Chapter 51: Care of the Patient with a Reproductive Disorder

13. A female patient, age 48, is undergoing a routine physical examination for the first time in 5 years. Which procedure would be included in this examination? a. Culdoscopy b. Colposcopy c. Cervical biopsy d. Papanicolaou smear

ANS: D The American Cancer Society recommends that all women who are or have been sexually active or who are at least 18 years of age have an annual Pap smear for 3 consecutive years and then every 3 years until middle age. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1783 OBJ: 5 TOP: Routine examination KEY: Nursing Process Step: Assessment

46. The nurse gives discharge instructions to a person who has had a modified radical mastectomy of the right side to perform the "elbow pull-in." Place the steps of the exercise in appropriate order. (Separate letters by a comma and space as follows: A, B, C, D) a. Pull elbows forward until they touch b. Lower and straighten the arms c. Extend arms sideways to shoulder level d. Bring elbows back and extend arms e. Clasp hands behind neck

ANS: C, E, A, D, B The exercise requires that you bring the arms out at shoulder level, clasp hands behind head and bring elbows to touch, then bring elbows back and extend arms lower and straighten arms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1823-1824, Box 51-7 OBJ: 19 TOP: Post-mastectomy exercise KEY: Nursing Process Step: N/A

45. Arrange the process of the menstrual cycle in order of their function to produce menses. (Separate letters by a comma and space as follows: A, B, C, D) a. Egg matures in the graafian follicle b. Corpus luteum is formed from old follicle c. Estrogen from the maturing follicle causes vascularization of the uterine lining d. Anterior pituitary releases luteinizing hormone (LH), releasing the ovum e. Anterior pituitary releases follicle-stimulating hormone (FSH) f. Corpus luteum releases estrogen and progesterone g. Corpus luteum disintegrates causing a decrease in progesterone h. Lining of uterus is shed as menses

ANS: E, A, C, D, B, F, G, H The anterior pituitary releases FHS, which allows the egg to mature in the graafian follicle; estrogen from the maturing follicle causes vascularization of the uterine lining; the anterior pituitary releases LS to release the ovum into the fallopian tubes and into the uterus; corpus luteum (made up of the old graafian follicle) releases estrogen and progesterone. The corpus luteum disintegrates, causing a decrease in progesterone and the lining of the uterus is shed as menses. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1779 OBJ: 2 TOP: Menstrual cycle KEY: Nursing Process Step: N/A

41. are the most benign tumors of the uterus and arise from the uterine muscle tissue.

ANS: Fibroids Fibroids are benign tumors arising from the muscle tissue of the uterus. PTS: 1 DIF: Cognitive Level: Application REF: Page 1806 OBJ: N/A TOP: Fibroids KEY: Nursing Process Step: Implementation

42. are produced in the seminiferous tubules and stored in the epididymis.

ANS: Sperm The two oval testes (gonads) are enclosed in the scrotum, a saclike structure that lies suspended from the exterior abdominal wall. This position keeps the temperature in the testes below normal body temperature, which is necessary for viable sperm production and storage. Each testis contains one to three coiled seminiferous tubules that produce the sperm cells. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1775 OBJ: 1 TOP: Male reproductive tract KEY: Nursing Process Step: Assessment

39. A is performed to evaluate living tissue to establish or confirm a diagnosis or to follow the course of a disease.

ANS: biopsy Biopsies are procedures in which samples of tissue are taken for evaluation to confirm or locate a lesion. PTS: 1 DIF: Cognitive Level: Application REF: Page 1818 OBJ: 14 TOP: Biopsy KEY: Nursing Process Step: Assessment

40. The nurse is assisting the physician in removing a small sample of tissue from the patient's cervix to have it evaluated. This procedure is called a cervical .

