Chapter 4, Assessment and Health Promotion, Maternity Ch. 8 Violence against women, OB Chapter 6: Reproductive System Concerns, Lowdermilk, Ch. 7, Sexually Transmitted and Other Infections - final, Maternity & Womens Health Care Ch. 8, Maternity & Wo...

13. One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. b. Menorrhagia. c. Leiomyoma. d. Metrorrhagia.

d. Metrorrhagia.

Which is a possible reason for the absence of congenital anomaly in the offspring of a type 1 diabetic pregnant client?

An euglycemic condition maintained during pregnancy

Which statement by the client indicates the need for further teaching regarding contraception and child spacing?

Barrier methods help prevent pregnancy but not sexually transmitted infections (STIs).

Which condition is described in the client who shows signs of depression, is excessively concerned about her body size and shape, and also eats uncontrollably?

Binge eating disorder

Which test would the nurse expect to be prescribed for further evaluation after a pathology report indicates that atypical endometrial cells were detected in a postmenopausal client's vaginal pool specimen?

Biopsy

Which nursing instruction is appropriate to assist a client in regaining control of the urinary sphincter?

Perform Kegel exercises.

Which nursing assessment is appropriate for a client with high levels of estrogen and luteinizing hormone and low levels of prostaglandin?

The ovum is not being released from the follicles.

Which nursing explanation is appropriate for a 27-year-old client who has been vaccinated against human papillomavirus (HPV) and does not understand why she must return to the clinic in 3 years for another Pap test?

"HPV testing is routinely obtained with a Pap test.

Which are the 4 Cs of cultural competence?

Call, cause, cope, and concerns

Which process is the uterus, a muscular pear-shaped organ, responsible for?

Cyclic menstruation

Which aspect of care would be the focus for a client with type 1 diabetes mellitus who is planning a pregnancy and seeking preconception care?

Prevention of fetal malformations

15. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin.

c. Nonsteroidal antiinflammatory drugs (NSAIDs).

Which statement by the client indicates effective learning of the instruction about Kegel exercises?

"I will hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises.

Which is the best nursing response for a client with a history of breast cancer who had a lumpectomy 2 years ago and is asking about the best time to perform monthly breast self-examination (BSE)?

"The best time of the month to perform your breast self-examination is 5 to 7 days after menstruation stops.

Which statement correlates with the proliferative phase of the endometrial cycle?

Estrogen affects the growth of the lining of the uterus

Which nursing advice is appropriate for the client who thinks she has "bumps" on her labia and is unsure how to check herself?

Explain the process of vulvar self-examination, and reassure the client that she will become familiar with normal and abnormal findings during the examination

Which are ways to encourage a client admitted with vaginal bleeding to share her health history? Select all that apply.

Facilitation Reflection Clarification Confrontation Empathic responses

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a.6 to 10 days b.2 to 4 weeks c.6 to 12 weeks d.6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

Which approximate age is expected for a client to have started perimenopause if she experienced menopause at 52 years of age?

48

46. Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (Select all that apply): a. Fellatio. b. Unprotected anal intercourse. c. Multiple sex partners. d. Dry kissing. e. Abstinence.

A, B, C

Which are sexually transmitted bacterial infections? Select all that apply. a. Syphilis b. Gonorrhea c. Chlamydia trachomatis d. Vulvovaginal candidiasis e.Pelvic inflammatory disease

A, B, C, E Syphilis is caused by Treponema pallidum, which enters the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse. Gonorrhea is caused by the aerobic, gram-negative diplococcus N. gonorrhoeae and is transmitted by sexual contact. Chlamydia trachomatis is the most commonly reported STI seen in sexually active women aged 15 to 24. Pelvic inflammatory disease (PID) is caused by N. gonorrhoeae, chlamydia trachomatis, and a wide variety of anaerobic and aerobic bacteria. Women who have multiple sex partners and a history of STIs are at risk for PID. Vulvovaginal candidiasis is a yeast infection caused by Candida albicans and is not sexually transmitted or bacterial. p. 148-152

45. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.

A, B, D, E

Which of these are the lowest-risk sexual practices? Select all that apply. a. Abstinence b. Dry kissing c. Wet kissing d. Mutual masturbation e. Hugging, massaging, touching (assuming no break in skin) f. Monogamous (both partners and no high-risk activities), but not tested for HIV or other STIs

A, B, D, E The lowest-risk sexual practices include abstinence; dry kissing; mutual masturbation; and hugging, massaging, and touching (assuming no break in skin). Wet kissing and having partners who are both monogamous and who have used no high-risk activities but have not been tested for HIV or other STIs are low-risk practices, but there are potential risks. P. 147

Which symptoms indicate syphilis? Select all that apply. a. Generalized lymphadenopathy b. Abdominal pain and irregular bleeding c. Wartlike infectious lesions on the vulva d. A painful papule at the site of inoculation e. The presence of rash on the palms and soles

A, C, E Generalized lymphadenopathy indicates secondary syphilis, which occurs 6 weeks to 6 months after the appearance of the chancre. Wartlike infectious lesions, also known as condylomata lata, may develop on the vulva, the perineum, or the anus. The presence of rash on the palms and soles also indicates secondary syphilis. Abdominal pain and irregular bleeding are symptoms of pelvic inflammatory disease (PID). Primary syphilis is a lesion that begins as a painless papule at the site of inoculation and becomes a nontender, shallow, indurated, clean ulcer. p. 151

A female client is receiving treatment for gonorrhea. What does the nurse tell the client while providing care? Select all that apply. a. Recommend that the client be tested for human immunodeficiency virus (HIV) b. Inform the client that the treatment has a poor success rate. c. Reinforce teaching of correct condom use during sexual activity. d. Inform the client that the disease is not reportable. e. Encourage the client to notify her partners about the infection.

A, C, E There is an increased risk for HIV infection in clients who have gonorrhea. Therefore the nurse needs to counsel the client to seek HIV testing. The nurse needs to instruct the client to use a condom during sexual activities, because there may be a chance of reinfection if preventive measures are not taken. Gonorrhea is a highly communicable disease, so the nurse encourages the client to notify her partners about their exposure to the disease so that they can seek appropriate assessment and treatment. The treatment does not have a poor success rate, but reinfection occurs if the client does not take proper preventive measures. Gonorrhea is a reportable communicable disease, and the nurse needs to inform the client that the case will be reported to the health authorities. p. 151

What are some known triggers that cause an outbreak of genital herpes? Select all that apply. a. Stress b. Safety issues c. Menstruation d. Acute illnesses e. Family illnesses f. Ultraviolet light

A, C, F Some known triggers that can cause an outbreak of genital herpes include stress, menstruation, and ultraviolet light. Safety issues and acute or family illnesses are not known triggers for an outbreak of genital herpes. P. 157

47. The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

A, D, E

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

In vitro fertilizationembryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. Which explanation regarding the procedure is most accurate? a. The procedure begins with collecting eggs from your wifes ovaries. b. A donor embryo will be transferred into your wifes uterus. c. Donor sperm will be used to inseminate your wife. d. Dont worry about the technical stuff; thats what we are here for.

ANS: A A womans eggs are collected from her ovaries, fertilized in the laboratory with the partners sperm, and transferred to her uterus after normal embryonic development has occurred. Transferring a donor embryo to the womans uterus describes the procedure for a donor embryo. Inseminating the woman with donor sperm describes therapeutic donor insemination. Telling the client not to worry discredits the clients need for teaching and is not the most appropriate response. DIF: Cognitive Level: Apply REF: p. 207 TOP: Nursing Process: Planning

9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester? a.Dilation and evacuation (D&E) b.Methotrexate administration c.Prostaglandin administration d.Vacuum aspiration

ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester. DIF: Cognitive Level: Understand REF: p. 194

7. Which statement regarding emergency contraception is correct? a.Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b.Emergency contraception may be taken right after ovulation. c.Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d.Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea. DIF: Cognitive Level: Understand REF: p. 186

13. Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a.Family planning b.Birth control c.Contraception d.Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility. DIF: Cognitive Level: Understand REF: p. 171

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a.Bacterial vaginosis b.Candidiasis c.Trichomoniasis d.Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a.Wear gloves. b.Wear mouth, nose, and eye protection. c.Wear a mask. d.Wash the hands after medication administration.

ANS: A Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)? a. Thyroid dysfunction b. Recent miscarriage c. PCOD d. Oocyte retrieval

ANS: A Synthroid is administered for anovulation associated with hypothyroidism. For women with polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have insufficient progesterone and require exogenous progesterone until placental production is sufficient. DIF: Cognitive Level: Remember REF: p. 205 TOP: Nursing Process: Diagnosis

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a.Vomiting and diarrhea b.Headache, myalgias, and arthralgia c.Preterm labor d.Jarisch-Herxheimer in the first 24 hours after treatment

ANS: A The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a.Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months. b.Determine the clients weight gain and loss pattern for the previous year. c.Examine skin pigmentation and hair texture for hormonal changes. d.Explore the clients previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method. DIF: Cognitive Level: Analyze REF: p. 174

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a.Fluconazole b.Tetracycline c.Clindamycin d.Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurses most appropriate response? a. This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen. d. Ten percent is a very low risk, so you dont need to worry too much.

