Chapter 53: Female Reproductive and Genital Problems Lewis: Medical-Surgical Nursing Test Bank

A patient has been diagnosed with pelvic inflammatory disease (PID). What is a priority topic that the nurse should discuss with the patient? A. The importance of contraception B. Benefits of hormone therapy (HT) C. Manifestations of further infection D. The importance of maintaining hygiene

C

The nurse is caring for a patient with pelvic inflammatory disease. The nurse knows that positioning the patient into supine position with the head of the bed to 30 degrees is known to do what? A. To promote circulation B. To prevent dehydration C. To reduce pelvic inflammation D. To promote drainage of the pelvic cavity

D

when teaching a group of postmenopausal women about the risk of osteoporosis, what information should the nurse include? Select all that apply. A. Inform that raloxifene prevents bone loss. B. Emphasize the need for estrogen replacement. C. Inform that Bisphosphonates enhance bone mineral density. D. Emphasize the need for adequate intake of calcium and vitamin E. E. Encourage avoidance of weight-bearing exercises, because they can cause bone loss.

A B C

When teaching a group of young women about pelvic inflammatory disease (PID), what information should the nurse include? Select all that apply. A. PID is associated with a higher risk of ectopic pregnancy. B. Old age and multiple sex partners are risk factors for PID. C. Causative organisms reach the pelvic organs through blood. D. PID is an infectious condition of the fallopian tubes, ovaries, and uterus. E Causative organisms reach the pelvic organs through the cervix in an ascending manner.

A C

A 22-yr-old patient tells the nurse that she has not had a menstrual period for the past 3 months. Which action is most important for the nurse to take? a. Obtain a urine specimen for a pregnancy test. b. Ask about any recent stressful lifestyle changes. c. Measure the patient's current height and weight. d. Question the patient about prescribed medications.

ANS: A Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age. The other actions are also appropriate, but it is important to check for pregnancy in this patient because pregnancy will require rapid implementation of actions to promote normal fetal development such as changes in lifestyle, folic acid intake, and so on.

Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal patient who prefers not to use hormone replacement therapy (HRT) (select all that apply)? a. Reduce caffeine intake. b. Exercise several times a week. c. Take black cohosh supplements. d. Drink a glass of wine in the evening. e. Increase intake of dietary soy products.

ANS: A, B, C, E Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.

A 24-year-old patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching? a. Abdominal pain may persist for several weeks. b. Return for a follow-up appointment in 2 to 3 days. c. Instruct a male partner to use a condom during sexual intercourse for the next week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring

ANS: B The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring

Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT) requires discussion with the health care provider about a change in therapy? a. Breast tenderness b. Left calf swelling c. Weight gain of 3 lb d. Intermittent spotting

ANS: B Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching? a. Abdominal pain may persist for several weeks. b. Return for a follow-up appointment in 2 to 3 days. c. Instruct a male partner to use a condom during sexual intercourse for the next week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring

ANS: B The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring. DIF: Cognitive Level: Apply (application) REF: 1252 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT. b. Increased incidence of colon cancer in women taking HT requires more frequent colonoscopy. c. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

ANS: C Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT

The nurse is caring for a 20-year-old patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Elevate the head of the bed to at least 30 degrees. d. Teach the patient how to perform Kegel exercises.

ANS: C The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID

A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT. b. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

ANS: C Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT. DIF: Cognitive Level: Apply (application) REF: 1249 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

15. The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Elevate the head of the bed at least 30 degrees. d. Teach the patient how to perform Kegel exercises.

ANS: C The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function test results will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID. DIF: Cognitive Level: Apply (application) REF: 1252 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual period for 3 months. Which response by the nurse is appropriate? a. "Have you thought about using hormone replacement therapy?" b. "Most women feel a little depressed about entering menopause." c. "What was your menstrual pattern before your periods stopped?" d. "Because you are in your mid-40s, it is likely that you are menopausal."

