ch 18 OB

The nurse is providing a community education class on menopause. Which are symptoms associated with menopause? Select all that apply. 1. Trouble falling asleep and staying asleep 2. Painful intercourse 3. Weight loss 4. Numbness in face 5. Night sweats

1. Trouble falling asleep and staying asleep 2. Painful intercourse 5. Night sweats

Which statement by the client diagnosed with menopause demonstrates an understanding of the prescribed estradiol cream (Estrace Cream)? 1. "This cream will help with my vulva soreness." 2. "This cream will treat my vaginal infection." 3. "This cream will lubricate me for sexual intercourse." 4. "This cream will increase my sexual desire."

"This cream will help with my vulva soreness."

The school nurse is planning an assembly for female high school students to provide risk reduction information. Categorize the following risk behaviors from most to least common as reported in a 2015 National Youth Risk Survey. Rarely or never wore a bicycle helmet Texted or e-mailed while driving a car Drink five or more drinks of alcohol in a row Ever used ecstasy

3, 4, 2, 1

The primary care nurse is obtaining the weight and body mass index (BMI) of several clients. Which client would be defined as having obesity? 1. A male client with a body mass index of 29 2. A male client with a weight of 102 kg (225 lbs.) 3. A female client with a body mass index of 31 4. A female client with a weight of 80 kg (175 lbs.)

A female client with a body mass index of 31

The nurse is giving a presentation about health promotion and alcohol use to a group of women in college. Which statement should be included in the presentation? 1. "Drinking in moderation means five or less drinks per day for women." 2. "Drinking alcohol decreases the effectiveness of hormonal birth control." 3. "Binge drinking increases the risk for sexual assault." 4. "Excessive drinking prior to pregnancy causes birth defects when pregnancy occurs."

"Binge drinking increases the risk for sexual assault."

The nurse is presenting on breast cancer screening during a health fair. Understanding of cancer detection that provides the best opportunity for successful treatment is reflected by which statement? 1. "Early detection of breast cancer when the small tumor has not spread." 2. "MRI screening is recommended for all women to detect breast cancer." 3. "Average risk for breast cancer includes BRACA1 gene mutation." 4. "Monthly self-breast exams are recommended for all women."

"Early detection of breast cancer when the small tumor has not spread."

The nurse is teaching a 16-year-old girl about the human papillomavirus (HPV) vaccine. Which statement by the teen indicates more teaching is needed? 1. "The vaccine will help prevent cervical cancer." 2. "The vaccine will help prevent genital warts." 3. "I will need to get three doses of the vaccine." 4. "I don't need to have a Pap test if I am fully vaccinated."

"I don't need to have a Pap test if I am fully vaccinated." Rationales Option 1: HPV vaccines can prevent HPV infections with HPV types associated with cervical cancer. Option 2: HPV vaccines can prevent HPV infections with HPV types associated with genital warts. Option 3: Three doses of the vaccine are recommended if over 15 years of age. Option 4: Routine screening with pap tests are still recommended.

The nurse is teaching health promotion to a class of high-school students. Which should be included regarding human papillomavirus (HPV)? Select all that apply. 1. HPV is the most common sexually transmitted virus in the United States. 2. HPV vaccine is recommended only for females. 3. HPV can cause cancer of the penis. 4. Most cases of cervical cancer are caused from HPV. 5. HPV vaccine is not indicated if a person already has genital warts.

1. HPV is the most common sexually transmitted virus in the United States. 3. HPV can cause cancer of the penis. 4. Most cases of cervical cancer are caused from HPV.

The nursing instructor has developed a presentation for nursing students on health needs of the female population over 65 years of age. Which health promotion activities are applicable for geriatric women? Select all that apply. 1. Perform weight-bearing exercises and weight-lifting. 2. Limit fluid intake to less than eight glasses. 3. Go to step-aerobic fitness classes. 4. Stop driving after getting lost in familiar location. 5. Get a pap test every three years.