ANS: A The incidence of multiple pregnancies with the use of these medications is higher than 25%. The clients concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the clients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is inaccurate. Furthermore, the clients concern is discredited with a statement such as, dont worry. DIF: Cognitive Level: Apply REF: p. 208 TOP: Nursing Process: Planning

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a.Herpes simplex virus 2 (HSV-2) b.HPV c.HIV d.CMV

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

12. Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal? a.You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash. b.You should remove your diaphragm right after intercourse to prevent TSS. c.Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS. d.Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get TSS.

ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses. DIF: Cognitive Level: Apply REF: p. 180 TOP: Nursing Process: Planning

17. Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a.Standard days variation b.Periodic abstinence c.Postovulation d.Coitus interruptus

ANS: A The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher. DIF: Cognitive Level: Remember REF: p. 174

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a.Only one vaccine for the HPV is available. b.The vaccine is given in three doses over a 6-month period. c.The vaccine is recommended for both boys and girls. d.Ideally, the vaccine is administered before the first sexual contact.

ANS: A Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

A probable cause for increasing infertility is the societal delay in pregnancy until later in life. What are the natural reasons for the decrease in female fertility? (Select all that apply.) a. Ovulation dysfunction b. Endocrine dysfunction c. Organ damage from toxins d. Endometriosis e. Tubal infections

ANS: A, C, D, E All of these factors may result in a cumulative effect, decreasing fertility in women. Male infertility is more often caused by unfavorable sperm production attributable to endocrine dysfunction or cumulative metabolic disease. DIF: Cognitive Level: Comprehend REF: p. 197

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a.Strategies to enhance condom use b.Choice of colors and special features c.Leaving the decision up to the male partner d.Places to carry condoms safely

ANS: A When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

To provide adequate care, the nurse should be cognitive of which important information regarding infertility? a. Is perceived differently by women and men. b. Has a relatively stable prevalence among the overall population and throughout a womans potential reproductive years. c. Is more likely the result of a physical flaw in the woman than in her male partner. d. Is the same thing as sterility.

ANS: A Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a womans age, especially after age 40 years. Of cases with an identifiable cause, approximately 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a prolonged time to conceive. DIF: Cognitive Level: Understand REF: p. 204

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners d.Dry kissing e.Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. Which factors are possible causes for female infertility? (Select all that apply.) a. Congenital or developmental b. Hormonal or ovulatory c. Tubal or peritoneal d. Uterine e. Emotional or psychologic

ANS: A, B, C, D Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors. Although the diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress, these are not considered factors associated with infertility. Feelings connected with infertility are many and complex. Resolve is an organization that provides support, advocacy, and education for both clients and health care providers. DIF: Cognitive Level: Remember REF: pp. 197-199

Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a.Menstruation b.Trauma c.Febrile illness d.Soap e.Ultraviolet light

ANS: A, B, C, E Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction and stroke c. Hypotension d. Breast tenderness and fluid retention e. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma. DIF: Cognitive Level: Understand REF: p. 184

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a.Intrapartum treatment with antiviral medications b.Cesarean birth c.Postpartum treatment with antiviral medications d.Avoidance of breastfeeding e.Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a.Toxoplasmosis b.Other infections c.Roseola d.Clostridium e.Herpes simplex

ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a.Number of partners b.Level of physical activity c.Prevention of pregnancy d.Protection from STIs e.Past history

ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a. It is highly unlikely that you will become pregnant after the procedure. b. Tubal ligation is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against STIs. d. Sterilization offers no protection against STIs. e. Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation. DIF: Cognitive Level: Apply REF: p. 190

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a.Miconazole ointment b.Topical podofilox 0.5% solution or gel c.Two doses of penicillin administered intramuscularly (IM) d.Metronidazole by mouth

ANS: B Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

18. Which contraceptive method best protects against STIs and the HIV? a.Periodic abstinence b.Barrier methods c.Hormonal methods d.Same protection with all methods

ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV. DIF: Cognitive Level: Apply REF: p. 177 TOP: Nursing Process: Planning

3. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response? a.Oral contraceptives are a highly effective method, but they have some side effects. b.Your current medications will reduce the effectiveness of the pill. c.Oral contraceptives will reduce the effectiveness of your seizure medication. d.The pill is a good choice for a woman of your age and with your personal history.

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy. DIF: Cognitive Level: Apply REF: p. 184 TOP: Nursing Process: Planning

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a.Vaccine exists for hepatitis C virus (HCV) but not for HBV. b.HAV is acquired by eating contaminated food or drinking polluted water. c.HBV is less contagious than HIV. d.Incidence of HCV is decreasing.

ANS: B Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge concerning contraception and her commitment to any particular method. c. Assess the womans willingness to touch her genitals and cervical mucus. d. Evaluate the womans contraceptive life plan.

ANS: B Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive. DIF: Cognitive Level: Analyze REF: pp. 171-172

8. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a.The IUD does not interfere with sex. b.The risk of pelvic inflammatory disease will be higher with the IUD. c.The IUD will protect you from sexually transmitted infections. d.Pregnancy rates are high with the IUD.

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%. DIF: Cognitive Level: Apply REF: p. 187 TOP: Nursing Process: Planning

2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a.Theyre not very effective, and it is very likely that youll get pregnant. b.FAMs can be effective for many couples; however, they require motivation. c.These methods have a few advantages and several health risks. d.You would be much safer going on the pill and not having to worry.

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part. DIF: Cognitive Level: Apply REF: pp. 173-174 TOP: Nursing Process: Planning

With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information? a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation will take several months and can be very costly. c. The woman is assessed first; if she is not the problem, then the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women.

ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment. Both partners are systematically and simultaneously assessed, first as individuals and then as a couple. Semen analysis is for men; however, the postcoital test is for the couple. DIF: Cognitive Level: Apply REF: p. 199

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide? a."It's just a little lump on your cervix. We can just freeze it off." b."HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." c."HPV is a type of early human immunodeficiency virus. You will die from this." d."You probably caught this from your current boyfriend. He should get tested for this."

ANS: B Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed? a. Anovulatory cycles b. Uterine fibroids c. Polycystic ovary disease (PCOD) d. Luteal phase inadequacy

ANS: B Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy. DIF: Cognitive Level: Remember REF: p. 206

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a.The lubricant prevents vaginal irritation. b.Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. c.The additional lubrication improves sex. d.Nonoxynol-9 improves penile sensitivity.

ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when informing the client on which herbal preparations may improve ovulation induction therapy? a. You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant. b. You may want to try black cohosh or phytoestrogens. c. You should take vitamins E and C, selenium, and zinc. d. Herbs have no bearing on fertility.

ANS: B Ovulation therapy may have better outcomes when supplemented by black cohosh, progesterone, or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10, and ginseng have been shown to improve male fertility. Although most herbal remedies have not been clinically proven, many women find them helpful. They should be prescribed by a health care provider who has knowledge of herbalism. DIF: Cognitive Level: Apply REF: p. 205 TOP: Nursing Process: Planning

Significant advances have been made with most reproductive technologies. Which improvement has resulted in increased success related to preimplantation genetic diagnosis? a. Embryos are transferred at the cleavage stage. b. Embryos are transferred at the blastocyst stage. c. More than two embryos can be transferred at a time. d. Two cells are removed from each embryo.

ANS: B Preimplantation genetic diagnosis can be performed on a single cell removed from each embryo after 3 to 4 days. With the availability of extended culture mediums, embryos are transferred at the blastocyst stage (day 5), which increases the chance of a live birth, compared with the older practice of transferring embryos at the cleavage stage (day 3). No more than two embryos should be transferred at a time. DIF: Cognitive Level: Understand REF: p. 207

11. The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a.LAM is effective until the infant is 9 months of age. b.This popular method of birth control works best if the mother is exclusively breastfeeding. c.Its typical failure rate is 5%. d.Feeding intervals should be 6 hours during the day.

ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night. DIF: Cognitive Level: Understand REF: p. 191

15. Which benefit regarding FAMs makes it an appealing choice for some women? a.Adherence to strict recordkeeping b.Absence of chemicals and hormones c.Decreased involvement and intimacy of partner d.Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a.HIV screening b.HIV antibody testing c.Cluster of differentiation 4 (CD4) counts d.Cluster of differentiation 8 (CD8) counts

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

20. Importantly, the nurse must be aware of which information related to the use of IUDs? a.Return to fertility can take several weeks after the device is removed. b.IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c.IUDs offer the same protection against STIs as the diaphragm. d.Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a.Oral antiviral therapy b.Bed rest in a semi-Fowler position c.Antibiotic regimen continued until symptoms subside d.Frequent pelvic examination to monitor the healing progress

ANS: B The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

Which test is performed around the time of ovulation to diagnose the basis of infertility? a. Hysterosalpingogram b. Ultrasonography c. Laparoscopy d. Follicle-stimulating hormone (FSH) level

ANS: B Ultrasonography is performed around the time of ovulation to assess pelvic structures for abnormalities, to verify follicular development, and to assess the thickness of the endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. DIF: Cognitive Level: Understand REF: p. 201 TOP: Nursing Process: Planning

Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are accurate? (Select all that apply.) a. Donor is inseminated with semen from the parent. b. Donor eggs are fertilized with the male partners sperm. c. Donors are under 35 years of age. d. Recipient undergoes hormonal stimulation. e. Ovum is placed into a surrogate.

