Maternal and Newborn Success Chapter 3 Women's Health Issues

A client is put on calcium supplements to maintain bone health. To maximize absorption, the client is also advised to take which of the following supplements? 1. Vitamin D. 2. Vitamin E. 3. Folic acid. 4. Iron.

1. Calcium absorption is enhanced dramatically when vitamin D is also consumed.

An adolescent woman confides to the school nurse that she is sexually active. The young woman asks the nurse to recommend a "very reliable" birth control method, but she refuses to be seen by a gynecologist. Which of the following methods would be best for the nurse to recommend? 1. Contraceptive patch. 2. Withdrawal method. 3. Female condom. 4. Contraceptive sponge.

3. The female condom is about 95% effective as a contraceptive device and is also effective as an infection-control device.

A nonpregnant young woman has been diagnosed with bacterial vaginosis (BV). The nurse questions the woman regarding her sexual history, including her frequency of intercourse, how many sexual partners she has, and her use of contraceptives. What is the rationale for the nurse's questions? 1. Clients with BV can infect their sexual partners. 2. The nurse is required by law to ask the questions. 3. Clients with BV can become infected with HIV and other sexually transmitted infections more easily than uninfected women. 4. The laboratory needs a full client history to know for which organisms and antibiotic sensitivities it should test.

3. This statement is true. The change in normal flora increases the woman's susceptibility to other organisms.

A client has been admitted to the hospital with a diagnosis of bulimia. Which of the following physical findings would the nurse expect to see? 1. Mastoiditis. 2. Hirsutism. 3. Gynecomastia. 4. Esophagitis.

4. Esophagitis is a common finding in people with bulimia.

The nurse in a pediatric clinic is caring for a 9-year-old girl who has been diagnosed with gonorrhea. Which of the following actions is appropriate for the nurse to take? 1. Notify the physician so the child can be admitted to the hospital. 2. Discuss with the girl the need to stop future sexual encounters. 3. Question the mother about her daughter's menstrual history. 4. Report the girl's medical findings to child protective services.

4. This child must be reported to child protective services.

The nurse is working with a client who states that she has multiple sex partners. Which of the following contraceptive methods would be best for the nurse to recommend to this client? 1. Intrauterine device. 2. Female condom. 3. Bilateral tubal ligation. 4. Birth control pills.

2. The female condom is recommended both for contraception and for infection control.

A young woman is seen in the emergency department. She states, "I took a pregnancy test today. I'm pregnant. My parents will be furious with me!! I have to do something!" Which of the following responses by the nurse is most appropriate? 1. "You can take medicine to abort the pregnancy so your parents won't know." 2. "Let's talk about your options." 3. "The best thing for you to do is to have the baby and to give it up for adoption." 4. "I can help you tell your parents."

2. This is correct. The nurse should discuss with the young woman all of her possible choices.

The public health nurse calls a woman and states, "I am afraid that I have some disturbing news. A man who has been treated for gonorrhea by the health department has told them that he had intercourse with you. It is very important that you seek medical attention." The woman replies, "There is no reason for me to go to the doctor! I feel fine!" Which of the following replies by the nurse is appropriate at this time? 1. "I am sure that you are upset by the disturbing news, but there is no reason to be angry with me." 2. "I am sorry. We must have received the wrong information." 3. "That certainly could be the case. Women often report no symptoms." 4. "All right, but please tell me your contacts because it is possible for you to pass the disease on even if you have no symptoms."

3. This is true. Women often have no symptoms when infected with gonorrhea.

A 19-year-old client with multiple sex partners is being counseled about the hepatitis B vaccination. During the counseling sessions, which of the following should the nurse advise the client to receive? 1. Hepatitis B immune globulin before receiving the vaccine. 2. Vaccine booster every 10 years. 3. Complete series of three intramuscular injections. 4. Vaccine as soon as she becomes 21.

3. To be immunized against hepatitis B, a three-injection vaccine series is administered.

A breastfeeding woman is requesting that she be prescribed Seasonale (ethinyl estradiol and levonorgestrel) as a birth control method. Which of the following information should be included in the patient teaching session? 1. The woman will menstruate every 8 to 9 weeks. 2. The pills are taken for 3 out of every 4 weeks. 3. Breakthrough bleeding is a common side effect. 4. Breastfeeding is compatible with the medication.

3. Women who take Seasonale frequently do experience breakthrough bleeding.

The nurse met four clients in the family planning clinic today. It would be most appropriate for the nurse to recommend the intrauterine device (IUD) to which of the clients? 1. Unmarried, 22-year-old, recent college graduate. 2. Married, 24-year-old, G0 P0000. 3. Unmarried, 25-year-old, history of chlamydia. 4. Married, 26-year-old, G3 P2102.

4. This client is in a stable relationship and has had children. She is the best candidate for the IUD.

A young woman was a victim of a sexual assault. After the rape examination was concluded, the client requests to be given emergency contraception (EC). Which of the following information should the nurse teach the client regarding the therapy? 1. EC is illegal in all 50 states. 2. The most common side effect of EC is excessive vaginal bleeding. 3. The same medicine that is used for EC is used to induce abortions. 4. EC is best when used within 72 hours of contact.

4. This statement is true. Although EC works up to 5 days after unprotected intercourse, it is most effective when taken within 72 hours of the exposure.

