TEST BANK for Olds' Maternal-Newborn Nursing & Women's Health Across the Lifespan 11th Edition David

Table of Contents PART I: INTRODUCTION TO MATERNAL-NEWBORN NURSING 1. Contemporary Maternal-Newborn Nursing 2. Families, Cultures, and Complementary Therapies PART II: WOMEN’S HEALTH ACROSS THE LIFESPAN 3. Health Promotion 4. Family Planning 5. Commonly Occurring Infections 6. Women’s Health Problems 7. Social Issues 8. Violence Against Women PART III: HUMAN REPRODUCTION 9. Reproductive Physiology, Conception, and Fetal Development 10. Reproductive Genetics PART IV: PREGNANCY 11. Physical and Psychologic Changes of Pregnancy 12. Antepartum Nursing Assessment 13. The Expectant Family: Needs and Care 14. Maternal Nutrition 15. Pregnancy in Selected Populations 16. Assessment of Fetal Well-Being 17. Pregnancy at Risk: Pregestational Problems 18. Pregnancy at Risk: Gestational Onset PART V: LABOR AND BIRTH 19. Processes and Stages of Labor and Birth 20. Intrapartum Nursing Assessment 21. The Family in Childbirth: Needs and Care 22. Pharmacologic Pain Management 23. Childbirth at Risk: Prelabor Onset Complications 24. Childbirth at Risk: Labor-Related Complications 25. Birth-Related Procedures PART VI: THE NEWBORN 26. Physiologic Responses of the Newborn to Birth 27. Nursing Assessment of the Newborn 28. The Normal Newborn: Needs and Care 29. Newborn Nutrition 30. The Newborn at Risk: Conditions Present at Birth 31. The Newborn at Risk: Birth-Related Stressors PART VII: POSTPARTUM 32. Postpartum Adaptation and Nursing Assessment 33. The Postpartum Family: Needs and Care 34. Home Care of the Postpartum Family 35. The Postpartum Family at Risk 36. Grief and Loss in the Childbearing Family

Old’s Maternal-Newborn Nursing and Women’s Health, 11e(Davidson/London/Ladewig) Chapter 1 Contemporary Maternal-Newborn Nursing 1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcarecommunity due to research findings that suggest that it has which effect? A) Shortens newborn length of stay B) Decreases use of home health agencies C) Decreases healthcare costs D) Decreases the number of emergency department visits Answer: C Explanation: A) Length of stay is often determined by third-party payer (insurance company) policies as well as the physiologic stability of the mother and newborn. Home healthcare agencies often are involved in client care to decrease hospital staytime. B) Home healthcare agencies often are involved in client care to decrease hospitalstay time. C) Research indicates that self-care significantly decreases healthcare costs. D) Acute emergencies are addressed by emergency departments, and are notdelayed by those practicing self-care. Page Ref: 3 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Self-Care Standards: QSEN Competencies: Ⅰ.A.2. Describe strategies to empower patients orfamilies in all aspects of the healthcare process. | AACN Essentials Competencies: Ⅸ .7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Context and Environment: Health careeconomic policy; reimbursement structures; accreditation standards; staffing models and productivity; supply chain models | Nursing/Integrated Concepts: Nursing Process:Planning. Learning Outcome: 1 Discuss the impact of the self-care movement on contemporary childbirth. MNL LO: Recognize contemporary issues related to care of the childbearing family.

2) Care delivered by nurse-midwives can be safe and effective and can represent a positive response to the healthcare provider shortage. Nurse-midwives tend to useless technology, which often results in which of the following? A) There is less trauma to the mother. B) More childbirth education classes are available. C) They are instrumental in providing change in the birth environment at work. D) They advocate for more home healthcare agencies. Answer: A Explanation: A) Nurse-midwife models of care can be one way to ensure that mothers receive excellent prenatal and intrapartum care. B) It is appropriate for nurse-midwives, in conjunction with doctors and hospitals, to provide childbirth classes for expectant families. C) By working with other staff members and doctors, the nurse-midwife is able to implement changes as needed within the birthing unit. D) Clients are increasingly going home sooner, so there needs to be more follow-upin the home. Page Ref: 3 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/DiseasePrevention Standards: QSEN Competencies: Ⅲ.A.6. Describe how the strength and relevance of available evidence influences the choice of interventions in provision of patient-centeredcare. | AACN Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered,evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

3) The nurse is telling a new client how advanced technology has permitted the physician to do which of the following? A) Treat the fetus and monitor fetal development. B) Deliver at home with a nurse-midwife and doula. C) Have the father act as the coach and cut the umbilical cord. D) Breastfeed a new baby on the delivery table. Answer: A Explanation: A) The fetus is increasingly viewed as a patient separate from the mother, although treatment of the fetus necessarily involves the mother. B) A nurse-midwife and a doula are not examples of technological care. C) Fathers being present during labor and coaching their partners represents nontechnological care during childbirth. D) Breastfeeding is not an example of technology impacting care. Page Ref: 2—3 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅰ.B.10. Engage patients or designated surrogatesin active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: Ⅸ.5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health careteam members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care. MNL LO: Recognize contemporary issues related to care of the childbearing family.

4) A nurse is examining different nursing roles. Which example best illustrates an advanced practice nursing role? A) A registered nurse who is the manager of a large obstetrical unit B) A registered nurse who is the circulating nurse during surgical deliveries (cesarean sections) C) A clinical nurse specialist working as a staff nurse on a mother-baby unit D) A clinical nurse specialist with whom other nurses consult for her expertise incaring for high-risk infants Answer: D Explanation: A) A registered nurse who is the manager of a large obstetrical unit is a professionalnurse who has graduated from an accredited program in nursing and completed the licensure examination. B) A registered nurse who is a circulating nurse at surgical deliveries (cesarean sections) is a professional nurse who has graduated from an accredited programin nursing and completed the licensure examination. C) A clinical nurse specialist working as a staff nurse on a mother-baby unit might have the qualifications for an advanced practice nursing staff member but is notworking in that capacity. D) A clinical nurse specialist with whom other nurses consult for expertise in caringfor high-risk infants is working in an advanced practice nursing role. This nurse has specialized knowledge and competence in a specific clinical area, and is master’s prepared. Page Ref: 5 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅱ.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: Ⅵ. 6. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on thehealthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

5) A nursing student investigating potential career goals is strongly considering becoming a nurse practitioner (NP). The major focus of the NP is on which of thefollowing? A) Leadership B) Physical and psychosocial clinical assessment C) Independent care of the high-risk pregnant client D) Tertiary prevention Answer: B Explanation: A) Leadership might be a quality of the NP, but it is not the major focus. B) Physical and psychosocial clinical assessment is the major focus of the NP. C) NPs cannot provide independent care of the high-risk pregnant client, but mustwork under a physician’s supervision. D) The NP cannot do tertiary prevention as a major focus. Page Ref: 5 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅱ.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: Ⅵ. 2. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on thehealthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

6) The nurse manager is consulting with a certified nurse-midwife about a client. Whatis the role of the CNM? Note: Credit will be given only if all correct choices and no incorrect choices areselected. Select all that apply. A) Be prepared to manage independently the care of women at low risk for complications during pregnancy and birth. B) Give primary care for high-risk clients who are in hospital settings. C) Give primary care for healthy newborns. D) Obtain a physician consultation for any technical procedures at delivery. E) Be educated in two disciplines of nursing. Answer: A, C, E Explanation: A) A CNM is prepared to manage independently the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns. B) CNMs cannot give primary care for high-risk clients who are in hospital settings.The physician provides the primary care. C) A CNM is prepared to manage independently the care of women at low risk for complications during pregnancy and birth and the care of healthy newborns. D) The CNM does not need to obtain a physician consultation for any technical procedures at delivery. E) The CNM is educated in the disciplines of nursing and midwifery. Page Ref: 5 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅱ.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: Ⅵ. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on thehealthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

7) The registered nurse who has completed a master’s degree program and passed a national certification exam has clinic appointments with clients who are pregnant or seeking wellwoman care. What is the role of this nurse considered to be? A) Professional nurse B) Certified registered nurse (RNC) C) Clinical nurse specialist D) Nurse practitioner Answer: D Explanation: A) A professional nurse is one who has completed an accredited basic educationalprogram and has passed the NCLEX-RN® exam. B) A certified registered nurse (RNC) has shown expertise in the field and has takena national certification exam. C) A clinical nurse specialist has completed a master’s degree program, has specialized knowledge and competence in a specific clinical area, and often isemployed in hospitals on specialized units. D) A nurse practitioner has completed either a master’s or doctoral degree in nursing and passed a certification exam, and functions as an advanced practicenurse. Ambulatory care settings and the community are common sites for nursepractitioners to provide client care. Page Ref: 5 Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance: Health Promotion/DiseasePrevention Standards: QSEN Competencies: Ⅱ.A.2. Describe scopes of practice and roles of healthcare team members. | AACN Essentials Competencies: Ⅵ. 6. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on thehealthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of health care team members, including overlaps. | Nursing/Integrated Concepts: Nursing Process: Assessment. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

8) While a child is being admitting to the hospital, the parent receives information aboutthe pediatric unit’s goals, including the statement that the unit practices family- centered care. The parent asks why that is important. The nurse responds that whatcommunication dynamic is characteristic of the family-centered care paradigm? A) The mother is the principal caregiver in each family. B) The child’s physician is the key person in ensuring that the health of a child is maintained. C) The family serves as the constant influence and continuing support in the child’slife. D) The father is the leader in each home; thus, all communications should includehim. Answer: C Explanation: A) Culturally competent care recognizes that both matriarchal and patriarchal households exist. B) The physician is not present during the day-to-day routines in a child’s life. C) Family-centered care is characterized by an emphasis on the family and family involvement throughout the pregnancy, birth, and postpartum period. D) Culturally competent care recognizes that both matriarchal and patriarchal households exist. Page Ref: 2 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Developmental Stages andTransitions Standards: QSEN Competencies: Ⅰ.B.3. Provide patient-centered care with sensitivityand respect for the diversity of human experience. | AACN Essentials Competencies: Ⅸ . 6. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in allhealthcare settings. | NLN Competencies: Relationship-Centered Care: Promote and accept the patient’s emotions; accept and respond to distress in the patient and self; facilitate hope, trust and faith. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 4 Identify specific factors that contribute to a family’s value system. MNL LO: Recognize contemporary issues related to care of the childbearing family.

