NR 602 Midterm Practice Questions Primary Care Of The Childbearing (Chamberlain University)

  Week 1 Women’s Health Chapter 5 1. A major contributor to pelvic stability is a. the coccyx. b. the pubis. c. the ilium and its ligaments. d. the sacrum. 2. The sheet made up of dense fibrous tissue that spans the opening of the anterior pelvic outlet is/are the a. sphinter muscles. b. deep perineal space. c. perineal membrane. d. distal vagina. 3. How many different fiber sections subdivide the levator ani muscular sheet? a. 2 b. 3 c. 4 d. 6 4. What is the function of the Bartholin’s gland? a. To help prevent infection of the introitus b. To secrete lubricating mucus into the introitus during sexual excitement c. To assist in keeping the vaginal introitus closed d. To secrete estrogen and regulate its levels 5. Which arteries supply blood to the clitoris? a. Arcuate arteries b. Dorsal and clitoral cavernosal arteries c. Two ovarian arteries d. Coiled arteries 6. What is the approximate number of ovarian follicles at the initiation of puberty? a. 100,000 b. 200,000 c. 400,000 d. 600,000 7. The four segments of a fallopian tube are the pars interstitialis, the isthmus, the ampulla, and the a. infundibulum. b. medulla. c. hilum. d. myometrium. 8. What causes the epithelium to thicken, differentiate, and accumulate glycogen? a. Progesterone b. Pudendal nerve c. Estrogen d. Vagus nerves 9. About how many openings are in the nipple? a. 1 to 5 b. 5 to 10 c. 10 - 15 d. 15 – 20 10. What is one of the most frequent reasons women visit their clinician? a. Changes in menstruation b. Family planning c. Pregnancy d. Prevention and wellness 11. What is the objective of the endometrial cycle? a. To emulate the activities of the ovaries b. To produce an ovum c. To reach the menstruation phase d. To prepare a site to nourish and maintain the ovum 12. Ovulation is dependent on an increased level of _ a. enzyme activity. b. progesterone. c. prostaglandins. d. estrogen and the LH surge. 13. What initiates contractions of the uterine muscle leading to menstruation? a. Lysosomal enzymes b. Vascular thrombosis c. Rupture of the basal arterioles d. Prostaglandins 14. Why does the cervical mucus become thick, viscous and opaque after ovulation? a. To make an hospitable environment for the sperm b. To promote stromal vascularization c. To relax the myometrial fibers that supply the cervix d. To reduce the risk of ascending infection at the time of implantation Women’s Health Chapter 6 1. What does the Greek term “gyne” mean from which “gynecology” is derived? a. Speculum b. Gender c. Woman — more as queen d. To reproduce 2. What is the primary purpose of taking a health history? a. To learn about a woman’s health concerns b. To establish a relationship with a woman while learning about her health c. To identify any unresolved/latent health issues d. To ensure that a woman’s health care records are up to date 3. Which skills are valued in a clinician taking a health history? a. Respectful attention b. Empathy c. Trust-building d. All of the above 4. What should be the clinician’s first objective after learning the chief reason the woman desires care? a. To give the reason or problem a structural and chronological framework b. To probe for any additional concerns missed c. To take a family history related to the presenting concern d. To gain insight into the woman’s cultural and social influences 5. Which of the following should NOT be a part of taking a health history? a. Taking a family health history b. Seeking information on stressors or personal problems c. Asking about exercise and sleep patterns d. Counseling for tobacco-use cessation 6. In the GTPAL system for recording pregnancy history, the “T” stands for: a. Term births. b. Terminal pregnancies. c. Total number of pregnancies. d. Type of birth (spontaneous, assisted, or cesarean). 7. In a complete physical examination in the ambulatory gynecology setting, it is customary to a. evaluate major organ systems briefly and carefully, but not exhaustively. b. ask the woman which physical examination maneuvers should be performed. c. evaluate major organ systems thoroughly. d. palpate the precordium. 8. How should the order of examination proceed? a. Head to toe b. Toe to head c. By major organ system d. By concern presented 9. Where may supernumerary occur? a. Anywhere from the neck to the ankle unilaterally b. Anywhere on the torso c. Anywhere along a vertical line from the axilla to the inner thigh d. Anywhere on the breast tissue, including the tall of Spence 10. Where in the breast do most malignancies develop? a. Upper inner quadrant b. Upper outer quadrant c. Lower outer quadrant d. Lower inner quadrant 11. Which type of speculum is best used to examine nulliparous women? a. Small Graves b. Pederson c. Large Graves d. Pediatric 12. What is the preferred maneuver order of the pelvic examination? a. Bimanual, external inspection and palpation, speculum b. External inspection and palpation, bimanual, speculum c. External inspection and palpation, speculum, bimanual d. Speculum, bimanual, external inspection and palpation 13. Under what conditions is a rectovaginal examination most useful? a. Under all conditions b. If screening for colorectal cancer is indicated c. If the uterus is anteverted or anteflexed d. If the uterus is retroflexed or retroverted 14. A clinician should present a therapeutic plan to the patient based on a. the individual woman’s desire for information and the degree of severity of the finding. b. consultation with another health professional. c. the examining clinician’s findings and assessments. d. the individual woman’s cultural sensitivities and level of education. Woman’s Health Chapter 7 1. What does a service grade of D represent in the U.S. Preventive Services Task Force (USPSTF) recommendations? a. Service carries insufficient evidence to recommend it b. Service is found to be beneficial c. Service is found to be either of no benefit or potentially harmful d. Service should not be routinely provided 2. Which statement best defines “risk factor”? a. Any factor which increases the need for medical attention b. Any behavior which places an individual at risk for illness c. The probability that an individual will develop a medical condition d. An attribute or exposure associated causally with an increased probability of a disease or injury 3. The USPSTF assigns a certainty level to assess the net benefit of a preventive service based on a. the nature of the overall evidence available. b. the cost-effectiveness of a service. c. known health outcomes. d. select studies in a limited primary care population. 4. What screening recommendation is similar across all groups for colorectal cancer? a. Screening women age 76 to 85 based on risk factors b. Screening only for those women at increased risk c. Screening for all women starting at age 50 d. Against routine screening in adults age 76 and over 5. What is the screening recommendation by the American College of Obstetricians and Gynecologists for intimate partner violence (IPV)? a. Routinely ask all women direct, specific questions about abuse. Refer to community-based services when identified. b. Insufficient evidence to recommend for or against routine screening. c. No screening recommendation. d. Remain alert for signs of family violence at every patient encounter. 