Contemporary Maternal Newborn Nursing, 9th ed By Ladewig - Test Bank

Contemporary Maternal Newborn Nursing, 9th ed By Ladewig – Test Bank

 

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Contemporary Maternal-Newborn Nursing, 9e (Ladewig et al.)

Chapter 5   Health Promotion for Women

 

1) The clinic nurse is returning phone calls. Which call should the nurse return first?

1. A 22-year-old client reporting that she has menstrual cramps and vomiting every month
2. A 17-year-old client asking if there is a problem with using one tampon for a whole day
3. A 46-year-old mother of a teen wondering if her daughter should be on birth control
4. A 34-year-old client requesting information on douching after intercourse

Answer:  2

Explanation:  1. Because vomiting can lead to dehydration, this patient will require further assessment. Her symptoms are not life-threatening; this client’s assessment is not the first priority.

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 more than 3 to 6 hours.
3. A sexually active teen could be at risk for unintended pregnancy, as well as sexually transmitted infections. However, it is unclear whether the daughter is sexually active. This call is a low priority.
4. Douching is not recommended, because the practice causes a change in the pH of the vagina and impacts the normal flora, predisposing clients to candidiasis and bacterial vaginosis. This client requires education but is not the first priority.

Page Ref: 64, 65

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 5.1-Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

MNL LO:  Explore the role of the nurse in maternity care delivery.

 

2) When taking a sexual history from a client, the nurse should:

1. Ask questions that the client can answer with a “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:  1. “Yes-or-no” answers indicate closed-ended questions that will not encourage the client to share the necessary information.

2. Open-ended questions are often useful in eliciting information because they encourage more than a one-word answer.
3. Filling out a questionnaire and reviewing it after the client leaves is not appropriate. It should be reviewed in the presence of the client, encouraging conversation regarding the results.
4. It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Eye contact encourages a connection between the involved parties and shows care and concern.

Page Ref: 64

Cognitive Level:  Analyzing

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 5.1-Describe accurate information to be provided to girls and women so that they can implement effective self-care measures for dealing with menstruation.

MNL LO:  Relate sexual maturation and its impact on the reproductive system.

 

3) Which client would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea?

1. A 17-year-old female who has never had a menstrual cycle.
2. A 16-year-old female who had regular menses for 4 years, but has had no menses in four months.
3. A 19-year-old female who had regular menses for 5 years that have suddenly become painful.
4. A 14-year-old female who had irregular menses for one year, experiences cramping every cycle.

Answer:  4

Explanation:  1. This is primary amenorrhea, or the lack of menses.

2. Secondary amenorrhea is the term used when a client has had regular cycles that cease.
3. Secondary dysmenorrhea is the sudden onset of pain and discomfort with menses.
4. Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle and consistently continues to be painful each month.

Page Ref: 67

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Coordination of care

Learning Outcome:  LO 5.2-Contrast the signs, symptoms, and nursing management of women with dysmenorrhea and those with premenstrual syndrome.

MNL LO:  Explore the role of the nurse in maternity care delivery.

4) A client asks her nurse, “Is it okay for me to use a vaginal douche each day when I’m on my period?” The nurse’s correct response is:

1. “Douching should be avoided when you’re on your period.”
2. “Using a douche each day will help prevent vaginal infections from occurring.”
3. “During your period, douching will help promote the flow of menstrual secretions.”
4. “Regular douching is necessary in order to promote good hygiene.”

Answer:  1

Explanation:  1. Women should avoid douching during menstruation because the cervix is dilated to permit the downward flow of menstrual fluids from the uterine lining.

2. Douching washes away the natural mucus and upsets the vaginal flora, which can make the vagina more susceptible to infection.
3. During menstruation, douching may interfere with downward flow of menstrual fluids from the uterine lining.
4. Douching as a hygiene practice is unnecessary because the vagina cleanses itself.

Page Ref: 65, 66

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 5.2-Contrast the signs, symptoms, and nursing management of women with dysmenorrhea and those with premenstrual syndrome.

