OB final

Which woman has the highest risk for endometrial cancer? Multiple choice question 1. A postmenopausal woman with hypertension 2. A woman who has an intrauterine device 3. A client who has been on birth control for 15 years 4. A perimenopausal woman who has a cystocele

1

A client approaches the primary health care provider due to ovulation problems. The nurse instructs the client to return for a visit 7 days before the menstrual cycle. What is the reason for these instructions? Multiple choice question 1. To assess the levels of progesterone in the client 2. To determine the thickness of the uterine lining 3. To evaluate the viscosity of the cervical mucus 4. To assess the follicle-stimulating hormone (FSH) level

1

A client has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? Multiple choice question 1. Nausea, hot flashes, and vaginal bleeding 2. Vomiting, weight loss, and hair loss 3. Nausea, vomiting, and diarrhea 4. Hot flashes, weight gain, and headaches

1

A nursing instructor is teaching student nurses about discharge planning and teaching for premenopausal women after hysterectomy. Which statement by the student nurses indicates a need for additional teaching? Multiple choice question 1. "Teach the client the pros and cons of hormonal replacement." 2. "Instruct the client to avoid exercise for 6 weeks." 3. "Educate the client about the need for follow-up care." 4. "Encourage the use of lubricants during vaginal intercourse."

1

The breast cancer risk assessment screening report of a 30-year-old woman indicates that the client is at high risk of developing malignant breast cancer. Which strategy should be added to the treatment plan to prevent breast cancer in the client? Multiple choice question 1. Administering tamoxifen (Nolvadex) 2. Avoiding pregnancy before the age of 40 3. Regular breast examination and mammography 4. Administering raloxifene hydrochloride (Evista)

1

The nurse is assessing a 40-year-old female client with fibrocystic changes in her breast. After reviewing the breast ultrasonography report, the nurse finds that the lump is a solid mass. What does the nurse tell the client? 1. "You may need to get a mammogram." 2. "You may be required to take estrogen therapy." 3. "You may want to consider taking oral contraceptives." 4. "You may need to get the lump aspirated on a regular basis."

1

The nurse reviews the medical reports of a client and finds that the client has a low sperm count. What should the nurse understand about the client? Multiple choice question 1. The client has retrograde ejaculation. 2. The client has azoospermia. 3. The client has erectile dysfunction. 4. The client has an attack of mumps.

1

When obtaining a health history, the nurse should be aware that the most common malignancy of the reproductive system is what? Multiple choice question 1. Endometrial cancer 2. Cervical cancer 3. Ovarian cancer 4. Vulvar and vaginal cancer

1

Which clinical findings are commonly present in both fibrocystic breast disease and fibroadenomas? Multiple choice question 1. Moveable 2. Single lump 3. Firm 4. No nipple discharge

1 Both fibrocystic breast disease and fibroadenomas are considered to be moveable breast masses. Fibrocystic breast disease presents with multiple lumps and fibroadenomas present as a single lump. Fibrocystic masses can be firm or soft, whereas fibroadenomas are firm. Fibrocystic masses may or not have nipple discharge whereas fibroadenomas do not have nipple discharge.

A 37-year-old client says, "I haven't been able to conceive after trying for 3 months." Upon evaluating the client's medical history, the nurse finds that the client has a history of endometriosis. What does the nurse tell the client? Multiple choice question 1. "Continue trying for another 3 months and come back for an evaluation." 2. "Continue trying for another 6 months and come back for an evaluation." 3. "Continue trying for another 9 months and come back for an evaluation." 4. "Continue trying for another year and come back for an evaluation."

1 Generally, a client is instructed to come for an evaluation after trying to conceive for one year. However, clients over the age of 35, or with risk factors such as endometriosis, are instructed to come for an evaluation after trying for 6 months. Because the client has already been trying to conceive for 3 months, the nurse should ask the client to come for evaluation after 3 additional months.

