Women's Health

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

1. Clients with bacterial vaginosis are at high risk for preterm labor.TEST-TAKING TIP: Bacterial vaginosis is quite common. The problem is characterized by a shift in the bacterial fl ora of the vagina, resulting in a copious, foul-smelling vaginal discharge. When cultured, the usual fi ndings show a decrease in lactobacilli with an increase in Gardnerella vaginalis or other anaerobic bacteria (see http://cdc.gov/std/BV/ STDFact-Bacterial-Vaginosis.htm).

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

1. IUDs can remain in place for extended periods of time.TEST-TAKING TIP: Women who have multiple sex partners or who have had a recent history of a sexually transmitted infection should be considered at highest risk for infection. The risk for all women is most pronounced during the 20 days immediately following IUD insertion.

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

1. The cervical mucus does become thin and elastic at the time of ovulation. TEST-TAKING TIP: 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.

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

1. The initial infection of herpes simplex 2 is often symptom-free but, if symptoms do occur, the client may complain of fl u-like symptoms as well as vesicles at the site of the viral invasion.TEST-TAKING TIP: 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 (see http://cdc.gov/std/ Herpes/STDFact-Herpes.htm).

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

1. The woman should regularly check the diaphragm by looking at it with a good light source. TEST-TAKING TIP: 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.

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

1. Toxic shock syndrome (TSS) is associated with diaphragm use. TEST-TAKING TIP: 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 (see Allen, 2004).

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

2. A pain-free lesion, called a chancre, is consistent with a diagnosis of primary syphilis. A reddish brown rash is seen with stage 2 syphilis.TEST-TAKING TIP: Syphilis is caused by a spirochete and, like other spirochetal illnesses, has a three-stage course. The fi rst 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 fl u-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 and include: dementia, paralysis, numbness, and blindness. The damage resulting from the tertiary stage of syphilis is not reversible (see http://cdc .gov/std/syphilis/STDFact-Syphilis.htm).

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

2. Pruritus is, by far, the most common symptom of pubic lice.TEST-TAKING TIP: 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 (For information regarding the recommended medical treatment of clients with sexually transmitted infections, see http://cdc.gov/std/ treatment/2010/STD-Treatment-2010 -RR5912.pdf).

4. 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 patch must be replaced at the same time each week. 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 fi rst two months.

2. The client should use sunscreen while receiving Depo-Provera for birth control. TEST-TAKING TIP: 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.

53. 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. Insert spermicidal jelly at the same time the sponge is inserted. 4. Replace the sponge with a new one if intercourse is repeated.

2. The sponge must be moistened with water until it is foamy. TEST-TAKING TIP: 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 such as condoms.

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

2. This is correct. The nurse should discuss with the young woman all of her possible choices. TEST-TAKING TIP: 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.

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

2. This is essential. The client must be interviewed in private. TEST-TAKING TIP: 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.

24. 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 immunodefi ciency virus (HIV) easier than girls do."

2. This is true. The mucous membranes of the female and of the teenager are more permeable to STIs than the mucous membranes of adults and men.TEST-TAKING TIP: There are a number of fallacies being communicated among unknowledgeable people. One of the most commonly heard fallacy 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. It is recommended that dental dams be used to minimize the transmission of STIs to the oral cavity

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

2. This is true. The seminal vesicles and the prostate are untouched. TEST-TAKING TIP: The vas deferens is ligated during a vasectomy. Once all sperm remaining in the vas have been ejaculated, this will prevent 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 fl uid.

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

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

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

3. The woman's libido should remain unchanged. TEST-TAKING TIP: Many men and women have misunderstandings regarding tubal ligations. The surgery merely disrupts the ability of the sperm to travel to the egg to complete fertilization. The fallopian tube is cut, tied, and often cauterized. The ovary and uterus are untouched; therefore, the woman's hormones are unaffected and menstruation does not stop.

