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ANS: B, C, D
The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than among any other age group. Research suggests that distractions, such as talking or texting on cell phones, eating, or playing with the radio, increase teen drivers risk of being involved in a crash. Nurses should talk to teens about these distractions, which can also include riding with a car full of other teens. Teens have a much higher nighttime crash fatality rate as well.
The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than among any other age group. Research suggests that distractions, such as talking or texting on cell phones, eating, or playing with the radio, increase teen drivers risk of being involved in a crash. Nurses should talk to teens about these distractions, which can also include riding with a car full of other teens. Teens have a much higher nighttime crash fatality rate as well.
2. A teenager has been using acne medications for the last 14 days. Her acne is no better, and in fact, it is a little worse. What information should the nurse offer this girl?
a. Wash your face at least four times a day, making sure to scrub well.
b. The medications can make acne appear worse at first; try to give it a few more weeks.
c. Avoid all chocolate products.
d. Because it is summertime, it would be good for your skin if you lie out in the sun for a few hours each day.
a. Wash your face at least four times a day, making sure to scrub well.
b. The medications can make acne appear worse at first; try to give it a few more weeks.
c. Avoid all chocolate products.
d. Because it is summertime, it would be good for your skin if you lie out in the sun for a few hours each day.
ANS: B
Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on acne, prolonged exposure should be avoided. Topical acne products make acne appear worse initially, and improvement occurs slowly over several months. Nurses should provide this information to teenagers planning to use acne products, so they are not discouraged early in therapy.
Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on acne, prolonged exposure should be avoided. Topical acne products make acne appear worse initially, and improvement occurs slowly over several months. Nurses should provide this information to teenagers planning to use acne products, so they are not discouraged early in therapy.
. The mother of a 13-year-old girl is concerned because her daughter has not started menstruating yet. The girl developed breast buds and started her height spurt at 12 years of age. Which of the following statements would be the most appropriate response from the nurse?
a. Usually, girls start menstruating when they develop breast buds; an endocrine evaluation might be warranted.
b. Everyone is different; it will happen when it happens.
c. Based on when the breast buds first appeared, she should starting menstruating around the age of 14.
d. She will not start menstruating until her breasts are of adult size and contour.
a. Usually, girls start menstruating when they develop breast buds; an endocrine evaluation might be warranted.
b. Everyone is different; it will happen when it happens.
c. Based on when the breast buds first appeared, she should starting menstruating around the age of 14.
d. She will not start menstruating until her breasts are of adult size and contour.
ANS: C
The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt. The onset of menstruation occurs approximately 2 years after the appearance of breast buds and near the end of the growth spurt. Thus, based on the age of breast bud appearance, the girl should start menstruating around age 14.
The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt. The onset of menstruation occurs approximately 2 years after the appearance of breast buds and near the end of the growth spurt. Thus, based on the age of breast bud appearance, the girl should start menstruating around age 14.
6. Parents recently discovered that their teenage daughter has been consuming alcohol on a regular basis. They ask the nurse for advice on how to best help their daughter. Which of the following recommendations should the nurse give to the parents?
a. Talk to their daughter at length regarding the dangers associated with drinking.
b. Tell their daughter she will not be allowed to use her cell phone if this continues.
c. Enroll their daughter in a peer support group focused on teenage drinking.
d. Provide their daughter with literature regarding the dangers of drinking.
a. Talk to their daughter at length regarding the dangers associated with drinking.
b. Tell their daughter she will not be allowed to use her cell phone if this continues.
c. Enroll their daughter in a peer support group focused on teenage drinking.
d. Provide their daughter with literature regarding the dangers of drinking.
ANS: C
Teens do not always consider health risks associated with their risky behaviors. Additionally, peer influence is primary and parental input is often rejected. In this case, the teenager may risk losing her cell phone and privileges by continuing with her risky behavior, but because peer influence is primary, the parents should enroll her in a peer support group focused on teenage drinking
Teens do not always consider health risks associated with their risky behaviors. Additionally, peer influence is primary and parental input is often rejected. In this case, the teenager may risk losing her cell phone and privileges by continuing with her risky behavior, but because peer influence is primary, the parents should enroll her in a peer support group focused on teenage drinking
ANS: A
Teenagers are known for their risk-taking behaviors. They do not always consider the health risks associated with their behaviors. In addition, they often do things because their friends do it. Therefore, riding an ATV without a helmet and risking a head injury is most reflective of a teenagers behavior.
Teenagers are known for their risk-taking behaviors. They do not always consider the health risks associated with their behaviors. In addition, they often do things because their friends do it. Therefore, riding an ATV without a helmet and risking a head injury is most reflective of a teenagers behavior.
9. During a physical exam, a teenager asks the nurse if she can have a stronger medication for her constipation because the laxatives she has been taking are not helping. During the physical exam, the nurse observes mild to moderate erosion of the tooth enamel. Which of the following disorders is the client most likely experiencing?
a. Bulimia nervosa
b. Binge eating disorder
c. Idiopathic constipation
d. Irritable bowel syndrome
a. Bulimia nervosa
b. Binge eating disorder
c. Idiopathic constipation
d. Irritable bowel syndrome
ANS: A
Bulimia nervosa is characterized by binge eating and then purging by self-induced vomiting and/or laxatives. Purging can also lead to erosion of the tooth enamel. Bulimia nervosa occurs more commonly in females. A teenage girl asking for stronger laxatives with tooth enamel erosion should cause any health care provider to consider the possibility of bulimia nervosa.
Bulimia nervosa is characterized by binge eating and then purging by self-induced vomiting and/or laxatives. Purging can also lead to erosion of the tooth enamel. Bulimia nervosa occurs more commonly in females. A teenage girl asking for stronger laxatives with tooth enamel erosion should cause any health care provider to consider the possibility of bulimia nervosa.
10. A teenager has a family history of Type 2 diabetes mellitus. He asks the nurse what he can do to try to prevent developing it himself. Which of the following instructions should the nurse give this client?
a. Tell him to avoid any and all sweets.
b. Tell him to be active and eat a balanced diet.
c. Tell him he should talk to his physician about genetic testing.
d. Tell him that very little can be done to avoid developing this disorderANS: B
Obesity is making Type 2 diabetes mellitus common among teens and young adults. Being overweight and inactive increases the risk. Therefore, encouraging activity and a balanced diet is the best information the nurse can give to the client. Telling him to avoid all sweets would be an impossible request, and genetic testing does not detect the development of this disorder.11. Which of the following teenage behaviors is cause for concern?
a. Has difficulty waking up in the morning and naps during the day
b. Goes to bed late and naps during the day
c. Takes frequent naps and states it is because he is bored
d. Participates in after school activities and has difficulty waking up
ANS: CANS: C
Adolescents need at least 8 hours of sleep per night. Often, they stay up late and wake up for school before their sleep cycles have finished; therefore, napping is common. However, those with a decreased energy level who use words such as bored or sad should be further evaluated for suspected depression. Therefore, a teenager who takes frequent naps and states it is because he is bored is cause for concern because this behavior might indicate depression.12. A mother is concerned because her daughter has been taking a nap every day after school. Which of the following statements would be the best response by the nurse?
a. Dont worry; all teenagers do that.
b. Tell me about your daughters schedule.
c. Lets bring her in for some blood work.
d. Have you addressed the topic of drugs with you daughter?ANS: B
Many teenagers take naps, although this does not address the mothers concern. Although the nap can be a symptom of a health problem or drug use, additional information is necessary to make that determination. Asking the mother to tell you about her daughters schedule provides information to determine whether the behavior is normal or whether it requires further investigation.13. Which of the following teenagers is at risk for not meeting his developmental task?
a. Arrested for petty theft
b. Decided he wants to major in accounting
c. Has recently broke up with his girlfriend
d. Is a member of the varsity basketball teamANS: A
The central task of adolescence according to Erikson is the establishment of identity, with the primary risk being role confusion. As the adolescent searches for direction, he makes choices in social, recreational, volunteer, academic, familial, and occupational activities. When the threat of confusion is exceedingly great, delinquent behavior and alterations in mental health can occur. Thus, a teenager arrested for petty theft is displaying delinquent behavior that may place him at risk for not meeting his developmental task of identity.14. Which of the following actions should parents take to help their teenager meet his developmental task?
a. Set strict rules to prevent the teenager from getting into any trouble.
b. Maintain an ongoing dialogue about important issues and upcoming challenges.
c. Maintain a friendship with the teenager, so he views parents as peers.
d. Be very lenient with the teenager so that he can figure out who he is as a person.ANS: B
Imposing strict limits and eliminating all rules are not helpful to teenagers. Families in which parents maintain a willingness to listen, demonstrate an ongoing affection for and acceptance of their adolescent, yet still maintain some consistent limits, experience more constructive, positive outcomes during adolescence. Thus, maintaining an ongoing dialogue about important issues and upcoming challenges demonstrates the parents willingness to listen and their concern.15. Which of the following teenagers is at increased risk for acquiring a sexually transmitted disease and should be provided with anticipatory guidance?
a. Asks the nurse for information about condoms
b. Feels her friends and family do not care about her
c. Has multiple friends and feels good about herself
d. Talks to her boyfriend on the phone for hoursANS: B
Adolescents often talk on the phone for hours, providing a safe way for them to interact with members of the opposite sex. However, adolescence is a time when teenagers fantasize about relationships and sex. Teenagers decide to become sexually active for a number of reasons, including affection. This can put them at increased risk for sexually transmitted diseases; therefore, anticipatory guidance regarding protection from sexually transmitted diseases needs to be provided before the adolescent is in a situation that can place him or her at risk.16. A mother is concerned because her 13-year-old daughter comes home happy one day and sad the next. The girl also argues with her younger sister more than she did in the past, and does not like participating in family activities anymore. Which of the following is the best initial response from the nurse?
a. The changes during adolescence can be stressful as they struggle to come to terms with who they are. What other types of behaviors has she been displaying?
b. Changes in affect can be a warning sign for suicide. Has she had any increase in risk-taking behaviors or physical violence?
c. Is there any history of psychological disorders in your family?
d. Withdrawal can be a sign of substance abuse. Has she given you any indication she might be using illicit drugs?ANS: A
Although dramatic swings in affect can be a warning sign for suicide, and withdrawal can be a sign of substance abuse, additional information is required before suggesting a diagnosis. Often, mood swings and spending more time with peers and less time with the family is normal adolescent behavior during this period of rapid change in physical, psychosocial, spiritual, moral, and cognitive growth. Parents and teenagers should be aware of and prepared for these changes.17. Which of the following is the third leading cause of death in adolescents between 10 and 24 years of age?
a. Accidents
b. Suicide
c. Cancer
d. Sport injuriesANS: B
The third leading cause of death in adolescents between 10 and 24 years of age is suicide.18. After offering a teenager the HPV vaccine, the teenager responds by saying, I cant have the vaccine because I have already been sexually active. Which of the following statements is the best response by the nurse?
a. You can still benefit from the vaccine, but there is a chance it will not be as effective.
b. The best way to protect yourself now is to make sure all your future sexual partners have received the vaccine.
c. You are correct, the vaccine is only indicated for females who have never been sexually active.
d. It depends on the number of partners you have had. If you have had less than five partners, you are still eligible for the vaccine.ANS: A
The HPV vaccine is recommended for 11- to 12-year-old girls and for 13- to 26-year olds who have not yet received or completed the vaccine series. Ideally, females should receive the vaccine before they are sexually active because girls who have not been infected with any of the four HPV types covered by the vaccine will receive the full benefits of the vaccine. Females who are sexually active may also benefit but to a lesser degree. It is not known if the vaccine is effective in boys or men. Thus, the best response is, You can still benefit from the vaccine, but there is a chance it will not be as effective.19. A nurse is initiating a discussion about alcohol consumption during a physical exam with a teenager. Which of the following questions would be most appropriate for the nurse to ask?
a. So, what do you and your friends do for fun and excitement?
b. Do you have access to alcohol?
c. Do any of your friends drink?
