Women's Health

A nurse is counseling an obese postmenopausal client how to prevent bone loss. Which statements indicate understanding of the strategies to prevent bone loss? Select all that apply. 1 "I need to go on a strict diet." 2 "I'll take 400 mg of vitamin D every day." 3 "I should take 1200 mg of calcium every day." 4 "Swimming or bike riding five times a week is good for me." 5 "Going to an aerobics class three times a week will help my bones."

-"I should take 1200 mg of calcium every day.Going to an aerobics class three times a week will help my bones." The recommended daily intake of calcium for a postmenopausal woman is 1200 mg. Weight-bearing activities (e.g., walking, dancing, weightlifting, aerobic exercise) are best for building bone mass.Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. Eight hundred or more (up to 2,000), international units, not 400, of vitamin D are the recommended daily intake for a postmenopausal woman. Swimming and bike riding promote overall health and joint preservation but do not increase the strength or mass of bone.

A 37-year-old woman is admitted to the unit with severe menorrhagia. During assessment the nurse learns that she has a history of fibroids, menorrhagia, pelvic pain, and depression. The client has been undergoing hormone therapy in hopes of easing the symptoms and reducing the size of the fibroids, without success. The lab reports hemoglobin and hematocrit readings of 6.8 and 20.2, respectively. The client begins to sob and cries, "I don't know what to do—the doctor is recommending a hysterectomy, but I haven't had children yet!" What is the best response by the nurse? 1 "There are so many orphans looking for a mother." 2 "This must be so difficult for you. Children are really important to you?" 3 "You really have no choice but to follow the recommendation; the doctor is right." 4 "Believe me when I tell you that kids are so difficult to raise—you're better off without them."

-"This must be so difficult for you. Children are really important to you?" Validating the client's feelings and including an open-ended question will encourage further expression. Previous problems and health conditions could later be included in the conversation to help the client make the best decision. Adoption is certainly an option for this person, but this is not what she needs to hear at this time. This statement also closes down communication. The client does have a choice, and telling her that she does not could close down communication and cause anger and defensiveness. Telling the client that she's better off without children is not what the client needs to hear, especially when she is facing an operation that could end her chance of giving birth to children.

A client with active genital herpes has a cesarean birth. The nurse teaches the mother how to limit transmission of the virus to her newborn. The nurse concludes that the instructions have been understood when the mother states: 1 "I should avoid kissing the baby on the lips." 2 "I have to wear gloves when I'm holding the baby." 3 "I should wash my clothes and my baby's clothes separately." 4 "I have to wash my hands with soap and water before handling the baby."

-"I have to wash my hands with soap and water before handling the baby." The herpes virus disintegrates rapidly on contact with soap used in meticulous handwashing. The lesion is in the genital area, not on the lips; kissing will not affect the infant. Wearing gloves when holding the infant is unnecessary; nor is washing the infant's clothes separately.

A young woman has been using oral contraceptives. When she misses her regular menstrual period, she visits the women's health clinic and tells the nurse that she may be pregnant because she missed taking her contraceptive pills for 1 week when she had the flu. How should the nurse respond? 1 "It's too late to worry about that now. You may want to consider having an abortion." 2 "Contraceptive pills are unpredictable. You probably would've become pregnant even if you had taken them regularly." 3 "You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective." 4 "That's the trouble with birth control pills. They're so effective that women tend to believe that they won't get pregnant even if they skip pills for a few days."

-"You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective." Monophasic, biphasic, and triphasic oral contraceptives are available; regardless of the type that is prescribed, the regimen should be followed exactly. Interruption in the schedule permits release of luteinizing hormone, resulting in ovulation and possible pregnancy. Telling the client that it is too late to worry about that now is callous, and giving advice is inappropriate; all options may be explored after a pregnancy has been confirmed. When taken as prescribed, oral contraceptives have a high rate of success. Stating that women tend to believe that they won't become pregnant even if the pills are skipped for a few days is judgmental; it is a generalization about women who take the pills and indicates that the nurse assumes that the client is similarly irresponsible.

A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? 1 "As long as you aren't having periods, you won't need a contraceptive." 2 "It would be best to delay sexual relations until you have your first period." Correct3 "You should use contraceptives, because ovulation may occur without a period." 4 "Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy."

-"You should use contraceptives, because ovulation may occur without a period." Anovulation occurs in nursing mothers for varying periods; breastfeeding is not a reliable method of birth control. Periods may not occur for several months; sexual relations need not be delayed this long. Ovulation can occur without menstruation. Lactation may delay menses but does not reliably suppress ovulation.

A nurse in a campus health clinic is assessing female students for risk factors associated with the future development of osteoporosis. What factors are included in this assessment? Select all that apply. 1 Cigarette smoking 2 Moderate exercise 3 Use of street drugs 4 Familial predisposition 5 Inadequate intake of dietary calcium

-1,4,5 Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. Moderate exercise is not considered a risk factor for the development of osteoporosis, although a sedentary lifestyle is. Use of street drugs is not considered a risk factor for osteoporosis.

A 30-year-old client with a 35-day menstrual cycle is trying to become pregnant. The nurse counsels the client and her partner about the optimal timing of intercourse during the cycle. The nurse determines that the counseling has been effective when the couple state that they should have intercourse on the: 12th day of the cycle 2 14th day of the cycle 3 21st day of the cycle 4 25th day of the cycle

-21st day of the cycle Ovulation usually occurs 14 days before menses; in a 35-day cycle, ovulation may occur as late as the 21st day. Day 12 day of the cycle is the proliferative phase of the cycle; ovulation has not yet occurred. If the woman had a 28-day cycle, ovulation is expected 14th day of the cycle. By the 25th day of the cycle, the ovum in this woman has passed out of the fallopian tube and can no longer be fertilized.

Which client is most at risk for osteoporosis? 1 A nonsmoking 60-year-old woman, 5 foot 7 inches tall and 173 lb 2 A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal 3 A 68-year-old black woman, 5 foot 5 and 140 lb, who is a retired receptionist 4 A 62-year-old woman, 5 foot 4 inches tall and 135 lb, who takes calcium carbonate daily

-A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal A postmenopausal woman who is small-boned, thin, and relatively sedentary is at risk for osteoporosis; other risk factors are family history, and white or Asian ethnicity. The postmenopausal years are considered to be 65 years and older; however, each individual is unique. A perimenopausal woman who is relatively heavy and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. The perimenopausal years are considered to be 45 to 64 years of age; however, each individual is unique. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A perimenopausal woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.