A female client asks the nurse about treatment for human papilloma viral warts. The nurse's response should be based on which of the following? 1. An antiviral injection cures approximately fifty percent of cases. 2. Aggressive treatment is required to cure warts. 3. Warts often spread when an attempt is made to remove them surgically. 4. Warts often recur a few months after a client is treated.

4. This statement is true. It is not uncommon for warts to return a few months after an initial treatment.

During a counseling session on natural family planning techniques, how should the nurse explain the consistency of cervical mucus at the time of ovulation? 1. It becomes thin and elastic. 2. It becomes opaque and acidic. 3. It contains numerous leukocytes to prevent vaginal infections. 4. It decreases in quantity in response to body temperature changes.

1. The cervical mucus does become thin and elastic at the time of ovulation.

A woman is taking Fosamax (alendronate) for osteoporosis. The nurse should advise the woman about which of the following when taking the medication? 1. Remain upright for 30 minutes after taking the medication. 2. Take only after eating a full meal. 3. Take medication in divided doses 3 times each day. 4. Do not break or crush the tablet.

1. This is a true statement. Clients are to take the medication on an empty stomach, immediately after awakening and remain upright for at least 30 minutes.

A nurse is providing contraceptive counseling to a perimenopausal client, G3 P2012, who is in a monogamous relationship. Which of the following comments by the woman indicates that further teaching is needed? 1. "The calendar method is the most reliable method for me to use." 2. "If I use the IUD, I am at minimal risk for pelvic inflammatory disease." 3. "I should still use birth control even though I had only 2 periods last year." 4. "The contraceptive patch contains both estrogen and progesterone."

1. This is not true. The menstrual cycle of perimenopausal women is very irregular. It is very difficult to identify safe and unsafe periods for these women.

A woman has a history of toxic shock syndrome. Which of the following forms of birth control should she be taught to avoid? Select all that apply. 1. Diaphragm. 2. Intrauterine device. 3. Birth control pills (estrogen-progestin combination). 4. Contraceptive sponge. 5. Depo-Provera (medroxyprogesterone acetate).

1. Toxic shock syndrome (TSS) is associated with diaphragm use. 3. Toxic shock syndrome (TSS) is associated with contraceptive sponge use.

A client has been diagnosed with pubic lice. Which of the following signs/symptoms would the nurse expect to see? 1. Macular rash on the labia. 2. Pruritus. 3. Hyperthermia. 4. Foul-smelling discharge.

2. Pruritus is, by far, the most common symptom of pubic lice.

What is essential for the nurse to teach a woman who has just had an intrauterine device (IUD) inserted? 1. Palpate her lower abdomen each month to check the patency of the device. 2. Remain on bed rest for 24 hours after insertion of the device. 3. Report any complaints of painful intercourse to the physician. 4. Insert spermicidal jelly within 4 hours of every sexual encounter.

3. Reports of dyspareunia should be communicated to the physician.

A client who is sexually active is asking the nurse about Gardasil, one of the vaccines that is given to prevent human papillomavirus (HPV). Which of the following should be included in the counseling session? 1. Gardasil is not recommended for women who are already sexually active. 2. Gardasil protects recipients from all strains of the virus. 3. The most common side effect from the vaccine is pain at the injection site. 4. Anyone who is allergic to eggs is advised against receiving the vaccine.

3. This statement is true. There are very few side effects experienced by those who receive the vaccine.

The nurse is educating a group of adolescent women regarding sexually transmitted infections (STIs). The nurse knows that learning was achieved when a group member states that the most common sign/symptom of sexually transmitted infections is which of the following? 1. Menstrual cramping. 2. Heavy menstrual periods. 3. Flu-like symptoms. 4. Lack of signs or symptoms.

4. Most commonly, women experience no signs or symptoms when they have contracted a sexually transmitted infection.

A woman, seen in the emergency department, is diagnosed with pelvic inflammatory disease (PID). Before discharge, the nurse should provide the woman with health teaching regarding which of the following? 1. Endometriosis. 2. Menopause. 3. Ovarian hyperstimulation. 4. Sexually transmitted infections.

4. PID usually occurs as a result of an ascending sexually transmitted infection.

The nurse is teaching a young woman how to use the female condom. Which of the following should be included in the teaching plan? 1. Reuse female condoms no more than five times. 2. Refrain from using lubricant because the condom may slip out of the vagina. 3. Wear both female and male condoms together to maximize effectiveness. 4. Remove the condom by twisting the outer ring and pulling gently.

4. The female condom should be removed by twisting the outer ring and pulling gently.

A client is being seen following a sexual assault. A rape examination is being conducted. Which of the following specimens may be collected from the victim during the examination? Select all that apply. 1. Buccal swab for genetic analysis. 2. Samples of pubic hair. 3. Toenail scrapings. 4. Samples of head hair. 5. Sputum for microbiological analysis.

1, 2, and 4 are correct. 1. A buccal swab may be taken. The woman's DNA must be ruled out when compared to any specimens obtained. 2. Pubic hair samples may be obtained. These are compared with any specimens taken. 4. Head hair samples are obtained. These are compared with any specimens taken.

A woman has contracted herpes simplex 2 for the first time. Which of the following signs/symptoms is the client likely to complain of? 1. Flu-like symptoms. 2. Metrorrhagia. 3. Amenorrhea. 4. Abdominal cramping.

1. The initial infection of herpes simplex 2 is often symptom free but, if symptoms do occur, the client may complain of flu-like symptoms as well as vesicles at the site of the viral invasion.

