NCLEX 56
A patient is diagnosed with hypertension. In addition, the patient reports skin discoloration, weight gain, and nausea. Which of the following contraceptive preparations would the nurse practitioner recommend for this patient? a) Monophasic b) Triphasic c) Progestin-only d) Biphasic
Progestin-only Explanation: Progestin-only preparations are useful for women who have had estrogen-related side effects (e.g., headaches, hypertension, leg pain, chloasma or skin discoloration, weight gain, or nausea) on combination pills. Combined preparations can be monophasic, biphasic, and or triphasic. Monophasic preparations supply the same dose of estrogen and progestin for 21 days. Biphasic preparations and triphasic pills vary the amount of hormonal components during the cycle.
Which of the following statements when made by a patient following a laparoscopic procedure requires immediate follow-up by the nurse? a) "I have pain in my left shoulder." b) "The area around my navel is tender." c) "I have moderate pain at my incision site." d) "My adhesive bandage has minimal drainage."
"The area around my navel is tender." Explanation: Tenderness and pain around the navel may indicate internal bleeding indicating possible bowel or bladder injury, or burns from the coagulator. The patient may experience abdominal or shoulder pain related to the use of carbon dioxide gas. Pain and minimal drainage are expected findings following a laparoscopic procedure.
Which of the following patients in the ED should the advance nurse practitioner treat first? a) A 32-year-old woman with bloating, headache, and reported depression b) A 48-year-old woman presenting with irregular menses, breast tenderness, and profuse sweating c) A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness d) A 19-year-old woman with vaginal irritation, malodorous, copious frothy/yellow-green discharge
) A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness Explanation: The patient with sharp colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority patient at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, malodorous copious frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority patient.
Which of the following terms refers to difficult or painful sexual intercourse? a) Dysmenorrhea b) Dyspareunia c) Amenorrhea d) Endometriosis
) Dyspareunia Explanation: Dyspareunia is a common problem of the aged woman. Amenorrhea refers to absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis.
During the premenstrual phase, which of the following hormones is increasing? a) Follicle-stimulating hormone (FSH) b) Luteinizing hormone (LH) c) Estrogen d) Progesterone
) Follicle-stimulating hormone (FSH) Explanation: In the premenstrual phase, the FSH is increasing. Estrogen is decreasing, along with LH and progesterone.
Which of the following is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent? a) Laparoscopy b) Endometrial ablation c) Hysterosalpingography (HSG) d) Hysteroscopy
) Hysterosalpingography (HSG) Explanation: An HSG is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows for visualization of the pelvic structures. A hysteroscopy allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.
During menstruation there is an absence of which hormone? a) Progesterone b) LH c) Estrogen d) FSH
) Progesterone Explanation: During menstruation, there is an absence of progesterone. Estrogen is low, FSH is increased, and LH is low during menstruation.
Following 2 years of infertility, a couple is interested in assisted reproduction. Which of the following nursing interventions are appropriate when working with couples during infertility treatment? Select all that apply. a) Assure the couple everything will be okay. b) Assess the couple's stress relief practices. c) Recommend a folic acid supplement. d) Refer the couple for individual counseling. e) Refer them to a smoking cessation program.
) Refer them to a smoking cessation program., c) Recommend a folic acid supplement., b) Assess the couple's stress relief practices. Explanation: Smoking is strongly discouraged because it has an adverse effect on the success of assisted reproduction. Diet, exercise, stress reduction techniques, folic acid supplementation, health maintenance, and disease prevention are emphasized in many infertility programs. Because infertility evaluations and treatments are expensive, time-consuming, invasive, stressful, and not always successful, couples need support in working together to deal with this process.
Which of the following positions is used for a pelvic examination? a) Trendelenburg b) Semi-Fowler's c) Side lying d) Supine lithotomy
) Supine lithotomy Explanation: The supine lithotomy position is utilized for a pelvic examination. The upright lithotomy position may also be used
A 35-year-old African American who is a regular smoker visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. She is also diabetic. Which of the following contraceptive methods is best for this patient? a) Cervical cap b) Clomiphene (Clomid) therapy c) Menotropins (Repronex) therapy d) NuvaRing placement
Cervical cap Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not utilize hormonal therapy and are appropriate in this case. Menotropins (Repronex, Pergonal), a combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), may be used to stimulate the ovaries to produce eggs. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this patient.
A female patient experienced a severe reduction in body fat by extreme caloric restriction and exercise. Which of the following female reproductive abnormalities could she acquire as a result of the reduction in body fat? a) Higher risk of fibrocystic breast disease b) Polycystic ovarian syndrome c) Small breasts d) Delay or cessation of menstruation
Delay or cessation of menstruation Explanation: She could acquire reproductive abnormalities, such as delay or cessation of menstruation. A cause of infertility in women is polycystic ovarian syndrome a multi-endocrine disorder linked to insulin resistance. High caffeine consumptions may also put a patient at risk of fibrocystic breast disease.
