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1523 KEY: LGBTQ| therapeutic communication MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Psychosocial Integrity 2. A nurse is providing health teaching to a middle-aged male-to-female (MtF) client who has undergone gender reassignment surgery. What information is most important to this client? a. Be sure to have an annual prostate examination. b. Continue your normal health screenings. c. Try to avoid being around people who are ill. d. You should have an annual flu vaccination.

A The MtF client retains the prostate, so annual screening examinations for prostate cancer remain important. The other statements are good general health teaching ideas for any client. DIF: Applying/Application

1224 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 18. Which finding from the nurses physical assessment of a 42-year-old male patient should be reported to the health care provider? a. One testis hangs lower than the other. b. Genital hair distribution is diamond shaped. c. Clear discharge is present at the penile meatus. d. Inguinal lymph nodes are nonpalpable bilaterally.

C Clear penile discharge may be indicative of a sexually transmitted infection (STI). The other findings are normal and do not need to be reported. DIF: Cognitive Level: Apply (application)

1273 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 15. Which patient will the nurse plan on teaching about the Gardasil vaccine? a. A 24-year-old female who has not been sexually active b. A 34-year-old woman who has multiple sexual partners c. A 19-year-old woman who is pregnant for the first time d. A 29-year-old woman who is in a monogamous relationship

A Gardasil is recommended for females ages 9 through 26, preferably those who have never been sexually active. It is not recommended for women during pregnancy or for older women. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 9. A client tells the nurse she is happy that she never had children because she has less risk of developing cancer. Which response by the nurse is best? a. Actually, your risk of breast cancer is slightly higher. b. Youre right; your risk of all reproductive cancer is quite low. c. In reality, smoking is the leading risk factor for all types of cancer. d. Your risk of uterine cancer is higher because you had no children.

A Women who have never had children have a slightly higher risk of breast cancer than the general population. Smoking is a major risk factor for many, but not all, cancers. Uterine cancer is not influenced by pregnancy. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialLaboratory Values) MSC: Integrated Process: Nursing Process (Implementation) MULTIPLE RESPONSE 1. The nurse is teaching high school girls about the female reproductive tract. Which statements by the nurse are accurate? (Select all that apply.) a. The vagina has an acidic environment. b. The cervix is where the Pap smear is taken from. c. The ovum is fertilized in the uterus. d. Ovaries produce sex steroid hormones. e. The breasts contain fat tissue.

A, B, D, E The acidic environment of the vagina helps protect against infection. The cervix is the site for Pap testing. The ovaries produce sex steroid hormones. The breasts contain fat, glandular, fibrous, and ductal tissue. Ova are fertilized in the fallopian tubes. DIF: Cognitive Level: Application/Applying or higher

1272 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 1. A 39-year-old patient with a history of IV drug use is seen at a community clinic. The patient reports difficulty walking, stating I dont know where my feet are. Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-Abs) tests. Based on the patient history, what will the nurse assess (select all that apply)? a. Heart sounds b. Genitalia for lesions c. Joints for swelling and inflammation d. Mental state for judgment and orientation e. Skin and mucous membranes for gummas

A, D, E The patients clinical manifestations and laboratory tests are consistent with tertiary syphilis. Valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage. DIF: Cognitive Level: Analyze (analysis)

1224 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. After scheduling a patient with a possible ovarian cyst for ultrasound, the nurse will teach the patient that she should a. expect to receive IV contrast during the procedure. b. drink several glasses of fluids before the procedure. c. experience mild abdominal cramps after the procedure. d. discontinue taking aspirin for 7 days before the procedure.

B A full bladder is needed for many ultrasound procedures, so the nurse will have the patient drink fluids before arriving for the ultrasound. The other instructions are not accurate for this procedure. DIF: Cognitive Level: Apply (application)

1542 KEY: Reproductive problems| infection| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 13. A 19-year-old college student seeks information from the schools nurse about how to avoid sexually transmitted diseases (STDs) without abstinence as a choice. Which statement by the nurse is best? a. Urinating after intercourse will eliminate the risk of infection. b. A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV). c. Oral contraception can prevent pregnancy and STDs. d. Good handwashing helps prevent infection associated with STDs.

B Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and genital warts. While there is some truth that urination after intercourse may decrease the risk of infection by flushing out organisms, it does not eliminate the risk of contaminating bacteria traveling up the urethra. The other statements are not accurate. DIF: Applying/Application

1525 KEY: LGBTQ| electrolyte imbalances MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 5. The nurse is teaching a transgender client about the medication goserelin (Zoladex). What action by the client indicates good understanding? a. Takes a manual blood pressure b. Administers a subcutaneous injection c. Prepares an implanted port for IV insertion d. States that the axillary area will be clothed

B Goserelin is administered via subcutaneous injection. The other actions are not related to self-management while on this medication. DIF: Evaluating/Synthesis

1270 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 11. When a 31-year-old male patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. When trying to determine the reason for the recurrent infection, which question is most appropriate for the nurse to ask the patient? a. Did you take the prescribed antibiotic for a week? b. Did you drink at least 2 quarts of fluids every day? c. Were your sexual partners treated with antibiotics? d. Do you wash your hands after using the bathroom?

C A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment. DIF: Cognitive Level: Apply (application)

1226 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. A 49-year-old man who has type 2 diabetes, high blood pressure, hyperlipidemia, and gastroesophageal reflux tells the nurse that he has had recent difficulty in achieving an erection. Which of the following drugs from his current medications list may cause erectile dysfunction (ED)? a. Ranitidine (Zantac) b. Atorvastatin (Lipitor) c. Propranolol (Inderal) d. Metformin (Glucophage)

C Some antihypertensives may cause erectile dysfunction, and the nurse should anticipate a change in antihypertensive therapy. The other medications will not affect erectile function. DIF: Cognitive Level: Apply (application)

1531 KEY: Reproductive problems| evidence-based practice| teaching| secondary prevention MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 2. A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. The nurse suspects syphilis. Which action by the nurse is appropriate? a. Reassure the client that this stage is not infectious unless she is pregnant. b. Assess the client for hearing loss and generalized weakness. c. Don gloves and further assess the clients lesions. d. Take a history regarding any cardiovascular symptoms.

C The client is displaying symptoms similar to secondary syphilis, with flu-like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the clients lesions with gloves since the client is highly contagious at this stage. Late latent syphilis is not infectious except to a fetus. Tertiary syphilis may display in the form of cardiovascular or central nervous system symptoms. DIF: Applying/Application

1541 KEY: Reproductive problems| infection| antibiotics MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 7. While evaluating a male client for treatment of gonorrhea, which question is the most important for the nurse to ask? a. Do you have a history of sexually transmitted disease? b. When was your last sexual encounter? c. When did your symptoms begin? d. What are the names of your recent sexual partners?

D Sexual partners, as well as the client, should be tested and treated for gonorrhea. Asking about sexually transmitted disease history, last sexual encounter, and onset of symptoms would be helpful with the history taking, but the priority is treating the clients sexual partners to limit the spread of the disease. DIF: Applying/Application

1458 KEY: Health promotion| self-care| laparoscopy MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 8. A 67-year-old male client had some serum tests performed during his annual examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL; prostate-specific antigen: 10 ng/mL; prolactin: 5 ng/mL. What action by the nurse is best? a. Assess for possible galactorrhea with breast discharge. b. Note the possibility of a testicular tumor. c. Communicate to the provider that results were normal. d. Prepare the client for further diagnostic testing.

D The prostate-specific antigen is increased from the normal of 0 to 2.5, which could indicate benign prostatic hyperplasia or prostate cancer. Further testing would have to be done. The values of testosterone and prolactin are within normal range. If the prolactin were increased, there would be a possibility of galactorrhea. An increase in testosterone could indicate a possible testicular tumor. DIF: Applying/Application

1524-1525 KEY: LGBTQ| health screening MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 1. A nurse instructor is teaching a student nurse about the factors that have increased the number of people with sexually transmitted diseases (STDs) seen in practice. Which statement by the student indicates a lack of understanding? a. There are improved techniques to diagnose an STD used in practice. b. There is increased incidence of sexual abuse and sexual trafficking. c. Females feel safe using oral agents rather than a condom as contraception. d. The organisms causing STDs are all becoming more virulent.

D There is no evidence that the organisms that cause STDs are becoming more virulent, but a client may need to use another anti-infective if allergic or the protocol was not effective. Extensive histories are taken in the clinic of clients of all ages, as well as assessment of laboratory data such as cervical, urethral, oral, or rectal specimens and lesion samples for microbiology and virology. There are changes in sexual attitudes and practices, cultural factors, migration, and international travel. Women often think that the oral contraceptives protect them from an STD. DIF: Applying/Application

1228 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. The nurse is assessing the sexual-reproductive functional health pattern of a 32-year-old woman. Which question is most useful in determining the patients sexual orientation and risk factors? a. Do you have sex with men, women, or both? b. Which gender do you prefer to have sex with? c. What types of sexual activities do you prefer? d. Are you heterosexual, homosexual, or bisexual?

