Nclex 57
A patient reports intermittent pelvic pain that does not appear to have a predictable occurrence. She recalls these episodes began approximately 8 months ago. Following months of physical and diagnostic tests, the physician diagnoses the patient with chronic pelvic pain. Which of the following choices should be used as possible treatment options? Select all that apply. a) Corticosteroids b) Oral contraceptives c) Antidepressants d) Estrogen replacement e) Analgesics
) Antidepressants, e) Analgesics, b) Oral contraceptives Explanation: Chronic pelvic pain is often difficult to treat. Treatment depends on physical and diagnostic test results and may include antidepressants, analgesics, oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, exercise, and various surgical procedures. GnRH agonists decrease estrogen production. Corticosteroids are not indicated in the treatment of chronic pelvic pain.
During consultations with the oncologist, a patient with cervical cancer is informed that radioactive materials will be inserted in the area of her tumor. She has to undergo these sessions over a period of 3 weeks. Which of the following methods of cancer treatment is being described here? a) Brachytherapy b) Chemotherapy c) Needle aspiration biopsy d) Antineoplastic therapy
) Brachytherapy Explanation: Internal radiation, or brachytherapy, delivers a dose of radiation to a localized area inside the body by use of an implant. The implant may be applied by a needle, seed, bead, or catheter or given orally. Antineoplastic agents used in chemotherapy interfere with the cellular function of the cancer cells and cause cell death. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.
A patient with HIV has recently completed a 7-day regimen of use of antibiotics. She reports vaginal itching and irritation. In addition, the patient has a white, cottage cheese-like vaginal discharge. Which of the following is the patient most likely suffering? a) Human papillomavirus (HPV) b) Trichomonas vaginalis c) Bacterial vaginosis d) Vulvovaginal candidiasis
) Vulvovaginal candidiasis Explanation: Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which leads to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick, but usually has a white, cottage cheese-like appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.
Which of the following is a downward displacement of the bladder toward the vaginal orifice? a) Vulvodynia b) Cystocele c) Rectocele d) Fistula
Cystocele Explanation: A cystocele is a downward displacement of the bladder toward the vaginal orifice, resulting from damage to the anterior vaginal support structures. A rectocele is a bulging of the rectum into the vagina. Vulvodynia is a painful condition that affects the vulva. A fistula is an abnormal opening between two organs or sites.
During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which of the following statements made by the patient's mother demonstrates understanding of HPV vaccinations? a) "I will track follow-up appointments in my smart phone so she receives all three injections." b) "It's nice that she can take this vaccination intranasally, to avoid repeated injections." c) "This vaccination is not indicated for my son, since boys cannot receive HPV vaccinations." d) "If my daughter is immunized against HPV, she can delay her first scheduled Pap test."
a) "I will track follow-up appointments in my smart phone so she receives all three injections." Explanation: The Centers for Disease Control and Prevention (CDC) recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in prevention of HPV. Women still need cervical cancer screening as recommended.
Which of the following is true regarding endometriosis? a) It affects women of reproductive age. b) It is a malignant lesion similar to those lining the uterus. c) Its cause is not linked to infertility. d) Extensive endometriosis causes many symptoms.
a) It affects women of reproductive age. Explanation: Endometriosis affects women of reproductive age. It is a benign lesion or lesions with cells similar to those lining the uterus. Extensive endometriosis causes few symptoms. Causation has been linked to infertility.
Upon examination, the nurse practitioner notes a backward positioning of the patient's uterus. How would the nurse document this finding? a) Retroversion b) Retroflexion c) Anteversion d) Anteflexion
a) Retroversion Explanation: In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.
A female patient, who is 24 years of age, delivers a healthy female infant. This patient was given diethylstilbestrol (DES) during her pregnancy. It is important that the nurse stresses frequent gynecologic examinations of the patient's daughter when she reaches a certain age due to which of the following concerns? a) To prevent the onset of vaginal carcinoma in the patient's daughter b) To ensure that the patient's daughter has a complication-free pregnancy c) To ensure regularized menstruation cycles in patient's daughter d) To prevent the onset of vulvar cancer in the patient's daughter
a) To prevent the onset of vaginal carcinoma in the patient's daughter Explanation: Studies have shown a relation between taking DES early during pregnancy and the development of vaginal carcinoma, not vulvar cancer, in the (young) female offspring. Therefore, DES is no longer used to treat problems associated with pregnancy. To prevent the onset of vaginal carcinoma in the patient's daughter, the nurse should instruct the patient to have complete gynecologic examinations of her daughter regularly. Gynecologic examinations of the patient's daughter will not ensure regular menstruation cycles or a complication-free pregnancy.