ANS: B, C, D Oocyte donation is usually provided by healthy women under the age of 35 years, who are recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are fertilized in a laboratory with the male partners sperm. The woman undergoes hormonal stimulation to allow the development of the uterine lining. Embryos are then transferred. A donor that is inseminated with the male partners semen or receives the fertilized ovum and then carries it to gestation is known as a surrogate mother. DIF: Cognitive Level: Understand REF: p. 207

Which statements regarding the HPV are accurate? (Select all that apply.)HPV infections: a.are thought to be less common in pregnant women than in women who are not pregnant. b.are thought to be more common in pregnant women than in women who are not pregnant. c.were previously called genital warts. d.were previously called herpes. e.may cause cancer.

ANS: B, C, E HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a. Fever higher than 39 C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than four pads in 2 hours e. Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache. DIF: Cognitive Level: Apply REF: p. 193

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a. Sterilization should be performed under general anesthesia. b. Pain, bleeding, and infection are possible complications. c. Pregnancy may still be possible. d. Vasectomy may affect potency. e. Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected. DIF: Cognitive Level: Understand REF: p. 190

5. Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a.The ideal candidate for DMPA wants menstrual regularity and predictability. b.The client has a history of thrombotic problems or breast cancer. c.The ideal candidate has difficulty remembering to take oral contraceptives daily. d.The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

What is the drug of choice for the treatment of gonorrhea? a.Penicillin G b.Tetracycline c.Ceftriaxone d.Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a.Gonorrhea b.Syphilis c.Chlamydia d.Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, Deficient knowledge, related to lack of understanding of the reproductive process with regard to conception. Which nursing intervention does not apply to this diagnosis? a. Assess the current level of factors promoting conception. b. Provide information regarding conception in a supportive manner. c. Evaluate the couples support system. d. Identify and describe the basic infertility tests.

ANS: C Evaluating the couples support system would be a nursing action more suitable to the diagnosis, Ineffective individual coping, related to the ability to conceive. DIF: Cognitive Level: Analyze REF: p. 203 TOP: Nursing Process: Diagnosis

. If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? a. Spermicides b. Female condoms c. Male condoms d. Diaphragms

ANS: C For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%. DIF: Cognitive Level: Remember REF: p. 179 TOP: Nursing Process: Planning

Which STI does not respond well to antibiotic therapy? a.Chlamydia b.Gonorrhea c.Genital herpes d.Syphilis

ANS: C Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

Which condition is the most life-threatening virus to the fetus and neonate? a.Hepatitis A virus (HAV) b.Herpes simplex virus (HSV) c.Hepatitis B virus (HBV) d.Cytomegalovirus (CMV)

ANS: C HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a.Avoid sexual contact for at least 10 days after starting the pill. b.Use condoms and foam for the first few weeks as a backup. c.Use another method of contraception for 1 week after starting the pill. d.Begin sexual relations once vaginal bleeding has ended.

ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy. DIF: Cognitive Level: Apply REF: p. 193 TOP: Nursing Process: Planning

14. In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a.B stands for birth control. b.R stands for reproduction. c.A stands for alternatives. d.I stands for ineffective.

ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified FSH (Metrodin). The nurse instructs her that this medication is administered in the form of what? a. Intranasal spray b. Vaginal suppository c. Intramuscular (IM) injection d. Tablet

ANS: C Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or a vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by mouth in tablet form. DIF: Cognitive Level: Comprehend REF: p. 206

16. The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a.The natural family planning method is the same as coitus interruptus or pulling out. b.This contraception method uses the calendar method to align the womans cycle with the natural phases of the moon. c.This practice is the only contraceptive method acceptable to the Roman Catholic Church. d.The natural family planning method relies on barrier methods during the fertility phases.

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. DIF: Cognitive Level: Understand REF: p. 173 TOP: Nursing Process: Planning

A couple arrives for their first appointment at an infertility center. Which of the following is a noninvasive test performed during the initial diagnostic phase of testing? a. Hysterosalpingogram b. Endometrial biopsy c. Sperm analysis d. Laparoscopy

ANS: C Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of testing for male infertility. Radiographic film examination allows visualization of the uterine cavity after the instillation of a radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure, during which a small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful to view the pelvic structures intraperitoneally and is an invasive procedure. DIF: Cognitive Level: Comprehend REF: pp. 202-203 TOP: Nursing Process: Planning

A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional testing is needed? a. Testicular biopsy b. Antisperm antibodies c. FSH level d. Examination for testicular infection

ANS: C This scenario does not indicate that the woman has had any testing related to her irregular menstrual cycles. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of the womans irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the case because the husband has already produced children, antisperm antibodies may be produced by the man against his own sperm. Examination for testicular infection would be performed before semen analysis. Furthermore, infection would affect spermatogenesis. DIF: Cognitive Level: Analyze REF: p. 201 TOP: Nursing Process: Diagnosis

10. A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a.Limit sexual contact for one cycle after starting the pill. b.Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c.Take one pill at the same time every day. d.Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days. DIF: Cognitive Level: Apply REF: pp. 181-184 TOP: Nursing Process: Planning

A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurses most appropriate response? a. Tell your friends and family so that they can help you. b. Talk only to other friends who are infertile, because only they can help. c. Get involved with a support group. Ill give you some names. d. Start adoption proceedings immediately, because adopting an infant can be very difficult.

ANS: C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs. However, depending on where the other couple is in their own recovery process, limiting their interactions may not be of assistance to them. Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being. DIF: Cognitive Level: Apply REF: p. 204

Which procedure falls into the category of micromanipulation techniques of the follicle? (Select all that apply.) a. Intrauterine insemination b. Preimplantation genetic diagnosis c. Intracytoplasmic sperm injection (ISCI) d. Assisted hatching e. IVF-ET

ANS: C, D ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by introducing sperm beneath the zone pellucid into the egg. Another micromanipulation technique is assisted hatching. An infrared laser breaks through the thick or tough zone pellucid, enabling the blastocyst to hatch. DIF: Cognitive Level: Understand REF: p. 207

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives to enable couples to make informed decisions about their choice of treatment. Which concern is unnecessary for the nurse to address before treatment? a. Risks of multiple gestation b. Whether or how to disclose the facts of conception to offspring c. Freezing embryos for later use d. Financial ability to cover the cost of treatment

ANS: D Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that multifetal reduction may be needed. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, donor oocytes, sperm, embryos, or a surrogate mother may be needed. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time. DIF: Cognitive Level: Apply REF: p. 208

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a.Bacterial vaginosis b.Candidiasis c.Yeast infection d.Trichomoniasis

ANS: D Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

What is the importance of obtaining informed consent for a number of contraceptive methods? a. Contraception is an invasive procedure that requires hospitalization. b. The method may require a surgical procedure to insert a device. c. The contraception method chosen may be unreliable. d. The method chosen has potentially dangerous side effects.

ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching. DIF: Cognitive Level: Understand REF: p. 172

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. Which guidance should the nurse provide? a. Your sperm count seems to be okay in the first semen analysis. b. Only marijuana cigarettes affect sperm count. c. Although smoking has no effect on sperm count, it can give you lung cancer. d. Smoking can reduce the quality of your sperm.

ANS: D Cigarette smoking has detrimental effects on sperm and has been associated with abnormal sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a smoking cessation program to increase the fertility of the male partner. Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. Marijuana use may depress the number and motility of sperm. Smoking is indeed a causative agent for lung cancer. DIF: Cognitive Level: Apply REF: p. 199 TOP: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

Which statement regarding the term contraceptive failure rate is the most accurate? a.The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b.It refers to the minimum rate that must be achieved to receive a government license. c.The contraceptive failure rate increases over time as couples become more careless. d.It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

Which statement is the most complete and accurate description of medical abortions? a.Medical abortions are performed only for maternal health. b.They can be achieved through surgical procedures or with drugs. c.Medical abortions are mostly performed in the second trimester. d.They can be either elective or therapeutic.

ANS: D Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a.Positive prenatal culture b.Preterm birth at 37 weeks or less of gestation c.Maternal temperature of 38° C or higher d.Premature rupture of membranes (PROM) 24 hours or longer before the birth

ANS: D PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

Male fertility declines slowly after age 40 years; however, no cessation of sperm production analogous to menopause in women occurs in men. What condition is not associated with advanced paternal age? a. Autosomal dominant disorder b. Schizophrenia c. Autism spectrum disorder d. Down syndrome

ANS: D Paternal age older than 40 years is associated with an increased risk for autosomal dominant disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down syndrome can occur in any pregnancy, it is often associated with advanced maternal age. DIF: Cognitive Level: Understand REF: p. 199

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a.Fever, headache, and malaise b.Widespread rash c.Identified by serologic testing d.Appearance of a chancre 2 months after infection

ANS: D Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate? a. Semen is collected after laparoscopy. b. Women must have two normal fallopian tubes. c. Ovulation spontaneously occurs. d. Ova and sperm are transferred to one tube.

ANS: D Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal tube. Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is collected before laparoscopy. The ova and sperm are then transferred to one uterine tube, permitting natural fertilization and cleavage. DIF: Cognitive Level: Remember REF: p. 207

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. What is the nurses mostappropriate response? a.This probably means that youre pregnant. b.Dont worry; its probably nothing. c.Have you been sick this month? d.You probably didnt ovulate during this cycle.

ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely the cause of an increase in BBT. DIF: Cognitive Level: Apply REF: pp. 175-176

6. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a.No spermicide is used with the cervical cap, so its less messy. b.The diaphragm can be left in place longer after intercourse. c.Repeated intercourse with the diaphragm is more convenient. d.The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed. DIF: Cognitive Level: Apply REF: p. 181 TOP: Nursing Process: Planning

19. Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a.COCs can cause TSS if the prescription is wrong. b.Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c.COCs increase the risk of endometrial and ovarian cancers. d.Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers. DIF: Cognitive Level: Understand REF: p. 184 TOP: Nursing Process: Planning

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a.HSV b.AIDS c.Venereal warts d.Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

1) The nurse is planning care for a client who is the victim of rape. Which psychosocial nursing diagnoses does the nurse include in the client's plan of care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fear 2. Fatigue 3. Powerlessness 4. Risk for infection 5. Readiness for enhanced knowledge

Answer: 1, 3 Explanation: When planning the psychosocial care for a client who is the victim of rape, the nurse would include the nursing diagnoses of fear and powerlessness in the plan of care. Fatigue, risk for infection, and readiness for enhanced knowledge are not diagnoses that the nurse would include in the plan of care for a client who is the victim of rape.

1) The nurse is providing care for a female client who is the victim of sexual assault. Which sexually transmitted infections (S T Is) does the nurse anticipate medication prescriptions to prevent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Syphilis 2. Gonorrhea 3. Chlamydia 4. Bacterial vaginosis 5. Herpes simplex virus

Answer: 2, 3, 4 Explanation: A client who is the victim of sexual assault is at the greatest risk for contracting gonorrhea, chlamydia, and bacterial vaginosis. The nurse would anticipate medication prescriptions for these S T Is. While the client is also at risk for syphilis and herpes simplex virus, these S T Is are not as common; therefore, the nurse would not anticipate medication prescriptions for these S T Is.

1) A female comes into the emergency department seeking treatment for possible rape. The patient recalls having a cocktail with friends at a local club but woke up in an alley three blocks away from the business. For which date rape drugs should the nurse prepare to have this patient tested? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Atropine 2. Ketamine 3. Scopolamine 4. Flunitrazepam 5. Gamma hydroxybutyrate

Answer: 2, 3, 4, 5 Explanation: Flunitrazepam (Rohypnol), a potent sedative-hypnotic has received considerable attention as the "date rape drug of choice" since the late 1990s. Typically, Rohypnol, which dissolves easily and is odorless, is slipped into the drink of an unsuspecting woman. Gamma hydroxybutyrate (G H B), ketamine, and scopolamine have also been identified as date rape drugs that are used to incapacitate a woman. Atropine is not identified as being a date rape drug.

1) The nurse is providing care to a female client in the acute phase of recovery following a sexual assault. Which nursing actions are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clarifying feelings 2. Creating a safe environment 3. Supporting advocacy efforts 4. Establishing a trusting relationship 5. Providing care for significant others

Answer: 2, 5 Explanation: During the acute phase of recovery following a sexual assault, the appropriate nursing actions include creating a safe environment and providing care for significant others. Clarifying feelings is an appropriate nursing action during the reorganizational phase of recovery following a sexual assault. Supporting advocacy efforts is an appropriate nursing action during the integration and recovery phases of recovery following a sexual assault. Establishing a trusting relationship is an appropriate nursing action during the outward adjustment phase following a sexual assault.

The nurse is assisting with the collection of evidence for a female client who is the victim of sexual assault. Which actions by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Drawing blood to test for gonorrhea 2. Placing each piece of clothing in a plastic bag 3. Pulling hair from the head and pubic region as evidence 4. Collecting a urine sample if drug-facilitated rape is suspected 5. Obtaining informed consent prior to photographing the injured areas

Answer: 3, 4, 5 Explanation: When collecting evidence for a female client who is the victim of sexual assault, the nurse will assist in pulling hair from the head and pubic region as evidence, collect a urine sample if drug-facilitated rape is suspected, and obtain informed consent prior to photographing the areas of injury. The nurse would draw blood to test for syphilis, not gonorrhea. The nurse would place each piece of the client's clothing into a paper bag, which is sealed and labeled. A plastic bag is not appropriate.

1) The nurse is participating in the collection of evidence from a victim of rape. In which order should the evidence be collected from this victim? 1. Oral swabs are obtained 2. Blood samples are drawn for syphilis 3. Hair samples and fingernail scrapings taken 4. Clothing is removed and bagged for evidence 5. Swabs of body stains and secretions are taken

Answer: 4, 5, 1, 3, 2 Explanation: When collecting evidence from a rape victim, the victim's clothing is removed and placed in a paper bag. Swabs of body stains and secretions are taken. Then oral swabs are obtained. Hair samples and fingernail scrapings are taken. Blood samples are then drawn to evaluate for syphilis.

1) The nurse is helping a victim of domestic violence create a safety plan. In which order should the nurse recommend that the steps of the plan be completed? 1. Decide where to go regardless of the day or time 2. Establish a code word that is shared with family and friends 3. Have money, identification, and bank account information prepared 4. Determine a planned escape route with emergency telephone numbers 5. Pack a change of clothes, toilet articles, and keys stored away from the home

Answer: 5, 3, 1, 2, 4 Explanation: The patient should pack a change of clothes including toilet articles and an extra set of car and house keys stored away from her house with a friend or neighbor; have money, identification papers, and bank account information prepared; have a plan for where she will go, regardless of the day or time; establish a code word for danger that is shared with family and friends; and have a planned escape route and emergency telephone numbers

1) The nurse is preparing an educational seminar about the frequency of intimate partner violence against females. Using the chart below, which age group should the nurse identify as experiencing the most intimate partner violence in 2010? A) 12-17 B) 18-24 C) 25-34 D) 35-49

Answer: C Explanation: The group experiencing the most intimate partner violence against women in 2010 is the solid green line which represents the 25-34 age group. The solid red line is the 12-17 age groups. The dotted red line is the 18-24 age group. The dotted blue line is the 35-49 age group. And the solid orange line is the 50 or older age group.

1) The nurse is identifying a plan to help a rape victim work through the phases of recovery. In which order should the nurse perform the following actions to help this victim? 1. Clarify the victim's feelings 2. Establish a trusting relationship 3. Acknowledge the victim's success 4. Provide advocacy as requested by the victim 5. Allow the victim to grieve and express feelings

Answer: 5, 4, 2, 1, 3 Explanation: The order in which nursing actions should be provided to a victim during the phases of rape recovery include allowing the victim to grieve and express feelings during the acute phase; provide advocacy as identified by the victim during the outward adjustment phase; establish a trusting relationship and clarify the victim's feelings during the reorganizational phase; and acknowledge the victim's success during the integration and recovery phase

1) The nurse is providing care to a client who is the victim of sexual assault. Which assessment finding does the nurse anticipate during the disorganization phase of rape trauma syndrome? A) Anxiety B) Insomnia C) Dyspepsia D) Depression

Answer: A Explanation: A) Anxiety is an expected clinical manifestation that occurs during the disorganization phase of rape trauma syndrome. B) Insomnia is an expected clinical manifestation that often occurs during the reorganization phase of rape trauma syndrome. C) Dyspepsia is an expected clinical manifestation that often occurs during the reorganization phase of rape trauma syndrome. D) Depression is an expected clinical manifestation that often occurs during the reorganization phase of rape trauma syndrome.

1) Which is a known characteristic of domestic violence batterers? A) Feeling inferior to others B) Working in a low-paying job C) Having a low socioeconomic status D) Being diagnosed with posttraumatic stress disorder

Answer: A Explanation: A) Domestic violence batterers often have feelings of insecurity, inferiority, powerlessness, and helplessness that conflict with their assumptions of male supremacy. B) Batterers come from all occupations, not just from low-paying jobs. C) Batterers come from all socioeconomic strata. A diagnosis of posttraumatic stress disorder is not a known characteristic of domestic violence batterers

1) A woman has come to the emergency department with multiple bruises on her body and a small laceration over her upper lip. She says she fell down the stairs while doing housework. Which observation would most cause the nurse to suspect that the client has been a victim of battering? A) The client is hesitant to provide details about how the injuries occurred. B) The client was accompanied to the emergency department by her mother instead of her partner. C) The client has sought care quickly after the incident. D) The client does not seem to be in pain.

Answer: A Explanation: A) Hesitation to provide detailed information about the injury and how it occurred is a common sign of abuse. B) Who accompanies the client to the emergency department is not a significant sign for abuse. C) Often a woman delays seeking care when there has been abuse. D) Pain level is not indicative of abuse. The experience of pain and how it is expressed is often a cultural issue.

1) The client has been a victim of a violent, sadistic rape. She is crying and asks the nurse, "Why would someone do something like that?" The nurse should explain that which of the following is the primary purpose of sadistic rape? A) Take pleasure from the victim's struggle and pain B) Express feelings of rage C) Feel a sense of power or mastery D) Relieve intolerable anxiety

Answer: A Explanation: A) In sadistic rape, the assailant has an antisocial personality and delights in torture and mutilation. In this type of rape, the victim and assailant are generally strangers, and the assault is planned. Sadistic rapes cause the most injuries, including homicide. B) In anger rape, the sexual assault is used to express feelings of rage and to retaliate for what the attacker perceives as wrongs against him. These perceived wrongs most often have nothing to do with the rape victim. Considerable brutality and degradation can characterize this type of rape. Attacks on older women often are a form of anger rape. C) In power rape, the purpose of the assault is control or mastery. The assailant uses sexual intercourse to place a woman in a powerless position so that he can feel dominant, potent, and strong. He often believes that his victim enjoys the assault, and he exerts only the amount of force necessary to subdue his victim. Often power rape is a planned stranger attack, but most acquaintance rapes are also power rapes. The vast majority of all rapes are motivated by this need for power and control. D) Anxiety is not associated with a type of rape.

