Maternity and Pediatric Nursing 1st (first) Edition by Ricci, Susan Scott – Test Bank


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Maternity and Pediatric Nursing 1st (first) Edition by Ricci, Susan Scott – Test Bank

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Ch. 2: Family centered-Community based care


  Difficulty:  Moderate
1. The nurse is caring for a 2-week-old girl with a metabolic disorder. Which of the following activities would deviate from the characteristics of family-centered care?
  A) Softening unpleasant information or prognoses
  B) Evaluating and changing the nursing plan of care
  C) Collaborating with the child and family as equals
  D) Showing respect for the family’s beliefs and wishes
  Ans: A
  Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses. Evaluating and changing the nursing plan of care to fit the needs of the child and family, collaborating with them as equals, and showing respect for their beliefs and wishes are guidelines for family-centered care.



  Difficulty:  Difficult
2. The nurse is providing home care for a 6-year-old girl with multiple medical challenges. Which of the following activities would be considered tertiary level of prevention?
  A) Arranging for a physical therapy session
  B) Teaching the parents to administer albuterol
  C) Reminding the parents to give the full course of antibiotics
  D) Giving DTaP vaccination at proper intervals
  Ans: A
  The tertiary level of prevention involves restorative, rehabilitative, or quality of life care, such as arranging for a physical therapy session. Teaching the parents to administer albuterol and reminding them to give the full course of antibiotics as prescribed are part of the secondary level of prevention, which focuses on diagnosis and treatment of illness. Giving a DTaP vaccination at proper intervals is an example of the primary level of prevention, which centers on health promotion and illness prevention.



  Difficulty:  Moderate
3. The nurse is caring for a 4-year-old boy with Ewing’s sarcoma who is scheduled for a CT scan tomorrow. Which of the following best reflects therapeutic communication?
  A) Telling him he will get a shot when he wakes up tomorrow morning
  B) Telling him how cool he looks in his baseball cap and pajamas
  C) Using family-familiar words and soft words when possible
  D) Describing what it is like to get a CT scan using words he understands
  Ans: D
  Describing what it is like to get a CT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.



  Difficulty:  Moderate
4. The nurse is caring for a 14-year-old boy with cancer. Which of the following communication techniques would be least effective for him?
  A) Letting him choose juice or soda to take his pills
  B) Seeking his input on all decisions
  C) Discussing the benefits of chemotherapy with him
  D) Avoiding undue criticism of noncompliance
  Ans: A
  Letting him choose juice or soda to take his pills is the least effective communication technique for an adolescent. It may provide some sense of control but is not as effective as seeking his input on all care decisions, including him in discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.



  Difficulty:  Moderate
5. The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which of the following teaching techniques would be most appropriate?
  A) Assessing the parents’ knowledge of anticonvulsant medications
  B) Demonstrating proper seizure safety procedures
  C) Discussing the surgical procedures for epilepsy
  D) Giving the parents information in small amounts at a time
  Ans: D
  Parents, when given a life-altering diagnosis, need time to absorb information and to ask questions. Therefore, giving the parents information in small amounts at a time is best. The child has just been diagnosed with epilepsy, and surgical intervention is not used unless seizures persist despite medication therapy. Therefore, discussing surgery would be inappropriate at this time. Assessing the parents’ knowledge of anticonvulsant medications identifies a knowledge gap and need to learn, but it would be unreasonable to think that they would understand the medications because the diagnosis had just been made. Demonstrating proper seizure safety procedures is an effective way to present information to an adult.