6. Alcohol consumption is considered hazardous for a woman who has a. either 5 or more drinks in one week or 3 per occasion. b. either 7 or more drinks in one week or 3 per occasion. c. either 9 or more drinks in one week or 4 per occasion. d. either 10 or more drinks in one week or 5 per occasion. 7. What is the Task Force recommendation grade assigned to screening all adults for depression? a. B b. A c. C d. D 8. How is being overweight defined on the BMI table? a. 18 to 29.9 b. 20 to 29.9 c. 25 to 29.9 d. 30 or greater 9. How is screening for the rubella immunity accomplished? a. By asking the patient b. By obtaining a history of vaccination or by ordering serologic studies c. By ordering serologic studies d. By obtaining vaccination records 10. What recommendation grade does the Task Force assign to screening all adults for tobacco use? a. A b. B c. C d. D 11. What is the Task Force recommendation regarding the efficacy of digital mammography or MRI versus the standard film mammography? a. Evidence exists that all screens are equally beneficial b. Film mammography is recommended as the best screen c. Digital mammography or MRI is recommended as the best screen d. Not enough evidence exists to assess benefits and risks as to which provides the best screen 12. What recommendation grade does the Task Force assign to cholesterol screening women between 20 and 44 years with preexisting risk factors for coronary artery disease? a. A b. B c. C d. D 13. Which of the following factor associated with increased risk for developing osteoporosis appears to be the best predictor of risk? a. Smoking b. Low body weight c. Sedentary lifestyle d. Family history 14. Which of the following are screening tests for type 2 diabetes mellitus? a. Fasting plasma glucose b. Two-hour post load plasma glucose c. Hemoglobin A1C d. All of the above 15. What population of women should be screened for signs and symptoms of thyroid dysfunction? a. All women b. Older women c. Older women, smokers, women with diabetes d. Older women, postpartum women, and women with Down syndrome Women’s Health Chapter 11 1. Most research studies on methods of contraception use the term efficacy to refer to a. the rate of success in those who are spacing their pregnancies. b. likelihood of pregnancy when a method is used exactly as prescribed. c. number of pregnancies when a method is used improperly or inconsistently. d. likelihood of user failure or typical-use failure rates in different populations. 2. Which contraceptive methods have inherent failure rates? a. None b. Some c. All d. All except sterilization 3. All of the following are physiologic methods of non-hormonal contraception except a. abstinence. b. lactational amenorrhea. c. coitus interruptus. d. spermicide. 4. Although barrier contraception methods are less effective in preventing pregnancy than more modern methods, interest in them is on the rise because they a. can help protect against STIs, including HIV. b. are coitus dependent and require planning. c. are non-allergenic and male controlled. d. involve the use of hormones. 5. Tubal sterilization for women who have completed their families is highly effective, but there are disadvantages such as a. the women are less likely to use condoms or return for health services. b. a decreased risk of ovarian cancer and pelvic inflammatory disease. c. a high likelihood of complications and side effects. d. the surgery is not covered by insurance. 6. Combined oral contraceptives (COCs) are among the most extensively studied medications available. Which one of the following statements about their use has been found to be true? a. Broad-spectrum antibiotics may enhance their efficacy. b. They do not increase the risk of venous thromboembolism. c. They decrease the relative risk of ovarian and endometrial cancers. d. Among possible side effects are acne, hirsuitism, and benign breast conditions. 7. Compared to COCs, the combined contraceptive patch and vaginal ring a. have the same theoretical efficacy. b. offer more opportunity for user error. c. have lower failure rates in obese women. d. are available in a larger variety of formulations. 8. Progestin-only pills (POPs) a. have no possible side effects. b. suppress ovulation as reliably as COCs. c. may be taken earlier or later than prescribed. d. in combination with lactation are nearly 100% effective. 9. The depot medroxyprogesterone acetate (DMPA) injection (Depo-Provera) is given at week intervals. a. 3 b. 6 c. 9 d. 12 10. Which one of the following statements about the subdermal progestin implant is false? a. It is associated with the development of benign follicular cysts. b. After removal, its contraceptive effects last 10 more months on average. c. Based on worldwide data, it appears to be as safe as other progestin-only methods. d. The shortage of research due to its only recent availability is a possible disadvantage. 11. Of the two intrauterine contraceptive devices currently available in the United States only one provides a local delivery of protestin. It is the a. combined contraceptive patch (Ortho Evra). b. copper IUD (T380A, ParaGard). c. LNG-IUS (Mirena). d. Dalkon Shield. 12. Emergency contraceptive pills (ECPs) can a. cause an abortion. b. prevent fertilization. c. harm an established pregnancy. d. offer protection from STIs, including HIV. Women’s Health Chapter 15 1. Cyclic mastalgia a. more likely causes unilateral, localized pain that is sharp or burning in nature. b. has an increased risk of occurrence in women whose diets are low in fat. c. occurs most frequently in women who are 18 to 30 years old. d. is caused by hormonal changes associated with menstruation. 2. The possibility of cancer is associated with mastalgia when the pain a. occurs in perimenopausal women who are receiving HT. b. is accompanied by skin changes or palpable abnormality. c. is felt in both breasts equally and is related to a cyclic pattern. d. is reproducible with palpation of the chest wall. 9 3. Effective for 85% of women who have mild or moderate symptoms of mastalgia, the first line of treatment is a. reassurance. b. reduction mammoplasty. c. isoflavones, or naturally occurring phytoestrogens. d. 2% lidocaine injection and 40 mg of methyl prednisone. 4. Mammary duct ectasia a. is one of the most common causes of milky nipple discharge. b. like intraductal papilloma, is typically unilateral and uniductal. c. usually occurs in women 20 to 35 years of age. d. discharge may be green, brown, or black in color. 5. If a woman is complaining of bilateral, milky nipple discharge, the clinician is to first a. perform a pregnancy test. b. perform a mammogram and an ultrasound of the breasts. c. assess the sella turcica with magnetic resonance imaging (MRI). d. obtain a serum prolactin level and a thyroid-stimulating hormone (TSH) measurement. 