Ch. 56: Assessment & Mgmt of Pts w/ Female Physiologic Processes

The nurse is completing community education when asked by a client without health insurance why a mammogram is needed if the women are completing breast self-examinations at home. The nurse is most correct to respond stating which of the following? "Mammograms can detect cysts or tumors too small to palpate." "Mammograms provide a reassurance that the breast is free of cancer." "Mammograms provide a baseline that shows changes in breast tissue." "Mammograms are just better."

Correct response: "Mammograms can detect cysts or tumors too small to palpate." Explanation: During community instruction, it is most important to relay facts in a clear, factual, and nonjudgmental way. Stating the need for mammograms to detect small cysts or tumors is clear and factual. Stating the mammograms are "better" is vague and provides no better understanding. Although a mammogram does provide a baseline and reassurance of breast health, the most clear and factual reason why the mammogram is completed is its ability to detect cancerous tumors at an early stage.

The nurse is providing client education to a 45-year-old female who asks how she can be certain that she has reached menopause. How should the nurse respond? "Menopause is likely if you have not menstruated for 12 months." "Menopause can be confirmed when a steady increase in estrogen levels is detected." "Menopause has been reached if there have been 8 years of menstrual irregularity." "Menopause is marked by persistent night sweats and hot flashes."

Correct response: "Menopause is likely if you have not menstruated for 12 months." Explanation: Menopause is defined retrospectively by 12 months of amenorrhea and loss of ovarian follicular activity. Estrogen levels decline leading up to menopause, not increase. Although a retrospective reporting of perimenopausal symptoms can take place up to 8 years or more before the final menstrual period, 8 years of menstrual irregularity does not necessarily confirm menopause. Other underlying causes should also be investigated in this case. Hallmark symptoms of perimenopause include hot flashes and night sweats. With the onset of menopause, these symptoms should decline or cease entirely.

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning? Vulva Mon pubis Vagina Labia majora

Correct response: Vagina Explanation: The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.

The nurse is conducting a health history when a middle-aged client states that her last menstrual period was 6 months ago. Upon further questioning, the client also states that symptoms of hot flashes and mood fluctuations. Which question should the nurse ask next? "Do you feel like hurting yourself?" "When was your first menstrual period?" "Are you finished having children?" "Are you taking any hormone replacement therapy?"

Correct response: "Are you taking any hormone replacement therapy?" Explanation: To ensure a thorough health history, a client who exhibits symptoms of perimenopause should be assessed for the use of hormone replacement therapy to alleviate the symptoms. This information adds to the data reported by the client. Asking if the client feels like hurting herself may be extreme with the report of mood fluctuations. Asking if the client is finished having children produces little additional data. Asking the first menstrual period is part of the health history but not the best question to ask after the client's statement.

A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception? Sterilization Hormonal contraception Barrier methods Abstinence

Correct response: Abstinence Explanation: Abstinence is the only completely effective means of contraception. It is followed by sterilization. Hormonal contraceptives and barrier methods are effective but they must be used consistently to be effective.

A client with anorexia experienced a severe reduction in body fat by extreme caloric restriction and exercise. Which female reproductive abnormalities could be acquired as a result of this reduction in body fat? Select all that apply. delay or cessation of menstruation impaired potential for the implantation of a fertilized ovum polycystic ovarian syndrome higher risk of fibrocystic breast disease

Correct response: delay or cessation of menstruation impaired potential for the implantation of a fertilized ovum Explanation: Clients with anorexia can experience amenorrhea and reproductive abnormalities such as small breasts and impaired potential for implantation of a fertilized ovum. Fibrocystic breast disease and polycystic ovarian syndrome are not associated with low body fat.

Which statement by a client following a laparoscopic procedure requires immediate follow-up by the nurse? "The area around my navel is tender." "My adhesive bandage has minimal drainage." "I have moderate pain at my incision site." "I have pain in my left shoulder."