1) What is the most important aspect of care for the nurse to remember when screening a woman for partner abuse? A) Ensuring privacy and confidentiality B) Conveying warmth and empathy C) Asking specific, direct questions about abuse D) Clarifying her myths about battering

Answer: A Explanation: A) Screening for women experiencing domestic violence must be done privately, with only the nurse and the client present, in a safe and quiet place. B) Warmth and empathy are helpful, but confidentiality is more important. C) General questions about possible abuse both will facilitate trust building and are more likely to obtain accurate information, but privacy to obtain this information is the first priority. D) Clarifying myths is not essential during screening.

1) Which action by the nurse is appropriate when providing care to a female client who is the victim of domestic violence? A) Providing adequate time for the client to tell her story B) Reporting the incident to the police to protect the client C) Telling the spouse about the client's accusations of abuse D) Stressing to the client that the abuse could have been avoided

Answer: A Explanation: A) The nurse should allow the client adequate time to work through her story, problems, and situation at her own pace. B) The nurse would not report the incident to the police to protect the client. Reporting the abuse is associated with the risk for further abuse towards the client. C) It is not appropriate for the nurse to tell the client's spouse about the accusations of abuse. This is a breach of confidentiality. D) It is not therapeutic for the nurse to stress to the client that the abuse could have been avoided.

1) The nurse is providing care to a female client who is the victim of domestic violence. Which referral by the nurse is most appropriate? A) Group therapy B) Physical therapy C) Nutrition therapy D) Occupational therapy

Answer: A Explanation: A) Victims of domestic violence require counseling and advocacy from the nurse. The most appropriate referral for this client is group therapy. B) Physical therapy is not an appropriate referral for this client. C) Nutrition therapy is not an appropriate referral for this client. D) Occupational therapy is not an appropriate referral for this client.

1) If a woman returns to an abusive situation, the nurse should encourage her to develop an exit, or safety, plan for herself and her children, if she has any. What should the plan include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Identify friends and family who know about the situation and will help her. B) Call the police if violence begins. C) Pack a change of clothes for herself and the children. D) Have a plan for where she will go. E) Have a planned escape route.

Answer: A, C, D, E Explanation: A) She should identify friends and family who know about the situation and will help her. Ask that she establish a code word for danger with those family and friends. B) She should ask a neighbor to call the police if violence begins. C) She should pack a change of clothes for herself and the children, including toilet articles and an extra set of car and house keys stored away from her house with a friend or neighbor. D) She should have a plan for where she will go, regardless of the day or time. E) She should have a planned escape route and emergency telephone numbers she can call.

1) Among women who have been sexually assaulted, which of the following are the most frequently diagnosed sexually transmitted infections (S T Is)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Bacterial vaginosis B) H I V C) Chlamydia D) Syphilis E) Gonorrhea

Answer: A, C, E Explanation: A) Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (S T Is). B) H I V is not one of the most frequently diagnosed S T Is following a sexual assault. C) Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (S T Is). D) Syphilis is not one of the most frequently diagnosed S T Is following a sexual assault. E) Among women who have been sexually assaulted, trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia are the most frequently diagnosed sexually transmitted infections (S T Is).

1) When a woman seeks care for an injury, the nurse should be alert to which clues of abuse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Defensive injuries B) Immediate reporting of symptoms or seeking care for injuries C) Lack of eye contact D) Providing too much detailed information about the injury E) Vague complaints without accompanying pathology

Answer: A, C, E Explanation: A) Defensive injuries may be a sign of abuse. B) Delayed reporting of symptoms or seeking care for injuries may be a sign of abuse, not immediate reporting and seeking care. C) Lack of eye contact may be a sign of abuse. D) Hesitation in providing detailed information about the injury and how it occurred may be a sign of abuse. E) Vague complaints without accompanying pathology may be a sign of abuse.

1) A client comes to the reproductive health clinic and reports that she woke up in a strange room this morning, her perineal area is sore, and she can't clearly remember what happened the previous evening. The client says she is afraid that she was a victim of a drug-facilitated sexual assault. Which statement should the nurse include when discussing this possibility with the client? A) "Drinking alcohol can lead to uninhibited sexual behavior, which is not the same as rape." B) "Some men use drugs mixed into a drink to subdue a potential victim prior to a rape." C) "It is rare that a woman doesn't remember what happened if she is actually raped." D) "We need to check for forensic evidence of rape before we can be sure what happened."

Answer: B Explanation: A) Although one effect of alcohol consumption is decreased inhibition, which can lead to less cautious sexual behavior, if a woman is drugged, the sexual act is nonconsensual and is therefore classified as rape. B) Drug-facilitated sexual assault occurs when a drug such as Rohypnol, which dissolves easily and is odorless, is slipped into the drink of an unsuspecting woman. C) Rohypnol, which dissolves easily and is odorless, can be slipped into the drink of an unsuspecting woman and causes amnesia of the attack. D) Forensic evidence is collected for possible legal prosecution of the attacker, but the absence of collectable evidence does not eliminate the possibility of rape.

1) A female client presents in the emergency department (E D) after being sexually assaulted at a party. Which assessment finding indicates that the client may have been drugged? A) Attending the party with a large group of friends B) Accepting a beverage from a stranger at the party C) Dancing and kissing several men during the party D) Drinking large amounts of alcohol during the party

Answer: B Explanation: A) Attending a party with a large group of friends is not an assessment finding that would indicate the client may have been drugged. B) Accepting a drink from someone else or drinking a drink that was left unattended would indicate the client may have been drugged. C) Dancing and kissing several men during the party is not an assessment finding that would indicate the client may have been drugged. D) Drinking large amounts of alcohol at the party is not an assessment finding that would indicate the client may have been drugged. Having one or two drinks and then suddenly feeling very drunk would be an indicator that the client had been drugged.

1) Which myth regarding rape will the community health nurse include in a teaching session within the community? A) Rape is a type of sexual assault. B) Women lie about rape as an act of revenge. C) Both men and women can be victims of rape. Rape is one of the most underreported violent crimes

Answer: B Explanation: A) Rape is a type of sexual assault. This is not a myth regarding rape. B) One myth regarding rape is that women lie about rape as an act of revenge. This is appropriate for the nurse to include in the teaching session. C) Both men and women can be victims of rape. This is not a myth regarding rape. Rape is one of the most underreported violent crimes. This is not a myth regarding rape

1) The nurse is planning a community education presentation on battering. Which statement about battering should the nurse include? A) Battering occurs in a small percentage of the population. B) Battering is mainly a lower-class, blue-collar problem. C) Battered women are at greatest risk for severe violence when they leave the batterer. D) If the batterer stops drinking, the violence usually stops.

Answer: C Explanation: A) The statistics on reported cases underrepresent the true incidence. As many as one in three women may be the victim of assault by her partner in her lifetime; however, it is a widely underreported crime. B) Domestic violence occurs among all sectors of society. It happens to women of all socioeconomic statuses, races, ethnicities, and religious faiths. C) Battered women are at greatest risk for injury or domestic homicide when they leave the abuser. D) Battered women sometimes think that the abuse will stop if their partners stop drinking or using drugs. Unfortunately, this usually does not happen.

1) The nurse is presenting a session on intimate partner violence. Which statement by a client indicates a need for further education? A) "My daughter is not to blame for the violence in her marriage." B) "Everyone experiences anger and hitting in a relationship." C) "Abusers can be either husbands or boyfriends or girlfriends." D) "The 'honeymoon period' follows an episode of violence."

Answer: B Explanation: A) This statement recognizes that the blame for her assault lies with her assailant, not with the victim. B) Violence is not a normal part of intimate relationships. Domestic violence, also called intimate partner violence (I P V), is defined as a pattern of coercive behaviors and methods used to gain and maintain power and control by one individual over another in an adult intimate relationship. This statement indicates that the client has likely been a victim of domestic violence herself. C) Batterers come from all racial, ethnic, and religious groups and all professions, occupations, and socioeconomic strata. Batterers can also be either male or female. An acute episode of battering is followed by the tranquil phase, or honeymoon period, which is characterized by extremely loving, kind, and contrite behaviors by the batterer

1) The nurse is conducting a health maintenance assessment for a new female client who recently moved to the city. Which finding would indicate the need for further assessment for intimate partner violence? A) A miscarriage two years ago noted during the reproductive history. B) A sprained ankle one year ago noted during the health history interview. C) A history of delaying treatment for a concussion and fractured extremity. A scar noted on the abdomen from a previous surgery during the physical examination

Answer: C Explanation: A) A miscarriage two years ago that is noted in the reproductive history would not cause the nurse to further assess the client for intimate partner abuse. B) Sprains and strains are not associated with intimate partner abuse. C) A client who delays treatment for a concussion or fractured extremity would indicate the need for further assessment for intimate partner violence. A scar from an old injury, not from a surgical procedure, would indicate the need for further assessment for intimate partner violence

1) The nurse is helping a victim of domestic abuse to develop a safety plan. Which client action would require intervention by the nurse? A) Asking a neighbor to call police if violence begins B) Establishing a code word for danger with family and friends C) Keeping a bag packed in the home in case the need to leave arises D) Having a planned escape route and emergency phone numbers if violence occurs

Answer: C Explanation: A) Asking a neighbor to call the police if violence begins is an appropriate client action that would not require intervention from the nurse. B) Establishing a code word for danger with family and friends is an appropriate client action that would not require intervention from the nurse. C) Keeping a bag packed in the home if the need arises to leave would require intervention from the nurse. The bag should be kept at the home of a neighbor or family member. If the abuser finds the bag the client's risk for injury may increase. D) Having a planned escape route and emergency phone numbers if violence occurs is an appropriate client action that would not require intervention from the nurse.