9) The current emphasis on federal healthcare reform has yielded what unexpectedbenefit? A) Assessment of the details of the family’s income and expenditures B) Case management to limit costly, unnecessary duplication of services C) Many healthcare providers and consumers are becoming more aware of the vitally important role nurses play in providing excellent care to clients and families D) Education of the family about the need for keeping regular well-child visit appointments Answer: C Explanation: A) Financial assessment is more commonly the function of a social worker. The social worker is part of the interdisciplinary team working with clients, and this professional’s expertise is helping clients get into the appropriate programs. B) The case management activity mentioned will not provide a source of funding. C) Nurses must clearly articulate their role in the changing environment to define and differentiate practice roles and the educational preparation required for theirnew roles. D) The education of the family will not provide a source of funding. Page Ref: 4 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/DiseasePrevention Standards: QSEN Competencies: Ⅰ.A.4. Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of patientsand families. | AACN Essentials Competencies: Ⅵ. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education, and licensure requirements). | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-basedtranscultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 2 Compare the nursing roles available to the maternal-newbornnurse. MNL LO: Recognize contemporary issues related to care of the childbearing family.

10) For prenatal care, the client is attending a clinic held in a church basement. The client’s care is provided by registered nurses and a certified nurse-midwife. What isthis type of prenatal care? A) Secondary care B) Tertiary care C) Community care D) Unnecessarily costly care Answer: C Explanation: A) Secondary care is specialized care; an example is checking the hemoglobin A1Cof a diabetic client at an endocrine clinic. B) Tertiary care is very specialized, and includes trauma units and neonatal intensive care units. C) Prenatal care is primary care. Community care is often provided at clinics in neighborhoods to facilitate clients’ access to primary care, including prenatal careand prevention of illness. D) Community care decreases costs while improving client outcomes, and is not unnecessarily expensive. Page Ref: 3 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum andNewborn Care Standards: QSEN Competencies: Ⅰ.A.1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: Ⅵ. 1. Compare/contrast the roles and perspectives of the nursing profession with other careprofessionals on the healthcare team (i.e. scope of discipline, education, and licensurerequirements). | NLN Competencies: Context and Environment: Environmental health;health promotion/disease prevention (e.g. transmission of disease, disease patterns, epidemiological principles); chronic disease management; health care systems; transcultural approaches to health; family dynamics. | Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 3 Describe the use of community-based nursing care in meetingthe needs of childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

11) The nurse at an elementary school is performing TB screenings on all of the students. Permission slips were returned for all but the children of one family. Whenthe nurse phones to obtain permission, the parent states in clearly understandable English that permission cannot be given because the grandmother is out of town for2 more weeks. Which cultural element is contributing to the dilemma that faces the nurse? A) Permissible physical contact with strangers B) Beliefs about the concepts of health and illness C) Religion and social beliefs D) Presence and influence of the extended family Answer: D Explanation: A) The situation the nurse faces is not being caused by permissible contact with strangers. B) The situation the nurse faces is not caused by beliefs about the concepts ofhealth and illness. C) The situation the nurse faces is not caused by religion and social beliefs. D) The presence and influence of the extended family is contributing to the situationthe nurse faces. In many cultures, a family elder is the primary decision maker when it comes to health care. In this case, the parent cannot grant permission tothe nurse until the parent consults the grandmother. Page Ref: 4 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Screening Standards: QSEN Competencies: Ⅰ.A.2. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. | AACN Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence- based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Analyze ethical challenges presented by ambiguous and uncertain clinical situations; self-assess one’s own tolerance for ambiguity and uncertainty; acceptthe possibility of multiple "right" answers (rather than one right answer thinking) in patient care and other professional situations. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 4 Identify specific factors that contribute to a family’s value system. MNL LO: Recognize contemporary issues related to care of the childbearing family.

12) A maternity client is in need of surgery. Which healthcare member is legally responsible for obtaining informed consent for an invasive procedure? A) The nurse B) The physician C) The unit secretary D) The social worker Answer: B Explanation: A) It is not the nurse’s legal responsibility to obtain informed consent. B) Informed consent is a legal concept designed to allow clients to make intelligent decisions regarding their own health care. Informed consent means that a client,or a legally designated decision maker, has granted permission for a specific treatment or procedure based on full information about that specific treatment orprocedure as it relates to that client under the specific circumstances of the permission. The individual who is ultimately responsible for the treatment or procedure should provide the information necessary to obtain informed consent.In most instances, this is a physician. C) Unit secretaries are not responsible for obtaining informed consent. D) It is not within a social worker’s scope of practice to obtain informed consent. Page Ref: 7—8 Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.12. Facilitate informed patient consent for care. | AACN Essentials Competencies: Ⅷ. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Codeof ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

13) A nurse who tells family members the sex of a newborn baby without first consultingthe parents would have committed which of the following? A) A breach of privacy B) Negligence C) Malpractice D) A breach of ethics Answer: A Explanation: A) A breach of privacy would have been committed in this situation, because informing other family members of the child’s sex without the parents’ consent violates the parents’ right to privacy. The right to privacy is the right of a person tokeep his person and property free from public scrutiny (or even from other family members). B) Negligence is a punishable legal offense, and is more serious. C) Malpractice is a punishable legal offense, and is more serious. D) No breach of ethics has been committed in this situation. Page Ref: 8 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Ethical Practice Standards: QSEN Competencies: Ⅰ.B.13. Assess own level of communication skill in encounters with patient and families. | AACN Essentials Competencies: Ⅳ. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients’ right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes;scope of practice considerations; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

14) The nursing instructor explains to the class that according to the 1973 SupremeCourt decision in Roe v. Wade, abortion is legal if induced: A) Before the 30th week of pregnancy. B) Before the period of viability. C) To provide tissue for therapeutic research. D) Can be done any time if mother, doctor, and hospital all agree. Answer: B Explanation: A) This statement is not true, because the fetus is viable many weeks before the30th week. B) Abortion can be performed legally until the period of viability. C) Abortion cannot be used for the sole purpose of providing tissue for therapeutic research. D) This is not true. Legal abortion can be done only up until the time of viability. Page Ref: 9 Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment: Ethical Practice Standards: QSEN Competencies: Ⅰ.B.3. Provide patient-centered care with sensitivityand respect for the diversity of human experience. | AACN Essentials Competencies: Ⅳ . 8. Uphold ethical standards related to data security, regulatory requirements,confidentiality and client’s right to privacy. | NLN Competencies: Context and Environment: Code of ethics (e.g. American Nurses Association 2005; International Council of Nurses, 2006); regulatory and professional standards (ANA Social Policy Statement [ANA, 2003]; HIPAA [Health Insurance Portability and Accountability Act]); ethical decision making modes; scope of practice considerations; principles of informedconsent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

15) The nurse reviewing charts for quality improvement notes that a client experienced a complication during labor. The nurse is uncertain whether the labor nurse took the appropriate action during the situation. What is the best way for the nurse to determine what the appropriate action should have been? A) Call the nurse manager of the labor and delivery unit and ask what the nurseshould have done. B) Ask the departmental chair of the obstetrical physicians what the best nursingaction would have been. C) Examine other charts to find cases of the same complication, and determine howit was handled in those situations. D) Look in the policy and procedure book, and examine the practice guidelines published by a professional nursing organization. Answer: D Explanation: A) The nurse should find the standards, and not rely on another person to determine appropriateness of care. B) Physician care and nursing care are very different; physicians might not be up todate on nursing standards of care or nursing policies and procedures. C) What nursing action was undertaken in a different situation might not be basedon the policies and procedures or other standards of care. The quality improvement nurse will obtain the most accurate information by examining thepolicies, procedures, and standards of care. D) Agency policies, procedures, and protocols contain guidelines for nursing actionin specific situations. Professional organizations such as the Association of Women’s Health, Obstetrical, and Neonatal Nurses (AWHONN) also publish standards of practice that should guide nursing care. Page Ref: 7 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅳ.A.4. Explain the importance of variation and measurement in assessing quality of care. | AACN Essentials Competencies: Ⅴ. 1. Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments; including local, state, national, and global healthcare trends. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strengthof evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

16) The nurse is reviewing care of clients on a mother-baby unit. Which situation shouldbe reported to the supervisor? A) A 2-day-old infant has breastfed every 2-3 hours and voided four times. B) An infant was placed in the wrong crib after examination by the physician. C) The client who delivered by cesarean birth yesterday received oral narcotics. D) A primiparous client who delivered today is requesting discharge within 24 hours. Answer: B Explanation: A) Breastfeeding every 2 hours and voiding four times is within normal limits for a 2-dayold infant. There is no negligence in this situation. B) Placing an infant in the wrong crib is malpractice. Malpractice is negligent actionby a professional person. C) Receiving oral narcotics at this point in the client’s stay is within normal limits.There is no negligence in this situation. D) If the client is feeling well and able to care for her infant, it is normal to be discharged at this time. The mother and baby both must be within normal limits tobe discharged. Page Ref: 7 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: Ⅴ.B.1. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: Ⅷ. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Quality and Safety: Communicate effectively with different individuals(team members, other care providers, patients, families, etc.) so as to minimize risksassociated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Evaluation. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