  Difficulty:  Difficult
6. The nurse is making a home visit to a client who had a cesarean birth 3 days ago. Assessment reveals that she is complaining of intermittent pain, rating it as 8 on a scale of 1 to 10. She states, “I’m pretty tired. And with this pain, I haven’t been drinking and eating like I should. The medication helps a bit but not much. My mom has been helping with the baby.” Her incision is clean, dry, and intact. Which nursing diagnosis would the nurse identify as the priority for this client?
  A) Impaired skin integrity related to cesarean birth incision
  B) Fatigue related to effects of surgery and caretaking activities
  C) Imbalanced nutrition, less than body requirements, related to poor fluid and food intake
  D) Acute pain related to incision and cesarean birth
  Ans: D
  The client reports a pain rating of 8 out of 10 and states that the medication is helping only a bit. She also mentions that the pain is interfering with her ability to eat and drink. Therefore, the priority nursing diagnosis is acute pain related to incision and cesarean birth. Her incision is clean, dry, and intact, so impaired skin integrity is not the problem. She is fatigued, but her complaints of pain supercede her fatigue. Although her nutritional intake is reduced, it is due to the pain.



  Difficulty:  Moderate
7. When caring for childbearing families from cultures different from one’s own, which of the following must be accomplished first?
  A) Adapt to the practices of the family’s culture
  B) Determine similarities between both cultures
  C) Assess personal feelings about that culture
  D) Learn as much as possible about that culture
  Ans: C
  The first step is to develop cultural awareness, engaging in self-exploration beyond one’s own culture, seeing patients from different cultures, and examining personal biases and prejudices toward other cultures. Once this occurs, the nurse can learn as much about the culture as possible and become familiar with similarities and differences between his or her own culture and the family’s culture. The nurse would adapt nursing care to address the practices of the family’s culture to provide culturally competent care.



  Difficulty:  Difficult
8. After teaching a group of students about the changes in health care delivery and funding, which of the following if identified by the group as a current trend seen in the maternal and child health care settings would indicate that the teaching was successful?
  A) Increase in ambulatory care
  B) Decrease in family poverty level
  C) Increase in hospitalization of children
  D) Decrease in managed care
  Ans: A
  The health care system has moved from reactive treatment strategies in hospitals to a proactive approach in the community, resulting in an increased emphasis on health promotion and illness prevention in the community through the use of community-based settings such as ambulatory care. Poverty levels have not decreased and the hospitalization of children has not increased. Case management also is a primary focus of care.



  Difficulty:  Moderate
9. The nurse would recommend the use of which supplement as a primary prevention strategy to prevent neural tube defects in pregnant women?
  A) Calcium
  B) Folic acid
  C) Vitamin C
  D) Iron
  Ans: B
  Prevention of neural tube defects in the offspring of pregnant women via the use of folic acid is an example of a primary prevention strategy. Calcium, vitamin C, and iron have no effect on the prevention of neural tube defects.



  Difficulty:  Moderate
10. Which action would the nurse include in a primary prevention program in the community to help reduce the incidence of HIV infection?
  A) Provide treatment for clients who test positive for HIV
  B) Monitor viral load counts periodically
  C) Educate clients about how to practice safe sex
  D) Offer testing for clients who practice unsafe sex
  Ans: C
  Primary prevention involves preventing disease before it occurs. Therefore, educating clients about safe sex practices would be an example of a primary prevention strategy. Providing treatment for clients who test positive for HIV, monitoring viral loads periodically, and offering testing for clients who practice unprotected sex are examples of secondary preventive strategies, which focus on early detection and treatment of adverse health conditions.



  Difficulty:  Moderate
11. When assuming the role of discharge planner for a child requiring ventilator support at home, the nurse would do which of the following?
  A) Confer with the school nurse or teacher
  B) Teach new self-care skills to the child
  C) Determine if there is a need for backup power
  D) Discuss coverage with the family’s insurance company
  Ans: C
  The nurse should establish if there is a need for backup power during discharge planning. Conferring with a school nurse or teacher and dealing with insurance companies are case management activities. Teaching self-care skills are activities associated with the nurse’s role as an educator.



  Difficulty:  Moderate
12. When speaking to a group of parents at a local elementary school, the nurse describes school nursing as a specialized practice of nursing based on the fact that a healthy child has a better chance to succeed in school. Which of the following best describes the strategy school nurses use to achieve student success?
  A) They coordinate all school health programs.
  B) They link community health services.
  C) They work to minimize health-related barriers to learning.
  D) They promote student health and safety.
  Ans: C
  School nurses work to remove or minimize health barriers to learning to give students the best opportunity for academic success. Coordinating school health programs, linking community health programs, and promoting health and safety are individual components within the main effort of removing or minimizing health barriers.