A postpartum woman is using the lactational amenorrhea method of birth control. The nurse should advise the client that the method is effective only if which of the following conditions is present? Select all that apply. 1. Being less than 6 months postpartum. 2. Being amenorrheic since delivery of the baby. 3. Supplementing with formula no more than once per day. 4. Losing less than 10% of weight since delivery. 5. Sleeping at least 8 hours every night.

1. The lactational amenorrhea method (LAM) can be effective until 6 months postpartum. 2. As long as the woman has had no period since delivery, the LAM can be effective.

Which of the following questions should be asked of women during all routine medical examinations? Select all that apply. 1. "Has anyone ever forced you to have sex?" 2. "Are you sexually active?" 3. "Are you ever afraid to go home?" 4. "Does anyone you know ever hit you?" 5. "Have you ever breastfed a child?"

1. This is a question that should be asked at each health care contact. 2. This is a question that should be asked at each health care contact. 3. This is a question that should be asked at each health care contact. 4. This is a question that should be asked at each health care contact.

A triage nurse answers a telephone call from the male partner of a woman who was recently diagnosed with cervical cancer. The man is requesting to be tested for human papillomavirus (HPV). The nurse's response should be based on which of the following? 1. There is currently no approved test to detect HPV in men. 2. A viral culture of the penis and rectum is used to detect HPV in men. 3. A Pap smear of the meatus of the penis is used to detect HPV in men. 4. There is no need for a test because men do not become infected with HPV.

1. This is true. The CDC has not approved any tests to detect HPV in men.

A woman has just entered an emergency department after a stranger rape. Which of the following interventions is highest priority at this time? 1. Create a safe environment. 2. Offer postcoital contraceptive therapy. 3. Provide sexually transmitted disease prophylaxis. 4. Take a thorough health history.

1. This woman has just been violated. It is essential that she be in a location where she feels safe.

A woman has gotten pregnant with a Copper T intrauterine device (IUD) in place. The physician has ordered an ultrasound to be done to evaluate the pregnancy. The client asks the nurse why this is so important. The nurse should tell the woman that the ultrasound is done primarily for which of the following reasons? 1. To assess for the presence of an ectopic pregnancy. 2. To check the baby for serious malformations. 3. To assess for pelvic inflammatory disease. 4. To check for the possibility of a twin pregnancy.

1. When pregnancy occurs with an IUD in place, an ectopic pregnancy should be ruled out.

A woman states that she feels "dirty" during her menses so she often douches to "clean myself." The nurse advises the woman that it is especially important to refrain from douching while menstruating because douching will increase the likelihood of her developing which of the following gynecological complications? 1. Fibroids. 2. Endometritis. 3. Cervical cancer. 4. Polyps.

2. Douching can increase a client's potential for endometritis.

The nurse has given postvasectomy teaching to a client. Which of the following responses by the client indicates that the teaching was effective? 1. "I will measure my urinary output for two days." 2. "I will ejaculate the same amount of semen as I did before the surgery." 3. "I will refrain from having an erection until next week." 4. "I will irrigate the wound twice today and once more tomorrow."

2. This is true. The seminal vesicles and the prostate are untouched.

A client asks a nurse to express an opinion on the value of taking hormone replacement therapy (HRT). The nurse should be aware that it is recognized that HRT is effective in which of the following situations? 1. No woman should ever take hormone replacement therapy. 2. Women experiencing severe menopausal symptoms. 3. Women with severe coronary artery disease. 4. Women with a history of breast cancer.

2. Women who are experiencing severe menopausal symptoms can benefit from HRT therapy. However, it is recommended that they not be on the medication for an extended period of time.

A woman has been diagnosed with pelvic inflammatory disease (PID). Which of the following organisms are the most likely causative agents? Select all that apply. 1. Gardnerella vaginalis. 2. Candida albicans. 3. Chlamydia trachomatis. 4. Neisseria gonorrhoeae. 5. Treponema pallidum.

3. Chlamydia trachomatis is a common cause of PID. 4. Neisseria gonorrhoeae is a common cause of PID.

The nurse should suspect that a client is bulimic when the client exhibits which of the following signs/symptoms? 1. Significant weight loss and hyperkalemia. 2. Respiratory acidosis and hypoxemia. 3. Dental caries and scars on her knuckles. 4. Hyperglycemia and large urine output.

3. Dental caries and scars on the knuckles are classic signs of bulimia.

The nurse is providing education to a couple regarding the proper procedure for male condom use. The nurse knows that the teaching was effective when the couple states that which of the following procedures should be taken if the man's penis becomes flaccid immediately after ejaculation? 1. The woman should douche with white vinegar and water. 2. The woman should consider taking a postcoital contraceptive. 3. The man should hold the edges of the condom during its removal. 4. The man should apply spermicide to the upper edges of the condom.

3. This is true. The man should carefully remove the condom while holding its edges.

A 16-year-old woman who had unprotected intercourse 24 hours ago has entered the emergency department seeking assistance. Which of the following responses by the nurse is appropriate? 1. "You can walk into your local pharmacy and buy Plan B (levonorgestrel)." 2. "I am sorry but because of your age I am unable to assist you." 3. "The emergency room doctor can prescribe high-dose birth control pills (BCP) for you." 4. The nurse's response is dependent upon which state he or she is practicing in.

