Chapter 26: Wellness and Health Promotion
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Question 1
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17s
A client is 25 weeks' pregnant. The client explains that she is having difficulty getting an adequate
amount of protein into the diet because she is a vegetarian. How can the nurse counsel this client?
You Selected:
"In addition to protein from dairy, eat complementary proteins such as beans and rice together, or
beans and wheat together."
Correct response:
"In addition to protein from dairy, eat complementary proteins such as beans and rice together, or
beans and wheat together."
Explanation:
It is important for the nurse to understand the vegetarian diet because nutrition is an important teaching
point for intrapartal woman. Women who are vegetarian usually do not eat fish and some do not eat
eggs. Most proteins from nonanimal sources are incomplete proteins that need to be combined with
other nonanimal proteins to become complete proteins. Client education on how to eat complementary
proteins such as beans and rice, legumes and rice, or beans and wheat can help vegetarians increase
protein in the diet. It is not realistic for the client to eat tofu at every meal.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, p. 612.
Chapter 26: Wellness and Health Promotion - Page 612
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Question 2
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13s
A nurse is conducting a teaching session with a group of adolescent females at a local women's health
clinic. When describing appropriate screening guidelines for cervical cancer, at which age would the
nurse would instruct the group to have their first Papanicolaou test?
You Selected:
21
Correct response:
21
Explanation:
Although professional medical organizations disagree as to the recommended frequency of screening
for cervical cancer, ACOG (2015) recommends that cervical cancer screening should begin at age 21
years (regardless of sexual history) since women younger than age 21 are at very low risk for cancer.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, p. 603.
Chapter 26: Wellness and Health Promotion - Page 603
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Question 3
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12s
A community health nurse is conducting an educational session at a local community center on
sexually transmitted infections (STIs). The nurse considers the session successful when participants
identify which statement as correct?
You Selected:
"Human papillomavirus is the cause of essentially all cases of cervical cancer."
Correct response:
"Human papillomavirus is the cause of essentially all cases of cervical cancer."
Explanation:
Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which
is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell
carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV. Antibiotics will only
cure those STIs caused by bacterial infections. A viral STI infection is a lifetime infection. Gonorrhea
and syphilis affect both men and women. Sexually transmitted infections are infections of the
reproductive tract caused by microorganisms transmitted through oral sexual intercourse.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Etiology of Cervical Cancer, p. 602.
Chapter 26: Wellness and Health Promotion - Page 602
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Question 4
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The nurse is teaching a cancer prevention to class to a group of young adult women. The nurse
teaches the group that cervical cancer screenings should start at what age?
You Selected:
25 years
44s
Correct response:
21 years
Explanation:
Screening for cervical cancer should start at age 21. Even women who do not report sexual activity
should be screened at 21 years. Screening women under the age of 21 is not beneficial as cervical
changes tend to resolve spontaneously in this age group.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, p. 603.
Chapter 26: Wellness and Health Promotion - Page 603
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Question 5
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13s
A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the
nurse inform the client about to detect cervical cancer at an early stage?
You Selected:
Papanicolaou test
Correct response:
Papanicolaou test
Explanation:
The client should have Papanicolaou tests regularly to detect cervical cancer during the early stages.
Blood tests for mutations in the BRCA genes indicate the lifetime risk of the client of developing breast
or ovarian cancer. CA-125 is a biologic tumor marker associated with ovarian cancer, but it is not
currently sensitive enough to serve as a screening tool. The transvaginal ultrasound can be used to
detect endometrial abnormalities.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Pap Test, p. 602.
Chapter 26: Wellness and Health Promotion - Page 602
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Question 6
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19s
The nurse is teaching a cancer prevention class to adult women. What exceptions to cervical screening
does the nurse teach these women? Select all that apply.
Screening may end at age 65.
Screening may end after having a hysterectomy with cervix removal.
Women with a history of cervical cancer should be screened for 30 years.
Screening for cervical cancer and HPV should happen every 3 years.
Screening should start at age 20.
Correct response:
Incorrect response:
Your selection:
Explanation:
In the United States, screening for cervical cancer and HPV begins at age 21. Women who are 65 or
older can stop screening provided they have had at least two consecutive negative co-tests in the past
10 years. Women who have had a hysterectomy that included the removal of the cervix should not be
screened. Women with a history of a hysterectomy with an intact cervix should continue to be screened
according to age and history. Women with a history of cancer should continue to be screened for 20
years after the completion of treatment for the cancer. In addition, the daughters of mothers who took
diethylstilbestrol should be screened frequently.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, Screening Exceptions, pp. 603-604.
Chapter 26: Wellness and Health Promotion - Page 603-604
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Question 7
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14s
A 30-year-old female is attending a health fair for women. The nurse at the fair is reviewing risk factors
for cervical cancer. Which important risk factor should the nurse include at the fair?
You Selected:
exposure to diethylstilbestrol (DES) in utero
Correct response:
exposure to diethylstilbestrol (DES) in utero
Explanation:
Cervical cancer has several risk factors: early age of first intercourse (in first year of menarche), lower
socioeconomic status, unprotected sex, family history of cervical cancer, exposure to DES in utero, HIV,
use of oral contraceptives, HPV, and multiple male partners.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Screeening Exceptions, p. 604.