A This question is the most simply stated and will increase the likelihood of obtaining the relevant information about sexual orientation and possible risk factors associated with sexual activity. A patient who prefers sex with women may also have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have sex with both men and women do not identify themselves as homosexual or bisexual. DIF: Cognitive Level: Apply (application)

1538 KEY: Reproductive problems| antiviral medications| infection| cancer MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A 26-year-old client with multiple sexual partners is being assessed for symptoms of dysuria and vaginal discharge. Because the results from the culture of the cervical cells are not available, the client will be treated for both Chlamydia and gonorrhea. Which explanation by the nurse is best? a. This early treatment will prevent obstruction to the fallopian tubes. b. Only azithromycin (Zithromax) is prescribed for both sexually transmitted diseases. c. The treatment will prevent aortic valve disease and aneurysms. d. Oral antibiotic treatment will prevent frequent occurrences of meningitis.

A Both gonorrhea and Chlamydia can cause pelvic inflammatory disease and scarring of the fallopian tubes, resulting in infertility problems. Azithromycin is the treatment of choice for both sexually transmitted diseases, but ceftriaxone (Rocephin) is also recommended for treatment of gonorrhea. Aortic valve disease and aneurysms usually occur with tertiary syphilis. Meningitis occurs rarely with a gonorrhea infection and is usually treated with intravenous antibiotic therapy in the hospital setting. DIF: Applying/Application

1525 KEY: LBGTQ| referrals| communication MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 7. A client has returned from the postanesthesia care unit after a vaginoplasty. What comfort measure does the nurse provide for this client? a. Apply ice to the perineum. b. Elevate the legs on pillows. c. Position the client on the left side. d. Raise the head of the bed.

A Ice is applied to the perineum to reduce pain and discomfort. Elevating the legs on pillows is not recommended after a lengthy procedure in the lithotomy position, which predisposes the client to venous thromboembolism. Positioning the client on the left side and raising the head of the bed are not comfort measures related to this procedure. DIF: Understanding/Comprehension

N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies-Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Analysis) COMPLETION 1. A client weighing 110 lb is admitted with acute pelvic inflammatory disease. The client is ordered to receive an initial dose of gentamicin (Garamycin), 2 mg/kg. The client will receive an initial dose of gentamicin of ____ milligrams.

100 1 kg = 2.2 lb 110 lb/(2.2 kg/lb) = 50 kg 2 mg/kg 50 kg = 100 mg of gentamicin DIF: Cognitive Level: Application/Applying or higher

1543 KEY: Reproductive problems| antibiotics| medication adherence MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies SHORT ANSWER 1. A 23-year-old female was admitted to the hospital for intravenous antibiotic treatment of pelvic inflammatory disease. The provider has ordered cefazolin (Ancef) to be administered every 8 hours. At what rate should the nurse infuse the medication if the pharmacy provides 1 g of the medication in 50 mL of 0.9% NaCl to infuse in 30 minutes? (Record your answer using a whole number.) _____ mL/hr

100 mL/hr To calculate using the dimensional analysis method: (50 mL/30 min) (60 min/1 hr) = 100 mL/hr. DIF: Applying/Application

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis) MSC: Integrated Process: Nursing Process (Implementation) 9. A client with primary syphilis was treated with an intramuscular injection of benzathine penicillin G. Later, the client reports a hard painful lump at the injection site and aching joints. Which is the nurses highest priority initial action? a. Assess the clients vital signs. b. Give the client acetaminophen (Tylenol). c. Document the finding in the chart. d. Apply a warm compress to the site.

A A common reaction to penicillin injections for primary syphilis is the Jarisch-Herxheimer reaction, caused by rapid destruction of the causative microorganism and release of intracellular products. This is not usually serious, but it can cause fever and hypotension. The nurse should first assess the clients blood pressure for stability and should take the temperature. Then if the clients condition warrants, the nurse can administer acetaminophen or even fluids if needed. Documentation can be completed after the assessment is done. A warm compress to the site may or may not be helpful. DIF: Cognitive Level: Application/Applying or higher

p. 1663 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning 13. A client is brought to the emergency department by the family, who state that the client was diagnosed last week with gonorrhea but has not taken the medications yet. Today the family notes that the client is not acting right and seems confused. Which action by the nurse is most appropriate? a. Start an IV and notify the health care provider about the clients diagnosis. b. Perform a thorough neurologic assessment and document the findings. c. Administer acetaminophen (Tylenol) if the client has a fever. d. Ask the client why he or she has not started the medication regimen yet.

A A rare but possible complication of gonorrhea is meningitis. Because the client has a change in mental status according to the family, the nurse must prepare the client for IV antibiotics to be given as soon as possible. The provider needs to know the diagnosis of untreated gonorrhea to help plan appropriate, rapid care. Conducting a neurologic examination and administering Tylenol are appropriate but do not take priority over initiating appropriate therapy. When the client is stable, the nurse can assess for reasons leading to noncompliance and offer appropriate assistance, such as referral to social services if the client cannot afford medications. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Assessment) 20. A female client admitted for cardiac problems also has condyloma acuminatum. Which type of precautions does the nursing staff implement with this client? a. Standard b. Airborne c. Contact d. Droplet

A Although it is considered highly contagious, condyloma acuminatum requires close intimate contact for transmission. Only Standard Precautions are needed for health care providers. DIF: Cognitive Level: Application/Applying or higher

1272 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 8. Which infection, reported in the health history of a woman who is having difficulty conceiving, will the nurse identify as a risk factor for infertility? a. N. gonorrhoeae b. Treponema pallidum c. Condyloma acuminatum d. Herpes simplex virus type 2

A Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility. Syphilis, genital warts, and genital herpes do not lead to problems with conceiving, although transmission to the fetus (syphilis) or newborn (genital warts or genital herpes) is a concern. DIF: Cognitive Level: Apply (application)

1263-1264 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 4. A 46-year-old man who has had blood drawn for an insurance screening has a positive Venereal Disease Research Laboratory (VDRL) test. Which action should the nurse take next? a. Ask the patient about past treatment for syphilis. b. Explain the need for blood and spinal fluid cultures. c. Obtain a specimen for fluorescent treponemal antibody absorption (FAT-Abs) testing. d. Assess for the presence of chancres, flulike symptoms, or a bilateral rash on the trunk.

A Once antibody testing is positive for syphilis, the antibodies remain present for an indefinite period of time even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FAT-Abs testing, and assessment for symptoms may be appropriate, based on whether the patient has been previously treated for syphilis. DIF: Cognitive Level: Apply (application)

1264 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 12. A 29-year-old female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following? a. My partner will need to take antibiotics at the same time I do. b. Go ahead and give me the antibiotic injection, so I will be cured. c. I will use condoms during sex until I finish taking all the antibiotics. d. I do not plan on having children, so treating the infection is not important.

A Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment, and condoms should be recommended during all sexual contacts to prevent infection. Chronic pelvic pain, as well as infertility, can result from untreated Chlamydia. DIF: Cognitive Level: Apply (application)

1272 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. A 20-year-old woman who is being seen in the family medicine clinic for an annual physical exam reports being sexually active. The nurse will plan to teach the patient about a. testing for Chlamydia infection. b. immunization for herpes simplex. c. infertility associated with the human papillomavirus (HPV). d. the relationship between the herpes virus and cervical cancer.

A Testing for Chlamydia is recommended for all sexually active females under age 25 by the Centers for Disease Control and Prevention. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 5. The nurse is working with a client who is recovering after a cervical biopsy. Which statement by the client indicates a need for further instruction? a. I can resume vaginal intercourse after 6 weeks. b. I should report heavy bleeding to the health care provider. c. I must not lift heavy objects for about 2 weeks. d. I will use the antiseptic rinse on a regular basis.

A The client should be instructed to keep the perineum clean and dry by using antiseptic solution rinses (as directed by her health care provider) and changing pads frequently. In addition, the client is instructed not to lift heavy objects for 2 weeks and to report excessive bleeding (more than like a normal period). She can resume intercourse in about 2 weeks, when the site has healed; she does not need to wait 6 weeks. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Teaching/Learning 2. Which statement by a middle-aged woman indicates that further instruction is needed for her and her partner regarding prevention of sexually transmitted diseases (STDs)? a. Im glad we dont have to use condoms anymore because I cant get pregnant. b. Changes in my vagina may make me more likely to be at risk for an STD. c. I told my partner that we need to switch to condoms instead of the pill now. d. I should report any evidence of infection, even if symptoms are minor.

A The female who is probably postmenopausal should still use barrier protection to decrease the risk of contracting a sexually transmitted disease. Unfortunately, many women forget that they need barrier protection (i.e., condoms) once the need for contraception is gone. Any evidence of infection should be reported promptly because vaginal atrophy makes this client more vulnerable to develop an STD. DIF: Cognitive Level: Application/Applying or higher

1264 | 1266 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. A 19-year-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because the warts are so disgusting. Which nursing diagnosis is mostappropriate? a. Disturbed body image related to feelings about the genital warts b. Ineffective coping related to denial of increased risk for infection c. Risk for infection related to lack of knowledge about transmission d. Anxiety related to impact of condition on interpersonal relationships

A The patients statement that her lesions are disgusting suggests that disturbed body image is the major concern. There is no evidence to indicate ineffective coping or lack of knowledge about mode of transmission. The patient may be experiencing anxiety, but there is nothing in the data indicating that the genital warts are impacting interpersonal relationships. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 15. When scheduling an annual pelvic examination and Pap test, the client asks if she should abstain from intercourse before the test. Which is the nurses best response? a. Yes. Avoid having intercourse for 24 hours before the test. b. Yes. Avoid having intercourse for 2 hours before the test. c. No. Intercourse does not interfere with this test. d. No. Intercourse can actually enhance the test results.