d. Do you want to talk about alcohol or drinking?ANS: C
Anticipatory guidance during a physical exam is important. This includes asking about substance use. Questions should not be vague because they may be misinterpreted. Direct questions are useful when discussing sensitive topics. However, asking first about friends and the adolescents feelings about them is a good lead-in approach to a discussion about substance use.20. The school nurse is working on a campaign in the school to prevent adolescent pregnancies. Which of the following interventions should the nurse implement?
a. Talk to teenagers about sex, including abstinence, contraception, and sexually transmitted diseases.
b. Tell the teenagers they should abstain from sex until they are old enough to cope with the potential consequences such as an unwanted pregnancy.
c. Encourage parents of all teenage girls to make sure their daughters start oral contraceptives early.
d. Offer all teenagers free condoms when they come in for physical exams.ANS: A
The emergence of secondary sexual characteristics increases adolescents awareness of themselves as sexual human beings leading to experimentation. Primary prevention is necessary to help prevent adolescent pregnancies. Parents, teachers, and health care providers will be more successful in assisting teens to manage their health needs if they treat them as joint partners. Talking to teenagers about sex, contraceptive options, and sexually transmitted diseases gives them the information and anticipatory guidance they need to help them make a decision.21. A teenager asks the school nurse for advice before getting a tattoo. Which of the following responses would be most appropriate for the nurse?
a. You should not get a tattoo.
b. It is okay to get a tattoo if you go to a licensed artist.
c. Tattoos are popular; however, they can lead to infection and/or bleeding.
d. A body piercing would be safer and less permanent.ANS: C
Tattoos and piercings carry similar risks, which include localized infection, bleeding, and dermatitis. In addition, tattoos carry a heightened concern for blood-borne disease such as hepatitis and HIV. When providing anticipatory guidance, nurses should treat teenagers as partners and give them the information they need to make an informed decision. Therefore, informing the teenager about the risk of infection is the best response.22. A teenager is expecting her menstrual period on May 14. On which of the following dates would the nurse recommend that she perform a self-breast exam?
a. May 11
b. May 14
c. May 17
d. May 23ANS: D
The best day to perform a self-breast exam is 2 to 3 days after ones period when breasts are least likely to be tender or swollen. A typical period lasts about 6 days. Thus, a teenager who starts her period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = 23).23. Which of the following teenagers is exhibiting a behavior that cause for concern and requires further evaluation?
a. Is always very happy
b. Is agitated and has trouble sleeping
c. Has a lot of homework and stays up late to finish it
d. Values his friends opinion more than his parents opinionANS: B
Nurses should be aware that the problem of substance abuse exists. They should also be aware of what the signs and symptoms are. Agitation and insomnia are signs of substance abuse and should therefore be evaluated further.24. Which stage of male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum?
a. 1
b. 2
c. 3
d. 4ANS: C
In stage 3, male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum.25. Which stage of female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae?
a. 1
b. 2
c. 3
d. 4ANS: B
In stage 2, female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae.26. A 14-year-old female is in for a physical exam. Which finding requires further investigation?
a. A height spurt since her last visit
b. Facial acne
c. The lack of breast buds
d. Noticeable sweating and body odor with activityANS: C
The onset of puberty usually begins around 11 to 13 years of age. Stage 2 is the usual time of peak height velocity for girls. Additionally, both sweat and sebaceous glands become more active during adolescence leading to sweat, body odor, and acne. Breast buds also usually appear during stage 2 of puberty. Females who have not begun pubertal development by age 14 should have an endocrine evaluation. Thus, the finding of lack of breast buds on this 14-year-old girl requires further investigation.. Which of the following are symptoms or warning signs of anorexia nervosa? (select all that apply)
a. Lack of menstruation in females
b. Preoccupation with food
c. Eating only small amounts of certain foods
d. Dramatic weight fluctuationsANS: A, B, C, D
Symptoms or warning signs of anorexia nervosa include the relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation in females, decreased sexual interests in males, compulsive physical activity, preoccupation with food, portioning food carefully, eating only small amounts of only certain foods, and a distorted body image. Dramatic weight fluctuations are seen with bulimia nervosa.1. A nurse is planning a community health education program for young adults. Which of the following considerations should be made by the nurse?
a. The age span encompassing young adulthood is between 20 to 30 years of age.
b. The number one cause of death for young adults is injury.
c. The number of young adults in the United States is increasing.
d. The maternal mortality rate is at its lowest point since 1980.ANS: B
Young adulthood spans the years between ages 18 to 35. The number of young adults in the United States is declining, and the maternal mortality rate is at its highest level since 1980.2. A nurse is completing a health counseling session with a 25-year-old woman. Which of the following statements should be made by the nurse during this session?
a. A yearly Pap test is recommended for detection of ovarian cancer.
b. Research supports that breast self-exams reduce breast cancer mortality.
c. The incidence of cervical cancer is very low in your age group.
d. Daily physical activity and weight control is one way to stay healthy.ANS: D
Screening is strongly recommended for cervical cancer in women who have been sexually active (Papanicolaou [Pap] smears). The incidence of carcinoma in situ is high in young adults. The US Preventative Services Task Force recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the additional benefits and harm of clinical breast examination beyond screening mammography for women 40 and older. After age 25, the preventive emphasis is on modifying coronary disease risk factors, which would be accomplished by discussing activity and weight control.3. A 26-year-old client has a total cholesterol of 206 mg/dL and an LDL of 110. Which of the following conclusions can be drawn by the nurse?
a. The client has achieved the target levels for cholesterol in young adults.
b. The client has a very low risk of developing heart disease.
c. The client requires counseling about cardiac disease risk factors.
d. The client has early-onset cardiac disease.ANS: C
Cardiovascular assessment of the young adult includes determining the presences of hyperlipemia, hypertension, diabetes, chest pain, or heart disease. This client has an elevated cholesterol levels and requires additional education about risk factors that may lead to cardiac disease. The Healthy People 2020 target is to reduce the mean total blood cholesterol levels among adults to 177.9 mg/dL. A diagnosis of heart disease cannot be made on the basis of these lab values.4. The public health nurse is conducting a screening of young adults for metabolic syndrome. When asked about the syndrome, which of the following responses should be made by the nurse?
a. Anyone who has low blood sugar, high cholesterol, and high blood pressure has this syndrome and is at risk for cardiac disease.
b. This syndrome helps predict heart disease. Once it is diagnosed, the correct medication can be prescribed and heart disease avoided.
c. This syndrome is a warning sign that the person could develop heart disease. When someone has metabolic syndrome, dietary and activity level changes are recommended.
d. Anyone who has high cholesterol, high blood pressure, and high blood sugar has coronary artery disease. Once we make the diagnosis, we can begin to treat the disease.ANS: C
Metabolic syndrome is diagnosed when a person has high cholesterol, high blood pressure, and high blood sugar. A person with this syndrome is at risk for coronary artery disease. Lifestyle changes are tried before medication is used.5. The university health services nurse is preparing a disease prevention program for college students. Which of the following information should the nurse include in the program?
a. Living in the dorm increases ones risk of developing meningococcal disease.
b. The mortality rate from meningococcal disease is very low.
c. There are no antiviral medications that can treat meningococcal outbreaks.
d. A vaccine for meningococcal disease has not been developed.ANS: A
Although most outbreaks of meningococcal disease are sporadic, young adults living in dormitories or crowded conditions may be more susceptible than young adults not living in close settings. Meningococcal disease has a high mortality rate. It is caused by a bacterium, not a virus, and antibiotics to treat the disease are readily available. A preventive vaccine is available.6. A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to assist with weight reduction. In which order would the nurse discuss the implementation of these interventions?
1. Gastric stapling
2. Medication to reduce appetite
3. Nutrition and exercise education
4. Assessment of lipid profile and blood pressure
a. 4, 3, 2, 1
b. 4, 2, 3, 1
c. 3, 4, 2, 1
d. 3, 2, 1, 4ANS: A
Assessment data must be complete before intervention. Diet and exercise are used first, and then pharmaceutical agents to reduce appetite. Bariatric surgery is used when all other options have failed.7. A nurse is discussing optimal activity for young adults. Which of the following information should be stressed?
a. Forty-five minutes of moderate exercise per day are required to maximize health benefits.
b. An increase in heart rate from 70 to 200 beats/min during exercise is optimal.
c. Moderately brisk walking is an appropriate aerobic exercise.
d. Sixty minutes of exercise three times a week is recommended.ANS: C
The Healthy People 2020 goal is to increase the proportion of adults who engage in moderate physical activity for 150 minutes a week (30 minutes five times per week) to 47.9% from 43.5%. Aerobic conditioning achieves cardiovascular fitness through five periods of moderately intense exercise weekly for about 30 minutes or more at a heart rate of approximately 220 minus the age of the person multiplied by 65% to 85%. Young adults are encouraged to engage in fitness activities that increase the heart rate to approximately 150 beats or more per minute. Moderately brisk walking that increases the heart rate is an appropriate aerobic exercise.8. The nurse working in the college health center is asked about a safe way to obtain a tan. Which of the following would be the best response by the nurse?
a. There is no safe way. Be sure to stay out of the sun as much as possible.
b. Tanning beds are much safer than exposure to actual sunlight.
c. Be sure to use sunblock agents and do not sunbathe between 10 AM and 2 PM.
d. Once you apply sunblock, you are protected all day, so be sure to use it before any outdoor activity.ANS: C
Young adults should avoid sunbathing during the 2-hour period before and after noon because two-thirds of the days ultraviolet light comes through the earths atmosphere during this time. There is no need to stay completely out of the sun. Tanning beds are not a safe way to tan. Sunblock should be reapplied if certain outdoor activities are part of the day, such as swimming.9. A nurse is working in the community to prevent bicycle and motorcycle fatalities. Which of the following measures would be most effective for the nurse to promote?
a. Use of helmets
b. Increasing the minimum age for motorcycle licensure
c. Construction of bike paths along busy roads
d. Right-of-way laws for bicyclistsANS: A
Head injury is the major cause of death related to bicycle or motorcycle accidents. Bicycle helmets are believed to be the single most effective preventive measure available to decrease the incidence of brain and head injury.10. Which of the following reflects Piagets theory as applied to young adults?
a. Voting for a candidate based on popularity
b. Voting for a candidate based on media advertisements
c. Voting for a candidate based on support of the candidate by peers
d. Voting for a candidate based on analysis of views about various issuesANS: D
Young adults are in Piagets formal operational thinking stage during which they analyze issues objectively and insightfully.11. Which of the following adults has transitioned to Eriksons intimacy versus isolation and loneliness stage of development?
a. A 21-year-old man who has a part-time job, spends most of his leisure time with his buddies, and has numerous short-term intimate relationships
b. A 25-year-old woman who is very concerned with how she is perceived by her coworkers and friends
c. A 30-year-old man who just graduated with a PhD and is looking for his first full-time job
d. A 26-year-old woman who has a long-term relationship with a female companionANS: D
Eriksons intimacy versus isolation and loneliness stage of development involves reciprocal expressions of affection and trust. Promiscuous behavior is not characteristic of this stage of development. Reliance on a positive perception by friends and coworkers for self-esteem is not characteristic of this stage of development.12. Which of the following young adults exemplifies Kohlbergs postconventional level of moral reasoning?
a. 28-year-old person who calls in sick so as to help a friend move to a new location
b. 22-year-old man who uses marijuana on the weekends with friends
c. 30-year-old woman who volunteers at a soup kitchen one day a month
d. 35-year-old who works long hours so as to be considered for a promotionANS: C
Someone in Kohlbergs postconventional level of moral reasoning is able to do what is beneficial or right regardless of peer pressure to take another course of action.13. Which of the following statements should be considered by a nurse working in occupational health who organizes a stress reduction workshop?
a. Women generally experience less workplace stress than do men.
b. Ones first job is exciting and leads to numerous opportunities, and therefore causes little stress.
c. Young adults adapt easily to changing job demands such as telecommuting and long work hours.