6. The most common benign breast masses are a. galactoceles. b. hamartomas. c. fibroadenomas and cysts. d. lipomas and phyllodes tumors. 7. Which breast tissue sampling procedure is best to use when density or calcification is seen on a mammogram in a location that cannot be effectively assessed with a core biopsy? a. Fine-needle aspiration b. MRI-guided needle biopsy c. Needle-localized breast biopsy d. Excisional breast biopsy 8. Among women aged 55 years and older a. macromastia is the most common cause of breast masses. b. breast masses are presumed malignant until proven otherwise. c. most breast masses decrease in size over time and many resolve completely. d. diagnostic imaging of a breast mass and tissue sampling should be deferred. 9. A woman’s lifetime risk of being diagnosed with breast cancer is a. 1 in 3. b. 1 in 8. c. 1 in 29. d. 1 in 233. 10. No risk factors other than age are identifiable in of women with breast cancer. a. 100% b. 85% c. 60% d. 24% 11. The genetic counselor has a significant role in the care of women because BRCA1 and BRCA2 genetic mutations account for 5% to 10% of all cancer cases a. breast b. ovarian c. uterine d. pancreatic 10 12. The most common sites of metastatic spread of invasive breast cancer include all of the following except a. bones. b. lungs. c. pituitary. d. lymph nodes. Women’s Health Chapter 29 1. A pregnant clients mother is worried that her daughter is not big enough at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the womans umbilicus. Which should the nurse report to the client and her mother? a. Youre right. Well inform the practitioner immediately. b. Lightening has occurred, so the fundal height is lower than expected. c. The body of the uterus is at the belly button level, just where it should be at this time. d. When you come for next months appointment, well check you again to make sure that the baby is growing. 2. While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the client stand up and retake her blood pressure. b. Have the client sit down and hold her arm in a dependent position. c. Have the client turn to her left side and recheck her blood pressure in 5 minutes. d. Have the client lie supine for 5 minutes and recheck her blood pressure on both arms. 3. A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b. These conditions are abnormal. Refer the client to an ear, nose, and throat specialist. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds. 4. Which suggestion is appropriate for the pregnant client who is experiencing heartburn? a. Drink plenty of fluids at bedtime. b. Eat only three meals a day so the stomach is empty between meals. c. Drink coffee or orange juice immediately on arising in the morning. d. Use Tums or Alkamints to obtain relief, as directed by the health care provider. 5. While providing education to a primiparous client regarding the normal changes of pregnancy, what is important for the nurse to explain about Braxton Hicks contractions? a. These contractions may indicate preterm labor. b. These are contractions that never cause any discomfort. c. Braxton Hicks contractions only start during the third trimester. d. These occur throughout pregnancy, but you may not feel them until the third trimester. 6. What is the reason for vascular volume increasing by 40% to 60% during pregnancy? a. Prevents maternal and fetal dehydration b. Eliminates metabolic wastes of the mother c. Provides adequate perfusion of the placenta d. Compensates for decreased renal plasma flow 7. Physiologic anemia often occurs during pregnancy because of: a. inadequate intake of iron. b. the fetus establishing iron stores. c. dilution of hemoglobin concentration. d. decreased production of erythrocytes. 8. Which is a positive sign of pregnancy? a. Amenorrhea b. Breast changes c. Fetal movement felt by the woman d. Visualization of fetus by ultrasound 9. A client is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Which are her gravida and para? a. 3, 2 b. 4, 3 c. 4, 2 d. 3, 3 10. A clients last menstrual period was June 10. What is her estimated date of birth (EDD)? a. April 7 b. March 17 c. March 27 d. April 17 11. Why should a woman in her first trimester of pregnancy expect to visit her health care provider every 4 weeks? a. Problems can be eliminated. b. She develops trust in the health care team. c. Her questions about labor can be answered. d. The conditions of the expectant mother and fetus can be monitored. 12. A client in her first trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurses best response? a. It is due to an increase in gastric motility. b. It may be due to changes in hormones. c. It is related to an increase in glucose levels. d. It is caused by a decrease in gastric secretions. 13. Which advice to the client is one of the most effective methods for preventing venous stasis? a. Sit with the legs crossed. b. Rest often with the feet elevated. c. Sleep with the foot of the bed elevated. d. Wear elastic stockings in the afternoon. 14. A client notices that the health care provider writes positive Chadwicks sign on her chart. She asks the nurse what this means. Which is the nurses best response? a. It means the cervix is softening. b. That refers to a positive sign of pregnancy. c. It refers to the bluish color of the cervix in pregnancy. d. The doctor was able to flex the uterus against the cervix. 12 15. Which is the gravida and para for a client who delivered triplets 2 years ago and is now pregnant again? a. 2, 3 b. 1, 2 c. 2, 1 d. 1, 3 16. To relieve a leg cramp, what should the client be instructed to perform? a. Dorsiflex the foot. b. Apply a warm pack. c. Stretch and point the toe. d. Massage the affected muscle. 17. A client, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is palpated 3 cm below the umbilicus. This finding is: a. appropriate for gestational age. b. a sign of impending complications. c. lower than normal for gestational age. d. higher than normal for gestational age. 18. Which complaint made by a client at 35 weeks of gestation requires additional assessment? a. Abdominal pain b. Ankle edema in the afternoon c. Backache with prolonged standing d. Shortness of breath when climbing stairs 19. A gravida client at 32 weeks of gestation reports that she has severe lower back pain. What should the nurses assessment include? a. Palpation of the lumbar spine b. Exercise pattern and duration c. Observation of posture and body mechanics d. Ability to sleep for at least 6 hours uninterrupted 20. A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the fivedigit system to describe this womans current obstetric history, what should the nurse record? a. 4-1-2-0-2 b. 3-1-2-0-2 c. 4-2-1-0-1 d. 3-1-1-1-3 21. Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy? a. Rubella titer, 1:6 b. Platelets, 300,000/mm3 c. White blood cell count, 6000/mm3 d. Hematocrit 38%, hemoglobin 13 g/dL 22. A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy? a. Only travel by car during pregnancy. b. Avoid use of the seat belt during the third trimester. c. You can travel by plane until your 38th week of gestation. d. If you are traveling by car stop to walk every 1 to 2 hours. 