ANS: conization Conization of the cervix is indicated when eroded or infected tissue is to be removed or when there is a need for confirmation of cervical cancer. A cone-shaped section is removed when the mass is confined to the epithelial tissue. PTS: 1 DIF: Cognitive Level: Application REF: Page 1809 OBJ: 6 TOP: Conization KEY: Nursing Process Step: Implementation

44. When the veins in the scrotum become dilated, and the scrotum becomes enlarged and dilated, the condition is called a .

ANS: varicocele A varicocele is a condition in which the scrotum becomes enlarged and dilated, from obstructed vessels. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1829 OBJ: 21 TOP: Varicocele KEY: Nursing Process Step: N/A

43. An alternative remedy, _ , is used by men for the treatment of impotence.

ANS: yohimbine, Pausinystalia yohimbe yohimbine Pausinystalia yohimbe Yohimbine is an alternative remedy for the treatment of male impotence. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1841, Complementary and Alternative OBJ: 21 TOP: Alternative remedy KEY: Nursing Process Step: N/A

5. On the fourth postoperative day after a modified radical mastectomy, the nurse finds the patient with her back to the nurse. She is crying and tells the nurse she feels ugly and is worried that her husband will not be in love with her anymore. The nurse bases subsequent nursing interventions on what diagnosis? a. Disturbed body image related to removal of her breast b. Deficient knowledge related to inadequate education c. Impaired social interaction related to depression d. Fear related to the cancer diagnosis and surgical intervention

ANS: A After losing a breast, many patients experience grief over the loss of a body part. The process of grieving is essential for personal adaptation to the loss. The nurse can assist the patient to find helpful coping mechanisms. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1824 OBJ: 18 TOP: Mastectomy KEY: Nursing Process Step: Planning

29. A 25-year-old woman comes to the clinic with a yellowish-green malodorous vaginal discharge. She says it makes her itch and makes it hard to urinate. After a microscopic examination that confirms trichomoniasis, the patient is placed on metronidazole (Flagyl) for 7 days. How should the nurse advise the patient? a. Avoid alcohol while on Flagyl b. Be aware that her urine may turn blue and will stain clothing c. Wear snug underwear during treatment d. Be aware that she need not notify her sexual partners as trichomoniasis is not contagious

ANS: A Alcohol should be avoided as it can cause disorientation, cramps, and possibly convulsions. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1835 OBJ: 23 TOP: Trichomoniasis KEY: Nursing Process Step: Implementation

21. The patient, age 52, is recovering from a modified radical mastectomy. Why is postoperative elevation of the patient's arm important after this procedure? a. To prevent vascular and lymph stasis, thus lymphedema b. To prevent drainage accumulation at the incisional site c. To prevent wound infection and dehiscence d. To prevent pleural effusion and respiratory distress

ANS: A If the arm is not restricted by dressings, it may be elevated on a pillow with the hand and wrist higher than the elbow and the elbow higher than the shoulder joint. This will facilitate the flow of fluids through the lymph and venous routes and prevent lymphedema. PTS: 1 DIF: Cognitive Level: Application REF: Page 1823 OBJ: 18 TOP: Mastectomy KEY: Nursing Process Step: Implementation

24. Which statement indicates that the patient who has had an abdominal hysterectomy needs further home teaching? a. "I understand I can lift as much as 20 lb." b. "I'm leaving today to stay with my daughter, who lives 20 miles away. My husband plans to drive the family car." c. "The doctor said I can't have sexual intercourse for 4 to 6 weeks." d. "I'm going to miss wearing my girdle or knee-high hose."

ANS: A If there has been an abdominal incision, there may be further restrictions on heavy lifting (nothing over 10 lb). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1814 OBJ: 14 TOP: Hysterectomy KEY: Nursing Process Step: Evaluation

20. Why is a mammogram the most useful method of diagnosing breast cancer? a. It is the most reliable method of detecting breast cancer before it becomes palpable. b. It is inexpensive and covered by most medical insurance plans. c. It involves no radiation and takes only a few minutes. d. It involves no pain or discomfort and is readily available.