17) The nurse manager is planning a presentation on ethical issues in caring for childbearing families. Which example should the nurse manager include to illustratematernal-fetal conflict? A) A client chooses an abortion after her fetus is diagnosed with a genetic anomaly. B) A 39-year-old nulliparous client undergoes therapeutic insemination. C) A family of a child with leukemia requests cord-blood banking at a sibling’s birth. D) A cesarean delivery of a breech fetus is court ordered after the client refuses. Answer: D Explanation: A) Abortion is a different type of ethical situation. B) Achieving pregnancy through the use of therapeutic insemination is a form of reproductive assistance, and is not considered a maternal-fetal conflict. C) Cord-blood banking is a different type of ethical situation. D) Maternal-fetal conflict is a special ethical situation where the rights of the fetus and the rights of the mother are considered separately. Forced cesarean birth, coercion of mothers who practice high-risk behaviors, and, perhaps most controversial, mandating experimental in utero therapy or surgery in an attemptto correct a specific birth defect are interventions that infringe on the mother’s autonomy. Page Ref: 9 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.9. Assess level of patient’s decisional conflict andprovide access to resources. | AACN Essentials Competencies: Ⅷ. 1. Demonstrate the professional standards of moral, ethical, and legal conduct. | NLN Competencies: Context and Environment: Show respect for others’ values; appreciate diversity; be civilduring relationships and work; value community empowerment and social justice; work to improve social conditions affecting health; adopt inclusive language. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

18) Client safety goals, which are evaluated and updated regularly, are requirements forwhat? A) Clinical practice guidelines B) Scope of practice C) Accreditation D) Standards of care Answer: C Explanation: A) Clinical practice guidelines are adopted within a healthcare setting to reduce variation in care management, to limit costs of care, and to evaluate the effectiveness of care. B) State nurse practice acts protect the public by broadly defining the legal scope ofpractice within which every nurse must function and by excluding untrained or unlicensed individuals from practicing nursing. C) The Joint Commission has identified client safety as an important responsibility of healthcare providers. D) Standards of care establish minimum criteria for competent, proficient delivery of nursing care. Page Ref: 7 Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅴ.A.7. Discuss potential and actual impact of national patient safety resources, initiatives, and regulations. | AACN Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high quality patientoutcomes. | NLN Competencies: Quality and Safety: Value and encourage nurses’ involvement in the design, selection, implementation, and evaluation of informationtechnologies to support patient care (e.g. as recommended by QSEN ). | Nursing/Integrated Concepts: Nursing Process: Assessment. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

19) A fetus has been diagnosed with myelomeningocele. Which of the following surgeries would be performed to correct this condition? A) Tubal ligation B) Intrauterine fetal surgery C) Cesarean section D) Sterilization Answer: B Explanation: A) Tubal ligation is not an intrauterine fetal surgery. B) Intrauterine fetal surgery, which is generally considered experimental, is a therapy for anatomic lesions that can be corrected surgically and are incompatible with life if not treated. Examples include surgery for myelomeningocele and some congenital cardiac defects. C) A cesarean birth is not considered an intrauterine fetal surgery. D) Sterilization surgery does not involve the fetus. Page Ref: 9 Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: Ⅱ.B.8. Integrate the contributions of others who playa role in helping the patient/family achieve health goals. | AACN Essentials Competencies: Ⅵ. 1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline,education, and licensure requirements). | NLN Competencies: Teamwork: Function competently within one’s own scope of practice as leader or member of the health care team and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

20) A nurse is providing guidance to a group of parents of children in the infant-to- preschool age group. After reviewing statistics on the most common cause of deathin this age group, the nurse includes information about prevention of which of the following? A) Cancer by reducing the use of pesticides in the home B) Accidental injury by reducing the risk of pool and traffic accidents C) Heart disease by incorporating heart-healthy foods into the child’s diet D) Pneumonia by providing a diet high in vitamin C from fruits and vegetables Answer: B Explanation: A) Cancer due to pesticide use is not a large cause of death in this age group. B) Unintentional injuries cause death in infants more often than cancer, heartdisease, and pneumonia. C) Heart disease is not a large cause of death in this age group. D) Pneumonia does not cause a large number of deaths. Page Ref: 13 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: Ⅴ.A.1. Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work- arounds and dangerous abbreviations) | AACN Essentials Competencies: Ⅱ. 7. Promote factors that create a culture of safety and caring. | NLN Competencies: Qualityand Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 7 Contrast descriptive and inferential statistics. MNL LO: Recognize contemporary issues related to care of the childbearing family.

21) The nurse is preparing a report on the number of births by three service providers at the facility (certified nurse-midwives, family practitioners, and obstetricians). What is this an example of? A) Inferential statistics B) Descriptive statistics C) Evidence-based practice D) Secondary use of data Answer: B Explanation: A) Inferential statistics allow the investigator to draw conclusions from data to either support or refute causation. B) Descriptive statistics concisely describe phenomena such as births by providers. C) Evidence-based practice is the use of research conclusions to improve nursingcare. D) Secondary use of data is analyzing data in a different way than was originally undertaken, or looking at different variables from a data set. Page Ref: 11 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅲ.A.2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: Ⅲ. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strengthof evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Planning. Learning Outcome: 7 Contrast descriptive and inferential statistics. MNL LO: Recognize contemporary issues related to care of the childbearing family.

22) The nurse is explaining the difference between descriptive statistics and inferential statistics to a group of student nurses. To illustrate descriptive statistics, what wouldthe nurse use as an example? A) A positive correlation between breastfeeding and infant weight gain B) The infant mortality rate in the state of Oklahoma C) A causal relationship between the number of sexual partners and sexually transmitted infections D) The total number of spontaneous abortions in drug-abusing women as comparedwith non-drug-abusing women Answer: B Explanation: A) A positive correlation between two or more variables is an inferential statistic. B) The infant mortality rate in the state of Oklahoma is a descriptive statistic, because it describes or summarizes a set of data. C) A causal relationship between the number of sexual partners and sexually transmitted infections is an inferential statistic. D) The total number of spontaneous abortions in drug-abusing women is an inferential statistic. Page Ref: 11 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/DiseasePrevention Standards: QSEN Competencies: Ⅲ.A.2. Describe EBP to include the components of research evidence, clinical expertise, and patient/family values. | AACN Essentials Competencies: Ⅲ. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strengthof evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation. Learning Outcome: 7 Contrast descriptive and inferential statistics. MNL LO: Recognize contemporary issues related to care of the childbearing family.

23) The nurse manager is examining the descriptive statistics of increasing teen pregnancy rates in the community. Which inferential statistical research question would the nurse manager find most useful in investigating the reasons for increasedfrequency of teen pregnancy? A) What providers do pregnant teens see for prenatal care? B) What are the ages of the parents of pregnant teens in the community? C) Do pregnant teens drink caffeinated beverages? D) What do pregnant teens do for recreation? Answer: A Explanation: A) Understanding which providers pregnant teens are most likely to seek out for prenatal care can lead to further investigation on why prenatal care with that provider is more acceptable to teens, which in turn can lead to greater understanding of the issue of teen pregnancy. B) A question about the age of parents of pregnant teens might prove useful inseeking causes of teen pregnancy, but it is not the most useful question in understanding the increased frequency of teen pregnancy. C) Whether pregnant teens drink caffeinated beverages gives no further insight intothe issues of teen pregnancy. D) Understanding the recreational activities of pregnant teens would not lead to an understanding of the issues surrounding increasing teen pregnancy rates. Page Ref: 11 Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance: Health Promotion/DiseasePrevention Standards: QSEN Competencies: Ⅲ.A.2. Describe EBP to include the components of research evidence, clinical expertise, and patient/family values. | AACN Essentials Competencies: Ⅲ. 2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strengthof evidence for application of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Diagnosis. Learning Outcome: 7 Contrast descriptive and inferential statistics. MNL LO: Recognize contemporary issues related to care of the childbearing family.

24) The Quality and Safety Education for Nurses (QSEN) project focused on competencies in which areas? Note: Credit will be given only if all correct choices and no incorrect choices areselected. Select all that apply. A) Client-centered care B) Teamwork and collaboration C) Evidence-based practice D) Family planning E) Injury and violence prevention Answer: A, B, C Explanation: A) The Quality and Safety Education for Nurses (QSEN ) project is designed "to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work," which includes client-centered care. B) The Quality and Safety Education for Nurses (QSEN ) project, is designed "tomeet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality andsafety of the healthcare systems within which they work," which includes teamwork and collaboration. C) The Quality and Safety Education for Nurses (QSEN ) project, is designed "tomeet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality andsafety of the healthcare systems within which they work," which includes evidence-based practice. D) Healthy People 2020 focuses on family planning. E) Healthy People 2020 focuses on injury and violence prevention. Page Ref: 7 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: V.B.8. Use national patient safety resources for ownprofessional development and to focus attention on safety in care settings. | AACN Essentials Competencies: Ⅷ. 12. Act to prevent unsafe, illegal, or unethical care practices. | NLN Competencies: Quality and Safety: Value and encourage nurses’ involvement in the design, selection, implementation, and evaluation of information

technologies to support patient care (e.g., as recommended by QSEN ). |Nursing/Integrated Concepts: Nursing Process: Implementation. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

25) The nurse is serving on a panel to evaluate the hospital staff’s reliance on evidence- based practice in their decision-making processes. Which practices characterize the basic competencies related to evidence-based practice? Note: Credit will be given only if all correct choices and no incorrect choices areselected. Select all that apply. A) Recognizing which clinical practices are supported by good evidence B) Recognizing and including clinical practice supported by intuitive evidence C) Using data in clinical work to evaluate outcomes of care D) Including quality-improvement measures in clinical practice E) Appraising and integrating scientific bases into practice Answer: A, C, E Explanation: A) Recognizing which clinical practices are supported by sound evidence is a basic competency related to evidence-based practice. B) Including clinical practice supported by intuitive evidence is not a basic competency related to evidence-based practice. C) Using data in clinical work to evaluate outcomes of care is one of the basic competencies related to evidence-based practice. D) Including quality-improvement measures is a form of evidence that can be usefulin making clinical practice decisions, but it is not a basic competency related to evidencebased practice. E) Appraising and integrating scientific bases into practice is one of the characteristics of the basic competencies related to evidence-based practice. Page Ref: 7 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅲ.A.2. Describe EBP to include the components of research evidence, clinical expertise and patient/family values. | AACN Essentials Competencies: Ⅱ. 5. Participate in quality and patient safety initiatives, recognizing thatthese are complex system issues, which involve individuals, families, groups, communities, populations and other members of the healthcare team. | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices. | Nursing/Integrated Concepts: Nursing Process:Assessment. Learning Outcome: 8 Identify the impact of evidence-based practice in improving thequality of nursing care for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