The clinic nurse is planning care for a client found to have Chlamydia. Which treatment should the nurse plan to implement? 1 Administration of acyclovir (Zovirax) 250 mg orally in a single dose 2 Administration of azithromycin (Zithromax) 1 g orally in a single dose 3 Administration of ceftriaxone (Rocephin) 250 mg intramuscularly in a single dose 4 Administration of Benzathine penicillin G 2.4 million units intramuscularly in a single dose

-Administration of azithromycin (Zithromax) 1 g orally in a single dose The treatment of choice for chlamydial infection is azithromycin (Zithromax) 1 g orally in a single dose. The one-dose course is preferred because of its ease of completion. Acyclovir (Zovirax) may be prescribed in a 7-day course for a genital herpes outbreak. Ceftriaxone (Rocephin) 250 mg intramuscularly in a single dose is the drug therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million unit dose is the treatment for primary, secondary, and early latent syphilis.

After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect? 1 An incisional nick in the bladder 2 A urinary infection from the catheter 3 Disseminated intravascular coagulopathy 4 Uterine relaxation with increased bleeding

-An incisional nick in the bladder Uterine relaxation with increased bleeding During an abdominal hysterectomy the urinary bladder may be nicked accidentally. The client is not likely to have an infection with bleeding so soon. Bleeding would be present from other sites, such as the incision, as well as in the urine bag. The uterus is removed with a hysterectomy; therefore there is no uterine bleeding.

A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a "fishy" odor that both she and her husband have noticed. A wet smear is performed and the presence of "clue cells" confirmed. Which type of infection does the nurse suspect? 1 Candidiasis 2 Trichomoniasis 3 Bacterial vaginosis 4 Group B Streptococcus

-Bacterial vaginosis Signs of bacterial vaginosis include a milky gray vaginal discharge that has a characteristic fishy odor. "Clue cells" noted on wet smear are indicative of BV. Candidiasis is a yeast infection caused by the organism Candida albicans. The most common symptom of a yeast infection is vulvar and vaginal pruritus. Vaginal discharge in a candidal infection is thick, white, and lumpy. A woman with a trichomoniasis infection may present with a frothy yellowish-green vaginal discharge. Vulvar irritation, pruritus, and dyspareunia are usually present. Group B Streptococcus may be considered part of the normal vaginal flora in a woman who is not pregnant, and no treatment is necessary.

A client at the women's health clinic complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse. For what condition does the nurse anticipate the client will be treated? 1 Urethritis 2 Bartholinitis 3 Vaginal hematoma 4 Inflamed Skene glands

-Bartholinitis The Bartholin glands are located beneath the vaginal vestibule; if cysts form and they become infected they cause labial, vaginal, or pelvic pain particularly during or after intercourse (dyspareunia). Urethritis causes painful urination. A vaginal hematoma causes swelling in the vaginal wall, not the labia. The Skene glands are located in the urethra, not the labia.

A nurse is reviewing a postmenopausal client's history, which reveals that the client previously received hormonal replacement therapy (HRT) as treatment for osteoporosis. For which problem does HRT increase the client's risk? 1 Breast cancer 2 Rapid weight loss 3 Accelerated bone loss 4 Vaginal tissue atrophy

-Breast cancer There is a relationship between HRT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HRT is weight gain with ankle and foot edema. Bone loss is retarded with HRT. Vaginal tissue maintains turgor and lubrication with HRT.

A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate (Depo-Provera) as a form of birth control. What important information should the nurse include when teaching the client about Depo-Provera? 1 Depo-Provera offers protection against the herpes simplex virus. 2 To continue the contraceptive effects the client will need to return for another injection in 6 months. 3 Women using Depo-Provera may lose more blood each month with their periods, so it is important to add iron-rich foods to the diet to help prevent anemia. 4 Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use

-Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use Loss of bone mineral density is a significant side effect of Depo-Provera, and increased calcium intake and exercise should be encouraged. Depo-Provera should be administered every 11 to 13 weeks; 6 months is too long before the next dose. Menstrual periods usually lighten or disappear over time. Depo-Provera confers no protection against herpes simplex virus.

A client has just been told that she has cervical erosion. The nurse would expect to help explain that early treatment of the erosion can help prevent: 1 Cancer of the cervix 2 Pelvic inflammatory disease 3 Unexpected vaginal bleeding 4 Additional cervical erosions

-Cancer of the cervix Erosion of the cervix frequently occurs at the columnosquamous junction, the most common site for carcinoma of the cervix. Treatment of cervical erosions does not prevent pelvic inflammatory disease; early onset of sexual intercourse (before 16 years of age), multiple sexual partners, and history of human papillomavirus (HPV) infection are risk factors for cancer of the cervix rather than consequences of precervical cancer. Metrorrhagia, abnormal bleeding from the uterus, may be present as erosion develops into carcinoma; however, spotting may be the earliest sign and will be eliminated when the cancer is treated. The goal of treatment of the erosion is to prevent cancer.

A school nurse is teaching high school girls about the importance of immunizations. What newborn anomaly can occur if rubella is contracted during the first trimester of pregnancy? 1 Phocomelia 2 Hydrocephalus 3 Down syndrome 4 Cardiac anomalies

-Cardiac anomalies Heart development occurs between the second and eighth weeks of gestation; any type of maternal infection during this time may result in cardiac anomalies in the newborn. The congenital absence of the proximal portion of a limb is associated with the intake of teratogenic drugs, not with rubella infection. Hydrocephalus is a neural tube defect that is not associated with rubella; however, the infant may have microcephaly. Down syndrome is a chromosomal disorder; it is not caused by a maternal infection.

A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely? 1 Respiratory 2 Reproductive 3 Integumentary 4 Cardiovascular

-Cardiovascular Syphilis is primarily a vascular disease; aortitis, valvular insufficiency, and aortic aneurysms are the most prevalent problems in tertiary syphilis. Although lesions may occur around the mouth (chancre in primary syphilis, mucous patches in secondary syphilis), the structures of the respiratory tract are not the major structures involved in tertiary syphilis. Although lesions occur on the genitalia in primary and secondary syphilis, the reproductive system is not the major body system affected by tertiary syphilis. A gumma skin lesion is the least commonly occurring lesion associated with tertiary syphilis; skin lesions, such as macular and papular eruptions, most commonly occur in secondary syphilis.

