: 1. FAS babies are easily overstimulated and have feeding difficulties, leading to more crying than an average baby does. 2. Facial characteristics of the FAS child include a broad and flat nasal bridge, wide-set eyes, small chin, and smooth philtrum. 3. FAS babies are easily overstimulated and tend to cry more if swaddled, cuddled, or rocked. A dark and quiet environment helps keep the child calm. 4. Ventral and atrial septal defects are common in babies with FAS. Page Ref: 596

8) The nurse is caring for an infant with abdominal contents protruding at the location of the umbilicus. What statement differentiates between omphalocele and gastroschisis? 1. With omphalocele, the abdominal contents are not covered with a sac; with gastroschisis, the abdominal contents are covered by a sac. 2. With omphalocele, the abdominal contents are covered with a sac; with gastroschisis, the abdominal contents are not covered by a sac. 3. With omphalocele, the abdominal contents protrude into the base of the umbilical cord; with gastroschisis, the abdominal contents protrude to the right of an intact umbilical cord. 4. With omphalocele, the abdominal contents protrude to the right of an intact umbilical cord; with gastroschisis, the abdominal contents protrude into the base of the umbilical cord.

3 Explanation: 1. If the abdominal contents are covered by a sac, it is omphalocele. However, if the abdominal contents are not covered by a sac, it could be either omphalocele or gastroschisis. The better way to differentiate between omphalocele and gastroschisis is that the abdominal contents protrude into the base of the umbilical cord in omphalocele but protrude to the right of the umbilical cord in gastroschisis. 2. If the abdominal contents are covered by a sac, it is omphalocele. However, if the abdominal contents are not covered by a sac, it could be either omphalocele or gastroschisis. The better way to differentiate between omphalocele and gastroschisis is that the abdominal contents protrude into the base of the umbilical cord in omphalocele but protrude to the right of the umbilical cord in gastroschisis. 3. This is the correct way to differentiate between omphalocele and gastroschisis. 4. This is the opposite description of gastroschisis and omphalocele. With omphalocele, the abdominal contents protrude into the base of the umbilical cord; with gastroschisis, the abdominal contents protrude to the right of an intact umbilical cord. Page Ref: 592-593

9) The physician has prescribed metronidazole (Flagyl) for a woman diagnosed with trichomoniasis. What should the nurse include when teaching about this medication? 1. "It will turn your urine orange." 2. "This medication could produce drowsiness." 3. "Both partners must be treated with the medication." 4. "Alcohol does not need to be avoided while taking this medication."

3 Explanation: 1. Metronidazole does not turn the urine orange. 2. Metronidazole does not cause drowsiness. 3. Both partners should be treated with the medication. 4. Alcohol should be avoided. Page Ref: 112

10) In the special care nursery, the nurse places an infant with hydrocephalus in the prone position and is careful to thoroughly cleanse the perineum after bowel movements. What was this infant most likely born with? 1. Omphalocele 2. Gastroschisis 3. Myelomeningocele 4. Diaphragmatic hernia

3 Explanation: 1. Omphalocele is a herniation of abdominal contents into the base of the umbilical cord. Positioning on the abdomen would be detrimental. Hydrocephalus is not associated with omphalocele. 2. Gastroschisis is a full-thickness defect of the abdominal wall, resulting in the abdominal organs' being located on the outside of the body. Positioning on the abdomen would be detrimental. Hydrocephalus is not associated with this condition. 3. Myelomeningocele is a neural tube defect in which the meninges and spinal cord are exposed. Surgical repair is undertaken to prevent encephalitis. Meticulous cleaning of the perineum helps prevent infection. The infant is positioned prone to prevent pressure on the defect. Hydrocephalus often is present. 4. Diaphragmatic hernia is incomplete formation of the diaphragm, resulting in bowel and sometimes stomach extending upward through the defect and being located in the chest cavity. Respiratory distress is the primary symptom. Surgical repair is required for normal respiratory function if the lungs have not been compromised by crowding from abdominal organs. Positioning should be high Fowler to facilitate respiratory efforts. Hydrocephalus is not associated with this condition. Page Ref: 594