13 23. The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwicks sign. When the client asks the nurse what this means, how should the nurse respond? a. Chadwicks sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood. b. That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy. c. This means that a mucous plug has formed in the cervical canal to help protect you from uterine infection. d. This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix. 24. When a pregnant woman develops ptyalism, what should the nurse advise? a. Chew gum or suck on lozenges between meals. b. Eat nutritious meals that provide adequate amounts of essential vitamins and minerals. c. Take short walks to stimulate circulation in the legs and elevate the legs periodically. d. Use pillows to support the abdomen and back during sleep. 25. A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations, which will the nurse administer? a. Hepatitis B b. Measles c. Rubella d. Varicella 26. When the pregnant woman develops changes caused by pregnancy, the nurse recognizes that the darkly pigmented vertical midabdominal line is the: a. epulis. b. linea nigra. c. melasma. d. striae gravidarum. 27. When documenting a client encounter, what term will the nurse use to describe the woman who is in the 28th week of her first pregnancy? a. Multigravida b. Multipara c. Nullipara d. Primigravida 28. You are performing assessments for an obstetric client who is 5 months pregnant with her third child. Which finding would cause you to suspect that the client was at risk? a. Client states that she doesnt feel any Braxton Hicks contractions like she had in her prior pregnancies. b. Fundal height is below the umbilicus. c. Cervical changes, such as Goodells sign and Chadwicks sign, are present. d. She has increased vaginal secretions. 29. What is the best explanation that you can provide to a pregnant client who is concerned that she has pseudoanemia of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated. b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. d. Contact the physician and get a prescription for iron pills to correct this condition. 30. Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases. b. Cardiac output increases during pregnancy. c. Blood pressure remains consistent independent of position changes. d. Maternal vasoconstriction occurs in response to increased metabolism. Women’s Health Chapter 30 1. A pregnant clients biophysical profile score is 8. She asks the nurse to explain the results. What is the nurses best response? a. The test results are within normal limits. b. Immediate birth by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding birth. 2. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Biophysical profile b. Multiple-marker screening c. Lecithin-to-sphingomyelin ratio d. Blood type and crossmatch of maternal and fetal serum 3. The clinic nurse is obtaining a health history on a newly pregnant client. Which is an indication for fetal diagnostic procedures if present in the health history? a. Maternal diabetes b. Weight gain of 25 lb c. Maternal age older than 30 d. Previous infant weighing more than 3000 g at birth Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. Excessive weight gain is an indication for testing. Normal weight gain is 25 to 35 lb. A maternal age older than 35 years is an indication for testing. Having had another infant weighing more than 4000 g is an indication for testing. 4. When is the most accurate time to determine gestational age through ultrasound? a. First trimester b. Second trimester c. Third trimester d. No difference in accuracy among the trimesters 5. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which? a. Hemophilia b. Sickle cell anemia c. A neural tube defect d. A normal lecithin-to-sphingomyelin ratio 6. When is the earliest that chorionic villus sampling can be performed during pregnancy? a. 4 weeks b. 8 weeks c. 10 weeks d. 12 weeks 7. On which aspect of fetal diagnostic testing do parents usually place the most importance? a. Safety of the fetus b. Duration of the test c. Cost of the procedure d. Physical discomfort caused by the procedure 8. The nurses role in diagnostic testing is to provide which of the following? a. Advice to the couple b. Information about the tests c. Reassurance about fetal safety d. Assistance with decision making 9. Which should be considered a contraindication for transcervical chorionic villus sampling? a. Rh-negative mother b. Gestation less than 15 weeks c. Maternal age younger than 35 years d. Positive for group B Streptococcus 10. Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? a. Perform an abdominal prep. b. Administer a soap suds enema. c. Ensure the client is NPO for 12 hours. d. Instruct the client to drink 1 to 2 quarts of water. 11. Which is the major advantage of chorionic villus sampling over amniocentesis? a. It is not an invasive procedure. b. It does not require a hospital setting. c. It requires less time to obtain results. d. It has less risk of spontaneous abortion. 12. What does nursing care after amniocentesis include? a. Forcing fluids by mouth b. Monitoring uterine activity c. Placing the client in a supine position for 2 hours d. Applying a pressure dressing to the puncture site 13. What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more bpm with fetal movement in a 20-minute period? a. Positive b. Negative c. Reactive d. Nonreactive 14. What is the purpose of initiating contractions in a contraction stress test (CST)? a. Increase placental blood flow. b. Identify fetal acceleration patterns. c. Determine the degree of fetal activity. d. Apply a stressful stimulus to the fetus. 15. What does a score of 9 on a biophysical profile signify? a. Normal b. Abnormal c. Equivocal d. Nonreactive 16 16. In preparing a pregnant client for a nonstress test (NST), which of the following should be included in the plan of care? a. Have the client void prior to being placed on the fetal monitor because a full bladder will interfere with results. b. Maintain NPO status prior to testing. c. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate. d. Have an infusion pump prepared with oxytocin per protocol for evaluation. 17. The results of a contraction stress test (CST) are positive. Which intervention is necessary based on this test result? a. Repeat the test in 1 week so that results can be trended based on this baseline result. b. Contact the health care provider to discuss birth options for the client. c. Send the client out for a meal and repeat the test to confirm that the results are valid. d. Ask the client to perform a fetal kick count assessment for the next 30 minutes and then reassess the client. 