4. This statement is true. Access to health care by adolescents, including access to birth control methods, is determined by individual states.

The nurse has provided a single, perimenopausal woman, G3 P2012, with contraceptive counseling. The woman has four sex partners and smokes 1 pack of cigarettes per day. Which of the following methods is best suited for this client? 1. Male condom. 2. Intrauterine device. 3. NuvaRing. 4. Oral contraceptives.

1. The male condom is the best device for this client.

A client is being taught about the care and use of the diaphragm. Which of the following comments by the woman shows that she understands the teaching that was provided? 1. "I should regularly put the diaphragm up to the light and look at it carefully." 2. "This is one method that can be used during menstruation." 3. "I can leave the diaphragm in place for a day or two." 4. "The diaphragm should be well powdered before I put it back in the case."

1. The woman should regularly check the diaphragm by looking at it with a good light source.

The nurse suspects that a client has been physically abused. The woman refuses to report the abuse to the police. Which statement by the client suggests to the nurse that the relationship may be in the "honeymoon phase"? 1. "My partner said that he will never hurt me again." 2. "My partner drinks alcohol only on the weekends." 3. "My partner yells less than he used to." 4. "My partner has frequent bouts of insomnia."

1. This is an example of a comment made during the "honeymoon phase."

An 18-year-old client is being evaluated for school soccer by the school nurse. The expected weight for the young woman's height is 120 lb. Her actual weight is 96 lb. The client states that she runs 6 miles every morning and swims 5 miles every afternoon. Which of the following actions should the nurse take at this time? 1. Ask the client the date of her last menstrual period. 2. Encourage the client to continue her excellent exercise schedule. 3. Congratulate the client on her ability to maintain such a good weight. 4. Advise the client that she will have to stop swimming once soccer starts.

1. This is the best response. The school nurse should also note that the client's weight is very low and that her exercise schedule is extreme.

Women who are on hormone replacement therapy (HRT) for an extended period of time have been shown to be high risk for which of the following complications? 1. Endometrial cancer. 2. Gynecomastia. 3. Renal dysfunction. 4. Mammary hypertrophy.

1. Women on HRT are high risk for gynecological cancers, especially endometrial and breast cancers.

Five women wish to use the Ortho Evra (patch) for family planning. Which of the women should be carefully counseled regarding the safety considerations of the method? Select all that apply. 1. The woman who smokes 1 pack of cigarettes each day. 2. The woman with a history of lung cancer. 3. The woman with a history of deep vein thrombosis. 4. The woman who runs at least 50 miles each week. 5. The woman with a history of cholecystitis.

1. Women who smoke should be counseled against using the patch. 3. Women who have a history of deep venous thrombosis (DVT) should be counseled against using the patch.

Four women with significant health histories wish to use the diaphragm as a contraceptive method. The nurse should counsel the woman with which of the following histories that the diaphragm may lead to a recurrence of her problem? 1. Urinary tract infections. 2. Herpes simplex infections. 3. Deep vein thromboses. 4. Human papilloma warts.

1. Women who use the diaphragm have increased incidence of urinary tract infections.

A woman is to receive 2.4 million units of penicillin G benzathine IM to treat syphilis. The medication is available as 1,200,000 units/mL. How many mL should the nurse administer? ______ mL

2 mL

The nurse is counseling a woman who has been diagnosed with mild osteoporosis. Which of the following lifestyle changes should the nurse recommend? Select all that apply. 1. Eat yellow and orange vegetables. 2. Go on daily walks. 3. Stop smoking. 4. Consume dairy products. 5. Sleep at least eight hours a night.

2. Daily exercise does help to prevent the development of osteoporosis. 3. Smoking is associated with the development of osteoporosis. 4. Dairy products contain calcium and many have vitamin D added. Both of these nutrients are essential for preventing osteoporosis.

A man has been diagnosed with a chlamydial infection. The nurse would expect the client to complain of pain at which of the following times? 1. When urinating. 2. When ejaculating. 3. When the penis becomes erect. 4. When the testicles are touched.

1. Men infected with Chlamydia often complain of pain on urination.

A client has been admitted to the hospital with a diagnosis of bulimia from forced vomiting. Which of the following serum laboratory reports would the nurse expect to see? Select all that apply. 1. Potassium 3.0 mEq/L. 2. Bicarbonate 30 mmol/L. 3. Platelet count 450,000 cells/mm3. 4. Hemoglobin A1C 9%. 5. Sodium 150 mEq/L.

1. The nurse would expect to see a low potassium level. 2. The nurse would expect to see a high bicarbonate level.

The nurse is teaching an uncircumcised male to use a condom. Which of the following information should be included in the teaching plan? 1. Apply mineral oil to the shaft of the penis after applying the condom. 2. Pull back the foreskin before applying the condom. 3. Create a reservoir at the tip of the condom after putting it on. 4. Wait five minutes after ejaculating before removing the condom.

2. The foreskin should be pulled back before applying the condom.

A woman with multiple bruises on her arms and face is seen in the emergency department, accompanied by her partner. When asked about the injuries, the partner states, "She ran into a door." Which of the following actions by the nurse is of highest priority? 1. Take the woman's vital signs. 2. Interview the woman in private. 3. Assess for additional bruising. 4. Document the location of the bruises.