What should the nurse teach a client about performing breast self-examination? 1 Compress the nipples to check for discharge. 2 Use the right hand to examine the right breast. 3 Press the palm against the breast to compress it to the chest wall. 4 Place a pillow under the shoulder opposite the side being examined.

-Compress the nipples to check for discharge. Serous or bloody discharge from the nipple is abnormal. The right hand should be used to examine the left breast because this allows the flattened fingers to palpate the entire breast, including the tail (upper outer quadrant toward the axilla) and axillary area. A small pillow or a rolled towel should be placed under the scapula of the side that is being examined. The flat part of the fingers, not the palm or fingertips, should be used for palpation.

A nurse is counseling a female client with type 1 diabetes who requests contraceptive information. What contraceptive method should the nurse recommend? 1 Oral contraceptive 2 Hormone replacement 3 Calendar/rhythm method 4 Diaphragm with spermicide

-Diaphragm with spermicide Diaphragm with spermicide is the preferred method for clients with diabetes because there are no physiologic side effects. Oral contraceptives have a diabetogenic effect; they alter carbohydrate metabolism, and insulin dosage must be adjusted. Calendar/rhythm method requires self-control and a strong desire to avoid pregnancy; it is not as effective as a diaphragm.

A 26-year-old woman whose sister recently had a lumpectomy for breast cancer calls the local women's health center for an appointment for a mammogram. What should the nurse advise the client in preparation for the test? 1 Do not eat for 6 hours before the test. 2 The room will be darkened throughout the procedure. 3 The first mammogram is usually performed at 50 years of age. 4 During the procedure, each breast will be compressed firmly between two plates

-During the procedure, each breast will be compressed firmly between two plates Compression of the breast flattens mammary tissue and maximizes penetration of the breast by x-rays; this is especially important for the dense breast tissue of adolescents, young nulliparous women, and women with large breasts. Fasting before the test is not necessary. The room is usually darkened for sonography, not mammography. The American Cancer Society recommends that women at risk for breast cancer (the client's sister had breast cancer) should have routine mammography, regardless of age or relationship to menopause. It is recommended that a woman have her first mammogram by age 40 to establish a baseline for future annual mammograms.

A client with a history of endometriosis has abdominal surgery to remove adhesions. What should this client's postoperative plan of care include? 1 Encouraging the client to ambulate in the hallway 2 Elevating the client's legs by gatching the bed 3 Helping the client dangle her legs over the side of the bed 4 Maintaining the client on bedrest until the dressings have been removed

-Encouraging the client to ambulate in the hallway Muscle contraction during ambulation improves venous return, which prevents venous stasis and thrombus formation. Gatching the bed and dangling the legs each place pressure on the popliteal spaces, limiting venous return and increasing the risk of thrombus formation. Bedrest is associated with venous stasis, which increases the risk of thrombus formation

A nurse is teaching a group of women about the side effects of different types of contraceptives. What frequent side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session? 1 Tubal pregnancy 2 Rupture of the uterus 3 Expulsion of the device 4 Excessive menstrual flow

-Excessive menstrual flow After IUD insertion there may be excessive menstrual flow for several cycles. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process. There is no documentation of a tubal pregnancy. Rupture of the uterus may occur on insertion but is uncommon. Expulsion of the device may occur, but it is not classified as a side effect.

A client with a benign ovarian tumor undergoes laparoscopic surgery. What should the nurse include in the postoperative teaching? 1 Resume usual activities after 12 hours. 2 Expect shoulder pain for 12 to 24 hours. 3 Douche with povidone-iodine twice a day. 4 Report vaginal spotting that occurs during the first 3 days after the surgery

-Expect shoulder pain for 12 to 24 hours. Postoperative teaching should include instructing the client to expect shoulder pain, caused by the insufflated carbon dioxide, which presses on the diaphragm, for 12 to 24 hours. This occurs more frequently when the client's head is elevated too soon after surgery. Usual activities should not be resumed until 2 to 3 days after surgery; the patient should undertake no heavy lifting or strenuous exercise for 4 to 7 days. There is no need to douche with povidone-iodine (Betadine) after the surgery. Vaginal spotting may occur but is benign. Frank bleeding should be reported.

When discussing future health management with a client who has had a total hysterectomy, the nurse advises regular physical examinations. The client agrees and adds, "It won't be so hard to go now that I won't need the pelvic examination and Pap smear." How should the nurse respond? 1 Discuss the need to have pelvic examinations and Pap smears until healing is complete. 2 Suggest that the client discuss the need for future pelvic examinations with her practitioner. 3 Agree that other components of the physical examination will be more important in the future. 4 Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future

-Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future Pelvic examinations and Pap smears will always be necessary to screen for atypical changes in vaginal tissue and will always remain a priority for this client. Suggesting that the client talk with her practitioner transfers the nurse's responsibility for client teaching to the practitioner.

A client who wishes to postpone having children until she and her husband are financially sound tells the nurse she has been taking oral contraceptive pills for several years. What finding indicates a potential risk in regard to continued use of birth control pills? 1 Dysmenorrhea 2 Lack of ovulation 3 Midcycle bleeding 4 Increased blood pressure

-Increased blood pressure The estrogen and/or progesterone in birth control pills increases the amount of renin produced in the kidneys. Increased renin will stimulate the production of angiotensin, a potent pressor substance, resulting in hypertension. Dysmenorrhea does not occur. Anovulation is the desired effect of oral contraceptives. Midcycle bleeding may indicate a low hormone level; it is corrected by changes in the type of medication prescribed.

A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecological history. What condition does the client have that causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy? 1 Prolapsed uterus 2 Large uterine fibroids 3 Mild dysplasia of the cervical os 4 Urinary incontinence when coughing

-Large uterine fibroids Attempting to remove a uterus with large uterine fibroids vaginally can cause trauma, resulting in hemorrhage. Vaginal hysterectomy is indicated for prolapsed uterus because the uterus is usually collapsed into the vagina. A hysterectomy is not the treatment of choice for mild cervical dysplasia; when a hysterectomy is necessary, the vaginal route is preferred. Urinary incontinence with coughing may be related to stress incontinence, which does not require a hysterectomy.

A nurse is teaching a female client about the side effects of estrogen in an oral contraceptive. Which common side effect identified by the client indicates to the nurse that the teaching was effective? 1 Nausea 2 Lethargy 3 Amenorrhea 4 Hypomenorrhea

-Nausea Nausea is related to the amount of hormone in the contraceptive. There may be an excess of estrogen; this symptom usually can be controlled by reducing the dose or by changing to another oral contraceptive. Lethargy can be related to excessive estrogen and progesterone, but they are not common side effects. Amenorrhea is associated with pregnancy; breakthrough bleeding is a more common response to estrogen. Hypomenorrhea is caused by estrogen deficiency.