A The woman should not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test. Such activities may prevent the accurate evaluation of smears, cultures, and cytologic data. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Implementation) 17. A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate? a. Do you still have your cervix? b. Are you sexually active? c. We can skip it if you like. d. Lets see what the doctor says.

A Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant. Simply stating that it can be skipped does not help the woman protect her health. Asking the provider does not help the nurse further assess the client. DIF: Cognitive Level: Application/Applying or higher

1534 KEY: Reproductive problems| infection| health screening MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 9. A 23-year-old female has been diagnosed with genital warts. Which action by the nurse is best? a. Encourage the client to have an annual Papanicolaou (Pap) test. b. Recommend an over-the-counter wart treatment for genital tissue. c. Report the case to the Centers for Disease Control and Prevention (CDC). d. Discuss popular options for contraception.

A An annual Pap test is recommended (due the strong relationship between genital warts and the development of dysplasia of the cervix) until three normal Pap smears are obtained. The Pap smear can detect any malignancies of the cervix. Prescribed cream or gel such as podofilox (Condylox) is the recommended treatment, but not over-the-counter treatments. Genital warts, or condylomata acuminata, do not have to be reported to the CDC in all states. Pregnancy is not contraindicated with genital warts. DIF: Applying/Application

1528 KEY: LGBTQ| postoperative nursing| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 2. A student nurse is learning about the health care needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients. Which terms are correctly defined? (Select all that apply.) a. Gender dysphoria Distress caused by incongruence between natal sex and gender identity b. Gender queer A label used when gender identity does not conform to male or female c. Natal sex The sex one is born with or is assigned to at birth d. Transgender A person who dresses in the clothing of the opposite sex e. Transition The time between questioning and establishing a sexual identity

A, B, C Gender dysphoria is emotional distress caused by the incongruence between natal sex (sex assigned at birth) and gender identity. Gender queer is a label sometimes used by people whose gender identity does not fit the established categories of male or female. Natal sex describes the gender a person is born with or is assigned to at birth. Transgender is an adjective to describe a person who crosses or transcends culturally defined categories of gender. Transition is the period of time when transgender individuals change from the gender role associated with their sex to a different gender role. DIF: Remembering/Knowledge

1536 KEY: Reproductive problems| pain| comfort measures MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort MULTIPLE RESPONSE 1. A primary care clinic sees some clients with sexually transmitted diseases. Which clients would the nurse be required to report to the local authority in every state, according to the Centers for Disease Control and Prevention? (Select all that apply.) a. Client with Chlamydia b. Woman with gonorrhea c. Man with syphilis d. Client with human immune deficiency virus e. Female with pelvic inflammatory disease

A, B, C, D Chlamydia, gonorrhea, syphilis, chancroid, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state. Pelvic inflammatory disease does not need to be reported. DIF: Remembering/Knowledge

1520 KEY: LGBTQ MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Psychosocial Integrity 3. A nurse works with many transgender clients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.) a. Lipid profile b. Liver function tests c. Mammograms if breast tissue is present d. Prostate-specific antigen (PSA) for natal males e. Renal profile

A, B, C, D Common routine monitoring for this population includes lipid and liver panels, mammograms if any breast tissue is present, and PSA for natal males as the prostate is not removed during a vaginoplasty/penectomy. Renal profiles are not required based on treatment options for this population. DIF: Remembering/Knowledge

1534 KEY: Reproductive problems| antibiotics| allergic reaction MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 4. Which risk factors would the nurse teach a 23-year-old client about to prevent pelvic inflammatory disease (PID)? (Select all that apply.) a. Having multiple sexual partners b. Using an intrauterine device (IUD) c. Smoking d. Drinking two alcoholic beverages per day e. Having a history of sexually transmitted diseases (STDs)

A, B, C, E Some of the same factors that place women at risk for STDs also place women at risk for PID: sexually active women of age younger than 26 years, multiple sexual partners, use of an IUD, smoking, and a history of STDs. Alcohol consumption does not impact a womans risk for PID. DIF: Remembering/Knowledge

1268-1269 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 3. The nurse in the outpatient clinic notes that the following patients have not received the human papillomavirus (HPV) vaccine. Which patients should the nurse plan to teach about benefits of the vaccine (select all that apply)? a. 24-year-old man who has a history of genital warts b. 18-year-old man who has had one male sexual partner c. 28-year-old woman who has never been sexually active d. 20-year-old woman who has a newly diagnosed Chlamydia infection e. 30-year-old woman whose sexual partner has a history of genital warts

A, B, D The HPV vaccines are recommended for male and female patients between ages 9 through 26. Ideally, the vaccines are administered before patients are sexually active, but they offer benefit even to those who already have HPV infection. DIF: Cognitive Level: Apply (application)

1527 KEY: LGBTQ| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The nurse is reviewing possible complications from a phalloplasty. What factors does the nurse include? (Select all that apply.) a. Infection of donor site b. Necrosis of the neopenis c. Rectal perforation d. Urinary tract stenosis e. Vaginal infections

A, B, D Complications from phalloplasty include infection or scarring of the donor site, necrosis, and stenosis of the urinary tract. Rectal perforation can occur with vaginoplasty, as can infections. DIF: Understanding/Comprehension

1542 KEY: Reproductive problems| primary survey| safer sexual practices MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 5. The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted disease (STD). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.) a. I need to drink at least 8 glasses of fluid each day with my antibiotic. b. I should read the instructions to see if I can take the medication with food. c. Antacids should not interfere with the effectiveness of the antibiotic. d. I need to wait 7 days after the last dose of the antibiotic to engage in intercourse. e. It should not matter if I skip a couple of doses of the antibiotic.

A, B, D When a client is being treated with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the last dose of the antibiotic and sexual intercourse to allow for the medications full effects. Use of antacids and missing doses could decrease the effectiveness of the antibiotic. DIF: Remembering/Knowledge

1531 KEY: Reproductive problems| infection control| secondary prevention MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a female client diagnosed with both diseases. Which items should be included in the clients teaching plan? (Select all that apply.) a. Expedited partner therapy b. Abstinence until therapy is completed c. Use of internal uterine devices d. Proper use of condoms e. Re-screening for infection f. Use of oral contraception

A, B, D, E As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and re-screening for re-infection 3 to 12 months after treatment. The use of an intrauterine device and oral contraception is not part of the plan. DIF: Applying/Application

1452 KEY: Adult life stages| older adult| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The nurse is assessing a client for reproductive health problems. What would be the priority assessments? (Select all that apply.) a. Bleeding b. Pain c. Sexual orientation d. Masses e. Discharge

A, B, D, E Bleeding, pain, masses, and discharge are common health problems that bring a client to a health care provider. Sexual orientation is not considered a health problem. Sexual activity should be assessed as part of the clients history. DIF: Remembering/Knowledge

1539 KEY: Reproductive problems| infection| patient-centered care MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 3. A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.) a. Red rash b. Shortness of breath c. Heart irregularity d. Chest tightness e. Anxiety

A, B, D, E The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness. Heart irregularity is not seen as an allergic manifestation. DIF: Remembering/Knowledge

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Teaching/Learning 2. A young adult client is in the clinic for evaluation of amenorrhea lasting 3 months. She takes birth control pills but is on no other medications. Which actions by the nurse are most appropriate? (Select all that apply.) a. Instruct the client on collecting a urinalysis for a pregnancy test. b. Assess the clients urinary and bowel habits. c. Perform a physical assessment on the clients abdomen. d. Weigh the client and calculate the body mass index. e. Reassure the client that amenorrhea can occur with oral contraception.

A, D Amenorrhea can be caused by several things, but not by urinary or bowel problems. Pregnancy should always be considered, even if the woman is on birth control of any type. Too little body fat can lead to menstrual irregularities. Simply reassuring the client is not as helpful as conducting further assessment. DIF: Cognitive Level: Application/Applying or higher

p. 1581 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Teaching/Learning 14. A young woman is not pregnant but has not had a menstrual period for 5 months. Which factors does the nurse explore as a possible cause of the amenorrhea? a. The clients mother having type 2 diabetes mellitus b. Running 10 to 15 miles/day c. Taking aspirin daily d. Having a diet high in protein

B Excessive exercise, with corresponding loss of body fat, is associated with insufficient estrogen levels for the maintenance of normal ovulatory and menstrual cycles. The other factors are noncontributory. DIF: Cognitive Level: Application/Applying or higher

p. 1584 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Teaching/Learning 19. An African-American client has a prostate-specific antigen (PSA) of 12 ng/mL. Which action by the nurse is best? a. Remind the client to repeat the test in 1 year. b. Prepare the client for further diagnostic testing. c. Ask if the client ejaculated within 48 hours of the test. d. Assess the client for alcohol and tobacco use.

