Walden University NRNP 6552 Midterm Exam Comprehensive Exam Mastery Guide: In-Depth Study Companion, Updated Practice Tests, Detailed Test Bank Review, and Advanced Knowledge Assessment Manual

Answer: D. HPV vaccine should not be given during pregnancy (Formerly Question 1) A pregnant woman asks whether she can receive the HPV vaccine after learning her sister had cervical cancer. What is the most appropriate clinical guidance? • A. HPV vaccine is safe during the first trimester • B. HPV vaccine is not effective in preventing cervical cancer • C. HPV vaccine is no longer recommended after age 20 • D. HPV vaccine should not be given during pregnancy Rationale: HPV vaccination is contraindicated during pregnancy due to lack of safety data, though inadvertent exposure is not an indication for pregnancy termination. It can be safely administered postpartum. The vaccine is highly effective in preventing high-risk HPV infections associated with cervical cancer and is recommended through age 26 (and up to age 45 based on shared clinical decision-making). Answer: D. High-dose folic acid 4 mg daily before conception (Formerly Question 2) A couple with a history of a child affected by spina bifida seeks advice for preventing recurrence. What is the best recommendation? • A. Iron supplementation 60 mg daily • B. Genetic counseling only • C. Chorionic villus sampling at 12–14 weeks • D. High-dose folic acid 4 mg daily before conception Rationale: Women with a prior neural tube defect-affected pregnancy require highdose folic acid (4 mg daily, compared to the standard 0.4 mg daily) starting preconception to significantly reduce recurrence risk. Iron supplementation does not prevent neural tube defects, and chorionic villus sampling (CVS) is diagnostic rather than preventive. Answer: B. “No-nit” policies are discouraged by AAP and NASN (Formerly Question 3) A school nurse asks about managing head lice outbreaks. What is the recommended policy approach? • A. Strict “no-nit” school exclusion policies are necessary • B. “No-nit” policies are discouraged by AAP and NASN • C. Herbal oils are first-line treatment in RCTs • D. Lindane is recommended first-line therapy Rationale: The American Academy of Pediatrics (AAP) and National Association of School Nurses (NASN) advise against exclusionary “no-nit” policies because nits (eggs) are not strongly associated with transmission. Effective management focuses on pediculicides and environmental control without causing unnecessary school absenteeism. Lindane is no longer first-line due to neurotoxicity risks. Answer: C. Gradual weaning over 3 weeks (Formerly Question 4) What is the safest method for suppressing lactation after delivery? • A. Hormonal suppression therapy • B. Breast binding • C. Gradual weaning over 3 weeks • D. Abrupt cessation of breastfeeding Rationale: Gradual weaning reduces the risk of painful engorgement, plug ducts, and mastitis. Hormonal suppression therapies (such as bromocriptine) are no longer routinely recommended due to serious potential side effects like hypertension and myocardial infarction. Abrupt cessation significantly increases complication risks. Answer: C. 18–20 weeks (Formerly Question 5) At what gestational age can fetal heart tones typically be heard with a fetoscope? • A. 7–8 weeks • B. 10–12 weeks • C. 18–20 weeks • D. After 20 weeks Rationale: A traditional fetoscope detects fetal heart tones later than a Doppler ultrasound probe (which can pick up sounds around 10–12 weeks). Around 18–20 weeks, heart sounds become clear and audible with a fetoscope due to fetal cardiac growth and positioning. Answer: B. Perception of insufficient milk supply (Formerly Question 6) The most common reason for early breastfeeding discontinuation before 8 weeks is: • A. Maternal return to work • B. Perception of insufficient milk supply • C. Formula convenience • D. Maternal illness Rationale: The primary reason mothers stop breastfeeding early is the perceived belief that their milk production is inadequate, even when physiologically normal. Lactation education, monitoring infant wet/dirty diapers, and weight checks help reassure mothers and improve continuation rates. Answer: B. Age 11–16 years (Formerly Question 7) A pediatric patient must meet which criterion before receiving OxyContin? • A. Age 5–16 years • B. Age 11–16 years • C. Age 8–16 years • D. Over 10 years Rationale: Extended-release oxycodone (OxyContin) FDA approval for pediatric use is specifically designated for adolescents aged 11–16 years who are already opioid- tolerant and require continuous around-the-clock opioid therapy for severe pain. Answer: B. Softening of uterine isthmus with ballottement (Formerly Question 8) Hegar’s sign refers to: • A. Cervical blueness • B. Softening of uterine isthmus with ballottement • C. Cervical softening • D. Fetal movement perception Rationale: Hegar’s sign is a probable physical sign of early pregnancy characterized by marked softening of the lower uterine segment (isthmus). Chadwick’s sign refers to cervical/vaginal blueness/bluish discoloration (Option A), and Goodell’s sign refers to cervical softening (Option C).