ANS: A Mammography is radiography of the soft tissue of the breast to allow identification of various benign and neoplastic processes, especially those not palpable on physical examination. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1817 OBJ: 5 TOP: Diagnostic procedures KEY: Nursing Process Step: Assessment

31. What factor influences older women's reluctance to seek medical care for problems of the reproductive system? a. Embarrassment and cultural factors b. Denial c. Religious convictions d. Lack of free time

ANS: A Many older women are reluctant to seek medical care for problems of the reproductive system. This may be related to cultural factors, embarrassment, or lack of knowledge. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1780, Lifespan OBJ: N/A TOP: Age KEY: Nursing Process Step: Assessment

23. When should postmenopausal women be instructed to perform breast self-examination (BSE)? a. On the same date of their choice each month b. Every 3 months c. Every day, because they are at high risk for breast cancer d. Whenever they begin to take estrogen supplements

ANS: A More than 90% of breast cancers are detected by the patient. BSE for postmenopausal women should be done on the same day of the month each month. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1816 OBJ: 15 TOP: Breast self-examination (BSE) KEY: Nursing Process Step: Assessment

10. Which patient is most at risk for the infection of epididymitis? a. 17-year-old athlete who trains for several hours a day b. 22-year-old who has been exposed to mumps c. 45-year-old who was circumcised at the age of 10 d. 50-year-old who has smoked for 30 years

ANS: A Symptoms can occur after trauma to the genital area, after instrumentation of the urethra and cystoscopy, and after physical exertion or prolonged sexual activity. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1828 OBJ: 20 TOP: Epididymitis KEY: Nursing Process Step: Assessment

12. The nurse provides discharge teaching for a patient regarding her activity level as she recovers from her modified radical mastectomy. Which statement by her indicates to the nurse that the teaching has been successful? a. "I should sleep on the side opposite my mastectomy." b. "I should keep my right arm supported in a sling when I am up and around until my incision is healed." c. "I can do whatever exercises and activities I want as long as I don't elevate my right hand above my head." d. "I should take aspirin before moving or exercising my arm to prevent pain during the exercises."

ANS: A The patient should be instructed to avoid sleeping on the involved arm. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1823-1824, Box 51-7 OBJ: 18 TOP: Mastectomy KEY: Nursing Process Step: Evaluation

35. Select the interventions that should be performed with caution, in the affected arm, on patients who have undergone a modified radical mastectomy. (Select all that apply.) a. Vaccinations b. Taking of blood pressure or samples c. Insertion of IV line d. Physical therapy on uninvolved arm e. Wear watch and jewelry on involved arm f. Carry purse on involved arm or shoulder

ANS: A, B, C Patients should be taught not to have any procedures involving the arm on the affected side—BP readings, injections, intravenous infusion of fluids, or the drawing of blood, which may cause edema or infection—and to guard against infections from burns, needle pricks (sewing), and gardening injuries. PTS: 1 DIF: Cognitive Level: Application REF: Page 1823, Nursing Care Plan OBJ: 18 TOP: Radical mastectomy KEY: Nursing Process Step: Planning

38. Which of the following are true of the Gardasil vaccine? (Select all that apply.) a. It requires two more immunizations at 6 months after the first dose b. It reduces incidence of cervical cancer c. It reduces the incidence of human papilloma virus (HPV) d. It can be given only to females e. It should be given before a person becomes sexually active f. It is safe for people as young as 8 years of age

ANS: A, B, C, E Gardasil is a vaccine that is effective against HPV and also reduces the incidence of cervical cancer; it can be given to males and females before they become sexually active. It is not recommended for children under 11 years of age. PTS: 1 DIF: Cognitive Level: Application REF: Page 1809 OBJ: 7 TOP: Gardasil KEY: Nursing Process Step: Implementation