MNL LO:  Explain the female reproductive cycle.

 

5) What should the gynecology clinic nurse recommend for the client experiencing premenstrual syndrome?

1. “Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding should begin.”
2. “Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin.”
3. “Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of bleeding.”
4. “Increase your consumption of red meat when you feel symptoms, and eat three large meals per day.”

Answer:  2

Explanation:  1. Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and colas should be limited throughout the month.

2. Regular aerobic activity helps to decrease PMS symptoms.
3. An intake of 1200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come from supplements or be obtained through dietary intake of dairy and soy products.
4. Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating several small meals per day rather than three large meals.

Page Ref: 67, 68

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 5.2-Contrast the signs, symptoms, and nursing management of women with dysmenorrhea and those with premenstrual syndrome.

MNL LO:  Explain the female reproductive cycle.

 

6) 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 two years. The most likely cause for the client’s complaint is:

1. Primary dysmenorrhea.
2. Secondary dysmenorrhea.
3. Menorrhagia.
4. Hypermenorrhea.

Answer:  2

Explanation:  1. Primary dysmenorrhea is defined as cramps without underlying disease.

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.
3. Menorrhagia is excessive, profuse flow.
4. Hypermenorrhea is an abnormally long menstrual flow.

Page Ref: 67, 68

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 5.2-Contrast the signs, symptoms, and nursing management of women with dysmenorrhea and those with premenstrual syndrome.

MNL LO:  Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

 

7) Which issues should the nurse consider when counseling a client on contraceptive methods? Select all that apply.

1. Cultural perspectives on menstruation and pregnancy
2. Efficacy of the method
3. Future childbearing plans
4. Whether the patient is a vegetarian
5. Age at menarche

Answer:  1, 2, 3

Explanation:  1. Cultural and religious beliefs, practices, and sanctions must be considered when discussing contraception with clients in order to avoid insulting a client for whom a particular type of contraceptive method is prohibited by her background.

2. Efficacy of contraceptive methods varies and must be considered when discussing contraception with clients. When pregnancy is medically contraindicated, high-efficacy methods (such as an IUD, hormonal methods, or sterilization) should be discussed with the client. When the client would like to avoid pregnancy at this time, but pregnancy is not medically contraindicated, lower-efficacy methods (e.g., diaphragm, cervical cap, or sponge) could be discussed.
3. If a client desires children in the future, sterilization methods would be inappropriate to discuss.
4. Vegetarianism has no impact on contraceptive method use.
5. Age at menarche has no impact on contraceptive method use.

Page Ref: 68—76

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 5.3-Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

MNL LO:  Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

 

8) A client has decided to use a vaginal contraceptive ring as her method of contraception. Which statement suggests the client needs further instruction?

1. “I do not need to be examined in order to determine the contraceptive ring size that is correct for me.”
2. “Every three months, I will need to remove the contraceptive ring and replace it with a new one.”
3. “When I store my replacement rings, I should keep them in my refrigerator.”
4. “The contraceptive ring provides a sustained release of low-dose contraceptive.”

Answer:  2

Explanation:  1. One size of the NuvaRing fits virtually all women.

2. The ring is left in place for 3 weeks and then removed for 1 week to allow for withdrawal bleeding.
3. Replacement rings should be kept in the refrigerator to maintain integrity.
4. The contraceptive ring provides a low-dose, sustained-release hormonal contraceptive.

Page Ref: 75

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 5.3-Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

MNL LO:  Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

 

9) Which client is not a good candidate for Depo-Provera (DMPA)?

1. One who wishes to get pregnant within three months
2. One who wishes to breastfeed
3. One with a vaginal prolapse
4. One who weighs 200 pounds

Answer:  1

Explanation:  1. Return of fertility after the use of Depo-Provera takes an average of nine months.

2. Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera.
3. There is no correlation between a vaginal prolapse and use of Depo-Provera.
4. There is no correlation between ones weight and use of Depo-Provera.

