OB ch. 3

A female patient schedules an appointment for a gynecologic examination. Which finding should indicate to the nurse that the patient is experiencing a vaginal infection? A) Foul odor from used tampons B) Scant menstrual flow at the end of the cycle C) Abdominal bloating a few days prior to menstruation D) Saturating a tampon every 2 hours during menstruation

Answer: A Explanation: An unusual odor when using tampons could indicate an infection. Scant menstrual flow at the end of the cycle is an expected finding. Abdominal bloating a few days prior to menstruation could be associated with premenstrual syndrome. Saturating a tampon every 2 hours during menstruation could indicate abnormal bleeding which should be evaluated.

10) A female patient with amenorrhea is suspected to have pituitary dysfunction. For which health problems should the nurse explain that the patient will most likely be evaluated? Select all that apply. 1. Cancer 2. Adenoma 3. Head trauma 4. Turner syndrome 5. Polycystic ovarian syndrome

Answer: 1, 2, 3 Explanation: In pituitary dysfunction, cancer and head trauma can cause hypopituitarism. A pituitary adenoma can cause changes in the hormones that the pituitary gland manufactures. Turner syndrome is a genetic disorder that is linked to chronic anovulation or ovarian failure. Polycystic ovarian syndrome is a cause of chronic anovulation. Page Ref: 38

13) A patient experiencing menopause asks what complementary and alternative therapy can be taken to reduce the symptoms. After reviewing the patient's health history, for which problems should the nurse encourage the patient to avoid taking phytoestrogens? Select all that apply. 1. Allergy to soy 2. Currently taking tamoxifen 3. Treated for breast cancer 5 years ago 4. Surgery for uterine fibroids in her 20s 5. Experiences insomnia several times a week

Answer: 2, 3, 4 Explanation: Women who have had or are at risk for diseases that are affected by hormones, such as breast cancer or uterine fibroids, and women who are taking medications that increase estrogen levels in the body such as tamoxifen need to be especially careful about using phytoestrogens. An allergy to soy and experiencing insomnia are not reasons for the patient to avoid taking phytoestrogens. Page Ref: 47

12) A female patient experiencing menopause is concerned that periodic lapses of memory are symptoms of Alzheimer disease. What should the nurse review with the patient to reduce the risk of developing Alzheimer disease (AD)? Select all that apply. 1. Increase rest 2. Stop smoking 3. Exercise regularly 4. Eat a healthy diet 5. Maintain mental activity

Answer: 2, 3, 4, 5 Explanation: Lifestyle practices may help prevent AD include smoking cessation, regular exercise of at least 30 minutes 5 days a week, eating a healthy diet, and remaining mentally active. Increased rest does not help prevent AD. Page Ref: 46

11) A patient in her late 40s asks the nurse what she should expect when entering menopause. In which order should the nurse identify changes that the patient will experience during menopause? 1. Amenorrhea 2. Anovulation 3. Reduced fertility 4. Changes in menstrual flow 5. Menstrual cycle irregularities

Answer: 2, 3, 4, 5, 1 Explanation: Beginning 2 to 8 years before menopause, women experience episodes of anovulation, reduced fertility, decreased or increased menstrual flow, menstrual cycle irregularities, and then, ultimately, amenorrhea. Page Ref: 44-45

14) The nurse is preparing an educational seminar for a group of middle-aged healthy women on health screening recommendations. What information should the nurse include during this educational session? Select all that apply. 1. Get a Pap test every 3 years 2. Schedule mammograms every 5 years 3. Get testing for HIV before the age of 60 4. Have a screening for colorectal cancer 5. Have blood pressure measured every year if 140/90

Answer: 3, 4 Explanation: A Pap test every 3 years is appropriate for women between the ages of 18 and 39. Mammograms should be obtained every 2 years through age 74. If the blood pressure measurement is 140/90 or higher, treatment should be discussed with the doctor or nurse. There is no age limit for HIV testing. Patient should be tested for HIV at least once if age 65 and have never been tested. Starting at age 50, patients should be screened for colorectal cancer. Page Ref: 42

29) A premenopausal female received a recommendation by her healthcare provider to have a bone mineral density (BMD) test done. What should the nurse identify as being the reason for the test at this time in the patient's life? A) History of an eating disorder B) Takes NSAIDs for osteoarthritis C) Lives with a spouse who smokes cigarettes D) Surgery for carpal tunnel syndrome last year

Answer: A Explanation: BMD testing may be indicated for premenopausal women with certain medical conditions such as eating disorders. BMD testing is not indicated when taking NSAIDs for osteoarthritis, living with a spouse who smokes, or after having carpal tunnel surgery.