1. Perform weight-bearing exercises and weight-lifting. 4. Stop driving after getting lost in familiar location.

The nurse is educating a group of women on health promotion and risks from obesity. Which conditions are women at higher risk for due to obesity? Select all that apply. 1. Sleep apnea 2. Type 2 diabetes 3. Breast cancer 4. Osteoporosis 5. Pregnancy complications

1. Sleep apnea 2. Type 2 diabetes 3. Breast cancer 5. Pregnancy complications

Question 3. The mother of a 10-year old girl asks the nurse when she should expect her daughter to have her first period. Which response by the nurse is correct? 1. 2 to 2.5 years after the beginning of puberty 2. About the time that the breasts begin to develop 3. Any time between 13 to 14 years of age 4. At the age the mother had menarche

2 to 2.5 years after the beginning of puberty Rationales Option 1: Menarche occurs 2 to 2.5 years after the onset of puberty. Option 2: Enlargement of the breasts occur with secretion of estrogen, before the onset of menarche. Option 3: Menarche onset is normal as early as age 9. Option 4: The mother's age of menarche does not predict the age of menarche for the daughter.

The nurse is caring for a client who identifies herself as lesbian. Which factors should the nurse consider when planning the client's care? Select all that apply. 1. Screening for breast and cervical cancers can be done less frequently in lesbian women. 2. Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities. 3. Domestic violence is not a concern in lesbian relationships. 4. Lesbians seek health care less often than do heterosexual women. 5. Lesbian women are less likely to use tobacco, alcohol, and illicit drugs compared to heterosexual women.

2. Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities. 4. Lesbians seek health care less often than do heterosexual women.

The nurse is reconciling the medication list for an elderly client. Which should the nurse consider when reviewing medications for this client? Select all that apply. 1. Older adults usually need larger doses of medications. 2. Older adults are at higher risk of drug toxicity. 3. Older adults are at more likely to have drug interactions. 4. Include vitamins and supplements on the medication list. 5. Over-the-counter medications do not need to be reviewed.

2. Older adults are at higher risk of drug toxicity. 3. Older adults are at more likely to have drug interactions. 4. Include vitamins and supplements on the medication list. Rationales Option 1: Older adults often need smaller doses due to slower metabolism and organ function. Option 2: Due to declining kidney function, drugs may be eliminated slower and may increase risk of toxicity. Option 3: Older adults take more medication than younger people, which increases possible drug interactions. Option 4: Drug interactions can occur with vitamins and supplements. Option 5: Over-the-counter medications can have drug interactions and should be reviewed.

An elderly female client has a nursing diagnosis of being at risk for falls related to impaired balance. The nurse has instructed the client on fall prevention. Which statement by the client indicates the need for further instruction? 1. "I should install grab bars near the shower." 2. "I should tape down the throw rugs in my home." 3. "I will schedule an annual eye exam." 4. "I should limit alcohol."

"I should tape down the throw rugs in my home."

Question 2. The nurse is teaching an adolescent female about cervical cancer screening (Pap test). Which statement indicates that teaching was effective? 1. "I will need to have a Pap test before my doctor will prescribe me birth control pills." 2. "A Pap test is used to diagnose cervical cancer." 3. "I should get my first Pap test when I turn 21." 4. "I can give a urine sample for the Pap test."

"I should get my first Pap test when I turn 21." Rationales Option 1: Pap tests are not necessary for initiation of oral contraceptives. Option 2: Pap tests screen for precancerous cells, but further testing is required to diagnose cervical cancer. Option 3: Pap tests should begin at age 21. Option 4: Pap tests collect specimens obtained from the cervix and vagina, not from urine.

A woman in her late 40s is reporting irregular menstrual cycles and asks the nurse if she still needs to use birth control. What is the best response by the nurse? 1. "It is possible for a woman to become pregnant during perimenopause." 2. "If you are experiencing hot flashes, you have reached menopause and you cannot get pregnant." 3. "Until you have gone six months without a menstrual period, you can still get pregnant." 4. "It is unlikely you would get pregnant now, and birth control is not safe to use at your age."

"It is possible for a woman to become pregnant during perimenopause."

The Sexual Assault Nurse Examiner (SANE) is planning to meet with the Mayor's Council for Women. Which statement prepared by the nurse is correct? 1. "The CDC reported in 2016 that binge drinking increases the risk for sexual assault, especially for women in college settings." 2. "The CDC reported in 2016 that cyber-bullying increases the risk for sexual assault, especially for women in college settings." 3. "The CDC reported in 2016 that cocaine increases the risk for sexual assault, especially for women in college settings." 4. "The CDC reported in 2016 that legalizing marijuana increased the risk for sexual assault, especially for women in college settings.

"The CDC reported in 2016 that binge drinking increases the risk for sexual assault, especially for women in college settings."