ANS: C The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions. DIF: Cognitive Level: Apply (application) REF: 1248 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective? a. "I can purchase an over-the-counter medication to treat this infection." b. "The symptoms are due to the overgrowth of normal vaginal bacteria." c. "The medication will need to be inserted once daily with an applicator." d. "Both my partner and I will need to take the medication for a full week."

ANS: D Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection. DIF: Cognitive Level: Apply (application) REF: 1251 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

Which nonhormonal measures should the nurse teach to a postmenopausal patient experiencing hot flashes to decrease heat production and increase heat loss? Select all that apply. A. Limit intake of alcohol. B. Increase intake of caffeine. C. Use heavy quilts when sleeping. D. Promote air circulation in the room. E. Avoid wearing clothes with tight necks.

A C D

A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. The nurse will anticipate teaching the patient about a. endometrial biopsy. b. endometrial ablation. c. uterine balloon therapy. d. dilation and curettage (D&C).

ANS: A A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient. DIF: Cognitive Level: Apply (application) REF: 1257 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate? a. "A frequent cause of spotting is endometrial cancer." b. "How long has it been since your last menstrual period?" c. "Breakthrough bleeding is not unusual in women your age." d. "Are you using prescription hormone replacement therapy?"

ANS: D In postmenopausal women, a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response. DIF: Cognitive Level: Apply (application) REF: 1249 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

Which diagnostic test does the nurse question when it is prescribed for a patient diagnosed with pelvic inflammatory disease (PID)? A. Rapid plasma reagin (RPR) B. Throat culture for streptococcus C. A Vaginal culture for Neisseria gonorrhea D. Complete blood count (CBC) with differential

B

Because of the risks associated with hormone therapy (HT), a female patient does not want to take HT and asks the nurse how she can tolerate the perimenopausal symptoms of hot flashes and sweating at night. What is the best response by the nurse? A. Increase warmth to avoid chills. B. Maintain good nutrition to avoid osteoporosis. C. Decrease heat production and increase heat loss. D. Take vitamin B complex and use vaginal lubrication.

C

The nurse is educating a postmenopausal woman who is not receiving hormone replacement therapy (HRT) about calcium supplementation. How many milligrams (mg) per day is the recommended dose? A. 500 mg B1,000 mg C. 1,500 mg D. 2,000 mg

C

A patient who is postmenopausal comes to the clinic reporting unexpected vaginal bleeding. What should the nurse tell the patient about diagnosing the cause of this bleeding? A. "It is probably only the end of menopause. B. ""You will need a hysterectomy to treat this bleeding C. .""You will need a Pap smear to see if you have endometrial cancer." D. "You will need an endometrial biopsy to determine the cause of bleeding."

D

The nurse is providing teaching to a group of perimenopausal women. Which herbs and/or supplements would the nurse include in a discussion regarding effective alternative therapies for menopausal symptoms (select all that apply.)? a. Soy b. Garlic c. Gingko d. Vitamin A e. Cinnamon f. Black cohosh

a. Soy f. Black cohosh There is good scientific evidence that soy is useful in decreasing menopausal hot flashes and that black cohosh is safe to use for up to 6 months to decrease menopausal symptoms. Garlic, gingko, vitamin A, and cinnamon do not affect menopausal symptoms. There is good scientific evidence that soy is useful in decreasing menopausal hot flashes and that black cohosh is safe to use for up to 6 months to decrease menopausal symptoms. Garlic, gingko, vitamin A, and cinnamon do not affect menopausal symptoms.

What should the nurse emphasize in the teaching for a woman diagnosed with pelvic inflammatory disease (PID)? a. The importance of contraception b. Manifestations of further infection c. The importance of maintaining hygiene d. Benefits of hormone replacement therapy (HRT)

b. Manifestations of further infection PID frequently progresses to serious infection of the reproductive structures. The diagnosis does not present a particular need for contraception or specific hygiene measures. HRT is not used to treat PID.