Maternal Success Women's Health Issues Chapter 3

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 The most common organisms to cause PID are the organisms that cause gonorrhea and chlamydia. In the early stages of these infections, women often experience only minor symptoms. It is not uncommon, therefore, for the organisms to proliferate and ascend into the uterus and fallopian tubes. The woman must be taught health care practices to decrease her likelihood of a recurrence of the problem

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 Women who have ingested date rape drugs often experience some amnesia afterward. GHB and Rohypnol decrease a woman's ability to resist sexual aggression. The medications can be detected in urine samples up to 72 hours after ingestion

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.

There is a black box recommendation on the Depo-Provera label. A black box warning is placed on some prescription medications that have been found to have significant side effects. The Food and Drug Administration (FDA) has the power to require pharmaceutical companies to include a black box on a medication that, although approved for use, carries risks when taken. In the case of Depo-Provera, there is an increased risk of 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.

1 2 3 4 5 Each and every one of these factors must be considered when providing family planning counseling. The age of the client will affect, for example, natural family planning, which is not the most appropriate means for young women or for women who are perimenopausal. The woman's beliefs can markedly affect her choices. If the woman has multiple sex partners, an infection-control device should be considered. Some choices are quite expensive and, depending on the client's access to insurance, may not be feasible. If a woman has completed her childbearing, she may wish a permanent form of birth control versus a woman who is young and still interested in having children.

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 2 Because bulimic clients force themselves to vomit, they are losing electrolytes and hydrochloric acid from their stomachs. Because of the low potassium levels, the clients are high risk for cardiac arrhythmias. Their cardiac status should be carefully monitored.

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 After providing any kind of teaching, including teaching about contraceptive measures, it is very important to evaluate the client's understanding. A client's misunderstanding could easily result in injury to her or, if she were to become pregnant, to the unborn baby.

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 Even when perimenopausal clients are being counseled, the nurse must ask about drug use, smoking, sexual patterns, and the like. It cannot be assumed that simply because a woman is in her 50s or more that she is asexual or that she is engaging in safe lifestyle choices.

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 There are two main reasons pregnancies occurring with an IUD in place are frequently ectopic. First, because the IUD affects the receptivity of the endometrium to the embryo, the fertilized egg often stops its migration and implants in the fallopian tube. Second, sometimes the fallopian tubes become narrowed, preventing the migration of the embryo to the uterine cavity.

15. 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 This client is likely developing TSS. It is associated with the use of superabsorbent tampons. Staphylococcus aureus, a bacterium that colonizes the skin, proliferates in the presence of the tampons. Women with the disorder develop a rash, fever, severe vomiting and diarrhea, muscle aches, and chills. The problem must be treated quickly. It is important to note that 5 out of every 100 women who develop TSS will die from the syndrome

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 3 4 5 After many years of abuse, victims often have very low selfesteem and are very frightened of their abusers. They need a great deal of emotional support as well as clear, structured guidance in how to leave the relationship. Nurses must be prepared to supply the support

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 3 4 There are a number of factors that clients are unable to control in relation to the development of osteoporosis—for example, sex (women are more at risk than are men), age (older women are more at risk than younger women), and genetics (family history plays a role). Any client who is at risk because of the preceding factors should be especially counseled to eat well, stop smoking, drink in moderation, and get daily exercise.

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 Because of its ability to protect a client from becoming pregnant for up to a full day, no matter how many times a couple should have intercourse, the sponge is a very popular method. It must be remembered, however, that the sponge does not protect against sexually transmitted infections and its effectiveness is not as high as the effectiveness of other methods like condoms.

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 Clients who have become infected with an STI are engaging in risk-taking behavior. Either they or their partners are sexually intimate with at least one other partner. And it is likely that the clients or the partners are not engaging in safe sex. It is important, therefore, that clients who have one disease be further evaluated for the presence of other infections.

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 The diagnostic criteria for anorexia nervosa are a body weight that is less than 85% of that expected, a pathological fear of gaining weight, a disturbed body image, and the failure to have a menstrual period for 3 or more cycles. Clients, usually women, who are anorexic often are high achievers who also exercise to excess.

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 4 It is important for the test taker to have a working knowledge of pathogens that cause infectious diseases. PID is caused by a bacterium. Candida is a yeast, and Treponema, the agent that causes syphilis, is a spirochete. The two bacterial organisms listed—Chlamydia trachomatis and Neisseria gonorrhoeae— are the most common causes of PID. Although Gardnerella vaginali is a bacterium, it is not a common cause of PID.