33) A premenopausal patient is experiencing vaginal dryness. What pharmacological intervention should the nurse suggest for this patient's symptom? A) Local low-dose vaginal estrogen B) Testosterone replacement therapy C) Menopausal hormone therapy with testosterone D) Menopausal hormone therapy with estrogen alone

Answer: A Explanation: Local low-dose vaginal estrogen is generally recommended to treat vaginal dryness or dyspareunia. Women are not provided with testosterone alone replacement therapy. Menopausal hormone therapy with testosterone helps to improve libido. Hormone therapy containing estrogen only is given to women who have undergone a hysterectomy.

28) The nurse is preparing a program about osteoporosis for a group of community members. What should the nurse emphasize as being the greatest risk factor for the development of this disorder? A) Family history B) Caucasian race C) Sedentary lifestyle D) Low lifetime intake of calcium

Answer: A Explanation: The greatest influencing factor for the development of osteoporosis is a family history of osteoporosis. Although Caucasian race, sedentary lifestyle, and low lifetime intake of calcium are risk factors, the greatest factor is family history.

5) The nurse is interviewing an adolescent client. The client reports a weight loss of 50 pounds over the last 4 months, and reports running at least 5 miles per day. The client asserts that her menarche was 5 years ago. Her menses are usually every 28 days, but her last menstrual period was 4 months ago. The client denies any sexual activity. Which is the best statement for the nurse to make? A) "Your lack of menses might be related to your rapid weight loss." B) "It is common and normal for runners to stop having any menses." C) "Increase your intake of iron-rich foods to reestablish menses." D) "Adolescents rarely have regular menses, even if they used to be regular."

Answer: A Explanation: A) Secondary amenorrhea can be caused by rapid weight loss, including the development of the eating disorders anorexia and bulimia. Runners with low body fat might have irregular menses, but amenorrhea is not a normal condition. B) It is common for runners to have amenorrhea, but it is not normal. C) Iron deficiency does not impact menstrual regularity. D) Although the first year or two after menarche might be characterized by irregular menses, once menses are established and regular, a lack of menses is secondary amenorrhea. Page Ref: 38

17) When analyzing data collected during a sexual history, the nurse notes that a patient has limited information about contraception. What should the nurse do to address this patient's need? A) Provide the patient with the information B) Suggest that the patient talk with the nurse practitioner C) Schedule an appointment for the patient to see the midwife D) Discuss the implications if contraception is not used correctly

Answer: A Explanation: If a deficiency in knowledge is identified the nurse can identify a plan of care to address this deficiency and provide the teaching. The patient does not need to talk with a nurse practitioner or a midwife to discuss contraception. The implications of inappropriately used contraception can be included when discussing the individual types with the patient

35) During a wellness visit, a 50-year-old female experiencing menopause says that she jogs three times a week and feels like her symptoms are becoming worse. What should the nurse recommend to help with the discomfort of menopause? Select all that apply. A) Yoga B) Tai chi C) Meditation D) Weight lifting E) Kegel exercises

Answer: A, B, C Explanation: A variety of therapeutic modalities have been proposed as treatment or prevention measures for the discomforts and ailments of the perimenopausal and postmenopausal years, including mind-body practices such as yoga, tai chi, and meditation. Weight lifting helps maintain bone mass caused by the reduction in estrogen. Kegel exercises help maintain vaginal muscle tone and increase blood circulation to the perineal area.

25) A 17-year-old high school student comes into the nurse's office to find out what to do about severe menstrual cramps. What should the nurse recommend to this student? Select all that apply. A) Rest B) Good nutrition C) Regular exercise D) Application of heat E) D & C of the uterus

Answer: A, B, C, D Explanation: Treatment of primary dysmenorrhea includes rest, good nutrition, regular exercise, and application of heat. D & C of the uterus is a treatment for secondary dysmenorrhea.

16) A 40-year-old patient is being seen in the clinic for gynecological changes. Which approaches should the nurse use when completing this patient's health interview? Select all that apply. A) Avoid writing B) Clarify terms used C) Maintain eye contact D) Analyze body language E) Use simple yes-no questions

Answer: A, B, C, D Explanation: When conducting a sexual history the nurse should avoid writing, clarify terms being used, maintain eye contact unless it is culturally inappropriate, and analyze the patient's body language. Using closed questions will limit the amount of information collected and should be avoided.