59. 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 for the remainder of the month." 2. "Stop taking the pill, and start using a condom for contraception." 3. "Come to the clinic this afternoon so that we can see what is going on." 4. "Those are common side effects that should disappear in a month or so."

3. This is an appropriate statement. This client should be seen by her healthcare practitioner. TEST-TAKING TIP: Clients who use hormonally based contraceptive methods are at 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 that could lead to stroke.

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

3. To be immunized against hepatitis B, a three-injection vaccine series is administered. TEST-TAKING TIP: 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 fi rst, respectively.

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

3. Trichomoniasis is characterized by a yellowish green, foul-smelling discharge.TEST-TAKING TIP: 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 (see http://cdc.gov/std/trichomonas/STDFact -Trichomoniasis.htm).

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

4. PID usually occurs as a result of an ascending sexually transmitted infection. TEST-TAKING TIP: 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 healthcare practices to decrease her likelihood of a recurrence of the problem (see http://cdc.gov/std/PID/STDFact -PID.htm).

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

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

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

1. Calcium absorption is enhanced dramatically when vitamin D is also consumed. TEST-TAKING TIP: To maintain proper bone health, it is important for clients, especially women, to consume suffi cient quantities of both calcium and vitamin D. The recommended intake of vitamin D from age 1 to 70 is 600 international units per day; after the age of 70, 800 international units per day. The recommended calcium intake for young adult to age 50 is 1,000 mg per day and after the age of 50, 1,200 mg per day (see http://ods.od.nih.gov/factsheets/ VitaminD-HealthProfessional/and http://ods.od.nih.gov/factsheets/ Calcium-HealthProfessional).

13. 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 immunodefi ciency virus (HIV). 3. Syphilis. 4. Trichomoniasis.

1. Human papillomavirus (HPV) is characterized by flat warts on the vaginal and rectal surfaces.TEST-TAKING TIP: The nurse should be familiar with the primary symptoms of sexually transmitted infections. A woman may confi de in the nurse about symptoms that she is experiencing. The nurse must be able to determine when symptoms require medical attention.

95. A couple whose son was born 1 day earlier is trying to decide whether or not to circumcise their baby. To help them decide, they ask the nurse which of the following items they have read are true regarding circumcision. Which should the nurse advise the couple is correct? 1. The incidence of HIV and other sexually transmitted infections is lower in men who have been circumcised. 2. Boys who suck on sucrose soothers during circumcision feel little to no pain. 3. Men who have been circumcised feel less sexual pleasure during intercourse. 4. The Academy of Pediatrics recommends that all boys be circumcised during the newborn period.

1. This statement is true. Men who have been circumcised become infected with HIV and other sexually transmitted infections at a lower rate than sexually active men who are uncircumcised. TEST-TAKING TIP: There is scientifi c evidence to show that circumcised males who have been exposed to HIV as well as other sexually transmitted infections are less likely to become infected with the infections than uncircumcised males. There is also evidence that circumcised boys under 2 years of age develop urinary tract infections less often than uncircumcised boys (see http:// pediatrics.aappublications.org/content/ pediatrics/130/3/e756.full.pdf).

39. 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 infl ammatory disease. 4. To check for the possibility of a twin pregnancy

1. When pregnancy occurs with an IUD in place, an ectopic pregnancy should be ruled out. TEST-TAKING TIP: There are two main reasons that 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.

73. 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 mEq/L. 2. Bicarbonate 30 mmol/L. 3. Platelet count 450,000 cells/mm 3 . 4. Hemoglobin A 1 C 9%. 5. Sodium 150 mEq/L.

1 and 2 are correct. 1. The nurse would expect to see a low potassium level. 2. The nurse would expect to see a high bicarbonate level. TEST-TAKING TIP: 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 at high risk for cardiac arrhythmias. Their cardiac status should be carefully monitored.