A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. The nurse explains that her parents will: Incorrect1 Need to know to sign a consent form for testing and treatment 2 Not be contacted, because treatment at the clinic is confidential 3 Be notified when the insurance company is billed for testing and treatment 4 Remain uninformed if the adolescent ensures that her sexual contacts will come for testing

-Not be contacted, because treatment at the clinic is confidential Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations; there is a concern that these teenagers will not seek or continue treatment if they fear disclosure. To maintain confidentiality, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Most family planning clinics receive funding and charge on a sliding scale based on income, thus encouraging adolescents to seek treatment. Telling the client that her parents will not be notified as long as she ensures that her sexual contacts come in for testing could be viewed as coercion; if the STI is reportable, follow-up of sexual partners is indicated, but the adolescent is not responsible for ensuring that they report for testing.

A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. 1 Obesity 2 Multiparity 3 Cigarette smoking 4 Early onset of menopause 5 Family history of endometrial cancer 6 Previous hormone replacement therapy

-Obesity,Family history of endometrial cancer, Correct 6 Previous hormone replacement therapy. Obesity is a risk factor for endometrial cancer because adipose cells store estrogen; the extent of exposure to estrogen is the most significant risk factor. Nulliparity, not multiparity, is a risk factor for endometrial cancer because of the increased exposure to estrogen. Cigarette smoking has not been identified as a risk factor for endometrial cancer. Late, not early, onset of menopause is a risk factor for endometrial cancer because of the increased exposure to estrogen. Although endometrial cancer has not been proved to have a genetic predisposition, it is more common in families who have gene mutations for hereditary nonpolyposis colon cancer.

A 37-year-old client with a nontender palpable breast mass has a questionable mammogram. She is undergoing further diagnostic tests to determine whether the mass is malignant. What information should the nurse take into consideration before planning health teaching for this client? 1 Squamous cell carcinomas are neoplasms arising from glandular tissues. 2 Results of a biopsy are necessary before a specific form of therapy is selected. 3 Mammographies should be repeated to confirm the presence of malignancies. 4 Waiting for several weeks before receiving confirmation of cancer is helpful to the client

-Results of a biopsy are necessary before a specific form of therapy is selected The therapy selected depends on whether there is a malignancy and, if so, the type of cancer cells, the extent of nodal involvement, and the presence and extent of metastasis. Adenocarcinomas, not squamous cell carcinomas, arise from glandular tissue; squamous cell carcinomas arise from epithelial tissue. Only a biopsy will confirm the diagnosis of a malignancy. Waiting several weeks for a diagnosis is not advisable; an extended waiting period increases the client's stress and anxiety.

During an assessment interview the nurse concludes that the client has been experiencing menorrhagia. What client statement led to this conclusion? 1 "It hurts when I have intercourse." 2 "I have a foul-smelling vaginal discharge." 3 "I have bleeding between my menstrual periods." 4 "I have severe bleeding during my menstrual periods."

-"I have severe bleeding during my menstrual periods." Menorrhagia is severe bleeding during a menstrual period. Painful intercourse is the definition of dyspareunia. Foul-smelling vaginal discharge is a sign of a vaginal infection. Metrorrhagia is uterine bleeding that occurs at any time other than during the menstrual period.

Azithromycin (Zithromax) 0.45 Gm IVPB is prescribed for a client with gonorrhea who is unable to tolerate oral medications. The medication is available in powdered form in a vial containing 500 mg. Instructions indicate that the medication must be reconstituted with 4.8 mL of sterile water and that the powdered medication displaces 0.2 mL. What volume of reconstituted medication should the nurse add to the intravenous piggyback solution? Record your answer using one decimal place. ___ mL

-4.5mL The prescribed dose of 0.45 Gm should be first converted to 450 mg so what is desired and what you have are expressed in the same unit of measurement. Because the problem does not specify the volume of reconstituted solution, it must be calculated: Add the volume of sterile water (diluent) and the volume displaced by the powdered medication: 4.8 mL + 0.2 mL = 5 mL of solution. Solve the problem with the use of

A 35-year-old client is scheduled for conization of the cervix to remove dysplastic cervical cells and to determine the extent of involvement. Effective teaching of postoperative instructions by the nurse would be evident if the client says: 1 "I'll abstain from sex for 48 hours." Correct2 "I know I'll have blood-tinged vaginal discharge for 3 to 5 days." 3 "I know I need to use sterile gloves for the sterile dressing change." 4 "I'll be sterile after the procedure, but I already have my children."

-"I know I'll have blood-tinged vaginal discharge for 3 to 5 days." The physical trauma of the procedure will result in a blood-tinged vaginal discharge for several days. Vaginal packing will be in place for 2 to 3 days; intercourse and tampon use should be delayed until total healing occurs. Conization does not involve an external incision or dressing. Conization affects only the cervix and does not alter reproductive ability.

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes? 1 Uterine cancer 2 Lack of estrogen 3 Early cervical carcinoma 4 Expected menopausal changes

-Expected menopausal changes The adaptations described and the client's age suggest that the client is experiencing menopause. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response? Select all that apply. 1 Expulsion of the device 2 Occasional dyspareunia 3 Delay of return to fertility 4 Risk for perforation of the uterus 5 Increased number of vaginal infections

-1,2,4 The presence of the IUD thread should be verified before coitus, because the device may be expelled during menses; if the IUD has been expelled, pregnancy can occur. Although dyspareunia is not common, if it does occur, it should be reported. Perforation may occur during insertion of the IUD. The IUD does not affect fertility, as does the oral contraceptive. Immediately after the device is removed the client may try to conceive. The incidence of vaginal infections is not increased with the use of an IUD unless there is unprotected sex with a partner who has a sexually transmitted infection.