26) A 30-year-old patient who experiences severe premenstrual syndrome every month asks for nonpharmacologic suggestions to treat this disorder. What should the nurse recommend? Select all that apply. A) Eat more frequent meals B) Engage in aerobic activity C) Limit alcohol to two drinks per day D) Restrict the intake of chocolate and coffee E) Increase the intake of fruits and vegetables

Answer: A, B, D, E Explanation: Nonpharmacologic approaches for treating premenstrual syndrome include eating more frequent meals, engaging in aerobic activity, restricting the intake of chocolate and coffee, and increasing the intake of fruits and vegetables. Alcohol should be restricted and not limited to two drinks per day.

15) The nurse is preparing to assess the sexual history of a 35-year-old female patient. Which approach should the nurse first use to facilitate this data collection? A) Ask if the patient is sexually active B) Review the present method of birth control C) Determine the patient's number of children D) Talk about the patient's medical-surgical history

Answer: D Explanation: D) When taking a history, the interview should start with less intimate areas, such as medical and surgical history, and then proceed to the sexual history toward the end of the history-taking session. This approach helps the woman develop a comfort level with the nurse before disclosing personal information. Page Ref: 35—36

The nurse is preparing an educational session for high school female students on self-care during menstruation. What should the nurse include regarding care when using a tampon? Select all that apply. A) Wash hands before inserting a tampon B) Wash hands after inserting the tampon C) Change the tampon every 8 to 12 hours D) Use tampons with the minimum amount of absorbency E) Avoid touching the part that will be inserted into the vagina

Answer: A, B, D, E Explanation: Teaching about the use of tampons should include washing the hands before and after inserting the tampon, using tampons with the least amount of absorbency, and to avoid touching the part of the tampon that will be inserted into the vagina. Tampons should be changed every 3 to 6 hours.

27) During an assessment, the nurse determines that a female patient is at risk for developing osteoporosis. Which information did the nurse use to make this clinical determination? Select all that apply. A) Body weight of 120 lbs B) Plays tennis twice a week C) Smokes 2 packs per day of cigarettes D) Ingests 2 to 3 cocktails every day E) Mother diagnosed with osteoporosis

Answer: A, C, D, E Explanation: Risk factors for the development of osteoporosis include bodyweight of less than 127 lbs, smoking cigarettes, ingestion of alcohol, and having a family history of osteoporosis. An active lifestyle is an action to reduce the risk of developing osteoporosis.

A female patient asks what can be done to control vaginal odor. How should the nurse respond? Select all that apply. A) Wear cotton underwear B) Use a mild vaginal deodorant C) Schedule douching to occur weekly D) Cleanse from front to back when toileting E) Use soap and water to cleanse the perineum

Answer: A, D, E Explanation: To control vaginal odor the patient should be instructed to wear cotton underwear, cleanse from front to back when toileting, and to use soap and water to cleanse the perineum. Vaginal deodorants and douching are not recommended.

1) The clinic nurse is returning phone calls. Which call should the nurse return first? A) The call from a 22-year-old reporting that she has menstrual cramps and vomiting every month B) The call from a 17-year-old asking whether there is a problem with using one tampon for a whole day C) The call from a 46-year-old mother of a teen wondering if her daughter should be on birth control D) The call from a 34-year-old requesting information on douching after intercourse

Answer: B Explanation: A) Because vomiting can lead to dehydration, this client is not completely normal or stable, but is not the top priority. B) Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially life-threatening condition. This client needs education on the danger of using one tampon longer than 3-6 hours. C) A sexually active teen could be at risk for unintended pregnancy, as well as sexually transmitted infections. However, it is unclear whether the daughter is sexually active. This call is a low priority. D) This client requires education, but is not a top priority. Page Ref: 37

2) The nurse who is taking a sexual history from a client should do which of the following? A) Ask questions that the client can answer with "yes" or "no." B) Ask mostly open-ended questions. C) Have the client fill out a comprehensive questionnaire and review it after the client leaves. D) Try not to make much direct eye contact.