9) The mother of a 4-day-old infant is concerned that the infant's skin tone is yellow and asks if the baby should be hospitalized. What should the nurse consider as being the cause of this infant's skin color change? 1. Pathologic jaundice 2. Physiologic jaundice 3. Acute bilirubin encephalopathy 4. Hemolytic disease of the newborn

3 Explanation: 1. Pathologic jaundice usually appears before 24 hours of life and is the result of a more serious underlying condition. 2. Infants can develop physiologic jaundice 4 to 5 days after birth as a result of a shortened red blood cell life span, slow uptake of bilirubin by the liver, a lack of intestinal bacteria, or poorly established hydration from initial breastfeeding. 3. Acute bilirubin encephalopathy, or kernicterus, is a serious medical condition resulting from very high bilirubin levels as a result of pathologic jaundice. This is unlikely to occur with physiologic jaundice. 4. Hemolytic disease of the newborn occurs as a result of blood incompatibility between the mother and infant and is usually diagnosed shortly after birth. Page Ref: 626

6) A client has decided to use the NuvaRing vaginal contraceptive ring as her method of contraception. Which statement suggests the client needs further instruction? 1. "When I store my replacement rings, I should keep them in my refrigerator." 2. "The contraceptive ring provides a sustained release of low-dose contraceptive." 3. "Every 3 months, I will need to remove the contraceptive ring and replace it with a new one." 4. "I do not need to be examined in order to determine the contraceptive ring size that is correct for me."

3 Explanation: 1. Replacement rings should be kept in the refrigerator to maintain integrity. 2. The contraceptive ring provides a low-dose, sustained-release hormonal contraceptive. 3. The ring is left in place for 3 weeks and then removed for 1 week to allow for withdrawal bleeding. 4. One size of the NuvaRing fits virtually all women. Page Ref: 89

21) The nurse manager is interviewing nurses for a position in an infertility clinic. Which statement best indicates that the interviewee understands the role of the nurse when working with infertile clients? 1. "This position is an assistant to the physician during diagnostic testing for infertility." 2. "My job will be teaching clients how to take their medications and scheduling tests." 3. "I will both teach and support families struggling with emotions as they attempt to become pregnant." 4. "Many of my duties will involve forming therapeutic relationships with clients struggling with infertility."

3 Explanation: 1. Some assisting might be a part of this position; the role of the RN in an infertility clinic involves much teaching and providing emotional support to infertile clients. 2. Although teaching and facilitating scheduling are important, the emotions that families deal with during treatment for infertility must also be addressed. 3. This answer addresses the two main aspects of the RN working with infertile clients: emotional support and education. 4. Although this response addresses the emotional aspects of infertility, it does not mention providing support or teaching, which are also major components of the job. Page Ref: 131

8) Which client is at greatest risk for developing Chlamydia trachomatis infection? 1. 35-year-old woman on oral contraceptives 2. 22-year-old mother of two, developed dyspareunia 3. 16-year-old, sexually active, using no contraceptive 4. 48-year-old woman with hot flashes and night sweats

3 Explanation: 1. There is no correlation between oral contraceptive use and an increased rate of chlamydial infection. Additionally, chlamydial infection is more commonly seen in young women. 2. Dyspareunia sometimes develops with chlamydial infection, but dyspareunia is not a symptom specific to chlamydial infection. 3. Teens have the highest incidence of sexually transmitted infections, especially chlamydial infection. A client not using contraceptives is not using condoms, which decrease the risk of contracting a sexually transmitted infection (STI). 4. This client is experiencing signs of menopause, not chlamydial infection. Page Ref: 112

4) The nurse is caring for an infant who delivered in a car on the way to the hospital and has developed cold stress. Which finding requires immediate intervention? 1. Blood glucose level of 45 2. Vasoconstriction and pallor 3. Room temperature IV running 4. Positioned under radiant warmer

3 Explanation: 1. This is an adequate blood sugar in a neonate. Less than 40 is hypoglycemic. 2. Vasoconstriction is the first physiologic response to a lowering temperature and will cause pallor. 3. IV fluids should be warmed prior to administration and wrapped in a blanket or other insulating material to keep them warm. Room temperature IV fluids will increase the cold stress. 4. Radiant warmers are used to gradually increase the neonate's temperature. Page Ref: 623

8) An infant born to a client with type 2 diabetes mellitus is lethargic, has a high-pitched cry, and has an initial plasma glucose level of 19 mg/dL. What should the nurse do immediately? 1. Have the mother breastfeed the infant. 2. Start an IV with D5W dextrose solution. 3. Start an IV with D10W dextrose solution. 4. Wait 30 minutes and retest plasma glucose levels.