B A normal PSA level is less than 4 ng/mL. Elevated PSA levels, particularly those over 10 ng/mL, are associated with cancer. African Americans tend to have higher PSA levels as they age, but this level is so high that the nurse must suspect cancer and prepare the client for further diagnostic testing. The client should not wait a year to repeat the test. The client should not ejaculate for 24 hours before having blood drawn. Alcohol and tobacco use does not cause an elevation in PSA. DIF: Cognitive Level: Application/Applying or higher

1523 KEY: LGBTQ| health screening| male reproductive problems MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 3. A transgender client is taking transdermal estrogen (Climara). What assessment finding does the nurse report immediately to the provider? a. Breast tenderness b. Headaches c. Red, swollen calf d. Swollen ankles

C A red, swollen calf could be a manifestation of a deep vein thrombosis, a known side effect of estrogen. The nurse reports this finding immediately. The other manifestations are also side effects of estrogen, but do not need to be reported as a priority. DIF: Applying/Application

1545 KEY: Reproductive problems| drug calculation| antibiotics MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 1. The nurse is counseling a postmenopausal woman about her new stress incontinence. Which statement by the nurse is most important? a. You can try a variety of briefs and undergarments. b. It will be important to keep that area clean and dry. c. I can refer you to a good incontinence clinic. d. Unfortunately, incontinence is common in women your age.

B After menopause, the vagina becomes dry, thinner, and smoother. This atrophy places the vagina at risk for infection. The combination of this fact with the presence of urine places the woman at higher risk for infection. The nurse should teach the client good hygienic practices to reduce the likelihood of infection. Education about briefs/undergarments may be needed, and a referral to an incontinence clinic would be very helpful, but neither takes priority over preventing infection. Stating that incontinence is common is not a helpful strategy. DIF: Cognitive Level: Application/Applying or higher

p. 1660 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 22. The nurse manages a clinic in an area with a high rate of sexually transmitted diseases (STDs). Which strategy best helps decrease the rate of infection? a. Start an expedited partner treatment program. b. Use a single-dose drug given in the clinic. c. Provide referrals to a low-cost pharmacy. d. Plan occasional community educational programs.

B Although all options could decrease the occurrence rate of STDs, administering the medications needed to control two common STDs (gonorrhea and Chlamydia) right in the clinic improves compliance and will help decrease rates of infection in the fastest way. The manager would need to investigate the legal issues surrounding expedited partner treatment before starting a program. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation) 17. A female client is diagnosed with human papilloma virus (HPV) infection. Which intervention by the nurse takes priority? a. Instruct the client on using podofilox (Condylox) cream. b. Prepare the client for a Pap test and HPV DNA testing. c. Teach the client to take all medications until they are gone. d. Encourage the client to drink 8 to 10 glasses of water daily.

B Because certain strains of HPV cause cervical cancer, the client needs to have a Pap smear and HPV DNA testing done. The nurse should also teach her to use topical medications, such as Condylox, but this is not as high a priority as diagnostic testing. The other two options are not related to infection with HPV. DIF: Cognitive Level: Application/Applying or higher

1232 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. A 24-year-old female says she wants to begin using oral contraceptives. Which information from the nursing assessment is most important to report to the health care provider? a. The patient quit smoking 5 months previously. b. The patients blood pressure is 154/86 mm Hg. c. The patient has not been vaccinated for rubella. d. The patient has chronic iron-deficiency anemia.

B Because hypertension increases the risk for morbidity and mortality in women taking oral contraceptives, the patients blood pressure should be controlled before oral contraceptives are prescribed. The other information also will be reported but will not affect the choice of contraceptive. DIF: Cognitive Level: Apply (application)

1267 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 3. A 22-year-old patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains to the patient that this combination of antibiotics is prescribed to a. prevent reinfection during treatment. b. treat any coexisting chlamydial infection. c. eradicate resistant strains of N. gonorrhoeae. d. prevent the development of resistant organisms.

B Because there is a high incidence of co-infection with gonorrhea and chlamydia, patients are usually treated for both. The other explanations about the purpose of the antibiotic combination are not accurate. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Psychosocial Integrity (Cultural Diversity) MSC: Integrated Process: Nursing Process (Assessment) 11. The nurse is teaching a postmenopausal woman about nutrition. Which statement by the nurse is most appropriate? a. Be sure to eat cereal fortified with folic acid and B vitamins. b. Make sure you take a calcium supplement every day. c. Vitamin C is important for the postmenopausal woman. d. You can get all the iron you need in two daily meat servings.

B Calcium is important throughout life, but for the postmenopausal woman, it is vital to help prevent osteoporosis. Folic acid and B and C vitamins are very important for the woman taking oral contraceptives. Iron might be important for this client for other reasons but is especially important for women with heavy menstrual bleeding. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationTherapeutic Procedures) MSC: Integrated Process: Nursing Process (Implementation) 7. A postmenopausal client says that she is experiencing difficulty with vaginal dryness during intercourse and wonders what might be causing this. Which is the nurses best response? a. The less frequently you have intercourse, the drier the vaginal tissues become. b. Estrogen deficiency causes the vaginal tissues to become drier and thinner. c. Drinking at least 3 liters of water each day will make all your tissues less dry. d. Try using a water-soluble lubricant during intercourse.

B Estrogen deprivation, which occurs as a result of menopause, decreases the moisture-secreting capacity of vaginal cells, thereby making the area drier. The vaginal tissues also become thinner and the rugae become smoother. Reduced frequency of intercourse will not dry out the vaginal tissues. Drinking excess water will not make the tissues less dry. A water-soluble lubricant may make intercourse less difficult. However, the client is asking what causes the problem. DIF: Cognitive Level: Application/Applying or higher

1234 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 5. A 22-year-old patient reports her concern about not having a menstrual period for the past 7 months. Which statement by the patient indicates a possible related factor to the amenorrhea? a. I drink at least 3 glasses of nonfat milk every day. b. I run 7 to 8 miles every day to keep my weight down. c. I was treated for a sexually transmitted infection 2 years ago. d. I am not sexually active but currently I have an IUD.

B Excessive exercise can cause amenorrhea. The other statements by the patient do not suggest any urgent teaching needs. DIF: Cognitive Level: Apply (application)

1263 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 6. A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-Abs) tests, rashes on the palms and the soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care? a. Assess for arterial aneurysms. b. Wear gloves for patient contact. c. Place the patient in a private room. d. Apply antibiotic ointment to the perineum.

B Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis. DIF: Cognitive Level: Apply (application)

1235 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 8. A couple is scheduled to have a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about a. being sedated during the procedure. b. determining the estimated time of ovulation. c. experiencing shoulder pain after the procedure. d. refraining from intercourse before the appointment.

B For the Huhner test, the couple should have intercourse at the estimated time of ovulation and then arrive for the test 2 to 8 hours after intercourse. The other instructions would be used for other types of fertility testing. DIF: Cognitive Level: Apply (application)

1264-1265 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 5. A 48-year-old male patient who has been diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that a. women do not develop gonorrhea infections but can serve as carriers to spread the disease to males. b. women may not be aware they have gonorrhea because they often do not have symptoms of infection. c. women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations. d. when gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.

B Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease (PID). Women who can transmit the disease have active infections. DIF: Cognitive Level: Understand (comprehension)

N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Teaching/Learning 2. An older woman is asking the nurse about her husbands sexual functioning. Which statement by the nurse is most accurate? a. Men his age tend to have a rapid decline in sexual abilities. b. His testosterone levels will decrease only slightly until he is quite old. c. Changes in testosterone levels do not affect sexual performance. d. You are lucky your husband is healthy enough for sexual activity.

B Men experience a gradual but slight decrease in testosterone until they are in their 80s. Low testosterone levels do affect sexual performance. Stating that the woman is lucky does not give accurate information about sexual functioning. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis) MSC: Integrated Process: Nursing Process (Implementation) 21. Why are women more likely than men to have silent sexually transmitted disease (STD) infection? a. Women are less susceptible to STDs and are not assessed often for them. b. Lesions may not be visible, or the woman can be asymptomatic. c. A mans longer urethra provides increased opportunity for bacteria to multiply. d. Symptoms of infection in women are likely to be systemic and vague, not local.

B Most clinical manifestations of an STD in a man are experienced in or around the penis. Most of a womans genital mucous membranes are inside the vagina and around the cervix, where direct observation of any lesions is unlikely. Also some women have no symptoms or only vague symptoms of STDs, and this leads to a delay in diagnosis. DIF: Cognitive Level: Comprehension/Understanding

p. 1656 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Teaching/Learning 5. A client has been diagnosed with genital herpes. Which statement by the client indicates an accurate understanding of the disease and treatment? a. Antiviral drugs can cure genital herpes and prevent a recurrence. b. I can prevent outbreaks with suppressive antiviral therapy. c. Suppressive therapy will prevent shedding of the virus. d. Medication should be taken only when symptoms are present.

B No cure for the disease is known, but it can be controlled with suppressive therapy with antiviral drugs. The client can be shedding the virus with no symptoms present and despite the use of antiviral medications. Medications should be taken on a suppressive basis or as soon as the client has symptoms. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures) MSC: Integrated Process: Nursing Process (Implementation) 10. Which statement made by a client about condom use indicates a need for clarification? a. I will use a new condom each time I have intercourse. b. I will use an oil-based lubricant whenever I have intercourse. c. I will always use a latex condom rather than a natural membrane condom. d. I will keep the condom on until I have withdrawn from the vagina.