Answer: B Explanation: A) Open-ended questions are often useful in eliciting information. Yes-or-no answers will not provide the necessary information. B) Open-ended questions are often useful in eliciting information. C) Asking a client to fill out a questionnaire about sexual history is not appropriate. D) It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Page Ref: 36

8) A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during sexual intercourse, and asks, "What should I use as a lubricant?" The nurse should recommend which of the following? A) Petroleum jelly B) A water-soluble lubricant C) Body cream or body lotion D) Less-frequent intercourse

Answer: B Explanation: A) Petroleum jelly is not a healthy choice for vaginal lubrication. B) A water-soluble jelly should be used. C) Body creams and body lotions are not healthy choices for vaginal lubrication. D) "Less-frequent intercourse" is an inappropriate response. Page Ref: 49

6) A client comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for 2 years. What is the most likely cause for the client's complaint? A) Primary dysmenorrhea B) Secondary dysmenorrhea C) Menorrhagia D) Hypermenorrhea

Answer: B Explanation: A) Primary dysmenorrhea is defined as cramps without underlying disease. B) Secondary dysmenorrhea is associated with pathology of the reproductive tract, and usually appears after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include ovarian cysts and the presence of an intrauterine device. C) Menorrhagia is excessive, profuse menstrual flow. D) Hypermenorrhea is an abnormally long menstrual flow. Page Ref: 39

The nurse suspects that a female patient is experiencing amenorrhea because of ovarian failure. For which situation should the nurse assess this patient? A) Severe stress B) Recent head trauma C) Treatment for cancer D) Antianxiety medication

Answer: C Explanation: Chemotherapy and radiation are reasons for the development of ovarian failure. Severe stress, antianxiety medication, and head trauma can cause hypothalamic dysfunction as a reason for amenorrhea.

During a health interview focused on sexual history, a female patient makes a statement about douching and intercourse. What should the nurse do in response to this statement? A) Recommend the frequency of douching B) Explain the proper procedure to douche C) Take the time now to educate the patient about the practice D) Document that the patient has misunderstandings about the use of douches

Answer: C Explanation: It is essential that the nurse listen and use teachable moments to educate women about their bodies. Since the patient mentioned douching and intercourse, the time to review information about that practice with the patient is now. The nurse needs to do more than recommend the frequency of douching or explain the proper douching procedure. The nurse also needs to do more than document that the patient has misunderstandings about the use of douches.

31) A patient with osteoporosis wants a medication that does not need to be taken every day. What should the nurse expect to be prescribed for this patient? A) Teriparatide (Forteo) B) Alendronate (Fosamax) C) Zoledronic acid (Zometa®) D) Salmon calcitonin (Miacalcin®)

Answer: C Explanation: Zoledronic acid (Zometa®) is administered via IV once a year. Teriparatide (Forteo) necessitates a daily subcutaneous injection. Alendronate (Fosamax) is a daily oral medication. Salmon calcitonin (Miacalcin®) is to be taken daily as a nasal spray.

3) A client asks her nurse, "Is it okay for me to take a tub bath during the heavy part of my menstruation?" What is the nurse's correct response? A) "Tub baths are contraindicated during menstruation." B) "You should shower and douche daily instead." C) "Either a bath or a shower is fine at that time." D) "You should bathe and use a feminine deodorant spray during menstruation."

Answer: C Explanation: A) Bathing in a tub is not contraindicated during menses. B) Douching should be avoided during menstruation. C) Bathing, whether it is a tub bath or a shower, is as important (if not more so) during menses as at any other time. D) Bathing is as important (if not more so) during menses as at any other time, but feminine deodorant sprays are unnecessary. Page Ref: 38

7) The nurse is teaching a group of women about menopause at a community clinic. The nurse tells them that the best indicator of menopause is which of the following symptoms? A) No menses for 8 consecutive months B) Hot flashes and night sweats C) FSH levels rise and ovarian follicles cease to produce estrogen D) Diagnosed with osteoporosis 4 months ago

Answer: C Explanation: A) Eight consecutive months of amenorrhea are enough to qualify as menopause. B) Although hot flashes and night sweats are common in menopause, they are not the most reliable indicator of menopause. C) Examining FSH and estrogen levels is a very accurate indication of menopause. D) Menopause is not the only cause of osteoporosis; therefore, the diagnosis of osteoporosis 4 months ago is not an indicator of menopause. Page Ref: 43

9) A 49-year-old client comes to the clinic with complaints of severe perimenopausal symptoms including hot flashes, night sweats, urinary urgency, and vaginal dryness. The physician has prescribed a combination hormone replacement therapy of estrogen and progestin. When the client asks the nurse why she must take both hormones, what is the nurse's best reply? A) "Hot flashes respond better when replacement includes both hormones." B) "You are having very severe symptoms, so you need more hormones replaced." C) "There is an increased risk of tissue abnormality inside the uterus if only one is given." D) "Your blood pressure can become elevated if only one hormone is used."