18. A pregnant client has received the results of her triple-screen testing and it is positive. She provides you with a copy of the test results that she obtained from the lab. What would the nurse anticipate as being implemented in the clients plan of care? a. No further testing is indicated at this time because results are normal. b. Refer to the physician for additional testing. c. Validate the results with the lab facility. d. Repeat the test in 2 weeks and have the client return for her regularly scheduled prenatal visit. 19. A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patients’ health care provider. When is the best time for the nurse to schedule the patient’s ultrasound? a. Immediately b. In 2 weeks c. In 4 weeks d. In 6 weeks Week 2 Women’s Health Chapter 19 1. What is the major source of normal vaginal secretions? a. Bartholin’s glands b. Apocrine glands c. Sebaceous glands d. Cervical mucosa 2. What is the term for the inflammation of the vagina characterized by an increased vaginal discharge containing numerous white blood cells? a. Vaginitis b. Vaginosis c. Cystitis d. Vaginal mucosa 3. How does vaginosis differ from vaginitis? a. It must be treated with metronidazole. b. The discharge does not contain white blood cells. c. The discharge does not have an odor. d. It causes itching and/or burning. 4. What is the most important step in preventing vaginal infections? a. Good personal hygiene b. Healthy diet c. Scented sanitary products d. Douching 5. What can bacterial vaginosis lead to? a. Vulvovaginal candidiasis b. Pelvic inflammatory disease c. Toxic shock syndrome d. Trichomoniasis 6. Approximately what percentage of women with bacterial vaginosis are asymptomatic? a. 25% b. 40% c. 75% d. 50% 7. What is the most common symptom of bacterial vaginosis? a. Vaginal itching and/or burning b. Cottage cheese-like discharge c. Fishy odor d. Yeasty odor 8. Vulvovaginal candidiasis accounts for what percentage of all vaginal infections? a. 10-15% b. 20-25% c. 50-55% d. 60-65% 9. Which organism causes 90% of vulvovaginal candidiasis episodes in women? a. Candida tropicalis b. Candida albicans c. Candida glabrata d. Candida krusei 10. What is the most common symptom of vulvovaginal candidiasis? a. Fishy odor b. Fever c. Thin, grayish-white discharge d. Vulvar pruritis 11. What percentage of Toxic Shock Syndrome cases are related to menses? a. 50% b. 25% c. 75% d. 90% 12. Women who have had Toxic Shock Syndrome should be instructed not to use tampons or a. barrier contraception methods. b. hormonal contraception methods. c. intravaginal antibiotic cream. d. oral antibiotics. 13. What is generally the cause of Bartholin’s cyst? a. Complications from gonorrhea b. Cystic fluid in Bartholin’s gland becomes infected c. A fungal infection in Bartholin’s gland d. Obstruction of a duct in Bartholin’s gland Women’s Health Chapter 20 1. Approximately how many Americans will contract one or more sexually transmitted infections during their lifetime? a. 50% b. 25% c. 40% d. 60% 2. Why is it often more difficult to detect STIs in women than in men? a. Men are two times more likely to transmit STIs to women than the reverse. b. The risk of a woman contracting an STI is much higher than a man’s risk. c. The anatomy of women’s genital tracts makes examination more difficult. d. Women tend to have fewer sexual partners than men do. 3. Who should be screened regularly for STIs? a. Women who have more than one sexual partner b. Women over the age of 21 c. Women who are sexually active d. Women over the age of 15 4. Of the more than 100 known serotypes of human papillomavirus (HPV), approximately how many can infect the genital tract? a. 80 b. 60 c. 20 d. 40 5. Routine HPV vaccination is recommended for girls of what age? a. 8-9 b. 13-14 c. 6-7 d. 11-12 6. An initial or primary genital herpes infection characteristically lasts about a. one week. b. three weeks. c. one month. d. six weeks. 7. How do systemic antivirul drugs treat genital herpes? a. They can control the symptoms. b. They can reduce the frequency of recurrences after discontinuation. c. They can prevent transmission to sexual partners. d. They can prevent secondary infection. 8. Which of the following is caused by an anaerobic one-celled protozoan that commonly lives in the vagina? a. Trichomoniasis b. Chlamydia c. Gonorrhea d. Syphilis 9. The prevalence of chlamydia is how many times higher in black women than in white women? a. Two times b. Three times c. Five times d. Four times 10. The second most commonly reported STI after chlamydia is a. gonorrhea. b. pelvic inflammatory disease. c. syphilis. d. hepatitis B. 11. Why do adolescents have the highest risk of developing pelvic inflammatory disease (PID)? a. They have the highest risk for bacterial vaginosis. b. They are the least at risk for developing other STIs. c. They are the most sexually active. d. They have decreased immunity to infectious organisms. 12. What is different about syphilis as compared to other bacterial STIs? a. The incidence in women is much higher than in men. b. The rates are higher for white women than for black women. c. It cannot be spread by kissing. d. It persists past age 25, into the 30s and 40s. 13. What has contributed to the decreased incidence of Hepatitis B over the past 20 years? a. The decrease in PID b. The HBV vaccination c. The increase in condom use d. More precise screening methods 14. Patients presenting for STI treatment should be screened for HIV a. at each visit. b. at the end of treatment. c. at the beginning of treatment. d. each year. Women’s Health Chapter 23 1. What term refers to the period from about 7 to 10 days before menstrual flow begins until the first or second day of menstrual flow? a. Amenorrhea b. Premenstrual c. Dysmenorrhea d. Perimenstrual 20 2. Approximately what percentage of women experience severe recurring symptoms associated with their menstrual cycle? a. 10% b. 20% c. 5% d. 25% 3. Why shouldn’t symptoms such as bloating and breast tenderness be considered disordered perimenstrual symptoms? a. Because only a small minority of women have these symptoms b. Because these symptoms affect the majority of women c. Because these symptoms do not affect women’s moods d. Because it is not possible to quantify these symptoms 4. Of the four symptom clusters of perimenstrual symptoms identified by Woods, Mitchell & Lentz (1999), which was the dominant one in terms of explaining variance in premenstrual symptoms? a. Fluid retention b. Arousal c. Turmoil d. Somatic symptoms 5. How is secondary dysmenorrhea defined? a. Absence of menstruation due to an underlying pathology b. Painful menstruation in the absence of pathology c. An underlying pathology causing pain symptoms during menstrual flow d. Painful menstruation that occurs in women after the age of 35 6. What is the term for the exacerbation of somatic or mood symptoms in the late luteal or menstrual phase of the cycle? a. Premenstrual magnification b. Perimenstrual dysmenorrhea c. Premenstrual syndrome d. Premenstrual dysphoric disorder 7. Which of the following is a diagnostic label that is listed in the Diagnostic and Statistical Manual IV-TR? a. Premenstrual dysphoric