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

1. Men infected with Chlamydia often complain of pain on urination.TEST-TAKING TIP: Because chlamydia is usually a silent infection in women, it is often their male partners who are fi rst identifi ed as being infected because they complain of painful urination. Health department practitioners, after being notifi ed 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 one reason why the disease is so prevalent (see http://cdc .gov/std/chlamydia/STDFact-Chlamydia .htm).

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

1. This is true. It is very important that women be evaluated to make sure that the pregnancy is terminated. Even when bleeding occurs, the pregnancy may still be intact. TEST-TAKING TIP: Mifeprex is available for use for terminating unwanted pregnancies, completing incomplete spontaneous abortions, and 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 (see www.fda.gov/ downloads/drugs/drugsafety/ucm088643 .pdf).

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

2. Of the four clients listed, this client is the best candidate for the use of the birth control pill. TEST-TAKING TIP: 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.

45. 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 bedrest for 24 hours after insertion of the device. 3. Report any complaints of painful intercourse to the physician. 4. Insert spermicidal jelly within 4 hours of every sexual encounter.

3. Reports of dyspareunia should be communicated to the physician. TEST-TAKING TIP: 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.

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

3. This is true. She and her partner should use condoms during sexual intercourse.immunodefi ciency 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 the virus, the progression to AIDS is hastened.

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

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

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% confi dence 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% confi dence interval is a statistically signifi cant fi nding. 3. A relative risk of 0.80 is moderately powerful. 4. Because there is no P value reported for the CI, the nurse is unable to make any conclusions about the data.

1. This is true. Relative risk connotes the probability of an experimental event occurring in relation to the control. An RR = 1 means that the rate of an experimental event occurring is the same as the rate of the control event occurring. An RR less than 1 means that the rate of an experimental event occurring is less than the rate of the control event occurring. An RR greater than 1 means that the rate of an experimental event occurring is greater than the rate of the control event occurring.TEST-TAKING TIP: Confi dence 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% confi dent that the actual mean is between 10 and 17. Consulting a statistics text when reading research studies is an excellent practice.

71. 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, and 4 are correct. 2. Daily exercise does help to prevent the development of osteoporosis. 3. Smoking is associated with the development of osteoporosis. 4. Dairy products contain calcium and many have vitamin D added. Both of these nutrients are essential for preventing osteoporosis. TEST-TAKING TIP: There are a number of factors that clients are unable to control in relation to the development of osteoporosis—for example, gender (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 alcohol in moderation, and get daily exercise.

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

2. The couple should chart temperatures for at least 6 months. TEST-TAKING TIP: 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 (For information regarding the safe administration of birth control methods for clients with medical illnesses, see http://www.cdc.gov/mmwr/pdf/rr/rr5904 .pdf).

31. 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 tip and shaft of the condom-covered penis. 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 fi ve minutes after ejaculating before removing the condom.

2. The foreskin should be pulled back before applying the condom.TEST-TAKING TIP: Latex condom use is an excellent means of infection control as well as the prevention of an unwanted pregnancy. However, this is true 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 removed 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. It is also inadvisable for a man to wear 2 condoms during coitus (see www.cdc.gov/ teenpregnancy/pdf/teen-condom-fact -sheet-2015.pdf).

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

3. Chlamydia trachomatis is a common cause of PID. 4. Neisseria gonorrhoeae is a common cause of PID. TEST-TAKING TIP: 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 vaginalis is a bacterium, it is not a common cause of PID.

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

3. The diaphragm should be left in place for at least 6 hours after intercourse has ended. TEST-TAKING TIP: It is important to note that evidence indicates 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 (see www.cdc.gov/std/ treatment/2010/clinical.htm).

50. 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 are 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 and 2 are correct. 1. The lactational amenorrhea method (LAM) can be effective until 6 months postpartum. 2. As long as the woman has had no period since delivery, the LAM can be effective 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 (see http://waba.org.my/ resources/lam/index.htm#LAM).