26) Nursing research is vital to do which of the following? Note: Credit will be given only if all correct choices and no incorrect choices areselected. Select all that apply. A) Expand the science of nursing. B) Foster evidence-based practice. C) Improve client care. D) Visually depict nursing management. E) Plan and organize care. Answer: A, B, C Explanation: A) Research is vital to expanding the science of nursing. B) Research is vital to fostering evidence-based practice. C) Research is vital to improving client care. D) The nursing process is research-based, but is not a part of the clinical pathway. Visually depicting nursing management is part of concept mapping, not nursingresearch. E) Organizing patient care is an aspect of the nursing process. Planning and organizing care is part of nursing care plans, not nursing research. Page Ref: 11 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅲ.A.7. Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. | AACN Essentials Competencies: Ⅲ. 5. Participate in the process of retrieval, appraisal and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes. | NLN Competencies: Knowledge and Science: Retrieve research findings and other sources of information; critique research to judge its value and usefulness; evaluate the strength of evidence forapplication of research findings to clinical practice. | Nursing/Integrated Concepts: Nursing Process: Evaluation. Learning Outcome: 8 Identify the impact of evidence-based practice in improving thequality of nursing care for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

27) A group of nurses are meeting as identified in the image below. Which behavior arethe nurses demonstrating during this meeting?

A) Privacy B) Advocacy C) Collaboration D) Informed consent Answer: C Explanation: C) Collaborative practice is a comprehensive model of health care that uses a multidisciplinary team of health professionals to provide cost-effective, high- quality care. In a successful team, each individual has autonomy but functions within a clearly defined scope of practice. In such a collaborative approach, no single profession "owns the patient." The right to privacy is the right of a person to keep his or her person and property free from public scrutiny. Advocacy is ensuring a patient receives necessary and required support. Informed consent isa legal concept designed to allow patients to make intelligent decisions regardingtheir own health care. Page Ref: 7 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅱ.B.9.9. Communicate with team members, adapting own style of communicating to needs of the team and situation. | AACN Essentials Competencies: Ⅵ.5. 5. Demonstrate appropriate teambuilding and collaborative strategies when working with interprofessional teams. | NLN Competencies: Relationship Centered Care; Practice; Share responsibility responsibly;collaborate and work cooperatively with others. | Nursing/Integrated Concepts: Assessment; Communication and Documentation. Learning Outcome: 3 Describe the use of community-based nursing care in meetingthe needs of childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

28) The nurse is reviewing the Quality and Safety Education for Nurses (QSEN) competencies while preparing an in-service program to address safety in the neonatal intensive care unit. In which order should the nurse present these competencies? 1. Safety 2. Informatics 3. Patient-centered care 4. Quality improvement 5. Evidence-based practice 6. Teamwork and collaboration Answer: 3, 6, 5, 4, 1, 2 Explanation: The Quality and Safety Education for Nurses (QSEN) project is designed "to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work. The project focuses on competencies in six areas: 1. Patient-centered care, 2. Teamwork and collaboration; 3. Evidence-based practice; 4.Quality improvement; 5. Safety; and 6. Informatics. Page Ref: 7 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: Ⅰ.A.1.1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: Ⅱ. 7. Promotefactors that create a culture of safety and caring. | NLN Competencies: Quality and Safety; Ethical Comportment; Commit to a generative safety culture. | Nursing/Integrated Concepts: Implementation; Teaching/Learning. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

29) The nurse is ensuring that a patient has provided informed consent before agreeing to an amniocentesis. In which order should the nurse validate that informed consent was provided by the patient? 1. Information provides risk and benefits 2. Information provided clearly and concisely 3. Information included treatment alternatives 4. Information explaining the right to refuse treatment 5. Information reviews consequences if no treatment provided Answer: 2, 1, 3, 5, 4 Explanation: Several elements must be addressed to ensure that the patient has given informed consent. The information must be clearly and concisely presented in a manner understandable to the patient and must include risks and benefits, the probability of success, and significant treatment alternatives. The patient also needs to be told the consequences of receiving no treatment or procedure. Finally, the patient must be toldof the right to refuse a specific treatment or procedure. Each patient should be told thatrefusing the specified treatment or procedure does not result in the withdrawal of all support or care. Page Ref: 7 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅰ.B.12. Facilitate informed patient consent for care. | AACN Essentials Competencies: Ⅱ. 7. Promote factors that create a culture of safetyand caring. | NLN Competencies: Context and Environment; Knowledge; principles of informed consent, confidentiality, patient self-determination. | Nursing/Integrated Concepts: Evaluation; Nursing Process. Learning Outcome: 5 Delineate significant legal and ethical issues that influence thepractice of nursing for childbearing families. MNL LO: Recognize contemporary issues related to care of the childbearing family.

30) The nurse is preparing a presentation for new labor and delivery nurses. Which cultural group should the nurse identify as having the lowest birth rate for the 20 to24 age range? Table 1-2 Birth Rate by Age and Race of Mother, 2011 American Indianor Alaska Age All Races White Black Native 10-14 0.4 0.3 0.9 0.5 15-19 31.3 29.1 47.3 36.1 15-17 15.4 14.1 24.7 18.2 18-19 54.1 50.8 78.8 61.6 20-24 85.3 83 111.9 86.6 25-29 107.2 110 101.7 75.4 30-34 96.5 100.1 74.1 47.3 35-39 47.2 47.6 38.0 23.1 40-44 10.3 10.1 9.4 5.5 45-49 0.7 0.6 0.7 0.2

Asian or Pacific Islander 0.1 10.2 4.6 18.1 41.9 93.7 114.9 64.1 15.2 1.2

Source: Martin, J.A., Hamilton, B.E., Ventura, S.J., Osterman, M.J.K., & Matthews, T.J.(2013). Births: Final data 2011. National Vital Statistics Reports, 62(1), 1-70. A) Asian B) White C) Black D) American Indian Answer: A Explanation: A) For the 20 to 24 age group, the lowest birth rate is within the Asian or Pacific Islander cultural group. The birth rate for Whites for this age range is the nextlowest. The birth rate for American Indians within this age group is the third highest and the highest birth rate for this age group is within the Black culturalgroup. Page Ref: 11-12 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅰ.A.1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: Ⅴ. 6. Explore the impact of socio-cultural, economic, legal and political factors influencing healthcaredelivery and practice. | NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a person’s development. | Nursing/Integrated Concepts: Implementation; Teaching/Learning. Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care. MNL LO: Recognize contemporary issues related to care of the childbearing family.

31) The manager of a maternal-child care area is preparing information to share withnursing staff regarding the leading causes of infant death in the United States. Inwhich order, from most to least frequent, should the manager provide this information? 1. SIDS 2. Low birth weight 3. Unintentional injuries 4. Maternal complications 5. Congenital malformation Answer: 5, 2, 1, 4, 3 Explanation: The five leading causes of deaths of infants in the United States, from highest to lowestin frequency, are congenital malformations, low birth weight, SIDS, maternal complications, and unintentional injuries. Page Ref: 13 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: Ⅰ.A.1. Integrate understanding of multiple dimensions of patient centered care. | AACN Essentials Competencies: Ⅴ. 6. Explore the impact of socio-cultural, economic, legal and political factors influencing healthcaredelivery and practice. | NLN Competencies: Relationship Centered Care; Knowledge; The role of family, culture, and community in a person’s development. | Nursing/Integrated Concepts: Implementation; Teaching/Learning. Learning Outcome: 6 Evaluate the potential impact of some of the special situations in contemporary maternity care. MNL LO: Recognize contemporary issues related to care of the childbearing family.

Old’s Maternal-Newborn Nursing and Women’s Health, 11e(Davidson/London/Ladewig) Chapter 2 Family, Culture, and Complementary Therapies 1) A couple who came to the United States two years ago with their two children are seeing the nurse in the community clinic. The nurse knows their family is acculturating when the mother makes which statement? 1. “The children are much less well-behaved than they used to be.” 2. “Our diet now includes hamburgers and French fries.” 3. “We celebrate the same holidays that we used to at home.” 4. “When the children leave the house, I worry about them.” Answer: 2. Inclusion of fast food in the diet is an indication of acculturation, because it shows a belief in the nutritional value of these foods and an acceptance of purchasing fast food as equivalent in value to home-cooked meals. 2) Which of the following best describes a nuclear family? 1. A family is composed of an unmarried woman who chooses to conceive or adopt without a life partner. 2. Children live in a household with both biologic parents and no other relatives or persons. 3. A couple shares household and childrearing responsibilities with parents, siblings, or other relatives. 4. The head of the household is widowed, divorced, abandoned, or separated or most often the mother remains unmarried. Answer: 2. In the nuclear family, children live in a household with both biologic parents and no other relatives or persons. 3) What is the term for when children alternate between two homes, spending varying amounts of time with each parent in a situation called co-parenting and usually involving joint custody? 1. Blended or reconstituted nuclear family 2. Extended kin network family 3. Binuclear family 4. Extended family Answer: 3. A binuclear family is a postdivorce family in which the biologic children are members of two nuclear households, with parenting by both the father and the mother. 4) Duvall’s eight stages in the family life cycle of a traditional nuclear family have been used as the foundation for contemporary models that describe the developmental processes and role expectations for different family types. Which of the following is an example of Stage IV of this family life cycle? 1. Families launching young adults (all children leave home) 2. Families with preschool-age children (oldest child is between 2.5 and 6 years of age) 3. Middle-aged parents (empty nest through retirement) 4. Families with schoolchildren (oldest child is between 6 and 13 years of age) Answer 4. Stage IV is families with schoolchildren (oldest child is between 6 and 13 years of age).