Which client care activity may a nurse safely delegate to a nursing assistant? 1 Assessing a client's mastectomy incision for signs of inflammation 2 Assisting a client who is recovering from an abdominal hysterectomy to the bathroom 3 Providing information about side effects to a client receiving chemotherapy for breast cancer 4 Evaluating the effectiveness of an antiemetic that was administered to a client to relieve nausea

-Assisting a client who is recovering from an abdominal hysterectomy to the bathroom A nursing assistant is taught how to safely ambulate clients; this activity does not require extensive nursing knowledge or expert clinical judgment. Assessment, teaching, and evaluation of client responses to care all require clinical judgment and a license to practice nursing.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do? 1 Ask her partner to withdraw before ejaculating. 2 Make certain their relationship is monogamous. 3 Insist that her partner use a condom when having sex. 4 Seek counseling about various contraceptive methods

-Insist that her partner use a condom when having sex A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Pre-ejaculatory fluid carries HIV in an infected individual. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV-positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from the HIV.

A client is found to have pelvic inflammatory disease, and the health care provider prescribes intravenous cefotetan 2 g twice a day. The instructions on the vial of cefotetan say to reconstitute 20 mL of diluent to yield 1 g/10.5 mL. How much solution (mL) should the nurse add to the 100-mL bag of 0.9% sodium chloride? Record your answer using a whole number. ___ mL

2x 10.5 = 21mL

nurse is planning care with a client for the recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included among the changes that the client should expect after surgery? 1 Depression 2 Weight gain 3 Urine retention 4 Surgical menopause

-Surgical menopause When bilateral oophorectomy is performed, both ovaries are excised, eliminating ovarian hormones and initiating menopause. Although depression may occur, it is not expected; if it does occur, intervention is required. There is no physiological reason for weight gain after hysterectomy. Urine retention is not an expected concern because a urine retention catheter is inserted before surgery and left in place generally for 24 hours, regardless of the type of hysterectomy (e.g., laparoscopic, abdominal, vaginal).

The nurse teaches a high school sex education class that herpes genitalis infection cannot be cured but that the disease is marked by remissions and exacerbations. What else should the students be taught about this infection? 1 A healthy lifestyle will prevent exacerbations. 2 Once the infection is effectively treated, exacerbations are rare. 3 Although exacerbations occur they are not as severe as the initial episode. 4 The most effective way to prevent exacerbations is to abstain from sexual activity

-Although exacerbations occur they are not as severe as the initial episode. The initial infection is both local and systemic; exacerbations are milder and localized. Although optimum health habits may limit exacerbations, they will not prevent them. There is no treatment that will limit the number of exacerbations. Exacerbations are precipitated by physical and emotional stress, not by sexual activity.

A nurse assesses a 35-year-old multiparous client who is scheduled for a tubal ligation to determine her emotional response to the planned procedure. What factor in the client's history will contribute most to the healthy resolution of any emotional problem associated with sterilization? 1 Belief that surgery will relieve her monthly dysmenorrheal 2 Knowledge that her partner does not want to have any more children 3 Feeling that her family is complete and she now has the children that were planned 4 Recovery from her previous complicated birth and does not want to experience another birth

- Feeling that her family is complete and she now has the children that were planned Many couples in their 30s who feel that their families are complete choose sterilization as their method of contraception. Sterilization by means of tubal ligation should have no effect on dysmenorrhea. The decision for sterilization should not be made by others, only by the woman herself. Decisions regarding sterilization should not be made when the client is under stress

A strict vegetarian (vegan) becomes pregnant and asks the nurse whether there is anything special she should do in regard to her diet during pregnancy. What is most the important measure for the nurse to instruct the client to take? 1 Eat at least 40 g/day of protein. 2 Drink at least 1 quart/day of milk. 3 Take a vitamin supplemented with iron every day. 4 Plan to eat from specific groups of vegetable proteins each day

-Plan to eat from specific groups of vegetable proteins each day A variety of incomplete proteins (vegetable proteins) can be combined to provide all of the essential amino acids. The pregnant client should eat at least 60 g/day of protein. Vegans do not drink milk. Taking a vitamin supplemented with iron each day is not the most important factor in diet planning; other nutrients also must be provided.

Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component? Select all that apply. 1 Oral drugs 2 Diaphragm 3 Cervical cap 4 Female condoms 5 Foam spermicide 6 Transdermal agents

1,6

A client with stage 4 ovarian cancer is admitted for dehydration. The client is to receive an intravenous bolus of 500 mL D5W for 1 hour, after which the rate is to be changed to 150 mL/hr. The drop factor is 15 gtt/mL. At what rate, in drops per minute, should the nurse regulate the IV after delivery of the 500-mL bolus? 15,25,38,42

The nurse should administer 38 gtt/min. Solve the problem with the following formula: 42 are too many drops per minute. The other options are too few drops per minute.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. 1 Fluid overload 2 Intermittent diarrhea 3 Pale mucous membranes 4 Difficulty emptying the bladder 5 High hemoglobin and hematocrit

-Pale mucous membranes, Difficulty emptying the bladder Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.

A woman visits the clinic because she has dysmenorrhea. What goal should the nurse identify for this client? 1 Reducing the pad saturation rate 2 Making intercourse less uncomfortable 3 Easing the pain of the client's menstruation 4 Eliminating bleeding between menstrual periods

-Easing the pain of the client's menstruation Dysmenorrhea is painful menstruation; the goal of care is making menstruation less painful. The other options are appropriate for a client who is experiencing excessive menstrual flow (menorrhagia) or dyspareunia (painful intercourse).

What instruction should a nurse include when teaching about the correct use of a female condom? 1 "Remove the condom before standing up." 2 "Insert the condom within 1 hour before intercourse." 3 "Have your partner wear a male condom at the same time." 4 "Cleanse the condom with warm water when preparing it for future use."

-"Remove the condom before standing up." Removing the condom before standing up keeps the semen in the female condom and prevents the inadvertent contact of semen with vaginal tissues. The female condom may be inserted as long as 8 hours before intercourse. Having the partner wear a male condom at the same time is unnecessary; this will increase friction that could tear the female condom. Female condoms should be used once and discarded.

A 45-year-old client is to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. What is the nurse's most appropriate response? 1 "You're right, but there are medicines you can take that will ease the symptoms." 2 "Sometimes that happens in women of your age, but you don't need to worry about it right now." 3 "You should probably talk to your surgeon, because I am not allowed to discuss this with you." 4 "Women may experience symptoms of menopause if their ovaries are removed with their uterus."

-"Women may experience symptoms of menopause if their ovaries are removed with their uterus. A hysterectomy involves only removal of the uterus. The ovaries, which secrete estrogen and progesterone, are not removed. Therefore menopause will not be precipitated but will occur naturally. Surgical menopause is precipitated by the removal of the ovaries, not the uterus. When the ovaries are removed, an older woman might have less severe symptoms than a younger woman; however, in this instance the ovaries are not removed. Telling the client that she needs to talk to her surgeon does not answer the question. The nurse should serve as a resource.