79. 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, and 4 are correct. 1. This is a question that should be asked at each healthcare contact. 2. This is a question that should be asked at each healthcare contact. 3. This is a question that should be asked at each healthcare contact. 4. This is a question that should be asked at each healthcare contact. TEST-TAKING TIP: 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.

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

1. The male condom is the best device for this client TEST-TAKING TIP: 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.

66. 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 capsule.

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

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

1. This is correct. To maintain the hormonal levels in the bloodstream, the woman should take the pill as soon as she remembers. TEST-TAKING TIP: Women who take low-dose 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 (see www .mayoclinic.org/drugs-supplements/ estrogen-and-progestin-oral -contraceptives-oral-route/proper-use/ drg-20069422).

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

1. This is true. The CDC has not approved any tests to detect HPV in menTEST-TAKING TIP: 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 (see http://cdc.gov/ std/hpv/STDFact-HPV-and-men.htm).

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

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

54. A man has just had a vasectomy. Which of the following postprocedure teachings should the nurse provide the client? Select all that apply. 1. Complete sterility will occur approximately 1 week postsurgery. 2. Bedrest 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-specifi c antigen (PSA) testing should be performed every year after a vasectomy.

3 and 4 are correct. 3. This is true. Bleeding into the scrotal sac is a rare complication of vasectomy. Men, therefore, are advised to report any marked swelling to their urologist. 4. This is true. To reduce the pain and swelling, men are encouraged to wear athletic supporters for a few days after the surgery. TEST-TAKING TIP: 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, whereas a vasectomy is done in a physician's offi ce with the patient under local anesthesia. There are few complications associated with the vasectomy, most notably, pain at the site and, rarely, infection at the site and/or bleeding into the scrotal sac.

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

3. This is the best answer. Hepatitis B is a very serious disease that can be transmitted sexually or via contact with blood and blood products. The vaccine is given in infancy to prevent future infections. TEST-TAKING TIP: 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 (see http:// cdc.gov/hepatitis/HBV/index.htm).

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

3. This statement is correct. Abdominal pain, bloating, and feeling of fullness are early symptoms of ovarian cancer. TEST-TAKING TIP: 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 identifi ed as early signs of the disease: pelvic pain, abdominal growth, and diffi culty eating. Women should be advised to seek care from their healthcare providers if they experience the symptoms.

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

3. This statement is true. The change in normal fl ora increases the woman's susceptibility to other organisms.TEST-TAKING TIP: Once the information regarding the client's history and lifestyle is ascertained, the nurse must provide needed care and teaching. Questions regarding intercourse with multiple partners as well as previous sexually transmitted illnesses (STIs), including HIV, should be asked and, when indicated, additional testing should be considered. In addition, the nurse should encourage the client in the future to use contraceptive methods that will protect her from infection as well as pregnancy.

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

4. It is likely that this woman has been a victim of a sexual assault after ingesting a date rape drug. TEST-TAKING TIP: 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 (see http://rainn .org/get-information).

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

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

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

4. Most commonly, women experience no signs or symptoms when they have contracted a sexually transmitted infection. TEST-TAKING TIP: Women are usually symptom-free when they initially contract gonorrhea or chlamydia. In addition, because 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

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

4. This response is correct. This client does not have cancer but should be carefully monitored. TEST-TAKING TIP: Because women who have fi brocystic breast disease have very dense and nodular breasts, it is very diffi cult 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.

90. 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 should be monitored for sexually transmitted infections.

4. This statement is true, lesbian women, like heterosexual women, should be monitored for sexually transmitted infections. TEST-TAKING TIP: 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 healthcare 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.

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

2 mL

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

4. This statement is very important. If the client refuses to touch her genital area, she is an unlikely candidate for a number of contraceptive devices: female condom, diaphragm, sponge, cervical cap, and IUD. TEST-TAKING TIP: It is very important for the nurse to listen very carefully to clients' comments. Many of their statements will infl uence the nurse's teaching in only minor ways, while other patient comments will dramatically affect the nurse's choices.