Chapter 26: Wellness and Health Promotion - Page 604
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Question 8
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31s
A client whose natal sex is identified as male reports issues with their parents because of wanting to
wear female clothing and makeup. Which problem should the nurse use when planning care for this
client?
You Selected:
conflict with gender identity
Correct response:
conflict with family over gender expression
Explanation:
The client’s natal sex is male; however, gender expression is that of female. The client further reports
issues with the parents because of the gender expression. The problem that would be most appropriate
to guide this client’s care is conflict with family over gender expression. There is not enough information
to determine if the client is at risk for gender dysphoria, because the client is not describing distress or
discomfort due to misalignment between gender identity and assigned sex. The client is not expressing
a conflict with gender identity. The client is not a transman, because the client was identified as a male
from birth.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Distinguishing Sex from Gender, p. 621.
Chapter 26: Wellness and Health Promotion - Page 621
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Question 9
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19s
An 18-year-old client tells the nurse about recently becoming sexually active and asks if they should
start getting an annual Papanicolaou (Pap) test. How will the nurse respond?
You Selected:
“It is recommended that screening for cervical cancer begin at age 25.”
Correct response:
“Screening is recommended starting at age 21 regardless of sexual activity.”
Explanation:
The nurse’s best response is that screening is recommended to begin at age 21 regardless of sexual
activity. Even those who do not report sexual activity should be screened beginning at age 21. Telling
the client that they are too young to begin screening is an incomplete answer and does not provide
guidelines for when to begin screenings. Screening for cervical cancer is recommended to begin at age
21, not 25.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, p. 603.
Chapter 26: Wellness and Health Promotion - Page 603
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Question 10
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54s
During a prenatal examination, the nurse notes that a pregnant client has bruises over the neck and
upper arms. Which statement will the nurse make before assessing if the client is a victim of intimate
partner violence (IPV)?
You Selected:
“It is a policy to screen clients for safety so help can be offered.”
Correct response:
“It is a policy to screen clients for safety so help can be offered.”
Explanation:
Assessing a client for intimate partner violence (IPV) is uncomfortable for the nurse and client. There
are different screening tools that can be used. However, the nurse must use care when delivering the
questions, which may feel invasive to the client and trigger shame or anxiety. Normalizing the
questioning by making it routine instead of targeted to the individual can be helpful. An example of a
normalizing statement is, “It is a policy to screen clients for safety so help can be offered.” Stating that
the client looks like they were in a fight is not a normalizing statement. Stating that abuse is common in
people who are pregnant is not a true statement. Stating that it is common for people to hide abusive
relationships from others also may not be true.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Intimate Partner Violence Screening, p. 610.
Chapter 26: Wellness and Health Promotion - Page 610
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Question 11
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1m 12s
During an assessment, a client whose natal sex is identified as female reports a gender identity as
being female. In which way should the nurse document this client’s gender identity?
You Selected:
cisgender
Correct response:
cisgender
Explanation:
Gender identity is a person’s innate sense of being male, female, or neither male nor female. A person
whose gender identity aligns with the assigned natal sex may be referred to as cisgender. The general
term transgender is used to refer to individuals whose gender identity is not the same as their assigned
natal sex. The term transgender man or transman describes a person with a male gender identity who
was assigned female at birth. The term transgender woman or transwoman describes a person with a
female gender identity who was assigned male at birth.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Distinguishing Sex from Gender, p. 621.
Chapter 26: Wellness and Health Promotion - Page 621
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Question 12
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A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client
education, what group should the nurse include as at risk for cervical cancer?
11s
You Selected:
clients who have genital warts
Correct response:
clients who have genital warts
Explanation:
The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women
with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not
cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease
have an increased risk of developing breast cancer, but not cervical cancer.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Etiology of Cervical Cancer, p. 602.
Chapter 26: Wellness and Health Promotion - Page 602
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Question 13
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19s
A 25-year-old woman is at the health care provider's office for her annual checkup. The nurse educated
the woman on risks for cervical cancer. Which question would be important to ask as part of a risk
screening?
You Selected:
“Were you sexually active at an early age?”
Correct response:
“Were you sexually active at an early age?”
Explanation:
Women that have a history of sexual activity within the first year of getting their menstrual cycle are at
increased risk for cervical cancer later in life. Infertility, obesity, and high blood pressure put women
more at risk for endometrial cancer.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, p. 603.
Chapter 26: Wellness and Health Promotion - Page 603
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Question 14
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1m 43s
A nurse is caring for a postmenopausal client concerned about having vaginal bleeding. The client
states, "I had a sexually transmitted infection that treated successfully 8 years ago." When assessing
the client further, which organism would be of highest concern at this time?