d. Work is of primary importance to young adults and helps form their self-image.ANS: D
Employment is more than a source of income to young adults; it provides self-esteem and social interaction. Women experience as much, and sometimes more, stress than do men because of child care issues. The demands of work are stressful and sometimes lead to unhealthy behavior.14. The parents of a young adult female have recently divorced. Which of the following is the young adult most likely to experience?
a. Relief
b. Depression
c. Unemployment
d. Inability to sustain own relationshipsANS: B
Although dissatisfaction and unhappiness are frequent precursors to separation and divorce, the decision to dissolve a marriage is not easy. Divorced young adults frequently suffer severe emotional strain and depression. Some young adults are unable to adjust to role and status changes and to threats of self-concept. Young adults whose parents divorce have an increased rate of divorce, but that does not mean that they are unable to sustain their own relationships.15. A 19-year-old college student is seen by the health services nurse. The young woman is distraught that she had unprotected sex 4 days ago and is afraid she may have become pregnant. Which of the following statements should be made by the nurse?
a. Lets talk about your options because you must be 21 years of age to purchase emergency contraception.
b. Dont worry; you can purchase Plan B, an emergency contraception drug, without a prescription and it will terminate the pregnancy.
c. I know you are upset, but we are in one of the 40 states that allow drugstores to carry Plan B, an emergency contraception drug. Lets talk about how to use the medication.
d. You have several options. Lets discuss what would be the best thing for you to do next.ANS: D
Emergency contraception can reduce the number of unintended pregnancies. There is a generic two-dose form Next Choice, and a one-dose form, Plan B One-Step. Both require a prescription for girls under 17. Emergency contraception must be used within three days of unprotected sex. It works by either altering tubal transport of either sperm or ova, inhibiting implantation. It will not terminate an existing pregnancy and does not provide protection against sexually transmitted diseases.16. The nurse working in the college health center is planning a program about sexually transmitted diseases (STDs). Which of the following information should the nurse include in the program?
a. STDs are the third most common infection in young adults.
b. STDs can be transmitted by any intimate contact, not just sexual intercourse.
c. STDs usually occur as a single infection.
d. STDs are the most common reason for a visit to the health center.ANS: B
STDs can be transmitted from oral and anal sex, not just vaginal intercourse, and many young adults do not understand this. STDs are the most common infection in persons age 15 to 24. A person may have multiple STDs. STDs are generally unreported and not treated.17. A 32-year-old woman visits the occupational health nurse because of malaise. Which of the following assessment data indicates that the client may be experiencing achievement-oriented stress?
a. Sleeping 10 hours per day
b. Unintentional loss of 10 pounds in the past 3 weeks
c. Expressed fear of company layoffs
d. Calling in sick once every 2 weeks for the past monthANS: B
Achievement-oriented stress is characterized by lack of sleep, skipping meals, and workaholic habits. It differs from situational stress, which would be caused by changes in job function for example.18. A nurse volunteered to work at a natural disaster site. Which of the following questions should the nurse ask to determine if the 26-year-old individual being screened is depressed or has suicide ideation?
a. Tell me about your pets.
b. What do you do for work? How has your work been affected by this disaster?
c. Have you thought of harming yourself?
d. Have you seen your friends since the disaster?ANS: C
Direct questioning about the intent to harm oneself is appropriate for the nurse to ask during screening/counseling sessions.19. A nurse is planning health care for young adults. Which of the following factors about the interventions should be recognized by the nurse as having the greatest impact on whether they are effective?
a. Culturally sensitive
b. Match the persons health care beliefs
c. Cost effective
d. Gender neutralANS: A
Unless the interventions are culturally sensitive, they are not likely to be successful. Although the other factors are important, the priority consideration is cultural sensitivity.20. Which of the following circumstances accounts for one of the leading cause of death in young adults?
a. Tobacco use
b. Binge drinking and driving
c. Illegal drug use
d. HIV infectionANS: B
Alcohol-related accidents among individuals ages 15 to 24 continue to be a leading cause of preventable morbidity, disability, and death.21. A nurse is counseling a 23-year-old woman about oral, transdermal, injectable, vaginal ring, and implant contraceptive methods. Which of the following risks of using these methods should be stressed by the nurse?
a. Toxic shock syndrome
b. Nausea
c. Blood clots
d. Ectopic pregnancyANS: C
Blood clots are a potential risk with using all of these contraceptive methods. Ectopic pregnancy is a possible complication of IUDs. Nausea may occur with the use of Plan B, and toxic shock syndrome may occur with use of a diaphragm.22. Which of the following interventions are appropriate relative to the nursing diagnosis: Health-Seeking Behaviors Related to Preconceptual Assessment and Preparation for Childbearing?
a. Encouraging the consumption of a moderate-fat diet to prepare for pregnancy
b. Referral to genetic counseling based on family history
c. Counseling to avoid hard liquor
d. Substituting a nutritional supplement for a meal so as to assure adequate vitamin intakeANS: B
Assessment of biophysical risk factor is an important intervention, which includes review of genetic disorders, nutrition problems, and current medical problems. Before and during pregnancy, the diet should be well-balanced, low in fat and sodium, and high in calcium and iron. Nutritional supplements are not required unless the woman is malnourished. Alcohol in all forms including beer and wine should be avoided.1. An occupational health nurse is conducting a blood pressure screening. Which of the following clients is at greatest risk of mortality from cardiac disease? (select all that apply)
a. Black man with a blood pressure of 130/80
b. Mexican American man with a blood pressure of 110/60
c. White woman with a bold pressure of 120/80
d. Black woman with a blood pressure of 128/78ANS: A, D
According to the JNC VII, the risk for cardiovascular events rises when blood pressure is greater than 115/75. Blacks have a higher death rate from heart disease than do Whites. Mexican Americans have the lowest rate of hypertension.2. A public health nurse is interested in writing a grant to improve vaccination rates of young adults. His focus should be on trying to obtain funding to support which of the following vaccination initiatives? (select all that apply)
a. Rubella prevention
b. Lyme disease prevention
c. Hepatitis B prevention
d. Human papilloma virus (HPV) preventionANS: C, D
Rubella in young adults is generally a minor disease; the population at risk is women of childbearing age. There is not a vaccine available for Lyme disease. Hepatitis B and HPV can both be prevented through immunization and young adults are at high risk for contracting these diseases.3. A nurse is conducting a community health education program for Hispanic women ages 18 to 35. Which of the following items should the nurse recommend that they increase in their diet on a daily basis? (select all that apply)
a. Calcium
b. Folic acid
c. Iron
d. SodiumANS: A, B, C
Women of childbearing age frequently consume a diet deficient in calcium, iron, and folic acid.4. A community health nurse has received a grant to present a program about violence prevention. Which of the following individuals has a higher than average risk of homicide? (select all that apply)
a. 33-year-old woman who served 5 years in prison
b. 20-year-old homeless man
c. 28-year-old man with a history of bipolar disorder
d. 24-year-old woman who has a female partnerANS: A, B, C
Homicide is closely associated with alcohol and drug abuse and frequently is related to other violent acts, such as robbery. Other risk factors for homicide include a history of loss of employment, detention or prison experience, access to firearms, abuse in the home, mental illness, social isolation, and homelessness.5. A nurse is working in a domestic violence shelter. Which of the following individuals would the nurse expect to encounter? (select all that apply)
a. 34-year-old White woman who is vice president of a communications company
b. 26-year-old Black woman who has a live-in boyfriend
c. 29-year-old Hispanic man who has been married for 2 years
d. 21-year-old unemployed White woman who has been with her boyfriend for 3 yearsANS: A, B, C, D
Abusive behavior victims come from all racial, ethnic, and socioeconomic levels.6. A nurse is planning community health programming for young adults. Based on the objectives for Healthy People 2020, which of the following topics would be priority areas for programming? (select all that apply)
a. Prenatal care
b. Physical activity
c. HIV
d. SuicideANS: A, B
Healthy People 2020 objectives targeted for the young adult include increasing the proportion of adults who engage in regular aerobic activity of moderate intensity and increasing the proportion of women who receive early and adequate prenatal care. HIV and suicide rates are not mentioned in the target areas for young adults.1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be most appropriate way for the nurse to reply?
a. There is really nothing you can do to prevent a lot of wrinkles. It is part of aging.
b. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it.
c. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure.
d. Wrinkles are caused by genetic factorsANS: C
Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles.2. A 45-year-old client who has experienced a ten pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take?
a. Ask the client to describe her daily activity and diet
b. Leave a note requesting an iron supplement on the clients chart for the doctor
c. Provide the client with information related to aerobic exercise classes
d. Ask the client if she is still menstruatingANS: A
A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a lack of energy.3. Which of the following is a normal physiological change that occurs during middle age?
a. Increase in gastric emptying resulting in acid reflux
b. Reduction in height caused by kyphosis
c. Reduction of glomerular filtration by 50%
d. Increase in the amount of estrogen produced in both gendersANS: C
Gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels decrease in women and increase in men as male testosterone levels decrease.4. A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-age adults?
a. Automobile accidents
b. Malignant disease
c. Homicide
d. SuicideANS: B
The leading causes of death during middle adulthood are heart disease, cancer, and accidents. Accidents are the major cause of death for children and young adults. Homicide and suicide are major causes of death for young adults.5. A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the groups efforts?
a. Asian Americans
b. Blacks
c. Hispanic Americans
d. Working-poor White AmericansANS: C
Hispanic Americans are the largest minority group in the United States and have the highest uninsured rate.6. A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit?
a. Hispanic women have the highest rate of breast cancer of all minority groups in the United States.
b. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups.
c. The death rate from breast cancer in Hispanic women has risen in the past 10 years.
d. Breast cancer in Hispanic women is usually diagnosed at an early stage.ANS: B
Even though Hispanic women have a breast cancer rate approximately 40% lower than non-Hispanic White women, their death rate is higher and the cancer is diagnosed at a later stage.7. A nurse has received a grant to provide a community-based education series for middle-age adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group?a. Diet and exercise
b. Seat belt use
c. Depression screening
d. Cancer preventionANS: A
Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet and exercise will have the greatest impact on health.8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29 kg/m2, age 41. Which of the following actions should be taken by the nurse?
a. Encourage the client to continue her dietary and exercise patterns.
b. Discuss her current dietary and exercise lifestyle habits.
c. Counsel the client that she will face chronic health problems because of her weight.
d. Encourage the client to adopt a low-calorie diet to help control her weight.ANS: B
Obesity is defined as a BMI of 30 kg/m2. The client is at risk for obesity. Further data should be gathered related to her dietary and exercise patterns so as to plan appropriate interventions. Adoption of a low-calorie diet may not be an appropriate intervention depending on what additional data collection reveals. Also, dietary changes should be accompanied by regular aerobic exercise.9. A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success?
a. Using a pre-set list of topics for discussion
b. Relying on printed material to relay information to the group
c. Asking for a list of topics that interest the group
d. Beginning each session with a 2-mile walkANS: C
When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for participants.10. A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop osteoporosis like her mother did. Which of the following statements is the most appropriate response by the nurse?
a. The American diet is much better now than when your mother was your age, so you have enough calcium in your diet to keep your bones strong.
b. You have a strong genetic risk factor. There is not much we can do to stop the process.
c. You need about 1000 mg of calcium a day to keep your bones strong. Lets talk about your diet.
d. Tell me about your diet, how much walking you do each day, and what medications you take.ANS: D
The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen. Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis.11. Which of the following statements about alcohol intake is correct?
a. Women have a higher death rate related to alcoholism than men.
b. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker.
c. More women than men are considered problem drinkers.
d. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a buzz from drinking.ANS: A
The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Women who are able to hold their liquor are more likely to drink excessively than those who cannot hold their liquor.12. The occupational health nurse is planning a health fair for employees. Which of the following information about dental health should be included?
a. Drinking bottled water helps prevent tooth decay.
b. Gingivitis results in bone destruction and can be eliminated by flossing daily.
c. Preventive dental care requires a visit to the dentist every 4 months.