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

4. To remove the nits, or eggs, the pubic hair should be combed with a fi ne-tooth nit comb after the shampoo is removed. TEST-TAKING TIP: Nits are very small, white, lice eggs that are about the size of a period at the end of a sentence. They adhere fi rmly 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 fi ne-tooth nit comb to prevent reinfestation.

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

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

49. Five women, aged 35 to 39, 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 and 3 are correct. 1. Women who smoke should be counseled against using the patch. 3. Women who have a history of deep vein thrombosis (DVT) should be counseled against using the patch. TEST-TAKING TIP: Women, especially those 35 years and older, 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 such as smoking that place them at high risk for thrombi should be counseled against use of the patch (see www.arhp.org/ uploadDocs/choosingqrg.pdf#search= %22contraindications%20hormonal%22).

64. The nurse met four sexually active 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? Select all that apply. 1. 16-year old, high school student 2. 20-year-old, recent college graduate. 3. 24-year-old, G0 P0000. 4. 28-year-old, recent history of chlamydia. 5. 30-year-old, G3 P2102.

1, 2, 3, and 5 are correct. 1. It would be appropriate to recommend the IUD to this patient. 2. It would be appropriate to recommend the IUD to this patient. 3. It would be appropriate to recommend the IUD to this patient. 5. It would be appropriate to recommend the IUD to this patient. of Pediatrics has published a policy statement recommending that pediatricians counsel sexually active adolescents to choose contraceptive options that are the most effective and require the least amount of adherence, that is, progestin implants and IUDs (see "Policy Statement: Contraception for Adolescents," 2014). Teens should be counseled also to use a condom for infection control. Although in the past, nulliparous clients who had IUDs inserted often complained of pain and many expelled the devices, nulliparous women prescribed IUDs currently on the market usually experience few, if any, side effects.

93. The nurse is educating a group of women on how to perform a breast selfexamination (BSE). Which of the following actions should the nurse advise the women to take? Select all that apply. 1. Use the fl at part of their index, middle, and ring fi ngers. 2. Use pressure in three intensities: light, moderate, and deep. 3. Look for dimpling while bending forward from the waist. 4. Feel for lumps throughout the entire breast, including the tail of Spence. 5. Check for nipple discharge.

1, 2, 4, and 5 are correct. 1. The fl at part of the fi ngers should be used to palpate the breast. 2. The breast should be palpated using three pressure depths—light, middle, and deep. 4. The women should feel for lumps throughout the entire breast, including the tail of Spence, while standing and while lying down. 5. Women should assess for nipple discharge. TEST-TAKING TIP: 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 healthcare practitioner has been shown to increase survival rates in clients with breast cancer. Only mammography has been shown to increase survival rates. (see http://www.nationalbreastcancer.org/ breast-self-exam)

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

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

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

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

1. A diffuse rash with fever should be taken very seriously. These are symptoms of toxic shock syndrome (TSS).TEST-TAKING TIP: 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 the mortality rate from TSS approaches 50% (see www.nlm.nih.gov/medlineplus/ency/ article/000653.htm).

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

1. The woman would abstain from intercourse from day 9 of her menstrual cycle until day 25. TEST-TAKING TIP: 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 six cycle lengths are needed to be able to have some confi dence in the method. In the current scenario, therefore, 27 - 18 = 9 and 36 - 11 = 25. Thus, the period of abstinence is days 9 to 25. As can be seen, women with irregular menstrual periods must abstain for extended periods of time.

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

1. This is an example of a comment made during the "honeymoon phase." TEST-TAKING TIP: The test taker must realize that when an abusive couple fi rst 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 fi rst, the nurse must revisit the discussion every time the woman revisits the healthcare system.

61. 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 infl ammatory disease." 3. "I should still use birth control even though I had only 2 periods last year." 4. "The contraceptive patch contains both estrogen and progesterone."

1. This is not true. The menstrual cycle of perimenopausal women is very irregular. It is very diffi cult to identify safe and unsafe periods for these women. TEST-TAKING TIP: 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.