5) A 7-year-old client tells the nurse that “Grandpa, Mommy, Daddy, and my brother live at my house.” The nurse identifies this as what type of family? 1. Binuclear 2. Extended 3. Gay or lesbian 4. Traditional Answer: 2. An extended family consists of a couple who share the house with their parents, siblings, or other relatives. 6) A nurse is performing an assessment on a family with a father and mother who both work. What type of family does she record this family as being? 1. A traditional nuclear family 2. A dual-career/dual-earner family 3. An extended family 4. An extended kin family Answer: 2. A dual-career/dual-earner family is characterized by both parents working, by choice or necessity. 7) Why is it important for the nurse to understand the type of family that a client comes from? Select all that apply. 1. Family structure can influence finances. 2. Some families choose to conceive or adopt without a life partner. 3. The nurse can anticipate which problems a client will experience based on the type of family the client has. 4. Understanding if the client’s family is nuclear or blended will help the nurse teach the client the appropriate information. 5. The values of the family will be predictable if the nurse knows what type of family the client is a part of. Answer: 1, 2 1. Single-parent families often face difficulties because the sole parent may lack social and emotional support, need assistance with childrearing issues, and face financial strain. 2. In the single mother by choice family, the mother is typically older, college-educated, and financially stable and has contemplated pregnancy significantly prior to conceiving. 8) The public health nurse is working with a student nurse. The student nurse asks which of the six groups of people they have seen today are considered to be families. How should the nurse respond?Select all that apply. 1. “The married heterosexual couple without children” 2. “The gay couple with two adopted children” 3. “The unmarried heterosexual couple with two biological children” 4. “The lesbian couple not living together that have no children” 5. “The married heterosexual couple with three children, living with grandparents” Answer: 1, 2, 3, 5

1. Families take many forms in today’s society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. A couple without children is still a family. 2. Families take many forms in today’s society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. Gay and lesbian families are those in which two or more people who share a same-sex orientation live together, or in which a gay or lesbian single parent rears a child. 3. Families take many forms in today’s society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. A family may be formed without a legal marriage. 5. Families take many forms in today’s society. The basis for people to be considered a family is a commitment to one another and the sharing of responsibilities, chores, and expenses. Extended family members, including parents or grandparents, will often live with their adult children or grandchildren, creating intergenerational families. 9) In assessing a new family coming to the clinic, the nurse determines they are an extended kin family because the family exhibits what as characteristics of an extended kin network family? Select all that apply. 1. A sharing of a social support network 2. Each family establishes their own sources of goods and services 3. Elderly parents share housing 4. Children are members of two nuclear families 5. A sharing of goods and services Answer: 1, 5 Explanation: 1. Extended kin family networks share a social support network. 5. Extended kin family networks share goods and services. 10) The transcultural nursing theory was developed in 1961 by Dr. Madeleine Leininger. Its foundation is in which of the following? 1. The framework categorizes a family’s progression over time 2. The family life cycle of a traditional nuclear family 3. Anthropology and nursing 4. Holistic health beliefs Answer: 3. Transcultural nursing theory is rooted in the caring that embraces the beliefs and practices of individuals or groups of similar or different cultures. 11) The nurse is preparing a community presentation on family development. Which statement should the nurse include? 1. The youngest child determines the family’s current stage. 2. A family does not experience overlapping of stages. 3. Family development ends when the youngest child leaves home. 4. The stages describe the family’s progression over time. Answer: 4. Family development stages describe the changes and adaptations that a family goes through over time as children are added to the family.

12) In learning about Duvall’s life-cycle stages ascribed to traditional families, the nursing student recognizes that developmental tasks of each stage include which of the following? Select all that apply. 1. Adjusting to new roles as mother and father 2. Working out authority and socialization roles with the school 3. Becoming a single parent with custodial responsibilities 4. Becoming a couple and dating 5. Adjusting to the loss of a spouse Answer: 1, 2, 5 1. Adjusting to new roles as mother and father occurs in Stage II, which describes childbearing families with infants. 2. Working out authority and socialization roles with schools occurs in Stage IV, which describes families with school-age children. 5. Stage VIII includes adjusting to the loss of a spouse. 13) The nurse is planning a community education program on the role of complementary and alternative therapies during pregnancy. Which statement about alternative and complementary therapies should the nurse include? 1. “They bring about cures for illnesses and diseases.” 2. “They are invasive but effective for achieving health.” 3. “They emphasize prevention and wellness.” 4. “They prevent pregnancy complications.” Answer: 3. Complementary and alternative therapies have many benefits during pregnancy. They emphasize prevention and wellness, aiming for holistic health rather than cure or treatment. 14) The nurse is preparing to assess the development of a family new to the clinic. The nurse understands that which of the following is the primary use of a family assessment tool? 1. Obtain a comprehensive medical history of family members. 2. Determine to which clinic the client should be referred. 3. Predict how a family will likely change with the addition of children. 4. Understand the physical, emotional, and spiritual needs of members. Answer: 4. Understanding the physical, emotional, and spiritual needs of members is the main reason for using a family assessment tool. 15) The nurse in the community should use a family assessment tool to obtain what type of information? 1. How long the family has lived at its current address 2. What other health insurance the family has had in the past 3. How the family meets its nutritional needs and obtains food 4. What eye color the family desires in its unborn child Answer: 3. A family assessment is a collection of data about the family’s type and structure, current level of functioning, support system, sociocultural background, environment, and needs.

16) In assessing a family, the community nurse uses a family assessment tool, which provides an organized framework to collect data concerning which of the following?Select all that apply. 1. Access to laundry and grocery facilities 2. Access to health care 3. Sharing of religious beliefs and values 4. Acculturation to traditional lifestyles 5. Ability to include a new spouse into the family unit Answer: 1, 2, 3 1. Access to laundry, grocery, and recreational facilities is a means of meeting the physical, emotional, and spiritual needs of members, which is part of the family assessment tool. 2. Access to health care is a means of meeting the physical, emotional, and spiritual needs of members, which is part of the family assessment tool. 3. Sharing of religious beliefs and values is a means of meeting the physical, emotional, and spiritual needs of members, which is part of the family assessment tool. 17) The nurse is assessing a client who reports seeing an acupuncturist on a weekly basis to treat back pain. The nurse understands that acupuncture is an example of what? 1. A risky practice without evidence of efficacy 2. A folk remedy 3. A complementary therapy 4. An alternative therapy Answer: 3 Explanation: 3. Acupuncture is a therapy that is used in conjunction with conventional medical treatment, and therefore is an example of a complementary therapy. 18) In caring for pregnant clients, the nurse realizes that information on conventional, complementary, and alternative medicine is best obtained by which of the following means? 1. Obtained at the medical office if the physician feels it is appropriate 2. Obtained from family and friends who have already experienced a situation 3. Readily obtainable on the Internet 4. Passed on by word of mouth Answer: 3. The dramatic increase in complementary and alternative therapies that began in the final decade of the 20th century is partially due to the advent of the Internet. 19) In working with immigrants in an inner-city setting, the nurse recognizes that acculturation of immigrants often brings with it which of the following benefits?Select all that apply. 1. Improved socioeconomic status 2. Use of preventive care services 3. Better nutrition 4. Increase in substance abuse over time 5. More physician visits due to language barriers Answer: 1, 2, 3 1. Improvement of socioeconomic status is a benefit of acculturation in the United States.

2. Acculturation of immigrants increases the likelihood that the family members will use preventive health services. 3. Improved socioeconomic status leads to better nutrition and access to health care. 20) The nurse is caring for a postpartal client of Hmong descent who immigrated to the United States 5 years ago. The client asks for the regular hospital menu because American food tastes best. The nurse assesses this response to be related to which of the following cultural concepts? 1. Acculturation 2. Ethnocentrism 3. Enculturation 4. Stereotyping Answer: 1. Acculturation (assimilation) is the correct assessment because the client adapted to a new cultural norm in terms of food choices. 21) The nurse is teaching a community education class on complementary and alternative therapies. To assess learning, the nurse asks, “In traditional Chinese medicine, what is the invisible flow of energy in the body that maintains health and ensures physiologic functioning?” Which answer indicates that teaching was successful? 1. Meridians 2. Chi 3. Yin 4. Yang Answer: 2. Chi is the energy that flows through the body along meridians, or pathways, to maintain health. 22) The nurse is admitting a client in labor who states that she is a naturopath. The nurse understands that this client believes which of the following? 1. An initial worsening of symptoms after treatment means the correct remedy has been used. 2. There are five elements that take form in the body. 3. Her pregnancy is a kapha condition. 4. Naturopathy is a form of medicine that utilizes the healing forces of nature. Answer: 4. This is the correct answer. Naturopathy is more precisely defined as a healing system that combines safe and effective traditional means of preventing and treating human disease with the most current advances in modern medicine. 23) The nurse is counseling a pregnant woman who intends to see a naturopathic physician. The nurse tells the woman that she can expect education on which of the following? Select all that apply. 1. Clinical nutrition 2. Botanical medicine 3. Lifestyle modification 4. Use of “like to cure like” 5. The role of yin and yang Answer: 1, 2, 3

1. Naturopathic physicians teach their clients about clinical nutrition. 2. The use of botanical medicine is a part of naturopathy. 3. Lifestyle modification is a part of naturopathy. 24) During the assessment phase of a family, the community nurse recognizes that culture influences childrearing and childbearing in which of the following ways?Select all that apply. 1. Beliefs about the importance of children 2. Beliefs and attitudes about pregnancy 3. Norms regarding infant feeding 4. Acculturation is important in rearing children 5. Time orientation to the future is very important Answer: 1, 2, 3 1. Culture influences beliefs about the importance of children. 2. Culture influences attitudes about pregnancy and the right vs. the obligation of women to bear children. 3. Culture influences infant feeding norms and practices. 25) The nurse is teaching a class to the community on mind-based therapies. A class participant gives an example of a friend with leukemia who was taught by her complementary therapist to concentrate on making antibodies that will fight and kill the cancer cells in the bloodstream. How would the nurse identify this technique? 1. Guided imagery 2. Qigong 3. Biofeedback 4. Homeopathy Answer: 1. Guided imagery is a state of intense, focused concentration used to create compelling mental images and is useful in imagining a desired effect. 26) The nurse in a rural clinic is talking with some clients about biofeedback. The nurse explains to the clients that biofeedback is which of the following? 1. An alternative therapy 2. A state of great mental and physical relaxation in which one is susceptible to suggestion 3. A method used to help individuals learn to control their physiologic responses based on the concept that the mind controls the body 4. A complementary therapy in which one goes into a relaxed state and focuses on positive scenes Answer: 3. Biofeedback is a method to learn control of physiological responses based on the concept that the mind controls the body. 27) The nurse is admitting a Mexican woman scheduled for a cholecystectomy. The nurse uses a cultural assessment tool during the admission. Which question would be most important for the nurse to ask? 1. “What other treatments have you used for your abdominal pain?” 2. “In what country were you were born?”