Correct response: "The area around my navel is tender." Explanation: Tenderness and pain around the navel may be a sign of internal bleeding, indicating possible bowel or bladder injury, or burns from the coagulator. The client may experience abdominal or shoulder pain related to the use of carbon dioxide gas. Pain and minimal drainage are expected findings following a laparoscopic procedure.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder? Eschar Candida Escherichia coli Trichomonas

Correct response: Trichomonas Explanation: A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curdlike, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. The nurse suspects the odor is caused by which bacteria? Candida Pseudomonas Trichomonas Escherichia coli

Correct response: Trichomonas Explanation: Trichomonas bacteria cause a copious and often frothy yellow-green colored discharge that is malodorous. A yeast infection doesn't have an odor but bacterial vaginosis is fishy in smell. Refer to Table 32-5 in the text.

Which structure is referred to as the vulva? external female genitalia clitoris mons pubis vagina

Correct response: external female genitalia Explanation: The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).

The opening into the vagina on the perineum is called the hymen. adnexa. introitus. cervix.

Correct response: introitus. Explanation: The introitus is the vaginal orifice. Adnexa is used to describe the fallopian tubes and ovaries together. The cervix is the bottom (interior) part of the uterus that is located in the vagina. The hymen is a tissue that may cover the vaginal opening partially or completely before vaginal penetration.

While examining the introitus, the nurse practitioner asks the client to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the client for which condition? Uterine prolapse Colorectal cancer Female genital mutilation Human papillomavirus

Correct response: Uterine prolapse Explanation: The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the client to "bear down." Examinations for colorectal cancer or female genital mutilation do not improve when the client bears down. A Pap test reveals atypical cells; the liquid method allows for human papillomavirus testing. This procedure does not require the client to bear down.

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort? Aspirin Ibuprofen Water-based lubricant Petroleum jelly

Correct response: Water-based lubricant Explanation: For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.

A patient has been diagnosed with a Trichomoniasis vaginal infection. The nurse would expect which color of discharge? Yellow-green White White, curd-like Gray

Correct response: Yellow-green Explanation: Vaginal discharge associated with Trichomoniasis vaginal infection is copious and often frothy/yellow-green. Candida infection is associated with thin to thick, curd-like, white discharge. White discharge is associated with a normal discharge. Bacterial vaginosis is associated with thin and grayish or yellow discharge.

An older female client reports pain during intercourse, disrupting the intimacy that she and her husband are accustomed to sharing. What might be the cause of her pain? lack of desire atrophy of Bartholin glands decreased sensitivity increased vascularity

Correct response: atrophy of Bartholin glands Explanation: The female genitalia change during the aging process. Changes include thinning of pubic hair; decrease in the size of the labia majora and minora; shortening and narrowing of the vagina; and atrophy of Bartholin's glands, which results in less lubrication.

Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele? Dyspareunia Decreased pH of the vagina Irregular menses Atrophic vaginitis

Correct response: Dyspareunia Explanation: A cystocele can cause dyspareunia and incontinence. See Table 32-2 in the text for a complete list of both structural and functional age-related changes.

The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as? Dysmenorrhea Dyspareunia Dysuria Dysthymia

Correct response: Dyspareunia Explanation: Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or secondary and may occur at the beginning of, during, or after intercourse.

The nurse is scheduling an appointment for Pap test with a client. What information should the nurse provide to the client to ensure the test is accurate? Select all that apply. "Avoid sexual intercourse for at least 2 days prior to the test." "It is best if you come during your menstrual period." "Ensure you have used any vaginal medication creams prior to the test." "Use a sanitary pad instead of tampon 2 to 3 days prior to the test." "Use vaginal cleansers such as douche to prepare for the test."

Correct response: "Avoid sexual intercourse for at least 2 days prior to the test." "Use a sanitary pad instead of tampon 2 to 3 days prior to the test." Explanation: It is important for the nurse to remind the client not to have sexual intercourse for at least 2 days before the test. The nurse should also remind the client not to use tampons; birth-control foams or jellies; other vaginal creams, moisturizers, or lubricants; or vaginal medicines for 2 to 3 days before the test. A sanitary pad is permitted and would not interfere with the results of the Pap test. The nurse should remind the client to try not to schedule an appointment for a time during the menstrual period. The best time to conduct the Pap test is at least 5 days after the menstrual period stops.

Cone biopsy describes a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which statements by the client demonstrates that the client undergoing a cone biopsy understands the discharge instructions? "I will need to use a menstrual pad to capture the moisture as my cervix unfreezes." "I require a repeat conization in 2 weeks after the edema subsides." "I will use a Sitz bath to relieve pain caused by the sutures." "I will avoid having sexual relations until I see the doctor again."

Correct response: "I will avoid having sexual relations until I see the doctor again." Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorraphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy.

A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct? "The office staff can schedule your clinical breast examination twice a year." "The clinical breast evaluation will be completed with annual gynecologic examination." "You can complete the examination at home and report if you found anything abnormal." "The diagnostic center will send you a reminder card to complete the annual examination."

Correct response: "The clinical breast evaluation will be completed with annual gynecologic examination." Explanation: A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.

A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse? "This will have no bearing on your test today." "We will proceed with the examination and reschedule your Pap smear for next week." "We will reschedule your examination when you have finished menstruating." "We will do the test and take into consideration that you are menstruating."

Correct response: "We will reschedule your examination when you have finished menstruating." Explanation: The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.

Which nursing question is essential when caring for a client prior to a pelvic examination? "Would you like to have assistance to get in position for the exam?" "Would you like to void at this time?" "Do you have any sexually transmitted diseases?" "Are you sexually active?"

Correct response: "Would you like to void at this time?" Explanation: Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.

A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation? Do not douche before the procedure Avoid intercourse for 7 days before the procedure Make sure the procedure is scheduled during menstruation Avoid consuming food that contains iodine 48 hours before the procedure

Correct response: Do not douche before the procedure Explanation: To avoid washing away cellular material, the client should be instructed not to douche before having a Pap test. A Pap test should be performed when a client is not menstruating because blood usually interferes with interpretation. Consuming food that contains iodine is not contraindicated for a Papanicolaou test. The client should be instructed to avoid intercourse for 2 days prior to having the Pap test.

Which patient in the ED should the advance nurse practitioner treat first? A 48-year-old woman presenting with irregular menses, breast tenderness, and profuse sweating A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness A 32-year-old woman with bloating, headache, and reported depression A 19-year-old woman with vaginal irritation, malodorous, copious frothy/yellow-green discharge

Correct response: A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness Explanation: The client with sharp, colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority client at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, copious malodorous and frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority.

The nurse is obtaining a history from a male client who states having difficulty achieving and sustaining an erection. When reviewing the medication history, which medication classification does the nurse anticipate? Bronchodilators Antihypertensives Cardiac dysrhythmics Antibiotics

Correct response: Antihypertensives Explanation: Due to the therapeutic effect of antihypertensive medications decreasing blood pressure, the nurse is correct to anticipate a side effect of a male client having difficulty achieving or sustaining an erection. The other medication classifications do not typically have an effect on the male reproductive system.

The nurse instructs a female client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for women who: Have had a history of ectopic pregnancies. Desire short-term use of a contraceptive. Are in a monogamous relationship. Have a history of sexually transmitted diseases (STDs).

Correct response: Are in a monogamous relationship. Explanation: The IUD is suitable for clients who desire long-term contraceptive use and are in a monogamous relationship. Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.

Fertility studies for men include a semen analysis to determine sperm count, sperm motility, and abnormal sperm. Which test can also be performed to determine infertility? Prostate-specific antigen (PSA) assay test Needle biopsy of prostatic tissue Blood test for luteinizing hormone (LH) Cystoscopy

Correct response: Blood test for luteinizing hormone (LH) Explanation: A decrease in the concentration of LH in the blood may be responsible for decreased testosterone production and infertility. A needle biopsy of prostatic tissue is obtained to diagnose a definitive cancer of the prostate. The PSA assay is a blood test that detects prostate cancer.

A 35-year-old African American woman who smokes regularly and had diabetes visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. Which contraceptive method is best for this client? Menotropins therapy Clomiphene therapy Cervical cap Placement of an etonogestrel/ethinyl estradiol vaginal ring

Correct response: Cervical cap Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not use hormonal therapy and are appropriate in this case. Menotropins, a combination of follicle-stimulating hormone and luteinizing hormone, may be used to stimulate the ovaries to produce eggs. An etonogestrel/ethinyl estradiol vaginal ring is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this client.

A nurse is providing care to a female client with infertility. Testing reveals a problem with hypothalmic stimulation of the pituitary gland to release hormones. Which agent would the nurse expect to be prescribed? Menotropins Clomiphene Leuprolide Follitropin-alpha

Correct response: Clomiphene Explanation: Clomiphene is an estrogen antagonist that is used when the hypothalamus is not stimulating the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Menotropins may be used to stimulate the ovaries to produce eggs in women with deficiencies in FSH and LH. Follitropin-alpha is used to treat ovulation disorders or to stimulate a follicle or egg production for assisted reproductive technologies. Leuprolide is used to prevent premature egg release and to shrink fibroids.

Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected? Colporrhaphy Cone biopsy (conization) Cryotherapy Perineorrhaphy

Correct response: Cone biopsy (conization) Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. Colporrhaphy refers to repair of the vagina. Cryotherapy refers to destruction of tissue by freezing. Perineorrhaphy refers to sutural repair of perineal lacerations.

Which of the following is an age-related functional change of the female reproductive system? Decreased ovulation Increased vaginal lubrication Decreased pH of vagina Hormone level stability

Correct response: Decreased ovulation Explanation: Functional changes of the female reproductive system include decreased ovulation, onset of menopause, hormonal fluctuations, decreased bone formation, decreased vaginal lubrication, and increased pH of the vagina.

A nurse practitioner is conducting a history and physical on a 42-year-old woman. One of the questions asked of someone in this age group is the type of medications that the patient's mother took during her pregnancy. The nurse is assessing for a past history of ______ use. Diethylstilbestrol Immunosuppressive agents Cancer drugs Antibiotics

Correct response: Diethylstilbestrol Explanation: Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.

Which term refers to painful menstruation? Amenorrhea Dysmenorrhea Ovulation Dyspareunia

Correct response: Dysmenorrhea Explanation: Dysmenorrhea is painful menstruation. Amenorrhea is the absence of menstrual flow. Ovulation is the discharge of mature ovum from the ovary. Dyspareunia is difficult or painful sexual intercourse.

Which of the following diagnostic tests is used for severe bleeding that is unresponsive to other therapies? Dilation and curettage (D & C) Laparoscopy Endometrial ablation Endometrial biopsy

Correct response: Endometrial ablation Explanation: Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. A D & C is used as a therapeutic measure for incomplete miscarriage. Laparoscopy involves inserting a laparoscope into the peritoneal cavity through a small incision below the umbilicus to allow visualization of the pelvic structures. An endometrial biopsy is a method of obtaining endometrial tissue by placing a flexible suction tube through the cervix into the uterus.

Which diagnostic test is indicated for postmenopausal bleeding? Computed tomography Magnetic resonance imaging Endometrial biopsy Ultrasound

Correct response: Endometrial biopsy Explanation: For postmenopausal bleeding, an endometrial biopsy or D&C is indicated.

The nurse, who is conducting a Papanicolaou (Pap) smear, performs which actions to promote client comfort during the procedure? Select all that apply. Lubricate the blades of the speculum Flush away any purulent material at the cervical os Ensure warming of the speculum Explain to the client that some discomfort is normal Use a quick motion to open the speculum once inserted

Correct response: Ensure warming of the speculum Lubricate the blades of the speculum Explain to the client that some discomfort is normal Explanation: Warming the speculum prior to insertion can be more comfortable for the client. Lubrication of the outer superior and inferior blade of the plastic vaginal speculum with a small amount of a water-soluble lubricant gel decreases the pain associated with insertion and opening of the vaginal speculum in both premenopausal and postmenopausal women, without affecting the quality of the cytology results during the collection of Pap test specimens. The nurse should share education about the pelvic examination with the client to proceed more smoothly and ensure the client knows what to expect. Along with other important information about the procedure, the nurse should tell the client it is normal to feel uncomfortable and apprehensive. During the pelvic examination, when the speculum is positioned properly, it should be opened slowly, not using a quick motion, to visualize the cervix as this would be uncomfortable to the client. If there is purulent drainage at the cervical os, this is an indication there could be an infection present. The nurse should obtain a culture of the drainage with a sterile applicator, not flushing the drainage away.

A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate? Giving the client a mild sedative before the procedure Administering laxatives and an enema prior to the procedure Ensuring that the client has a full bladder Checking that it has been 5 days since the end of her menses

Correct response: Ensuring that the client has a full bladder Explanation: An abdominal ultrasound is a simple procedure that requires no specific preparation other than ensuring that the client has a full bladder to enhance visualization of abdominal area. A mild sedative, laxatives, and an enema would be used prior to a hysterosalpingography. A hysteroscopy should be done about 5 days after menstruation ceases.

A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle? January 30 February 5 January 27 February 8

Correct response: February 5 Explanation: February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors.

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply. Fluid retention Low back pain Fever Headache Hypotension

Correct response: Fluid retention Low back pain Headache Explanation: Major symptoms of PMS include physical symptoms such as headache, fatigue, low back pain, painful breasts, and a feeling of abdominal fullness, caused by fluid retention. Fever and hypotension are not typical symptoms of PMS.

A nurse is reviewing the medical record of a client who has come to the clinic for contraception. What condition would hormonal contraceptives be contraindicated for in a client? Controlled hypertension History of thrombophlebitis Severe acne An irregular menstrual cycle

Correct response: History of thrombophlebitis Explanation: Absolute contraindications to the use of hormonal contraceptives include a history of thrombophlebitis because of the increased risk for emboli formation. Hypertension, if controlled in an otherwise healthy young nonsmoker, is not a contraindication for the use of combination agents. However, the client would require a low dose and careful monitoring. Hormonal contraceptives may decrease acne in some situations and help to establish a regular bleeding cycle. An irregular menstrual cycle is not a contraindication.

Which test is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent? Laparoscopy Hysterosalpingography Hysteroscopy Endometrial ablation

Correct response: Hysterosalpingography Explanation: Hysterosalpingography is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows the pelvic structures to be visualized. A hysteroscopy allows direct visualization of all parts of the uterine cavity be means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.

The nurse is relating health education to male students when asked where sperm is actually made. Which location is most correct? In the seminiferous tubules Sperm are present from birth. In the testes within the scrotum In the male reproductive system

Correct response: In the testes within the scrotum Explanation: Health instruction should be clear, specific, and factual. The specific location for sperm production is in the testes, which lie in the scrotum. More general information is that the sperm are produced in the male reproductive system and immature spermatozoa are formed in the seminiferous tubules. Sperm are not present from birth.

Which statement is true regarding hormonal contraception? It increases risk for benign breast cancer. It increases risk for venous thromboembolism. Fetal anomalies are a concern. It increases risk for uterine cancer.

Correct response: It increases risk for venous thromboembolism. Explanation: Clients taking hormonal contraception have an increased risk for venous thromboembolism but a decreased risk for benign breast cancer and uterine cancer. Fetal anomalies are not a concern.

Which statement is true regarding hormonal contraception? It increases the risk of uterine cancer. It increases the risk for venous thromboembolism. It increases the risk of benign breast cancer. Fetal anomalies are a concern.

Correct response: It increases the risk for venous thromboembolism. Explanation: Clients taking hormonal contraception have an increased risk for venous thromboembolism, but their risk for benign breast cancer and uterine cancer is decreased. Fetal anomalies are not a concern.

The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening? Fourchette Clitoris Meatus Labia majora and minora

Correct response: Labia majora and minora Explanation: The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.

The nurse is preparing the female client for a pelvic examination. In which position will the nurse assist the client? Lithotomy position Supine position Trendelenburg's position Lateral recumbent

Correct response: Lithotomy position Explanation: For a pelvic examination, the nurse is most correct to assist the client to the lithotomy position. In this position, the client lies on her back with the legs bent and spread. Many times, the feet are in lithotomy stirrups. The supine position is flat on the back. The Trendelenburg's position provides the feet higher than the head at a 15° to 30° angle. The lateral recumbent position is a side-lying position.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone? Methotrexate is used only in early pregnancy to terminate a pregnancy nonsurgically. Clomiphene (Clomid) is used only in early pregnancy to terminate a pregnancy nonsurgically. Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Birth control pills can be used to terminate the pregnancy.

Correct response: Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Explanation: Mifepristone (Mifeprex), formerly known as RU-486, is a medication used only in early pregnancy (up to 49 days from the last menstrual period) to induce abortion. It works by blocking progesterone.

A nurse is conducting a health education class for a group of 12- to 14-year-old girls and describing the events of secretory phase. Which of the following would the nurse include? Thickening of the uterine wall Ovulation Disintegration of the ovum Shedding of the uterine lining

Correct response: Ovulation Explanation: The secretory phase occurs near the middle portion of the cycle, during which ovulation occurs. Thickening of the uterine wall occurs during the proliferative phase. Disintegration of the ovum and shedding of the uterine lining occur during the luteal phase.

A positive chandelier sign is indicative of which of the following? Endometriosis Pelvic infection Uterine prolapse Rectocele

Correct response: Pelvic infection Explanation: Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.

A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client? Combined hormonal contraceptive use Pelvic inflammatory disease (PID) Use of in vitro fertilization Habitual abortions

Correct response: Pelvic inflammatory disease (PID) Explanation: PID is a major risk factor for ectopic pregnancy. Other risk factors include salpingitis, peritubal ahdesions, structural abnormalities of the tube, previous ectopic pregnancy, previous tubal surgery, multiple previous induced abortions, tumors that distort the tube, and IUD and progestin-only contraceptives. Combined hormonal contraceptive use, in vitro fertilization, and habitual abortions are not risk factors for ectopic pregnancy.

A client is prescribed a combination hormonal contraceptive. What condition would the nurse instruct the client to report to the healthcare provider immediately? Nausea Mood changes Difficulty hearing Pregnancy

Correct response: Pregnancy Explanation: A client taking combined hormonal contraceptives should immediately report thrombophlebitis or known or suspected pregnancy because of serious complications like pulmonary emboli or miscarriage. Although nausea and mood changes are bothersome adverse effects, they do not need to be reported immediately. Difficulty hearing is not associated with combined hormonal contraceptive use.

A client is diagnosed with hypertension. The client also reports skin discoloration, weight gain, and nausea. Which contraceptive preparations would the nurse practitioner recommend for this client? Progestin-only Triphasic Biphasic Monophasic

Correct response: Progestin-only Explanation: Progestin-only preparations are useful for women who have experienced estrogen-related side effects (e.g., headaches, hypertension, leg pain, chloasma or skin discoloration, weight gain, or nausea) when taking combination pills. Combined preparations can be monophasic, biphasic, and or triphasic. Monophasic preparations supply the same dose of estrogen and progestin for 21 days. Biphasic preparations and triphasic pills vary the amount of hormonal components during the cycle.

A nurse is obtaining health history from a young adult woman. Which of the following would alert the nurse to a possible problem? Age of 13 years at menarche Menstrual cycle averaging 28 to 29 days Reports of dyspareunia Mucus-like vaginal discharge

Correct response: Reports of dyspareunia Explanation: Dyspareunia, or pain with intercourse, is an abnormal finding associated with numerous potential problems. Onset of menarche is usually between 12 to 14 years but could be as early as age 10 or 11 years. The menstrual cycle typically averages 28 days but it can vary from 21 to 42 days. A mucus-like vaginal discharge is normal.

The nurse is caring for a client who states having an irregular menstrual period. Which diagnostic test provides information of the body's ability to ovulate? Estrogen level Serum follicle-stimulating hormone Thyroid level Serum luteinizing hormone

Correct response: Serum follicle-stimulating hormone Explanation: The anterior pituitary hormone known a follicle-stimulating hormone (FSH) initiates ovulation monthly. Monitoring the FSH level provides information about the timing of ovulation. Thyroid level, estrogen level, and serum luteinizing hormone do not give information about the ability to ovulate

Which of the following positions may be utilized for a patient who is unable to maintain the supine lithotomy position? Sims' Trendelenburg Prone Semi-Fowler's

Correct response: Sims' Explanation: Although several positions may be used for the pelvic examination, the supine lithotomy position is used most commonly. Sims' position may be used with a patient who is unable to maintain the supine lithotomy position due to acute illness or disability. The prone, semi-Fowler's, and Trendelenburg position would not be used.

Nursing students are reviewing information about natural family planning methods in preparation for a quiz the next day. The students demonstrate a need for additional study when they identify which of the following as an example? Basal body temperature Symptothermal method Spermicide Calendar method

Correct response: Spermicide Explanation: Spermicides are considered a barrier method of contraception. Natural family planning methods include the calendar, basal body temperature, symptothermal, and ovulation methods.

Which of the following positions is commonly used for a pelvic examination? Supine lithotomy Prone Reverse Trendelenburg Trendelenburg

Correct response: Supine lithotomy Explanation: Although several positions may be used for the pelvic examination, the supine lithotomy position is used most commonly. Sims' position may be used with a patient who is unable to maintain the supine lithotomy position due to acute illness or disability. The prone, reverse Trendelenburg, and Trendelenburg position would not be used.

The nurse is outlining the female internal reproductive structures on a diagram. Where on the diagram would the nurse highlight the typical site of ovum fertilization? The nurse would highlight the fallopian tube. The nurse would highlight the ovaries. The nurse would highlight the uterus. The nurse would highlight the cervix.

Correct response: The nurse would highlight the fallopian tube. Explanation: The nurse would highlight the fallopian tubes as the site of ovum fertilization. Once fertilized, the fertilized egg moves to the uterus for implantation. The cervix is the lower, narrowed neck portion leading to the center of the uterus. The ovaries release the ovum, which is swept into the fallopian tubes.

During physical examination of the male reproductive system, which method would best provide the nurse information about the prostate's size as well as evidence of tumor? inspection of the size of the scrotum scrotal radiography transillumination digital rectal examination

Correct response: digital rectal examination Explanation: A digital rectal examination (DRE) is performed to assess the prostate for size as well as evidence of tumor.

Because of a client's reluctance to begin hormone therapy, the advance nurse practitioner prescribes venlafaxine to decrease the risk of hot flashes. stroke. heart attack. blood clots.

Correct response: hot flashes. Explanation: Problematic hot flashes have been treated with low-dose venlafaxine as an alternative to hormone therapy. Hormone therapy decreases the risk of hot flashes, but it increases the risk of stroke, heart attack, and blood clots.