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 It is important to note that recent evidence has indicated that vaginal spermicides containing nonoxynol-9 (N-9) are not effective in preventing cervical gonorrhea, chlamydial infection, or HIV infection. Although spermicide is not recommended to be used with condoms, diaphragms that are being used for contraception are not effective without the addition of spermicidal gels or creams

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 Any time a sexually transmitted disease is discovered in a minor, the nurse has the legal obligation to report the finding to a child protection agency. In addition, if required by law, the health department should also be notified to track and follow up on sexually transmitted infections.

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 2 3 4 Women (or men) who are being abused rarely discuss their relationships unless asked directly. To identify clients who are being threatened, physically abused, and/or sexually abused, it is essential that nurses query them at each and every visit. The questioning can be done during a face-to-face interview or via a paper and pencil questionnaire. If the client states that he or she is being abused, the nurse should be ready to provide information on safe environments, police contacts, and the like. To be able to provide comprehensive care, the nurse must also know if his or her client is sexually active.

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 2 4 5 Nurses must use all their senses when interviewing clients. A physical assessment should be conducted as well as questions asked to check for evidence of abuse. In addition, the client's communications must be critically assessed. Women who always defer to their partners may be exhibiting a sign of abuse. Plus, the history provided by the client and/or her partner must be evaluated for its credibility. If any injuries do not coincide with the story provided, the nurse must investigate the situation further.

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 4 In many ways, a rape examination is another form of invasion for a woman who has been raped. The examiner, only after being given permission by the victim, will take a number of samples, including those mentioned above. Other samples that may be obtained include vaginal smears, any and all clothing worn by the victim, and pictures of any and all injuries. If the perpetrator were to go to trial, it would be far in the future. By that time the victim will no longer have any outward signs of assault. It is important to provide the prosecution with as much evidence as possible if a conviction is to be obtained. It is essential to remember, however, that the victim must be allowed to refuse any examinations

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 2 The LAM is a natural family planning method that is highly effective for postpartum women. However, there are three criteria that must be in place for the method to be effective. (1) The woman must be exclusively breastfeeding her baby. (2) The woman's baby must be less than 6 months old. (3) The woman must not yet have regained her menses after the delivery

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 3 TSS is associated with women who use tampons, especially superabsorbent tampons, and those who use barrier types of contraceptives. It is important, therefore, that anyone who has already experienced an episode of TSS be warned against using those items

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 3 Women who use the patch are particularly high risk for the development of thrombi. Women with certain medical conditions, such as diabetes or DVT, or with lifestyle issues, like smoking, that place them at high risk for thrombi should be counseled against use of the patch

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 5 It is very important that young women protect themselves from date rape. Being in a crowd is one excellent way to prevent the potential for being a victim of sexual assault. And because odorless and tasteless date rape drugs—namely, GHB or Rohypnol—can be added to beverages, it is important for young women to consume drinks that have not been out of their sight.

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 At the time of ovulation, the cervical mucus is most receptive to the migration of sperm into the uterine cavity. It is thin, slippery, and alkaline, making it most hospitable to the sperm. Women can monitor the consistency of their cervical mucus daily to predict their most fertile periods.

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 Bacterial vaginosis is quite common. The problem is characterized by a shift in the bacterial flora of the vagina, resulting in a copious, foul-smelling vaginal discharge. When cultured, the usual findings show a decrease in lactobacilli with an increase in Gardnerella vaginalis or other anaerobic bacteria (

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 Because chlamydia is usually a silent infection in women, it is often their male partners who are first identified as being infected because they complain of painful urination. Health department practitioners, after being notified of the infection, work to track down the males' contacts so that they can be treated. It is important to note, however, that many men are also symptom free. This is why the disease is so prevalent

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 Because the lip of the diaphragm must be inserted under the symphysis, the woman's urethra is sometimes pinched. This makes it difficult to completely empty the bladder when urinating. As a result, the woman is high risk for developing urinary tract infections.

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 Both herpes simplex 1 and herpes simplex 2 can infect the mucous membranes of the gynecological tract and the oral cavity. The viruses can be transmitted when a vesicle comes in contact with broken skin or mucous membranes. Although outbreaks do resolve, the virus stays dormant in the body and recurrences are often seen during periods of physical and/or emotional stress

10. 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 Confidence intervals are often reported in relation to relative risk (also called risk ratios) or odds ratios. They also are often reported to interpret raw data. For example, a mean may be reported as 15 with a 95% CI of 10 to 17. The researchers are then stating that the calculated mean is 15 and they are 95% confident that the mean is between 10 and 17. Consulting a statistics text when reading research studies is an excellent practice

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 Fosamax must be consumed with a full glass of water on an empty stomach. It is especially important that the client sit upright for at least 30 minutes after taking the medication because severe upper gastrointestinal irritation can result when reclining. Esophageal irritation, ulceration, and erosions can develop when the medication is taken improperly.