36. What are some advantages of a vaginal hysterectomy over the abdominal hysterectomy? (Select all that apply.) a. Less postoperative discomfort b. Reduced hospital stay c. Less expensive d. Better visualization of the intrapelvic area e. Faster recovery

ANS: A, B, C, E The vaginal approach allows for less postoperative discomfort, a reduced hospital stay, is less expensive, and offers a faster recovery. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1813 OBJ: 7 TOP: Vaginal hysterectomy KEY: Nursing Process Step: Implementation

34. Vaginal fistulas are caused by an ulcerating process resulting from (select all that apply): a. Cancer b. Radiation c. Poor hygiene d. Multiple sexual partners e. Weakening of tissue from pregnancies f. Surgical interventions

ANS: A, B, E, F Vaginal fistulas are caused by an ulcerating process resulting from cancer, radiation, weakening of tissue by pregnancies, and surgical interventions. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1804 OBJ: 10 TOP: Vaginal fistulas KEY: Nursing Process Step: Assessment

37. The nurse instructs a group of women who attend the health clinic that persons who are particularly at risk for cervical cancer are persons who (select all that apply): a. Smoke b. Wear tampons c. Have been sexually active since their teens d. Have multiple sexual partners e. Had chickenpox as a child f. Have a history of sexually transmitted diseases (STD)

ANS: A, C, D, F Women who have been sexually active since their teens, have multiple sexual partners, and have a history of STDs are more at risk for cancer of the cervix. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1808 OBJ: 7 TOP: Cervical cancer KEY: Nursing Process Step: Implementation

22. A patient, age 46, is recovering from an abdominal hysterectomy. Postoperative nursing assessment findings include a urinary output of 100 mL in 4 hours. What should the nurse do? a. Force fluids b. Report urinary retention to the charge nurse c. "Milk" the urinary catheter d. Turn the patient onto her right side

ANS: B Postoperative nursing interventions for patients with abdominal hysterectomy focus on monitoring vital signs and preventing urinary retention. The patient should have an output of at least 30 mL/hr. Anything less than that should be reported. PTS: 1 DIF: Cognitive Level: Application REF: Page 1813 OBJ: 14 TOP: Hysterectomy KEY: Nursing Process Step: Implementation

16. What instruction should a nurse give a patient with congenital herpes who does not have lesions at the present? a. "Continued use of acyclovir (Zovirax) will prevent reinfection by the virus." b. "Condoms should be used during all sexual activity to prevent transmission of the virus, even when lesions are not present." c. "Acyclovir ointment should be applied to the lesions to increase comfort and speed healing." d. "Recurrent genital herpes is promoted by any sexual stimulation."

ANS: B Sexual transmission of HSV (genital herpes, a virus) has been documented even in the absence of clinical lesions, and the use of condoms should be encouraged. Acyclovir does not cure the disease but makes the attacks less virulent. PTS: 1 DIF: Cognitive Level: Application REF: Page 1831, Safety Alert OBJ: 23 TOP: Genital herpes KEY: Nursing Process Step: Implementation

2. On the second postoperative day, a patient who has had an abdominal hysterectomy complains of gas and abdominal distention. Which intervention would be most appropriate to stimulate a bowel movement? a. Offering carbonated beverages b. Encouraging ambulation at least four times per day c. Administering a 1000-mL soapsuds enema d. Applying an abdominal binder

ANS: B Early ambulation is very helpful to return the bowel to normal function. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1813 OBJ: 14 TOP: Hysterectomy KEY: Nursing Process Step: Implementation

32. Although menopause is a normal part of aging, why do many women enter menopause at an earlier age? a. Having become sexually active at an early age b. Living at high altitudes c. Excessive use of alcohol d. Morbid obesity

ANS: B Early menopause may be brought on at an earlier age because of living in high altitudes, smoking, cancer treatment, and family history. PTS: 1 DIF: Cognitive Level: Application REF: Page 1780 OBJ: 5 TOP: Early menopause KEY: Nursing Process Step: N/A