1) The nurse has been talking to a woman about the reorganization phase following a rape. Which response would indicate that the client understands this phase? A) "By using denial and suppression in this phase, I will eventually be able to accept what has happened to me." B) "During this time, I won't talk much about the rape, because I am examining my inward feelings regarding the rape." C) "During this time, I will repeatedly replay the role of the victim until I come to terms with the experience." D) "My perception of a normal sexual relationship will be similar to my perception prior to the rape."

Answer: C Explanation: A) Denial and suppression indicate the client is experiencing the outward adjustment phase of rape trauma syndrome. B) Denial and suppression indicate the client is experiencing the outward adjustment phase of rape trauma syndrome. C) During reorganization, a victim adjusts her self-concept to include the rape. D) Sexual relationships often develop dysfunction after rape.

1) The emergency department nurse is admitting a client who has been sexually assaulted. The nurse is explaining how the physical evidence will be collected. Which statement by the client indicates that teaching has been effective? A) "All the evidence will be kept in a locked cupboard until the police arrive." B) "You collect urine samples to make sure the rapist did not get me pregnant." C) "The evidence you collect might be able to identify the rapist." D) "Blood samples are taken to help identify whether the rapist had H I V."

Answer: C Explanation: A) The evidence must remain in the hands of the nurse until handed directly to the police. B) Urine should be collected in cases in which a drug-facilitated sexual assault is suspected. C) D N A can be obtained from collected evidence to identify the rapist. D) Blood is drawn to test for syphilis and to determine the woman's blood type, and additional blood may be drawn for a pregnancy test.

1) When a woman who has been raped is admitted to the emergency department, the nurse caring for the woman knows that which of the following is the priority nursing intervention? A) Explaining exactly what will need to be done to preserve legal evidence B) Assuring the woman that everything will be all right C) Creating a safe, secure environment for her D) Contacting family members

Answer: C Explanation: A) The legal interventions would not take priority over safety at this time. B) Assuring the woman that everything will be all right is not the first priority nursing intervention in caring for a survivor of a sexual assault. C) The first priority in caring for a survivor of a sexual assault is to create a safe, secure environment. Contacting family members is important, but is not the priority nursing intervention

1) The nurse is teaching a class about domestic violence to enhance education within the community. Which statement regarding the cycle of violence should the nurse include in the presentation? A) "The tension-building phase lasts a few hours." B) "The batterer often feels remorse during the tension-building phase." C) "The acute battery incident is often triggered by an external event, such as the loss of a job." D) "The acute battery incident often finds the victim hoping the relationship will change for the better."

Answer: C Explanation: A) The length of the tension-building phase of the cycle of violence varies considerably across individual cases and can range from weeks to years. It is often the acute battery incident that lasts a few hours. B) The batterer often feels remorse during the tranquil phase or honeymoon period, not the tension-building phase. C) An acute battery incident is often triggered by an external event for the abuser, such as the loss of a job. D) The victim of abuse often hopes the relationship will improve in the tension-building phase, not during the acute battery incident.

1) The nurse is conducting a health maintenance assessment for a female client. Which neurologic data would cause the nurse to further assess for intimate partner abuse? A) Anxiety B) Depression C) Weight gain D) Tension headaches

Answer: D Explanation: A) Anxiety is a psychiatric, not neurologic, assessment finding that would cause the nurse to further assess for intimate partner abuse. B) Depression is a psychiatric, not neurologic, assessment finding that would cause the nurse to further assess for intimate partner abuse. C) Weight gain is a constitutional, not neurologic, assessment finding that would cause the nurse to further assess for intimate partner abuse. D) Tension headaches are a neurologic assessment finding that would cause the nurse to further assess for intimate partner abuse.

1) The client with limited English language skills has a black eye and bruises across her face and arms. The client's husband has been acting as an interpreter for her, and answers all of the questions the nurse asks, often without talking to his wife first. The nurse suspects the client has been a victim of domestic abuse. What should the nurse do next? A) Ask the husband whether he has beaten his wife. B) Ask the husband to have a female friend come in with his wife. C) Provide written materials in English for the client to read at home. D) Ask the husband to step out of the room, and obtain an interpreter.

Answer: D Explanation: A) Asking the abuser whether he has abused his spouse is useless, as most abusers see their behavior as appropriate. B) Asking the husband to have a female friend come with his wife is not the best action for the nurse to take next. C) Written proficiency develops after verbal fluency; therefore, written materials in English are inappropriate for this client. D) Screening for women experiencing domestic violence must be done privately. An interpreter should also be provided as necessary.

1) The nurse is interviewing a client who has admitted to being a victim of domestic violence. What is the most typical description of how the domestic violence developed in a relationship? A) "He changed overnight. Everything was fine, and all of a sudden he flipped out and beat me up; he nearly killed me." B) "It was severe from the beginning. As soon as we got married, he began hitting me and threatening to kill me." C) "We've both always dated other people. I thought that was understood. He was as emotionally abusive in the beginning as he is now." D) "I don't know when it started, really. It was gradual. First, just yelling, blaming, and shoving. Then the beatings started; and now they're more frequent."

Answer: D Explanation: A) Domestic violence does not begin suddenly, and will always escalate. B) Typically, these forms of abuse begin slowly and subtly after some form of commitment, such as engagement, onset of a sexual relationship, or marriage. C) Typically, these forms of abuse begin slowly and subtly after some form of commitment, such as engagement, onset of a sexual relationship, or marriage. D) Typically, these forms of abuse begin slowly and subtly after some form of commitment, such as engagement, onset of a sexual relationship, marriage, pregnancy, or first childbirth.

1) The nurse is providing care to a female client who presents in the emergency department (E D) with multiple bruises and lacerations. The nurse suspects the client is the victim of domestic violence. Which action by the nurse is appropriate? A) Reporting the incident to the police to enhance safety B) Documenting domestic violence in the medical record C) Avoiding photographs of the injuries to prevent embarrassment D) Communicating the level of confidentiality that can be expected

Answer: D Explanation: A) Reporting domestic violence may be mandatory in some states. However, it is important to note that reporting domestic violence may increase the client's risk for further abuse, not enhance the client's safety. B) The nurse would document the client's injuries in the medical record and use the term "probable battering." To protect the client's confidentiality and safety, it is critical that the nurse not refer to domestic violence or abuse on any discharge papers. C) Photographs of the client's injuries can be of great value along with documentation of the extent of the injuries and noting of the client's exact words in the medical record. D) It is important for the nurse to explain the assessment process to the client and communicate the level of confidentiality that can be expected.

1) The nurse is preparing a female client for a scheduled pelvic examination. During the health history interview, the client states, "My husband constantly criticizes me and calls me stupid. I am afraid that he will begin to hit me one of these days." Which type of intimate partner violence is the client experiencing based on the assessment data? A) Sexual abuse B) Physical abuse C) Economic abuse D) Emotional abuse

Answer: D Explanation: A) Sexual abuse is forced sex, including vaginal, oral, or anal intercourse. This type of abuse also includes sexually demeaning treatment, forced use of objects, or forcing a woman to have sex with someone else against her will. B) Physical abuse may include acts such as pushing, shoving, slapping, hitting with a fist or object, kicking, choking, threatening with a gun or knife, or using a gun or knife against a woman. This type of abuse can also include forcing alcohol or drug use or denying a partner medical care. C) Economic abuse would include preventing a spouse or significant other from getting or keeping a job; making a spouse or significant other ask for money; controlling a spouse or significant other's money; destruction of property; or making all financial decisions for the spouse or significant other. D) Emotional abuse includes constant criticism, name calling, and unreasonable demands from a spouse or significant other. This type of abuse also includes damaging a spouse or significant other's relationship with a child and others who matter to him or her.

1) The nurse is teaching an in-service educational presentation about working with battered women. The nurse should explain that it is often frustrating for nurses to work with battered women for which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) There is little the nurse can really do to help. B) Healthcare policies and practices are not supportive of abused women. C) Both husband and wife must agree to therapy. D) These women might return to the abusive situation. E) Women often believe that they are the cause of the abuse.

Answer: D, E Explanation: A) Healthcare providers can play a critical role in identifying and reducing violence, even in homicide prevention efforts. B) Since 1980, there have been a number of notable changes in healthcare policy and practices aimed at responding to violence against women. C) The abuser must seek behavior change therapy to accomplish permanent change. D) Women often believe that escape is futile, or escape and then return when the crisis is over. E) Women are often convinced by the abusers that it is their own behavior that causes the abuse.

Which nursing information is appropriate to include when conducting a special adolescent program to reduce teenage pregnancy? Select all that apply.

Available methods of family planning Effective educational programs about sex Effective educational programs about family life

What nursing instructions are appropriate for the client who is scheduling a pelvic examination? Select all that apply.