A woman visits the clinic for an annual physical examination, and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. How should the nurse reply? 1 "There's a sore in your vagina." 2 "There's a rash near your vagina." 3 "You have a typical discharge from your vagina." 4 "You have blisters on the skin around your vagina."

-"You have blisters on the skin around your vagina." Herpes genitalis is characterized by a cluster of vesicles, not one lesion or a rash or vaginal discharge. The characteristic sign of herpes genitalis is a cluster of vesicles (blisters) on the vulva, perineum, vagina, cervix, and/or perianal area. These rupture spontaneously, leaving painful erosions.

Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. What does the nurse need to assess when a vaginal infection is suspected? Select all that apply. 1 Abdominal pain 2 Urinary frequency 3 Rising temperature 4 Decreased pulse rate 5 Decreased blood pressure

-1,3 A pelvic infection is suspected. One characteristic of this disorder is abdominal pain. A rising temperature is a sign of infection. Urinary frequency is associated with cystitis, not a pelvic infection. Increases, not decreases, in pulse rate and blood pressure are expected because the metabolic rate increases in the presence of an increased temperature.

The nurse is teaching a sex education course to high school students. What should the nurse teach them about why gonorrhea is difficult to control? Select all that apply. 1 Symptoms of the disease are vague. 2 Screening blood tests are expensive. 3 The incubation period is relatively short. 4 Causative organisms have become resistant to treatment. 5 Diagnostic tests for the causative organism are not yet available.

-1,3,4 Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains; at times backup secondary medications must be used. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.

A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January? 7 , 16, 24 or 29

-16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.

A 24-year-old client complains to the nurse in the women's health clinic that her breasts become tender before her menstrual period. What should the nurse recommend that the client do 1 week before an expected menses? 1 Take salt tablets daily. 2 Increase protein intake. 3 Eliminate daily exercise. 4 Decrease caffeine intake

-Decrease caffeine intake The client is exhibiting one symptom of premenstrual syndrome (PMS); eliminating food and beverages containing caffeine can limit breast swelling. Salt intake should be reduced premenstrually to limit the development of edema. Increased protein intake is unnecessary if the client is eating a nutritious diet. Exercise should be increased before the menstrual period to help ease the symptoms of PMS.

A 24-year-old woman wants to use her basal body temperature (BBT) in natural family planning but is unsure when to take her temperature. The nurse informs her that an accurate BBT is best taken: 1 Each night right before bed 2 On the first day of her next menstrual cycle 3 Each morning prior to getting out of bed or increasing her activity 4 At bedtime beginning on day 14 of her menstrual cycle and continuing until her next period

-Each morning prior to getting out of bed or increasing her activity The most accurate BBT is taken before a woman gets out of bed and begins any type of activity that could increase the body's temperature even slightly. BBT should be charted daily on a calendar to permit interpretation of temperature fluctuations. A BBT taken in the evening may be increased after a day of activity. Daily assessment and recording of BBT during the first half of the menstrual cycle is also crucial, because a woman's BBT is lower then than during the second half of her cycle. The BBT temperature may rise slightly with ovulation.

A nurse evaluates that a client who is taking oral contraceptives understands the related dietary teaching when the client states, "While I'm taking birth control pills I should increase my intake of foods containing: 1 Calcium" 2 Folic acid" 3 Vitamin A" 4 Vitamin D"

-Folic acid" Oral contraceptives are thought to cause deficiencies of folic acid, vitamin C, vitamin B6 and vitamin B12. It is unnecessary to increase calcium intake when taking oral contraceptives. There is no clinical evidence to link oral contraceptives to a deficiency of vitamin A. There is no clinical evidence to link oral contraceptives to a deficiency of vitamin D

After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse? 1 Avoid regular use of tampons. 2 Decrease intake of prune juice. 3 Increase daily fluid consumption. 4 Cleanse the perineum from back to front.

-Increase daily fluid consumption. Increasing fluid intake flushes the urinary tract of microorganisms. Tampons do not increase the risk of cystitis. Fluids should be increased, not decreased; prune juice promotes acidic urine, which is desirable because it discourages the growth of microorganisms. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis.

A thin older adult client is found to have osteoporosis. What should the nurse include in the discharge plan for this client? 1 Encouraging gradual weight gain 2 Monitoring for decreased urine calcium 3 Providing instructions relative to diet and exercise 4 Teaching about safety factors in the use of opioids and nonsteroidal antiinflammatory drugs

-Providing instructions relative to diet and exercise A diet high in calcium and exercise, which helps deposit calcium into bone, are the most important factors in limiting the extent of osteoporosis. Weight gain should be discouraged to limit stress on the client's bones. Increased, not decreased, urine calcium should be monitored because it reflects demineralization of bone. Opioids are usually not prescribed; other analgesics are used for pain

A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question? 1 User motivation 2 Simplicity of use 3 Reliability record 4 Identified risk factors

-User motivation Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method

A nurse is teaching a client how to use the calendar (rhythm) method of birth control. The nurse determines that the client understands how to calculate the beginning of the fertile period when the client says: 1 "I'll subtract 11 days from the length of my longest cycle." 2 "I'll subtract 18 days from the length of my shortest cycle." 3 "I'll abstain from sexual intercourse after the 10th day of my cycle." 4 "I'll abstain from intercourse from the 10th day before the middle of my average cycle."

-"I'll subtract 18 days from the length of my shortest cycle." The fertile period is determined by subtracting 18 days from the length of the shortest cycle to determine the first unsafe day. Subtracting 11 days from the length of the longest cycle is how the last day, not the first day, of the unsafe period is determined. Abstaining from sexual intercourse after the 10th day of the cycle is true if the shortest cycle is 28 days; the date depends on a calculation based on the length of the woman's shortest and longest cycles. The longest and shortest cycles, not the average length of a cycle, are used.

A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond? 1 "It covers the entrance to the cervical os." 2 "The openings to the fallopian tubes are blocked." 3 "The sperm are kept from reaching the vagina." 4 "It produces a spermicidal intrauterine environment."

-"It produces a spermicidal intrauterine environment." Intrauterine devices produce a spermicidal intrauterine environment. A copper IUD (ParaGard T380A) inflames the endometrium, damaging or killing sperm and preventing fertilization and/or implantation; a Mirena IUD (LNG-IUS) releases levonorgestrel, damaging sperm and causing the endometrium to atrophy, thus preventing fertilization and/implantation. A diaphragm blocks the cervical os. The IUD does not act by blocking the openings to the fallopian tubes.Preventing sperm from reaching the vagina is the function of a condom.