Which type of yeast infection is manifested by white, cottage cheese-like discharge? a) Cervicitis b) Candidiasis c) Bacterial vaginosis d) Trichomoniasis
b) Candidiasis Explanation: The discharge of candidiasis may be watery or thick, but has a white, cottage cheese-like appearance. The other disorders do not have a cheese-like appearance.
Which of the following is the main cause of anemia in a patient with active uterine leiomyoma? a) Pressure of the fibroid on the pelvic veins b) Menorrhagia c) Poor intake of foods containing iron d) Hemolysis
b) Menorrhagia Explanation: Uterine leiomyomas or fibroids cause menorrhagia, which in turn causes anemia. A poor dietary intake of iron does not cause anemia but aggravates the problem. Although there can be a feeling of pressure in the pelvic region, this does not cause anemia.
While caring for a patient who is being treated for severe pelvic inflammatory disease (PID), which of the following nursing actions minimizes transmission of infection? a) Keeping the patient in a sitting position b) Performing hand hygiene when entering the room c) Strictly adhering to the no visitation policy d) Implementing reverse isolation precautions
b) Performing hand hygiene when entering the room Explanation: While caring for a patient hospitalized with PID, the nurse has to reduce the risk of the spread of pathogenic microorganisms. Meticulous hand hygiene minimizes the transmission of infection. There is no reason to restrict visitors in this situation; however, visitors need to be educated in proper hand hygiene. Reverse isolation is not indicated for this patient. A sitting position will not aid in preventing nosocomial infections.
A patient is admitted to the health care center with abdominal pain, nausea, and vomiting. She has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the patient's symptoms to be which of the following conditions? a) Cancer of the cervix b) Polycystic ovary syndrome (PCOS) c) Endometriosis d) Bacterial vaginosis
b) Polycystic ovary syndrome (PCOS) Explanation: Features of PCOS includes obesity, sleep apnea, and irregular menstrual periods. Bacterial vaginosis can occur throughout the menstrual cycle and does not produce local discomfort or pain. Symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse are consistent with cancer of the cervix. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur.
Which of the following is the most effective treatment for trichomoniasis? a) Clindamycin (Cleocin) b) Tinidazole (Tindamax) c) Miconazole (Monistat) d) Clotrimazole (Gyne-Lotrimin)
b) Tinidazole (Tindamax) Explanation: The most effective treatment for trichomoniasis is metronidazole or tinidazole (Tindamax). Monistat, Cleocin, and Gyne-Lotrimin are not the most effective treatment for trichomoniasis.
Which of the following terms describes an opening between the bladder and the vagina? a) Cystocele b) Vesicovaginal fistula c) Rectocele d) Rectovaginal fistula
b) Vesicovaginal fistula Explanation: A vesicovaginal fistula may occur because of tissue injury sustained during surgery, vaginal delivery, or a disease process. A cystocele is a downward displacement of the bladder toward the vaginal orifice. A rectocele is a bulging of the rectum into the vagina. A rectovaginal fistula is an opening between the rectum and the vagina.
Which of the following statements made by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female patient? a) "Why didn't you start annual Pap-test at an earlier age?" b) "Have you had sex with more than one partner?" c) "What questions do you have related to your sexual health?" d) "Do you know how to properly apply a male condom?"
c) "What questions do you have related to your sexual health?" Explanation: Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the patient to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the patient in a defensive position that may block communication.
A woman in her late thirties has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the last few weeks. On further enquiry, she reveals that she also has postcoital pain and bleeding. To which of the following diagnoses do you think the investigations are most likely to lead? a) Cancer of the urinary tract b) Hodgkin's disease c) Cervical cancer d) Colorectal cancer
c) Cervical cancer Explanation: The patient's symptoms are those of cervical cancer. The symptoms of cervical cancer include abnormal vaginal bleeding and persistent discharge that is yellowish, blood tinged, or foul smelling. Patients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the patient may experience pain in the flank regions of the body.
Which of the following is a risk factor for cervical cancer? a) Late childbearing b) Underweight status c) Exposure to the human papilloma virus (HPV) d) Sex with circumcised males
c) Exposure to the human papilloma virus (HPV) Explanation: Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight status, and early childbearing.
Most cervical cancers, if not detected and treated, spread to which area? a) Vagina b) Uterus c) Regional pelvic lymph nodes d) Fundus
c) Regional pelvic lymph nodes Explanation: Most cervical cancers, if not detected and treated, spread to regional pelvic lymph nodes.