3. “When you talk to family members, how close do you stand?” 4. “How would you describe your role within your family?” Answer: 1. Knowing what other treatments the client has used for pain is most important because some traditional or folk remedies include the use of herbs, which can have medication interactions. 28) The nurse works in a facility that cares for clients from a broad range of racial, ethnic, cultural, and religious backgrounds. Which statement should the nurse include in a presentation to recently hired nurses on the client population of the facility? 1. “Our clients come from a broad range of backgrounds, but we have a good interpreter service.” 2. “Many of our clients come from backgrounds different from your own, but it doesn’t cause problems for the nurses.” 3. “Because most of the doctors are bilingual, we don’t have to deal with the differences in cultural backgrounds of our clients.” 4. “Understanding the common values and health practices of our diverse clients will facilitate better care and health outcomes.” Answer: 4. Because of the implications for care based on cultural background, it is important for nurses to understand the backgrounds of the client population that accesses the facility. Without cultural awareness, caregivers tend to project their own cultural responses onto foreign-born clients; clients from different socioeconomic, religious, or educational groups; or clients from different regions of the country. 29) The nurse manager in a hospital with a large immigrant population is planning an in-service. Aware of how ethnocentrism affects nursing care, the nurse manager asks, “The belief that one’s own values and beliefs are the only or the best values has which of the following results?” 1. It implies newcomers to the United States should adopt the norms and values of the country. 2. It can create barriers to communication through misunderstanding. 3. It leads to an expectation that all clients will exhibit pain the same way. 4. It improves the quality of care provided to culturally diverse client bases. Answer: 2. When the nurse assumes that a client has the same values and beliefs as the nurse, misunderstanding will frequently occur, which in turn can negatively impact nurse-client communication. Ethnocentrism is the conviction that the values and beliefs of one’s own cultural group are the best or only acceptable ones. 30) The client reports using an alternative therapy that involves the manipulation of soft tissues. This therapy has reduced the client’s stress, diminished pain, and increased circulation. Which therapy has this client most likely received? 1. Guided imagery 2. Homeopathy 3. Massage therapy 4. Reflexolog yAnswer: 3 Explanation: 3. Massage therapy involves the manipulation of soft tissues.

31) The client in the first trimester of pregnancy tells the nurse she regularly sees a massage therapist to help with pain in her shoulders and neck. The nurse tells her that massage has which of the following added advantages?Select all that apply. 1. Increasing circulation 2. Reducing anxiety 3. Promoting a sense of well-being 4. Eliminating energy blockages 5. Allowing coordination of breathing and moving Answer: 1, 2, 3 1. Massage therapy has been shown to increase circulation. 2. Massage therapy has been shown to reduce anxiety. 3. Massage therapy has been shown to promote a sense of well-being. 32) A nurse is working in a clinic where clients from several cultures are seen. As a first step toward the goal of personal cultural competence, the nurse will do which of the following? 1. Enhance cultural skills. 2. Gain cultural awareness. 3. Seek cultural encounters. 4. Acquire cultural knowledge. Answer: 2. One begins to gain cultural competence by gaining cultural awareness or by gaining an effective and cognitive self-awareness of personal worldview biases, beliefs, etc. 33) When teaching a culturally diverse group of childbearing families about hospital birthing options, the culturally competent nurse does which of the following? 1. Understands that the families have the same values as the nurse 2. Teaches the families how childbearing takes place in the United States 3. Insists that the clients answer questions instead of their husbands 4. Incorporates the specific beliefs of the cultural groups that are attending the class Answer: 4. Providing culturally competent care involves recognizing the importance of the childbearing family’s value system, acknowledging that differences occur among people, and respecting and responding to ethnic diversity in a way that leads to mutually desirable outcomes. 34) Which questions are appropriate for the nurse to ask during a cultural assessment of a client who is new to the clinic? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. What genetic and other biological differences affect caregiving? 2. Which family member must be consulted for decisions about care? 3. What type of health provider is the most appropriate? 4. Does the client have beliefs or traditions that might impact the care plan? 5. Are communications patterns established? Answer: 2, 3, 4

2. It is important the nurse recognize cultural differences in regard to which family member must be consulted for decisions about care. 3. Some cultures do not allow a person of the opposite gender to touch the client. Cultural sensitivity will recognize and allow for this. 4. The nurse must be aware of traditions and beliefs that might impact the care plan. 35) The nurse is working with a client whose religious beliefs differ from those of the general population. What is the best nursing intervention to use to meet the specific spiritual needs of this family? 1. Ask how important the client’s religious and spiritual beliefs are when making decisions about health care. 2. Show respect while allowing time and privacy for religious rituals. 3. Ask for the client’s opinion on what caused the illness. 4. Identify healthcare practices forbidden by religious or spiritual beliefs. Answer: 2. Providing spiritually sensitive care involves determining the current spiritual and religious beliefs and practices that will affect the mother and baby, accommodating these practices where possible, and examining one’s own spiritual or religious beliefs to be more aware and able to provide nonjudgmental care. 36) The labor and delivery nurse is caring for a laboring client who has asked for a priest to visit her during labor. The client’s mother died during childbirth, and although there are no complications during her pregnancy, the client is fearful of her own death during labor. What is the best response by the nurse? 1. “Nothing is going to happen to you. We’ll take very good care of you during your birth.” 2. “Would you like to have an epidural so that you won’t feel the pain of the contractions?” 3. “The priest won’t be able to prevent complications, and might get in the way of your providers.” 4. “Would you like me to contact your parish or our hospital chaplain to come see you?” Answer: 4. Providing spiritually sensitive care involves determining the current spiritual and religious beliefs and practices that will affect the mother and baby and accommodating these practices where possible. 37) The client reports relief from headaches when she rubs the temples on each side of the head. The nurse understands that this is a form of which of the following? 1. Acupressure 2. Acupuncture 3. Reflexology 4. Hydrotherapy Answer: 1. Acupressure uses pressure from the fingers and thumbs to stimulate pressure points to relieve symptoms.

Old’s Maternal-Newborn Nursing and Women’s Health, 11e(Davidson/London/Ladewig) Chapter 3. Health Promotion 1) The clinic nurse is returning phone calls. Which call should the nurse return first? 1. The call from a 22-year-old reporting that she has menstrual cramps and vomiting every month 2. The call from a 17-year-old asking whether there is a problem with using one tampon for a whole day 3. The call from a 46-year-old mother of a teen wondering if her daughter should be on birth control 4. The call from a 34-year-old requesting information on douching after intercourse Answer: 2 Explanation: 2. Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially life-threatening condition. This client needs education on the danger of using one tampon longer than 3-6 hours. Page Ref: 39 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts Nursing Process: Implementation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation. 2) The nurse who is taking a sexual history from a client should do which of the following? 1. Ask questions that the client can answer with "yes" or "no." 2. Ask mostly open-ended questions. 3. Have the client fill out a comprehensive questionnaire and review it after the client leaves. 4. Try not to make much direct eye contact. Answer: 2 Explanation: 2. Open-ended questions are often useful in eliciting information. Page Ref: 37 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: VII. 3. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. | NLN Competencies: RelationshipCentered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1 Discuss the key points a nurse should consider when taking a sexual history.

3) The nurse is taking a history on a new client in the clinic. She determines from talking with the client that she is recently divorced, is dating, and has had sex with various men. The nurse would be concerned about and would provide some education on what issues? 1. The ethics of dating and having sex with more than one man 2. The client having some kind of permanent birth control done, so she does not become pregnant 3. Education about sexual activity and sexually transmitted infections 4. Referral to a psychologist or counselor for follow-up on the multiple dating Answer: 3 Explanation: 3. Education about sexual activity and sexually transmitted infections is correct, since it has been determined that the client is having sex with multiple partners. Page Ref: 37 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | AACN Essentials Competencies: VII. 6. Use information and communication technologies in preventive care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1 Discuss the key points a nurse should consider when taking a sexual history. MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections. 4) The nurse is taking a history of a new client in the clinic. Histories tend to be lengthy, and the sexual part can be difficult for the client. The nurse should use what technique to make it easier for the client? 1. Let the client fill out a paper copy, so she does not have to talk about intimate matters. 2. Skip the sexual part until the next time the client comes into the clinic. 3. Start with the easier medical and surgical questions, and develop a feeling of trust with the client. 4. Leave the sexual part of the history for the doctor to ask about. Answer: 3 Explanation: 3. Starting with easy-to-answer questions and then going to the sexual ones helps, as client might be at ease by then. Page Ref: 37 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: VII. 3. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1 Discuss the key points a nurse should consider when taking a sexual history.