3 Explanation: 1. This is an appropriate nursing action if the infant's plasma glucose levels are between 25 and 40 mg/dL. This infant needs more aggressive treatment. 2. D5W dextrose is primarily use to either prevent hypoglycemia or titrate down the concentration of administered glucose when the infant is transitioning off the glucose. A higher concentration of glucose is required for severely hypoglycemic infants. 3. This is the proper nursing action. Infants with severe hypoglycemia should be aggressively treated with IV infusion of D10W dextrose. 4. This infant is suffering from severe hypoglycemia. Aggressive treatment with D10W dextrose by IV is recommended. Page Ref: 624

1) Which client should the nurse document as exhibiting signs and symptoms of primary dysmenorrhea? 1. 17-year-old, has never had a menstrual cycle 2. 19-year-old, regular menses for 5 years that have suddenly become painful 3. 14-year-old, irregular menses for 1 year, experiences cramping every cycle 4. 16-year-old, had regular menses for 4 years, but has had no menses in 4 months

3 Explanation: 1. This is primary amenorrhea, or the lack of menses. 2. Secondary dysmenorrhea is the sudden onset of pain and discomfort with menses. 3. Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle and consistently continues to be painful each month. 4. Secondary amenorrhea is the term used when a client has had regular cycles that cease. Page Ref: 81

5) An infant was born at 31 weeks' gestation and weighed 1430 g. What number of calories should this infant receive each day? 1. 72 2. 143 3. 200 4. 258

3 Explanation: 1. This is using the formula 50 kcal/g/day, which is not sufficient for this infant's growth. 2. This is using the formula 100 kcal/g/day, which is not sufficient for this infant's growth. 3. This is using the formula 140 kcal/g/day, which is appropriate for this infant's growth. 4. This is using the formula 180 kcal/g/day, which is too many calories for this infant's weight and size to support normal growth. Page Ref: 580

18) The nurse is preparing a community education session on the stages of the rape trauma syndrome. In which order should the nurse explain the phases of this syndrome? 1. Buys a weapon 2. Advocates for others 3. Desires revenge and feels guilty 4. Changes email address and phone number

3, 1, 4, 2 Explanation: 1. Buying a weapon occurs during the outward adjustment phase. 2. Advocating for others occurs during the integration and recovery phase. 3. Desiring revenge and feeling guilty occurs during the acute phase. 4. Changing communication methods occurs during the reorganization phase. Page Ref: 101

16) During a wellness visit a young adult client asks for information regarding weight management and exercise prior to pregnancy. What should the nurse explain to this client? Select all that apply. 1. Reduce the intake of complex carbohydrates. 2. Achieve normal weight for height before conceiving. 3. Begin an exercise program a month before conceiving. 4. Select an exercise program to be followed throughout the pregnancy. 5. Reduce weight to below normal for height to compensate for pregnancy weight gain.

3, 4 Explanation: 1. No particular food group should be avoided for adequate nutritional status. 2. Before conception, it is advisable for the woman to be at an average weight for her body build and height. 3. A woman is advised to establish a regular exercise plan beginning at least 3 months before she plans to attempt to become pregnant. 4. The exercise should be one she enjoys and will continue. 5. Weight should not be reduced to an unhealthy level before conceiving. Page Ref: 92

13) The nurse is discharging a client after hospitalization for pelvic inflammatory disease (PID). Which statements indicate that teaching was effective? Select all that apply. 1. "Tubal pregnancy could occur after PID." 2. "My PID was caused by a yeast infection." 3. "It is important for me to finish my antibiotics." 4. "I might have infertility because of this infection." 5. "I am going to have an IUD placed for contraception."