d. In addition to screening for tooth decay, dentists screen for mouth cancer.ANS: D
Dental health is essential to overall health. Dental professionals may be the first to detect a symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone destruction. An annual dental check-up is recommended for the average person, not a check-up every 4 months.13. Which of the following people has exceeded the recommended guidelines for activity?
a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity
b. A 45-year-old woman who swims and has a pulse rate of 145 during activity
c. A 50-year-old man who jogs and has a pulse rate of 120 during activity
d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activityANS: D
During activity, the persons pulse rate should not exceed 220 minus the age times 0.75. Thus the woman who is 60 years old would subtract (220 60 = 180); then multiply 180 by 0.75 to give 120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended optimal rate of 120.14. A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse?
a. Do you want a sleeping pill?
b. Make sure that you do not nap during the day even if you are tired.
c. Do you feel excessively tired during the day?
d. The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.ANS: C
It is important to assess the quality of sleep as well as the effects that the limited sleep has on this individuals daily activities. Medication should not be the first intervention used to help someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake.15. A nurse conducted a 5-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Blooms taxonomy?
a. If I eat too much food and do not exercise, I will gain weight.
b. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight.
c. I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight.
d. I can eat more if I exercise more.ANS: B
During the analysis stage of cognition, all aspects of learning come together in thought and the individual is cognizant of the relationships and interactions of all the parts. If I eat too much food and do not exercise, I will gain weight indicates knowledge (recall of facts). I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight indicates application. I can eat more if I exercise more indicates comprehension.16. A 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes, I do not notice objects unless they are in front of me. Which of the following disorders is the client likely experiencing?
a. Presbyopia
b. Glaucoma
c. Cataracts
d. Diabetic retinopathyANS: B
Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is farsightedness. Cataracts cause cloudy vision.17. Which of the following middle-age adults has successfully transitioned to Eriksons generativity-versus-stagnation stage of development?
a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week
b. A 63-year-old man who regrets his career choice and feels he cannot change careers
c. A 45-year-old woman who resents having to care for her aging mother-in-law
d. A 50-year-old man who has not saved for retirement but spends his discretionary income on vacations he takes by himselfANS: A
Generativity according to Eriksons theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense of isolation and focus on oneself.18. A 52-year-old woman going through menopause tells the nurse working in the womens health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse?
a. The latest research has shown that estrogen is safe to take and will help keep you healthy. Ill tell the nurse practitioner that you are interested in estrogen therapy.
b. Estrogen is safe to take for about 10 years. Ill get you some information on estrogen therapy that you can take home and read.
c. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes.
d. You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.ANS: C
Research about the safety of estrogen therapy is mixed, therefore it is only recommended for short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need research to back up their claims of safety or efficacy.19. The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries?
a. Make the work environment smoke-free.
b. Reduce environmental noise levels.
c. Conduct regular walk-through assessments at the worksite.
d. Increase paid personal days from one to three.ANS: A
Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking has such an impact on accident rates, this would have the largest effect on reduction of work-related injuries.20. Which of the following effects of divorce on middle-age adults and children has been documented by research?
a. Children adapt to divorce more rapidly than do adults.
b. Emotional healing after a divorce takes approximately 24 months in adults.
c. Children of divorced parents may have life-long difficulty forming relationships.
d. Children of divorced parents undergo similar emotional turmoil as their parents.ANS: C
Although research is continuing, longitudinal studies by Wallerstein and her colleagues beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years after the event.21. A nurse is discussing sexuality with middle-age men and women. Which of the following information should be stressed by the nurse?
a. Contraception usage should be decreased as a woman nears menopause.
b. Difficulty with sexual performance among men happens near age 60.
c. HIV infection after age 50 is rare.
d. The majority of new HIV/AIDS cases occur among middle-age adults.ANS: D
Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy occurs most often in middle-age women. Male sexual performance issues begin between the ages of 40 to 50. HIV infection is not rare among middle-age adults.22. An occupational health nurse is planning injury-prevention educational sessions. Which of the following considerations should be made by the nurse?
a. Education should be focused on workers with the least experience.
b. All workers need continued education related to safety issues.
c. OSHA rules apply to all companies with more than 25 employees.
d. Middle-age workers have the lowest rate of injury of any age group.ANS: B
The role of the occupational health nurse is focused on keeping the worksite safe for employees. Experienced workers may not know how to prevent injury. OSHA applies to all companies. There are no data to support that middle-age workers have the lowest rate of injury. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing).23. Taking into account all of the agents that affect middle-age adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first?
a. Limiting unprotected exposure to sun
b. Starting a smoking cessation program
c. Exercising at least three times a week
d. Scheduling a complete physical and dental examANS: D
Although limited unprotected exposure to the sun, starting a smoking cessation program, and regular exercise are important to overall health, assessment data must first be collected to create an effective lifestyle change program. Health care needs and issues vary according to race and ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education must be individualized.24. Which of the following medications is generally recommended to help preserve cardiovascular health in middle-age women?
a. Aspirin
b. Folic acid
c. Estrogen
d. Estrogen receptor modulatorANS: A
Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot formation.1. Which of the following individuals is at risk for developing osteoporosis? (select all that apply)
a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis
b. A 40-year-old woman who works as a secretary
c. A 60-year-old woman who walks three miles a day
d. A 50-year-old man who works as a masonANS: A, B
Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use. It increases with age.2. Blacks are more likely than non-Hispanic White Americans to be diagnosed with cancer at a later stage and have a less optimal outcome after the diagnosis is made. Which of the following reasons help explain this difference? (select all that apply)
a. Lack of access to, or utilization of, cancer screening
b. Lack of health insurance
c. Genetic variations
d. Lack of resiliency against diseaseANS: A, B, C
Although poverty and lack of access may account for lack of screening and early diagnosis, genetic variations in tumor growth and response to medication along with other major health problems also affect outcomes.3. A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (select all that apply)
a. A 54-year-old couple whose young adult daughter and grandson move back into their home
b. A 44-year-old single mother raising three adolescent children without child support
c. A 60-year-old couple whose children have established successful careers in another state
d. A 36-year-old couple whose child plays competitive tennisANS: A, B, D
Stressors of middle age include adult children moving back home, heading a single parent household, and parents whose child plays competitive sports with an emphasis on winning. The couple who has children living out of state who have established successful careers are at the least risk to have stress related to family dynamics.4. The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (select all that apply)
a. On-site walking paths
b. On-site food vendors
c. On-site counseling services
d. On-site meetings of support groups such as Alcoholics AnonymousANS: A, C, D
On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Depending on the food vendor who is on-site, the healthy food options may not be beneficial to the employees.1. A nurse is encouraging members of the community to advocate for the prevention of premature deaths in children under the age of 5 at the international level. Which of the following interventions would most likely be discussed by the nurse?
a. Using mosquito netting in sleeping areas
b. Participating in international vaccination programs
c. Implementing accident prevention programs
d. Providing nutritional supplementsANS: D
Protein-energy malnutrition can be severely harmful to the mental and physical development of individuals, especially young children under the age of 5. Worldwide, one out of two deaths among children younger than 5 years old stems from protein-energy malnutrition.2. A nurse is working at a clinic in a third world country and suspects a child has severe acute malnutrition (SAM). Which of the following assessment findings would be expected?
a. Distended abdomen
b. Bulging eyes
c. Large tears when crying
d. LethargyANS: A
Severe wasting is characterized by sunken eyes, visible ribs, and protruding shoulder blades. Children with severe wasting usually have a distended abdomen and general overall appearance in some way similar to an older adult. In general, these children are irritable, anxious, and cry easily; yet they will often have absence of tears while crying due to lachrymal gland atrophy.3. A nurse is determining if children with severe acute malnutrition (SAM) should receive facility-based or community-based care. Which of the following children should receive care in the community?
a. 3-year-old male who has a history of dehydration
b. 9-month-old male whose family has adequate support and resources to obtain the recommended treatment
c. 4-year-old female who has sensitivity to milk products
d. 6-month-old female who has a good appetite and no underlying medical conditionsANS: D
When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods (RUTF) under community-based care are appropriate. RUTF are special milk-based foods which are soft, crushable, and tasty nutrient- and energy-rich foods that can be consumed by children six months or older.4. A nurse working on a post-partum unit of a large urban hospital has received a grant to begin a Baby-Friendly Hospital Initiative developed by WHO. Which of the following statements would the nurse most likely make when explaining the major premises of the initiative to the unit manager?
a. This program is meant to encourage sibling visits in the early postpartum period, so the adjustment to a new baby is a smooth process.
b. A major goal of this program is to ensure that all infant/pediatric units have implemented basic safety initiatives.
c. Improving nutrition by promoting breast-feeding of newborns through four months of age is what this program is all about.
d. The purpose of this program is to make sure that all health care providers who care for newborns and children up to the age of 18 really understand basic principles of growth and development.ANS: C
The purpose of the initiative is to improve newborn nutrition by promoting breast-feeding of newborns through age 4 months.5. Which of the following projects would most likely be administered by International Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program?
a. Researching best methods to preserve the freshness of foods
b. Surveying various populations about consumption patterns
c. Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables
d. Analyzing the relationship between BMI and cardiovascular diseaseANS: B
IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral deficiencies around the globe. The IMMPaCT programs activities include conducting surveys; providing micronutrients to infants, young children, and women of childbearing age; and monitoring and evaluating intervention systems.6. The school nurse has been asked to present a workshop on CA-MRSA for high school teachers. Which of the following information would the nurse most likely include?
a. CA-MRSA is a common viral infection that responds well to antiviral meds.
b. CA-MRSA is a serious bacterial infection that does not spread easily.
c. CA-MRSA is a fungal infection common in school settings.
d. CA-MRSA is a potentially fatal skin infection that is difficult to treat.ANS: D
CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in pneumonia and death.7. The school nurse has been asked to present a workshop on how to prevent CA-MRSA spread in the school. Which of the following interventions should be emphasized?
a. Completing prophylactic antibiotic therapy for those in close contact with an infected person
b. Using correct hand-washing technique
c. Requiring those infected stay home from school until the infection has resolved
d. Disinfecting all classrooms on a daily basisANS: B
Hand washing is an effective way to prevent spread of the infection. In order to contract the infection, students must come into contact with a draining wound, etc.8. A nurse is providing care to HIV positive clients living in sub-Saharan communities in Africa. When discussing prevention of the transmission of HIV, which of the following statements should be made by the nurse?
a. Alternative practices to traditional sexual cleansing should be considered after the death of a spouse.
b. Traditional sexual cleansing should be performed with a cleanser who is known to not have HIV.
c. Virgin cleansing is a safer option than traditional sexual cleansing.
d. Traditional sexual cleansing can lead to further transmission of HIV.ANS: A
Although traditional sexual cleansing can lead to further transmission of HIV is a true statement, it is not the most culturally sensitive response by the nurse. The nurse should respect the cultural practices of the clients living in the sub-Saharan community and discuss that alternative practices may be a better option to traditional sexual cleansing.9. A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the following activities would the nurse most likely be involved in?
a. Determining prevalence rates of HIV/AIDS in African countries
b. Administering antiretroviral medications to pregnant women who are HIV positive
c. Providing treatment access for all HIV-positive individuals who need medication
d. Reporting confirmed cases of HIV to the World Health OrganizationANS: C
UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing the next generation for treatment, care, and support; and advancing human rights and gender equality in responses to HIV. Providing treatment access for all HIV-positive individuals who need medication meets the strategic direction of catalyzing the next generation for treatment, care, and support.10. A nurse is using the four-step public health approach to address violence in the community. Which of the following actions would the nurse take first?
a. Analyze a variety of data sources to determine the cause of the problem.
b. Examine risk factors that have contributed to the violence.
c. Develop an evidence-based program to address the problem.
d. Train community members to discuss the problem within their neighborhoods.ANS: B
The WHO has proposed a four-step public health approach which includes: defining the problem; identifying risks and protective factors; devising and testing means of dealing with violence; and applying successful means on a large scale. Defining the problem is the first step in this process. Examination of different data sources are needed to understand the magnitude of the problem.11. A nurse using the four-step public health approach to respond to violence. Which of the following actions would occur as the nurse identifies risk and protective factors?
