Question 1

A nurse midwife in a community health center teaches a group of women about the importance of Pap smears. Which of the following women requires a Pap smear immediately?

Accepted Answer

A 70-year-old woman with a new sexual partner requires a Pap smear. A woman over the age of 65 who has had only negative results in the past 10 years only needs a Pap smear test when she engages in a sexual relationship with a new partner. Otherwise, she may stop regular Pap smears. Women who are either over the age of 21 or sexually active (whichever comes first) should have Pap smears every two years. Women over the age of 30 who had three negative Pap smears in a row may have their Pap smears every three years.

Question 2

A client delivered a healthy infant through cesarean section. The nurse midwife encourages the client to eat which food item to promote wound healing?

Accepted Answer

The client should be encouraged to eat oranges. Citrus fruits and juices are high in vitamin C, which is necessary to form collagen. Collagen is used in synthesis of skin, scar tissues and blood vessels. Bananas are high in potassium. Wheat bread is high in fiber, which lowers cholesterol and prevents constipation. Milk is high in calcium.

Question 3

A female client who is being treated for alcohol abuse has thiamine deficiency. The client is encouraged to eat which food item to support the treatment of thiamine deficiency?

Accepted Answer

Pork is a good source of thiamine. Thiamine is obtained from animal and plant sources. Legumes, nuts and whole grain cereals are also high in thiamine. Chicken is high in niacin. Salmon is high in omega-3-fatty acids. Green leafy vegetables are high in vitamin K.

Question 4

A client is encouraged to consume sufficient amounts of which food item to prevent iron-deficiency anemia?

Accepted Answer

Organ meats are high in iron. Iron is used to make hemoglobin, the oxygen carrying component of red blood cells. Salmon is high in omega 3 fatty acids. Chicken is high in niacin. Oranges are high in vitamin K.

Question 5

An 18-year-old informs the nurse midwife that she has a family history of osteoporosis. The client asks the nurse which food item she should eat to prevent this condition. Which of the following foods would not be a helpful suggestion for this client?

Accepted Answer

Tomatoes are high in potassium, not calcium. Cheese, sardines, tofu and milk are high in calcium. Research shows that women should store as much calcium as they can to before reaching the peak bone mass between 18 and 25 years, as eating calcium-rich foods later in life does not increase the calcium content of bones.

Question 6

At a screening clinic, a 23-year-old female client has a cholesterol blood test. The nurse midwife informs the client that healthy eating and moderate physical activity can keep her cholesterol level in the healthy range, which is below:

Accepted Answer

A cholesterol level below 200 mg/dL is considered normal and healthy. Keeping the cholesterol level below 200 mg/dL can decrease the client's risk for atherosclerosis, diabetes and other cardiovascular disease.

Question 7

A series of laboratory examinations are conducted for a client who is admitted to the facility for an annual checkup. Blood is drawn for serum electrolyte testing. Which of the following assessment findings requires further evaluation?

Accepted Answer

The client's serum chloride level is below the normal range of 98 to 107 mEq/L. Hypochloremia may be caused by excessive sweating or vomiting, or by adrenal and kidney diseases. The other laboratory findings are normal.

Question 8

A 34-year-old female client is scheduled to have a glucose tolerance test in three days. Which of the following instructions by the nurse midwife is the most appropriate for the client?

Accepted Answer

Before a glucose tolerance test, the client has to eat a high-carbohydrate diet, which is between 200 and 300 grams of carbohydrates, for three days. The client should fast for 10 to 16 hours before the test. Alcohol, smoking and coffee are avoided during the two or three days preceding the test. Exercise should be avoided during the eight-hour period preceding the test and during the eight-hour period following the test.

Question 9

A nurse midwife is teaching a group of women in the community about mammograms. Which of the following statements made by one of the women indicates that further teaching is necessary?

Accepted Answer

Although the amount of radiation administered in mammography is low and approved by the National Department of Health and Human Services, women who may be pregnant should notify their physicians about their condition. Radiation can pose risks to a developing fetus. A pregnant client may have a mammogram only if there are symptoms of breast cancer or tumor.

Question 10

A 35-year-old female client comes to the facility to inquire about getting her basal mammogram. Which of the following instructions by the nurse midwife is the most appropriate?

Accepted Answer

The client must avoid applying deodorants or creams under the arms or on the breasts before the test. The metallic powders of antiperspirants may be visible on the mammogram as microcalcifications and may result in inaccurate results. A mammogram should be scheduled for either one week before or after the menstrual bleeding. The breasts are tender before the menses. The procedure involves compression of the breasts between two panels, which can be painful. Over-the-counter pain relievers can be taken before the test but the client must inform the doctor of any medications she has taken. Caffeine should be avoided during the week before a mammogram.