3, 4 Explanation: 1. There is no evidence to support that PID increases the risk of tubal pregnancies. 2. PID is caused by bacteria, most commonly Chlamydia trachomatis or Neisseria gonorrhoeae. Yeast infections do not ascend and become upper reproductive tract infections. 3. Antibiotic therapy should always be completed when a client is diagnosed with any infection. 4. Women sometimes become infertile because of scarring in the fallopian tubes as a result of the inflammation of PID. 5. An intrauterine device (IUD) in place increases the risk of developing PID; a client who has a history of PID is not a good candidate for an IUD. Page Ref: 117

19) During a group session of rape trauma survivors the nurse notes that one participant is in the reorganization phase of recovery. What did this participant demonstrate to cause the nurse to make this decision? Select all that apply. 1. Blames the assailant for the rape 2. Asks what she did to deserve the attack 3. Explains about constantly reliving the rape 4. Asks when the nightmares are going to stop 5. Talks about having one-night stands after bar hopping

3, 4, 5 Explanation: 1. Blaming the assailant is a behavior consistent with the integration and recovery phase. 2. Asking what she did to deserve the attack is a characteristic of the acute phase. 3. Constantly reliving the rape or having flashbacks is a characteristic of the reorganization phase. 4. Experiencing nightmares is a characteristic of the reorganization phase. 5. Risky sexual behavior is a characteristic of the reorganization phase. Page Ref: 101

5) Place the following nursing interventions related to resuscitation in the correct order according to complexity of the method and seriousness of the infant's condition. 1. Perform chest compressions. 2. Administer epinephrine. 3. Rub the infant's back with a blanket. 4. Administer 21% oxygen in a positive-pressure ventilator. 5. Administer 100% oxygen in a positive-pressure ventilator.

3, 4, 5, 1, 2 Explanation: 1. Chest compressions should only be performed if the infant's heart rate is below 60 beats/min despite 30 seconds of effective positive-pressure ventilation. 2. Epinephrine should be administered when the heart rate remains below 60 beats/min despite 45 to 60 seconds of chest compressions and ventilation. 3. Rubbing the infant's back is the least invasive therapy and should be attempted before any other resuscitation method. 4. If rubbing the back does not establish adequate breathing, the infant should be placed on 21% oxygen with a positive-pressure ventilator. 5. Oxygen should be increased from 21% to 100% before chest compressions begin. Page Ref: 611

19) A newborn weighing 8 lb, 4 oz is prescribed intravenous vancomycin 30 mg/kg/day in divided doses every 8 hours. How many milligrams of the medication should the nurse prepare to administer to this infant for every dose? (Calculate to the nearest tenth decimal point.)

37.5 mg Explanation. First determine the infant's weight in kilograms. The current weight is 8 lb and 4 oz. Determine the weight in metric measurement by dividing 4 oz/16 oz. The infant weighs 8.25 lb. Next divide the weight in pounds by 2.2 to determine the weight in kilograms, or 8.25/2.2 = 3.75 kg. Then multiply the prescribed medication dose of 30 mg by the weight, or 30 mg × 3.75 = 112.5 mg, which is the total daily dose. To determine the amount of medication to provide for each dose, every 8 hours, divide the total dose by 3, or 112.5/3 = 37.5 mg. Each dose will be 37.5 mg. Page Ref: 637

4) A client diagnosed with polycystic ovarian disease (PCOS) asks why spironolactone (Aldactone) has been prescribed. How should the nurse respond? 1. "Spironolactone is often used to reduce complications associated with PCOS, including rectocele." 2. "Menstrual irregularities related to polycystic ovarian disease are treated using spironolactone." 3. "Condylomata acuminata, which are sometimes caused by polycystic ovarian disease, are treated with spironolactone." 4. "Spironolactone may be used to decrease symptoms associated with PCOS, such as excessive hair growth and acne."

4 Explanation: 1. A rectocele, which may develop when the posterior vaginal wall is weakened, is associated with pelvic relaxation. 2. Combined oral contraceptive (COC) or cyclic progesterone is used to treat menstrual irregularities associated with PCOS. 3. Condylomata acuminata, also called genital or venereal warts, is a sexually transmitted condition unrelated to PCOS. 4. Spironolactone may be used to treat symptoms of hyperandrogenism that are secondary to PCOS, including excessive hair growth and acne. Page Ref: 109

6) A client pregnant at 41 weeks asks if labor induction is necessary. Which response is best for the nurse to make? 1. "The healthcare provider wants to be proactive in preventing any problems with your baby if the baby gets any bigger." 2. "Sometimes the placenta ages excessively, and we want to take care of that problem before it happens." 3. "When infants are born 2 or more weeks after their due date, they have meconium in the amniotic fluid." 4. "Babies can develop postmaturity syndrome, which increases their chances of having complications after birth."