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 If the test taker is unaware of the risks associated with HRT, he or she could deduce the correct answer to this question. First, if the test taker is familiar with prefixes and suffixes, he or she would realize that two responses are saying the same thing: "gyne" means "female" and "mastia" means "breast." Gynecomastia usually refers to males who develop breast tissue, but can also refer to women whose breasts are hypertrophied. The test taker, therefore, can easily eliminate choices 2 and 4. Second, since response 1 relates to the gynecological system, it is the logical choice between responses 1 and 3.

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 Mifeprex is available for use for terminating unwanted pregnancies, for completing incomplete spontaneous abortions, and for terminating ectopic pregnancies. If the medicine should be ineffective and the pregnancy survives, there is a strong possibility that the fetus will be damaged. It is very important, therefore, that the client be assessed to make sure that she truly aborted the conceptus

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 Not only does the IUD not reduce the likelihood of a woman developing a pelvic infection, there are clients who are particularly at high risk for pelvic inflammatory disease following insertion of an IUD. Women who have multiple sex partners or who have a recent history of a sexually transmitted infection should be considered at high risk for infection. It is recommended that the IUD be placed in these women with caution.

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 Some gay men do have anal Pap smears done to attempt to detect cancer cells in the rectum. This practice is controversial and has not been accepted by the CDC

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 diaphragm is only as good as the barrier that it creates. If there are any holes or breaks in the material, sperm will be able to ascend into the uterine cavity. The woman, therefore, must carefully check for pin-sized holes by regularly examining the diaphragm with a good light source.

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 The initial action the nurse must perform when caring for a client who has just been sexually assaulted is to provide the woman with an environment that enables her to regain a feeling of control. The nurse should ask permission for all care, including history taking. And the care should take place in a secure location. Only after the client has given permission for care should the nurse and other caregivers discuss other issues like history, postcoital contraception, and prophylaxis for infections.

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 nurse must be able to advise clients about all types of birth control methods, including natural family planning methods. To calculate the period of abstinence when using the calendar method, the nurse must subtract 18 from the shortest cycle length and 11 from the longest cycle length. The woman must abstain for the entirety of that period to be certain of not becoming pregnant. At least 6 cycle lengths are needed to be able to have some confidence in the method. In the current scenario, therefore, 27 - 18 = 9 and 36 - 11 = 25. The period of abstinence is, therefore, days 9 to 25. As can be seen, women with irregular menstrual periods must abstain for extended periods of time.

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 The nurse should be familiar with the primary symptoms of sexually transmitted infections. A woman may confide in the nurse about symptoms that she is experiencing. The nurse must be able to determine when symptoms require medical attention.

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 The test taker must realize that when an abusive couple first dated, there was love and commitment in the relationship. That love and commitment last well into the time when the relationship becomes violent. In addition, it is important for the test taker to realize that the feelings generated by both parties during the "honeymoon phase"—the period of love and intimacy that immediately follows the abusive phase—revisit that early period of the relationship. It is essential, therefore, for the nurse to develop a rapport with the victim and to remind her that no one deserves to be abused. Options must then be provided to her. Even if she refuses to acknowledge her situation at first, the nurse must revisit the discussion every time the woman revisits the health care system.

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 question requires the test taker to calculate the percentage of the young woman's weight in relation to her expected weight. Once it is noted that she is more than 15% below her expected weight (120 - 96/120 × 100 = 20%) and that she exercises excessively, the nurse needs to assess whether or not she is exhibiting another sign of anorexia nervosa—namely, amenorrhea.

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 To maintain proper bone health, it is important for clients, especially women, to consume sufficient quantities of both calcium and vitamin D. The recommended intake of vitamin D per day is from age 1 to 70: 600 IU per day, and after the age of 70: 800 IU per day. The recommended calcium intake per day is for young adult to age 50: 1000 mg per day and after the age of 50: 1200 mg per day

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 Women who take lowdose birth control pills experience many fewer side effects than women who take high-dose pills. It is important, however, that the pills be taken regularly, ideally at the same time each day. If one pill is missed, it should be taken as soon as possible. If two or more are missed, an alternate form of contraception should be used and the doctor should be questioned regarding whether or not the rest of the pills should be taken

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 3 4 The diaphragm is an excellent device if it is used properly. In addition to the factors cited in the question, the device must be refitted after a client has given birth, it must remain in place for at least 6 hours after intercourse, and, if the couple should decide to engage in intercourse again within the 6-hour period, additional spermicide must be inserted into the vagina before penile penetration.