5) The nurse working in a women's clinic is training a recent graduate of nursing school who has been hired. The experienced nurse explains that nurses caring for women of all ages must be which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Aware of their own feelings 2. Judgmental when discussing sexuality 3. Aware of personal values and attitudes 4. Minimally knowledgeable about reproduction 5. Willing to discuss sexuality only one-on-one Answer: 1, 3 Explanation: 1. Nurses must be aware of their own feelings. 3. Nurses must develop an awareness of their own values and attitudes about sexuality so that they can be more sensitive and objective when they encounter the values and beliefs of others. Page Ref: 37 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: II. B. 5. Assume role of team member or leader based on the situation. | AACN Essentials Competencies: VI. 2. Use inter-and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care. | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the health care team and manage delegation effectively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1 Discuss the key points a nurse should consider when taking a sexual history. 6) A client asks her nurse, "Is it okay for me to take a tub bath during the heavy part of my menstruation?" What is the nurse's correct response? 1. "Tub baths are contraindicated during menstruation." 2. "You should shower and douche daily instead." 3. "Either a bath or a shower is fine at that time." 4. "You should bathe and use a feminine deodorant spray during menstruation." Answer: 3 Explanation: 3. Bathing, whether it is a tub bath or a shower, is as important (if not more so) during menses as at any other time. Page Ref: 39 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 6. Use information and communication technologies in preventive care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation.

7) Which client would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea? 1. 17-year-old, has never had a menstrual cycle 2. 16-year-old, had regular menses for 4 years, but has had no menses in 4 months 3. 19-year-old, regular menses for 5 years that have suddenly become painful 4. 14-year-old, irregular menses for 1 year, experiences cramping every cycle Answer: 4 Explanation: 4. Dysmenorrhea, or painful menstruation, occurs at, or a day before, the onset of menstruation and disappears by the end of menses. Primary dysmenorrhea is defined as cramps without underlying disease. Page Ref: 40 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 4 Contrast dysmenorrhea and premenstrual syndrome. 8) The nurse is conducting health screening at a community clinic. The client has asked whether there are any risks with body piercing and tattooing, or whether these activities would impact sexual activity. How should the nurse respond? 1. "You should avoid piercing your genitalia and your nipples." 2. "There are no problems that occur with either body piercing or tattooing." 3. "Both piercing and tattooing carry risks of infection, including hepatitis." 4. "The benefit of body art outweighs any risk of infection of a tattoo or piercing." Answer: 3 Explanation: 3. For tattooing and body piercing, risks include infections such as HIV and hepatitis B and C because of the use of inadequately sterilized equipment, as well as allergic reactions, local swelling and burns, granulomas, and keloid formation. Page Ref: 44 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | AACN Essentials Competencies: VII. 5. Use evidencebased practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1 Discuss the key points a nurse should consider when taking a sexual history. MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.

9) The nurse is teaching a class on menstruation to young girls. What information would be important for 10-12-year-olds to know? 1. The age they will start having their periods 2. Variations in the age menstruation begins, length of the cycle, and duration of the menses 3. The number of days they will be ill when they have their menses 4. The number of days they will not be able to take part in physical education at school during their menses Answer: 2 Explanation: 2. These are the issues young girls like to know, as they always question whether they are different from their peers. Page Ref: 44 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation. 10) The nurse is interviewing a 16-year-old client who has been using deodorant tampons during her menses. She comes into the gynecology office complaining of a rash and open sores on her labia and tenderness in the vagina. After obtaining her history, what will the nurse determine is the most likely cause of this client's problem? 1. She had forceful intercourse, which caused the trauma. 2. She is reacting to the deodorant in the tampon. 3. She might be allergic to the underwear she is wearing. 4. She is having a normal reaction to her menses. Answer: 2 Explanation: 2. This is the correct answer, as women often will react to the deodorant used on pads and tampons. Page Ref: 38 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation.

11) The nurse educator is teaching a group of teens and 20-year-olds reproductive health care. When several of the women bring up douching, what is the best response the nurse could make? 1. "One should always douche after having intercourse." 2. "When douching, use force putting them in and get the solution up high." 3. "It is a good idea to douche before intercourse so the area is clean for the sperm." 4. "Douching is unnecessary because the lining of the vagina has numerous glands that provide natural cleansing." Answer: 4 Explanation: 4. This is a true statement. The vagina has a natural cleansing system. Page Ref: 39 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation.

12) The nurse is instructing a young client on avoiding toxic shock syndrome. Education was successful when the client makes which statements? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. "I will wash my hands before inserting a tampon." 2. "I will change my tampon every 3-6 hours." 3. "I will not touch the part of the tampon I insert." 4. "I will just put the used tampon in the trash." 5. "I will take prophylactic antibiotics if needed." Answer: 1, 2, 3 Explanation: 1. Washing hands before inserting or removing a tampon is correct. 2. Changing the tampon every 3-6 hours will help prevent toxic shock syndrome from developing. 3. After the tampon is unwrapped, the client should avoid touching the portion of the tampon to be inserted into the vagina. Page Ref: 39 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation.

13) The nurse is interviewing an adolescent client. The client reports a weight loss of 50 pounds over the last 4 months, and reports running at least 5 miles per day. The client asserts that her menarche was 5 years ago. Her menses are usually every 28 days, but her last menstrual period was 4 months ago. The client denies any sexual activity. Which is the best statement for the nurse to make? 1. "Your lack of menses might be related to your rapid weight loss." 2. "It is common and normal for runners to stop having any menses." 3. "Increase your intake of iron-rich foods to reestablish menses." 4. "Adolescents rarely have regular menses, even if they used to be regular." Answer: 1 Explanation: 1. Secondary amenorrhea can be caused by rapid weight loss, including the development of the eating disorders anorexia and bulimia. Runners with low body fat might have irregular menses, but amenorrhea is not a normal condition. Page Ref: 39 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3 Identify causes of amenorrhea. 14) A 19-year-old woman comes to the gynecologist's office. When the nurse asks the reason for this visit, the client explains that she has never had a menstrual period, and that she is concerned there might be something wrong. What is the diagnosis that the physician is most likely to make based on this information? 1. Primary dysmenorrhea 2. Secondary infertility 3. Primary amenorrhea 4. Secondary amenorrhea Answer: 3 Explanation: 3. Primary amenorrhea is the term for the condition when menses have never occurred. Page Ref: 39 Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 3 Identify causes of amenorrhea.

15) The nurse educator is talking with the students in the clinical area about amenorrhea. She has discussed both primary and secondary amenorrhea and their possible causes and knows that her teaching has been successful when, upon being questioned, a student explains that amenorrhea can be caused by which of the following? 1. Malfunctioning of the pancreas and insulin usage 2. Lack of testosterone after the time for menses to start 3. Lack of vitamin D and calcium in the system 4. Dysfunction of the hypothalamus Answer: 4 Explanation: 4. Causes for amenorrhea include dysfunction of the hypothalamus, pituitary, and/or anovulation. Page Ref: 39, 40 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I.B.10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 3 Identify causes of amenorrhea. 16) A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for 2 years. What is the most likely cause for the client's complaint? 1. Primary dysmenorrhea 2. Secondary dysmenorrhea 3. Menorrhagia 4. Hypermenorrhea Answer: 2 Explanation: 2. Secondary dysmenorrhea is associated with pathology of the reproductive tract, and usually appears after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device. Page Ref: 40 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 4 Contrast dysmenorrhea and premenstrual syndrome. MNL LO: 6.1.2 Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

17) The nurse teaches a group of young women that self-care measures for dysmenorrhea include which of the following actions? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Taking vitamins B and E 2. Decreasing salt intake 3. Using cold packs as needed 4. Using intermittent exercise 5. Taking FSH replacement Answer: 1, 2 Explanation: 1. Some nutritionists suggest that vitamins B and E help relieve the discomforts associated with menstruation. 2. Self-care measures such as regular exercise, rest, application of heat, and good nutrition— including reducing salt—will help dysmenorrhea symptoms. Page Ref: 40 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4 Contrast dysmenorrhea and premenstrual syndrome.

18) The nurse at a women's clinic is planning a class on premenstrual dysphoric disorder (PMDD). The nurse includes in the education information about what medications that are shown to be effective for PMDD? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Fluoxetine hydrochloride (Prozac) 2. Sertraline hydrochloride (Zoloft) 3. Paroxeline CR (Paxil CR) 4. Hyoscyamine (Anaspaz) 5. Promethazine (Phenergan) Answer: 1, 2, 3 Explanation: 1. Selective serotonin inhibitors such as fluoxetine hydrocholoride (Prozac) have been found to be effective in controlling PMDD. 2. Setraline hydrochloride (Zoloft) is a selective serotonin inhibitor and has been found to be effective in controlling PMDD. 3. Paroxeline CR (Paxil CR) is a selective serotonin inhibitor and has been found to be effective in controlling PMDD. Page Ref: 41 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2 Summarize information that women may need in order to implement appropriate self-care measures for dealing with menstruation.

19) The nurse is teaching a group of women about menopause at a community clinic. The nurse tells them that the best indicator of menopause is which of the following symptoms? 1. No menses for 8 consecutive months 2. Hot flashes and night sweats 3. FSH levels rise and ovarian follicles cease to produce estrogen 4. Diagnosed with osteoporosis 4 months ago Answer: 3 Explanation: 3. Examining FSH and estrogen levels is a very accurate indication of menopause. Page Ref: 45 Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms. 20) A client who is in perimenopause is having a number of severe symptoms. The nurse assesses this client and knows the doctor will likely prescribe what to assist in relieving the distress? 1. Calcium and vitamin D 2. A form of hormonal contraception 3. Prescriptive pain medication 4. Antibiotics Answer: 2 Explanation: 2. Hormonal contraception is the correct answer, as pregnancy can still be a concern, plus the estrogen will relieve other symptoms, such as hot flashes and vaginal dryness. Page Ref: 45 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients and designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