2. This is essential. The client must be interviewed in private.

A client who has been taking birth control pills for 2 months calls the clinic with the following complaint: "I have had a bad headache for the past couple of days and I now have pain in my right leg." Which of the following responses should the nurse make? 1. "Continue the pill, but take one aspirin tablet with it each day from now on." 2. "Stop taking the pill, and start using a condom for contraception." 3. "Come to the clinic this afternoon so that we can see what is going on." 4. "Those are common side effects that should disappear in a month or so."

3. This is an appropriate statement. This client should be seen by her health care practitioner.

A client states that she has been diagnosed with fibrocystic breast disease. She asks the nurse, "Does that mean that I have breast cancer?" Which of the following statements by the nurse is appropriate at this time? 1. "I am so sorry. I am sure that the doctor will do everything possible to cure you of the cancer." 2. "I am not the best person to ask about your diagnosis. I suggest that you ask the doctor." 3. "If your lumps are round and mobile they are not cancerous, but if they are hard to the touch you probably do have cancer." 4. "You do not have cancer, but it is especially important for you to have regular mammograms to monitor for any changes."

4. This response is correct. This client does not have cancer but should be carefully monitored.

A gravid, married client, 24 weeks' gestation, is found to have bacterial vaginosis. Her health care practitioner has ordered metronidazole (Flagyl) to treat the problem. Which of the following educational information is important for the nurse to provide the woman at this time? 1. The woman must be careful to observe for signs of preterm labor. 2. The woman must advise her partner to seek therapy as soon as possible. 3. A common side effect of the medicine is a copious vaginal discharge. 4. A repeat culture should be taken two weeks after completing the therapy.

1. Clients with bacterial vaginosis are high risk for preterm labor.

Which of the following behaviors would indicate to a nurse that a gravid woman may be being abused? Select all that apply. 1. Denies that any injuries occurred, even when bruising is visible. 2. Gives an implausible explanation for any injuries. 3. Gives the nurse eye contact while answering questions. 4. Allows her partner to answer the nurse's questions. 5. Frequently calls to change appointment times.

1. Women who skip appointments, delay reporting injuries, or simply do not report injuries should be suspected of being abused. 2. The history should be assessed very carefully. Often the injuries are not supported by the story. 4. Abusers frequently dominate conversations with their victims. When asked questions by the nurse, abusers frequently respond rather than allowing their partners to respond. 5. Women who frequently skip prenatal or other follow-up appointments must be queried regarding the reason for the absences. There are many possible explanations—for example, they may have no transportation to the site or they may be forced to remain at home because of visible injuries. A visiting nurse should be sent to the home to determine the reason for the absences.

The clinic nurse is interviewing a client preceding her annual checkup. Which of the following findings would make the nurse suspicious that the client is an anorexic? 1. Aversion to exercise and food allergies. 2. Significant weight loss and amenorrhea. 3. Respiratory distress and thick oral mucus. 4. Cardiac arrhythmias and anasarca.

2. Significant weight loss and amenorrhea are characteristic signs of anorexia.

The nurse is educating a group of women on how to perform a breast self-examination (BSE). Which of the following actions should the nurse advise the women to take? 1. Use the fingertips of their index, middle, and ring fingers. 2. Use pressure in two intensities, light and deep. 3. Look for dimpling while bending forward from the waist. 4. Feel for lumps while encircling the breast from nipple outward.

3. The breasts should be examined visually in four positions, including bent at the waist.

A postpartum client has decided to use Depo-Provera (medroxyprogesterone acetate) as her contraceptive method. What should the nurse advise the client regarding this medication? 1. Take the pill at the same time each day. 2. Refrain from breastfeeding while using the method. 3. Expect to have no periods as long as she takes the medicine. 4. Consider switching to another birth control method in a year or so.

4. Many women who use Depo-Provera for over 2 years have been found to suffer from loss of bone density. Some of the changes in bone density may be irreversible.

A couple is seeking family planning advice. They are newly married and wish to delay childbearing for at least 3 years. The woman, age 26, G0 P0000, has no medical problems and does not smoke. She states, however, that she is very embarrassed when she touches her vagina. Which of the following methods would be most appropriate for the nurse to suggest to this couple? 1. Diaphragm. 2. Cervical cap. 3. Intrauterine device (IUD). 4. Birth control pills (BCP).

4. The birth control pill would be the best choice for this client. She has no medical contraindications to the pill, she wishes to bear children in the future, and it requires no vaginal manipulation.

A woman is noted to have multiple soft warts on her perineum and rectal areas. The nurse suspects that this client is infected with which of the following sexually transmitted infections? 1. Human papillomavirus (HPV). 2. Human immunodeficiency virus (HIV). 3. Syphilis. 4. Trichomoniasis.

1. Human papillomavirus (HPV) is characterized by flat warts on the vaginal and rectal surfaces.

A woman has been diagnosed with primary syphilis. Which of the following physical findings would the nurse expect to see? 1. Cluster of vesicles. 2. Pain-free lesion. 3. Macular rash. 4. Foul-smelling discharge.

2. A pain-free lesion, called a chancre, is consistent with a diagnosis of primary syphilis. A reddish brown rash is seen with stage 2 syphilis.

Which of the following clients, who are all seeking a family planning method, is the best candidate for birth control pills? 1. 19-year-old with multiple sex partners. 2. 27-year-old who bottle feeds her newborn. 3. 29-year-old with chronic hypertension. 4. 37-year-old who smokes one pack per day.

2. Of the 4 clients listed, this client is the best candidate for the use of the birth control pill.

A woman is using the contraceptive sponge as a birth control method. Which of the following actions is it important for her to perform to maximize the sponge's effectiveness? 1. Insert the sponge at least one hour before intercourse. 2. Thoroughly moisten the sponge with water before inserting. 3. Spermicidal jelly must be inserted at the same time the sponge is inserted. 4. A new sponge must be inserted every time a couple has intercourse.

2. The sponge must be moistened with water until it is foamy.

A woman is being seen in the gynecology clinic. The nurse notes that the woman has a swollen eye and a bruise on her cheek. Which of the following is an appropriate statement for the nurse to make? 1. "I am required by law to notify the police department of your injuries." 2. "Women who are abused often have injuries like yours." 3. "You must leave your partner before you are injured again." 4. "It is important that you refrain from doing things that anger your partner."

2. This is an appropriate statement.

The nurse at Victims Assistance Services is speaking with a young woman who states that she was sexually assaulted at a party the evening before. The victim states, "I ran home and took a shower as soon as it happened. I felt so dirty." Which of the following responses should the nurse make first? 1. "The evidence kit may still reveal important information." 2. "It was important for you to do that for yourself." 3. "Have you washed your clothes? If not, we might be able to obtain evidence from them." 4. "Do you remember what happened? If not, someone may have put a drug in your drink"

2. This statement acknowledges the fact that the client needed to regain some control over her situation.

The nurse is developing a teaching plan for a client undergoing a bilateral tubal ligation. Which of the following should be included in the plan? 1. The surgical procedure is easily reversible. 2. Menstruation usually ceases after the procedure. 3. Libido should remain the same after the procedure. 4. The incision will be made endocervically.

3. The woman's libido should remain unchanged.

An asymptomatic woman is being treated for HIV infection at the women's health clinic. Which of the following comments by the woman shows that she understands her care? 1. "If I get pregnant, my baby will be HIV positive." 2. "I should have my viral load and antibody levels checked every day." 3. "Since my partner and I are both HIV positive, we use a condom." 4. "To be safe, my partner and I engage only in oral sex."

3. This is true. She and her partner should use condoms during sexual intercourse.

Which of the following sexually transmitted infections is characterized by a foulsmelling, yellow-green discharge that is often accompanied by vaginal pain and dyspareunia? 1. Syphilis. 2. Herpes simplex. 3. Trichomoniasis. 4. Condylomata acuminata.

3. Trichomoniasis is characterized by a yellowish green, foul-smelling discharge.

A nurse is caring for a client who states that she is a lesbian. Which of the following should the nurse consider when caring for this client? 1. Lesbian women are usually less sexually active than straight women. 2. Lesbian women need not be asked about domestic violence issues. 3. Lesbian women should be tested for cervical cancer every three to seven years. 4. Lesbian women are at higher risk for bacterial vaginosis than are straight women.

4. This statement is true, although the precise reason for the high incidence of bacterial vaginosis in gay women is unknown.

The nurse is teaching a client regarding the treatment for pubic lice. Which of the following should be included in the teaching session? 1. The antibiotics should be taken for a full 10 days. 2. All clothing should be pretreated with bleach before wearing. 3. Shampoo should be applied for at least 2 hours before rinsing. 4. The pubic hair should be combed after shampoo is removed.

4. To remove the nits, or eggs, the pubic hair should be combed with a fine-tooth nit comb after the shampoo is removed.

A woman, who wishes to use the calendar method for contraception, reports that her last 6 menstrual cycles were 28, 32, 29, 36, 30, and 27 days long, respectively. In the future, if used correctly, she should abstain from intercourse on which of the following days of her cycle? 1. Days 9 to 25. 2. Days 10 to 15. 3. Days 11 to 20. 4. Days 12 to 17.

1. The woman would abstain from intercourse from day 9 of her menstrual cycle until day 25.

The nurse is administering Depo-Provera (medroxyprogesterone acetate) to a postpartum client. Which of the following data must the nurse consider before administering the medication? 1. The capsule must be taken at the same time each day. 2. The client must be taught to use sunscreen whenever in the sunlight. 3. The medicine is contraindicated if the woman has lung or esophageal cancer. 4. The client must use an alternate form of birth control for the first two months.

2. The client should use sunscreen while receiving Depo-Provera for birth control.

The nurse has taught a couple about the temperature rhythm method of fertility control. Which of the following behaviors would indicate that the teaching was effective? 1. The woman takes her basal body temperature before retiring each evening. 2. The couple charts information from at least six menstrual cycles before using the method. 3. The couple resumes having intercourse as soon as they see a rise in the basal body temperature. 4. The woman assesses her vaginal discharge daily for changes in color and odor.

2. The couple should chart temperatures for at least 6 months.

A woman is being taught how to use the diaphragm as a contraceptive device. Which of the following statements by the woman indicates that the teaching was effective? Select all that apply. 1. Petroleum-based lubricants may be used with the device. 2. The device must be refitted if the woman gains or loses 10 pounds or more. 3. The anterior lip must be pushed under the symphysis pubis. 4. Additional spermicide must be added if the device has been in place over 6 hours. 5. The diaphragm should be cleaned with a 10% bleach solution after every use.

2. This is true. If a woman's weight either increases or decreases by 10 lb or more, the device must be refitted. 3. This is true. For the diaphragm to fit appropriately, the anterior lip must be pushed snugly under the symphysis. 4. This is true. Although the device is a type of barrier, it is ineffective without spermicide and the action of spermicide is only effective for 6 hours.

After a sex education class, the school nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that teaching about infection control was effective? 1. "I don't have to worry about getting infected if I have oral sex." 2. "Teen women are most high risk for sexually transmitted infections (STI)." 3. "The best thing to do if I have sex a lot is to use spermicide each and every time." 4. "Boys get human immunodeficiency virus (HIV) easier than girls do."

2. This is true. The mucous membranes of the female and of the teenager are more permeable to STIs than are the mucous membranes of adults and of men.

The nurse advises the women to whom she is providing health care teaching at a local church that they should see their health care provider to be assessed for ovarian cancer if they experience which of the following signs/symptoms? 1. Vaginal bleeding and weight loss. 2. Frequent urination, breast tenderness, and extreme fatigue. 3. Abdominal pain, bloating, and a constant feeling of fullness. 4. Hardness on one side of the abdomen.

3. This statement is correct. Abdominal pain, bloating, and feeling of fullness are early symptoms of ovarian cancer.

A school nurse notices that a young woman with scars on the knuckles of her right hand runs to the bathroom each day immediately after eating a high-calorie lunch. Which of the following actions by the nurse is appropriate at this time? 1. Nothing, because her behavior is normal. 2. Question the young woman to see if she is being abused. 3. Recommend that the young woman be seen by her doctor. 4. Follow the young woman to the bathroom.

4. The nurse should follow the young woman into the bathroom to see if she is vomiting.

The nurse is developing a standard care plan for the administration of Mifeprex (misepristone/misoprostol; formerly known as RU-486). Which of the following information should the nurse include in the plan? 1. Women should be evaluated by their health care practitioners 2 weeks after taking the medicine. 2. This is the preferred method for terminating an ectopic pregnancy when an intrauterine device is in place. 3. The only symptom clients should experience is bleeding 2 to 3 days after taking the medicine. 4. Women who experience no bleeding within 3 days should immediately take a home pregnancy test.

1. This is true. It is very important that women be evaluated to make sure that the pregnancy is terminated. Even when bleeding occurs, the pregnancy may still be intact.

A woman has been diagnosed with syphilis. Which of the following nursing interventions is appropriate? 1. Council the woman about how to live with a chronic infection. 2. Question the woman regarding symptoms of other sexually transmitted infections. 3. Assist the primary health care practitioner with cryotherapy procedures. 4. Educate the woman regarding the safe disposal of menstrual pads.

2. Any time someone is infected with one sexually-transmitted infection (STI), it is recommended that he or she be assessed for other STIs.

The nurse is interviewing a client regarding contraceptive choices. Which of the following client statements would most influence the nurse's teaching? 1. "I have 2 children." 2. "My partner and I have sex twice a week." 3. "I am 25 years old." 4. "I feel funny touching my private parts."

4. This statement is very important. If the client refuses to touch her genital area, she is an unlikely candidate for a number of contraceptive devices: female condom, diaphragm, sponge, cervical cap, and IUD.

The nurse is conducting a seminar with young adolescent women regarding date rape. Which of the following guidelines are essential to include in the discussion? Select all that apply. 1. The girls should consume drinks from enclosed containers. 2. The girls should keep extra money in their shoes or bras. 3. The girls should keep condoms in their pocketbooks. 4. The girls should meet a new date in a public place. 5. The girls should go on group dates whenever possible.

1, 4, and 5 are correct. 1. It is essential that young women remember to drink liquids only from containers that they have opened themselves and that have never been out of their possession. 4. Young women should be encouraged to meet new dates in a public place. It is unlikely that an assault will occur in a place where others are present. 5. When a mixed group goes out together, it is unlikely that an assault will take place.

The nurse teaches a couple that the diaphragm is an excellent method of contraception providing that the woman does which of the following? 1. Does not use any cream or jelly with it. 2. Douches promptly after its removal. 3. Leaves it in place for 6 hours following intercourse. 4. Inserts it at least 5 hours prior to having intercourse.

3. The diaphragm should be left in place for at least 6 hours after intercourse has ended.

A nurse is educating a group of women in her parish about osteoporosis. The nurse should include in her discussion that which of the following is a risk factor for the disease process? 1. Multiparity. 2. Increased body weight. 3. Late onset of menopause. 4. Heavy alcohol intake.

4. Alcohol consumption is a contributing factor to osteoporosis.

The nurse is developing a plan of care for clients seeking contraception information. Which of the following issues about the woman must the nurse consider before suggesting contraceptive choices? Select all that apply. 1. Age. 2. Ethical and moral beliefs. 3. Sexual patterns. 4. Socioeconomic status. 5. Childbearing plans.

All choices—1, 2, 3, 4, and 5—are correct. 1. The woman's age should be considered. 2. The woman's ethical and moral beliefs should be considered. 3. The woman's sexual patterns should be considered. 4. The woman's socioeconomic status should be considered. 5. The woman's childbearing plans should be considered.

Four women who use superabsorbent tampons during their menses are being seen in the medical clinic. The woman with which of the following findings would lead the nurse to suspect that the woman's complaints are related to her use of tampons rather than to an unrelated medical problem? 1. Diffuse rash with fever. 2. Angina. 3. Hypertension. 4. Thrombocytopenia with pallor.