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 A very common response by women to a sexual assault is the need to cleanse their bodies. They frequently state that they feel "dirty." This action does destroy much of the evidence needed if the case were to go to trial, but the nurse must communicate to the client an understanding and acceptance of the young woman's decisions.

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 Although it was once thought that HRT protected women from coronary artery disease, new evidence shows that is not the case. HRT does help to protect women from osteoporosis, but the incidence of breast cancer in women who take the medication does increase. The recommendation by the FDA is that women who need to take HRT for menopausal symptom relief should do so at the lowest dose possible for the shortest period of time possible. Those who are prone to osteoporosis should use other means—for example, exercise, plus calcium and vitamin D intake—to prevent bone loss

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 Birth control pills that contain both estrogen and progesterone are inappropriate for clients who breastfeed because the estrogen inhibits milk production. There is no such contraindication for mothers who bottle feed. It is important to remember, however, that women who breastfeed can use progestin-only pills

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 It is essential that a full 6 months of information be obtained before using the rhythm method as a birth control device. All activities should be recorded on the BBT sheet. For example, the couple should document when the woman has a period, when they have intercourse, when they sleep late, and when the woman feels ill. Each of these situations, and many more, can affect the woman's temperature.

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 Latex condom use is an excellent means of infection control as well as the prevention of an unwanted pregnancy. This is true, however, only when the condom is applied correctly. In addition to the items noted above, the condom should be applied before any contact between partners has been made, the rim of the condom should be held when removing to keep the semen from spilling, and the male and female condoms should not be used simultaneously because the friction that is caused by the two devices can cause one of them to come off or break

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 Pubic lice, not to be confused with head lice, are commonly called crabs. They are insects, usually sexually transmitted, that invade the pubic hair. Although they are not the same as head lice, the pubic infestation is treated with the same pediculicidal shampoos.

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 Syphilis is caused by a spirochete and, like other spirochetal illnesses, has a 3-stage course. The first stage of the disease is the chancre stage. A chancre is a small, round, painless lesion that will disappear, even without treatment, after a month or so. If the client is not treated, the disease will progress to stage 2, during which a reddish brown rash, usually on the palms and soles; sores on the mucous membranes; and flu-like symptoms develop. If the client is still left untreated, the disease will progress to stage 3, the symptoms of which often appear years later: dementia, paralysis, numbness, and blindness. The damage caused in the tertiary stage of syphilis is not reversible (

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 The act of douching can cause serious gynecological infections up to and including PID. When a woman douches she disrupts the normal flora in her vagina. Pathogens can then invade the area and be pushed upward into the upper gynecological system. Douching should never be performed unless ordered by a health care practitioner.

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 key to answering this question is the fact that the client has multiple sex partners. The client is high risk for becoming pregnant, but as important is also high risk for acquiring a sexually transmitted infection. It is important for the nurse to consider that fact when providing family planning information.

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 The vas deferens is ligated during a vasectomy. This will prevent all sperm in the future from migrating from the testes through the vas deferens to the urethra. The blockage is made before the seminal vesicles and prostate, however, so the client will still ejaculate the same amount of fluid.

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 There are a number of fallacies being communicated among unknowledgeable people. One of the most commonly heard fallacies is that oral sex is safe. It is not. Rather than infecting the reproductive system, the STI will infect the mucous membranes of the mouth. For example, genital warts have been seen in the mouth and throat, and herpes simplex 2 can infect the oral cavity.

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 client is exhibiting classic signs of physical abuse. The partner is domineering and the client has injuries that are not supported by the history. To obtain a more accurate history, the nurse must interview the client alone. This can often take place in the women's restroom since, unless this is a lesbian relationship, the partner is unable to follow.

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 Unless working in an environment that precludes the nurse from discussing the possibility of an abortion, the nurse is obligated to provide the young woman with all of her choices— maintaining the pregnancy and keeping the baby, maintaining the pregnancy and giving the baby up for adoption, and terminating the pregnancy. If the nurse has a personal bias against abortion, he or she should refer the client to another nurse who will discuss the option.