Page Ref: 76

Cognitive Level:  Understanding

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 5.3-Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

MNL LO:  Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

10) The public health nurse receives a phone call from a 16-year-old female who asks, “Do I need to have a Pap smear just because I’m sexually active?” What is the nurse’s correct response?

1. “Yes, all sexually active females should be screened for both cervical cancer and HPV.”
2. “No, you do not need to be screened for cervical cancer until you are 21 years old.”
3. “Yes, all women under the age of 29 should be screened for both cervical cancer and HPV.”
4. “No, but you will need to begin your screenings for both cervical cancer and HPV when you are 18 years old.”

Answer:  2

Explanation:  1. Engaging in sexual activity is not an indication for routine cervical cancer or for HPV screening.

2. The 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating cervical cancer screening at age 21.
3. The 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend cervical cancer screening without HPV co-testing in women ages 21 to 29.
4. The 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating cervical cancer screening at age 21.

Page Ref: 81

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence based practice | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 5.5-Identify basic gynecologic screening procedures indicated for well women.

MNL LO:  Explore the role of the nurse in maternity care delivery.

 

11) A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate the likelihood that she understands how to detect changes such as lumps in her breast? Select all that apply.

1. “I should perform BSE one week prior to the start of my period.”
2. “When I reach menopause, I will perform BSE every two months.”
3. “Knowing the texture and feel of my breasts is important.”
4. “I should inspect my breasts in a circular manner.”
5. “I should inspect my breasts while in a supine position, with my arms at my sides.”

Answer:  3, 4

Explanation:  1. A BSE should be performed one week after the start of each menstrual period because hormonal levels are lowest and allow closer exam of softer breast tissue.

2. A BSE should be performed monthly, on the same day each month, during menopause.
3. A woman who knows the texture and feel of her own breasts is far more likely to detect changes that develop.
4. Checking breasts in a circular manner, feeling all parts of the breast, provides adequate palpation and possible detection of lumps.
5. The breasts should be inspected while standing with arms at sides.

Page Ref: 79

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence based practice | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 5.5-Identify basic gynecologic screening procedures indicated for well women.

MNL LO:  Describe the structures and functions of the female reproductive system.

 

 

12) What is the best indicator that the client is experiencing menopause?

1. No menses for 8 consecutive months
2. Hot flashes and night sweats
3. High serum FSH with low serum estrogen
4. Diagnosed with osteoporosis 4 months ago

Answer:  3

Explanation:  1. Menopause is defined as 12 months of amenorrhea.

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

Page Ref: 81—83

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 5.6-Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

MNL LO:  Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

 

13) A 63-year-old female client requests information about complementary and alternative therapies that promote wellness during menopause. Which therapies should the nurse recommend?

1. Non-weight-bearing exercise, such as swimming.
2. Increased consumption of phytoestrogens (i.e., plant products with estrogen properties) for women with a history of endometriosis or fibroids.
3. Calcium intake of 600 mg per day to help prevent osteoporosis.
4. Soy for reducing insomnia symptoms.

Answer:  4

Explanation:  1. Weight-bearing exercises such as walking, jogging, tennis, and low-impact aerobics are encouraged in order to increase bone mass and decrease the risk of osteoporosis.

2. Women who have endometriosis or fibroids should be cautioned on the use of phytoestrogens
3. Peri- and postmenopausal women are advised to have a calcium intake of at least 1200 mg per day. Most women require supplements to achieve this level.
4. Research suggests that isoflavones, which are found in soy, are effective in reducing symptoms of insomnia in postmenopausal women.

Page Ref: 84

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 5.6-Explain the physical and psychologic aspects and clinical treatment options of menopause when caring for menopausal women.

MNL LO:  Explain hormonal changes that occur in menopause and methods to manage the associated symptoms.

 

14) The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further education?

1. “My daughter is not to blame for the violence in her marriage.”
2. “Everyone experiences anger and hitting in a relationship.”
3. “Abusers can be either husbands or boyfriends or girlfriends.”
4. “The honeymoon period follows an episode of violence.”