4 Explanation: 1. Although this is true, the answer is incomplete. The risk of postmaturity syndrome is also an issue. 2. Although this statement is true, it is too vague. It is better to be specific and call postmaturity syndrome by its name. 3. Although this statement is partially true, meconium-stained amniotic fluid is not always present or the only complication of postmaturity syndrome. 4. This statement is correct. Babies older than 41 weeks' gestation are prone to developing postmaturity syndrome. Page Ref: 575

2) The nurse is caring for a client diagnosed with endometriosis. Which statement by the client requires immediate follow-up? 1. "I've noticed my voice is lower since I started taking danazol." 2. "I am having many hot flashes since I had the Lupron injection." 3. "The pain I experience with intercourse is becoming more severe." 4. "My leg has become painful and swollen since I started taking birth control pills."

4 Explanation: 1. Danocrine (danazol) is a testosterone derivative that suppresses gonadotrophin-releasing hormone (GnRH) and has high-androgen and low-estrogen effects. A lowered voice is one side effect of danazol. This client is not experiencing a complication. 2. Leuprolide acetate (Lupron) is a GnRH agonist and causes symptoms of a hypoestrogenic state (hot flashes, vaginal dryness, decreased libido, and bone density loss). Hot flashes are expected and not a complication. 3. Dyspareunia is a common symptom of endometriosis and therefore is not a complication. 4. Combination oral contraceptive pills contain estrogen. A painful, swollen lower extremity can be a sign of deep vein thrombosis, which can cause thromboembolus, which is potentially life threatening. This is a complication and must be addressed immediately. Page Ref: 108

1) At birth, an infant newborn has a heart rate of 100, is not breathing, and is limp and bluish in color. What nursing action is best? 1. Assess blood pressure. 2. Deep suction the airways. 3. Begin chest compressions. 4. Begin bag-and-mask ventilation.

4 Explanation: 1. Establishment of airway and breathing take priority over assessment of blood pressure. 2. This would be appropriate if there were meconium-stained fluid. There is no information about the amniotic fluid. 3. Chest compressions are not initiated until the heart rate is less than 60 and respirations have been established. 4. When an infant is not breathing and has poor muscle tone, bag-and-mask ventilation is the appropriate resuscitation measure. Page Ref: 609

14) The mother of a severely premature infant is being prepared to see her baby for the first time. The infant has an IV and a feeding tube, is receiving phototherapy, and is being monitored for cardiac and respiratory functioning. What information would be the least supportive for the mother at this time? 1. Wash hands before holding the infant. 2. The infant has tubes and monitoring equipment in place. 3. The appearance of the different machines and tubes attached to the infant. 4. Avoid touching the infant because the baby's skin is fragile and could be easily hurt.

4 Explanation: 1. If the mother is going to hold her infant, she will need to thoroughly wash her hands to decrease the risk of infection. 2. The nurse should prepare the mother for what her infant will look like, especially if the infant is hooked up to several machines or tubes. 3. Seeing her child for the first time can be emotionally difficult for a mother, but a description of the equipment and its purpose will help the mother understand the care her child is receiving and help ease her anxiety. 4. Physical contact between the mother and infant will facilitate bonding and should be encouraged. Page Ref: 641

11) A newborn is diagnosed with sepsis. What finding should the nurse use to suspect this health problem? 1. Irritability and flushing of the skin at 8 hours of age 2. Respiratory distress syndrome developed 48 hours after birth 3. Bradycardia and tachypnea develop when the infant is 36 hours old 4. Temperature of 97.0°F 2 hours after warming the infant from 97.4°F

4 Explanation: 1. Irritability or lethargy with pallor after the first 24 hours might indicate sepsis, especially if skin is cool and clammy. 2. Respiratory distress developing at 12 to 24 hours of age might indicate sepsis. 3. Tachycardia and periods of apnea are seen with sepsis, especially within the first 24 hours of life. 4. Temperature instability is often seen with sepsis. Fever is rare in a newborn. Page Ref: 638