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 Women can develop dark patches on their skin when using Depo-Provera. The patches often become darker in women who are in the sun without protection. It is strongly recommended that women who use Depo-Provera use sunscreen whenever they are exposed to the sun.

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 Women who are being abused will often deny the abuse. It is not uncommon for abused women to enter the health care system numbers of times before making the decision to terminate the relationship with the abuser. The nurse must discuss his or her observations with the young woman—always in private—and provide the client with possible options at each visit. It is essential that the nurse not ignore the signs, no matter how many times the woman denies that she is being abused.

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 4 A vasectomy procedure is much less invasive than a tubal ligation. A tubal ligation is done in the hospital via laparoscope with the patient under anesthesia, while a vasectomy is done in a physician's office with the patient under local anesthesia. There are few complications associated with the vasectomy: pain at the site and, rarely, infection at the site and/or bleeding into the scrotal sac.

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 A number of individuals who contract the hepatitis B virus become long-term carriers of the disease and are able to transmit it to others. They are also at high risk for the development of chronic liver disease and liver cancer

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 Adolescents' sex practices are often different from adults'. Teens rarely plan to have intercourse. They "hook up," often having sex on the spur of the moment. It is important, therefore, that they use a method that is immediately effective. In addition, it is not uncommon for adolescents to have more than one sexual partner. Infection control must be a consideration. Female condoms meet both needs.

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 Adolescents' sex practices are often different from adults'. Teens rarely plan to have intercourse. They "hook up," often having sex on the spur of the moment. It is important, therefore, that they use a method that is immediately effective. In addition, it is not uncommon for adolescents to have more than one sexual partner. Infection control must be a consideration. Female condoms meet both needs.

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 Bulimic clients force themselves to vomit. The dentition is adversely affected because of the repeated vomiting. The knuckle scarring, called Russell's sign, develops from tissue injury during the act of jamming the fingers down the throat to force vomiting. Bulimics are also known to take large quantities of cathartics.

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 Clients who use hormonally based contraceptive methods are high risk for clot formation. This client is communicating symptoms that may indicate the presence of a clot. She should be seen by her practitioner to rule out deep vein thrombosis and a possible stroke.

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 Once the information regarding the client's history and lifestyle is ascertained, the nurse must provide needed care and teaching. If the client has had multiple partners, other sexually transmitted illnesses (STIs), including HIV, should be considered. The nurse should counsel the client to seek further testing. In addition, the nurse should encourage the client to use contraceptive methods that will protect her from infection as well as pregnancy.

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 Ovarian cancer is often called the silent killer because it rarely is diagnosed in its early stages. The following signs/symptoms—along with those above—have been identified as early signs of the disease: pelvic pain, abdominal growth, and difficulty eating. Women should be advised to seek care from their health care providers if they experience the symptoms.

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 The CDC Advisory Committee on Immunization Practices recommends that the HPV vaccine— Gardasil—be given to all young men and women between the ages of 11 and 12, or as young as age 9, and up to age 26. There is also a second HPV vaccine on the market, Cervarix. Both Gardasil and Cervarix effectively protect recipients against HPV types 16 and 18—the two types that cause most HPV-related cancers. Only Gardasil®, however, also protects against two additional strains of HPV—types 6 and 11—that cause most cases of genital warts

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 The current recommendation by the Centers for Disease Control and Prevention (CDC) is that the hepatitis B vaccine series be administered during the neonatal period. For those who have not received the vaccine in infancy, it can be administered at any age. The second and third shots are administered 1 month and 6 months after the first, respectively.

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 The human immunodeficiency virus is prone to mutation. It is important that clients use condoms whenever they have intercourse because if the virus mutates and the client becomes infected with two strains of virus, the progression to AIDS is hastened.

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 The penis becomes flaccid very rapidly after ejaculation. The man should carefully remove the penis from the vagina before the penis becomes flaccid while holding the edges of the condom or, if it does become flaccid, he should be especially careful during its removal.

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 The sudden onset of dyspareunia can indicate the development of PID. The client should be examined to determine whether or not she has developed an infection.

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 test-taker should be familiar with the BSE and be able to teach women how to perform the skill. Clients are then able to take an active role in their own health. In addition, however, it is important for the nurse to advise women that neither the BSE nor a palpation examination performed by a health care practitioner has been shown to increase survival rates in clients with breast cancer. Only mammography has been shown to increase survival rates. Women who are at risk of developing breast cancer should be strongly encouraged, therefore, to have yearly breast mammograms.