You Selected:
chlamydia
Correct response:
human papillomavirus
Explanation:
Unexplained vaginal bleeding can be a concern for possible reproductive cancer. The nurse is correct
that genital herpes infection is associated with an increased risk of cervical cancer. If untreated,
syphilis can progress to affect the central nervous system, causing dementia. Chlamydia increases the
risk for other STIs. Data suggest that gonorrhea facilitates HIV transmission.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, p. 602.
Chapter 26: Wellness and Health Promotion - Page 602
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Question 15
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13s
A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are
vaccines available to prevent STIs. How should the nurse respond?
You Selected:
"A vaccine has been approved to prevent the human papillomavirus."
Correct response:
"A vaccine has been approved to prevent the human papillomavirus."
Explanation:
Vaccine-preventable STIs can be effectively prevented through preexposure vaccination. Vaccines are
under development or are undergoing clinical trials for certain STIs, including HIV and HSV. The only
vaccines currently available are for prevention of hepatitis A virus, hepatitis B virus, and HPV infection.
Vaccination efforts focus largely on integrating the use of these available vaccines into STI prevention
and treatment activities.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Human Papillomavirus Vaccination, p. 605.
Chapter 26: Wellness and Health Promotion - Page 605
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Question 16
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A 30-year-old woman asks the nurse if she should continue to have a Papanicolaou test every year.
How should the nurse respond?
You Selected:
"You can now start getting screened with a Papanicolaou test every 3 years."
Correct response:
21s
"You can now start getting screened with a Papanicolaou test every 3 years."
Explanation:
After the age of 30 years, women may continue to be screened with the Pap test alone every 3 years.
Alternatively, they may be screened with a combination of a Pap test and HPV testing every 5 years.
There is no need to screen more often because women over 30 are less likely to have transient HPV
infections.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, p. 603.
Chapter 26: Wellness and Health Promotion - Page 603
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Question 17
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15s
A client has been referred for a colposcopy by the primary care provider. The client wants to know more
about the examination. Which information regarding a colposcopy should the nurse give to the client?
You Selected:
The test is conducted because of abnormal results in a Papanicolaou test.
Correct response:
The test is conducted because of abnormal results in a Papanicolaou test.
Explanation:
The nurse should explain to the client that the colposcopy is done because the care provider has
observed abnormalities in the Papanicolaou test results. The nurse should also explain to the client that
the procedure is painless and there are no adverse effects, such as pain during urination. There is no
need to avoid intercourse for a week after the colposcopy.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Management of Abnormal Results, p. 605.
Chapter 26: Wellness and Health Promotion - Page 605
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Question 18
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1m 12s
The nurse is completing a 24-hour diet recall with a client who is demonstrating symptoms of anorexia
nervosa. Which question should the nurse ask to obtain the most valid information?
You Selected:
“What did you put on your spaghetti?”
Correct response:
“What did you put on your spaghetti?”
Explanation:
During a 24-hour diet recall interview, the nurse asks the client to report what the client ate and drank,
the portion size, and the method of food preparation over the course of the past 24 hours. These
interviews are guided by clusters of questions about eating and avoid using leading questions. To find
out what a client ate with spaghetti, a specific question such as “what did you put on your spaghetti?”
should be asked instead of leading questions such as “was the spaghetti with meat sauce?”; “were
there meatballs with the spaghetti?”; or “did you sprinkle cheeses on your spaghetti?”
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Table 26.5 Portion Size Estimator, p. 615.
Chapter 26: Wellness and Health Promotion - Page 615
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Question 19
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16s
The nurse is educating a female client diagnosed with human papillomavirus (HPV). Which information
will the nurse include in the client's education plan?
You Selected:
"You should be sure to receive consistent testing for cervical cancer."
Correct response:
"You should be sure to receive consistent testing for cervical cancer."
Explanation:
An infection with HPV is a risk factor for developing cervical cancer. Women with a history of HPV
should receive consistent testing/screening for cervical cancer. HPV is a virus; however, no antiviral to
date resolves the virus in the body. Surgical removal is an option for genital warts; however, it is not the
best option as the virus can still be spread without the presence of warts. Wart removal is done for
comfort and appearance. Outbreaks are most noted during times of stress or illness and trauma;
outbreaks are not temperature related.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Etiology of Cervical Cancer, p. 602.
Chapter 26: Wellness and Health Promotion - Page 602
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Question 20
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24s
The nurse is conducting a physical assessment on a 25-year-old client who identifies as transgender
man. The client states the cervix is intact. The nurse instructs the client that cervical screenings should
occur on what schedule?
You Selected:
every three years
Correct response:
every three years
Explanation:
In the case of a client whose gender expression does not match his or her documented sex, the person
not revealing his or her natal sex may have real health consequences. A transgender man with a cervix
still requires routine screening for cervical cancer. This client still needs to be screened for cervical
cancer on a schedule similar to other female clients. For a 25-year-old this would be screenings every 3
years.
Reference:
O'Meara, A., Maternity, Newborn, and Women's Health, 1st ed., Philadelphia, Wolters Kluwer, 2019,
Chapter 26: Wellness and Health Promotion, Timing of Screening, Distinguishing Sex From Gender, p.
603, 621.
Chapter 26: Wellness and Health Promotion - Page 603, 621
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