B Oil-based lubricants can dissolve or damage the condom. Only water-soluble lubricants should be used with condoms. The other statements are accurate. DIF: Cognitive Level: Application/Applying or higher

1227 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. An 18-year-old female patient who has been admitted to the emergency department after a motor vehicle crash is scheduled for chest and abdominal x-rays. Which information is most important to report to the health care provider before the x-rays are obtained? a. Severity of abdominal pain b. Positive result of hCG test c. Blood pressure 172/88 mm Hg d. Temperature 102.1 F (38.9 C)

B Positive hCG testing indicates that the patient is pregnant and that unnecessary abdominal x-rays should be avoided. The other information is also important to report, but it will not affect whether the x-rays should be done. DIF: Cognitive Level: Apply (application)

p. 1577 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Teaching/Learning 3. The nurse is preparing a teaching plan for a client who is scheduled to undergo mammography for the first time. What instruction by the nurse is accurate? a. The test should be carried out even if you are pregnant. b. Do not use deodorant on breasts or underarms before the test. c. You will not experience any discomfort because this is just an x-ray. d. The entire test should not take longer than 1 hour.

B The client should be reminded not to use creams, powders, or deodorant on breast or underarm areas before mammography because these products can show on the x-ray. The test should be rescheduled if any possibility exists that the client is pregnant. Women can experience discomfort as the breasts are compressed. The test is generally much less than an hour in duration. DIF: Cognitive Level: Comprehension/Understanding

p. 1663 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) 16. Which should be the nursing focus for a female client during the initial outbreak of genital herpes simplex? a. Instruction in condom use b. Promotion of comfort c. Prevention of pregnancy d. Institution of isolation

B The initial outbreak of genital herpes simplex in a woman causes severe discomfort. Promotion of comfort is the first priority, because clients may not be receptive to instruction attempts until some degree of comfort has been achieved. DIF: Cognitive Level: Application/Applying or higher

p. 1656 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Teaching/Learning 8. A client has secondary syphilis. What precautions are necessary for the nurse to take when caring for this client? a. No precautions in addition to Standard Precautions are necessary. b. Gloves should be worn whenever direct contact with the clients skin is required. c. Handwashing is required before and after contact with the client. d. A mask should be worn by anyone entering the clients room.

B The secondary stage of syphilis is a systemic disease, with microorganisms present in the clients blood. Skin lesions and rashes are present. These lesions are considered highly contagious and should not be touched without gloves. Handwashing before and after contact is needed but is not sufficient to prevent spread of the disease. Masks are not needed. DIF: Cognitive Level: Application/Applying or higher

1264 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 14. A 32-year-old woman who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? a. You may need professional counseling to help resolve your anger. b. It is understandable that you are angry with your husband right now. c. Your feelings are justified and you should share them with your husband. d. It is important that both you and your husband be treated for the infection.

B This response expresses the nurses acceptance of the patients feelings and encourages further discussion and problem solving. The patient may need professional counseling, but more assessment of the patient is needed before making this judgment. The nurse should also assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patients current anger suggests that this is not the appropriate time to bring this up. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Nursing Process (Evaluation) 11. A client has been diagnosed with Trichomonas vaginalis. Which statement by the client indicates an accurate understanding of this disease? a. I need to have a throat culture for Trichomonas. b. This will affect only my vagina and can cause itching. c. My partner does not need to be treated. d. My lymph nodes may stay swollen after treatment.

B Trichomoniasis affects only the vagina in females, leading to itching and vaginal discharge. Men can get it too, so both partners need treatment. Lymph nodes are not affected. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Assessment) 1. The nurse is teaching a young woman about her risk of contracting a sexually transmitted disease (STD). Which statement by the client indicates that further instruction is needed? a. I am at decreased risk for an STD if I dont rely on contraceptive sponges or foams to protect me. b. I am at decreased risk for an STD because I am using an intrauterine device for contraception. c. I am at increased risk for an STD because of the way that my body is designed as a woman. d. I will be at increased risk for an STD if I rely on oral contraceptives to protect me from contracting a disease.

B Using an intrauterine device provides no protection against contracting a sexually transmitted disease. Other risk factors that increase a young womans chances of contracting a sexually transmitted disease include the vascularity of the vagina and reliance on contraceptive sponges or foams or on oral contraceptives for protection against pregnancy and STDs. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication) MSC: Integrated Process: Nursing Process (Assessment) 7. A client has just been diagnosed with a recurrence of genital herpes simplex. She asks how this is possible because she has not had sex since she was diagnosed and treated 1 year ago. Which is the nurses best response? a. Sometimes one course of therapy is not enough to eradicate the disease. b. The disease can be controlled but is never cured, and outbreaks are common. c. Did you take the medication exactly the way it was prescribed for you? d. If you have more than one sex partner, you may have more than one strain.

B Viral diseases cannot be cured. Antiviral drugs suppress viral replication but do not kill the organism. The causative virus remains in the body and can become active at any time. The other statements are not accurate. DIF: Cognitive Level: Comprehension/Understanding

1455 KEY: Older adult| health promotion| prostate cancer MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 9. A 72-year-old woman is being assessed by the nurse for an annual physical. Which finding is of concern to the nurse? a. Thinning of pubic hair b. Increased size of the uterus c. Decreased size of the clitoris d. Loss of tone of the pelvic ligaments

B An increased size of the uterus is an abnormal finding and should be assessed further. Normal changes in the reproductive system related to aging include the graying and thinning of pubic hair, decreased size of the labia majora and clitoris, and loss of tone and elasticity of the pelvic ligaments and connective tissue. The uterus would normally be decreased, not increased, in size due to changes in hormonal levels and atrophy. DIF: Remembering/Knowledge

1532 KEY: Reproductive problems| secondary prevention| nursing assessment| Standard Precautions MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time? a. Have you been using latex condoms? b. Are you allergic to penicillin? c. When was your last sexual encounter? d. Do you have a history of sexually transmitted disease?

B Benzathine penicillin G is the evidence-based treatment for primary syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the clients history of sexually transmitted diseases but not as important as knowing whether the client is allergic to penicillin. DIF: Applying/Application

1453 KEY: Adult life stages| older adult| nursing assessment MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. The nurse is reviewing discharge instructions with a client who has just experienced an endometrial biopsy. Which finding should be reported to the health care provider immediately? a. Mild cramping b. Slight chills and fever c. Spotting of blood on a perineal pad d. Fatigue after anesthesia

B Chills and fever could indicate an infection and should be reported immediately to the health care provider. Mild cramping, spotting, and fatigue are normal findings after an endometrial biopsy. DIF: Applying/Application

1527 KEY: LGBTQ| comfort measures| postoperative nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 8. A client had a vaginoplasty under epidural anesthetic. Which action by the nurse is most important? a. Ensure that the urinary catheter is securely attached to the leg. b. Instruct the client not to try to get out of bed unassisted. c. Monitor the clients dressings and wound drainage. d. Position the Jackson-Pratt drain to the contralateral side.

B Epidural anesthesia will cause the client to not be able to move (or feel) the legs for several hours. It is important for client safety that adequate help is available prior to this client trying to get out of bed. Securing the catheter to the leg and monitoring dressings and drainage are important for any client after surgery. Positioning the drain to the contralateral side is not needed. DIF: Applying/Application

1525 KEY: LGBTQ| medication administration| patient education MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A client is preparing for gender reassignment surgery and will transition from male to female. The client is worried about the voice not sounding feminine enough. What action by the nurse is best? a. Ask if the client has considered vocal cord surgery to change the voice. b. Refer the client for vocal therapy with speech-language pathology. c. Teach the client that there will be no effect on the clients voice. d. Tell the client that the use of hormones will eventually change the voice.

B Male-to-female clients can consult with a speech-language pathologist for vocal training to help with intonation and pitch. While vocal surgery is possible, it may not be the best first option due to cost and invasiveness. Telling the client there will be no change to the voice does not give the client information to address the concern. While the hormones this client is taking will not affect the voice, simply stating that fact does not help the client manage this issue. DIF: Applying/Application

1453 KEY: Exercise| health promotion| lifestyle choices MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity 5. A nurse and unlicensed assistive personnel (UAP) are helping a client during a hysterosalpingogram. Which action by the nurse is best delegated to the UAP? a. Witnessing of the consent form b. Assisting the client into a lithotomy position c. Asking about allergies to iodine or shellfish d. Assessing for pelvic or shoulder pain after the study

B The UAP would be able to position the client for the procedure. Only the nurse has the ability to witness the consent form and assess allergies and pain within the nursing scope of practice. DIF: Applying/Application

1533 KEY: Reproductive problems| patient safety| secondary prevention MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 4. An African-American female with blisters on the vagina is being treated with acyclovir (Zovirax) for genital herpes. She is angry at her partner for transmitting the infection. Which action by the nurse is best? a. Encourage the client to engage in sexual activity since she is on medication. b. Be sensitive to the clients feelings and refer her to a support group. c. Reinforce that the disease can no longer be spread to other partners. d. Reassure the client that sexual activity will not be painful while on acyclovir.

B The nurse needs to be sensitive and supportive of the client since infected clients may feel angry, lonely, and isolated. Allow the client to verbalize her feelings and refer her to a local support group, such as the National Herpes Resource Center. Sexual activity should not occur while the lesions are present because of discomfort and viral transmission. Genital herpes is an incurable viral disease, and the antiviral drugs minimize the infection but do not cure it. Condoms should be used to avoid the spread of the disease. DIF: Applying/Application

1458 KEY: Infection control| wound infection| discharge teaching MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 4. A client is concerned about her irregular menstrual periods since she has increased her daily workouts at the gym to 2 hours each day. What is the nurses best response? a. Do you want to talk about the need for that much exercise? b. Exercise is healthy but can decrease body fat and cause irregular periods. c. Bingeing and purging can cause electrolyte problems in your body. d. Anorexic behavior can result in decreased estrogen levels.