  Difficulty:  Moderate
13. The parents of an 8-year-old with cancer are telling the nurse their problems and successes when caring for their child. In response, the nurse arranges for social services to meet with the parents to help them obtain financial assistance. The nurse is acting in which role?
  A) Educator
  B) Advocate
  C) Case manager
  D) Direct care provider
  Ans: B
  The nurse is acting as an advocate, representing the client and family to a third party, by ensuring that the family has the resources and services to provide care for their child. The nurse acts as a direct care provider through assessment, observation of physical care, and actually providing physical care. The role of educator would require the nurse to give rather than receive information. Case management involves coordinating elements of a nursing plan of care.



  Difficulty:  Moderate
14. The nurse is speaking to a group of parents of medically fragile children about day-care center options. When describing these centers, which statement would the nurse include as an advantage?
  A) They encourage greater parental involvement in care.
  B) Their capabilities are similar to an acute care facility.
  C) Insurance and Medicare cover their costs.
  D) They decrease the need for rehospitalization.
  Ans: D
  The advantage of medically fragile day-care centers is that they decrease the need for rehospitalization. They give parents respite from caregiving during the day. They don’t have the capabilities of a hospital, but they are equipped to meet the needs of the children they serve. Private insurance or Medicare does not always cover the cost.



  Difficulty:  Moderate
15. When explaining community-based nursing vs. nursing in the acute care setting to a group of nursing students, the nurse describes the challenges associated with community-based nursing. Which of the following would the nurse include?
  A) Increased time available for education
  B) Improved access to resources
  C) Decision making in isolation
  D) Greater environmental structure
  Ans: C
  Community-based nurses often have to make decisions in isolation. This is in contrast to the acute care setting, where other health care professionals are readily available. Nursing care and procedures in the community also are becoming more complex and time-consuming, leaving limited time for education. Nurses working in the community have fewer resources available and the environment is less structured and controlled when compared to the acute care setting.


Ch. 4: Common Reproductive Issues


1. After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?
  A) Oral contraceptives
  B) Tubal ligation
  C) Condoms
  D) Intrauterine system
  Ans: C
  Condoms are a barrier method of contraception. In addition to providing a physical barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and intrauterine systems provide no protection against STIs.



2. When discussing contraceptive options, which method would the nurse recommend as being the most reliable?
  A) Coitus interruptus
  B) Lactational amenorrheal method (LAM)
  C) Natural family planning
  D) Intrauterine system
  Ans: D
  An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planning are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These behavioral methods must be followed exactly as prescribed; otherwise, they are associated with a 27% failure rate.



3. A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which of the following to confirm this suspicion?
  A) Pelvic examination
  B) Transvaginal ultrasound
  C) Laparoscopy
  D) Hysterosalpingogram
  Ans: C
  The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.



4. A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing:
  A) Synthetic progestin
  B) Combined estrogen and progestin
  C) Concentrated spermicide
  D) Concentrated estrogen
  Ans: A
  Implantable contraceptives deliver synthetic progestin that act by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. Implantable contraceptives do not contain combined estrogen and progestin, concentrated spermicide, or concentrated estrogen.



5. The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription?
  A) Condom
  B) Spermicide
  C) Diaphragm
  D) Basal body temperature
  Ans: C
  The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter.



6. When developing a teaching plan for a couple who are considering contraception options, which of the following statements would the nurse include?
  A) “You should select one that is considered to be 100% effective.”
  B) “The best one is the one that is the least expensive and most convenient.”
  C) “A good contraceptive doesn’t require a physician’s prescription.”
  D) The best contraceptive is one that you will use correctly and consistently.”
  Ans: D
  For a contraceptive to be most effective, the client must be able to use it correctly and consistently. Even if a method is considered 100% effective, it is not the best choice if the couple does not use it correctly or consistently. Cost is a consideration, but the least expensive method is not necessarily the best choice. The need for a prescription is not relevant to the couple’s choice.