a. Planning a community-based educational program to respond to violence
b. Reviewing police reports and population-based surveys
c. Interviewing local community members about their experiences with violence
d. Examining characteristics in the community where violence has not occurredANS: D
A risk factor is defined as a characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence, and a protective factor as a characteristic that decreases the likelihood of a person becoming a victim or perpetrator of violence. Knowing risk and protective factors can help responsible organizations and personnel to estimate violence magnitudes and devise appropriate prevention measures.12. The school nurse is planning a workshop for high school students about interpersonal violence (IPV). Which of the following information would the nurse discuss as risk factors for IPV?
a. Cultural norms
b. Family support
c. Drug and alcohol abuse
d. DepressionANS: C
Risk factors for IPV may include a victims low self-esteem, low self-control, and personality/conduct disorders. Other risk factors are reported to be lack of social support, dysfunctional family structure, family history of violence, and drug and alcohol abuse.13. The nurse is working at a crisis hotline center. Which of the following callers would be most at risk for suicide?
a. A 16-year-old girl who broke up with her boyfriend
b. A 26-year-old male who has been laid off from his job
c. A 50-year-old female who has a history of alcohol abuse
d. A 40-year-old male whose brother died suddenlyANS: C
Older adults have a greater risk of committing suicide than do younger people. Major factors contributing to suicide in Europe and North America include mental disorders especially depression and alcohol use disorders.14. Which of the following age groups is experiencing the greatest increase in suicide rates?
a. 15 to 24
b. 25 to 39
c. 40 to 59
d. 60 to 70ANS: A
Suicide rates among people aged 15 to 24 have been increasing to such an extent that they are the second leading cause of death in this age group in some developed and developing countries.15. Which of the following information about anthrax is correct?
a. Anthrax is a viral infection.
b. Anthrax can cause skin lesions or pneumonia.
c. Anthrax is spread by person-to-person contact.
d. Anthrax is treated by IV penicillin for 30 days.ANS: B
Anthrax is a bacillus that is not spread person-to-person. An anthrax infection is treated by using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days.16. Which of the following statements about smallpox is accurate?
a. Smallpox results in a rash that looks similar to the chickenpox rash.
b. Side effects from a smallpox vaccine include acute renal failure.
c. The last case of smallpox occurred in 1997.
d. The rash associated with smallpox is most prominent on the face and extremities.ANS: D
A rash from smallpox is most prominent on the face and extremities with the same stage of legion development. Additionally, smallpox symptoms usually resemble influenza symptoms. The smallpox rash is distinctive from the varicella rash. Side effects from the vaccination mostly involve a low fever, soreness in the injection area, and enlarged glands under the armpit. The last case of smallpox was in 1977.17. A nurse is working in the emergency department (ED). Which of the following situations would cause the nurse to suspect bioterrorism?
a. When two people out of twenty who ate at a restaurant come to the ED with nausea and vomiting
b. When a worker in a lab comes to the ED complaining of a severe headache
c. When thirteen people, aged 24 to 33, come to the ED with ascending flaccid muscle paralysis
d. When five people come to the ED with an upper respiratory infectionANS: C
The other examples are common problems for which people seek health care. Flaccid paralysis is a symptom of botulism.18. Which of the following statements best explains priorities related to preventative health care?
a. Global initiatives have been developed to respond to health care needs around the world.
b. Health care initiatives are focused mainly on people in developed countries because of the access to medication.
c. Health care initiatives are focused mainly on people in developing countries because of their great need.
d. Public health agencies are leaders in health care development.ANS: A
Health care initiatives have a global focus and involve developing as well as developed countries. Nurses play a major role in this initiative.19. A nurse states that many community members are concerned about the increasing number of natural disasters that have been occurring in the United States. Which of the following would the community members be referring to?
a. Fires and suicides
b. Wildfires and hurricanes
c. Traffic accidents and floods
d. Tornadoes and food poisoningsANS: B
Natural disasters phenomena that occur through natural forces involving land, air, or water, and they often have large-scale negative impacts on humans who live in the affected areas. Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter weather, and others.20. A hurricane has just caused extensive damage within a local community. Which of the following are community members at risk to experience?
a. Unequal access to health care
b. Exposure to community-associated methicillin-resistant Staphylococcus aureus
c. Increased incidence of suicide
d. Outbreaks of acute respiratory infectionANS: D
Victims of natural disasters tend to have limited access to essential infrastructures for survival related to food, water, shelter, and sanitation. Infection outbreaks commonly diagnosed after natural disasters include diarrhea, acute respiratory infections, viral hepatitis, and snail and trematode infections.21. A primary care clinic is being established in a rural county that recently experienced a hurricane severely damaging its infrastructure for medical care. Which of the following considerations would be the priority when planning for this clinic?
a. The ability to provide mental health services to community members
b. The ability to deliver primary care services to community members
c. The ability to refer community members to other necessary services
d. The ability to supply community members with daily necessitiesANS: A
The priority in planning should be the ability to provide mental health services to the community members. In 2007, the Inter-Agency Standing Committee developed its Guidelines on Mental Health and Psychosocial Support in Emergency Setting. It emphasizes the importance of primary care clinics being able to provide mental health services to victims of the disaster.22. A nurse is advocating for improved disease prevention and health promotion within the local community. Which of the following interventions would the nurse most likely implement?
a. Educate community members about the violence rates that exist within the community.
b. Administer flu shots for elderly at a local senior citizens center.
c. Participate in a disaster planning committee within the community.
d. Talk with a state legislator about improved access to health care for the uninsured and underinsured.ANS: D
In order to be advocates for newly emerging priorities for disease prevention and health promotion, nurses in the twenty-first century need to participate in policy development for health promotion as the health care of individuals in acute settings shifts from hospitals to home and community settings, influence public expectations about health promotion, and promote equitable access to preventive health care. Talking with a state legislator about improving access to health care for the uninsured and underinsured is the only example that demonstrates the nurse in the role of an advocate working in one of these priority areas.1. Which of the following are classifications within the World Health Organizations (WHO) definition of malnutrition? (select all that apply)
a. Obesity
b. Micronutrients deficiencies
c. Protein-energy malnutrition
d. Water insufficiencyANS: A, B, C
Inadequate or excessive intake of protein and or vitamins and obesity are components of the WHOs definition of malnutrition.2. Which of the following individuals would be susceptible to CA-MRSA? (select all that apply)
a. 16-year-old student who plays football
b. 48-year-old person who has taken antibiotics for sinus infections
c. 36-year-old man serving 12 months in jail for robbery
d. 22-year-old woman who shares a towel after a swimming meetANS: A, B, C, D
CA-MRSA is spread by close skin-to-skin contact such as during contact sports, by sharing towels and clothing, and by those living in crowded conditions. People who take or who have been on antibiotic therapy are also susceptible to CA-MRSA.3. A nurse employed by the World Health Organization is working with HIV positive clients in Africa and is teaching them about ways to reduce transmission of this disease. Which of the following barriers should be considered when planning this education? (select all that apply)
a. Culture-specific practices
b. Unavailability of antibiotic therapy
c. Lack of understanding about the transmission process
d. Overcrowded living areasANS: A, C
Culture-specific sexual practices such as sexual cleansing and a lack of understanding about how HIV is spread contribute to its transmission. HIV is a viral infection, not a bacterial infection. Simply living with someone who has HIV will not result in transmission unless the person comes into contact with blood or bodily fluid from the infected person.4. A school nurse is planning an educational presentation for high school students about violence. Which of the following statements would be included in the presentation? (select all that apply)
a. Violent behavior happens when someone bullies another person.
b. Withholding food from a child as a punishment is violent behavior.
c. Collective violence occurs during an argument between two people.
d. Painting a racial slur on a building is violent behavior.ANS: A, B, D
Violent behavior as defined by WHO is the intentional use of physical force or power, threatened or actual against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives.5. Which of the following individuals assessed by the nurse is experiencing interpersonal violence? (select all that apply)
a. A 16-year-old female who hides in her apartment due to civil unrest in the country
b. A 32-year-old male whose co-worker sends him insulting e-mails at work
c. A 19-year old male who has attempted suicide
d. A 78-year-old female living in a nursing home who is force-fed by aidesANS: B, D
Interpersonal violence is violence committed by an individual or a small group of people in a wide range of acts and behaviors (emotional, physical, sexual, and psychological). The violence can happen to people of any age and at any place. Self-directed violence occurs with self-abuse and suicide. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives.6. A nurse is participating in disaster preparedness planning for the local community. Which of the following would be an appropriate responsibility for the nurse? (select all that apply)
a. Completing a risk assessment in the community
b. Implementing strategies to decrease posttraumatic stress disorder
c. Coordinating meetings among multiple agencies and disciplines
d. Evaluating the economic impact of the disasterANS: A, C
The International Council for Nurses spells out its position on the role of the nurse concerning disaster preparedness to include risk assessment as well as management strategies bridging multiple disciplines and system levels. To coordinate health sector preparedness, regulatory meetings and frameworks across cultures will help nurses plan for and streamline health care responses to such mass events internationally.Question 1
Type: MCSA
A nurse is helping the parents of 2-year-old twins cope with the daily demands of life in an active household. Which strategy is most appropriate for the nurse to use?
1. Health maintenance
2. Health promotion
3. Health protection
4. Health supervisionorrect Answer: 2
Rationale 1: In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.
Rationale 2: In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.
Rationale 3: In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.
Rationale 4: In health promotion, nurses partner with families to promote family strategies in the areas of lifestyle and coping. The definition of health maintenance and health supervision makes the other answers incorrect. Health protection is another term for health maintenance.Question 2
Type: MCSA
A nurse in the outpatient pediatric clinic is reviewing the records of a preschool-age child and notes that because the parents often miss routine healthcare visits the child has not received the second measles, mumps, and rubella (MMR) vaccine. Which action by the nurse is most appropriate in this situation?
1. Speak firmly with the parents about the importance of being compliant.
2. Notify the physician that the childs immunizations are no longer up to date.
3. Call the parents and encourage them to bring the child for recommended care.
4. Plan to discuss the principles of health supervision at the next scheduled visit.orrect Answer: 3
Rationale 1: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.
Rationale 2: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.
Rationale 3: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.
Rationale 4: The nurse in the pediatric healthcare setting is responsible for reviewing the health supervision of the child. Partnering with the parents and encouraging the parents to follow health-supervision guidelines are the best strategies to use. Speaking firmly with the parents about compliance will alienate the parents at this time. A discussion of the principles of health supervision without an intervention at this visit would mean a delay in needed health care for the child in this example. Discussing with the physician that the immunizations are not up to date is not necessary in an outpatient clinic. Immunizations are given per schedule.Question 3
Type: MCSA
A mother brings a child to the pediatric office for a sick visit. Which action by the nurse is the most appropriate?
1. Focus exclusively on the reported illness.
2. Review health-promotion and health-maintenance activities.
3. Ask the mother to leave the room after obtaining the history.
4. Obtain a comprehensive history, including sociodemographic data.Correct Answer: 2
Rationale 1: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.
Rationale 2: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.
Rationale 3: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.
Rationale 4: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.
Global Rationale: A nurse should use every opportunity during an office visit to review health-promotion and health-maintenance activities. Focusing exclusively on the reported illnesses ignores the opportunity to use health-promotion strategies. There is not enough data in this scenario to determine whether the mother should be asked to leave the room. There is not enough information to indicate that a comprehensive history should be taken at this visit.Question 4
Type: MCSA
Which of these strategies would be most effective for a teachable moment during a routine office visit for the parents of a 6-year-old child?
1. Select one topic and present a brief amount of information on the topic.
2. Review all 6-year-old anticipatory guidelines with the parents.
3. Review 7-year-old anticipatory guidelines with the parents.
4. Discuss signs of malnutrition with the parents.Correct Answer: 1
Rationale 1: Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.
Rationale 2: Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.
Rationale 3: Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.