Avoid intercourse for 48 hours before the examination." "If you start your menstrual cycle on the day of the examination, we will need to reschedule.

Which statement by the student nurse about pelvic inflammatory disease (PID) indicates effective learning? a. PID causes miscarriage. b. The menstrual period facilitates the development of PID. c. N. Gonorrhoeae is the only organism that causes PID. d. PID occurs as organisms spread from the upper genital tract to the vagina.

B During the menstrual period, the cervical os is slightly open and the cervical mucus barrier is absent. In addition, menstrual blood is an excellent medium for the growth of organisms that cause PID. PID may also develop after a miscarriage or an induced abortion. A wide variety of anaerobic and aerobic bacteria, including N. Gonorrhoeae, may cause PID. C. trachomatis is now estimated to cause half of all cases of PID. PID results from the spread of microorganisms from the vagina and endocervix to the upper genital tract. P. 153

The nurse suspects that a client with frequent complaints of diarrhea, weight loss, and rash has human immunodeficiency virus (HIV) infection. The client is afraid of having blood drawn for screening purposes. What does the nurse tell the client? a. "You can take some time to prepare for this test." b. "You can provide a saliva sample for testing." c. "A blood test is the only means of detecting the virus." d. "If you don't get this test done, the virus may prove fatal."

B If a client is unwilling to take a blood test, an oral fluid sample can also be obtained for testing for the presence of HIV infection. It has a sensitivity and specificity rate of more than 99%. The nurse should not advise the client to take time to prepare for the test, because the client may be infected, and prompt treatment may be required. The blood test is not the sole means of detecting the virus. The client can provide a blood sample obtained by fingerstick or venipuncture, an oral fluid sample, or a urine sample for testing. Telling the client that the virus may prove fatal will increase the client's anxiety. Instead the nurse should inform the client about alternative methods of testing. p. 160

Which statements about genital herpes are accurate? Select all that apply. a. Genital herpes is also known as genital warts. b. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences. c. Genital herpes is chronic and recurring, and has no known cure. d. Plain soap and water are all that are needed to clean hands that have come into contact with herpetic lesions. e. Contact isolation is needed for clients with genital herpes.

B, C, D Recurrence of genital herpes can be triggered by stress and illness. The disease is chronic and has no known cure. Good handwashing can prevent the spread of infection from contact with the lesions. Genital warts are one of the most common sexually transmitted infections (STIs); however, they are also known as human papillomavirus (HPV), not genital herpes. Isolation is not appropriate for patients with genital herpes. p. 156-157

Which instructions are given to a client with genital herpes simplex virus (HSV) infection? Select all that apply. a. "Avoid the use of aspirin for pain relief." b. "Take warm sitz baths with baking soda." c. "Take 400 mg of acyclovir orally three times daily for a week." d. "Dry the lesions with cool air from a hair dryer." e. "Clean the lesions once a day with warm water."

B, C, D Warm sitz baths with baking soda increase the client's comfort when the lesions are active. The nurse would also provide the client teaching about the administration of acyclovir, famciclovir, or valacyclovir, which can help decrease the number of HSV infections. The client should dry the lesions by directing cool air from a hair dryer onto them or by patting them dry with a soft towel. Oral analgesics such as aspirin or ibuprofen can be used to relieve pain, because there are no side effects with these medications. The lesions need to be cleaned twice a day with saline to prevent secondary infection. P. 157

What are the maternal effects of Chlamydia? Select all that apply. a. Meningitis b. Preterm labor c. Chorioamnionitis d. Postpartum sepsis e. Postpartum endometritis

B, E Chlamydia is a bacterial infection caused by Chlamydia trachomatis. The patient with Chlamydia has a risk of pelvic inflammatory disease, due to which the client may have preterm labor and postpartum endometritis. Meningitis, chorioamnionitis, and postpartum sepsis are most commonly seen in clients with gonorrhea. Chlamydia trachomatis does not affect the brain, fetal membranes, chorion, and amnion. p. 165

A client who is breastfeeding has been diagnosed with gonorrhea. Which treatment plan should be instituted? a. Amoxicillin 500 mg three times a day for 1 week. b. Benzathine Penicillin G 2.4 million units one injection c. Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection d. Ceftriaxone 250 mg IM injectio

C Dual therapy of amoxicillin and ceftriaxone can be used for treatment of gonorrhea and empirical treatment of chlamydia. Amoxicillin and ceftriaxone can both be part of the treatment plan for gonorrhea but the client should be treated empirically for chlamydia as well. Benzathine penicillin is indicated for treatment of syphilis in the lactating client. p. 148

What is the most common causative agent of ophthalmia neonatorum? a. Neisseria gonorrhea b. Human papillomavirus c. Chlamydia trachomatis d. Gardnerella and Mobiluncus

C Ophthalmia neonatorum is a conjunctivitis that occurs in newborns. It is most commonly caused by Chlamydia trachomatis. Therefore, it is most commonly seen in the neonates born to clients with Chlamydial infection. Neisseria gonorrhea causes gonococcal infections. Human papillomavirus causes condylomata acuminate or genital warts, but not ophthalmia neonatorum. Gardnerella and Mobiluncus are the anaerobic bacteria that cause bacterial vaginosis, but not ophthalmia neonatorum. p. 148

Which infections are collectively known as TORCH infections? Select all that apply. a. Chlamydia b. Gonorrhea c. Toxoplasmosis d. German measles e. Cytomegalovirus f. Herpes genitalis

C, D, E, F Toxoplasmosis, German measles, cytomegalovirus, and herpes genitalis are collectively known as TORCH infections. The causative agents of these infections cross the placenta and cause influenza-like symptoms in the mother and significant birth defects in the newborn. Chlamydia and gonorrhea do not cause significant birth defects and fetal death. Therefore, Chlamydia and gonorrhea are not TORCH infections. p. 165

Which stressor can result in "empty nest syndrome"?

Children leaving home to seek higher education

Which position is appropriate for a physically disabled client undergoing a pelvic examination who is unable to lie comfortably in the lithotomy position?

Comfortable alternative position

Which infection is prevented with the Cervarix and Gardasil vaccines? a. Bacterial vaginosis (BV) b. Vulvovaginal candidiasis (VVC) c. Pelvic inflammatory disease (PID) d. Human papillomavirus (HPV)

D The Cervarix and Gardasil vaccines are recommended for children aged 9 to 26. The vaccines are effective in protecting against human papillomavirus (HPV) infections, which can lead to genital warts and cancers. Bacterial vaginosis (BV) is treated with oral metronidazole (Flagyl); there are not any preventive vaccines for this. Exogenous lactobacillus (found in dairy products or powder, tablet, capsule, or suppository supplements) and garlic have been suggested for prevention and treatment of vulvovaginal candidiasis. Vaccination is not effective in preventing pelvic inflammatory disease (PID). It can be prevented only by practicing risk reduction measures and using barrier methods. p. 156

Which physiologic process is affected in the client who has low levels of gonadotropin-releasing hormone (GnRH)?

Development of ovum

Which nursing information is appropriate for the client who reports having her menses on May 11, some light bleeding on May 26, and her next menses on June 8?

Having bleeding in the middle of your cycle is a normal finding.

Which statement is accurate about the difference between health promotion and illness prevention?

Health promotion is the motivation to increase well-being, and illness prevention is the desire to avoid illness

Which statement by the client indicates the need for further teaching about the steps to be followed before undergoing a Papanicolaou test?

I should clean my vagina by douching before the test.

Which preconception counseling interventions can decrease the incidence of spina bifida in the fetus?

Include a daily intake of 600 mcg of folic acid during pregnancy.

Which is the role of a registered nurse in women's health promotion and illness prevention? Select all that apply.

Integrating various modalities of care Working to influence health policy Collaborating with other health care practitioners

Which statement is accurate regarding educating the client about preconception care?

It could include interventions to reduce substance use and abuse.

Which is the order when instructing clients about the steps of breast self-examination technique?

Lie down, put a pillow under your right shoulder, and place your right arm behind your head. Use the finger pads of the three middle fingers of your left hand to feel for thickening. Use circular motions of your finger pads, and press firmly to feel the breast tissue. Move around your breast from your collarbone to your ribs Move around your breast from your underarm to the middle of your chest Then, examine your left breast using the finger pads of your right hand If any changes are found, consult your health care provider

Which phase of the ovarian cycle is characteristic of high progesterone levels?

Luteal phase The follicular, ovulatory, and luteal phases are the phases of the ovarian cycle. High progesterone levels are characteristic of the luteal phase as a result of formation of the corpus luteum. Progesterone levels are low during the follicular phase, gradually increase in the ovulatory phase, and reach high levels in the luteal phase. The ischemic phase is not part of the ovarian cycle, but it is part of the endometrial cycle; progesterone levels decline in this phase.

Place the nursing actions in the order in which they would be performed for a client who is having a Papanicolaou test.

Make sure the client has not douched, used vaginal medications, or had sexual intercourse for 24 to 48 hours. Explain the purpose of the test and what sensations she will feel as the specimen is obtained (e.g., pressure but not pain). Assist client into the lithotomy position. Insert the speculum into the vagina. Obtain the cytologic specimen, label it, and promptly send it to the pathology laboratory. Instruct the client concerning routine checkups for cervical and vaginal cancer.