B There needs to be a certain level of body fat and weight to maintain regular menstrual cycles. The client has only indicated that she has increased her workouts. There is no indication that she has anorexic or bingeing and purging behaviors. DIF: Applying/Application

1265 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex (select all that apply)? a. Infected areas should be kept moist to speed healing. b. Sitz baths may be used to relieve discomfort caused by the lesions. c. Genital herpes can be cured by consistent use of antiviral medications. d. Recurrent genital herpes episodes usually are shorter than the first episode. e. The virus can infect sexual partners even when you do not have symptoms of infection.

B, D, E Patients are taught that shedding of the virus and infection of sexual partners can occur even in asymptomatic periods, that recurrent episodes resolve more quickly, and that sitz baths can be used to relieve pain caused by the lesions. Antiviral medications decrease the number of outbreaks, but do not cure herpes simplex infections. Infected areas may be kept dry if this decreases pain and itching. DIF: Cognitive Level: Apply (application)

1267 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. A woman is diagnosed with primary syphilis during her eighth week of pregnancy. The nurse will plan to teach the patient about the a. likelihood of a stillbirth. b. plans for cesarean section c. intramuscular injection of penicillin. d. antibiotic eye drops for the newborn.

C A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and prevent transmission of the disease to the fetus. Instillation of erythromycin into the eyes of the newborn is used to prevent gonorrheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the tenth week of gestation will eliminate in utero transmission to the fetus. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment) 13. The nurse is counseling a mother who wants her teenage daughter to have a Pap smear and pelvic examination. Which statement by the nurse is most accurate? a. If your daughter is over 18, she needs a pelvic examination and Pap smear. b. A teenager does not need this examination unless she is sexually active. c. Teach her to have her first examination by the age of 21 at the latest. d. It is not needed unless you are worried about sexually transmitted diseases.

C A woman needs to have her first pelvic examination with Pap smear by the age of 21, or within 3 years of becoming sexually active. The other statements are not accurate. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) 12. When performing an assessment of the external genitalia of an older man, the nurse observes the scrotum to have smooth skin and to be very pendulous. Which action by the nurse is most appropriate? a. Suggest to the client that he should wear an athletic supporter while awake. b. Ask the client if he has been treated for a sexually transmitted disease. c. Document the observation and continue the assessment. d. Notify the health care provider and facilitate a scrotal ultrasound.

C As the male client ages, the scrotum loses rugae and becomes increasingly pendulous. This is a normal assessment finding. No further action is needed. DIF: Cognitive Level: Application/Applying or higher

1226 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 12. A 19-year-old patient calls the school clinic and tells the nurse, My menstrual period is very heavy this time. I have to change my tampon every 4 hours. Which action should the nurse take next? a. Tell the patient that her flow is not unusually heavy. b. Schedule the patient for an appointment later that day. c. Ask the patient how heavy her usual menstrual flow is. d. Have the patient call again if the heavy flow continues.

C Because a heavy menstrual flow is usually indicated by saturating a pad or tampon in 1 to 2 hours, the nurse should first assess how heavy the patients usual flow is. There is no need to schedule the patient for an appointment that day. The patient may need to call again, but this is not the first action that the nurse should take. Telling the patient that she does not have a heavy flow implies that the patients concern is not important. DIF: Cognitive Level: Apply (application)

1229 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 4. The nurse is providing teaching by telephone to a patient who is scheduled for a pelvic examination and Pap test next week. The nurse instructs the patient that she should a. shower, but not take a tub bath, before the examination. b. not have sexual intercourse the day before the Pap test. c. avoid douching for at least 24 hours before the examination. d. schedule to have the Pap test just after her menstrual period.

C Because the results of a Pap test may be affected by douching, the patient should not douche before the examination. The exam may be scheduled without regard to the menstrual period. The patient may shower or bathe before the examination. Sexual intercourse does not affect the results of the examination or Pap test. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Teaching/Learning 8. The nurse is assessing a client with a history of irregular periods. Which condition does the nurse possibly correlate with this problem? a. Childhood mumps b. Past valve replacement surgery c. Diabetes mellitus d. Mild intermittent asthma

C Endocrine disorders can affect the hypothalamic-pituitary-gonadal function of both men and women. Mumps would be important to know if the client were male. Past valve replacement surgery would not be contributory. Mild intermittent asthma also would not contribute to this problem. However, a client with more severe asthma who takes steroids on a long-term basis may develop secondary diabetes. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesDosage Calculation) MSC: Integrated Process: Nursing Process (Implementation) 1. Which question should the nurse ask when assessing a 60-year-old patient who has a history of benign prostatic hyperplasia (BPH)? a. Have you noticed any unusual discharge from your penis? b. Has there been any change in your sex life in the last year? c. Has there been a decrease in the force of your urinary stream? d. Have you been experiencing any difficulty in achieving an erection?

C Enlargement of the prostate blocks the urethra, leading to urinary changes such as a decrease in the force of the urinary stream. The other questions address possible problems with infection or sexual difficulties, but they would not be helpful in determining whether there were functional changes caused by BPH. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities) MSC: Integrated Process: Nursing Process (Analysis) 18. A 24-year-old woman has just been diagnosed with human papilloma virus (HPV) infection. She is very angry at her ex-boyfriend, who has been her only sexual contact. She is crying and says that she isnt going to tell him that he is infected. Which is the nurses best response? a. You do not have to tell him because this is not a reportable disease in this state. b. Because there is no cure for this disease, telling him would be of no benefit. c. He should be told so he can take precautions to prevent the spread of infection. d. You should tell him because he may not know that this can cause cancer.

C Many clients are angry at the person who infected them with a sexually transmitted disease. Even though HPV is not a reportable disease in many states, all contacts should be told, so that they can take precautions to prevent infecting others. Although some strains of HPV do cause cancer, this is not the primary reason for telling a male sexual contact about the infection. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis) MSC: Integrated Process: Nursing Process (Implementation) 4. The nurse is counseling a client who has recently been diagnosed with syphilis. Which is the highest priority instruction that the nurse provides to the client regarding sexual partners? a. As long as both of you are being treated, abstinence is not necessary. b. If you both have the same disease, you can continue to have sex. c. Your partner must be treated with antibiotics within the next 90 days. d. Once the health department gets your partners name, confidentiality is not considered to be important.

C Once a client has been diagnosed with syphilis, his or her partner must be prophylactically treated as soon as possible, preferably within the next 90 days. Sexual abstinence is required of both partners until they complete treatment. Although the disease will be reported to the local health department, all information will be held in strictest confidence. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Evaluation) 12. A client with pelvic inflammatory disease (PID) from gonorrhea asks how this can cause sterility. Which is the nurses response? a. The infection damages the ovary so that less estrogen is secreted and ovulation is not possible. b. The infection remains in your body and can infect your baby, so it is best if you dont become pregnant. c. If the infection is present in the fallopian tubes, it can cause enough scarring to block the tubes permanently. d. The infection causes such damage to the cervix that it cannot contain a pregnancy inside the uterus for longer than 3 months.

C The chronic inflammation sets up scar tissue formation in the fallopian tubes, thereby narrowing or completely blocking the lumens. This situation can prevent fertilization by not allowing sperm to reach the ovulated egg. Irreversible scarring or stricture, causing sterility, may occur even before the condition is diagnosed. The other statements are inaccurate. DIF: Cognitive Level: Comprehension/Understanding

1231 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 16. The following patients call the outpatient clinic. Which phone call should the nurse return first? a. A 44-year-old patient who has bloody discharge after a hysteroscopy earlier today b. A 64-year-old patient who is experiencing shoulder pain after a laparoscopy yesterday c. A 34-year-old patient who is short of breath after pelvic computed tomography (CT) with contrast d. A 54-year-old patient who has severe breast tenderness following a needle aspiration breast biopsy

C The patients dyspnea suggests a delayed reaction to the iodine dye used for the CT scan. The other patients symptoms are not unusual after the procedures they had done. DIF: Cognitive Level: Analyze (analysis)

N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Teaching/Learning 6. A client has recently been diagnosed with gonorrhea. The client comes from a deeply religious family. When the nurse finds the client weeping, the client tells the nurse, Im being punished for having an affair. How does the nurse respond? a. Surely you dont really believe that. b. Why dont we get you a sedative? c. Tell me more about how you feel. d. Which religion do you practice?

C The priority for the nurse is to gain more information to have a clear understanding about how the client feels. The other answers discount the seriousness of the clients feelings or are evasive. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment) 18. A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate? a. Do not eat or drink anything after midnight. b. Take these laxatives the morning of the test. c. Do not urinate an hour before the test; a full bladder will give best results. d. Have a designated driver because you will be sleepy from the anesthesia.

C The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate. DIF: Cognitive Level: Comprehension/Understanding

1264-1265 TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 7. Which statement by a 24-year-old patient indicates that the nurses teaching about management of primary genital herpes has been effective? a. I will use acyclovir ointment on the area to relieve the pain. b. I will use condoms for intercourse until the medication is all gone. c. I will take the acyclovir (Zovirax) every 8 hours for the next week. d. I will need to take all of the medication to be sure the infection is cured.