Question 11

A nurse is teaching a group of women between the ages of 19 and 23 about breast examination. Which of the following statements made by one of the participants indicates that further teaching is needed?

Accepted Answer

Starting at age 40, clinical breast examination should be done every year. The other options are accurate statements about breast health. Premenopausal women should perform breast self-examination on a monthly basis, about a week after the menses.

Question 12

A nurse midwife teaches a client that before palpating her breasts during breast self-examination, she needs to inspect her breasts for abnormalities in which of the following positions?
I.With her arms relaxed at her sides
II.With her arms lifted over her head
III.With her hands pressed against the hips
IV.With her hands pressed against the waist, leaning forward

Accepted Answer

Before palpating the breasts, the client should begin her monthly breast self-examination with inspection or observation of her breasts in the following positions: arms relaxed at her sides, arms lifted over her head, hands pressed against the hips and hands pressed together at the waist. The client should be instructed to look at each breast carefully and individually and to compare them. Lumps, dimpling, irregular shape, significant asymmetry and discharges should be reported.

Question 13

A nurse midwife is teaching a female client how to perform a breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary?

Accepted Answer

The client needs further teaching if she uses the tips of her second, third and fourth fingers to press every part of her breast. The client should use the pads of her fingers to palpate her breasts.

Question 14

A nurse midwife performs a bimanual pelvic examination on a 25-year-old female client during her annual examination. Which of the following findings indicates a need for further evaluation?

Accepted Answer

Cervical motion tenderness should alert the nurse midwife that further evaluation is necessary. This finding is commonly associated with pelvic inflammatory disease. The fallopian tubes and ovaries are small, and it is normal that they are not palpated in certain patients. If they are palpated, they must be smooth and firm. The uterus is normally freely movable.

Question 15

A nurse midwife is about to assess a female client through the use of vaginal speculum. When choosing the size of the speculum, the nurse midwife considers:
I.Age of the client
II.Size of the vagina
III.History of sexual intercourse
IV.Gravidity

Accepted Answer

When choosing the size of the speculum, the nurse midwife should consider the age of the client, the size of the vagina, the client's history of sexual intercourse and gravidity. The Graves speculum is used for examining adult women. The Pederson speculum, the narrower of the two, is used for young girls, virgins and postmenopausal women with vaginal atrophy.

Question 16

A nurse midwife is about to conduct intravaginal assessment through the use of vaginal speculum on a G3P3 female client. Cells will be taken for cytologic studies, and cultures are to be obtained. Which of the following actions by the nurse midwife is the least appropriate?

Accepted Answer

The least appropriate action of the nurse is to apply water-based gel to the speculum. If cultures are to be obtained, the nurse midwife should not use water or gel to warm or lubricate the speculum. The other options are appropriate actions. If cytologic studies are to be done, vaginal medications and douching should be avoided before the procedure.

Question 17

A nurse midwife palpates for which of the following anatomic locations when evaluating the Bartholin's glands?

Accepted Answer

The client palpates the posterior labia majora when evaluating the Bartholin's glands. These glands secrete mucus that lubricates the lips of vagina. The Skene's glands can be palpated over and along both sides of the urethra.

Question 18

A female client is admitted to the facility due to alcohol abuse. During the first 24 hours, which of following interventions is the least appropriate?

Accepted Answer

Initiating bleeding precautions is not a priority action during the first 24 hours of treatment for alcohol abuse. Signs of alcohol withdrawal occur during this time period. The nurse has to orient the client frequently to alleviate anxiety and to reinforce reality, as hallucinations and illusions are common. Seizures may occur as the withdrawal progresses, so precautions are initiated on admission. A quiet and non-stimulating environment decreases anxiety and prevents seizures.

Question 19

A nurse midwife is managing the care of a G2P3 client who is in treatment for alcohol abuse. Which of the following interventions is the most appropriate?

Accepted Answer

The most appropriate intervention is to focus the client's attention on the substance abuse problem. The nurse midwife should inform the client that she is accountable for all of her actions. Alcohol abuse requires the client to develop her own problem-solving skills. The nurse midwife should help the client to identify situations that precipitate angry feelings and to make her own plan of action to prevent anger. The nurse midwife should set limits on manipulative behaviors.

Question 20

A female client asks a nurse midwife why a newborn is not immunized with MMR immediately after birth. The client was immunized with MMR about 5 months ago and is planning to get pregnant. Which of the following possible responses is the most appropriate?

Accepted Answer

The nurse midwife should inform the client that a newborn is protected from infectious diseases, such as German measles, during the first months of life because IgG maternal bodies can cross the placenta during the third trimester, which is a form of passive immunity. IgG is the only group of antibodies that can cross the placenta barrier. The level of IgG peaks at birth and decreases over the next eight months. The transfer of maternal antibodies to the fetus through the placenta is an example of passive immunity.

Quiz 6: Primary-Care