A female client who has been sexually active for 5 years is found to have gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective? 1 "I'll douche after each time I have sex." 2 "Having sex is a thing of the past for me." 3 "My partner has to use a condom all the time." 4 "I'll be using a spermicidal cream from now on."

-"My partner has to use a condom all the time." Although not 100% effective, a condom is the best protection against gonorrhea in a sexually active person. Douching has no proven protective effect against sexually transmitted infections; excessive douching can alter the natural environment of the vagina and may even promote an ascending infection. Although abstaining from sex is the best way to prevent a sexually transmitted infection, it is not the most realistic response for a sexually active person. Once people become sexually active, they usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy.

A client has been taking clomiphene citrate (Clomid) for 3 months to treat anovulatory cycles. Which finding should be reported to the health care provider immediately? 1 Nausea and vomiting 2 Blurred vision 3 Weight gain 4 Hot flashes

-Nausea and vomiting Clomid is classified in pregnancy category X, and it should be discontinued if the client is pregnant. The client should notify her health care provider of the presumptive signs of pregnancy. Weight gain, blurred vision, and hot flashes are all common side effects of this ovulation inducer.

Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component? Select all that apply. 1 Oral drugs 2 Diaphragm 3 Cervical cap 4 Female condoms 5 Foam spermicide 6 Transdermal agents

-Oral drugs,Transdermal agents Oral agents have a hormonal component. Transdermal agents have a hormonal component. The diaphragm acts as a barrier. The cervical cap acts as a barrier. The female condom acts as a barrier. Foam spermicides kill the sperm; there is no hormonal effect.

The public health nurse presents a program on breast self-examination. After a return demonstration the nurse concludes that she needs to review certain aspects of the teaching program. Which behavior by one of the students supports this conclusion? 1 Palpating each breast while in the sitting position 2 Checking her breasts for any deviation from what is expected 3 Palpating each breast with the palmar surface of her extended fingers 4 Checking her breasts for symmetry while holding her arms above her head

-Palpating each breast while in the sitting position Breast palpation should be performed in the supine position with a small rolled towel under the shoulder of the palpated side; it may also be done standing in the shower, but the sitting position is not recommended. Checking the breasts for deviations from expected findings, palpating each breast with the palmar surfaces of the extended fingers, and checking the breasts for symmetry while holding the arms over the head are all correct procedures for breast self-examination.

A 60-year-old woman is admitted for a vaginal hysterectomy and anterior and posterior repair of the vaginal wall. While taking the nursing history the nurse expects the client to state that one of the reasons she is having surgery is because she has been experiencing: 1 Hematuria 2 Dysmenorrhea 3 Pain on urination 4 Stress incontinence

-Stress incontinence Increased intraabdominal pressure associated with lifting, coughing, or laughing, in conjunction with a relaxed pelvic musculature and a bladder displaced into the vagina, results in inability to suppress urination. Hematuria is usually associated with urinary tract infection, bladder tumor, or renal calculi, not with cystocele or rectocele. Dysmenorrhea is usually associated with pelvic inflammatory disease, endometriosis, or cervical stenosis, not with cystocele or rectocele; the client is probably postmenopausal. Pain on urination is usually associated with urinary infection, not with cystocele or rectocele.

After a mastectomy or hysterectomy, the client may feel incomplete as a woman. Which statement causes the nurse to realize that a client may be experiencing this concern? 1 "I can't wait to see my friends." 2 "I want to go home soon to see my grandchild." 3 "I feel washed out; there isn't much left for my family." 4 "My husband arranged for me to recuperate at our daughter's home."

-"I feel washed out; there isn't much left for my family." The client's statement of feeling "washed out" connotes a feeling of emptiness and loss. Resumption of social activities indicates acceptance and a willingness to move on with life. Expressing desire to see a grandchild is a response typical of a grandparent anxious to resume life. The client is planning for rehabilitation by stating her intention to recuperate at her daughter's home, not expressing a sense of loss. Topics

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor? 1 "I will go, but it is against my beliefs and values." 2 "I won't do it, because I do not believe in birth control at all." 3 "I would prefer another assignment that is not contrary to my beliefs." 4 "I will have to stress that the rhythm method is the method of choice."

-"I would prefer another assignment that is not contrary to my beliefs." Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area where the nurse's personal values will not pose a problem. Fulfilling the request even though it is against the nurse's beliefs is an ineffective way to resolve value conflict; undoubtedly a client would sense this conflict. The nurse may not have the legal, ethical, or professional right to refuse this assignment if employed by the facility. Stressing that the rhythm method is the method of choice is unethical and unprofessional.

A 15-year-old client tells a school nurse, "I have this awful pain during my periods—it never stops." What should the nurse encourage her to do? 1 Continue daily activities. 2 Have a gynecologic examination. 3 Eat a nutritious diet containing iron. 4 Practice relaxation of abdominal muscles.

-Have a gynecologic examination. Persistent pain of any kind during menstruation (dysmenorrhea) usually indicates a problem, and the client should seek medical attention. Although diversion is a means of altering pain perception, the presence of pain requires investigation of possible causes. Although a nutritious diet is beneficial, iron does not prevent the pain of dysmenorrhea. Voluntary relaxation of the abdominal muscles does not result in cessation of dysmenorrhea.

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1 Obesity 2 High-fat diet 3 Hypertension 4 Late-onset menarche

-Late-onset menarche Early-onset, not late-onset, menarche is a risk factor for endometrial cancer. A high-fat diet, hypertension, and obesity are all risk factors

The day after a hysterectomy, the client asks for sanitary pads because she feels that she is going to menstruate. What information should influence the nurse's response? 1 Menstruation will not occur because the uterus has been removed. 2 It will take several weeks before regular menstruation is reestablished. 3 Abdominal cramping and menstruation are expected after surgery. 4 The appearance of frank vaginal bleeding is expected after this type of surgery

-Menstruation will not occur because the uterus has been removed. Menstruation is shedding of the endometrial lining of the uterus. A woman who has undergone a hysterectomy has had her uterus removed and will no longer menstruate. Abdominal pain is common after a hysterectomy, but menstruation is impossible after the surgery; additional symptoms are necessary before any conclusion can be made. Frank bleeding is not expected after a hysterectomy.