A 50-year-old female client is prescribed menopausal hormone therapy (MHT) for severe hot flashes. The client asks why she needs to take progesterone if her symptoms are due to low estrogen. Which is the best explanation by the nurse? 1. "Estrogen alone is not enough to control hot flashes." 2. "Severe menopausal symptoms require both hormones." 3. "Estrogen given alone increases the risk of blood-clotting disorders." 4. "The use of progesterone with estrogen therapy reduces the risk of endometrial cancer."

"The use of progesterone with estrogen therapy reduces the risk of endometrial cancer." Rationales Option 1: Estrogen is the hormone which will improve hot flashes, but progesterone is added to prevent endometrial hyperplasia. Option 2: Progesterone is given to decrease the risk of endometrial cancer, not to treat hot flashes. Option 3: Estrogen with or without progesterone increases the risk of thromboembolism, and is contraindicated with a history of blood-clotting disorders Option 4: Unopposed estrogen can cause endometrial hyperplasia, which increases the risk of uterine cancer.

The client has been prescribed alendronate (Fosamax). Which statement reflects an understanding of the appropriate measures to reduce the side effects of this medication? Select all that apply. 1. "I should take this medication in a standing position." 2. "I should remain upright for at least 30 minutes after taking this medication." 3. "I should remain supine for at least 30 minutes after taking this medication." 4. "I should take this medication with at least 8 ounces of water" 5. "I should take this medication with either food or juice."

1. "I should take this medication in a standing position." 2. "I should remain upright for at least 30 minutes after taking this medication." 4. "I should take this medication with at least 8 ounces of water"

The nurse is interviewing a 50-year-old female client about menopause related symptoms. Which description by the client indicates she is experiencing vasomotor symptoms? 1. "I feel dry in my vaginal area." 2. "I'm putting on weight, especially around my waist." 3. "My neck and face turn red and I then I begin to sweat." 4. "My skin is dry."

3. "My neck and face turn red and I then I begin to sweat."

A female client in primary care is asking about hormone therapy for menopause symptoms. Which finding in the client's medical record should alert the nurse to a contraindication for estrogen? 1. Hypothyroidism 2. Diabetes 3. Hysterectomy 4. Deep vein thrombosis

Deep vein thrombosis

The nurse has developed a health promotion poster with diet recommendations to reduce the risk of osteoporosis. The 2012 ACOG guidelines recommend the highest daily calcium intake for which population? 1. Girls 9-18 years of age 2. Women 19-50 years of age 3. Women 51 years of age and older 4. Women 19-50 years of age while pregnant/lactating

Girls 9-18 years of age

A 17-year-old female client received her first dose of the human papillomavirus (HPV) vaccine. When should the nurse advise the client to return for her next dose? 1. In 1 year 2. In 6 to 12 months 3. In 1 to 2 months 4. In 1 to 2 weeks

In 1 to 2 months

The nurse is reviewing the results of a dual-energy x-ray absorptiometry (DXA) with a client. The client had a T-score of -1. Which is the best interpretation of this DXA result? 1. Indicates normal bone density 2. Indicates osteopenia 3. Indicates osteoporosis 4. Indicates collapsed vertebrae

Indicates osteopenia Rationales Option 1: A T-score above -1 is normal bone density. Option 2: This score indicates osteopenia, which puts a person at risk for osteoporosis. Option 3: A T-score of -2.5 or below is indicative of osteoporosis. Option 4: The DXA score indicates the density of the bones, not the physical integrity.

A female client with a history of breast cancer reports hot flashes and night sweats. Which treatment option would the nurse question if included in her plan of care? 1. Low-dose antidepressants 2. Oral estrogen 3. Avoid alcohol, hot beverages, and spicy foods 4. Biofeedback

Oral estrogen

A client's dual-energy x-ray absorptiometry scan (DXA) T-score is -2.7. The nurse understands this is indicative of what condition? 1. Osteoporosis 2. Menopause 3. Infertility 4. Osteopenia

Osteoporosis

A female client was prescribed an estrogen-receptor modulator for the treatment of osteoporosis. Which sign or symptom of an adverse effect should the nurse teach the client to watch for? 1. Pain and swelling in calf 2. Difficulty swallowing 3. Constipation 4. Diarrhea

Pain and swelling in calf Rationales Option 1: This may indicate venous thromboembolism, which is an adverse effect of estrogen-receptor modulator medications. Option 2: This is an adverse effect from bisphosphonates. Option 3: This is not an adverse effect associated with estrogen-receptor modulators. Option 4: Gastrointestinal irritation is not associated with estrogen-receptor modulators, but with bisphosphonates.

