Set Final

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

Answer: A Rationale: Caffeine is a stimulant and eliminating it will help reduce symptoms of fibrocystic breast disease. Cigarettes, dairy products, and sweets are not associated with symptoms of fibrocystic breast disease. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 208

21. A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that the woman is achieving good glucose control based on which result? A. 88 mg/dL B. 100 mg/dL C. 110 mg/dL D. 120 mg/dL

Answer: A Rationale: For a pregnant woman with diabetes, the ADA and ACOG recommend maintaining a fasting blood glucose level below 95 mg/dL, with postprandial levels below 140 mg/dL at 1 hour, below 120 mg/dL at 2 hours. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 708

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

Answer: A Rationale: Tamoxifen is an example of a SERM used as adjunctive treatment for breast cancer. Letrozole and exemestane are aromatase inhibitors used to treat advanced breast cancer. Cortisone is a steroid and would not be used. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 224

11. A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? A. calcium gluconate B. potassium chloride C. ferrous sulfate D. calcium carbonate

Answer: A Rationale: The woman is at risk for magnesium toxicity. The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 686

25. A pregnant client has received dinoprostone. Following administration of this medication, the nurse assesses the client and determines that the client is experiencing an adverse effect of the medication based on which client report? Select all that apply. A. headache B. nausea C. diarrhea D. tachycardia E. hypotension

Answer: A, B, C Rationale: Adverse effects associated with dinoprostone include headache, nauseas and vomiting, and diarrhea. Tachycardia and hypotension are not associated with this drug. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 789

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

Answer: A, B, C, E Rationale: When leaving an abusive relationship, the victim should take a driver's license or photo ID, Social Security number or green card/work permit, birth certificates, any court papers or orders, credit cards, cash, and health insurance cards. The victim should avoid phone cards because they leave a trail to follow. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 305

19. A nurse is explaining to a group of nurses new to the labor and birth unit about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? A. herbal agents B. laminaria C. membrane stripping D. amniotomy

Answer: B Rationale: Laminaria is a hygroscopic dilator that is used as a mechanical method for cervical ripening. Herbal agents are a nonpharmacologic method. Membrane stripping and amniotomy are considered surgical methods. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 788

24. A woman with a history of systemic lupus erythematosus comes to the clinic for evaluation. The woman tells the nurse that she and her partner would like to have a baby but that they are afraid her lupus will be a problem. Which response would be most appropriate for the nurse to make? A. "It's probably not a good idea for you to get pregnant since you have lupus." B. "Be sure that your lupus is stable or in remission for 6 months before getting pregnant." C. "Your lupus will not have any effect on your pregnancy whatsoever." D. "If you get pregnant, we'll have to add quite a few medications to your normal treatment plan.

Answer: B Rationale: The time at which the nurse comes in contact with the woman in her childbearing life cycle will determine the focus of the assessment. If the woman is considering pregnancy, it is recommended that she postpone conception until the disease has been stable or in remission for 6 months. Active disease at time of conception and history of renal disease increase the likelihood of a poor pregnancy outcome (Cunningham et al., 2018). In particular, if pregnancy is planned during periods of inactive or stable disease, the result is often giving birth to healthy full-term babies without increased risks of pregnancy complications. Nonetheless, pregnancies with most autoimmune diseases are still classified as high risk because of the potential for major complications. Preconception counseling should include the medical and obstetric risks of spontaneous abortion, stillbirth, fetal death, fetal growth restriction, preeclampsia, preterm labor, and neonatal death and the need for more frequent visits for monitoring the condition. Treatment ofSLE in pregnancy is generally limited to NSAIDs (e.g., ibuprofen), prednisone, and an antimalarial agent, hydroxychloroquine. During pregnancy in the woman with SLE, the goal is to keep drug therapy to a minimum. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 731

4. A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? A. sedatives B. tocolytics C. uterine stimulants D. corticosteroids

Answer: C Rationale: For hypotonic labor, a uterine stimulant such as oxytocin may be prescribed once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 770

4. A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? A. use of oral contraceptives for 5 years B. ovarian cyst 2 years ago C. recurrent pelvic infections D. heavy, irregular menses

Answer: C Rationale: In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 663

17. A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? A. "rll sit down to rest for 30 minutes." B. "I'll try to move my bowels." C. "I'll lie down with my legs raised." D. "rll drink several glasses of water."

Answer: D Rationale: If the woman experiences any signs and symptoms ofpreterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 784

1. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? A. supine B. side-lying C. sitting D. knee- chest

Answer: D Rationale: Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 796

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

Answer: D Rationale: Rohypnol is the most common date rape drug. Others include gamma hydroxybutyrate (or liquid ecstasy) and ketamine. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 309

6. It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? A. at 32 weeks' gestation and immediately before discharge B. 24 hours before birth and 24 hours after birth C. in the first trimester and within 2 hours of birth D. at 28 weeks' gestation and again within 72 hours after birth

Answer: D Rationale: To prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 693

19. A pregnant woman comes to the clinic for her first evaluation. The woman is screened for hepatitis B (HBV) and tests positive. The nurse would anticipate administering which agent? A. HBV immune globulin B. HBV vaccine C. acylcovir D. valacyclovir

Answer: A Rationale: If a woman tests positive for HBV, expect to administer HBV immune globulin. The newborn will also receive HBV vaccine within 12 hours of birth. Acyclovir or valacyclovir would be used to treat herpes simplex virus infection. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 737

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

Answer: A Rationale: The goal of intervention is to enable the victim to gain control by providing sensitive, predictable care in an accepting setting. Assisting the client to project anger would not be helpful when the client needs support and education. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 300

5. A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority? A. hemorrhage B.jaundice C. edema D. infection

Answer: A Rationale: With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 663

19. A nurse suspects that a pregnant client may be experiencing a placental abruption based on assessment of which finding? Select all that apply. A. dark red vaginal bleeding B. insidious onset C. absence of pain D. rigid uterus E. absent fetal heart tones

Answer: A, D, E Rationale: Assessment findings associated with a placental abruption include a sudden onset with concealed or visible dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones. Question format: Multiple Select Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 677

7. When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? A. monthly visits until 32 weeks, then bi-monthly visits B. bi-monthly visits until 28 weeks, then weekly visits C. monthly visits until 20 weeks, then bi-monthly visits D. bi-monthly visits until 36 weeks, then weekly visits

Answer: B Rationale: For the woman with chronic hypertension, antepartum visits typically occur every 2 weeks until 28 weeks' gestation and then weekly to allow for frequent maternal and fetal surveillance. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 722

25. A nurse is conducting a presentation for a group of pregnant women about measures to prevent toxoplasmosis. The nurse determines that additional teaching is needed when the group identifies which measure as preventive? A. washing raw fruits and vegetables before eating them B. cooking all meat to an internal temperature of 125° F (52° C) C. wearing gardening gloves when working in the soil D. avoiding contact with a cat's litter box

Answer: B Rationale: Meats should be cooked to an internal temperature of 160° F (71° C). Other measures to prevent toxoplasmosis include peeling or thoroughly washing all raw fruits and vegetables before eating them, wearing gardening gloves when in contact with outdoor soil, and avoiding the emptying or cleaning of a cat's litter box. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 740

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

Answer: B Rationale: Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Gestational hypertension is not associated with violence during pregnancy. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 298

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

Answer: C Rationale: The American Cancer Society still recommends annual mammograms and clinical breast exams for women starting at age 40. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 217

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

Answer: D Rationale: Malignant breast masses typically are difficult to palpate, painless, irregularly shaped, and immobile, with nipple retraction and skin dimpling. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 228

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

Answer: D Rationale: The first step in the clinical breast exam is to inspect the woman's breasts. The nurse then palpates the breasts, compresses the nipple to check for a discharge, and finally palpates the axillary area. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 225

2. A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbAlc) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? A. congenital anomalies B. incompetent cervix C. placenta previa D. placental abruption (abruptio placentae)

Answer: A Rationale: A HbAlc level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental abruption (abruptio placentae). Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 708

28. A pregnant client at 24 weeks' gestation comes to the clinic for an evaluation. The client called the clinic earlier in the day stating that she had not felt the fetus moving since yesterday evening. Further assessment reveals absent fetal heart tones. Intrauterine fetal demise is suspected. The nurse would expect to prepare the client for which testing to confirm the suspicion? A. Ultrasound B. Amniocentesis C. Human chorionic gonadotropin (hCG) level D. Triple marker screening

Answer: A Rationale: A client experiencing an intrauterine fetal demise (TIJFD) is likely to seek care when she notices that the fetus is not moving or when she experiences contractions, loss of fluid, or vaginal bleeding. History and physical examination frequently are of limited value in the diagnosis of fetal death, since many times the only history tends to be recent absence of fetal movement and no fetal heart beat heard. An inability to obtain fetal heart sounds on examination suggests fetal demise, but an ultrasound is necessary to confirm the absence of fetal cardiac activity. Once fetal demise is confirmed, induction of labor or expectant management is offered to the client. An amniocentesis, hCG level, or triple marker screening would not be used to confirm IUFD. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 794

8. A client comes to the clinic for an evaluation. The client is at 22 weeks' gestation. After reviewing a client's history, which factor would the nurse identify as placing her at risk for preeclampsia? A. Her mother had preeclampsia during pregnancy. B. Client has a twin sister. C. Her sister-in-law had gestational hypertension. D. This is the client's second pregnancy.