Which are the major goals of prenatal care? Select all that apply

Monitor the development of the fetus. Improve the nutritional status of mother and fetus. Provide appropriate education and counseling to the parents. Minimize the risk of complications in both the mother and fetus

Which nursing action is appropriate for the client who reports vaginal bleeding after menopause, along with hot flashes?

Notify the primary health care provider

Which category of weight is appropriate for the client with a calculated body mass index (BMI) of 32?

Obesity

Which nursing interventions are performed to assist a client during a pelvic examination? Select all that apply.

Performing relaxation techniques Moving the client into a sitting position after completion The nurse would assist the client with relaxation techniques before and during a pelvic examination. Once the examination is completed, the nurse would assist the client into a sitting position. Privacy would be provided when the client changes into a hospital gown for the examination. The examiner, not the nurse, collects cytologic specimens, and hence the nurse would assist the examiner while collecting specimens. The examiner, not the nurse, uses water-soluble lubricant during the examination.

Which phase of female sexual response is characterized by the retraction of the clitoris under the clitoral hood and engorgement of the lower one-third of the vagina?

Plateau phase The plateau phase is the second phase of sexual response. This phase is characterized by retraction of the clitoris under the clitoral hood, and the engorgement of the lower one-third of the vagina. The excitement phase is characterized by an increase in the diameter of the clitoris and lubrication of vagina. The orgasmic phase is characterized by a sensation of rhythmic contractions of the vagina and clitoris, along with a sensation of warmth through the pelvic area. The resolution phase is characterized by resolution of the vaginal and pelvic engorgement.

Which hormone is responsible for maturation of mammary gland tissue?

Progesterone

Which finding indicates a pelvic infection in a client during a pelvic examination?

Prominent skene gland openings Skene glands are located on each side of the urethra and produce mucus, which aids in lubrication of the vagina. Generally, the openings to the skene glands are not visible, but prominent openings may be seen if the glands are infected. A palpable uterus is a normal finding of the pelvic examination. Nonpalpable ovaries are a result of menopause and are not indicative of infection. Palpable adnexal masses are abnormal findings that indicate unwanted growth or tumors

Which phase of the menstrual cycle describes the implantation of the fertilized ovum?

Secretory During the secretory phase, the secretion of progesterone by the corpus luteum results in thickening of the uterine lining, creating the perfect environment for the fertilized ovum. The menstrual phase is marked by the shedding of the lining of the uterus. This phase lasts 3 to 5 days and is known as the woman's period. The proliferative phase begins at the end of menses and is one of restoration and repair. Under the influence of estrogen, the uterine lining proliferates and becomes more vascular. Progesterone is not a phase.

Which instruction is appropriate in preparing a client for a Papanicolaou (Pap) test?

The client should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test.

Which statement by the client indicates the need for further teaching about health promotion and vaccinations?

The human papillomavirus (HPV) vaccination eliminates the need for the Papanicolaou (Pap) test

Which is the likely effect of low prostaglandin levels on the client's menstrual cycle?

The ovum remains entrapped in the graafian follicle

37. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the woman's side.

a. The blood pressure (BP) cuff should not be applied to the affected arm.

Which statement about female sexual response is accurate? Select all that apply.

Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. Vasocongestion is the congestion of blood vessels. Facial grimaces and spasms of hands and feet are often part of arousal

Which statements are accurate regarding the occurrence of obesity in the United States? Select all that apply.

Women in the age group of 40 to 59 years have the highest prevalence. Obesity is associated with hypercholesterolemia. Women who are obese may be more likely to have irregularities of the menstrual cycle

3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. "I feel irritable and moody a week before my period is supposed to start." b. "I have lower abdominal pain beginning the third day of my menstrual period." c. "I have nausea and headaches after my period starts, and they last 2 to 3 days." d. "I have abdominal bloating and breast pain after a couple days of my period."

a. "I feel irritable and moody a week before my period is supposed to start."

23. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: a. Bacterial vaginosis (BV). b. Candidiasis. c. Trichomoniasis. d. Gonorrhea.

a. Bacterial vaginosis (BV)

39. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.

a. Diuretic administration.

41. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. b. Intraductal papilloma. c. Chronic cystic disease. d. Fibroadenoma.

a. Ductal ectasia.

4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. b. PMS. c. Primary dysmenorrhea. d. Secondary dysmenorrhea.

a. Endometriosis.

20. A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

a. Fluconazole

25. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

a. Herpes simplex virus (HSV)-2

14. As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids.

a. It is most commonly caused by anovulation.

34. A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

a. Nausea, hot flashes, and vaginal bleeding

29. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely.

a. Strategies to enhance condom use.

A pregnant woman is infected with human immunodeficiency virus (HIV), with a viral load of more than 400 copies/ml. It is therefore recommended that she have a caesarean birth at 38 weeks of gestation. On assessment at 36 weeks, the nurse finds that the patient has a viral load of 800 copies/ml and ruptured membranes, and the labor is progressing rapidly. What is the primary health care provider likely to order? a. Scalp pH sampling b. Immediate vaginal birth c. Immediate caesarean birth d. Use of fetal scalp electrode

b. Ruptured membranes and a rapidly progressing labor indicate that the client is ready for vaginal birth. If the viral load in the client is less than 1000 copies/ml at 36 weeks, the patient can be prepared for a vaginal birth. Scalp pH sampling is avoided, because it may result in inoculation of the virus into the fetus. If the viral load is more than 1000 copies/ml, it is recommended that the client have a caesarean birth. The use of a fetal scalp electrode is avoided, because it increases the risk of transmission of infection to the fetus. p. 161

27. A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" Your best response is: a. "It's just a little lump on your cervix. We can freeze it off." b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." c. "HPV is a type of early human immunodeficiency virus (HIV). You will die from this." d. "You probably caught this from your current boyfriend. He should get tested for this."

b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer."

22. Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely would include: a. Oral antiviral therapy. b. Bed rest in a semi-Fowler position. c. Antibiotic regimen continued until symptoms subside. d. Frequent pelvic examination to monitor the progress of healing.

b. Bed rest in a semi-Fowler position.

9. During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. b. Dysmenorrhea. c. Dyspareunia. d. Premenstrual syndrome (PMS).

b. Dysmenorrhea.

21. To detect human immunodeficiency virus (HIV), most laboratory tests focus on the: a. virus. b. HIV antibodies. c. CD4 counts. d. CD8 counts.

b. HIV antibodies.

28. Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

18. The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).

b. Human papillomavirus (HPV).

6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days.

b. She describes her flow as very heavy.

19. The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client-applied: a. Miconazole ointment. b. Topical podofilox 0.5% solution or gel. c. Penicillin given intramuscularly for two doses. d. Metronidazole by mouth.

b. Topical podofilox 0.5% solution or gel.

26. The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. b. 2 to 4 weeks. c. 6 to 8 weeks. d. 6 months.

c. 6 to 8 weeks.

42. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman b. A 50-year-old woman c. A 16-year-old girl d. A 27-year-old woman

c. A 16-year-old girl

43. The drug of choice for treatment of gonorrhea is: a. Penicillin G. b. Tetracycline. c. Ceftriaxone. d. Acyclovir.

c. Ceftriaxone.

17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. b. Syphilis. c. Chlamydia. d. Candidiasis.

c. Chlamydia.

31. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Fine-needle aspiration (FNA) d. CA 15.3

c. Fine-needle aspiration (FNA)

38. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. b. Lipoma. c. Intraductal papilloma. d. Mammary duct ectasia.

c. Intraductal papilloma.

12. With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility.

c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.

1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. b. Type 1 diabetes mellitus. c. Lack of exercise. d. Hysterectomy.

c. Lack of exercise.

44. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles

8. A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids increase in size during the perimenopausal period. c. Menorrhagia is a common finding. d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.

c. Menorrhagia is a common finding.

7. When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. b. Excessive exercise. c. Pregnancy. d. Eating disorders.

c. Pregnancy.

11. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established.

c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms.

35. After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.

32. A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. "Do you have transportation to the teaching hospital so that you can get your mammogram?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "It's very dangerous to skip your mammograms; your breasts need to be checked." d. "Would you like me to make an appointment for you to have your mammogram here?"

d. "Would you like me to make an appointment for you to have your mammogram here?"

36. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

d. A single lump in one breast that can be expected to shrink as the woman ages.

5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness.

d. Can cause her to experience some hot flashes and vaginal dryness.

40. The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

d. Chlamydia

33. The nurse must watch for what common complications in a patient who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap? a. Axillary edema and tissue necrosis b. Delayed wound healing and muscle contractions c. Delayed wound healing and axillary edema d. Delayed wound healing and hematoma

d. Delayed wound healing and hematoma

10. With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women. b. It is more common in leaner women who exercise strenuously. c. Symptoms can begin at any point in the ovulatory cycle. d. Pain usually occurs in the suprapubic area or lower abdomen.

d. Pain usually occurs in the suprapubic area or lower abdomen.

16. The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors.

d. Risky sexual behaviors and inadequate preventive health behaviors.

30. The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

d. The exact cause of breast cancer is unknown.

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

d. Using a heating pad on the abdomen to relieve cramping

24. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. b. Ofloxacin. c. Podophyllin. d. Zidovudine.

d. Zidovudine.

The home care nurse is visiting a pregnant client with diabetes who has multiple medications prescribed. The client is also a single parent to two other children. Which action would the nurse take to ensure the safety of the client and the family?

identify a safe place to store medications.