A 27-year-old patient is a regular smoker and is diabetic. She is requesting contraceptive therapy. She has been diagnosed with hypertension. She says she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure. Her vital signs are temperature 98.8°F, pulse 72, respirations 12, BP 112/72 mm Hg. In addition, laboratory reports show a hemoglobin A1C level of 5%. Which of the following aspects of patient teaching would the nurse recommend? Select all that apply. a) Purchasing a self-monitoring cuff b) Advising a smoking cessation program c) Discussing methods for stress reduction d) Prescribing a combination oral contraceptive pill e) Administering glycemic control
Purchasing a self-monitoring cuff, c) Discussing methods for stress reduction, b) Advising a smoking cessation program, d) Prescribing a combination oral contraceptive pill Explanation: Because this patient finds it time consuming to visit the doctor just for a BP reading, the nurse can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction and advising a smoking cessation would constitute patient education in managing hypertension. Controlled hypertension in otherwise healthy young nonsmokers is generally not a contraindication to use of combination agents, but does require a low dose and careful BP monitoring. Hemoglobin A1C levels are within acceptable levels; administering glycemic control is not indicated at this time.
The nurse is educating a young man about nonpharmacological contraception methods. The nurse educator knows that he demonstrates an understanding of latex condom use by which of the following statements. a) "I should use Avanti male condoms because I itch after eating bananas." b) "The condom needs to fit snuggly to the head of the penis." c) "I need to buy sheepskin condoms to protect myself against HIV infection." d) "I need to remove the condom following erection for best results."
a) "I should use Avanti male condoms because I itch after eating bananas." Explanation: The nurse needs to consider the possibility of latex allergy. Swelling and itching after eating kiwis, bananas, pineapples, passion fruit, avocados, or chestnuts may indicate latex sensitivity. The male condom (Avanti) is made of polyurethane. The tip of the condom is pinched while being applied to leave space for ejaculate. Natural condoms (those made from animal tissue) do not protect against HIV infection. The condom, held in place, is removed from the vagina while still erect to prevent the ejaculate from leaking.
Cone biopsy is a term used to describe a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which of the following statements made by the patient demonstrates that the patient undergoing a cone biopsy understands the discharge instructions? a) "I will avoid having sexual relations until I see the doctor again." b) "I require a repeat conization in 2 weeks after the edema subsides." c) "I will use a sitz bath to relieve pain caused by the sutures." d) "I will need to use a menstrual pad to capture the moisture as my cervix unfreezes."
a) "I will avoid having sexual relations until I see the doctor again." Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the patient is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorraphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy.
A 15-year-old high school student reports to the school nurse with complaints of cramping, nausea, diarrhea, and backache. Which of the following assessment questions by the nurse is most appropriate in this situation? a) "When was your last period?" b) "Tell me if you are sexually active." c) "When was your last flu shot?" d) "Do you experience burning with urination?"
a) "When was your last period?" Explanation: Primary dysmenorrhea is painful menstruation, with no identifiable pelvic pathology. It occurs at the time of menarche or shortly thereafter. It is characterized by cramping pain, nausea, diarrhea, and backache. Symptoms begin before or shortly after the onset of menstrual flow and continue for 48 to 72 hours. Amenorrhea is the absence of menstrual flow. Ovulation is the discharge of mature ovum from the ovary. Dyspareunia is difficult or painful sexual intercourse.
Fertility studies for men include a semen analysis to determine sperm count, sperm motility, and abnormal sperm. Which of the following tests can also be performed to determine infertility? a) Blood test for luteinizing hormone (LH) b) Prostate-specific antigen (PSA) assay test c) Needle biopsy of prostatic tissue d) Cystoscopy
a) Blood test for luteinizing hormone (LH) Explanation: A decrease in the blood level of LH may be responsible for decreased testosterone production and infertility. A needle biopsy of prostatic tissue is obtained to diagnose a definitive cancer of the prostate. The PSA assay is a blood test that detects prostate cancer.
While examining the introitus, the nurse practitioner asks the patient to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the patient for which of the following conditions? a) Uterine prolapse b) Colorectal cancer c) Female genital mutilation d) Human papillomavirus (HPV)
a) Uterine prolapse Explanation: The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the patient to "bear down." Examination for colorectal cancer does not improve when the patient bears down. Examination for female genital mutilation does not improve when the patient bears down. The Pap smear reveals atypical cells; the liquid method allows for HPV testing. This procedure does not require the patient to bear down.