Answer: A Rationale: A family history of preeclampsia, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 683

22. A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which effect? A. uterine hyperstimulation B. headache C. blurred vision D. hypotension

Answer: A Rationale: A major adverse effect of the obstetric use of misoprostol is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with magnesium sulfate. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 789

1. After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? A. "I will be sure to avoid getting pregnant for at least 1 year." B. "My intake of iron will have to be closely monitored for 6 months." C. "My blood pressure will continue to be increased for about 6 more months." D. "I won't use my birth control pills for at least a year or two."

Answer: A Rationale: After evacuation of trophoblastic tissue (hydatiform mole), long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year, and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 667

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

Answer: A Rationale: Although reassurance, documentation, and education are important for the client experiencing intimate partner violence, ensuring safety is the most important. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 301

23. A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? A. "I'll make sure to limit the amount of long distance traveling I do." B. "Stress isn't a problem that is related to preterm labor." C. "Separating pregnancies by about a year should be helpful." D. "I'll need extra iron in my diet so I have extra for the baby."

Answer: A Rationale: Appropriate measures to reduce the risk for preterm labor include: avoiding travel for long distances in cars, trains, planes or buses; achieving adequate iron store through balanced nutrition (excess iron is not necessary); waiting for at least 18 months between pregnancies, and using stress management techniques for stress. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 784

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

Answer: A Rationale: Caffeine is a stimulant, and eliminating it will help reduce symptoms of fibrocystic breast disease. Thus cutting out coffee from the client's intake indicates understanding of the situation. Although smoking cessation is important for anyone, cigarettes, along with dairy products such as milk and cheese, and sweets, such as cookies and baked goods, are not associated with symptoms of fibrocystic breast disease. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 208

3. A nurse is conducting a review class for a group of perinatal nurses working at the local clinic. The clinic sees a high population of women who are HIV positive. After discussing the recommendations for antiretroviral therapy with the group, the nurse determines that the teaching was successful when the group identifies which rationale as the underlying principle for the therapy? A. reduction in viral loads in the blood B. treatment of opportunistic infections C. adjunct therapy to radiation and chemotherapy D. can cure acute HIV/AIDS infections

Answer: A Rationale: Drug therapy is the mainstay of treatment and is important in reducing the viral load as much as possible. Antiretroviral agents do not treat opportunistic infections and are not adjunctive therapy. There is no cure for HIV/AIDS. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 742

12. When developing a presentation for a local community organization on violence, the nurse is planning to include statistics on intimate partner violence and its effects on children. When addressing these statistics, what is the rate of the cases involving a parent and the children being abused? A. 1in8 B. 1in3 C. 1in5 D. 1in10

Answer: A Rationale: In many cases when a parent is abused, the children are abused as well. Approximately 1 in 8 children are abused annually in the United States. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 295

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

Answer: A Rationale: Incest is any type of sexual exploitation between blood relatives or surrogate relatives before the victim reaches 18 years of age. Rape is a violent, aggressive assault on the victim's body and integrity. Rape is a legal rather than a medical term. It denotes penile penetration of the vagina, mouth, or rectum of the female or male without consent. It may or may not include the use of a weapon. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 306-307

18. A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which measure would the nurse include as a priority? A. frequent handwashing B. immunization C. prenatal screening D. antibody titer screening

Answer: A Rationale: Most women are asymptomatic and do not know they have been exposed to CMV. Prenatal screening for CMV infection is not routinely performed. Since there is no therapy that prevents or treats CMV infections, nurses are responsible for educating and supporting childbearing-age women at risk for CMV infection. Stressing the importance of good handwashing and use of sound hygiene practices can help to reduce transmission of the virus. There is no immunization for CMV. Antibody titer levels would be useful for identifying women at risk for rubella. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 735

28. A young adult woman comes to the clinic for a routine check-up. During the visit, the woman who works in a day care facility tells the nurse that she and her partner are considering having a baby. "We are concerned that I might be exposed to common childhood illnesses." The woman undergoes testing and finds out that she is not immune from chickenpox. Based on this information, which information would the nurse give to the client? A. "You will need to be vaccinated now and wait at least 1 month before getting pregnant." B. "It is very likely that you will need to quit your job if you do get pregnant." C. "Because chickenpox is so rare nowadays, there is nothing to worry about." D. "You will need to take a leave of absence during winter and spring months."

Answer: A Rationale: Preconception counseling is important for preventing chickenpox (varicella). A major component of counseling involves determining the woman's varicella immunity. Vaccination is the cornerstone of prevention. The vaccine is administered if needed. Varicella vaccine is a live attenuated viral vaccine. It should be administered to all adolescents and adults 13 years of age and older who do not have evidence of varicella immunity. Therefore, the woman should be vaccinated now before she becomes pregnant and then wait at least 1 month before getting pregnant. The varicella vaccine is contraindicated for pregnant women because the effects of the vaccine on the fetus are unknown. There is no need for the woman to quit her job once she is immunized nor does she need to take a leave of abscence during the winter and spring months when the incidence is highest. Chickenpox does occur and is highly contagious. Maternal varicella can be transmitted to the fetus through the placenta, leading to congenital varicella syndrome if the mother is infected during the first half of pregnancy via an ascending aorta. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 738

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

Answer: A Rationale: Reach for Recovery is an organization that gives women and their families opportunities to express their feelings, verbalize their fears, and get answers. Reach to Recovery volunteers provide living proof that people can survive breast cancer and lead productive lives. Reach to Recovery helps raise funds, provide supplies, and collect statistics, but these are not the program's primary purpose. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 221-222

5. When teaching a class of pregnant women about the effects of substance use during pregnancy, the nurse would include which effect? A. low-birthweight infants B. excessive weight gain C. higher pain tolerance D. longer gestational periods

Answer: A Rationale: Substance use during pregnancy is associated with low birth weight infants, preterm labor, abortion, intrauterine growth restriction, abruptio placentae, neurobehavioral abnormalities, and long-term childhood developmental consequences. Excessive weight gain, higher pain tolerance, and longer gestational periods are not associated with substance use. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 752

13. The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? A. 11 B. 7 c. 5 D.3

Answer: A Rationale: The Bishop score helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success. Bishop scores of less than 6 usually indicate that a cervical ripening method should be used prior to induction. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 787

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

Answer: A Rationale: The characteristics of the palpated mass suggest that it is a benign mass, most likely a fibroadenoma. However, since other breast lesions have similar characteristics, the lump needs to be evaluated via mammography. Hormone receptor status is used to determine if a malignant mass is stimulated to grow by estrogen or progesterone. A fine-needle aspiration may be done later on ifthere is reason to suspect a malignancy. Genetic testing for the BRCA genes would be done to determine a woman's risk for breast cancer, but this would not be done next. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 217

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

Answer: A Rationale: The first step is to screen for intimate partner violence and identify the connection between the client's injuries and that abuse. Once intimate partner violence is detected, the nurse should immediately isolate the client to provide privacy and prevent retaliation by the abuser. Encouraging the client to leave the abuser immediately is not realistic. Setting up an appointment with a counselor would be appropriate once intimate partner violence is detected and the client is safe. Questioning the suspected abuser might worsen the situation. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 300

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

Answer: A Rationale: The nurse needs to communicate nonjudgmental support and explain that no one deserves to be abused. Doing so helps to establish trust and rapport. Asking the victim what he or she did to make the partner so angry, telling the victim to clean the house earlier in the day, and telling the victim to meet the partner's needs all shift the blame to the victim and are thus inappropriate. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 304