21) The nurse is teaching a group of menopausal women about the signs and symptoms of menopause and how they can get relief. One of the main concerns of the group is vaginal dryness and difficult intercourse. What is the reason the nurse will give for this? 1. The loss of cervical gland function leads to dryness of the mucous membranes of the vagina. 2. The vaginal pH increases, and the number of Doderlein's bacilli decreases. 3. The uterine lining thins and the muscle layer atrophies. 4. The labia shrink and lose their pigmentation. Answer: 1 Explanation: 1. The loss of cervical gland function leads to dryness of the mucous membranes of the vagina. Page Ref: 45 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships in health and safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms. 22) A client is asking the nurse what she can do about the "falling down of her reproductive organs and urinary tract wall." The nurse will tell the client to try what exercise? 1. Lifting weights to strengthen those muscles 2. Running two miles a day 3. Running up and down stairs a few times every day 4. Performing Kegel exercises and having regular sexual activity Answer: 4 Explanation: 4. This is the correct answer. Kegel exercises are done by tightening and relaxing the perineal muscles, and this activity as well as sexual activity will help the client's problem. Page Ref: 45 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms. 23) The nurse educator is talking with a group of students doing their gynecological rotation. The

nurse describes a number of symptoms that include anovulation, reduced fertility, either decreased or increased menstrual flow, and menstrual cycle irregularities. The nurse is describing what condition? 1. Intermenstrual bleeding 2. Hypermenorrhea 3. Menopause 4. Primary amenorrhea Answer: 3 Explanation: 3. This is the correct answer. Anovulation, reduced fertility, either decreased or increased menstrual flow, and menstrual cycle irregularities are some of the symptoms of menopause. Page Ref: 45 Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

24) When caring for the menopausal woman, nurses need to be empathetic in approaching which of the following areas? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Administering medications 2. Health teaching 3. Providing physical care 4. Counseling 5. Encouraging hormone therapy Answer: 2, 3, 4 Explanation: 2. The nurse needs to use an empathetic approach in counseling, health teaching, and providing physical care. 3. The nurse needs to use an empathetic approach in counseling, health teaching, and providing physical care. 4. The nurse needs to use an empathetic approach in counseling, health teaching, and providing physical care. Page Ref: 50 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

25) The nurse assessing a 47-year-old client who is perimenopausal includes which important topics? Note: credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Vasomotor symptoms 2. A decrease in vaginal lubrication 3. Pregnancy not being an option 4. Mood changes that occur 5. An increase in the libido Answer: 1, 2, 4 Explanation: 1. Women need to know that vasomotor symptoms occur. It might be important to investigate other possible causes of the vasomotor symptoms. 2. Women need to know that a decrease in vaginal lubrication occurs, and that water-soluble lubricants should be used. 4. Mood changes and irritability occur, and the woman might experience more forgetfulness. Page Ref: 44 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients and designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

26) In teaching a group of adolescents, the nurse discusses which risk factors for cardiovascular disease (CVD) in women? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Being over 55 and postmenopausal 2. Using cigarettes and tobacco 3. Being overweight 4. Having a low cholesterol level 5. Having an active lifestyle Answer: 1, 2, 3 Explanation: 1. Being over the age of 55 and postmenopausal increases the risk of CVD. 2. The use of cigarettes and tobacco increases the risk of CVD. 3. Being overweight or obese increases the risk of CVD. Page Ref: 46 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

27) The nurse in the OB-GYN clinic has been seeing a client through her menopausal stage of life. The nurse assesses psychological concerns if the client makes which statement? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. "I feel so lost with all of the kids away from home." 2. "I wish I were younger, and could have a baby." 3. "Although my parents are aging, they travel a lot." 4. "I don't think I am a good wife anymore." 5. "I really enjoy being able to go out when I want." Answer: 1, 2, 4 Explanation: 1. Adjustment to an "empty nest" is a psychological concern during menopause. 2. Some women express disappointment in approaching this time of their lives, whereas others might see it as a positive transition that offers freedom from menses or concern about contraception. 4. Numerous personal factors influence a woman's ability to transition and cope with these changes, such as self-concept. Page Ref: 45 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

28) The nurse is answering the perimenopausal client's questions about hormone replacement therapy. Which client statement indicates a need for further teaching? 1. "Estrogen therapy will decrease my chances of developing osteoporosis." 2. "If I am taking estrogen therapy, I will not have to worry about my cholesterol being checked." 3. "Osteoporosis is a decrease in bone strength due to bone density and quality." 4. "Bone mass tends to decrease after menopause." Answer: 2 Explanation: 2. Cholesterol levels should be checked regularly even when normal, so this statement indicates the need for more teaching. Page Ref: 43 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

29) The charge nurse is giving an in-service to the orthopedic and gynecology nurses concerning the relationship between estrogen and osteoporosis. Which is a statement the nurse would make concerning this relationship? 1. "Males have a higher incidence of osteoporosis than do females." 2. "Women who experience menopause at a younger age and have less bone mass could have more bone loss." 3. "Estrogen levels affect only bone mass, but they have nothing to with bone strength and bone density." 4. "Osteoporosis puts the client at a decreased risk for fractures of the forearm and vertebrae." Answer: 2 Explanation: 2. This is a true statement, as women who experience menopause at a younger age and have less bone mass lose the benefit of estrogen for more years. Page Ref: 39 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6 Explain the relationship between menopause and osteoporosis. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

30) The nurse is interviewing a new client in the clinic. The client is premenopausal, but is concerned about the bone changes and osteoporosis that can occur, since she is getting close to menopause. The nurse tells the client that prevention is the primary goal. Which of the following would be a primary goal for prevention? 1. Eliminating all alcohol intake 2. Taking 500 mg of calcium each day 3. Use of sunscreen to assist with absorption of vitamin D 4. Regular weight-bearing and muscle-strengthening exercises Answer: 4 Explanation: 4. This is correct. Regular weight bearing of the long bones is a primary goal for the prevention of osteoporosis. Page Ref: 48 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6 Explain the relationship between menopause and osteoporosis. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

31) The nurse is teaching a group of clients about risk factors for osteoporosis. The nurse will include which of the following risk factors in the teaching? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Menopause at an early age increases bone loss 2. A family history of osteoporosis 3. A lifetime of high calcium intake 4. Having an active lifestyle 5. A vitamin D deficiency Answer: 1, 2, 5 Explanation: 1. Abnormal absence of menses and early onset of menopause increase the risk of osteoporosis. 2. Family history of osteoporosis, especially a maternal hip fracture, increases the risk of osteoporosis. 5. Vitamin D deficiency increases the risk of osteoporosis. Page Ref: 46 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships in health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6 Explain the relationship between menopause and osteoporosis. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

32) A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during sexual intercourse, and asks, "What should I use as a lubricant?" The nurse should recommend which of the following? 1. Petroleum jelly 2. A water-soluble lubricant 3. Body cream or body lotion 4. Less-frequent intercourse Answer: 2 Explanation: 2. A water-soluble jelly should be used. Page Ref: 50 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

33) A 49-year-old client comes to the clinic with complaints of severe perimenopausal symptoms including hot flashes, night sweats, urinary urgency, and vaginal dryness. The physician has prescribed a combination hormone replacement therapy of estrogen and progestin. When the client asks the nurse why she must take both hormones, what is the nurse's best reply? 1. "Hot flashes respond better when replacement includes both hormones." 2. "You are having very severe symptoms, so you need more hormones replaced." 3. "There is an increased risk of tissue abnormality inside the uterus if only one is given." 4. "Your blood pressure can become elevated if only one hormone is used." Answer: 3 Explanation: 3. Estrogen alone, in a woman with a uterus (unopposed estrogen), increases the risk of endometrial (the lining of the uterus) cancer by eightfold and, therefore, is never given without progesterone in these women. Page Ref: 47 Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4 Contrast dysmenorrhea and premenstrual syndrome. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

34) The nurse assessing a 50-year-old female client at an orthopedic center asks about the use of complementary and alternative therapies. Which of the following are among those women often try during menopause? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Vitamin and mineral supplements 2. Increasing caffeine intake 3. Soy and red clover 4. Selective estrogen receptor modulators 5. Salmon calcitonin Answer: 1, 3 Explanation: 1. Vitamin and mineral supplements, especially calcium and vitamins D, E, and B complex, are used to control the symptoms of menopause. 3. Soy and red clover have shown to be effective for some women in controlling their menopausal symptoms. Page Ref: 49 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7 Identify medical and complementary therapies to alleviate the discomforts of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

35) The nurse is teaching a group of perimenopausal women about treatment choices for their symptoms. The nurse will include which information? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Importance of continuing contraception 2. Benefits of menstrual regulation with hormones 3. Increase in vaginal dryness with hormones 4. Decrease in acne and hirsutism 5. Increase in endometrial cancer risk Answer: 1, 2, 4 Explanation: 1. Thirty-eight percent of pregnancies for women ages 40 and older are unplanned; some form of contraception is needed. 2. Regulation of menses with effective contraception is a benefit to the perimenopausal woman. 4. Women on hormones might experience less acne and hirsutism. Page Ref: 45 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Implementation Learning Outcome: 5 Delineate the physical and psychologic aspects of menopause. MNL LO: 6.1.1 Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

Old’s Maternal-Newborn Nursing and Women’s Health, 11e(Davidson/London/Ladewig) Chapter 4. Family Planning 1. A nurse is teaching contraception to a group of college students during a health

class. What reason will the nurse include as to why couples might choose to use contraception?Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Couples use contraception to avoid pregnancy. 2. Couples use contraception to space future pregnancies. 3. Couples use contraception to gain control over the number of children conceived. 4. Couples use contraception to avoid decisions about the number of children to have. 5. Couples use contraception to avoid contracting sexually transmitted diseases. Answer: 1, 2, 3, 5 Explanation: 1. This is the main reason for the use of contraception. 2. Contraception is used to space children. 3. Contraception is used to control the number of children that a couple desires. 5. Some types of birth control will avoid sexually transmitted diseases—for example, some ofthe barrier methods. Page Ref: 53, 57 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships to promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1 Describe the reasons why women and couples choose to use contraception. MNL LO: 6.1.2 Compare advantages, disadvantages, risk factors, and contraindications ofcontraception methods. 1) The nurse is planning an educational session about contraception. What will the nurse emphasize as being the most significant factor in determining the effectiveness of a specificmethod of contraception to avoid pregnancy? 1. Reliability 2. Ease of use 3. Consistency of use 4. Cost Answer: 3 Explanation: 3. Consistency of use is the most important factor for determining the effectiveness of a specific type of contraception.