Which of the following is the usual treatment for vulvar dystrophy? a) Antifungals b) Progestins c) Topical corticosteroids d) Antibiotics
c) Topical corticosteroids Explanation: Topical corticosteroids are the usual treatment for vulvar dystrophy. Antibiotics, antifungals, and progestins are not usual treatment for vulvar dystrophy
Which of the following patient statements demonstrates an understanding related to Pap smear testing? a) "I plan to postpone my first Pap test because it is a painful experience." b) "I have my Pap test every other year to reduce cost related to this expensive screening." c) "Pap tests are not indicated for older women past childbearing age." d) "I need to have my first Pap test when I turn 21 or earlier if I become sexually active."
d) "I need to have my first Pap test when I turn 21 or earlier if I become sexually active." Explanation: Screening should begin within 3 years of the initiation of sexual intercourse or at 21 years of age. Pap smear is a painless and relatively inexpensive method of early detection. Preventive measures for cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age.
A patient undergoing treatment for vaginosis is also counseled about measures to prevent its recurrence. Which patient statement best indicates effective counseling? a) "I will insert a vaginal suppository after intercourse." b) "My sexual partner will avoid condoms until I'm better." c) "I will void immediately after intercourse." d) "I will avoid douching after my period."
d) "I will avoid douching after my period." Explanation: Vaginitis is a condition in which the vagina is inflamed. Frequent douching predisposes the patient to vaginitis. Treatment of patients' partners does not seem to be effective, but use of condoms may be helpful. Antiprotozoal vaginal suppositories should be used at regular intervals rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis.
When a female patient reports profuse purulent discharge, dysuria, and bleeding, the advance practice nurse is most likely to prescribe which of the following medications to treat this condition? a) Tinidazole (Tindamax) one time for each partner b) Terconazole (Terazol) cream inserted into the vagina at bedtime c) Metronidazole (Flagyl), administered orally twice a day for 1 week d) Doxycycline (Vibramycin) for 1 week
d) Doxycycline (Vibramycin) for 1 week Explanation: Chlamydia causes a profuse purulent discharge and may be accompanied with dysuria and bleeding. The CDC recommends treating chlamydia with doxycycline (Vibramycin) for 1 week. Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Treatment for Trichomonas vaginalis is metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose. Candidiasis causes a white, cheeselike discharge clinging to the vaginal epithelium. (Terazol) cream inserted into the vagina with an applicator at bedtime is the appropriate treatment for Candidiasis. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Metronidazole (Flagyl) is taken orally twice a day for 1 week to treat Gardnerella vaginalis.
The nurse is providing education regarding sexually transmitted infections. Which of the following statements regarding herpes virus 2 (herpes genitalis) is accurate? a) Usually, the virus is killed at room temperature by drying. b) Transmission of the virus requires sexual contact. c) The virus is very difficult to kill. d) In pregnant women with active herpes virus, babies delivered vaginally may become infected with the virus.
d) In pregnant women with active herpes virus, babies delivered vaginally may become infected with the virus. Explanation: A cesarean delivery may be performed if the virus recurs near the time of delivery. Asexual transmission by contact with wet surfaces or self-transmission (i.e., touching a cold sore and then touching the genital area) can occur. Transmission occurs only when the carrier has symptoms. Transmission is possible even when the carrier does not have symptoms.
The nurse reports to work an evening shift on the postsurgical unit. Based on the following information received at report, which of the following patients does the nurse need to see first? a) Joan, 2 days post vaginal reconstructive surgery reports vaginal bleeding. Joan's vital signs are temperature 100.2°F, pulse 90, respirations 20, blood pressure 128/76. b) Mary, 1-day post robotic-assisted laparoscopic surgery reporting sharp chest pain. Mary's vital signs are temperature 99.2°F, pulse 82, respirations 18, and blood pressure 114/72. c) Donna, 1-day post cryosurgery reporting vaginal drainage. Donna's vital signs are temperature 98.2°F, pulse 86, respirations 20, blood pressure, 136/ 80. d) June, 2 days post-abdominal surgery reports chest discomfort. June's vital signs are temperature, 99.4°F, pulse 98, respirations 12, and blood pressure 140/86.
d) June, 2 days post-abdominal surgery reports chest discomfort. June's vital signs are temperature, 99.4°F, pulse 98, respirations 12, and blood pressure 140/86. Explanation: The patient's symptoms are consistent with a pulmonary embolism (PE) (chest pain, tachycardia, and dyspnea) and directly relate to breathing and are a priority. Chest pain following laparoscopic surgery is an expected finding. Vaginal drainage following cryosurgery is an expected finding. Vaginal bleeding postoperative vaginal reconstructive surgery is expected.
A patient has been diagnosed with genital herpes. Knowing patient education is an essential part of nursing care of the patient with a genital herpes infection, the nurse plans to include which of the following methods to minimize HIV transmission? Select all that apply. a) Avoiding physical contact with others in crowded places b) Avoiding multiple partners for sexual intercourse c) Avoiding IV drug use d) Avoiding HPV vaccinations e) Avoiding unprotected sexual intercourse
e) Avoiding unprotected sexual intercourse, b) Avoiding multiple partners for sexual intercourse, c) Avoiding IV drug use Explanation: Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.