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

Answer: A Rationale: The nurse should immediately stop the technician from obtaining the specimen. The left arm cannot be used because the mastectomy was performed on that side. The right arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Telling the technician to come back later on does not address the situation at present. Notifying the surgeon may be appropriate, but a cut-down procedure is invasive, and other less invasive options should be attempted first before considering such a procedure. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 221-222

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

Answer: A Rationale: Trastuzumab is immunotherapy approved for breast cancer. Breast cancers that overexpress the protein HER-2/neu are associated with a more aggressive form of disease and a poorer prognosis. Trastuzumab target the HER2 pathway to inhibit the growth of cancer cells. The aromatase inhibitors work by inhibiting the conversion of androgens to estrogens. SERMs Interfere with the hormone receptors that allow estrogen to enter the cell and stimulate it to divide. The goal of any chemotherapeutic regimen is to perform a system sweep of the body to reduce the chances that distant tumors will grow or micrometastasis will occur. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 225

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

Answer: A Rationale: Upon return from surgery, the nurse's priority would be on the client's respiratory function, encouraging the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Body image and prevention of lymphedema would be priorities later on in the client's course of care. The client will most likely have a surgical dressing in place that most likely would not be removed in the immediate postoperative period. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 229

20. After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which foods as being good sources of iron in her diet? Select all that apply. A. dried fruits B. peanut butter C. meats D. milk E. white bread

Answer: A, B, C Rationale: Foods high in iron include meats, green leafy vegetables, legumes, dried fruits, whole grains, peanut butter, bean dip, whole-wheat fortified breads, and cereals. Question format: Multiple Select Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 729

27. A nurse is taking a history on a woman who is at 20 weeks' gestation. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply. A. dull low backache B. viscous vaginal discharge C. dysuria D. constipation E. occasional cramping

Answer: A, B, C Rationale: Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and heaviness or aching in the thighs. Constipation is not known to be a sign of preterm labor. Preterm labor is assessed when there are more than six contractions per hour. Occasional asymptomatic cramping can be normal. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 780

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

Answer: A, B, C, D Rationale: Sexual violence includes IPV, human trafficking, incest, female genital cutting, forced prostitution, bondage, exploitation, neglect, infanticide, and sexual assault. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 305

26. A nurse is reading a journal article about cesarean births and the indications for them. Place the indications for cesarean birth below in the proper sequence from most frequent to least frequent. All options must be used. A. Labor dystocia B. Abnormal fetal heart rate tracing C. Fetal malpresentation D. Multiple gestation E. Suspected macrosomia

Answer: A, B, C, D, E Rationale: The most common indications for primary cesarean births include, in order of frequency: labor dystocia as the labor does not progress, abnormal fetal heart rate tracing indicating fetal distress, fetal malpresentation making a difficult progression of labor, multiple gestation , and suspected macrosomia. Question format: Drag and Drop Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 768

30. A pregnant client at 30 weeks' gestation calls the clinic because she thinks that she may be in labor. To determine ifthe client is experiencing labor, which question(s) would be appropriate for the nurse to ask? Select all that apply. A. "Are you feeling any pressure or heaviness in your pelvis?" B. "Are you having contractions that come and go, off and on?" C. "Have you noticed any fluid leaking from your vagina?" D. "Are you having problems with heartburn?" E. "Have you been having any nausea or vomiting?"

Answer: A, B, C, E Rationale: Frequently, women are unaware that uterine contractions, effacement, and dilation are occurring, thus making early intervention ineffective in arresting preterm labor and preventing the birth of a premature newborn. The nurse should ask the client about any signs/symptoms, being alert for subtle symptoms of preterm labor, which may include: a change or increase in vaginal discharge with mucous, water, or blood in it; pelvic pressure (pushing-down sensation); low dull backache; menstrual-like cramps; urinary tract infection symptoms; feeling of pelvic pressure or fullness; gastrointestinal upset like nausea, vomiting, and diarrhea; general sense of discomfort or unease; heaviness or aching in the thighs; uterine contractions with or without pain; more than six contractions per hour; intestinal cramping with or without diarrhea. Contractions also must be persistent, such that four contractions occur every 20 minutes or eight contractions occur in 1 hour. A report of heartburn is unrelated to preterm labor. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 784

21. A nurse is conducting an in-service program for a group of labor and birth unit nurses about cesarean birth. The group demonstrates understanding of the information when they identify which conditions as appropriate indications? Select all that apply. A. active genital herpes infection B. placenta previa C. previous cesarean birth D. prolonged labor E. fetal distress

Answer: A, B, C, E Rationale: The leading indications for cesarean birth are previous cesarean birth, breech presentation, dystocia, and fetal distress. Examples of specific indications include active genital herpes, fetal macrosomia, fetopelvic disproportion, prolapsed umbilical cord, placental abnormality (placenta previa or placental abruption), previous classic uterine incision or scar, gestational hypertension, diabetes, positive human immunodeficiency virus (RN) status, and dystocia. Fetal indications include malpresentation (nonvertex presentation), congenital anomalies (fetal neural tube defects, hydrocephalus, abdominal wall defects), and fetal distress. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 800

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

Answer: A, B, C, E Rationale: Victims often will not describe themselves as abused. In battered woman syndrome, the woman has experienced deliberate and repeated physical or sexual assault by an intimate partner over an extended period of time. She is terrified and feels trapped, helpless, and alone. She reacts to any expression of anger or threat by avoidance and withdrawal behavior. Some women believe that the abuse is caused by a personality flaw or inadequacy in themselves (e.g., inability to keep the partner happy). These feelings of failure are reinforced and exploited by their partners. After being told repeatedly that they are "bad," some women begin to believe it. Many victims were abused as children and may have poor self-esteem, poor health, posttraumatic stress disorder (PTSD), depression, insomnia, low education achievement, or a history of suicide attempts, injury, or drug and alcohol abuse. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 297

14. While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios. Which information would the nurse use to support this suspicion? Select all that apply. A. history of diabetes B. reports of shortness of breath C. identifiable fetal parts on abdominal palpation D. difficulty obtaining fetal heart rate E. fundal height below that for expected gestational age

Answer: A, B, D Rationale: Factors such as maternal diabetes or multiple gestations place the woman at risk for hydramnios. In addition, there is a discrepancy between fundal height and gestational age, such that a rapid growth of the uterus is noted. Shortness of breath may result from overstretching of the uterus due to the increased amount of amniotic fluid. Often, fetal parts are difficult to palpate and fetal heart rate is difficult to obtain because of the excess fluid present. Question format: Multiple Select Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 694

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

Answer: A, B, D, E Rationale: Phytochemical-rich foods include green tea and herbal teas; garlic; whole grains and legumes; onions and leeks; soybeans and soy products; tomato products (cooked tomatoes); fruits (citrus, apricots, pumpkin, berries); green leafy vegetables (spinach, collards, romaine); colorful vegetables (carrots, squash, tomatoes); cruciferous vegetables (broccoli, cabbage, cauliflower); and flax seeds. Question format: Multiple Select Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 231

16. A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. A. nifedipine B. magnesium sulfate C. dinoprostone D. misoprostol E. indomethacin

Answer: A, B, E Rationale: Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), indomethacin (a prostaglandin synthetase inhibitor), and nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 783

29. A nurse is obtaining a medication history from a pregnant client with a history of systemic lupus erythematosus (SLE). Which medication(s) would the nurse expect the woman to report to be currently using? Select all that apply. A. Ibuprofen B. Hydroxychloroquine C. Methotrexate D. Leflunomide E. Prednisone

Answer: A, B, E Rationale: Treatment of SLE in pregnancy is generally limited to NSAIDs like ibuprofen, prednisone, and an antimalarial agent, hydroxychloroquine. Methotrexate and leflunomide are used to treat rheumatoid arthritis but are contraindicated for use in pregnancy because of the potential for fetal toxicity. Question format: Multiple Select Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 731

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

Answer: A, C Rationale: The majority of victims never tell anyone about a rape. Almost two-thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few individuals falsely cry "rape." Reality and fantasy are different, and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 308

20. The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. When reporting this suspicion, which finding(s) would the nurse include in the report? Select all that apply. A. significant difficulty breathing B. hypertension C. tachycardia D. pulmonary edema E. bleeding with bruising

Answer: A, C, D, E Rationale: Anaphylactoid syndrome of pregnancy (ASP), also known as amniotic fluid embolism, is an unforeseeable, life-threatening complication of childbirth. The etiology of ASP remains an enigmatic, devastating obstetric condition associated with significant maternal and newborn morbidity and mortality. It is a rare and often fatal event characterized by the sudden onset ofhypotension, cardiopulmonary collapse, hypoxia, and coagulopathy. ASP should be suspected in any pregnant women with an acute onset of dyspnea, hypotension, and DIC. By knowing how to intervene, the nurse can promote a better chance of survival for both the mother and her newborn. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation

29. A 32-year-old black woman in her second trimester has come to the clinic for an evaluation. While interviewing the client, she reports a history of fibroids and urinary tract infection. The client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor( s) would the nurse identify as increasing the client's risk for preterm labor? Select all that apply. A. African heritage B. Maternal age C. History of fibroids D. Cigarette smoking E. History of urinary tract infections F. Complete blood count results

Answer: A, C, D, E, F Rationale: For this client, risk factors associated with preterm labor and birth would include African heritage, cigarette smoking, uterine abnormalities, such as fibroids, urinary tract infection, and possible anemia based on her complete blood count results. Maternal age extremes (younger than 16 years and older than 35 years) are also a risk factor but do not apply to this client. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 782

26. A nurse is teaching a woman with mild preeclampsia about important areas that she needs to monitor at home. The nurse determines that the teaching was successful based on which statements by the woman? Select all that apply. A. "I should check my blood pressure twice a day." B. "I will weigh myself once a week." C. "I should complete a fetal kick count each day." D. "I will check my urine for protein four times a day." E. "I'll call my health care provider if I have burning when I urinate."

Answer: A, C, E Rationale: The client should take her blood pressure twice daily, check and record weight daily, perform urine dipstick checks for protein twice daily, record the number of fetal kicks daily, and notify her health care provider if she experiences burning on urination. Question format: Multiple Select Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 687

16. A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which aspects? Select all that apply. A. peer pressure to become sexually active B. rise in teen birth rates over the years. C. Asian Americans as having the highest teen birth rate D. loss of self-esteem as a major impact E. about half occurring within a year of first sexual intercourse

Answer: A,D Rationale: Adolescent pregnancy has emerged as one of the most significant social problems facing our society. Early pregnancies among adolescents have major health consequences for mothers and their infants. The latest estimates show that approximately 1 million teenagers become pregnant each year in the United States, accounting for 13% of all U.S. births, but the rates have been declining in the last several years. Teen birth rates in the United States have declined but remain high,especially among African American and Hispanic teenagers and adolescents in southern states. The most important impact lies in the psychosocial area as it contributes to a loss of self-esteem, a destruction of life projects, and the maintenance of the circle of poverty. Moreover, about half of all teen pregnancies occur within 6 months of first having sexual intercourse. About one in four teen mothers under age 18 have a second baby within 2 years after the birth of the first baby. Question format: Multiple Select Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 747

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

Answer: B Rationale: A mammogram involves taking X-ray pictures of the breasts while they are compressed between two plastic plates. There is no need to darken the room or to refrain from eating or drinking after midnight. A ductography involves the injection of dye to highlight the breast ducts. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 217

8. A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and maintains the infusion at the prescribed rate based on which finding? A. Respiratory rate-16 breaths/minute B. Decreased fetal heart rate variability C. Urine output 22 mL/hour D. Absent deep tendon reflexes

Answer: B Rationale: A respiratory rate of 16 breaths per minute is appropriate and within acceptable parameters to continue the infusion. When administering magnesium sulfate, the nurse would immediately report decreaed fetal heart rate variability, a urine output less than 30 mL/hour, and decreased or absent deep tendon reflexes. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 781

22. A nurse is presenting a discussion on sexual violence at a local community college. When describing the incidence of sexual violence, the nurse would identify that a woman has which chance of experiencing a sexual assault in her lifetime? A. 1in3 B. 1in5 C. 2 in 15 D. 3 in20

Answer: B Rationale: According to the National Sexual Violence Resource Center (NSVRC), nearly one in five women and one in 9 men in the United States have experienced rape, physical violence, and/or stalking by a partner with IPV-related impact in their lifetimes. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 292

25. A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? A. 3.3 mEq/L B. 6.1 mEq/L c. 8.4 mEq/L D. 10.8 mEq/L

Answer: B Rationale: Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 690

24. A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority? A. fluid replacement B. oxygenation C. control of hypertension D. birth of the fetus

Answer: B Rationale: As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. Delivery of fetus is determined once the seizures are controlled and the woman is stable. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 686

27. A client comes to the emergency department with moderate vaginal bleeding. She says, "I have had to change my pad about every 2 hours and it looks like I may have passed some tissue and clots." The woman reports that she is 9 weeks' pregnant. Further assessment reveals the following: • Cervical dilation • Strong abdominal cramping • Low human chorionic gonadotropin (hCG) levels • Ultrasound positive for products of conception The nurse suspects that the woman is experiencing which type of spontaneous abortion? A. Threatened B. Inevitable C. Incomplete D. Complete

Answer: B Rationale: Based on the assessment findings, the woman is likely experiencing an inevitable abortion characterized by vaginal bleeding, rupture of membranes, cervical dilation, strong abdominal cramping, possible passage of products of conception, and ultrasound and hCG levels indicating pregnancy loss. A threatened abortion is characterized by slight vaginal bleeding, no cervical dilation or cange in cervical consistency, mild abdominal cramping, close cervical os, and no passage of fetal tissue. An incomplete abortion is characterized by intense abdominal cramping, heavy vaginal bleeding and cervical dilation with passage of some products of conception. A complete abortion is characterized by a history of vaginal bleeding and abdominal pain along with passage of tissue and subsequent decrease in pain and decrease in bleeding. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 663

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

Answer: B Rationale: Breast self-examination (BSE) is a technique that enables a woman to detect any changes in her breasts. Breast self-exams, once thought essential for early breast cancer detection, are now considered optional. Instead, breast awareness is stressed. Breast awareness refers to a woman being familiar with the normal consistency of both breasts and the underlying tissue. This emphasis is now on awareness of breast changes, not just discovery of cancer. Research has shown that breast self-examination plays a small role in detecting breast cancer compared with self-awareness. However, doing breast self-examination is one way for a woman to know how her breasts normally feel so that she can notice any changes that do occur. Clinical breast examination has not replaced BSE. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 230

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

Answer: B Rationale: Breast-conserving surgery is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue. A lumpectomy is often used for early-stage localized tumors and is followed by radiation to eradicate residual microscopic cancer cells. A simple mastectomy is the removal of all breast tissue, the nipple, and the areola. The axillary nodes and pectoral muscles are spared. A modified radical mastectomy involves removal of breast tissue, the axillary nodes, and some chest muscles, but not the pectoralis major, thus avoiding a concave anterior chest. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 221

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

Answer: B Rationale: Communicating support through a nonjudgmental attitude and telling the victim that no one deserves to be abused are the first steps in establishing trust and rapport. Allowing the client to cry is appropriate after the client is safe, the client's privacy is protected, and the nurse has emphasized that there is a problem. Notifying the police is done once the assessment reveals suspicion or actual indications of intimate partner violence. Asking the abuser to describe the story is inappropriate because asking the abuser about the situation may trigger an abusive episode. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 300

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

Answer: B Rationale: Current estimates indicate that 1 of 5 girls is sexually assaulted, and the peak ages of such abuse are from 8 to 12 years of age. At every age in the life span, females are more likely to be victims of sexual violence by father, brother, family member, neighbor, boyfriend, husband, partner or ex-partner than by a stranger or anonymous assailant. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 306

10. A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately? A. respiratory rate of 16 breaths per minute B. 1 + deep tendon reflexes C. urine output of 45 mL/hour D. alert level of consciousness

Answer: B Rationale: Diminished deep tendon reflexes (1 +)suggest magnesium toxicity, which requires immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less than 12 breaths/minute, urine output less than 30 mL/hour, and a decreased level of consciousness. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 781

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

Answer: B Rationale: During the second phase of the cycle of violence, the violence explodes and the batterer loses control physically and emotionally. During the honeymoon or third phase, the batterer is contrite and attempts to apologize for the behavior. During the first phase or tensionbuilding phase, verbal or minor battery occurs and the victim often accepts the partner's building anger as legitimately directed toward him or her. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 296

18. A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines thatmore teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus? A. aging of the placenta B. increased amniotic fluid volume C. meconium aspiration D. cord compression

