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?&#10;A)A 75-year-old woman who has had three negative tests in the past 10 years.&#10;B)A 20-year-old female college student who has never been sexually active.&#10;C)A 70-year-old woman with a new sexual partner.&#10;D)A 35-year-old woman who had three negative Pap smears in a row; her most recent Pap smear was obtained two years ago.

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?&#10;A)Banana&#10;B)Wheat bread&#10;C)Orange&#10;D)Milk

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?&#10;A)Salmon&#10;B)Chicken&#10;C)Pork&#10;D)Green, leafy vegetables

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?&#10;A)Salmon&#10;B)Chicken&#10;C)Orange&#10;D)Organ meats

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?

A)Cheese
B)Tomatoes
C)Tofu
D)Milk

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:

A)500 mg/dL
B)400 mg/dL
C)300 mg/dL
D)200 mg/dL

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?

A)Sodium = 137 mEq/L
B)Potassium = 4.3 mEq/L
C)Chloride = 93 mEq/L
D)Bicarbonate = 27 mEq/L

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?&#10;A)&#34;Fast for 24 hours before the test.&#34;&#10;B)&#34;Eat a high-carbohydrate diet for three days before the test.&#34;&#10;C)&#34;Alcohol, smoking and coffee should be avoided for eight hours before the test.&#34;&#10;D)&#34;Be sure to exercise some time in the eight-hour period before the test and after the test.&#34;

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?&#10;A)&#34;After the age of 40, I should have a yearly mammogram.&#34;&#10;B)&#34;I can obtain my first baseline mammogram between the ages of 35 and 40 years.&#34;&#10;C)&#34;Mammograms can detect breast tumors two years before they are palpable.&#34;&#10;D)&#34;I can still have a regular screening even if I am pregnant, with or without the symptoms of breast cancer.&#34;

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?&#10;A)&#34;Schedule a mammogram during your menstrual cycle.&#34;&#10;B)&#34;Avoid applying deodorants or creams under the arms or on the breasts before the test.&#34;&#10;C)&#34;Avoid over-the-counter pain medications before the test.&#34;&#10;D)&#34;Caffeine intake should be limited during the eight hours preceding the test.&#34;

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?

A)"Women should conduct a monthly breast examination starting at age 20."
B)"Women should have a clinical breast examination every three years from ages 20 to 39."
C)"Starting at age 40, women should have a yearly mammogram."
D)"Starting at age 40, clinical breast examination should be done every other year."

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Accepted Answer

The answer of A nurse is teaching a group of...

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

A)I and II only
B)I, III and IV
C)I, II and III
D)She should inspect her breasts in all of the above positions.

Accepted Answer

The answer of A nurse midwife teaches a client that...

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?

A)The client uses the tips of her second, third and fourth fingers to press every part of her breast.
B)Using the right hand to examine the left breast, the client examines the entire breast using small circular motions in a spiral pattern.
C)In a supine position, the client places a folded towel under her right shoulder and puts her right hand behind her head. Using the left hand, she palpates her right breast.
D)In a standing position, the client places her hands on her hips and presses down firmly.

Accepted Answer

The answer of A nurse midwife is teaching a female...

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?&#10;A)Cervical motion tenderness&#10;B)The fallopian tubes and ovaries are not palpable.&#10;C)The ovaries are smooth and firm.&#10;D)The uterus is freely movable.

Accepted Answer

The answer of A nurse midwife performs a bimanual pelvic...

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

A)I and II only
B)I and IV only
C)I, II and IV
D)All of the above.

Accepted Answer

The answer of A nurse midwife is about to assess...

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?

A)The nurse midwife uses a water-based gel to lubricate the speculum.
B)The nurse midwife verifies that no vaginal medications were used before the procedure.
C)The nurse midwife rolls a sterile, cotton-tipped applicator on the vaginal wall below the cervix to collect cells from the vaginal pool.
D)Before withdrawing the speculum, the nurse midwife loosens the lever control. The blades are slowly closed, and the speculum is rotated.

Accepted Answer

The answer of A nurse midwife is about to conduct...

Question 17

A nurse midwife palpates for which of the following anatomic locations when evaluating the Bartholin's glands?&#10;A)Over and along both sides of the urethra&#10;B)Clitoris&#10;C)Posterior labia majora&#10;D)Labia minora

Accepted Answer

The answer of A nurse midwife palpates for which of...

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?&#10;A)Orient the client frequently.&#10;B)Initiate seizure precautions.&#10;C)Provide a quiet, non-stimulating environment.&#10;D)Initiate bleeding precautions.

Accepted Answer

The answer of A female client is admitted to the...

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?&#10;A)Help the client recognize that she cannot be accountable for all of her actions.&#10;B)Avoid situations that precipitate angry feelings.&#10;C)Focus the client's attention on the substance abuse problem.&#10;D)Acknowledge that some of her behaviors are due to her alcohol problem.

Accepted Answer

The answer of A nurse midwife is managing the care...

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?

A)"IgM maternal antibodies cross the placenta into the fetus during the third trimester, giving the newborn temporary passive immunity during the first months of life."
B)"If the mother has been immunized within five months before the pregnancy, the newborn is temporarily protected from German measles during the first months of life. This is an example of active immunity."
C)"IgG maternal antibodies cross the placenta into the fetus during the third trimester, so temporary active immunity is attained during the newborn's first months of life."
D)"IgG maternal antibodies cross the placenta during the third trimester, giving the newborn temporary passive immunity during the first months of life."

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Deck 6: Primary-Care