1. Which condition would prevent the use of a vaginal hysterectomy? a. A woman with more than four pregnancies b. Large uterine fibroids c. Menorrhagia for over 6 months d. Women over the age of 50

ANS: B In the case of large uterine fibroids, a vaginal hysterectomy is not an option. PTS: 1 DIF: Cognitive Level: Application REF: Page 1813 OBJ: 14 TOP: Hysterectomy KEY: Nursing Process Step: Implementation

27. The 69-year-old patient laughs at the nurse when the nurse suggests that she should have a Pap smear and says, "I had my uterus removed except for the cervix 30 years ago and I am almost 70. Why in the world would I want to get a Pap smear at my age?" What is the nurse's most informative reply? a. "All persons who have a cervix remaining should be screened up to the age of 75." b. "Well, you have one more year to go to get a Pap smear." c. "My goodness, you look so young I thought you were still in the age bracket for regular Pap screens." d. "You are right. If you had no trouble so far, there is no need to do the smear."

ANS: B Persons who have a hysterectomy without the removal of the cervix should continue to be screened at least until the age of 70. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1809 OBJ: 12 TOP: Anatomy KEY: Nursing Process Step: Assessment

25. The patient with a swollen scrotum is amazed that diagnosis of the condition of hydrocele is such a simple thing as: a. placing the scrotum on a warm pad. b. shining a flashlight through the scrotum. c. squatting and letting the scrotum hang dependently. d. packing the scrotum in ice.

ANS: B Shining a flashlight from behind the scrotum and visualizing the testes surrounded by fluid is called transillumination. That process is the simple diagnostic test for hydrocele. PTS: 1 DIF: Cognitive Level: Application REF: Page 1829 OBJ: 11 TOP: Hydrocele KEY: Nursing Process Step: Assessment

4. A patient, age 41, has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis. She asks the nurse if she will have "hot flashes." What knowledge will guide the nurse's response? a. Only the uterus was removed, and the ovaries are still producing estrogen and she will not have hot flashes. b. The patient is too young to have hot flashes associated with menopause. c. The uterus, ovaries, and fallopian tubes were removed, and she will have surgically induced menopause and may have hot flashes. d. The uterus and fallopian tubes were removed, and she will not experience "hot flashes."

ANS: C A total abdominal hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, fallopian tubes, and ovaries. If the ovaries are removed in these surgeries, the surgery will induce menopause and hot flashes may occur. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1813 OBJ: 14 TOP: Hysterectomy KEY: Nursing Process Step: Implementation

6. Why would the nurse encourage the patient who is recovering from a modified radical mastectomy to exercise the affected arm? a. To reduce pain b. To stimulate appetite c. To reduce lymphedema d. To increase muscle tension

ANS: C An exercise regimen, built up gradually, can help reduce lymphedema following a modified radical mastectomy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1823-1824, Box 51-7 OBJ: 19 TOP: Postmastectomy exercises KEY: Nursing Process Step: Planning

33. Why do false-negative results in mammography occur in specific age groups? a. Older women have greater density of breast tissue. b. Older women have less density of breast tissue. c. Younger women have greater density of breast tissue. d. Younger women have less density of breast tissue.

ANS: C Because of the greater density of breast tissue, mammography is less sensitive in younger women, which may result in more false-negative results. PTS: 1 DIF: Cognitive Level: Application REF: Page 1817 OBJ: 5 TOP: Diagnostic tests KEY: Nursing Process Step: Planning

9. Which statement made by a patient who has been taught the technique of testicular self-examination indicates the need for further teaching? a. "The testes feel smooth and egg-shaped." b. "The best time to perform TSE is after a shower." c. "I will examine my scrotum after every ejaculation." d. "The epididymis feels like a soft tube."