disorder b. Premenstrual magnification c. Dysmenorrhea d. Premenstrual syndrome 8. Women who report experiencing the most severe symptoms of PMS tend to be a. in their late 40s. b. in their early 20s. c. in their late teens. d. in their late 30s. 9. Which of the following is one of the key criteria for a diagnosis of PMS? a. The symptoms markedly interfere with occupational functioning b. One of the symptoms is depressed mood, anxiety, or irritability c. Exclusion of other diagnoses that may better explain the symptoms d. The symptoms are confirmed by prospective daily ratings over at least two menstrual cycles 10. All menstruating women report that which type of symptoms is highest during menses? a. Muscular b. Gastrointestinal c. Incontinent d. Skeletal 11. What hormone has been shown to help with relieving the mood discomfort cluster of symptoms of PMS? a. Diuretics b. NSAID c. Progesterone d. Fluoxetine 12. Which dietary supplement has been shown to help treat PMS? a. Calcium b. Magnesium c. Vitamin B12 d. Iron 13. The only botanical treatment with Level I evidence to support its use in PMS is a. echinacea. b. chaste tree berry. c. linolenic acid. d. cramp bark. 14. Research suggests a link between PMS and a. seasonal affective disorder. b. celiac disease. c. high blood pressure. d. hypoglycemia. Women’s Health Chapter 24 1. What is the best definition of abnormal uterine bleeding (AUB)? a. Uterine bleeding for which no pelvic pathology is found b. Uterine bleeding that is irregular during a woman’s menstrual cycle c. Uterine bleeding that is irregular in amount or frequency d. Uterine bleeding that is related to systemic conditions 2. What is a good first question to ask women who present with a concern about abnormal bleeding? a. What is a normal pattern for you? b. How long has this persisted? c. What was your last menstrual cycle like? d. How many times has this occurred? 3. In women of reproductive age, the most common cause of a bleeding pattern that is suddenly different is a. an increase in estrogen. b. a reaction to a change in eating or exercise habits. c. adrenal hyperplasia. d. a complication of pregnancy. 4. Progesterone breakthrough bleeding is sometimes seen in women who a. have polycystic ovary syndrome. b. are obese. c. use progesterone-only contraception. d. have ceased progesterone therapy. 5. The least variation in menses occurs during the ages of a. 30-50. b. 40-50. c. 12-20. d. 20-40. 6. How can liver and renal diseases result in abnormal uterine bleeding? a. They cause an imbalance in platelet aggregation. b. They result in an inability to adequately clear estrogen from the body. c. They cause thyroid dysfunction, which leads to bleeding abnormalities. d. They result in elevated prolactin levels, which leads to bleeding abnormalities. 7. Signs of endometrial or cervical cancer may present abnormal uterine bleeding, often as heavy, prolonged bleeding or a. menometrorrhagia. b. amenorrhea. c. oligomenorrhea. d. polymenorrhea. 8. Products from which of the following herbs have been associated with alterations in estrogen levels, resulting in AUB? a. Gingko b. Echinacea c. Evening Primrose d. Chaste tree berry 9. Exercise-induced amenorrhea is probably due to the combination of low body fat and decreased secretion of a. estrogen. b. prolactin. c. progesterone. d. GnRH. 10. When is a pelvic examination unnecessary for a woman who is experiencing AUB? a. If she is not sexually active b. If she has recently begun menstruating c. If her bleeding is extremely heavy d. If she also has anemia 11. What test should be ordered for a woman who is experiencing AUB as well as headaches and peripheral vision changes? a. Thyroid-stimulating hormone test b. Nucleic acid amplification test c. Complete blood count d. Prolactin level test 12. Gonadotropin hormone-releasing agonists are recommended for only short-term use to treat heavy bleeding due to a. their many side effects, such as hot flashes. b. the fact that they cause amenorrhea. c. the fact that they are poorly understood. d. their poor interaction with hormonal contraception. 13. What treatment was introduced in the 1990s as a less invasive alternative to hysterectomy? a. Myomectomy b. NSAIDs c. Endometrial ablation d. LNG-INS 14. What is the definition of primary amenorrhea? a. The cessation of menses for an interval of 6 months b. The failure to begin menses by age 14 c. The cessation of menses due to outflow tract obstruction d. The failure to begin menses by age 16 Women’s Health Chapter 26 1. What is the definitive diagnostic technique for vulvar dermatoses? a. Pap test b. Biopsy c. Colposcopy d. Physical exam 2. Lichen sclerosis is a benign, chronic, progressive disease of the skin in which the most common symptom is a. vulvar pruritis. b. vaginal discharge. c. postcoital bleeding. d. dyspareunia 3. Which type of cervical polyps should be removed? a. Erosive polyps b. Hypertrophic polyps c. Asymptomatic polyps d. Atypical polyps 4. The incidence of uterine fibroids a. increases with age. b. decreases with age. c. is often caused by early menopause. d. is related to the age of first menses. 5. Why is adenomyosis frequently underdiagnosed? a. It cannot be detected via an ultrasound. b. It is almost always asymptomatic. c. It is most common in adolescents. d. It has similar symptoms to other pelvic pain conditions. 6. The most common site for endometrial implants found in other parts of the body is a. the appendix. b. the uterus. c. the ovaries. d. the fallopian tubes. 7. Which of the following is associated with increased risk of endometriosis? a. Late menarche b. Long menstrual cycles c. Early menarche d. Late menopause 8. The most widely accepted theory for the origin of endometriosis is that reverse flow of menses out of the fallopian tubes allows endometrial cells to enter the pelvis and become implanted on the pelvic organs, which is the a. induction theory. b. retrograde menstruation theory. c. coelomic metaplasia theory. d. endometrial repair theory. 9. Most functional ovarian cysts will resolve within a. six months. b. three months. c. six weeks. d. one year. 10. What is not a likely symptom of ovarian cysts? a. Irregular menstrual cycle b. Increase in blood pressure c. Heart rate increase d. Fever Week 3 Burns Chapter 8 1. A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother’s concerns, the primary care pediatric nurse practitioner will suggest S. developing consistent daily routines for the child. T. exposing her child to extended family members when possible. U. not working outside the home during the first few years. V. taking her child to regular play date activities with other children. 2. During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the nurse practitioner do? R. Reassure them that the child is too young to understand. S. Recommend that they continue to not argue in front of the child. T. Suggest counseling to learn ways to handle stress. U. Tell them that the conflict will resolve when the situation changes. 