A 25-year-old sales manager with a financial firm reports to the health care unit with high stress levels and a BP reading of 130/80 mm Hg. She admits that her life has been stressful as she is unable to meet sales targets and is going through a financial crisis. She suffers from frequent headaches and blurred vision. She currently uses a cervical ring for contraception. Which of the following additional assessment questions related to the patient's choice of contraception does the nurse need to ask? Select all that apply. a) "Have you noticed any episodes of chest pain?" b) "Tell me about the last time you had leg pain." c) "When was your last bowel movement?" d) "When was your last self-breast exam?" e) "Describe any abdominal pain you may be experiencing."
b) "Tell me about the last time you had leg pain.", e) "Describe any abdominal pain you may be experiencing.", a) "Have you noticed any episodes of chest pain?" Explanation: Using the American College of Healthcare Executives (ACHE) assessment for patients using combination contraceptives, the nurse needs to assess for abdominal pain, chest pains, and severe leg pains. Last bowel movement and self-breast exam are to be included in the patient's assessment, but do not directly relate to the assessment of the patient's method of contraception.
Due to a patient's reluctance to begin hormone therapy, the advance nurse practitioner prescribes venlafaxine (Effexor) to decreases the risk of which of the following? a) Heart attack b) Stroke c) Hot flashes d) Blood clots
c) Hot flashes Explanation: Problematic hot flashes have been treated with low-dose venlafaxine (Effexor) as an alternative therapy for hot flashes. Hormone therapy decreases the risk of hot flashes, but it increases the risk of stroke, heart attack, and blood clots.
Which of the following is the recommended health screening diagnostic testing for women 19 to 39 years of age? a) Mammography b) Cholesterol and lipid profile c) Pap smear d) Bone mineral density testing
c) Pap smear Explanation: A Pap smear is recommended for women 19 to 39 years of age, as well as for women 40 years of age and older. Mammography is recommended for health screening for women 40 years of age and older. A cholesterol and lipid profile is recommended for women 40 years of age and older. Bone mineral density testing is recommended for women 40 years of age and older.
Which of the following dinner selections demonstrates an understanding of nutritional therapy used by women to decrease the signs and symptoms of menopause? a) Corn chips, grapes, lean meat, and baked beans b) Wheat toast, apple slices, broiled chicken breast, and steamed carrots c) Saltine crackers, fruit cocktail, lima beans, and meatloaf d) White toast, apple sauce, grilled chicken, and glazed carrots
) Wheat toast, apple slices, broiled chicken breast, and steamed carrots Explanation: To decrease the signs and symptoms of menopause, women are encouraged to decrease their fat and caloric intake and increase their intake of whole grains, fiber, fruit, and vegetables. Saltine crackers, white toast, and corn chips are not good sources of fiber. Fruit cocktail, applesauce, and grapes are high in artificial and natural sugars. Meatloaf is high in fat. Glazed carrots and baked beans can be high in sugar content.
Which of the following is true regarding hormonal contraception? a) Fetal anomalies are a concern b) Increases the risk of benign breast cancer c) Increases the risk of uterine cancer d) Increases the risk for venous thromboembolism
Increases the risk for venous thromboembolism Explanation: There is an increased risk for venous thromboembolism in those taking hormonal contraception. There is a decreased risk of benign breast cancer and uterine cancer. Fetal anomalies are not a concern.
A 55-year-old patient has hypertension. She has admitted to her physician that she stopped taking her regular medications about 3 months ago and started an alternative, new-age therapy. When the patient asks about herbal remedies to treat her hot flashes, which of the following natural estrogens is the physician likely to recommend? a) Bitter gourd tea b) Turmeric powder c) Soy milk d) Ginkgo biloba
Soy milk Explanation: Alternative treatments like natural estrogens found in soy products may be effective in treating hot flashes associated with menopause. Ginkgo biloba is an herbal remedy that may help to treat blood disorders and improve memory. The benefits of drinking bitter gourd tea include possible blood sugar regulation, cancer prevention, and antioxidant protection. Turmeric is used in the treatment of digestive and liver problems.
Which diagnostic is indicated for postmenopausal bleeding? a) Endometrial biopsy b) CT c) MRI d) Ultrasound
a) Endometrial biopsy Explanation: For postmenopausal bleeding, an endometrial biopsy or a D & C is indicated
A patient reports a pain rating of 6 (on a 1 to 10 pain scale, with 10 being the worst possible pain) when the nurse examiner gently moves the cervix. This finding is most consistent with which of the following conditions? a) Endometriosis b) Pelvic infection c) Uterine prolapse d) Rectocele
b) Pelvic infection Explanation: Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection
