CH 45 NCLEX Qs
A nurse who works in a fertility clinic is conducting a program on options for various fertility issues. The nurse judges that the participants are understanding the education when they identify that donor eggs are the best option for which one of the following women? a) A 28-year-old b) A 42-year-old c) A 38-year-old d) A 33-year-old
b) A 42-year-old Donor eggs provide a much higher likelihood of success for women older than 40 years of age, when both egg numbers and egg quality decline.
A client who has a history of untreated cervicitis tells the nurse that she is concerned about the risk of experiencing problems with fertility. The nurse explains that problems may result from: a) Severe abdominal peritonitis b) Ascending infection of the fallopian tubes c) Development of low back pain d) Acute urinary tract infection
b) Ascending infection of the fallopian tubes Untreated cervicitis may extend to include the development of pelvic cellulitis, low back pain, dyspareunia, cervical stenosis, dysmenorrheal, and ascending infection of the uterus or fallopian tubes. The other conditions would not contribute to the problem.
A nurse monitors for side effects in a female patient receiving endometriosis treatment with the gonadotropin-releasing hormone (GnRH) agonist leuprolide (Lupron). Which of the following adverse effects would be cause to limit duration of treatment? a) Nose bleed and cough b) Hot flashes and night sweats c) Muscle spasms d) Decreased bone density
d) Decreased bone density The GnRH agonist leuprolide (Lupron) suppresses the release of estrogens from the ovaries. This allows endometrial tissue to shrink and reduces manifestations of endometriosis. Side effects include hot flashes, nose bleed, cough, hypocalcemia, and decreased bone density. Except for bone density, all of these side effects will stop with treatment. A rapid decrease in bone density may be cause to stop treatment because it may not be completely reversed when therapy is ended and could lead to osteoporosis.
A college student presents to the nurse's office complaining of premenstrual syndrome. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply. a) Abdominal bloating b) Painful intercourse c) Painful, edematous breasts d) Burning during urination e) Thick, cheesy vaginal secretions
a) Abdominal bloating c) Painful, edematous breasts Physical symptoms of PMS include painful and swollen breasts, bloating, abdominal pain, headache, and backache. Burning with urination could be caused by a vaginal or bladder infection. A thick, cheesy, vaginal secretion is usually associated with a yeast infection.
Which symptoms are believed to have a strong association with ovarian cancer? (Select all that apply.) a) Abdominal or pelvic pain b) Increased appetite c) Increased intestinal gas d) Difficulty eating e) Bloating
a) Abdominal or pelvic pain d) Difficulty eating e) Bloating Symptoms that are believed to have a strong correlation to ovarian cancer include abdominal or pelvic pain, increased abdominal size or bloating, and difficulty eating or feeling full quickly after ingesting food. Increased intestinal gas and an increased appetite are not highly correlated with ovarian cancer.
A 45-year-old client reports "needing to bear down with urination," frequency, and occasional loss of urine when coughing. Based on symptoms, which diagnosis is most appropriate for this client? a) Cystocele b) Spermatocele c) Rectocele d) Enterocele
a) Cystocele The symptoms described are commonly found with cystocele, which is the herniation of the bladder into the vagina resulting in urinary symptoms. The bear-down sensation is common in this disorder and not found in the other disorders. Rectocele is the herniation of the rectum into the vagina. Enterocele can be asymptomatic or cause a dull, dragging sensation and occasionally low backache. Spermatocele is a male disorder.
A female client is being evaluated for abdominal pain and unusual menstrual bleeding. What factors in their history will the nurse identify as increasing the risk for endometrial cancer? Select all that apply. a) Diabetes mellitus b) Obesity c) Estrogen therapy d) Trichomonas infection e) Polycystic ovary syndrome
a) Diabetes mellitus b) Obesity c) Estrogen therapy e) Polycystic ovary syndrome Unopposed estrogen stimulates endometrial hyperplasia which can lead to cell abnormalities developing into cancers. Obesity, diabetes mellitus, polycystic ovary syndrome, and hormone replacement therapy with unopposed estrogen are all factors that produce a situation with increased estrogen levels that increase risk of endometrial cancer. Sexually transmitted infections such as trichomonas do not change estrogen levels.
The nurse is caring for a patient in the emergency room with lower abdominal pain that is greater on the right side and who has light vaginal spotting. When the patient's human chorionic gonadroptropin (hCG) level is lower than normal, the nurse plans care for a patient with which of the following? a) Ectopic pregnancy b) Cervical cancer c) Appendicitis d) Premenstrual syndrome
a) Ectopic pregnancy The symptoms described and the positive but low hCG would be most indicative of an ectopic pregnancy. Appendicitis could be suspected with right lower abdominal pain, but would not have a positive hCG and spotting. Neither PMS nor cervical cancer would present with all the above symptomology
The nurse performs a complete physical assessment on a client with polycystic ovary syndrome (PCOS). Which assessment findings support this diagnosis? Select all that apply. a) Increased dark facial hair b) Elevated blood glucose c) Decreased luteinizing hormone (LH) level d) Obesity e) Dysmenorrhea
a) Increased dark facial hair b) Elevated blood glucose d) Obesity PCOS is an endocrine disorder affecting between 5% and 10% of women of child-bearing age. Common manifestations include irregular infrequent menstrual periods, signs of hyperandrogenism such as acne and excess body hair, elevated testosterone levels, obesity, insulin resistance, and polycystic ovaries. Also characteristic of the disorder is an imbalance between LH and FSH (follicle-stimulating hormone) where the LH levels are higher in proportion to FSH. This leads to anovulation and infertility.
The parents of a 9-year-old child ask the nurse for information about quadrivalent human papillomavirus recombinant vaccine (Gardasil) vaccine. Which of the following instructions are appropriate for the nurse to provide? Select all that apply. a) It should be given before the child is sexually active. b) It prevents sexually transmitted infections. c) It produces short-term immunity. d) It can be given to boys and girls. e) It prevents a common cause of cervical cancer.
a) It should be given before the child is sexually active. d) It can be given to boys and girls. e) It prevents a common cause of cervical cancer. The quadrivalent human papillomavirus recombinant vaccine (Gardasil) vaccine is given to boys and girls between the ages of 9 and 26 years before they begin sexual activity. The vaccine provides long-term immunity from HPV, which is a common cause of cervical cancer. It does not protect against other sexually transmitted diseases.
The nurse is assessing a 24-year-old client who states that she has infrequent menstrual periods that are approximately 40 to 42 days apart. She also states, "My periods are really light. It's almost like I hardly even need to use a pad sometimes." The nurse should document which medical terms associated with this client's menstruation? Select all that apply a) Oligomenorrhea b) Amenorrhea c) Polymenorrhea d) Hypomenorrhea e) Menometrorrhagia
a) Oligomenorrhea d) Hypomenorrhea Dysfunctional cycles may take the form of amenorrhea (absence of menstruation), hypomenorrhea (scanty menstruation), oligomenorrhea (infrequent menstruation, periods more than 35 days apart), polymenorrhea (frequent menstruation, periods less than 21 days apart), menorrhagia (excessive menstruation), or metrorrhagia (bleeding between periods). Menometrorrhagia is heavy bleeding during and between menstrual periods. This client exhibits hypomenorrhea and oligomenorrhea.
A client has been diagnosed with endometriosis. What assessment finding does the nurse expect? Select all that apply a) Premenstrual pain b) Increased fertility c) Pelvic pain d) Back pain e) Referred chest pain
a) Premenstrual pain c) Pelvic pain d) Back pain Endometriosis symptoms present with pelvic pain and back pain, and most pain occurs premenstrually, subsiding after cessation of menstruation. There is decreased fertility with this condition. Chest pain is not a reported symptom.
Which clinical manifestations would the nurse expect to observe in a female with pelvic inflammatory disease (PID)? Select all that apply. a) Purulent cervical discharge b) Lower abdominal pain c) White blood cell (WBC) count of 7500 cells/mL d) Elevated C-reactive protein e) Temperature of 100°F (37.8°C)
a) Purulent cervical discharge b) Lower abdominal pain d) Elevated C-reactive protein Manifestations of PID include lower abdominal pain, dyspareunia, purulent cervical discharge, cervix pain with manual examination, temperature greater than 100°F, a WBC greater than 10,000 cells/mL, and elevated C-reactive protein.
A client is experiencing oligomenorrhea. The nurse interprets this as: a) Heavy bleeding between and during menstrual cycles b) Infrequent menstruation with periods more than 35 days apart c) Frequent menstruation with periods less than 21 days apart d) Bleeding that occurs between menstrual cycles
b) Infrequent menstruation with periods more than 35 days apart Oligomenorrhea is infrequent menstruation, periods more than 35 days apart; polymenorrhea is frequent menstruation, periods less than 21 days apart; menorrhagia is excessive menstruation; metrorrhagia is bleeding between periods; amenorrhea is absence of menstruation; hypomenorrhea is scanty menstruation.
A 29-year-old female client has been diagnosed with fibrocystic breasts. The nurse should assess the client for which symptoms associated with fibrotic changes? Select all that apply. a) Breast pain or discomfort b) Palpable breast masses that change during the menstrual cycle c) Purulent nipple discharge that is whitish or yellowish in color d) Breast engorgement e) Erythema on skin regions within 1 to 2 cm of the areolae
b) Palpable breast masses that change during the menstrual cycle c) Purulent nipple discharge that is whitish or yellowish in color Fibrocystic changes include nodular granular breast masses that are more prominent and painful during the luteal or progesterone-dominant portion of the menstrual cycle. Discomfort ranges from heaviness to exquisite tenderness, depending on the degree of vascular engorgement and cystic distention. Engorgement, erythema, and discharge are atypical.
The nurse is teaching the client about risk factors for cervical cancer. What will be included in the plan of care? Select all that apply. a) Alcohol consumption b) Smoking c) Multiple sexual partners d) Diabetes e) First intercourse at an early age f) History of sexually transmitted infections
b) Smoking c) Multiple sexual partners e) First intercourse at an early age f) History of sexually transmitted infections Risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, smoking, and a history of STDs. Diabetes and alcohol consumption are not risk factors.
The nurse working in a fertility clinic is assessing a patient's risk for fallopian tube obstruction. Which one of the following places the woman at greatest risk? a) Vaginitis b) Uterine prolapse c) Endometriosis d) Dysmenorrhea
c) Endometriosis Tubal patency is required for fertilization and can be disrupted secondary to PID, ectopic pregnancy, large myomas, endometriosis, pelvic adhesions, and previous tubal ligation. The remaining options do not relate to the fallopian tubes.
What is the term for the condition that involves dyspareunia, and widespread vaginal burning in the absence of bacterial presence? a) Localized valvodynia b) Vaginitis c) Generalized vulvodynia d) Bartholin gland abscess
c) Generalized vulvodynia The type of vulvodynia that is described is generalized vulvodynia, as opposed to localized, which not as widespread. Vaginitis would have bacterial involvement. These are not the symptoms associated with a Bartholin gland abscess.
A school nurse is providing an informational session about the prevention of cervical cancer in young girls and women. The most important information for the nurse to present would be: a) Use of latex condom with each and every sexual encounter b) Use of low-dose estrogen oral contraceptive pills or patches c) HPV vaccine before becoming sexually active d) Abstinence of sexual activity until in a monogamous relationship
c) HPV vaccine before becoming sexually active Two types of HPV vaccines are currently available to prevent HPV infection: a quadrivalent vaccine (Gardasil) to prevent infection by HPV subtypes 16, 18, 6, and 11 and a bivalent vaccine (Cervarix) to prevent infection by subtypes 16 and 18. The quadrivalent vaccine has been approved for females and males between the ages of 9 and 26 years, optimally before initiation of sexual activity. Abstinence and condoms may help, also but the vaccine is recommended.
A client who has been diagnosed with premenstrual syndrome (PMS) asks if there is anything to help alleviate the symptoms. The best response would be: a) Limit activities and maintain bed rest as necessary b) Increase intake of caffeine products during this period c) Decrease intake of fluids to reduce fluid retention d) Eat a diet low in simple sugars and high in protein
d) Eat a diet low in simple sugars and high in protein Treatment for PMS includes treating various symptoms. A diet low in sugar and high in protein and reduction in caffeine intake are recommended. Other suggestions include diuretics to reduce fluid retention, continue fluid intake as usual, regular exercise, and analgesics for pain.
After a long and frustrating course of constant vaginal pain, a 38 year-old woman has diagnosed with generalized vulvodynia by her gynecologist. What treatment plan is most likely to be prescribed by her healthcare provider? a) Lifestyle modifications aimed at accommodating and managing neuropathic pain. b) Narcotic analgesia and non-steroidal anti-inflammatory medications. c) Alternative herbal therapies coupled with antifungal medications. d) Tricyclic antidepressants and gabapentin, an antiepileptic medication.
d) Tricyclic antidepressants and gabapentin, an antiepileptic medication. Treatment of vulvodynia necessitates a long-term, chronic pain approach; antidepressants and anti-epileptic medications are often used. Alternative therapies, standard analgesic regimens and simple lifestyle modifications are less likely to be effective.