C The treatment regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from intercourse until the lesions are gone. (Condoms should be used even when the patient is asymptomatic.) Acyclovir ointment is not effective in treating lesions or reducing pain. Herpes infection is chronic and recurrent. DIF: Cognitive Level: Apply (application)

p. 1581 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationSystem-Specific Assessments) MSC: Integrated Process: Teaching/Learning 16. During examination of the male clients external genitalia, the nurse observes a discharge from the urethra when compressing the glans. Which is the nurses next action? a. Document the observation. b. Ask the client to turn his head and cough. c. Obtain a specimen for culture. d. Test the cremasteric reflex.

C Urethral discharge is not considered normal in a continent client and should be cultured. The other options would not help provide information about the nature of the discharge. DIF: Cognitive Level: Application/Applying or higher

1270 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. After the nurse has taught a patient with a newly diagnosed sexually transmitted infection about expedited partner therapy, which patient statement indicates that the teaching has been effective? a. I will tell my partner that it is important to be examined at the clinic. b. I will have my partner take the antibiotics if any STI symptoms occur. c. I will make sure that my partner takes all of the prescribed medication. d. I will have my partner use a condom until I have finished the antibiotics.

C With expedited partner therapy, the patient is given a prescription or medications for the partner. The partner does not need to be evaluated by the health care provider, but is presumed to be infected and should be treated concurrently with the patient. Use of a condom will not treat the presumed STI in the partner. DIF: Cognitive Level: Apply (application)

1539 KEY: Reproductive problems| health promotion| infection MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 8. Before marriage, a female client has a blood test drawn for syphilis. The test reveals a positive Venereal Disease Research Laboratory (VDRL) serum test. What is the advice that the nurse should give the client? a. Check with your future husband about his sexual activity. b. You must determine if you are pregnant at this time. c. Submit to a more specific treponemal test to confirm the infection. d. Agree to a benzathine penicillin G injection in multiple doses.

C False-positive reactions can occur with viral infections, hepatitis, and systemic lupus erythematosus. A health care provider can request more specific treponemal tests such a fluorescent treponemal antibody absorption or microhemagglutination assay for Treponema palladium performed by the laboratory. While it would be good to confirm sexual activity with her future husband, this inquiry could wait until after further testing is performed. Penicillin is the treatment of choice, but as a single 2.4-million-unit dose. A different regimen would be recommended if the client were pregnant. DIF: Applying/Application

1524 KEY: LGBTQ| venous thromboembolism| estrogens| nursing assessment MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A transgender client taking spironolactone (Aldactone) is in the internal medicine clinic reporting heart palpitations. What action by the nurse takes priority? a. Draw blood to test serum potassium. b. Have the client lie down. c. Obtain a STAT electrocardiogram (ECG). d. Take a set of vital signs.

C Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause cardiac dysrhythmias. The nurses priority is to obtain an ECG, then to facilitate a serum potassium level being drawn. Having the client lie down and obtaining vital signs are also important care measures, but do not take priority. DIF: Applying/Application

1539 KEY: Reproductive problems| infection MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 11. A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0 to 10. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Administer Tylenol #3 immediately. b. Apply a heating pad to the lower abdomen. c. Position the client in a semi-Fowlers position. d. Teach the client to increase intake of fluids.

C The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The UAP can position the client. Only the nurse can administer medications, initially apply heat to the clients abdomen, and perform teaching. DIF: Applying/Application

1458 KEY: Medical care| surgical procedures| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 1. A nurse is reviewing the chart of a new client in the family medicine clinic and notes the client is identified as George Smith. The nurse enters the room and finds a woman in a skirt. What action by the nurse is best? a. Apologize and declare confusion about the client. b. Ask Mrs. Smith where her husband is right now. c. Ask the client about preferred forms of address. d. Explain that the chart must contain an error.

C The nurse may encounter transgender clients whose outward appearance does not match their demographic data. In this case, the nurse should greet the client and ask the client to explain his or her preferred forms of address. Lengthy apologies can often create embarrassment. The nurse should not assume the client is not present in the room. The chart may or may not contain errors, but that is not related to determining how the client prefers to be addressed. DIF: Understanding/Comprehension

1537 KEY: Reproductive problems| nursing interventions| infection MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Health Promotion and Maintenance 10. A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection? a. I did practice abstinence while taking the medication. b. I took doxycycline two times a day for a week. c. I never told my boyfriend about the infection. d. I did drink wine when taking the medication for Chlamydia.

C There is a good possibility that the boyfriend re-infected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated. The other statements were in compliance with the recommendations of abstinence and the usual medication regimen with doxycycline. Wine should not interfere with the treatment. DIF: Applying/Application

1454 KEY: Health promotion| cancer screening Pap smear MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 2. The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is cause for immediate action by the nurse? a. Vaginal dryness b. Need for a Papanicolaou test if none for 3 years c. Bleeding from the vagina d. Leakage of urine

C Vaginal bleeding is not normal for the postmenopausal woman. Vaginal dryness and leakage of urine are common findings in adults of this age range. Pap tests may not be needed for women over 65 who have had regular cervical cancer testing with normal results. DIF: Applying/Application

1453 KEY: Safety| reproductive health problems| assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 2. The nurse is reviewing discharge plans with a client who is recovering from a cervical biopsy. Which statements indicate good understanding by the client? (Select all that apply.) a. I can return to work this afternoon. b. There should be no problem lifting my 2-year-old toddler when I get home. c. I cannot douche until the biopsy site is healed. d. I need to wait for about 2 weeks to have intercourse with my husband. e. If I have some bleeding, I can use a regular tampon this evening.

C, D The client should not douche, have intercourse, or use tampons until the biopsy site is healed. The client should rest for 24 hours after the procedure and should not lift heavy objects. DIF: Applying/Application

p. 1583 TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening) MSC: Integrated Process: Teaching/Learning 4. The nurse is conducting a reproductive assessment of a postmenopausal woman. Which assessment finding reported by the client requires immediate intervention by the nurse? a. Urinary incontinence b. Vaginal dryness c. Painful intercourse d. Returning periods

D All client reports require some action by the nurse, but the priority would be to further investigate and report the returning periods. In a postmenopausal woman, this can signal cancer. DIF: Cognitive Level: Application/Applying or higher

1235 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 9. A 44-year-old patient in the sexually transmitted infection clinic has a positive Venereal Disease Research Laboratory (VDRL) test, but no chancre is visible on assessment. The nurse will plan to send specimens for a. gram stain. b. cytologic studies. c. rapid plasma reagin (RPR) agglutination. d. fluorescent treponemal antibody absorption (FTA-Abs).

D Because false positives are common with VDRL and RPR testing, FTA-Abs testing is recommended to confirm a diagnosis of syphilis. Gram staining is used for other sexually transmitted infections (STIs) such as gonorrhea and Chlamydia and cytologic studies are used to detect abnormal cells (such as neoplastic cells). DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities) MSC: Integrated Process: Nursing Process (Analysis) 14. A client was diagnosed with chancroid. Which manifestation does the nurse associate with this condition? a. Vaginal discharge b. High fever c. History of ectopic pregnancies d. Genital ulcers

D Chancroid is characterized by genital ulcers and occasionally by enlarged lymph nodes. The other assessment findings are not related to chancroid. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Teaching/Learning 6. The nurse is working with a client who is recovering after a laparoscopy. Which assessment finding is considered a priority by the nurse? a. Slight drainage from the incision site b. Grogginess after the anesthesia c. Discomfort from the catheter d. Reports of shoulder pain

D Clients should expect mild drainage or blood from the incision site. Grogginess from the anesthesia and discomfort from a catheter are also expected minor occurrences post-laparoscopy. The nurse would not be concerned about these but should intervene and treat the client with shoulder pain. Shoulder pain is referred pain from phrenic nerve irritation and can be expected. DIF: Cognitive Level: Application/Applying or higher

1228 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. The nurse explains to a 37-year-old patient being prepared for colposcopy with a cervical biopsy that the procedure a. involves dilation of the cervix and biopsy of the tissue lining the uterus. b. will take place in a same-day surgery center so that local anesthesia can be used. c. requires that the patient have nothing to eat or drink for 6 hours before the procedure. d. is similar to a speculum examination of the cervix and should result in little discomfort.

D Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. Anesthesia is not required and fasting is not necessary. A cervical biopsy may cause a minimal amount of pain. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Implementation) 23. The nurse assesses a client and finds the manifestation shown in the photograph. Which drug does the nurse prepare to administer to the client? a. Doxycycline (Vibramycin) b. Ceftriaxone (Rocephin) c. Acyclovir (Zovirax) d. Podophyllin (Pododerm)

D The image is of a perianal HPV infection, which can be treated by provider-applied Pododerm. Doxycycline is used to treat chlamydia, ceftriaxone is for gonorrhea, and acyclovir is for herpes. DIF: Cognitive Level: Application/Applying or higher

p. 1578-1579 TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Teaching/Learning 10. A client who has had numerous children is having her annual examination. The nurse wishes to discuss contraception, but the client is not interested. Which action by the nurse is most appropriate? a. Provide education on the value of spacing children. b. Explain the many alternatives from which to choose. c. Ask the client how her husband feels about so many children. d. Assess the clients religious and cultural background.

D Cultural and religious backgrounds can have a great deal of influence on clients attitudes toward sexuality and reproduction. Because the client does not seem interested in the topic, the nurse should gently assess for these background influences and respect them. Providing education that the client does not want is not helpful and is disrespectful. Asking about the husbands preferences diminishes the nurse-client relationship, which should be focused on the client. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms) MSC: Integrated Process: Nursing Process (Implementation) 19. A client has been diagnosed with anal cancer. Which test does the nurse prepare the client for? a. Darkfield microscopy b. Culture of discharge c. Blood draw for the Venereal Disease Research Laboratory (VDRL) test d. Human papilloma virus (HPV) DNA

D Human papilloma virus is known to cause cancers of the genitals, anus, and perianal areas. The client needs to undergo testing for HPV DNA. Darkfield microscopy is used to detect syphilis. Discharge is tested for gonorrhea, Chlamydia, and pelvic inflammatory disease. The VDRL is also used for syphilis. DIF: Cognitive Level: Application/Applying or higher

1226 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 1. A 32-year-old man who has a profuse, purulent urethral discharge with painful urination is seen at the clinic. Which information will be most important for the nurse to obtain? a. Contraceptive use b. Sexual orientation c. Immunization history d. Recent sexual contacts

D Information about sexual contacts is needed to help establish whether the patient has been exposed to a sexually transmitted infection (STI) and because sexual contacts also will need treatment. The other information also may be gathered but is not as important in determining the plan of care for the patients current symptoms. DIF: Cognitive Level: Apply (application)

1232 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 19. Which information shown in the accompanying figure and obtained by the nurse about a 72-year-old man who is complaining of erectile dysfunction is most important to communicate to the health care provider? a. Recent knee surgery b. Low position of left testis c. Pulse and blood pressure level d. Use of antihypertensive drugs

D Many medications used for hypertension can cause erectile dysfunction. More information is needed regarding the specific medications. The other assessment data will not impact erectile function (recent knee surgery) or are normal for a 70-year-old man (physical exam data and vital signs). DIF: Cognitive Level: Analyze (analysis)

1267 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 13. A 55-year-old woman in the sexually transmitted infection (STI) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea by her partner. To determine whether the patient has gonorrhea, the nurse will plan to a. interview the patient about symptoms of gonorrhea. b. take a sample of cervical discharge for Gram staining. c. draw a blood specimen or rapid plasma reagin (RPR) testing. d. obtain secretions for a nucleic acid amplification test (NAAT).

D NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms may not be helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble N. gonorrhoeae. RPR testing is used to detect syphilis. DIF: Cognitive Level: Apply (application)

1234 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 14. The nurse will plan to teach a 51-year-old man who is scheduled for an annual physical exam about a(n) a. increased risk for testicular cancer. b. possible changes in erectile function. c. normal decreases in testosterone level. d. prostate specific antigen (PSA) testing.

D PSA testing may be recommended annually for men, starting at age 50. There is no indication that the other patient teaching topics are appropriate for this patient. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology) MSC: Integrated Process: Nursing Process (Analysis) 15. Which disease process places the client at greatest risk for development of an ectopic pregnancy? a. Chlamydia infection b. Genital herpes c. Human papilloma virus infection d. Pelvic inflammatory disease (PID)

D Pelvic inflammatory disease is a leading cause of infertility and ectopic pregnancies. The other diseases are not as likely to cause an ectopic pregnancy. DIF: Cognitive Level: Knowledge/Remembering

1228 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. After a 26-year-old patient has been treated for pelvic inflammatory disease, the nurse will plan to teach about a. use of hormone therapy (HT). b. irregularities in the menstrual cycle. c. changes in secondary sex characteristics. d. possible difficulty with becoming pregnant.

D Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HT, have irregular menstrual cycles, or experience changes in secondary sex characteristics. DIF: Cognitive Level: Apply (application)

1233-1235 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment 17. A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated three tampons in the past 2 hours. The nurse estimates that the amount of blood loss over the past 2 hours is _____ mL. a. 20 to 30 b. 30 to 40 c. 40 to 60 d. 60 to 90

D The average tampon absorbs 20 to 30 mL. DIF: Cognitive Level: Understand (comprehension)

1229 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 3. A 68-year-old male patient tells the nurse that he is worried because he does not respond to sexual stimulation the same way he did when he was younger. The nurses best response to the patients concern is which of the following? a. Interest in sex frequently decreases as men get older. b. Many men need additional sexual stimulation with aging. c. Erectile dysfunction is a common problem with older men. d. Tell me more about how your sexual response has changed.

D The initial response by the nurse should be further assessment of the problem. The other statements by the nurse are accurate but may not respond to the patients concerns. DIF: Cognitive Level: Apply (application)

N/A TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care) MSC: Integrated Process: Teaching/Learning 3. The nurse is conducting an assessment on a client and identifies a lesion that appears as a smooth indurated area. Which is the highest priority action on the part of the nurse? a. Question the client further regarding sexual practices. b. Ask the client about any associated symptoms. c. Document the findings and obtain a specimen of fluid from the lesion. d. Don gloves before continuing to assess the lesion any further.

D The lesion could be a chancre, which is highly contagious. The nurse should be wearing gloves. The nurse should finish assessment of the lesion before continuing to interview the client and documenting findings. The nurse does need to collect fluid for a culture, but the nurses safety is the priority. DIF: Cognitive Level: Application/Applying or higher

1543 KEY: Reproductive problems| pain| comfort measures| unlicensed assistive personnel (UAP) MSC: Integrated Process: Caring NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort 12. A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action? a. Feelings of anger that her partner infected her b. Loose stools over the last 2 days c. Anorexia and nausea d. Chills and a temperature of 101 F

D Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic. Anger is a normal reaction to a sexually transmitted disease and the pain of pelvic inflammatory disease. Gastrointestinal symptoms are common side effects of antibiotics but not an immediate cause for intervention. DIF: Applying/Application

1536 KEY: Antiviral medication| reproductive problems| caring| infection control MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity 5. A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate? a. Gardasil protects against all HPV strains. b. You are too young to receive the vaccine. c. Only females can receive the vaccine. d. This will lower your risk for cervical cancer.

D Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and warts. The vaccine is recommended for people ages 10 to 26 years. DIF: Remembering/Knowledge

1. The nurse is developing a teaching plan for a client who is scheduled for her first Papanicolaou test. What instruction by the nurse is the most accurate? a. The timing of the Pap smear does not matter. b. Sexual intercourse will not interfere with the results. c. Results can be interpreted immediately in the office. d. Results are best if you do not douche 24 hours before the test.

D In order to prevent false interpretation, the client must not douche or have sexual intercourse for at least 24 hours before the Pap smear. Timing is important, with the test scheduled between the clients menstrual periods so that the menstrual flow does not interfere with laboratory analysis. The specimens are placed on a glass slide and sent to the laboratory for examination and cannot be interpreted immediately. DIF: Understanding/Comprehension

1454 KEY: Health promotion| self-care| reproductive screenings MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 7. A client is scheduled for a laparoscopy to remove endometriosis tissue. Which response by the client alerts the nurse of the need for further teaching? a. The surgeon told me that carbon dioxide would be infused into my pelvic cavity. b. There will be one or more small incisions in order to visualize all of the organs. c. There will be some shoulder pain after the procedure that may last 48 hours. d. I can return to jogging my 3-mile routine in a few days.

D No strenuous activity should occur for 7 days after the procedure. Carbon dioxide is infused into the pelvic cavity to visualize the organs. There are only one or more small incisions with this procedure. The referred shoulder pain that will occur should only last 48 hours. DIF: Applying/Application

1527 KEY: LGBTQ| postoperative nursing| epidural anesthesia| patient safety MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 9. After a vaginoplasty, what instruction by the nurse is most important? a. Avoid vaginal douching to prevent infection. b. Do not have sexual intercourse for at least 6 months. c. Use oil-based lubricants with the vaginal dilators. d. You must dilate the vagina several times a day for months.

D Self-care management for this client includes instructions to dilate the new vagina several times a day for months after the procedure, using water-based lubricant. The client also needs to douche regularly, especially after intercourse, to avoid infections. Sexual intercourse is another way to keep the vagina dilated. DIF: Understanding/Comprehension

1456 KEY: Management| delegation| intraoperative nursing| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 6. The mother of an 18-year-old girl asks the nurse which screening her daughter should receive now based on evidence-based recommendations. Which suggestion by the nurse is best? a. Papanicolaou test b. Human papilloma virus (HPV) test c. Mammogram d. No screenings at this time

D Since the daughter is only 18, it is not recommended that she receive any of these screenings. Pap screenings are recommended to start at age 21. The HPV test can be done with the Pap test for women older than 30 or who had an abnormal Pap test result. A mammogram is recommended for women age 40 or older since cancers are more able to be distinguished from normal glandular tissue at that age. DIF: Applying/Application

1538 KEY: Reproductive problems| patient teaching| infection| safer sexual practices MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 14. The nurse teaches a client with genital herpes about effective comfort measures. Which statement by the client indicates a need for further teaching by the nurse? a. I can apply warm towels or ice packs to the lesions. b. Sitz baths three times a day may help ease the pain. c. I understand there are anesthetic sprays and ointments. d. I really should try to limit urination due to the pain.

D The client should urinate frequently, not limit voiding. Voiding while in the shower or tub should lessen the discomfort. Warm compresses, ice packs, sitz baths, and anesthetic sprays and ointments are all effective comfort measures that can be used with genital herpes. DIF: Remembering/Knowledge