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

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

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

1. Women on HRT are at high risk for gynecological cancers, especially endometrial and breast cancers. TEST-TAKING TIP: 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 prefi xes and suffi xes, 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.

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

1. Women who use the diaphragm have increased incidence of urinary tract infections. TEST-TAKING TIP: Because the lip of the diaphragm must be inserted under the symphysis, the woman's urethra is sometimes pinched. This makes it diffi cult to completely empty the bladder when urinating. As a result, the woman is at high risk for developing urinary tract infections.

81. A woman who has been abused for a number of years is fi nally 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, and 5 are correct. 2. It is very important to assist the victim to develop a safety plan. The victim will likely be in danger once the abuser learns that she has decided to leave. 3. It is very important to remind the victim that the abuse was not her fault. Many victims believe that they deserve the violence. 4. It is very important to assure the victim that she will receive support for her decision. It is very scary to decide to break off a relationship, especially if the abuser is the victim's source of fi nancial support. 5. It is very important to help the victim to contact a domestic violence center. This is a very diffi cult step for victims to take. TEST-TAKING TIP: 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 (see http:// mysistersplacedc.org).

51. 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 refi tted 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, and 4 are correct. 2. This is true. If a woman's weight either increases or decreases by 10 lb or more, the device must be refi tted. 3. This is true. For the diaphragm to fi t appropriately, the anterior lip must be pushed snugly under the symphysis. 4. This is true. Although the device is a type of barrier, it is ineffective without spermicide and the action of spermicide is only effective for 6 hours. TEST-TAKING TIP: The diaphragm is an excellent device if it is used properly. In addition to the factors cited in the question, the device must be refi tted 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.

23. A woman has been diagnosed with syphilis. Which of the following nursing interventions is appropriate? 1. Counsel 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 healthcare practitioner with cryotherapy procedures. 4. Educate the woman regarding the safe disposal of menstrual pads.

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

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

2. Douching can increase a client's potential for endometritis TEST-TAKING TIP: The act of douching can cause serious gynecological infections up to and including PID. When a woman douches, she disrupts the normal fl ora 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 healthcare practitioner

76. The clinic nurse is interviewing a client preceding her annual checkup. Which of the following fi ndings would make the nurse suspicious that the client is an anorexic? 1. Food allergies and an aversion to exercise. 2. Signifi cant weight loss and amenorrhea. 3. Respiratory distress and thick oral mucus. 4. Cardiac arrhythmias and anasarca.

2. Signifi cant weight loss and amenorrhea are characteristic signs of anorexia. TEST-TAKING TIP: 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 three or more cycles. Clients, usually women, who are anorexic often are high achievers who also exercise to excess.

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

2. The female condom is recommended both for contraception and for infection control. TEST-TAKING TIP: The key to answering this question is the fact that the client has multiple sex partners. The client is at high risk for becoming pregnant but as important is also at high risk for acquiring a sexually transmitted infection. It is important for the nurse to consider that fact when providing family planning information.

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

2. This is an appropriate statement. TEST-TAKING TIP: Women who are being abused will often deny the abuse. It is not uncommon for abused women to enter the healthcare 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.

9. A nurse is reading the research article "Effi cacy of Informational Letters on Hepatitis B Immunization Rates in University Students" (Marron et al, 1998). In the article, the researchers analyzed the means by which the students learned about the hepatitis B vaccine and compared that information with whether or not the students actually received the vaccine. Table 3-1 describes the data. Which of the following interpretations of the data from Table 3-1 is correct? 1. When one considers those who "read/heard" about the vaccine, there is no signifi cant difference between the percentage of students who received the immunization and those who did not receive the immunization. 2. The likelihood of students who receive the vaccine when they learned about it from the "health history form" was about 1.6 times that of the "health history form" students who did not receive the vaccine. 3. Of those who were not vaccinated, 44.4% received their information from "Letters." 4. The largest percentage of students who received the vaccine learned about it from the "University Health Service (UHS) providers."