The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching? 1 "I know not to lift anything heavier than 5 lb." 2 "I'll limit my stair climbing to four times a day." 3 "I'll avoid crossing my legs at the knees when I sit." 4 "I'm glad I'll be able to get back into my jogging routine next week."

-"I'm glad I'll be able to get back into my jogging routine next week." Discharge instructions after abdominal hysterectomy includes avoiding jogging, aerobic exercise, participating in sports, and other any strenuous activity for 2 to 6 weeks after the surgery. The statement indicating that the client plans to start jogging again next week means that the client requires more teaching. Stair climbing should be limited to fewer than five times per day. Nothing heavier than 5 to 10 lb should be lifted. The client should not cross her legs at the knees when sitting. Those three statements by the client are accurate and indicate understanding of the teaching.

While being admitted for a lumpectomy the client begins to cry and says, "I found the lump a few months ago, but I didn't go to the doctor because of what it could be." How should the nurse reply? 1 "This has been frightening for you." 2 "About 80% of breast lumps are benign." 3 "Cry as long as you like and get it out of your system." 4 "More than 95% of breast lumps are discovered by the woman herself."

-"This has been frightening for you." The correct response involves the use of reflective technique to acknowledge the client's feelings. Providing statistics does not acknowledge the client's feelings and may cut off communication. Providing false reassurance that crying will ease her concerns is inappropriate

A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the health care provider will most likely prescribe? 1 Penicillin G 2 Gentian violet 3 Nystatin (Mycostatin) 4 Metronidazole (Flagyl)

-Metronidazole (Flagyl) Metronidazole (Flagyl) is a potent amebicide. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Gentian violet is a local antiinfective that is applied topically; it may cause discoloration of the skin. It is effective against Candida albicans. Nystatin (Mycostatin) is an antifungal for infections caused by C. albicans.

A nurse is teaching a family planning class about ovulation and conception. The nurse should instruct the class that the ovum is thought to be viable for what period of time after ovulation? 1 1 to 6 hours 2 12 to 18 hours 3 24 to 36 hours 4 48 to 72 hours

-24 to 36 hours The ovum is capable of being fertilized for 24 to 36 hours after ovulation. After this time it travels a variable distance between the fallopian tube and uterus and, if not fertilized, disintegrates and is phagocytized by leukocytes. The ovum is viable for longer than 36 hours, but the ovum is not fertilizable after 36 hours.

A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? 1 Estrogen therapy 2 Hypoparathyroidism 3 Prolonged immobility 4 Excessive calcium intake

-Prolonged immobility Prolonged immobility results in bone demineralization because there is decreased bone production by osteoblasts and increased resorption by osteoclasts. Estrogen helps prevent bone demineralization. Hypoparathyroidism decreases mobilization of calcium from the bones, thereby reducing the serum level of calcium. Decreased calcium intake or absorption may precipitate osteoporosis.

A client at the women's health clinic tells the nurse that she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply. 1 Insomnia 2 Ecchymosis 3 Rectal pressure 4 Abdominal pain 5 Skipped periods 6 Pelvic infections

-Rectal pressure, Abdominal pain Endometriosis is the presence of aberrant endometrial tissue outside the uterus. The tissue responds to ovarian stimulation and bleeds during menstruation, which causes rectal pressure and abdominal pain. Insomnia, ecchymoses, and skipped periods are not related to endometriosis. Pelvic infections are not caused by endometriosis; most frequently they are sexually transmitted.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure? 1 The Pap smear can detect cancer of the cervix. 2 Vaginal bleeding is expected after a Pap smear. 3 Colposcopy will be used to visualize the cervix. 4 Scraping the cervix is the most uncomfortable part

-The Pap smear can detect cancer of the cervix. The Pap smear can detect cancer of the cervix by revealing atypical as well as cancerous cells. Scraping of the cells can cause a few drops of blood to be expelled; vaginal bleeding does not occur. A colposcopy is not part of a routine Pap smear. Insertion of the speculum usually is the most uncomfortable part of the test.

A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have exploratory surgery. How should the nurse respond? "What has the physician told you?" 2 "I don't know the answer to that question." 3 "I'm not allowed to give you that information." 4 "Have you talked to your wife about your concerns?"

-"Have you talked to your wife about your concerns?" The correct response protects the wife's confidentiality while fostering open communication between the couple. Asking about communication with the physician does not foster communication between the client and the client's husband. Claiming not to know the answer to the question or claiming not to be able to supply the information in question supports neither the wife nor the husband.

A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. What is a description of dysmenorrhea? 1 Pain with menses 2 Endometrial hyperplasia 3 Bleeding between menses 4 Heavy bleeding with menses

-Pain with menses Dysmenorrhea is defined as pain with menses. Endometrial hyperplasia results from anovulation and persistent estrogen stimulation. Bleeding between menses is metrorrhagia. Heavy bleeding with menses is menorrhagia.

When performing a routine physical assessment on a client who is postmenopausal the nurse determines that the client has enlarged breasts with galactorrhea. For what blood hormone level does the nurse expect the client to be tested? 1 Prolactin 2 Estrogen 3 Oxytocin 4 Progesterone

-Prolactin Prolactin is a hormone that is produced and secreted by the anterior pituitary. A pituitary tumor is the most probable cause of an increased prolactin level that results in lactation not associated with childbirth or nursing (galactorrhea). If the client is taking oral contraceptives the estrogen level will increase, causing galactorrhea in some women; this client is postmenopausal. The production of oxytocin is not related to the occurrence of galactorrhea. The production of progesterone is not related to the occurrence of galactorrhea.

The school nurse is discussing issues related to premarital sex with a group of adolescents taking a health education course. The students are asked to write an essay on what they have learned about preventing pregnancy. Which comment alerts the nurse to have a private discussion with the student? 1 "I can't get pregnant if I have sex during my period." 2 "The pill may prevent me from getting pregnant, but I can still get an STI." 3 "I won't get pregnant if I swim in a pool where a boy has just masturbated." 4 "A condom won't always protect me from getting pregnant, but it can protect me from getting an STI."

-"I can't get pregnant if I have sex during my period." Although unusual, conception can occur during menses. The pill prevents ovulation and therefore conception. However, the pill does not protect a female from being exposed to a sexually transmitted microorganism. Sperm cannot survive in a large body of water. Condoms provide the lowest risk of contracting an STI, but there is still a risk of pregnancy with their use because they are not 100% effective.