ANS: C It is not recommended for a patient to perform a testicular self-examination after every ejaculation. Perform testicular self-examination after a bath or shower when the scrotum is warm and most relaxed. The testes should feel smooth and be firm to the touch. The epididymis feels like a soft tube. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1830, Figure 51-16 OBJ: 22 TOP: Testicular self-examination KEY: Nursing Process Step: Evaluation

18. A Gram stain smear of the patient's discharge reveals the presence of N. gonorrhoeae. He tells the nurse that he had sexual contact with a new girlfriend but does not think he was exposed to gonorrhea because she did not appear to have any disease. Which information should the nurse include in response to his comment? a. "Women do not develop gonorrhea infections but can serve as carriers to spread the disease to males." b. "When gonorrhea infections occur in women, the disease affects only the ovaries and not the other genital organs." c. "Many women are not aware that they have gonorrhea because they often do not have symptoms of infection." d. "Women develop subclinical cases of gonorrhea that do not cause tissue damage or symptoms."

ANS: C Most women remain asymptomatic but may show a greenish-yellow discharge from the cervix. PTS: 1 DIF: Cognitive Level: Application REF: Page 1834 OBJ: 23 TOP: Infectious diseases KEY: Nursing Process Step: Planning

17. The 10-year-old clinic patient reports that she is free of gonorrhea and can now engage in sexual activity. Which response is most appropriate? a. "If you have been free of symptoms for 2 weeks you are cured." b. "You should get a rapid plasma reagin (RPR) just to make sure." c. "No case is considered cured until you have had three consecutive negative cervical smears." d. "To confirm your cure, you should get a Venereal Disease Research Lab (VDRL)."

ANS: C No case of gonorrhea is considered cured until you have had three consecutive negative cervical smears. The RPR and the VDRL are tests for syphilis. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1835 OBJ: 8 TOP: Pelvic inflammatory disease (PID) KEY: Nursing Process Step: Assessment

15. What does the diagnosis of secondary infertility refer to? a. Has never conceived b. Is infertile because of repeated infection c. Has conceived but is now unable to do so d. Is over the age of 38

ANS: C Secondary infertility refers to a woman who has conceived in the past and now is unable to do so. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1797 OBJ: 7 TOP: Infertility KEY: Nursing Process Step: Implementation

14. What is the recommended age range for a baseline mammogram? a. 25 and 30 years b. 31 and 34 years c. 35 and 39 years d. 40 and 45 years

ANS: C The American Cancer Society recommends that mammograms be performed on women between 35 and 39, and annually for women 40 years of age and older. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1816-1817 OBJ: 5 TOP: Routine examination KEY: Nursing Process Step: Assessment

8. At what age should a male be taught testicular self-examination (TSE)? a. 10 b. 13 c. 15 d. 20

ANS: C Young men should be taught to perform TSE monthly beginning at 15 years of age. PTS: 1 DIF: Cognitive Level: Application REF: Page 1830 OBJ: 22 TOP: Testicular self-examination KEY: Nursing Process Step: Planning

19. The patient who had a colporrhaphy for the repair of a cystocele and rectocele asks that the catheter be removed as it is bothersome to her. How should the nurse explain the reason for the catheter? a. It replaces uncomfortable gauze packing b. It will prevent adhesions and will be in place for about 2 weeks c. It allows for quick urine sample collection d. It keeps the bladder empty, and prevents stress on the sutures

ANS: D A retention catheter is usually inserted into the bladder to keep it empty and prevent pressure on sutures. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1806 OBJ: 14 TOP: Postoperative care KEY: Nursing Process Step: Assessment

26. A patient, age 36, is scheduled for a unilateral orchiectomy for treatment of testicular cancer. He is withdrawn and does not initiate interaction with the nurse. What is the most appropriate nursing action at this time? a. Carefully explain the postoperative activity restrictions. b. Show him a diagram of what the orchiectomy will accomplish. c. Assure him that he will have adequate future sexual functioning. d. Assess his concerns related to his diagnosis and treatment.