3. During a well child assessment of an 18 month old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do? S. Allow the parent to put the child in a “timeout.” T. Ask the parent about usual discipline practices. U. Offer the child a book or a toy to look at. V. Stop the exam since the child has reached a “meltdown.” 25 4. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3yearold child who draws on the walls with crayons? O. Give the child washable markers so the drawings can be removed easily. P. Provide a roll of paper for drawing and teach the child to use this. Q. Put the child in “timeout” each time the child draws on the walls. R. Take the crayons away from the child to prevent the behavior. 5. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? P. Consult a developmental specialist for a more complete evaluation. Q. Prepare the parents for a potentially serious developmental disorder. R. Refer the infant to an early intervention program for physical therapy. S. Teach the parents to provide exercises to encourage motor development. 6. The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? L. Explain to the parent that developmental delays often do not manifest at first. M. Perform a developmental assessment and tell the parent which delays are evident. N. Point out the tasks that the infant can perform while conducting the assessment. D. Refer the infant to a developmental specialist for a complete evaluation. 7. The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially? L. Ask the parents if they have an individualized family service plan (IFSP). M. Consult with a physician to ensure the child gets appropriate care. N. Inform the family that services are provided when the child begins school. O. Refer the family to a social worker for assistance with referrals and services. 8. The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children? A. Care coordination and collaboration O. Developing protocols for parents to follow P. Monitoring individual education plans (IEPs) Q. Providing lists of resources for families 9. The primary care pediatric nurse practitioner performs a physical examination on a 9montholdinfant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? I. To begin brushing the infant’s teeth with toothpaste J. To consider weaning the infant from breastfeeding K. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination 10. The primary care pediatric nurse practitioner enters an exam room and finds a 2 month old infant in a car seat on the exam table. The infant’s mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as H. a sign that the mother has postpartum depression. I. extremely concerning for potential parental neglect. J. of moderate concern for parenting problems. K. within the normal range of behavior in early parenthood. Burns Chapter 9 26 1. 1. A mother brings her 9 month infant in for a routine visit. What milestone would be appropriate for the doctor to ask if the infant is meeting? 1. Walking 2. Speaking in two word phrases 3. Rolls back to stomach and stomach to back 4. All of the above 2. A 5 day old infant comes in for a newborn checkup. On assessment of the newborn, you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant has only had 2 diapers today. The infant is strictly breastfed and this is moms first child. She states baby is having trouble latching on. A bilirubin level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby? 1. Phototherapy 2. Providing support and education for the lactating mother 3. Strict monitoring of intake and output 4. All of the above 3. Apgar scores measure heart rate, respiratory rate, reflex irritability, color and: 1. Rigidity 2. Muscle tone 3. Birth weight 4. Capillary refill 4. A mother on the postpartum unit asked to have her infant back from the nursery so that she can breastfeed. The nurse brings the newborn to the room and hands the baby to the mother. She asks the mother to let her know how long the baby feeds. What vital step did the nurse forget to take before giving the baby to the mother? 1. The nurse should have made sure that the baby was latching correctly 2. The nurse should have identified the babys ID band with the mothers 3. The nurse should have the mother speak with a lactation consultant 4. The nurse should have asked the mother how long she planned to feed 5. Excessive heat loss results in which of these? 1. RDS 2. Depletion of glucose levels 3. Jaundice 4. Increase in surfactant levels 6. A mother has just delivered her new baby a few hours ago. She asks the nurse if she can bathe the baby because he has blood on him. The best response from the nurse would be. 1. Sure, let me get you some soap and washcloths 2. Why don’t you get some rest, there will be lots of time for bathing 3. It’s important that we not bathe the baby too soon after birth. Let’s wait till later in the day. 4. Sure, but why don’t you feed the baby 7. A 4 week old infant is brought to the ED. Mom states that the baby hasn’t been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the 27 baby is difficult to arouse, is hypotonic and temperature is 35.4 rectally. What is an important lab value to check? Choose the best answer. 1. Complete metabolic panel 2. Liver panel 3. Blood glucose 4. PTT 8. A pregnant woman with a history of a clotting disorder is required to self-administer heparin during her pregnancy. After delivery, the infant will be at greater risk for: 1. Low blood sugar 2. Decrease Vitamin K 3. Increased Vitamin K 4. High blood sugar 9. A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at: 1. 3 months, 6 months, 9 months 2. 2 months, 4 months, 6 months and 1 year 3. 2 months, 4 months, 6 month, 9 months and 1 year 4. 2 months, 4 months, 9 months and 1 year 10. You are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been watching his I & Os. What would you expect the infants urinary output to be in order to maintain adequate hydration? 1. 0.52 ml/kg/hr 2. 0.52.5 ml/kg/hr 3. 13 ml/kg/hr 4. As long as he is having wet diapers it doesn’t matter 11. A mother brings her newborn daughter to the ER with concerns that she is having vaginal bleeding. You know this is normal and called what? 1. Pseudomenstruation 2. Milia 3. Vernix caseosa 4. Toxicum 12. While interviewing the mother of an infant, you note that the mother gets frustrated as she explains that her baby has been up all night crying at least 3 times a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response from you as the nurse? 1. Believe me, I know. I have a newborn too. 2. Have you tried warm milk? 3. Its ok to be frustrated and feel overwhelmed. 4. You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty. Burns Chapter 10 28 1. The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant’s future intellectual growth. What will the nurse practitioner tell the parent? W. Cognitive learning begins during the toddler years. X. Intellectual growth begin when speech develops. Y. Language and literacy skills begin at birth. Z. Preschool is an optimal time to begin general learning. 