2. This is true. The risk ratio for the "Health History form" category is 1.62. TEST-TAKING TIP: To provide evidencebased nursing, it is very important to be able to read tables and interpret data from scholarly articles. Risk ratios, confi dence intervals, and signifi cance data are especially critical and must be understood. It is of interest to note that in the study in question, the healthcare providers were the poorest source of information about the hepatitis B vaccine.

88. 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 fi rst? 1. "The evidence kit may still reveal important information." 2. "It was important for you to do that for yourself." 3. "Have you washed your clothes? If not, we might be able to obtain evidence from them." 4. "Do you remember what happened? If not, someone may have put a drug in your drink."

2. This statement acknowledges the fact that the client needed to regain some control over her situation. TEST-TAKING TIP: 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.

94. A school nurse is conducting a class on the transmission of human papillomavirus (HPV) for middle school students. Which of the following information should be included in the discussion? 1. The enzymes in the mouth effectively metabolize and destroy HPV. 2. To prevent oral infection, sexually active individuals should wear dental dams when engaging in oral intercourse. 3. HPV vaccines effectively prevent oral as well as genital and rectal HPV infections. 4. When cultured routinely, oropharyngeal excretions accurately predict the likelihood of the development of HPV-induced cancer.

2. This statement is correct. To prevent oral infection, sexually active individuals should wear dental dams when engaging in oral intercourse. TEST-TAKING TIP: Sequela related to oral HPV—warts as well as cancer—are on the rise since many adolescents, up to 80% of whom engage in oral intercourse, falsely assume that unprotected oral intercourse is safe. To prevent transmission of HPV to the oropharyngeal cavity, it is recommended that individuals wear a dental dam—a piece of latex inserted into the mouth— whenever engaging in oral intercourse. A dam can be easily made from a latex condom or glove (see www.cdc.gov/std/ hpv/stdfact-hpvandoropharyngealcancer .htm).

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

2. Women who are experiencing severe menopausal symptoms can benefi t from HRT. However, it is recommended that they not be on the medication for an extended period of time. TEST-TAKING TIP: Although it was once thought that HRT protected women from coronary artery disease, new evidence shows that it 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 (see www.fda.gov/ForConsumers/ByAudience/ ForWomen/ucm118624.htm).

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

3. Dental caries and scars on the knuckles are classic signs of bulimia. TEST-TAKING TIP: Bulimic clients force themselves to vomit. The dentition is adversely affected because of the repeated vomiting. The knuckle scarring, called Russell sign, develops from tissue injury during the act of jamming the fi ngers down the throat to force vomiting. Bulimics are also known to take large quantities of cathartics.

56. 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 before the man's penis becomes fl accid after ejaculation? 1. The woman should douche with white vinegar and water. 2. The woman should consider taking a postcoital contraceptive. 3. The man should hold the edges of the condom during its removal. 4. The man should apply spermicide to the upper edges of the condom.

3. This is true. The man should carefully remove the condom while holding its edges. TEST-TAKING TIP: The penis becomes fl accid very rapidly after ejaculation. The man should carefully remove the penis from the vagina before the penis becomes fl accid while holding the edges of the condom or, if it does become fl accid, he should be especially careful during its removal.

21. 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 fi ne!" Which of the following replies by the nurse is appropriate at this time? 1. "I am sure that you are upset by the disturbing news, but there is no reason to be angry with me." 2. "I am sorry. We must have received the wrong information." 3. "That certainly could be the case. Women often report no symptoms." 4. "All right, but please tell me your contacts because it is possible for you to pass the disease on even if you have no symptoms."

3. This is true. Women often have no symptoms when infected with gonorrhea.TEST-TAKING TIP: 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.

30. 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 spermicide can increase the transmission of some viruses." 4. "That is not necessarily true. Spermicide has been shown to cause cancer in men and women who use it too frequently."