The school nurse is educating high school students about healthy behaviors. Which topic would address the leading cause of death in females ages 15-19? 1. Prevention of unintentional injuries and suicides 2. Prevention of sexually transmitted infections 3. Prevention of heart disease 4. Prevention of cancer

Prevention of unintentional injuries and suicides

The nurse is reviewing preventive screening tests for a female client. What is the recommended screening for chlamydia in women? 1. Screen yearly from ages 16 to 65 2. Screen all women yearly 3. Screen sexually active women yearly until age 24 4. Screen all women yearly with a pap test

Screen sexually active women yearly until age 24

The nurse is educating a group of female clients about breast cancer screening. Which should be included in the teaching? 1. Screening mammograms should begin at age 30. 2. Women who are at high risk for breast cancer may need MRI screening and mammograms. 3. Self-breast exams should be done every month. 4. Mammograms are best for detecting large tumors which a woman has felt.

Women who are at high risk for breast cancer may need MRI screening and mammograms.

A postmenopausal client was prescribed vaginal estrogen cream. Which statement should be included in the nurse's teaching regarding this medication? 1. "Apply topically to the labia and vulva." 2. "Use the cream just prior to intercourse to help with lubrication." 3. "Apply the cream inside the vagina." 4. "Side effects include irregular bleeding from the vagina."

"Apply the cream inside the vagina."

The nurse in the emergency department suspects that her female client had a stroke. Which signs would alert the nurse of a possible stroke? Select all that apply. 1. Severe headache with no known cause 2. Sudden onset of numbness in the face 3. Shortness of breath 4. Pain or pressure in the chest 5. Sudden onset of dizziness or loss of balance

1. Severe headache with no known cause 2. Sudden onset of numbness in the face 5. Sudden onset of dizziness or loss of balance

The nurse in the primary care clinic is evaluating the immunization schedule of a 62-year-old female client. Which immunization is recommended for this client? 1. Herpes zoster vaccine (HZV) 2. Human papillomavirus vaccine (HPV) 3. Measles, mumps, and rubella vaccine (MMR) 4. Meningococcal vaccine

Herpes zoster vaccine (HZV)

The clinic nurse is teaching a client about a screening colonoscopy procedure. Which statement should be included in the teaching? 1. "This is recommended every 10 years starting at age 50." 2. "This is recommended every 5 years starting at age 50." 3. "This test is recommended if the Pap test is abnormal." 4. "This test is recommended only for people at risk for colon cancer."

"This is recommended every 10 years starting at age 50." Rationales Option 1: This is the recommended frequency for colon cancer screening. Option 2: The recommended interval is every 10 years; it is more frequently if the client is at risk for colon cancer. Option 3: The test after an abnormal pap test is called a colposcopy. Option 4: A colonoscopy is recommended for all people to screen for colon cancer; those at risk should be screened more frequently.

The nurse has received bedside report on clients with postoperative conditions. Which findings require communication with the prescribing provider for medication clarification due to potential error? Select all that apply. 1. Bilateral salpingo-oophorectomy, discharge prescriptions include 17β-estradiol (Estraderm®) 2. Total vaginal hysterectomy, discharge prescriptions include17β-estradiol (Estraderm®) 3. Abdominal hysterectomy with salpingectomy, postoperative day 2, discharge prescriptions include 17β-estradiol topical emulsion/topical gel (EstroGel®) 4. Laparoscopic bilateral tubal ligation, postoperative day 1, discharge prescriptions include 17β-estradiol and norgestimate (Ortho-Prefest®) 5. Total abdominal hysterectomy, discharge prescriptions include 17β-estradiol and norgestimate (Ortho-Prefest®)

1. Bilateral salpingo-oophorectomy, discharge prescriptions include 17β-estradiol (Estraderm®) 5. Total abdominal hysterectomy, discharge prescriptions include 17β-estradiol and norgestimate (Ortho-Prefest®)

The nurse knows that which health issues are reported more frequently in women who are obese? Select all that apply. 1. Endometrial cancer 2. Sexually transmitted infections 3. Abnormal menstrual cycle 4. Infertility 5. Osteoporosis

1. Endometrial cancer 3. Abnormal menstrual cycle 4. Infertility

The nurse is preparing a community presentation on cerebrovascular health warning signs. As a leading cause of death for females in the U.S., it is important for the attendees to remember which warning signs for stroke? Select all that apply. 1. Facial numbness 2. Partial blindness 3. Coordination loss 4. Severe headache 5. Jaw discomfort