Answer: C Explanation: A) Estrogen, not progestin, improves hot flashes and most other perimenopausal symptoms. B) The severity of symptoms will be considered by the physician in determining the appropriate dose for the client. C) Estrogen alone, in a woman with a uterus (unopposed estrogen), increases the risk of endometrial (the lining of the uterus) cancer by eightfold and, therefore, is never given without progesterone in these women. D) Estrogen therapy does not cause hypertension. Page Ref: 46-47

34) A patient experiencing symptoms of menopause asks if there are any vitamin supplements she should take at this time. Which vitamins should the nurse suggest to this patient? Select all that apply. A) Vitamin A B) Vitamin C C) Vitamin D D) Vitamin E E) Vitamin B complex

Answer: C, D, E Explanation: Therapeutic modalities proposed as treatment or prevention measures for the discomforts and ailments of the perimenopausal and postmenopausal years include vitamins E, D, and B complex. Vitamins A and C have not been identified as being beneficial to reduce the symptoms associated with menopause.

32) The nurse is identifying complementary and alternative therapies for a patient with a history of liver disorders who is experiencing symptoms of menopause. Which herbal supplement should this patient be counseled to avoid? A) Ginger B) Ginseng C) Red clover D) Black cohosh

Answer: D Explanation: Black cohosh has been associated with liver inflammation and disease. Ginger is useful to control nausea and vomiting. Ginseng helps with mood symptoms and sleep disorders. Red clover helps with hot flashes. Ginger, ginseng, and red clover are not associated with liver disease.

30) A patient who is postmenopausal is encouraged to take calcium 1500 mg every day. How should the nurse instruct the patient to take this supplement? A) Take calcium 750 mg with breakfast and dinner B) Take the complete dose first thing in the morning C) Take the complete dose prior to bedtime every day D) Take calcium 500 mg three times a day with meals

Answer: D Explanation: Calcium supplementation is most effective when single doses do not exceed 500 mg and when taken with a meal. Taking calcium 750 mg twice a day is less effective. Taking calcium 1500 mg in the morning or at night is not recommended since the mineral will not have peak absorption.

23) A patient with amenorrhea has an elevated serum prolactin level. Which diagnostic test should the nurse expect will be prescribed for this patient? A) Laparoscopy B) Abdominal ultrasound C) CT scan of the abdomen D) Magnetic resonance imaging (MRI)

Answer: D Explanation: If serum prolactin levels are elevated, magnetic resonance imaging (MRI) will be ordered to rule out a pituitary tumor. A laparoscopy, abdominal ultrasound, or CT scan of the abdomen is not indicated for a patient with amenorrhea and an elevated serum prolactin level.

24) A 38-year-old patient is concerned that a month after becoming a widow, her menstrual cycles stopped. What should the nurse suspect as being the cause for this patient's secondary amenorrhea? A) Ovarian failure B) Pituitary dysfunction C) Anatomic abnormality D) Hypothalamic dysfunction

Answer: D Explanation: Severe or prolonged stress such as that which occurs with an unexpected death can lead to hypothalamic dysfunction. Ovarian failure is related to exposure to radiation, chemotherapy, viral infection, and surgical removal of the ovary. Pituitary dysfunction is related to pituitary tumors or disease, use of antipsychotic medication, low prolactin levels, head trauma, and cancer. With an anatomic abnormality the patient would not have ever had a menstrual cycle

4) Which client would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea? A) 17-year-old, has never had a menstrual cycle B) 16-year-old, had regular menses for 4 years, but has had no menses in 4 months C) 19-year-old, regular menses for 5 years that have suddenly become painful D) 14-year-old, irregular menses for 1 year, experiences cramping every cycle

Answer: D Explanation: A) This is primary amenorrhea, or the lack of menses. B) Secondary amenorrhea is the term used when a client has had regular cycles that cease. C) Secondary dysmenorrhea is the sudden onset of pain and discomfort with menses. D) Dysmenorrhea, or painful menstruation, occurs at, or a day before, the onset of menstruation and disappears by the end of menses. Primary dysmenorrhea is defined as cramps without underlying disease. Page Ref: 39