Answer: B Rationale: Fetal risks associated with a post-term pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome (loss of subcutaneous fat and muscle and meconium staining), and cephalopelvic disproportion. As the placenta ages, its perfusion decreases and it becomes less efficient at delivering oxygen and nutrients to the fetus. Amniotic fluid volume also begins to decline after 38 weeks' gestation, possibly leading to oligohydramnios, subsequently resulting in fetal hypoxia and an increased risk of cord compression because the cushioning effect offered by adequate fluid is no longer present. Hypoxia and oligohydramnios predispose the fetus to aspiration of meconium, which is released by the fetus in response to a hypoxic insult (Norwitz, 2019). All of these issues can compromise fetal well-being and lead to fetal distress. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 785

29. A client who has experienced an incomplete abortion is prescribed mifepristone to assist in removing the retained products of conception. Which medication would the nurse expect to adminster if prescribed before administering mifepristone? A. Opioid analgesic for relief of cramping B. Antiemetic to minimize nausea C. Vitamin K to reduce bleeding D. Diuretic to promote fluid loss

Answer: B Rationale: For the client receiving mifepristone, the nurse would anticipate administering an antiemetic beforehand to reduce nausea and vomiting. Acetaminophen would be useful for pain relief, not an opioid. Vitamin K or a diuretic would not be appropriate when administering mifepristone. Vitamin K would be used to counteract bleeding such as that associated with heparin administration. A diuretic would be appropriate to promote fluid excretion with fluid overload. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 664

22. A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? A. "My mother lives next door and can drive me here if necessary." B. "I have a toddler and preschooler at home who need my attention." C. "I know to call my health care provider right away if I start to bleed again." D. "I realize the importance of following the instructions for my care."

Answer: B Rationale: Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportation, and can comprehend instructions. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 672

12. A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum? A. syphilis B. gonorrhea C. chlamydia D.HPV

Answer: B Rationale: Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 734

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

Answer: B Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. However, wearing a well-fitted compression sleeve would promote drainage return. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 221

10. The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? A. wide, large eyes B. thin upper lip C. protruding jaw D. elongated nose

Answer: B Rationale: Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 752

3. Which assessment finding will alert the nurse to be on the lookout for possible placental abruption during labor? A. macrosomia B. gestational hypertension C. gestational diabetes D. low parity

Answer: B Rationale: Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 797

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

Answer: B Rationale: The acute phase of rape recovery is disorganization characterized by shock, fear, disbelief, anger, shame, guilt and feelings of uncleanliness. This is followed by denial (outward adjustment), reorganization, and finally integration and recovery. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 309

30. A client at 33 weeks' gestation comes to the emergency department with vaginal bleeding. Assessment reveals the following: • Onset of slight vaginal bleeding at 29 weeks with spontaneous cessation • Recent onset of bright red vaginal bleeding, more than with previous episode • No uterine contractions at present • Fetal heart rate within normal range • Uterus soft and nontender Based on the assessment findings, which condition would the nurse likely suspect? A. Placental abruption B. Placenta previa C. Ruptured ectopic pregnancy D. Polyhydramnios

Answer: B Rationale: The assessment findings suggest placenta previa, a bleeding condition that occurs during the last two trimesters of pregnancy. It is characterized by slight birght red vaginal bleeding initially that stops spontaneously and then recurs later in amounts greater than the initial episode; absence of pain/contractions; soft, relaxed uterine tone; and a fetal heart rate within normal parameters. Placental abruption is characterized by a sudden onset with concealed or visible dark vaginal bleeding, utuerie tenderness and pain, with a firm or rigid uterus and fetal distress. The hallmark of ectopic pregnancy is abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period. If ectopic rupture or hemorrhage occurs before treatment begins, symptoms may worsen and include severe, sharp, and sudden pain in the lower abdomen as the tube tears open and the embryo is expelled into the pelvic cavity; feelings of faintness; referred pain to the shoulder area, indicating bleeding into the abdomen caused by phrenic nerve irritation; hypotension; marked abdominal tenderness with distention; and hypovolemic shock. Polyhydramnios is initially suspected when uterine enlargement, maternal abdominal girth, and fundal height are larger than expected for the fetus 's gestational age. With polyhydramnios, there is a discrepancy between fundal height and gestational age, or a rapid growth of the uterus is noted. Shortness of breath and uterine contractions from overstretching may occur. Often the fetal parts and heart rate are difficult to obtain because of the excess fluid present. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 677

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

Answer: B Rationale: The cycle of violence typically increases in frequency and severity as it is repeated over and over again. The woman needs to understand this. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 295

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

Answer: B Rationale: The cyclic behavior begins with a time of tension-building arguments, progresses to violence, and settles into a making-up or calm period. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 295

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

Answer: B Rationale: The most appropriate action would be to suggest that a finger stick be done. The right arm cannot be used because the mastectomy was performed on that side. The left arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Holding the client's arm still is inappropriate because neither arm should be used. Less invasive options should be attempted first before considering a femoral puncture. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 221-222

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

Answer: B Rationale: The objective of endocrine therapy is to block or counter the effect of estrogen in the pathogenesis of cancer. The best-known agent is tamoxifen. Use of estrogens in postmenopausal women increases a woman's risk for breast cancer. In addition, estrogen is a considered to play a major role in the development of breast cancer and as such would not be used. Cortisone is a steroid and would not be used. Trastuzumab is an immunotherapeutic agent. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 211

12. When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage? A. Regular contractions B. Cervical dilation C. Fetal movement through the birth canal D. Placental separation

Answer: B Rationale: The primary change occurring during the first stage of labor is progressive cervical dilation. Contractions occur during the first and second stages of labor. Fetal movement through the birth canal is the major change during the second stage of labor. Placental separation occurs during the third stage of labor. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 768

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

Answer: B Rationale: The question is used to assess the survivor for intrusive thoughts that reflect the client reexperiencing the trauma. Physical symptoms would be assessed with questions about sleeping, eating, palpitations and other problems. Avoidance would be reflected in questions involving withdrawal socially, avoiding situations that remind the survivor of the rape. Hyperarousal would be noted by irritability and an exaggerated startle response. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 311

2. A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? A. a low-lying placenta B. fetopelvic disproportion C. contraction ring D. uterine bleeding

Answer: B Rationale: The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 773

22. A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes? A. stability of the woman's emotional and psychological status B. degree of blood glucose control achieved during the pregnancy C. reduction in retinopathy risk by frequent ophthalmologic evaluations D. control of blood urea nitrogen (BUN) levels for optimal kidney function

Answer: B Rationale: Therapeutic management for the woman with diabetes focuses on tight glucose control, thereby minimizing the risks to the mother, fetus, and neonate. The woman's emotional and psychological status is highly variable and may or may not affect the pregnancy. Evaluating for long-term diabetic complications such as retinopathy or nephropathy, as evidenced by laboratory testing such as BUN levels, is an important aspect of preconception care to ensure that the mother enters the pregnancy in an optimal state. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 709

30. The nurse reviews the medical record of a woman who has come to the clinic for an evaluation. The client has a history of mitral valve prolapse and is listed as risk class II. During the visit, the woman states, "We want to have a baby, but I know I am at higher risk. But what is my risk, really?" Which response by the nurse would be appropriate? A. "If you do get pregnant, you will need to be seen by a cardiologist every other month for monitoring." B. "Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant." C. "Your heart disease would put too much strain on your heart if you were to get pregnant." D. "Your pregnancy would be uneventful, but you would need specialized care for labor and birth."

Answer: B Rationale: Typically, a woman with class I or II cardiac disease can go through a pregnancy without major complications. For class I disease, there is no detectable increased risk of maternal mortality and no increase or a mild increase in morbidity. For class II disease, there is a small increased risk of maternal mortality or moderate increase in morbidity and cardiac consultation should occur every trimester. It is best to have the woman see her cardiologist before becoming pregnant. A woman with class ill disease needs frequent visits with the cardiac care team throughout pregnancy. There is a significantly increased risk of maternal mortality or severe morbidity and cardiologist consult should occur every other month with prenatal care and delivery occurring at an appropriate level hospital. A woman with class IV disease is typically advised to avoid pregnancy. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 717

11. After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching? A. "Holding a pillow against my incision will help me when I cough." B. "I'm going to have to wait a few days before I can start breastfeeding." C. "I guess the nurses will be getting me up and out of bed rather quickly." D. "rll probably have a tube in my bladder for about 24 hours or so."

Answer: B Rationale: Typically, breastfeeding is initiated early as soon as possible after birth to promote bonding. The woman may need to use alternate positioning techniques to reduce incisional discomfort. Splinting with pillows helps to reduce the discomfort associated with coughing. Early ambulation is encouraged to prevent respiratory and cardiovascular problems and promote peristalsis. An indwelling urinary catheter is typically inserted to drain the bladder. It usually remains in place for approximately 24 hours. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 800

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

Answer: B Rationale: When performing breast self-examination, the client should use the pads of the middle three fingers to palpate the breast. When performing the visual part of the procedure, the woman should look at her breasts with her arms up behind the head, with arms down at the sides, and while bending forward. When palpating the breast, the woman should check the breasts as well as the area between the breast and the axilla, the axilla itself, and the area above the breast up to the clavicle and across the shoulder. When palpating, the woman should use a spiral, pie wedge, or vertical strip approach. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 230

7. A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem? A. oligohydramnios B. preeclampsia C. post-term labor D. chorioamnionitis

Answer: B Rationale: Women with multiple gestations are at high risk for preeclampsia, preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 695

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

Answer: B, C Rationale: When leaving an abusive relationship, the victim should take the following items: driver's license or photo ID; Social Security number or green card/work permit; birth certificates for oneself and one's children; phone numbers for social services or shelter; deed or lease to the home or apartment; any court papers or orders; a change of clothing for oneself and one's children; pay stubs, checkbook, credit cards, and cash; and health insurance cards. Phone cards should not be used because they leave a trail to follow. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 305

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

Answer: B, C, D Rationale: Individual risk factors associated with intimate partner violence include young age, heavy drinking, low academic achievement, and experience of or witnessing of violence as a child. Dysfunctional family system and economic stress are risk factors associated with the relationship. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 294

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

Answer: B, C, D Rationale: The American Institute for Cancer Research (AICR), which conducts extensive research, made the following recommendations to reduce a woman's risk for developing breast cancer: engaging in daily moderate exercise and weekly vigorous physical activity; consuming at least five servings of fruits and vegetables daily; not smoking or using any tobacco products; keeping a maximum body mass index (BMI) of 25 and limiting weight gain to no more than 11 pounds (5 kilograms) since age 18; consuming seven or more daily portions of complex carbohydrates, such as whole grains and cereals; limiting intake of processed foods and refined sugar; restricting red meat intake to approximately 3 ounces (.08 kilograms) daily; limiting intake of fatty foods, particularly those of animal origin; and restricting intake of salted foods and use of salt in cooking. Question format: Multiple Select Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 231

21. A nurse is reviewing an article about preterm prelabor rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply. A. high body mass index B. urinary tract infection C. low socioeconomic status D. single gestations E. smoking

Answer: B, C, E Rationale: High-risk factors associated with prelabor rupture of membranes (PROM) include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis. Question format: Multiple Select Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 697

16. A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. A. fetal bradycardia B. abdominal tenderness C. elevated maternal pulse rate D. decreased C-reactive protein levels E. cloudy malodorous fluid

Answer: B, C, E Rationale: Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foulsmelling amniotic fluid. Question format: Multiple Select Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 698

31. A pregnant woman with chronic hypertension is entering her second trimester. The nurse is providing anticipatory guidance to the woman about measures to promote a healthy outcome. The nurse determines that the teaching was successful based on which client statement(s)? Select all that apply. A. "I will need to schedule follow-up appointments every 2 weeks until I reach 32 weeks' gestation." B. "I should try to lie down and rest on my left side for about an hour each day." C. "I will start doing daily counts of my baby's activity at about 24 weeks' gestation." D. "I will need to have an ultrasound at each visit beginning at 28 weeks' gestation." E. "I should take my blood pressure frequently at home and report any high readings."

Answer: B, C, E Rationale: The woman with chronic hypertension will be seen more frequently (every 2 weeks until 28 weeks' gestation and then weekly until birth) to monitor her blood pressure and to assess for any signs of preeclampsia. At approximately 24 weeks' gestation, the woman will be instructed to document fetal movement. At this same time, serial ultrasounds will be prescribed to monitor fetal growth and amniotic fluid volume. The woman should also have daily periods of rest (1 hour) in the left lateral recumbent position to maximize placental perfusion and use home blood pressure monitoring devices frequently (daily checks would be preferred), reporting any elevations. Question format: Multiple Select Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 722

24. A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply. A. "Walk around the house for the next half hour." B. "Drink two or three glasses of water." C. "Lie down on your back." D. "Try emptying your bladder." E. "Stop what you are doing and rest."

Answer: B, D, E Rationale: Appropriate instructions for the woman who may be experiencing preterm labor include having the client stop what she is doing and rest for an hour, empty her bladder, lie down on her left side, and drink two to three glasses of water. Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 784

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

Answer: B, D, E Rationale: Letrozole, exemestane, and anastrozole are examples of aromatase inhibitors. Examples of SERMs include tamoxifen and raloxifene. Question format: Multiple Select Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 224-225

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

Answer: B, D, E Rationale: The majority of victims never tell anyone about a rape. Almost two-thirds of victims never report it to the police. The victim feels vulnerable, betrayed, and insecure after a rape. Few women falsely cry "rape." Reality and fantasy are different, and dreams have nothing to do with the brutal violation of rape. Medication can help initially, but counseling is usually needed. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 308

15. A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which signs would the nurse assess? Select all that apply. A. low whimpering cry B. hypertonicity C. lethargy D. excessive sneezing E. overly vigorous sucking F. tremors

Answer: B, D, F Rationale: Signs and symptoms of withdrawal, or neonatal abstinence syndrome, include: irritability, hypertonicity, excessive and often high-pitched crying, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures. Question format: Multiple Select Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 755

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

Answer: B, E Rationale: When asking the client direct questions using the SA VE model, the nurse should maintain continuous eye contact with the client, avoid the use of technical or medical language, not dismiss or minimize what the client says, even if the client does so, use direct, to the point questions, not leading questions, and wait for each answer patiently. Question format: Multiple Select Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 301

13. A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A. rubella B. hepatitis B C. cytomegalovirus D. parvovirus B19

Answer: C Rationale: Although rubella, hepatitis B, and parovirus B 19 can affect pregnant women and their fetuses, cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. CMV is the leading cause of congenital infection, with morbidity and mortality at birth and sequelae. Each year approximately 1 % to 7% of pregnant women acquire a primary CMV infection. Of these, about 30% to 40% transmits infection to their fetuses. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 734

15. A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common? A. macrosomia B. breech presentation C. persistent occiput posterior position D. multifetal pregnancy

Answer: C Rationale: Common problems involving the passenger include occiput posterior position, breech presentation, multifetal pregnancy, excessive size (macrosomia) as it relates to cephalopelvic disproportion (CPD), and structural anomalies. Of these, persistent occiput posterior is the most common malposition, occurring in about 15% of laboring women. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 775

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

Answer: C Rationale: Duct ectasia is manifested by a greenish nipple discharge. Subareolar redness and swelling can be noted, along with tortuous tubular swellings beneath the areola. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papilloma is manifested by a wart-like growth in the mammary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur. Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 213

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

Answer: C Rationale: During the first phase of intimate partner violence, tension-building, the victim attempts to keep the situation from exploding based on the belief that the partner's anger is legitimately directed at him or her. The battering phase involves the explosion of violence. The honeymoon or reconciliation phase is manifested by a period of calm, loving, contrite behavior on the part of the batterer. The batterer may be genuinely sorry for the pain caused. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 295

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

Answer: C Rationale: During the reorganization phase, the survivor attempts to make life adjustments by moving or changing jobs and uses emotional distancing to cope. The disorganization phase is characterized by shock, fear, disbelief, anger, shame, guilt, and feelings of uncleanliness. During the denial or outward adjustment phase, the survivor appears outwardly composed and returns to work or school and refuses to discuss the assault and denies the need for counseling. During the integration and recovery phase, the survivor begins to feel safe and starts to trust others. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Analyze Client Needs: Psychosocial Integrity Integrated Process: Culture and Spirituality Reference: p. 309

1. The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? A. "I'll basically follow the same diet that I was following before I became pregnant." B. "Because I need extra protein, I'll have to increase my intake of milk and meat." C. "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." D. "I'll adjust my diet and insulin based on the results of my urine tests for glucose."

Answer: C Rationale: In pregnancy, placental hormones cause insulin resistance at a level that tends to parallel growth of the fetoplacental unit. Nutritional management focuses on maintaining balanced glucose levels. Thus, the woman will probably need to make adjustments in her diet. Protein needs increase during pregnancy, but this is unrelated to diabetes. Blood glucose monitoring results typically guide therapy. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 705

9. A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about her prescribed iron supplement, which statement indicates successful teaching? A. "I should take my iron with milk." B. "I should avoid drinking orange juice." C. "I need to eat foods high in fiber." D. "I'll call the primary care provider if my stool is black and tarry."

Answer: C Rationale: Iron supplements can lead to constipation, so the woman needs to increase her intake of fluids and high-fiber foods. Mille inhibits absorption and should be discouraged. Vitamin Ccontaining fluids such as orange juice are encouraged because they promote absorption. Ideally the woman should take the iron on an empty stomach to improve absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman should take it with meals. Iron typically causes the stool to become black and tarry; there is no need for the woman to notify her primary care provider. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 729

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

Answer: C Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 222

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

Answer: C Rationale: Providing reassurance and support to victims of intimate partner violence is key if the violence is to end. Appropriate actions can help victims express their thoughts and feelings in constructive ways and strengthen their control over their lives. Although interventions related to personal appearance and creativity can enhance the victim's self-esteem, they are not helpful in dealing with intimate partner violence. Planning nutritious meals helps to promote a healthy lifestyle but is ineffective in dealing with intimate partner violence. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 305

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

Answer: C Rationale: Stage II breast cancer is characterized by a tumor from 1 to 2 inches in diameter with spread to adjacent lymph nodes. Stage 0 cancer is an early stage in which the cancer is extremely localized. Stage I cancer involves a tumor that is localized and less than 1 inch in diameter. Stage III cancer involves a tumor that is 2 inches or larger with spread to other lymph nodes and tissues. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 215

23. A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? A. "Make sure that anything around your waist is quite snug." B. "Try to eat three large meals a day with less snacking." C. "Drink fluids in between meals rather than with meals." D. "Lie down for about an hour after you eat."

Answer: C Rationale: Suggestions to minimize nausea and vomiting include avoiding tight waistbands to minimize pressure on the abdomen, eating small frequent meals throughout the day, separating fluids from solids by consuming fluids in between meals; and avoiding lying down or reclining for at least 2 hours after eating. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Reference: p. 682

3. Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate? A. "Why are you crying?" B. "Will a pill help your pain?" C. "I'm sorry you lost your baby." D. "A baby still wasn't formed in your uterus."

Answer: C Rationale: Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby was not formed is inappropriate and discounts any feelings or beliefs that the client has. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 661

15. A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions? A. maternal disease B. cervical insufficiency C. fetal genetic abnormalities D. uterine fibroids

Answer: C Rationale: The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester, and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital, or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension, and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 662

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

Answer: C Rationale: The diagnosis of breast cancer and subsequent removal of the breast via surgery can affect all aspects of life for the woman, but most significantly her body image due to the loss of a body part. Therefore, the most important nursing diagnosis would be disturbed body image. Deficient fluid volume, activity intolerance, and impaired urinary elimination are possible due to the effects of surgery, but these are not as important preoperatively as the client's body image. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Psychosocial Integrity Reference: p. 226-228

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

Answer: C Rationale: The goal of interventions is to enable the victim to gain control over life. Although the nurse can encourage a victim to leave an abuser, the choice to leave must be made by the victim. The nurse can provide support and assistance with coping, but the ultimate goal is for the victim to become empowered. Arresting the abuser does not necessarily stop the abuse. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 304

26. A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement? A. "Taking the iron supplement with food will help with the side effects." B. "I will need to avoid coffee and tea when I take this supplement." C. "I will take the iron with milk instead of orange or grapefruit juice." D. "lfI happen to miss a dose, I will take it as soon as I remember."

Answer: C Rationale: The pregnant client should take the iron supplement with vitamin C-containing fluids such as orange juice, which will promote absorption, rather than milk, which can inhibit iron absorption. Taking iron on an empty stomach improves its absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman is advised to take it with meals. The woman also needs instruction about adverse effects, which are predominantly gastrointestinal and include gastric discomfort, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Taking the iron supplement with meals and increasing intake of fiber and fluids helps overcome the most common side effects. If the woman misses a dose, she should take a dose as soon as she remembers. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 729

17. A nurse is teaching a pregnant woman with preterm pre labor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? A. "I need to keep a close eye on how active my baby is each day." B. "I need to call my doctor if my temperature increases." C. "It's okay for my husband and me to have sexual intercourse." D. "I can shower, but I shouldn't take a tub bath."

Answer: C Rationale: The woman with preterm prelabor rupture of membranes should monitor her baby's activity by performing fetal kick counts daily, check her temperature and report any increases to the health care provider, not insert anything into her vagina or vaginal area, such as tampons or vaginal intercourse, and avoid sitting in a tub bath. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 697

9. A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care? A. clear liquid diet B. total parenteral nutrition C. nothing by mouth D. administration of labetalol

Answer: C Rationale: Typically, on admission, the woman with hyperemesis has oral food and fluids withheld to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 680

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

Answer: C Rationale: Upon return from surgery, the nurse should encourage the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Asking the client how she feels about her breast removal should be done at a later time, when she is more alert and oriented and has had time to think about what has happened. The sign should state that no BP, IV lines, and lab work should be done on the client's right arm. The right arm should be elevated on a pillow to promote lymph drainage. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 221

5. A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? A. asphyxia B. clavicular fracture C. cephalhematoma D. central nervous system injury

Answer: C Rationale: Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes, but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 799-800

7. A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? A. amniotic fluid embolism B. shoulder dystocia C. uterine rupture D. umbilical cord prolapse

Answer: C Rationale: Uterine rupture is associated with crack cocaine use disorder. Generally, the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 797

20. The health care provider prescribes PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which action would be most important for the nurse to do? A. Use clean technique to administer the drug. B. Keep the gel cool until ready to use. C. Maintain the client supine for 30 minutes after administration. D. Administer intramuscularly into the deltoid area.

Answer: C Rationale: When PGE2 is prescribed, the gel should come to room temperature before administering it. Sterile technique should be used, and the client should remain supine for 30 minutes after administration. Rho(D) immune globulin is administered intramuscularly into the deltoid area. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 664

11. After teaching a group of nurses working at the women's health clinic about the impact of pregnancy on the older woman, which statement by the group indicates that the teaching was successful? A. "The majority of women who become pregnant over age 35 experience complications." B. "Women over the age of 3 5 who become pregnant require a specialized type of assessment." C. "Women over age 35 and are pregnant have an increased risk for spontaneous abortions." D. "Women over age 35 are more likely to have a substance use disorder."

Answer: C Rationale: Whether childbearing is delayed by choice or by chance, women starting a family at age 35 or older are not doing so without risk. Women in this age group may already have chronic health conditions that can put the pregnancy at risk. In addition, numerous studies have shown that increasing maternal age is a risk factor for infertility and spontaneous abortions, gestational diabetes, chronic hypertension, postpartum hemorrhage, preeclampsia, preterm labor and birth, multiple pregnancy, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restriction, low Apgar scores, and surgical births (Dillion et al. 2019). However, even though increased age implies increased complications, most women today who become pregnant after age 34, have healthy pregnancies and healthy newborns. Nursing assessment of the pregnant woman over age 35 is the same as that for any pregnant woman. Women of this age have the same risk for a substance use disorder as any other age group. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 749

2. A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which fmding? A. urinary output of 20 mL per hour B. respiratory rate of 10 breaths/minute C. deep tendons reflexes 2+ D. difficulty in arousing

Answer: C Rationale: With magnesium sulfate, deep tendon reflexes of2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 689

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

Answer: C, D Rationale: Benign breast masses are typically painful, firm, and rubbery in consistency, often bilateral, no dimpling and mobile, without being affixed to the chest wall. Question format: Multiple Select Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 225

14. A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factors? Select all that apply. A. plan for pudendal block anesthetic use B. multiparity C. short maternal stature D. Body mass index 30.2 E. breech fetal presentation

Answer: C, D, E Rationale: Risk factors for dystocia may include maternal short stature, obesity, hydramnios, uterine abnormalities, fetal malpresentation, cephalopelvic disproportion, overstimulation with oxytocin, maternal exhaustion, ineffective pushing, excessive size fetus, poor maternal positioning in labor, and maternal anxiety and fear Question format: Multiple Select Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 768

12. A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM? A. yellow-green fluid B. blue color on Nitrazine testing C. ferning D. foul odor

Answer: D Rationale: A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 697

9. The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? A. posterior position B.firm C. closed D. shortened

Answer: D Rationale: A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 787

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

Answer: D Rationale: Chemotherapy typically causes side effects of nausea, vomiting, hair loss, fatigue, and myelosuppression. Of these, myelosuppression would be the most serious because it increases the risk for infection, bleeding, and a reduced red blood cell count, which can lead to anemia. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 224

4. Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? A. marijuana B. alcohol C. heroin D. cocaine

Answer: D Rationale: Cocaine use produces vasoconstriction, tachycardia, and hypertension in both the mother and fetus. The effects of marijuana are not yet fully understood. Alcohol ingestion would lead to cognitive and behavioral problems in the newborn. Heroin is a central nervous system depressant. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 756

6. A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? A. "You'll probably have a cesarean birth to prevent exposing your newborn." B. "Antibodies cross the placenta and provide immunity to the newborn." C. "Wait until after the infant is born, and then something can be done." D. "Antiretroviral medications are available to help reduce the risk of transmission."

Answer: D Rationale: Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The goal of therapy is to reduce the viral load as much as possible; this reduces the risk of transmission to the fetus. Decisions about the method of birth should be based on the woman's viral load, duration of ruptured membranes, progress of labor, and other pertinent clinical factors. The newborn is at risk for HIV because of potential perinatal transmission. Waiting until after the infant is born may be too late. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 741

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

Answer: D Rationale: Early breast cancer has no symptoms. If a lump can be palpated, the cancer has been there for quite some time. The earliest sign of breast cancer is often an abnormality seen on a screening mammogram before the woman or the health care professional feels it. A healthy, asymptomatic presentation is typical. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 225

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

Answer: D Rationale: Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast. Duct ectasia occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation. Periareolar infections consist of active inflammation around nondilated subareolar breast ductsa condition termed periductal mastitis. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papilloma is manifested by a wart-like growth in the mammary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 211-212

10. A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? A. hyperglycemia B. elevated platelet count C. disseminated intravascular coagulation (DIC) D. elevated liver enzymes

Answer: D Rationale: HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia is not a part of this syndrome. HELLP may increase the woman's risk for DIC but it is not an assessment finding. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 691

13. The nurse is reviewing the laboratory test results of a pregnant client. Which finding would alert the nurse to the development of HELLP syndrome? A. hyperglycemia B. elevated platelet count C. leukocytosis D. elevated liver enzymes

Answer: D Rationale: HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 691

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

Answer: D Rationale: If intimate partner violence is suspected, the nurse must use direct or indirect questions to screen for abuse. Asking the client if he or she has ever been physically hurt by the partner is most appropriate. Offering the client a pamphlet, calling the client at home, or waiting until the client returns are inappropriate and do not validate the suspicion. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 301

27. A client in her first trimester comes to the clinic for an evaluation. Assessment reveals reports of fatigue, anorexia, and frequent upper respiratory infections. The client's skin is pale and the client is slightly tachycardic. The client also reports drinking about 6 cups of coffee on average each day. A diagnosis of iron-deficiency anemia is suspected. The client is scheduled for laboratory testing and the results are as follows: • Hemoglobin 11.5 g/dL (115 g/L) • Hematocrit 35% (0.35) • Serum iron 32 μg/dL (5.73 μmol/L) • Serum ferritin 90 ng/dL (90 μg/L) Which laboratory finding would the nurse correlate with the suspected diagnosis? A. Hemoglobin B. Hematocrit C. Serum iron level D. Serum ferritin level

Answer: D Rationale: Laboratory tests for iron-deficiency anemia usually reveal low hemoglobin (less than 11 g/dL or 110 g/L), low hematocrit (less than 35% or 0.35), low serum iron (less than 30 μg/dL or 5.37 μmol/L), microcytic and hypochromic cells, and low serum ferritin (less than 100 ng/dL or 100 μg/L). The client's hemoglobin, hematocrit, and serum iron levels are borderline low normal, but the client's serum ferritin is below 100 ng/dL (100 μg/L), helping to support the diagnosis. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 728

17. A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. The nurse would emphasize the need to avoid which medication at this time? A. hydroxychloroquine B. nonsteroidal anti-inflammatory drugs C. glucocorticoid D. methotrexate

Answer: D Rationale: Methotrexate is contraindicated during pregnancy. For rheumatoid arthritis, medications are limited to hydroxychloroquine, glucocorticoids, and NSAIDS. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 733

8. A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant? A. ipratropium B. albuterol C. salmeterol D. Prednisone

Answer: D Rationale: Oral corticosteroids such as prednisone are not preferred for the long-term treatment of asthma during pregnancy. Inhaled steroids are the choice for maintenance medications to reduce inflammation that leads to bronchospasm. Common ones prescribed include beclomethasone and salmeterol. Rescue agents such as albuterol or ipratropium provide immediate symptomatic relief by reducing acute bronchospasm. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 724

6. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? A. fetal heart rate of 150 beats/minute B. contractions every 2 minutes, lasting 45 seconds C. uterine resting tone of 14 mm Hg D. urine output of20 mL/hour

Answer: D Rationale: Oxytocin can lead to water intoxication. Therefore, a urine output of20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention. Question format: Multiple Choice Chapter 21: Nursing Management of Labor and Birth at Risk Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 792

23. A nurse is providing care to several pregnant women at different weeks of gestation. The nurse would expect to screen for group B streptococcus infection in the client who is at: A. 16 weeks' gestation. B. 28 weeks' gestation. C. 32 weeks' gestation. D. 36 weeks' gestation.

Answer: D Rationale: Pregnant women between 36 and 37 weeks' gestation should be universally screened for GBS infection during a prenatal visit and if positive, receive appropriate intrapartum antibiotic prophylaxis. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 739

18. A nurse is assessing a pregnant woman with gestational hypertension. Which finding would lead the nurse to suspect that the client has developed severe preeclampsia? A. urine protein 300 mg/24 hours B. blood pressure 150/96 mm Hg C. mild facial edema D. hyperreflexia

Answer: D Rationale: Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours, and hyperreflexia. Mild facial edema is associated with mild preeclampsia. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 683

28. A pregnant client with preeclampsia is being treated with intravenous magnesium sulfate. The nurse assesses the client's deep tendon reflexes and grades them as 4+. The nurse notifies the health care provider about this finding, describing them using which term to ensure accurate communication? A. Absent B. Average C. Brisk D. Clonus

Answer: D Rationale: The National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health, published a scale in the early 1990s that, though subjective, is used widely today. It grades reflexes from 0 to 4+. Grades 2+ and 3+ are considered normal, and grades 0 which indicates an absent reflex and 4 which indicates cl onus may indicate pathology. Because these are subjective assessments, to improve communication ofreflex results, condensed descriptor categories such as absent, average, brisk, or clonus should be used rather than numeric codes. A 4+ grade indicates clonus which is the presence of rhythmic involuntary contractions, most often at the foot or ankle. Sustained clonus confirms central nervous system involvement. Question format: Multiple Choice Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 690

14. A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate? A. "The caffeine in coffee has been linked to birth defects." B. "Caffeine has been shown to restrict growth in the fetus." C. "Caffeine is a stimulant and needs to be avoided completely." D. "If you keep your intake to less than 200 mg/day, you should be okay."

Answer: D Rationale: The effect of caffeine intake during pregnancy on fetal growth and development is still unclear. A recent study found that caffeine intake of no more than 200 mg/day during pregnancy does not affect pregnancy duration and the condition of the newborn. Birth defects have not been linked to caffeine consumption, but maternal coffee consumption decreases iron absorption and may increase the risk of anemia during pregnancy. It is not known if there is a correlation between high caffeine intake and miscarriage due to lack of sufficient studies. Question format: Multiple Choice Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 754

7. A nurse is working with a victim of violence. Which statement would be most appropriate to empower the victim to take action? A. "Give your partner more time to come around. 11 B. "Remember-children do best in two-parent families. 11 C. "Change your behavior so as not to trigger the violence." D. "You are a good person, and you deserve better than this. 11

Answer: D Rationale: To help the victim gain control over his or her life, the nurse should emphasize that violence is never okay and that the victim did not deserve the violent attack or ask for it. Telling the victim to give the partner more time, saying that children need two parents, and suggesting that the client change his or her behavior do not promote control, rather they attempt to excuse the partner's behavior. Question format: Multiple Choice Chapter 9: Violence and Abuse Cognitive Level: Apply Client Needs: Psychosocial Integrity Reference: p. 300

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

Answer: D Rationale: Treatment of severe fibrocystic breast disease may include the use of tamoxifen, bromocriptine, or danazol. Penicillin would be used to treat an infection such as mastitis. Question format: Multiple Choice Chapter 6: Disorders of the Breasts Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 208