Rationale 4: Children and families often learn best when presented with small bits of information. Do not give too much information to the parents at one time; therefore, selecting one topic and presenting information is appropriate. It is not appropriate to discuss malnutrition with these parents, since nothing in the stem of the question indicates that the child has a problem with nutrition.Question 5
Type: MCMA
The clinic administrator has asked each nurse to classify the nursing activities as a beginning step of clinic reorganization. Which of these strategies can be identified as health promotion and health maintenance?
Standard Text: Select all that apply.
1. Administration of the flu vaccine for infants from 6 months to 23 months old.
2. Daily feeding schedules for infants.
3. Instruction to adolescents on how to use dental floss.
4. Treatment for a child with a diagnosis of acute otitis media.Correct Answer: 1,2,3
Rationale 1: Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.
Rationale 2: Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.
Rationale 3: Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.
Rationale 4: Administering flu vaccines, discussion of feeding schedules, and instructions to adolescents are all health-promotion and/or health-maintenance topics. Treatment of an acute ear infection (otitis media) would not be a topic for health promotion and health maintenance since it is an acute illness.Question 6
Type: MCSA
A mother of a 2-year-old child becomes very anxious when the child has a temper tantrum in the medical office. Which response by the nurse is the most appropriate?
1. What do you usually do or say during a temper tantrum?
2. Lets ignore this behavior; it will stop sooner or later.
3. Pick up and cuddle your child now, please.
4. This is definitely a temper tantrum; I know exactly what you are feeling right now.Correct Answer: 1
Rationale 1: Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother (I know exactly what you are feeling) are not effective ways to problem solve for temper tantrums.
Rationale 2: Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother (I know exactly what you are feeling) are not effective ways to problem solve for temper tantrums.
Rationale 3: Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother (I know exactly what you are feeling) are not effective ways to problem solve for temper tantrums.
Rationale 4: Asking the mother to describe her usual behavior via an open-ended question will encourage the mother to talk about home management and will lead the nurse to assist the mother in making a plan of care for temper tantrums. Ignoring the behavior, instructing the mother to cuddle the child, or sympathizing with the mother (I know exactly what you are feeling) are not effective ways to problem solve for temper tantrums.Question 7
Type: MCSA
A nurse says to the mother of a 6-month-old infant, Does the baby sit without assistance, and is the baby crawling? Which process is the nurse using in this interaction?
1. Health promotion
2. Health maintenance
3. Disease surveillance
4. Developmental surveillanceCorrect Answer: 4
Rationale 1: The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers health promotion and health maintenance are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.
Rationale 2: The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers health promotion and health maintenance are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.
Rationale 3: The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers health promotion and health maintenance are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.
Rationale 4: The question asked by the nurse is seeking information about developmental milestones; therefore, the nurse is involved in developmental surveillance. While health-promotion and health-maintenance activities are related to developmental surveillance, this question is looking specifically at the milestones; therefore, the answers health promotion and health maintenance are incorrect. The questions asked in the stem are not classified as disease-surveillance questions.Question 8
Type: MCSA
A parent says to a nurse, How do you know when my child needs these screening tests the doctor just mentioned? Which response by the nurse is the most appropriate?
1. Screening tests are administered at the ages when a child is most likely to develop a condition.
2. Screening tests are done in the newborn nursery and from these results, additional screening tests are ordered throughout the first two years of life.
3. Screening tests are most often done when the doctor suspects something is wrong with the child.
4. Screening tests are done at each office visit.Correct Answer: 1
Rationale 1: Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.
Rationale 2: Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.
Rationale 3: Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.
Rationale 4: Screening tests administered at ages when a child is most likely to develop a condition provide a good basis for health promotion. The remaining answers all provide incorrect information to the parent. Abnormal newborn screening tests require immediate follow-up. Screening tests are done to detect the possibility of problems, not when a problem is suspected; at that point, a child needs diagnostic testing. Screening tests are not done at each office visit.Question 9
Type: MCMA
Which nursing assessment activities should be included for the child and family at each health-supervision visit?
Standard Text: Select all that apply.
1. Interview to obtain an updated health history.
2. Performing an age-appropriate development assessment.
3. Monitoring parents ability to pay for services.
4. Performing age-appropriate screening examinations.
5. Physical assessment for genetic abnormalities.Correct Answer: 1,2,4
Rationale 1: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.
Rationale 2: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.
Rationale 3: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.
Rationale 4: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.
Rationale 5: The interview, the developmental assessment, and age-appropriate screenings are all included in the nursing assessment of a child and family during each health-supervision visit. A nurse would not assess the parents financial status at each health-supervision visit. Physical assessments for genetic abnormalities would be done based on history and/or physical findings, not at each routine visit.Question 10
Type: MCSA
The nurse of an outpatient clinic is sitting with the parents while their adolescent goes for a test. The parents are complaining about their childs behavior. Which statement by the nurse fosters family-centered communication?
1. I agree with you, discipline is an important part of parenting.
2. I know just how you feel. I had the same experience with my children.
3. You are so right. Adolescents function in the me-first mode all the time.
4. Tell me what concerns you about your childs behavior.Correct Answer: 4
Rationale 1: Using an open-ended question allows the parents to discuss a family concern. All the other questions or statements are blocking statements and would not foster family-centered communication.
Rationale 2: Using an open-ended question allows the parents to discuss a family concern. All the other questions or statements are blocking statements and would not foster family-centered communication.Question 11
Type: MCSA
The nurse is assessing an adolescent client whose weight is in the 5th percentile. Based on this information, which question is most appropriate for the nurse to ask the adolescent client?
1. Do you eat the school lunches?
2. Do you have any concerns about your weight?
3. Do you eat fruits, vegetables, and drink milk?
4. How many meals do you eat each day?vCorrect Answer: 2
Rationale 1: The only question that addresses the adolescents weight, which is below the expected norm, is Do you have any concerns about your weight? Asking about school lunches, eating fruits and vegetables, and how many meals eaten each day should be used to obtain a nutritional history; however, those questions do not address the underweight status of the adolescent.
Rationale 2: The only question thaQuestion 12
Type: MCSA
In the pediatric well-child clinic, the nurse explains the reason for an immunization series to the childs mother. This action represents which item?
1. Health assessment
2. Health promotion
3. Health maintenance
4. Health screeningCorrect Answer: 2
Rationale 1: The explanation to the mother by the nurse provides an understanding of the immunization series to the mother and enables the mother to make an intelligent choice. While administering immunizations is considered health maintenance, the activity described in the question is clearly health promotion. A health assessment would be completed to determine what immunizations are needed. Health maintenance is the actual administration of the immunization and health screening involves looking at the immunization record to determine which immunizations are needed.Question 13
Type: MCSA
A pediatric nurse who is employed in a busy ambulatory clinic setting is informed by the nurse manager that average nursing time allocated for each child and family is being reduced to 10 minutes to more efficiently manage the clinic. The nursing activities must include a nursing assessment and discussion on anticipatory guidance. Which of these strategies should the nurse utilize in the plan of care delivery?
1. Attempt to complete the assessment and education in 10 minutes, but extend the time whenever the nurse deems necessary.
2. Plan to do the anticipatory guidance first since either the nurse practitioner or the physician can perform the assessment of the child.
3. Encourage the parent to ask for specific time to talk with the nurse privately at each office visit.
4. Focus anticipatory guidance strategies on topics that the parent or child have expressed as an area of interest.Correct Answer: 4
Rationale 1: With limited time for each visit, the nurse should focus on anticipatory guidance strategies that will most benefit the parent and child during that office visit.Question 14
Type: MCSA
Which assessment would not be included with a 17-year-olds screening during a routine health supervision visit?
1. STI evaluation
2. Autism screening
3. Hemoglobin test
4. Vision screeningCorrect Answer: 2
Rationale 1: Autism screening would not be appropriate at this age. If autism were present, it would have presented before this age. STI evaluation, hemoglobin test, and vision screening are all appropriate for a 17-year-old.Question 15
Type: MCSA
A nurse is discussing health promotion activities with parents of a 4-year-old client. What health-promotion activity is most appropriate for this family?
1. Make arrangements to tour the kindergarten in which the child will enroll next year.
2. Plan a movie afternoon with the childs big brother.
3. Maintain appropriate immunizations.
4. Teach the child the proper method for brushing the teeth.Correct Answer: 4
Rationale 1: Teaching proper oral hygiene through proper teeth brushing is a health-promotion activity. Touring the kindergarten might alleviate anxiety, but is not health promotion. A movie afternoon with the big brother is sedentary, and also not a health-promotion activity. Maintaining immunizations is a health-maintenance, not health-promotion, activity.Question 16
Type: MCMA
The nurse educator is teaching a group of students about the key concepts of a medical home during the developmental years of the pediatric client. Which items should the educator include in the teaching session?
Standard Text: Select all that apply.
1. Financial accessibility
2. Consistent, ongoing care
3. Coordination of care
4. No individualization of care
5. A paternalistic view of careCorrect Answer: 1,2,3
Rationale 1: All children need a medical home, where accessible, continuous, and coordinated health supervision is provided during the developmental years. Accessibility refers to both financial and geographic access; continuous indicates that the care is ongoing with consistent care providers; coordination refers to the need for communication among health professionals to provide for the needs of the child. Care is individualized and is not paternalistic.1. Which nutrients recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a.
Energy (kcal)
b.
Iron
c.
Vitamin A
d.
Folic acidANS: A
Nutrient needs for energyprotein, calcium, iodine, zinc, B vitamins, and vitamin Cremain higher during lactation than during pregnancy. The need for iron is not higher during lactation than during pregnancy. A lactating woman does not have a greater requirement for vitamin A than a nonpregnant woman. Folic acid requirements are the highest during the first trimester of pregnancy.2. A pregnant womans diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about?
a.
Calcium
b.
Protein
c.
Vitamin B12
d.
Folic acidANS: C
A pregnant womans diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the womans food choices, a pregnant womans diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the womans intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.3. Which statement made by a lactating woman leads the nurse to believe that the client might have lactose intolerance?
a.
I always have heartburn after I drink milk.
b.
If I drink more than a cup of milk, I usually have abdominal cramps and bloating.
c.
Drinking milk usually makes me break out in hives.
d.
Sometimes I notice that I have bad breath after I drink a cup of milk.ANS: B
Lactose intolerance, which is an inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine, is a problem that interferes with milk consumption. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. A woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A client who breaks out in hives after consuming milk is more likely to have a milk allergy and should be advised to simply brush her teeth after consuming dairy products.4. A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake?
a.
Fresh apricots
b.
Canned clams
c.
Spaghetti with meat sauce
d.
Canned sardinesANS: D
Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.5. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. What is this clients total recommended weight gain during pregnancy?
a.
20 kg (44 lb)
b.
16 kg (35 lb)
c.
12.5 kg (27.5 lb)
d.
10 kg (22 lb)NS: C
This woman has a normal BMI and should gain 11.5 to 16 kg during her pregnancy. A weight gain of 20 kg (44 lb) is unhealthy for most women; a weight gain of 16 kg (35 lb) is at the high end of the range of weight this woman should gain in her pregnancy; and a weight gain of 10 kg (22 lb) is appropriate for an obese woman. This woman has a normal BMI, which indicates that her weight is average.6. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive?
a.
Discontinue all contraception now.
b.
Lose weight so that you can gain more during pregnancy.
c.
You may take any medications you have been regularly taking.
d.
Make sure you include adequate folic acid in your diet.ANS: D
A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A womans folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception that she has been using, discontinuing all contraception at this time may not be appropriate. Advising this client to lose weight now so that she can gain more during pregnancy is also not appropriate advice. Depending on the type of medications the woman is taking, continuing to take them regularly may not be appropriate.7. To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements?
a.
On a full stomach
b.
At bedtime
c.
After eating a meal
d.
With milkANS: B
Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.8. After the nurse completes nutritional counseling for a pregnant woman, she asks the client to repeat the instructions to assess the clients understanding. Which statement indicates that the client understands the role of protein in her pregnancy?
a.
Protein will help my baby grow.
b.
Eating protein will prevent me from becoming anemic.
c.
