QUESTIONS AND CORRECT

NCLEX Health Promotion and Maintenance COMPLETE REVISION

QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED

ANSWERS) ALREADY GRADED A+

• Ana, a pregnant mother comes to the facility for her first prenatal visit. When providing teaching, the

nurse should be sure to cover which topic?

• Labor techniques
• Danger signs during pregnancy
• Signs and symptoms of pregnancy
• Tests to evaluate for high-risk pregnancy - Answer: 1. B. No matter how far the client's pregnancy has

progressed by the time of her first prenatal visit, the nurse should teach about danger signs during pregnancy so the client can identify and report them early, helping to avoid complications. The nurse should discuss other topics just before they're expected to occur.

• When developing a plan of care for a child, nurse Josefina identifies which eriksonian stage as

corresponding to Freud's oral stage of psychosexual development?

• Initiative versus guilt
• Autonomy versus shame and doubt
• Trust versus mistrust
• Industry versus inferiority - Answer: 2. C. Freud defined the first 2 years of life as the oral stage and

suggested that the mouth is the primary source of satisfaction for the developing child. Erikson posited that infancy (from birth to age 12 months) is the stage of trust versus mistrust, during which the infant learns to deal with the environment through the emergence of trustfulness or mistrust. Initiative versus guilt corresponds to Freud's phallic stage. Autonomy versus shame and doubt corresponds to Freud's anal/sensory stage. Industry versus inferiority corresponds to Freud's latency period.

• At a public health fair, nurse Karen teaches a group of women about breast cancer awareness.

Possible signs of breast cancer include:

• Fever 1 / 2

• breast changes during menstruation
• nipple discharge and a breast nodule
• fever and erythema of the breast - Answer: 3. C. Nipple discharge, breast nodules, nipple retraction,

and lymphadenopathy may be signs of breast cancer and should be reported. Mammary duct ectasia may cause fever, nipple discharge, breast nodules, erythema of the breast, and itching. Breast changes during menstruation are normal; for this reason, women should examine their breasts 4 to 7 days after the menstrual period ends, when the breasts are least congested. Fever and erythema of the breast may indicate a breast abscess.

• A female newborn born by elective cesarean section to a 25-year-old mother weighs 3,265 g (7 lb, 3

oz). Nurse Agatha places the newborn under the warmer unit. In addition to routine assessments, the nurse should closely monitor this newborn for which of the following?

• Temperature instability due to type of birth
• Respiratory distress due to lack of contractions
• Signs of acrocyanosis
• Unstable blood sugars - Answer: 4. B. The squeezing action of the contractions during labor enhances

fetal lung maturity. Infants who aren't subjected to contractions are at an increased risk for developing respiratory distress. The type of birth has nothing to do with temperature or glucose stability, and acrocyanosis is a normal finding.

• Nurse Ellen is aware that the following factors can cause hepatitis A?
• Contact with infected blood
• Blood transfusions with infected blood
• Eating contaminated shellfish
• Sexual contact with an infected person - Answer: 5. C. Hepatitis A can be caused by consuming

contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.

• Which findings would be considered positive signs of pregnancy?
• Fatigue and skin changes
• Quickening and breast enlargement
• Fetal heartbeat and fetal movement on palpation
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