4) A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for 2 years. What is the most likely reason for this client's complaint? 1. Menorrhagia 2. Hypermenorrhea 3. Primary dysmenorrhea 4. Secondary dysmenorrhea

4 Explanation: 1. Menorrhagia is excessive, profuse flow. 2. Hypermenorrhea is an abnormally long menstrual flow. 3. Primary dysmenorrhea is defined as cramps without underlying disease. 4. Secondary dysmenorrhea is associated with pathology of the reproductive tract and usually appears after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device. Page Ref: 81

2) A 2-hour-old newborn delivered by cesarean section at 38 weeks with clear amniotic fluid has a respiratory rate of 80 with grunting and nasal flaring. The mother experienced preeclampsia while pregnant. What is the most likely cause of this infant's condition? 1. Prematurity of the neonate 2. Respiratory distress syndrome 3. Meconium aspiration syndrome 4. Transient tachypnea of the newborn

4 Explanation: 1. The infant is not premature. Prematurity alone does not cause respiratory distress; the lack of surfactant causes respiratory distress syndrome. 2. The infant is not premature and therefore is not likely to be experiencing respiratory distress syndrome. 3. There was no meconium in the amniotic fluid, which rules out meconium aspiration syndrome. 4. The infant is term and born by cesarean section. The baby is most likely experiencing transient tachypnea of the newborn. Page Ref: 616

7) Which client is not a good candidate for Depo-Provera (DMPA)? 1. One with a vaginal prolapse 2. One who weighs 200 pounds 3. One who wishes to breastfeed 4. One who wishes to get pregnant within 3 months

4 Explanation: 1. There is no correlation between a vaginal prolapse and use of Depo-Provera. 2. There is no correlation between one's weight and use of Depo-Provera. 3. Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera. 4. Return of fertility after the use of Depo-Provera takes an average of 10 months. Page Ref: 89

17) A client who has been unable to conceive asks the nurse if it is her fault or her husband's fault that they have not been able to become pregnant. What is the nurse's best response? 1. "The male infertility factors are more common than female." 2. "Female infertility issues are more common than male issues." 3. "The testing the doctor will order will determine who is at fault." 4. "We will know more about what is causing your infertility after some tests are done."

4 Explanation: 1. This statement is not true. Because of the complexity of ovulation and maintaining a pregnancy, it is more likely that a female issue is causing the infertility. Regardless, using the term "at fault" is blaming and should be avoided. 2. Although this statement is true because of the complexity of ovulation and maintaining a pregnancy, using the term "at fault" is blaming and should be avoided. 3. Testing will determine what the infertility issue is, but using the term "at fault" is blaming and should be avoided. 4. This is a factual answer that avoids using the term "at fault." This statement is therapeutically worded and therefore is the best answer. Page Ref: 123

10) The nurse reviews the consequences of not treating a chlamydial infection with a young couple. Which statements indicate that teaching has been effective? Select all that apply. 1. "She could become pregnant." 2. "It could cause us to develop rashes." 3. "She could have severe vaginal itching." 4. "She could develop a worse infection of the uterus and tubes." 5. "He could get an infection in the tube that carries the urine out."

4, 5 Explanation: 1. Chlamydial infection does not cause a woman to become pregnant. 2. Chlamydial infection does not cause a rash. 3. Chlamydial infection does not cause vaginal itching. 4. Chlamydial cervicitis can ascend and become pelvic inflammatory disease, or infection of the uterus, fallopian tubes, and sometimes ovaries. 5. Chlamydia trachomatis is a major cause of nongonococcal urethritis (NGU) in men. Page Ref: 113

15) The nurse is caring for a newborn with hypoglycemia. Which areas on the diagram should the nurse use to obtain blood to assess this newborn's blood glucose levels? Select all that apply.

4, 5 Explanation: 1. This is not identified as an area to obtain blood to assess glucose level in a newborn. 2. This is not identified as an area to obtain blood to assess glucose level in a newborn. 3. This area could puncture an artery and is not identified as an area to obtain blood to assess glucose level in a newborn. 4. This is an ideal area to obtain blood to assess glucose level in a newborn. This area avoids arteries and major nerves. 5. This is an ideal area to obtain blood to assess glucose level in a newborn. This area avoids arteries and major nerves. Page Ref: 625