1. Facial numbness 2. Partial blindness 3. Coordination loss 4. Severe headache

The nurse is attending a continuing education conference session titled, "Care Considerations for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals." Which health issues are experienced more frequently in lesbian clients? Select all that apply. 1. Lack of health insurance 2. More frequent medical care visits 3. Provider lack of understanding 4. Obesity 5. Reproductive organ cancer

1. Lack of health insurance 3. Provider lack of understanding 4. Obesity 5. Reproductive organ cancer

The community health nurse is talking to a group of adolescents about human papillomavirus (HPV) prevention. Which strategies should the nurse include to reduce the risk of HPV? Select all that apply. 1. Limit the number of sexual partners 2. Get vaccinated for HPV 3. Get regular Pap tests (females) 4. Use condoms with sexual activity 5. Get treated promptly if HPV is diagnosed

1. Limit the number of sexual partners 2. Get vaccinated for HPV 4. Use condoms with sexual activity Rationales Option 1: Limiting number of lifetime partners minimizes the chance of exposure and transmission of HPV. Option 2: Vaccines are available, which can prevent several types of HPV. Option 3: Pap tests do not prevent HPV, but detect abnormal cervical cells caused by HPV. Option 4: Condoms reduce the chance of all sexually transmitted infections. Option 5: This is a virus, and there is no cure. Treatment may occur for continued HPV infections, but this is not a preventive measure.

A 55-year-old female client is concerned because her twin sister has osteoporosis. She asks the nurse what she can do to prevent osteoporosis. Which methods of risk reduction should the nurse advise? Select all that apply. 1. "Ensure a daily calcium intake of 500 mg through diet or supplements." 2. "Avoid smoking." 3. "Ensure adequate intake of vitamin D from diet, sunlight, and/or supplements." 4. "Try to swim three to four times per week." 5. "Try to walk or jog three to four times per week."

2. "Avoid smoking." 3. "Ensure adequate intake of vitamin D from diet, sunlight, and/or supplements." 5. "Try to walk or jog three to four times per week." Rationales Option 1: An intake of 500 mg of calcium per day is too low. The recommended daily intake of calcium for women 51 years and older is 1,200 mg. Option 2: Smoking increases the risk of osteoporosis. Option 3: Vitamin D helps with absorption of calcium which helps prevent osteoporosis. Option 4: Swimming is not a weight-bearing exercise and would not be effective in preventing osteoporosis. Option 5: Walking and jogging are weight-bearing exercises which will reduce the risk of osteoporosis.

A female client with osteoporosis is being prescribed alendronate (Fosamax). What should the nurse include when teaching the client about bisphosphonates? Select all that apply. 1. "Take the medication with food." 2. "Take the medication in a sitting or standing position." 3. "Remain upright for at least 30 minutes after taking the pill." 4. "This medication works by increasing the resorption of bone." 5. "Side effects include musculoskeletal aches and pains, gastrointestinal irritation, and esophageal ulcerations."

2. "Take the medication in a sitting or standing position." 3. "Remain upright for at least 30 minutes after taking the pill." 5. "Side effects include musculoskeletal aches and pains, gastrointestinal irritation, and esophageal ulcerations." Rationales Option 1: Bisphosphonates must be taken on an empty stomach to reduce side effects and to enhance absorption. Option 2: This reduces the risk of the pill becoming lodged in the esophagus where it can cause ulcerations and scarring. Option 3: This will decrease the risk of reflux of the pill into the esophagus. Option 4: Bisphosphonates work by inhibiting resorption of bone. Option 5: Most common side effects of alendronate are gastrointestinal irritation, and less commonly esophageal ulcerations.

The nurse in an outpatient clinic is reviewing charts for clients coming in today. Which client should the nurse anticipate needing a Pap test today? 1. 29-year-old woman with a normal Pap test two years ago 2. 18-year-old woman with no prior Pap tests and onset of sexual activity three years ago 3. 45-year-old woman with history of total hysterectomy for fibroids whose last Pap was 7 years ago 4. 21-year-old woman with no prior Pap tests and a history of HPV vaccines completed

21-year-old woman with no prior Pap tests and a history of HPV vaccines completed

The nurse is teaching a postmenopausal woman about osteoporosis prevention and calcium intake. The client states she is lactose intolerant. Which calcium-rich food should the nurse recommend for this client? 1. Plain low-fat yogurt 2. Lean red meat 3. Cooked shrimp 4. Green leafy vegetables

Green leafy vegetables