Eating protein will make my baby have strong teeth after he is born.
d.
Eating protein will prevent me from being diabetic.ANS: A
Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of the amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in those with diabetes; protein is one nutritional factor to consider for glycemic control but not the primary role of protein intake.9. Pregnant adolescents are at greater risk for decreased BMI and fad dieting with which condition?
a.
Obesity
b.
Gestational diabetes
c.
Low-birth-weight babies
d.
High-birth-weight babiesANS: C
Adolescents tend to have lower BMIs. In addition, the fetus and the still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity is associated with a higher-than-normal BMI. Unless the teenager has type 1 diabetes, an adolescent with a low BMI is less likely to develop gestational diabetes. High-birth-weight or large-for-gestational age (LGA) babies are most often associated with gestational diabetes.10. Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case?
a.
Maternal nutritional status is extremely difficult to adjust because of an individuals ingrained eating habits.
b.
Adequate nutrition is an important preventive measure for a variety of problems.
c.
Women love obsessing about their weight and diets.
d.
A womans preconception weight becomes irrelevant.ANS: B
Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach. Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will benefit their baby. Pregnancy is not the time to begin a weight loss diet. Clients and their caregivers should still be concerned with appropriate weight gain.11. With regard to weight gain during pregnancy, the nurse should be aware of which important information?
a.
In pregnancy, the womans height is not a factor in determining her target weight.
b.
Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with women of normal weight.
c.
Women with inadequate weight gain have an increased risk of delivering a preterm infant with intrauterine growth restriction (IUGR).
d.
Greater than expected weight gain during pregnancy is almost always attributable to old-fashioned overeating.ANS: C
IUGR is associated with women with inadequate weight gain. The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the womans height. Obese women are twice as likely as women of normal weight to give birth to a child with major congenital defects. Overeating is only one of several likely causes.12. Which nutritional recommendation regarding fluids is accurate?
a.
A womans daily intake should be six to eight glasses of water, milk, and/or juice.
b.
Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry.
c.
Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns.
d.
Water with fluoride is especially encouraged because it reduces the childs risk of tooth decay.ANS: A
Six to eight glasses is still the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be consumed only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. Although no evidence indicates that prenatal fluoride consumption reduces childhood tooth decay, fluoride still helps the mother.13. Which minerals and vitamins are usually recommended as a supplement in a pregnant clients diet?
a.
Fat-soluble vitamins A and D
b.
Water-soluble vitamins C and B6
c.
Iron and folate
d.
Calcium and zincANS: C
Iron should generally be supplemented, and folic acid supplements are often needed because folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C is sometimes naturally consumed in excess; vitamin B6 is prescribed only if the woman has a very poor diet; and zinc is sometimes supplemented. Most women get enough calcium.4. Which vitamins or minerals may lead to congenital malformations of the fetus if taken in excess by the mother?
a.
Zinc
b.
Vitamin D
c.
Folic acid
d.
Vitamin AANS: D
If taken in excess, vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. Zinc, vitamin D, and folic acid are all vital to good maternity and fetal health and are highly unlikely to be consumed in excess.15. While obtaining a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior indicate?
a.
Preeclampsia
b.
Pyrosis
c.
Pica
d.
PurgingANS: C
The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica. Preeclampsia is a vasospastic disease process encountered after 20 weeks of gestation. Characteristics of preeclampsia include increasing hypertension, proteinuria, and hemoconcentration. Pyrosis is a burning sensation in the epigastric region, otherwise known as heartburn. Purging refers to self-induced vomiting after consuming large quantities of food.16. Assessment of a womans nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. Which finding might require consultation to a higher level of care?
a.
Oral contraceptive use may interfere with the absorption of iron.
b.
Illnesses that have created nutritional deficits, such as PKU, may require nutritional care before conception.
c.
The womans socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker.
d.
Testing for diabetes is the only nutrition-related laboratory test most pregnant women need.ANS: B
A registered dietitian can help with therapeutic diets. Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss. A womans finances can affect her access to good nutrition; her education (or lack thereof) can influence the nurses teaching decisions. The nutrition-related laboratory test that pregnant women usually need is a screen for anemia.
DIF: Cognitive Level: Apply REF: p. 35617. Which guidance might the nurse provide for a client with severe morning sickness?
a.
Trying lemonade and potato chips
b.
Drinking plenty of fluids early in the day
c.
Immediately brushing her teeth after eating
d.
Never snacking before bedtimeANS: A
Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.18. Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide?
a.
Canned white tuna is a preferred choice.
b.
Shark, swordfish, and mackerel should be avoided.
c.
Fish caught in local waterways is the safest.
d.
Salmon and shrimp contain high levels of mercury.ANS: B
As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well as the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. Assisting the client in understanding the differences between numerous sources of mercury is essential for the nurse. A pregnant client may eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, then these fish sources should be avoided, limited to less than 6 ounces per week, or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces of commercially caught fish per week. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.19. Nutrition is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse is able to evaluate the clients nutritional status by observing a number of physical signs. Which physical sign indicates to the nurse that the client has unmet nutritional needs?
a.
Normal heart rate, rhythm, and blood pressure
b.
Bright, clear, and shiny eyes
c.
Alert and responsive with good endurance
d.
Edema, tender calves, and tinglingANS: D
The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, edema in the lower extremities may also be a common physical finding during the third trimester. Completing a thorough health history and physical assessment and requesting further laboratory testing, if indicated, are essential for the nurse. The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A client receiving adequate nutrition will have bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae are signs of poor nutrition. A client who is alert and responsive with good endurance is20. A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. Which recommendation would the nurse make for this particular client after a tennis match?
a.
Drink several glasses of fluid.
b.
Eat extra protein sources such as peanut butter.
c.
Enjoy salty foods to replace lost sodium.
d.
Consume easily digested sources of carbohydrate.ANS: A
If no medical or obstetric problems contraindicate physical activity, then pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The womans caloric intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.
DIF: Cognitive Level: Apply REF: p. 356 TOP: Nursing Process: Planning21. A woman in the 34th week of pregnancy reports that she is very uncomfortable because of heartburn. Which recommendation would be appropriate for this client?
a.
Substitute other calcium sources for milk in her diet.
b.
Lie down after each meal.
c.
Reduce the amount of fiber she consumes.
d.
Eat five small meals daily.ANS: D
Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.
DIF: Cognitive Level: Apply REF: p. 362 TOP: Nursing Process: Planning22. Which information regarding protein in the diet of a pregnant woman is most helpful to the client?
a.
Many protein-rich foods are also good sources of calcium, iron, and B vitamins.
b.
Many women need to increase their protein intake during pregnancy.
c.
As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet.
d.
High-protein supplements can be used without risk by women on macrobiotic diets.ANS: A
Good sources for protein, such as meat, milk, eggs, and cheese, have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.23. A client states that she plans to breastfeed her newborn infant. What guidance would be useful for this new mother?
a.
The mothers intake of vitamin C, zinc, and protein can now be lower than during pregnancy.
b.
Caffeine consumed by the mother accumulates in the infant, who may be unusually active and wakeful.
c.
Critical iron and folic acid levels must be maintained.
d.
Lactating women can go back to their prepregnant caloric intake.NS: B
A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are lower during lactation. Lactating women should consume approximately 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.24. The labor and delivery nurse is preparing a client who is severely obese (bariatric) for an elective cesarean birth. Which piece of specialized equipment will not likely be needed when providing care for this pregnant woman?
a.
Extra-long surgical instruments
b.
Wide surgical table
c.
Temporal thermometer
d.
Increased diameter blood pressure cuffANS: C
Obstetricians today are seeing an increasing number of morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty,bariatric obstetrics, has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant client of any size.25. Which pregnant woman should strictly follow weight gain recommendations during pregnancy?
a.
Pregnant with twins
b.
In early adolescence
c.
Shorter than 62 inches or 157 cm
d.
Was 20 pounds overweight before pregnancyANS: D
A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth, as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.26. The major source of nutrients in the diet of a pregnant woman should be composed of what?
a.
Simple sugars
b.
Fats
c.
Fiber
d.
Complex carbohydratesANS: D
Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is primarily supplied by complex carbohydrates.27. A pregnant womans diet may not meet her increased need for folates. Which food is a rich source of this nutrient?
a.
Chicken
b.
Cheese
c.
Potatoes
d.
Green leafy vegetablesANS: D
Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor sources for folates. Potatoes contain carbohydrates and vitamins and minerals but are poor sources for folates.
DIF: Cognitive Level: Remember28. If a clients normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy?
a.
5
b.
10
c.
25
d.
30ANS: C
The recommended intake of protein for the pregnant woman is 70 g. Therefore, additional protein intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than would be necessary and would add extra calories.
DIF: Cognitive Level: Understand REF: p.29. Which action is the first priority for the nurse who is assessing the influence of culture on a clients diet?
a.
Evaluate the clients weight gain during pregnancy.
b.
Assess the socioeconomic status of the client.
c.
Discuss the four food groups with the client.
d.
Identify the food preferences and methods of food preparation common to the clients culture.ANS: D
Understanding the clients food preferences and how she prepares food will assist the nurse in determining whether the clients culture is adversely affecting her nutritional intake. An evaluation of a clients weight gain during pregnancy should be included for all clients, not only for clients from different cultural backgrounds. The socioeconomic status of the client may alter the nutritional intake but not the cultural influence. Teaching the food groups to the client should come after assessing her food preferences.30. The nurse has formulated a diagnosis of Imbalanced nutrition: Less than body requirements for the client. Which goal is most appropriate for this client to obtain?
a.
Gain a total of 30 pounds.
b.
Consistently take daily supplements.
c.
Decrease her intake of snack foods.
d.
Increase her intake of complex carbohydrates.ANS: A
A weight gain of 30 pounds is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this client and does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be needed and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant client. Although increasing the intake of complex carbohydrates is important for this client, monitoring the weight gain should be the end goal.31. Which action is the highest priority for the nurse when educating a pregnant adolescent?
a.
Emphasize the need to eliminate common teenage snack foods because they are high in fat and sodium.
b.
Determine the weight gain needed to meet adolescent growth, and add 35 pounds.
c.
Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value.
d.
Realize that most adolescents are unwilling to make dietary changes during pregnancy.ANS: B
Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The client should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.
DIF: Cognitive Level: Apply REF: p. 3561. Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.)
a.
Preexisting or gestational illness such as diabetes
b.
Ethnic or cultural food patterns
c.
Obesity
d.
Vegetarian diets
e.
Multifetal pregnancyANS: A, B, C, D
The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia, as well as an increased risk for perinatal morbidity and mortality, the client with a preexisting or gestational illness would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant client may be under the misapprehension that, because of her excess weight, little or no weight gain is necessary. According to the Institute of Medicine, a client with a BMI in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may require in-depth counseling on the optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A multifetal pregnancy can be managed by increasing the number of servings of complex carbohydrates and proteins.
DIF: Cognitive Level: Apply REF: pp. 358-3592. Foodborne illnesses can cause adverse effects for both mother and fetus. The nurse is in an ideal position to evaluate the clients knowledge regarding steps to prevent a foodborne illness. The nurse asks the client to teach back the fours simple steps of food preparation. What are they? (Select all that apply.)
a.
Purchase
b.
Clean
c.
Separate
d.
Cook
e.
ChillANS: B, C, D, E
According to the U.S. Food and Drug Administration (2013), the four simple steps are:
Clean: Frequently cleanse hands, food preparation surfaces, and utensils.
Separate: Avoid contact among raw meat, fish, or poultry and other foods that will not be cooked before consumption.
Cook: Cook foods to the proper temperature.
Chill: Properly store foods, and promptly refrigerate.Question 1
Type: MCSA
A school-age client, recently diagnosed with asthma, also has a peanut allergy. The nurse instructs the family to not only avoid peanuts but also to carefully check food label ingredients for peanut products and to make sure dishes and utensils are adequately washed prior to food preparation. The mother asks why this is specific for her child. Based on the clients history, the nurse knows that this client is at an increased risk for which complication?