Answer:  2

Explanation:  1. The victims of violence are not the cause of the violence. Abusers are responsible for their violent behavior. Avoiding blaming and shaming of victims of domestic violence is important to establish a therapeutic relationship.

2. Violence is not a normal part of intimate relationships. This statement indicates that the client has likely been a victim of domestic violence.
3. Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be experienced in any intimate relationship, regardless of whether the couple is straight, gay, or lesbian, and both within marriage and outside of marriage.
4. An acute episode of battering is followed by the tranquil phase, or honeymoon period, when the abuser is often repentant and promising never to abuse the victim again. In some cases, the honeymoon period is the only time there is a lack of building tension.

Page Ref: 85—87

Cognitive Level:  Analyzing

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 5.9-Examine the nurses role in screening and caring for women who have experienced domestic violence or rape.

MNL LO:  Determine strategies to assist the victim of domestic violence.

 

15) When a woman who has been raped is admitted to the emergency department, which nursing intervention has priority?

1. Explain exactly what will need to be done to preserve legal evidence.
2. Assure the woman that everything will be all right.
3. Create a safe, secure atmosphere for the woman.
4. Contact family members.

Answer:  3

Explanation:  1. Explaining exactly what will need to be done to preserve legal evidence is not the top priority.

2. Assuring the woman that everything will be all right is not the top priority and is giving false promise.
3. The first priority in caring for a survivor of a sexual assault is to create a safe, secure atmosphere that will allow the woman to process what has happened.
4. Contacting family members is not the top priority and can wait until a safe environment is established.

Page Ref: 88, 89

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 5.9-Examine the nurses role in screening and caring for women who have experienced domestic violence or rape.

MNL LO:  Recognize social issues affecting women in todays society.

 

16) The nurse in the obstetrical clinic is setting appointments for clients seeking pre-conceptual care. Which client should be seen first?

1. A 36-year-old female who has never been pregnant. She takes medication for a seizure disorder.
2. A 15-year-old female who smokes one pack per day. She had a miscarriage four months ago.
3. A 22-year-old female who runs long distances. She has been on the pill for six years.
4. A 29-year-old female who has had two abortions. She takes a multiple-vitamin supplement.

Answer:  1

Explanation:  1. This client is the top priority because she has multiple risk factors: She is older than 35 and therefore is at risk for trisomies; some medications are teratogenic and are contraindicated during pregnancy; and pregnancy is not recommended for women with some conditions. This client needs to see the specialist who prescribes her antiseizure medication, as well with an obstetric provider, to discuss the risks her age presents to a possible pregnancy.

2. Although this client has the risks of being young and a smoker, she is not the highest priority.
3. The only risk factor this client has is a need to increase folic acid intake due to being on the pill for six years.
4. This client has no risk factors for pregnancy. A history of more than three abortions increases the risks of preterm labor and infertility, but this client has only had two abortions.

Page Ref: 78, 79

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Health teaching and health promotion

Learning Outcome:  LO 5.4-Summarize major health measures to address in providing pre-conceptual counseling.

MNL LO:  Relate various factors to their effect on pregnancy outcomes.

 

17) While teaching a preconception class, the nurse should include which of the following recommendations concerning intake of vitamins during pregnancy?

1. Take a daily supplement of folic acid daily to reduce the risk of trisomy 21 (Down syndrome).
2. The pregnant woman should consult the recommended dietary allowance (RDA) guidelines regarding vitamins.
3. Take Vitamin C daily to reduce the risk of neural tube defects.
4. The pregnant woman should consume the greatest quantity of vitamins possible.

Answer:  2

Explanation:  1. Folic acid supplementation prior to conception is recommended for decreasing the risk of neural tube defects.

2. Intake of vitamins in greater than the recommended dietary allowance (RDA) can cause severe fetal problems and should be avoided.
3. Folic acid is linked to decreased risk for neural tube defects.
4. Intake of vitamins in greater than the recommended dietary allowance (RDA) can cause severe fetal problems and should be avoided.

Page Ref: 78, 79

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 5.4-Summarize major health measures to address in providing pre-conceptual counseling.