ANS: D An appropriate nursing diagnosis for a patient with a reproductive disorder is Disturbed body image and Ineffective coping. It is beneficial to listen to the concerns about this treatment. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1830 OBJ: 20 TOP: Orchiectomy KEY: Nursing Process Step: Assessment

3. The young husband of a patient who has been scheduled for a hysterectomy because of the discovery of ovarian cancer in both ovaries says to the nurse, "Please go talk to my wife. She is real upset and says she won't be a 'woman' anymore." What is the nurse's most therapeutic response? a. "Don't be concerned. All young women get upset before this kind of surgery." b. "Certainly, I will be glad to tell her about hormone replacement." c. "She will get over this feeling soon." d. "No matter what I may say to her, it is you that needs to listen to her concerns and assure her."

ANS: D Assisting patients with recognizing and clarifying fears and with developing coping strategies for those fears by listening is helpful. PTS: 1 DIF: Cognitive Level: Application REF: Page 1822, Nursing Care Plan OBJ: 12 TOP: Ovarian cancer KEY: Nursing Process Step: Implementation

30. The young woman comes to the free clinic for the complaint of stomach cramps. During the examination, the nurse recommends that she be tested for chlamydia. The woman says "I don't need any test...I don't have any symptoms for a sexual infection...I just came for my stomach." Which response is most informative? a. "Well, if you get more symptoms come back for testing." b. "The doctor may have to order medicine for syphilis and chlamydia. You probably have that too. You need to be tested today!" c. "Testing is not mandatory...I probably wouldn't bother either since you have no symptoms." d. "That stomachache may be part of a chlamydia infection. Many women do not have a discharge, but are carriers."

ANS: D Chlamydia frequently displays no signs or symptoms in women. The Centers for Disease Control and Prevention (CDC) recommends an annual screening for all women over 25 who are at risk for STDs. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1836 OBJ: 14 TOP: Chlamydia KEY: Nursing Process Step: Implementation

11. A patient, age 26, has had a tubal insufflation (Rubin test) to ascertain whether her fallopian tubes are patent. She complains of pain in her right shoulder. Which response is most appropriate? a. "Don't worry, that is a normal reaction." b. "I'll report the findings immediately to the head nurse." c. "That is a symptom that resulted from your position on the operating table." d. "That is from the carbon dioxide passing from the fallopian tubes into your abdomen."

ANS: D The Rubin insufflation test determines tubal patency. Carbon dioxide escapes into the abdominal cavity through the patent left fallopian tube. PTS: 1 DIF: Cognitive Level: Application REF: Page 1786 OBJ: 4 TOP: Diagnostic procedures KEY: Nursing Process Step: Assessment

28. A male patient, age 23, seeks care at the health clinic because he has developed a profuse, purulent urethral discharge, and urination is painful. During assessment of the patient, it is most important that the nurse gather information related to his history of: a. recent urinary infections. b. episodes of prostatitis. c. contagious diseases like mumps. d. present and past sexual partners, and notify them to get treatment.

ANS: D The nurse should encourage notification of present and past sexual partners of the diagnosis, and stress the need for them promptly to seek medical care. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1835 OBJ: 23 TOP: Sexually transmitted diseases (STDs) KEY: Nursing Process Step: Assessment

7. A 20-year-old patient presents in the emergency room with a temperature of 103° F, blood pressure of 92/58, headache, and desquamation of both palms. What should the nurse make sure to ask about during the interview? a. Any recent traveling outside the country b. Immunization against influenza c. Method of birth control d. Use of tampons

ANS: D These are signs of toxic shock frequently brought on by leaving a tampon in place too long. The nurse should inquire about tampon use, headache, muscle pain, and fatigue. PTS: 1 DIF: Cognitive Level: Application REF: Page 1802 OBJ: 6 TOP: Toxic shock syndrome (TSS) KEY: Nursing Process Step: Assessment