2. The primary care pediatric nurse practitioner performs a well baby examination on a 7 day old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? V. Follow up at the 2 month checkup. W. Refer to a lactation consultant. X. Schedule a weight check in 1 week. Y. Suggest supplementing with formula. 3. During an assessment of a 4 week old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4 hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? A. Continuing to nurse the infant using the current pattern W. Nursing the infant for longer periods every 4 hours X. Supplementing with formula at the last nighttime feeding Y. Waking the infant every 2 hours to nurse during the night 4. The primary care pediatric nurse practitioner is performing a well baby examination on a 2 month old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? S. She may not be making as much breastmilk as before. T. She should keep a log of the frequency and duration of each feeding. U. The infant may be going through an expected growth spurt. V. The infant should stay on the previously established nursing schedule. . 5. The mother of a 6 week old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? T. Her baby is probably constipated. U. It may be related to her dietary intake. V. She should consume more water. W. This may be normal for breastfed babies. 6 . The mother of a 3 month old child tells the primary care pediatric nurse practitioner that it is “so much fun” now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? A. Appropriate ways to stimulate and entertain the infant B. How to read the infant’s cues for overstimulation O. The importance of scheduling “play dates” with other infants P. To provide musical toys to engage the infant 7. The parent of a 5 month old is worried because the infant becomes fussy but doesn’t always seem interested in nursing. What will the nurse practitioner tell this parent? P. The infant may be expressing a desire to play or to rest. Q. The parent should give ibuprofen for teething pain before nursing. R. This is an indication that the infant is ready for solid foods. S. This may indicate gastrointestinal discomfort such as constipation. 8. The mother of a 6monthold infant is distressed because the infant can Say “dada” but not “mama” and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? R. “At this age, your baby does not understand the meaning of sounds.” S. “Babies at this age cannot make the ‘ma’ sound.” T. “Most sounds made by babies at this age are accidental.” U. “This may mean that your baby doesn’t hear well.” 9. The primary care pediatric nurse practitioner is performing a well child examination on a 9 month old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? L. Provide educational videos that focus on language. M. Read simple board books to the infant at bedtime. L. Sing to the child and play lullabies in the baby’s room. M. Turn the television to Sesame Street during the day. 10. The primary care pediatric nurse practitioner is examining a 12 month old Infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? G. Perform an indepth developmental assessment. H. Reassure the parent that this is normal for a premature infant. I. Refer the infant to a developmental specialist. J. Suggest activities to improve fine motor skills. Burns Chapter 11 1. The primary care pediatric nurse practitioner is evaluating a 2 year old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? AA. Ask the child’s parents whether they read to the child. BB. Give parents educational materials to encourage speech. CC. Refer the child to an early intervention program. DD. Suggest that they purchase age appropriate music videos. 2. The primary care pediatric nurse practitioner performs a developmental assessment on a 32 month old child. The child’s parent reports that about 70% of the child’s speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. Which action is correct? Z. Evaluate the child’s cognitive abilities. AA. Obtain a hearing evaluation. BB. Reassure the parent that this is normal. CC. Refer the child to a speech therapist. 3. During a well child assessment of an 18 monthold child, the primary care pediatric nurse practitioner observes the child point to a picture of a dog and say, “Want puppy!” The nurse practitioner recognizes this as an example of Z. holophrastic speech. AA. receptive speech. BB. semantic speech. CC. telegraphic speech. 4. The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12monthold child. The parents are bilingual in Spanish and English and have many Spanish speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents? GG. Children who learn two languages simultaneously often confuse them in conversation. HH. Children with Multilanguage proficiency do not understand that others cannot do this. II. Learning two languages at an early age prevents children from developing a dominant language. X. Most bilingual children are able to shift from one language to another when appropriate. 5. The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? • Allow the child to explore and experiment while providing appropriate limits. • Be present while the child plays to continually teach the child what is appropriate. • Let the child experiment at will and to make mistakes in order to learn. • Say “no” whenever the child does something that is not acceptable. 6. The mother of a 3 year old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? U. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. V. The toddler may have a language delay that interferes with socialization with other children. W. Toddlers may be interested in other children but usually do not engage in interactive play. X. Toddlers need more structured play to encourage interaction and socialization with others. 7. The parent of a 4yearold points to a picture and says, “That’s your sister.” The child responds by saying, “No! It’s my baby!” This is an example of which type of thinking in preschool age children? P. Animism Q. Artificialism R. Egocentrism D. Realism 8. The parent of a 24 month old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? N. “Begin by reading to your child about toileting.” O. “Most children are capable by age 2 years.” K. “Tell me about your child’s daily habits.” L. “We should assess your child’s motor skills.” 9. The primary care pediatric nurse practitioner performs a physical examination on a 9 month old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? D. To begin brushing the infant’s teeth with toothpaste E. To consider weaning the infant from breastfeeding F. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination 10. The parents of a 3 year old child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child’s rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do? D. Allow the child to choose foods for meals to improve caloric intake. E. Place a variety of nutritious foods on the child’s plate at each meal. F. Prepare mashed potatoes and chicken strips for the child at mealtimes. G. Suggest cutting out snacks to improve the child’s appetite at mealtimes. Burns Chapter 12 1