MNL LO:  Relate various factors to their effect on pregnancy outcomes.

 

 

18) A 38-year-old woman with no prior pregnancies calls the clinic to inquire about preconception counseling. Which element of early prenatal education should the nurse expect to facilitate?

1. Availability of prenatal and genetic testing
2. Birth choices
3. Infertility counseling
4. Nutrition classes

Answer:  1

Explanation:  1. Prenatal and genetic testing is incorporated among early prenatal classes, which often include pre-pregnant women. Due to maternal age, this woman is at increased risk for having a child with a chromosomal abnormality.

2. Birth classes are incorporated into later classes; specifically, the second and third trimester.
3. Infertility counseling is not incorporated within preconception counseling.
4. Nutrition classes are incorporated among early prenatal education; however, due the woman’s age, availability of prenatal and genetic testing is a higher priority.

Page Ref: 78, 79

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Health teaching and health promotion

Learning Outcome:  LO 5.4-Summarize major health measures to address in providing pre-conceptual counseling.

MNL LO:  Relate various factors to their effect on pregnancy outcomes.

 

19) A client comes to the clinic for birth control, while reviewing the history the client tells the nurse that she has had Toxic shock syndrome (TSS). Which forms of birth control should the nurse teach the client to avoid? Select all that apply.

1. Depo-Provera
2. Sponge
3. Vaginal condom
4. Ring
5. Intrauterine device (IUD)

Answer:  2, 3

Explanation:  1. TSS is not associated with Depo-Provera.

2. TSS is associated with sponge use.
3. TSS is associated with vaginal condom use.
4. TSS is not associated with ring use.
5. TSS is not associated with the IUD.

Page Ref: 65, 68—76

Cognitive Level:  Application

Client Need&Sub:  Safe and Effective Care Environment | Management of Care

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 5.3-Compare the advantages, disadvantages, and effectiveness of the various methods of contraception available today.

MNL LO:  Compare advantages, disadvantages, risk factors, and contraindications of contraception methods.

 

 

20) A woman who was raped three months ago comes to the family practitioner for a ruddy rash on the palms of her hands and soles of her feet, and flulike symptoms. When taking a history, the nurse discovers history of rape and last month the woman had a small painless lesion that went away. The nurse is to administer 2.4 million units of Penicillin G intramuscularly. The medication is available as 1,200,000 units per milliliter (mL). How many milliliters (mLs) should the nurse administer?

1. 0.50 mLs
2. 0.2 mLs
3. 0.20 mLs
4. 2 mLs

Answer:  4

Explanation:  1. A reddish brown rash on the palms of the hands and soles of the feet, flulike symptoms are seen in Stage II Syphilis; the client must be treated before moving into Stage II Syphilis where irreparable damage to the organs can follow. The order is 2,400,000 units, available is 1,200,000 units/mL, the client will get 2 mLs.

2. A reddish brown rash on the palms of the hands and soles of the feet, flulike symptoms are seen in Stage II Syphilis; the client must be treated before moving into Stage II Syphilis where irreparable damage to the organs can follow. The order is 2,400,000 units, available is 1,200,000 units/mL, the client will get 2 mLs.
3. A reddish brown rash on the palms of the hands and soles of the feet, flulike symptoms are seen in Stage II Syphilis; the client must be treated before moving into Stage II Syphilis where irreparable damage to the organs can follow. The order is 2,400,000 units, available is 1,200,000 units/mL, the client will get 2 mLs.
4. A reddish brown rash on the palms of the hands and soles of the feet, flulike symptoms are seen in Stage II Syphilis; the client must be treated before moving into Stage II Syphilis where irreparable damage to the organs can follow. The order is 2,400,000 units, available is 1,200,000 units/mL, the client will get 2 mLs.

Page Ref: 88, 89

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity | Pharmacological and Parenteral Therapy

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Intervention/Coordination of care

Learning Outcome:  LO 5.9-Examine the nurses role in screening and caring for women who have experienced domestic violence or rape.

MNL LO:  Recognize social issues affecting women in todays society.