1. Urticaria
2. Diarrhea
3. Anaphylaxis
4. HeadacheCorrect Answer: 3
Rationale 1: Children with food allergies may experience all of the above reactions to a particular food, but the child who also has asthma is most at risk for death secondary to anaphylaxis caused by a food allergy.Question 2
Type: MCSA
While teaching the parents of a newborn about infant care and feeding, which instruction by the nurse is the most appropriate?
1. Delay supplemental foods until the infant is 4 to 6 months old.
2. Delay supplemental foods until the infant reaches 15 pounds or greater.
3. Begin diluted fruit juice at 2 months of age, but wait three to five days before trying a new food.
4. Add rice cereal to the nighttime feeding if the infant is having difficulty sleeping after 2 months of age.Correct Answer: 1
Rationale 1: Four to six months is the optimal age to begin supplemental feedings because earlier feeding of nonformula foods is not needed by the infant and does not promote sleep. Earlier feeding of nonformula foods, regardless of the infants weight, is more likely to cause the development of food allergies. Also, early feeding is not well tolerated by infants because the necessary tongue control is not well developed and they lack the digestive enzymes to take in and metabolize many food products.Question 3
Type: MCSA
During a 4-month-olds well-child check, the nurse discusses introduction of solid foods into the infants diet and concerns for foods commonly associated with food allergies. Due to allergies, which foods will the nurse instruction the parents to avoid until after 1 year of age?
1. Strawberries, eggs, and wheat
2. Peas, tomatoes, and spinach
3. Carrots, beets, and spinach
4. Squash, pork, and tomatoesCorrect Answer: 1
Rationale 1: Strawberries, eggs, and wheat, along with corn, fish, and nut products, are all foods that have commonly been associated with food allergies. Carrots, beets, and spinach contain nitrates and should not be given before the age of 4 months. Squash, peas, and tomatoes are acceptable to try after an infant is 4 to 6 months old but should be given one at a time and three to five days after starting a new food. Pork can be tried after the infant is 8 to 10 months old, as meats are harder to digest and have a high protein load.Question 4
Type: MCSA
The mother of a toddler is concerned because her child does not seem interested in eating. The child is drinking five to six cups of whole milk per day and one cup of fruit juice. When the weight-to-height percentile is calculated, the child is in the 90th to 95th percentile. What is the best advice the nurse can provide to the mother?
1. Eliminate the fruit juice from the childs diet.
2. Offer healthy snacks, presented in a creative manner, and let the child choose what he wants to eat without pressure from the parents.
3. Change from whole milk to 2 percent milk and decrease milk consumption to three to four cups per day and the fruit juice to a half cup per day, offering water if the child is still thirsty in between.
4. Make sure that the child is getting adequate opportunities for exercise, as this will increase his appetite and help lower the childs weight-to-height percentile.Correct Answer: 3
Rationale 1: Toddlers require a maximum of about one liter of milk per day. This toddler is consuming most of his or her calories from the milk and thus is not hungry. The high fat content of the milk and the high sugar content of the fruit juice are also contributing to the childs higher weight-to-height percentile. Decreasing the amount and fat content of the milk and decreasing the intake of fruit juice will decrease calories and thus make the child hungry for other foods. The other advice is also appropriate but did not address the problem of excessive milk consumption.Question 5
Type: MCSA
A nurse is talking to the mother of an exclusively breast-fed African American 3-month-old infant who was born in late fall. Which supplement will the nurse recommend for this infant?
1. Iron
2. Vitamin D
3. Fluoride
4. CalciumCorrect Answer: 2
Rationale 1: An infants iron stores are usually adequate until about 4 to 6 months of age. The infant should be receiving sufficient amounts of calcium from breast milk, and fluoride supplementation, if needed, does not begin until the child is approximately 6 months old. This infant will have limited exposure to sunlight and thus vitamin D because of the infants dark skin and decreased sun exposure in the fall and winter months.Question 6
Type: MCSA
The nurse is teaching the parents of a 4-month-old infant about good feeding habits. The nurse emphasizes the importance of holding the baby during feeding and not letting the infant go to sleep with the bottle. Which disorder is associated with propped feedings and going to sleep with the bottle?
1. Otitis media
2. Aspiration
3. Malocclusion problems
4. Sleeping disordersCorrect Answer: 1
Rationale 1: It has been shown in numerous studies that allowing an infant to fall asleep with a bottle in his or her mouth causes pooling of the formula in the mouth, which increases the risk of both dental caries and otitis media. There has been limited data to date showing a positive correlation between bottle propping and increased risk of aspiration, malocclusions, and sleeping disorders.Question 7
Type: MCMA
The parents of a toddler are concerned about their childs finicky eating habits. While counseling the parents, which statements by the nurse are the most appropriate?
Standard Text: Select all that apply.
1. The child is experiencing physiologic anorexia, which is normal for this age group.
2. A general guideline for food quantity at a meal is one-quarter cup of each food per year of age.
3. It is more appropriate to assess a toddlers nutritional demands over a 1-week period rather than a 24-hour one.
4. Nutritious foods should be made available at all times of the day so that she is able to graze whenever she is hungry.
5. The toddler should drink 16 to 24 ounces of milk daily.Correct Answer: 1,3,5
Rationale 1: Physiologic anorexia is caused when the extremely high metabolic demands of infancy slow to keep pace with the slower growth of toddlerhood, and it is a very normal finding at this age. It is not unusual for toddlers to have food jags during which they only want one or two food items for that day. So it is more helpful to look at what their intake has been over a week instead of a day. Two to three cups of milk per day are sufficient for a toddler, and more than that can decrease the childs desire for other foods and lead to dietary deficiencies. The correct general guideline for food quantity is one tablespoon of each food per year of age. Food should only be offered at meal and snack times, and children should sit at the table while eating to encourage their socialization skills.Question 8
Type: MCSA
The nurse is providing nutritional guidance to the parents of a toddler. Which comment by the parent would prompt the nurse to provide additional education?
1. I should not give my child raw oysters.
2. It is safe to leave my meat red in the center as long as there are no juices running.
3. We always wash our hands well before any food preparation.
4. We use separate utensils for preparing raw meat and preparing fruits, vegetables, and other foods.Correct Answer: 2
Rationale 1: Meats should be cooked thoroughly before eating. Meat that is red in the center, with or without running juices, is insufficiently cooked and increases the risk of food-borne illness. Washing hands and using separate utensils help to prevent infection with food-borne pathogens. Raw oysters should be avoided.Question 9
Type: MCSA
During a well-child physical, an adolescent female has a normal history and physical except for an excessive amount of tooth enamel erosion, a greater-than-normal number of filled cavities, and calluses on the back of her hand. Her body mass index is in the 50th to 75th percentile for her age. Which disorder is the nurse concerned about based on the assessment findings?
1. Anorexia nervosa
2. Kwashiorkor
3. Bulimia nervosa
4. Marasmus.Correct Answer: 3
Rationale 1: The erosion of tooth enamel, dental caries, and calluses on the back of her hand all most likely are due to frequent vomiting of gastric acids, which is common with bulimia nervosa as part of a bingepurge cycle. Anorexia nervosa is an eating disorder where adolescents literally starve themselves to prevent weight gain; they also exercise excessively and use laxatives and diuretics to lose weight. Anorexia usually manifests as extreme weight loss and an obsession with food. Kwashiorkor is a protein deficiency, usually from malnutrition, that manifests as generalized edema. Marasmus is a lack of energy-producing calories that can be seen in anorexia, and this causes emaciation, decreased energy levels, and retarded development.Question 10
Type: MCSA
The nurse is instructing a parent of a newborn on the foods that are to be started based on age. The nurse instructs the parent that the first food given to a newborn is rice cereal. What statement by the parent suggests appropriate understanding of the next food that can be introduced?
1. Chicken can be given next.
2. Eggs can be given next.
3. Fruits should be given next.
4. Whole milk should be started.Correct Answer: 3
Rationale 1: Chicken is not given until 810 months, eggs are not given until 12 months, and whole milk is given at 12 months. Fruits are given after rice cereal.Question 11
Type: MCSA
The mother of an infant born prematurely at 32 weeks expresses the desire to breastfeed her child. The nurse correctly responds with which statement when the mother asks how long she should breastfeed her baby?
1. Until the child begins solid foods.
2. Many breastfeed for 2 years.
3. It is recommended that mothers of preterm infants breastfeed at least a month.
4. Breast milk should be the only food for the first 6 months.Correct Answer: 4
Rationale 1: Breast milk should be the only food for the first 6 months, and should continue until 12 months even after solid foods are introduced.Question 12
Type: MCSA
Celiac disease presents many challenges for a family. What should the nurse emphasize when educating the parents of a newly diagnosed child?
1. Ice cream is a safe dessert on a gluten-free diet.
2. The childs weight and height should reach normal levels in about 1 year.
3. Processed foods are usually gluten-free.
4. Insurance pays only a small amount of the cost of celiac diets.Correct Answer: 2
Rationale 1: Ice cream and many processed foods contain gluten. Payment by insurance is dependent on the plan the family has. Once on a gluten-free diet, the childs height and weight will reach normal range in about 1 year.Question 13
Type: MCSA
While teaching a health promotion class to a group of parents of children in a Head Start class, which information should the nurse include to help decrease the risk of dental caries?
1. Delay introducing cows milk until at least 1 year of age.
2. Offer drinking cups only at meal and snack times.
3. Encourage use of homemade baby food without preservatives.
4. Offer juices diluted 50% with water.Correct Answer: 2
Rationale 1: Offering drinking cups only at meal and snack times encourages drinking when thirsty rather than carrying a cup around. This reduces the risk of dental caries. Delaying the introduction of cows milk, making homemade baby food, or diluting juice does not decrease dental caries.Question 14
Type: MCSA
The nurse is planning a class for school-age children on prevention of obesity through exercise. It is important to encourage the children to exercise a minimum of how many minutes a day to meet current recommendations?
1. 20 minutes
2. 30 minutes
3. 60 minutes
4. 90 minutesCorrect Answer: 3
Rationale 1: The current recommendation is 60 minutes of exercise daily.Question 15
Type: MCMA
Parents of a child who will begin enteral feedings ask the nurse what advantage this type of feeding has over other methods. Which responses by the nurse are the most appropriate?
Standard Text: Select all that apply.
1. Enteral feeding is the closest to natural feeding methods.
2. The child must be able to absorb nutrients.
3. Enteral feeding is complex to administer.
4. Enteral feeding requires a central venous catheter.
5. Enteral feeding has a high success rate.Correct Answer: 1,2,5
Rationale 1: Enteral feedings are the closest to natural feeding methods. The child must be able to absorb nutrients. Enteral feeding has a high success rate. It is not complex to administer, and does not require a central venous catheter.Question 16
Type: MCSA
The nurse is providing care to a pediatric client recently diagnosed with celiac disease. Which food choice indicates appropriate understanding of the material presented?
1. Pizza with milk
2. Spaghetti and meat sauce with juice
3. Hot dog on a bun with a shake
4. Fruit plate with GatoradeCorrect Answer: 4
Rationale 1: A child with celiac disease needs a gluten-free diet. Included on the list are fruits, meats, rice, and vegetables, including corn. Excluded are bread, cake, doughnuts, cookies, crackers, and many processed foods that may contain hidden gluten. Therefore, the child would be allowed to have the fruit plate with Gatorade.Question 17
Type: MCMA
The nurse is conducting a nutritional assessment for a toddler client who is diagnosed with failure to thrive (FTT). Which parameters will the nurse include in the assessment process for this toddler and family?
Standard Text: Select all that apply.
1. Height
2. Weight
3. Hemoglobin and hematocrit
4. Twenty four hour food diary
5. Maternal dietary intake during pregnancyCorrect Answer: 1,2,3,4
Rationale 1: In order to adequately assess the toddler clients FTT, the nurse would plan to measure height and weight; obtain a hemoglobin and hematocrit; and ask the family for a twenty-four hour food diary. Information regarding maternal dietary intake during pregnancy is not information that is necessary to assess for a toddler diagnosed with FTT.
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