1. A diffuse rash with fever should be taken very seriously. These are symptoms of toxic shock syndrome (TSS).

Which statement by the client indicates that she understands the teaching provided about the intrauterine device (IUD)? 1. "The IUD can remain in place for a year or more." 2. "I will not menstruate while the IUD is in." 3. "Pain during intercourse is a common side effect." 4. "The device will reduce my chances of getting infected."

1. IUDs can remain in place for extended periods of time.

A woman is being issued a new prescription for a low-dose combination birth control pill. What advice should the nurse give the woman if she ever forgets to take a pill? 1. Take it as soon as she remembers, even if that means taking two pills in one day. 2. Skip that pill and refrain from intercourse for the remainder of the month. 3. Wear a pad for the next week because she will experience vaginal bleeding. 4. Take an at-home pregnancy test at the end of the month to check for a pregnancy.

1. This is correct. To maintain the hormonal levels in the bloodstream, the woman should take the pill as soon as she remembers.

A nurse is reading a research article on the incidence of sexually transmitted diseases in one population as compared with a second population. The relative risk (RR) is reported as 0.80 and the 95% confidence interval (CI) is reported as 0.62 to 1.4. How should the nurse interpret the results? 1. Because the CI of the RR includes the value of 1, the difference between the groups is meaningless. 2. A 95% confidence interval is a statistically significant finding. 3. A relative risk of 0.80 is moderately powerful. 4. Because there is no P value reported for the CI, the nurse is unable to make any conclusions about the data.

1. This is true. Relative risk connotes the probability of an experimental event occurring in relation to the control. An RR = 1 means that the rate of an experimental event occurring is the same as the rate of the control event occurring. An RR < 1 means that the rate of an experimental event occurring is less than the rate of the control event occurring. An RR > 1 means that the rate of an experimental event occurring is greater than the rate of the control event occurring.

A woman who has been abused for a number of years is finally seeking assistance in leaving her relationship. Identify the actions that the nurse should take at this time. Select all that apply. 1. Comment that the victim could have left long ago. 2. Assist the victim to develop a safety plan. 3. Remind the victim that the abuse was not her fault. 4. Assure the victim that she will receive support for her decision. 5. Help the victim to contact a domestic violence center.

2. It is very important to assist the victim to develop a safety plan. The victim will likely be in danger once the abuser learns that she has decided to leave. 3. It is very important to remind the victim that the abuse was not her fault. Many victims believe that they deserve the violence. 4. It is very important to assure the victim that she will receive support for her decision. It is very scary to decide to break off a relationship, especially if the abuser is the victim's source of financial support. 5. It is very important to help the victim to contact a domestic violence center. This is a very difficult step for victims to take.

The parent of a newborn angrily asks the nurse, "Why would the doctor want to give my baby the vaccination for hepatitis B? It's a sexually transmitted disease, you know!" Which of the following is the best response by the nurse? 1. "The hepatitis B vaccine is given to all babies. It is given because many babies get infected from their mothers during pregnancy." 2. "It is important for your baby to get the vaccine in the hospital because the shot may not be available when your child gets older." 3. "Hepatitis B can be a life-threatening infection that is contracted by contact with contaminated blood as well as sexually." 4. "Most parents want to protect their children from as many serious diseases as possible. Hepatitis B is one of those diseases."

3. This is the best answer. Hepatitis B is a very serious disease that can be transmitted sexually or via contact with blood and blood products. The vaccine is given in infancy to prevent future infections.

A man has just had a vasectomy. Which of the following post-procedure teachings should the nurse provide the client? Select all that apply. 1. Complete sterility will occur approximately 1 week post-surgery. 2. Bed rest should be maintained for a full 24 hours after the vasectomy. 3. The surgeon should be contacted immediately if marked enlargement of the scrotal sac is noted after the procedure. 4. An athletic supporter should be worn to protect the surgical site. 5. Prostate-specific antigen testing (PSA) should be performed every year after a vasectomy.

3. This is true. Bleeding into the scrotal sac is a rare complication of vasectomy. Men, therefore, are advised to report any marked swelling to their urologist. 4. This is true. To reduce the pain and swelling, men are encouraged to wear athletic supporters for a few days after the surgery.

A couple seeking contraception and infection-prevention counseling state, "We know that the best way for us to prevent both pregnancy and infection is to use condoms plus spermicide every time we have sex." Which of the following is the best response by the nurse? 1. "That is correct. It is best to use a condom with spermicide during every sexual contact." 2. "That is true, except if you have intercourse twice in one evening. Then you do not have to apply more spermicide." 3. "That is not true. It has been shown that condoms alone are very effective and that the spermicide might increase the transmission of some viruses." 4. "That is not necessarily true. Spermicide has been shown to cause cancer in men and women who use it too frequently."

3. This statement is true. Spermicidal creams have been shown actually to increase the transmission of some sexually transmitted infections.

A young woman in a disheveled state is admitted to the emergency department. She states that she awoke this morning without her underwear on but with no memory of what happened the evening before. She thinks she may have been raped. Which of the following assessments by the nurse is most likely accurate? 1. The woman is spoiled and is exhibiting attention-seeking behavior. 2. The woman is experiencing a psychotic break. 3. The woman regrets having had consensual sex. 4. The woman unknowingly ingested a date rape drug.

4. It is likely that this woman has been a victim of a sexual assault after ingesting a date rape drug.