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 client is exhibiting signs of denial. The nurse must empathize with the woman regarding the unexpected and unwanted news, but the nurse also must convince the woman to seek care. Giving her the information that many women have no signs of symptoms of disease is essential.

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 question is a lesson in changing practice. For many years, it was recommended that men and women always use condoms with spermicide to prevent the spread of STIs, including HIV. It has been shown, however, that latex and polyurethane condoms alone are as effective as condoms with spermicide. In addition, there is evidence to show that spermicides increase the permeability of the mucous membranes to HIV. The test taker must be sure to read the literature to remain current

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 a sexually transmitted infection caused by a protozoan. Women who develop the infection during pregnancy may develop preterm labor. Women who are infected with trichomoniasis have an increased risk of contracting HIV if exposed

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 wish to breastfeed can take some types of birth control pills (BCPs), but not pills that contain an estrogen medication. Seasonale contains an estrogen. Estrogen inhibits milk production. If they wish to take BCPs, breastfeeding women should take progestin-only pills.

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 As in the scenario, the nurse must take multiple factors into consideration before making suggestions about a contraception choice for a client. Because of the number of choices available, the nurse must narrow the choices to those that are best in each situation.

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 Because bulimics repeatedly induce themselves to vomit, their esophagi are repeatedly exposed to the acids from the stomach. They, therefore, develop many upper gastrointestinal complications, including esophagitis. Those bulimics who also abuse laxatives may be found to have guaiac-positive stools.

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 Because women who have fibrocystic breast disease have very dense and nodular breasts it is very difficult to detect cancerous lesions by simple palpation. It is very important, therefore, that these women have regular mammograms and ultrasounds and magnetic resonance images (MRIs), if recommended, to monitor for malignant changes.

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 Genital warts are caused by the human papillomavirus. There are more than 100 viral types of HPV. Most of them are harmless, but unfortunately, some high-risk types can cause cancer. Some of the topical treatments for genital warts can be applied at home by the individual or can be administered by a practitioner. Surgery and cryotherapy, also used to treat warts, must be performed by a skilled practitioner

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 It is essential that the nurse knows and understands the rights of clients in his or her state. It is important to note, however, that because the NCLEX-RN® is a national examination, state-specific information will not be asked

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 It is essential that the nurse understand the differences between EC and an abortifacient. EC is used to prevent pregnancy after unprotected intercourse. If the woman is unknowingly pregnant at the time she takes EC, she will not abort the fetus. EC is used up to 5 days following exposure while an abortifacient—Mifeprex (misepristone/ misoprostol), formerly known as RU-486—is used to abort a fetus and is used up to 9 weeks' gestation.

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 It is very important for the nurse to listen very carefully to clients' comments. Many of their statements will influence the nurse's teaching in only minor ways, while other patient comments will dramatically affect the nurse's choices.

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 Nits are very small, white eggs that are about the size of a period at the end of a sentence. They adhere firmly to the shaft of the pubic hair and take about 1 week to hatch. It is very important, therefore, that the nits be removed with a fine-tooth nit comb to prevent reinfestation.

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 Nurses must be prepared to care for clients in every walk of life. The special needs of gay men and women are often ignored by health care workers. When caring for clients, one question that should be asked is the client's sexual preference. Unless the nurse asks the question, important issues may be missed.

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 goal of condom use is to prevent contact of the mucous membranes with sperm and with infectious secretions. The best way to prevent these situations from happening is by enclosing the fluid in the condom as quickly as possible. The male should hold the rim of the male condom while removing the penis from the vagina. Similarly, the female should twist and hold the rim of her condom while removing it from the vagina.

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 This question requires the test taker to use previously learned information. To know facts is not sufficient for the nurse. Nurses must be able to assess the needs of clients in their care and act appropriately.

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 question requires the test taker to use previously learned information. To know facts is not sufficient for the nurse. Nurses must be able to assess the needs of clients in their care and act appropriately.

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 This young woman is exhibiting classic signs of bulimia: Russell's sign, gorging (eating a caloriefilled meal), and proceeding to the bathroom immediately after eating. It is very likely that the young woman will purge herself of the large meal (by selfinduced vomiting). The nurse should then discuss her observations with the young woman and, if appropriate, with her parents.

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 Women are usually symptom free when they initially contract gonorrhea or chlamydia. In addition, since the primary infection of syphilis, the chancre, is pain free, women may not realize they have been infected with the spirochete. As a result, it is very important that women, especially those with multiple sex partners, be seen yearly by a gynecologist or nurse practitioner to be tested for STIs.