3. This statement is true. Spermicidal creams have been shown actually to increase the transmission of some sexually transmitted infections.TEST-TAKING TIP: 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 without added spermicide are effective. In addition, there is evidence that spermicides can actually increase the permeability of the mucous membranes to HIV (see www.cdc.gov/ mmwr/pdf/rr/rr6403.pdf).

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

3. This statement is true. There are very few side effects experienced by those who receive the vaccine. TEST-TAKING TIP: The CDC Advisory Committee on Immunization Practices recommends that all young men and women between the ages of 11 and 12, or as young as age 9 and up to age 26, be immunized against HPV. There are two vaccines available in the United States. 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 (see www.cdc.gov/std/tg2015/hpv.htm and http://cdc.gov/vaccines/vpd-vac/hpv/ vac-faqs.htm).

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

3. Women who take Seasonale frequently do experience breakthrough bleeding. TEST-TAKING TIP: 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.

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

4. Alcohol consumption is a contributing factor to osteoporosis. TEST-TAKING TIP: Daily consumption of alcohol is a contributing factor to the development of osteoporosis because alcohol interferes with the absorption of vitamin D and calcium in the body. An adequate consumption of the vitamin and mineral is essential for strong bones, and alcohol should be consumed in moderation.

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

4. Esophagitis is a common fi nding in people with bulimia. TEST-TAKING TIP: 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.

32. 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 fi ve times. 2. Refrain from using lubricant because the condom may slip out of the vagina. 3. Wear both female and male condoms together to maximize effectiveness. 4. Remove the condom by twisting the outer ring and pulling gently.

4. The female condom should be removed by twisting the outer ring and pulling gently. TEST-TAKING TIP: The goal of condom use is to prevent sperm from ascending into the uterine cavity and for sperm and/or infectious secretions from coming in contact with mucous membranes. The best way to prevent these situations from happening is by enclosing the fl uid 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.

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

4. The nurse should follow the young woman into the bathroom to see if she is vomiting. TEST-TAKING TIP: This young woman is exhibiting classic signs of bulimia such as Russell sign, gorging (eating a caloriefi lled 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 self-induced vomiting). The nurse should then discuss her observations with the young woman and, if appropriate, with her parents.

1. 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 fi ndings to child protective services.

4. This child must be reported to child protective services. TEST-TAKING TIP: Any time a sexually transmitted disease is discovered in a minor, the nurse has the legal obligation to report the fi nding to a child protection agency. In addition, if required by law, the health department should also be notifi ed to track and follow up on sexually transmitted infections.

46. 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 department doctor can prescribe high-dose birth control pills (BCP) for you." 4. The nurse's response is dependent upon which state he or she is practicing in.

4. This statement is true. Access to health care by adolescents, including access to birth control methods, is determined by individual states. TEST-TAKING TIP: 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-specifi c information will not be asked. (For state specifi c information, see www.guttmacher.org/ statecenter/spibs/spib_OMCL.pdf)

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

4. This statement is true. Although EC works up to 5 days after unprotected intercourse, it is most effective when taken within 72 hours of the exposure. TEST-TAKING TIP: 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 (mifepristone/ misoprostol), formerly known as RU-486—is used to abort a fetus and is used up to 70 days from the fi rst day of the last menstrual period. (see http:// www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafetyInformationfor PatientsandProviders/ucm492705.htm)

26. 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 fi fty percent of cases. 2. Aggressive treatment is required to cure warts. 3. Warts often spread when an attempt is made to remove them surgically. 4. Warts often recur a few months after a client is treated.

4. This statement is true. It is not uncommon for warts to return a few months after an initial treatment. TEST-TAKING TIP: Genital warts are caused by the human papillomavirus. There are more than 100 viral types of HPV. Most of them are harmless, but some high-risk types result in genital wars while others 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 (see www.cdc.gov/std/ tg2015/warts.htm).