7. Which of the following measures would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause?
  A) Taking vitamin supplements
  B) Eating high-fiber, high-calorie foods
  C) Restricting fluid to 1,000 mL daily
  D) Participating in regular daily exercise
  Ans: D
  Measures to reduce osteoporosis after menopause include daily weight-bearing exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol intake. General vitamin supplements may be helpful overall, but they are not specific to reducing the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be appropriate. Restricting fluids would have no effect on preventing osteoporosis.



8. When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which of the following as the primary cause?
  A) Poor dietary intake
  B) Estrogen deficiency
  C) Active lifestyle
  D) Changes in vaginal pH
  Ans: B
  Hot flashes and night sweats are classic signs of estrogen deficiency. They are unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with genitourinary changes of menopause.



9. A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for:
  A) DEXA scan
  B) Ultrasound
  C) MRI
  D) Pelvic x-ray
  Ans: A
  The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic x-ray would be of little help in determining bone mass.



10. The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis?
  A) A woman of African American descent
  B) A woman who plays tennis twice a week
  C) A thin woman with small bones
  D) A woman who drinks one cup of coffee a day
  Ans: C
  A woman with a small frame and thin bones is at a higher risk for osteoporosis. Caucasian or Asian women, not African American women, are at higher risk for the condition. A woman who plays tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest excessive amounts of caffeine are at increased risk.



11. Which of the following would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis?
  A) Swimming daily
  B) Taking vitamin A
  C) Using hormone replacements
  D) Taking calcium supplements
  Ans: D
  Osteoporosis is a condition in which bone mass declines to such an extent that fractures occur with minimal trauma. Increasing calcium and vitamin D intake is a major preventive measure. Other measures to reduce the risk include engaging in weightbearing exercise such as walking. Swimming, although a beneficial exercise, is not a weightbearing exercise. Taking vitamin A supplements would have no effect on preventing bone loss. Recent studies have shown that the overall health risks associated with hormone replacement therapy exceed the benefits, increasing the woman’s risk for heart attacks, strokes, and breast cancer.



12. Which finding would the nurse expect to find in a client with endometriosis?
  A) Hot flashes
  B) Dysuria
  C) Fluid retention
  D) Fever
  Ans: B
  The client with endometriosis is often asymptomatic, but clinical manifestations include painful urination, pain before and during menstrual periods, pain during or after sexual intercourse, infertility, depression, fatigue, painful bowel movements, chronic pelvic pain, hypermenorrhea, pelvic adhesions, irregular and more frequent menses, and premenstrual spotting. Hot flashes may be associated with premenstrual syndrome or menopause. Fluid retention is associated with premenstrual syndrome. Fever would suggest an infection.



13. After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?
  A) I will make sure to take my estrogen supplements a week before my period.”
  B) “I’ve signed up for an aerobic exercise class three times a week.”
  C) “I’ll cut down on the amount of coffee and colas I drink.”
  D) “I quit smoking about a month ago, so that should help.”
  Ans: A
  Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical symptoms; spironolactone may help with bloating and water retention.



14. A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which of the following?
  A) Onset of menses
  B) Ovulation
  C) Pregnancy
  D) Safe period for intercourse
  Ans: B
  Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy.



15. A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which of the following?
  A) Spinnbarkeit mucus
  B) Purulent mucus
  C) Post-ovulatory mucus
  D) Normal pre-ovulation mucus
  Ans: A
  The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green and malodorous. Pre-ovulation mucus is clear but not as copious, slippery, and stretchable.



16. The nurse is reviewing the laboratory test results of a client with dysfunctional uterine bleeding (DUB). Which finding would be of concern?
  A) Negative pregnancy test
  B) Hemoglobin level of 10.1 g/dL
  C) Prothrombin time of 60 seconds
  D) Serum cholesterol of 140 mg/dL
  Ans: B
  A hemoglobin level of 10.1 g/dL suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, a prothrombin time of 60 seconds, and a serum cholesterol level of 140 mg/dL are within normal parameters.




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