Uterine prolapse is a serious type of uterine displacement. What can contribute to uterine prolapse? Multiple selection question 1. Obesity 2. Pelvic trauma 3. Vaginal childbirth injury 4. Pelvic inflammatory disease 5. Congenital weakness of the pelvic muscles

1, 2, 3, 5

What are some risk factors for breast cancer development included in the Breast Cancer Risk Assessment Tool? Multiple selection question 1. Woman's age 2. Number of breast biopsies 3. Age of woman at menarche 4. Age of woman at third live birth 5. Number of third-degree relatives affected 6. History of atypical hyperplasia in biopsy specimens

1, 2, 3, 6

The nurse is assessing a 28-year-old client with breast cancer who is prescribed tamoxifen (Nolvadex). Which parameters does the nurse monitor to ensure the safety of the client? Multiple selection question 1. Eye function 2. Cholesterol levels 3. Thyroid function 4. Hepatic function 5. Loss of facial hair

1, 2, 4

What are common types of uterine displacement? Multiple selection question 1. Anteflexion 2. Retroflexion 3. Dorsiflexion 4. Retroversion 5. Plantar flexion

1, 2, 4

A client is being discharged home after having a mastectomy. What discharge instructions should the nurse teach the client and family? Multiple selection question 1. Perform arm exercises as directed. 2. Take medications for pain as soon as pain begins. 3. Wash hands only after touching the incision area or drains. 4. Call your health care provider if inflammation of the incision or swelling of the incision or the arm occurs. 5. Avoid driving, lifting more than 10 pounds, or reaching above your head until given permission by the surgeon. 6. Empty surgical drains once a day and as needed, recording the amount in each drain, the date, and time, and bring to your follow-up appointment.

1, 2, 4, 5 rationale for answer 3: wash hands well before and after touching incision area or drains (not just after) rationale for answer 6: empty surgical drains twice (not just once) a day and as needed, recording the amount in each drain, the date, and time, and bring the information to your follow-up appointment.

The nurse is assessing a postmenopausal client who has osteoporosis and Cowden syndrome. The primary health care provider prescribes raloxifene hydrochloride (Evista) to treat osteoporosis and reduce the risks associated with Cowden syndrome. For what does the nurse regularly monitor to ensure the client's safety? Multiple selection question 1. Pain in the chest region 2. Increased urinary output 3. Pain and warmth in the legs 4. Yellow discoloration of the sclera 5. White discharge from the nipples

1, 3

Which nursing interventions should be performed for a client who has undergone a vaginal hysterectomy? Multiple selection question 1. Assess vaginal bleeding by perineal pad count. 2. Instruct the client to avoid exercising and get enough rest. 3. Monitor intake and output of fluids. 4. Provide psychologic support to the client to avoid depression. 5. Encourage the client to apply a heating pad to the perineum.

1, 3, 4

Which of these are used in the therapeutic management of fibrocystic breast disease? Multiple selection question 1. Taking vitamin E and B 6 supplements 2. Taking vitamin A, C, and D supplements 3. Dietary changes and vitamin supplements 4. Refraining from both smoking and consuming alcohol 5. Decreasing potassium intake or taking strong diuretics after menses 6. Reducing consumption of or eliminating methylxanthines (i.e., colas, coffee, tea, chocolate)

1, 3, 4, 6

The nurse is caring for a client who had a mastectomy three days ago. The physician prescribed Tamoxifen at discharge as a chemoprevention drug. The client asks about the side effects of Tamoxifen. What is included in the nurse's best response? Multiple selection question 1. Cataracts 2. Weight loss 3. Blood loss 4. Hot flashes 5. Hepatitis A 6. Risk for uterine cancer

1, 4, 6

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to do what? Multiple choice question 1. Ejaculate into a sterile container 2. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days 3. Transport specimen with container packed in ice 4. Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

2

The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure? Multiple choice question 1. Radiation 2. Adjuvant systemic therapy 3. Hormonal therapy 4. Chemotherapy

2

The rate of fertility declines dramatically after the age of 35. While explaining the cause of this rapid decline in fertility to the client, the nurse is aware that the primary reason for this is related to what? Multiple choice question 1. Endometriosis 2. Abnormalities of oocytes 3. Infection 4. Metabolic disease

2

Which is a true statement about the TNM system for clinical staging of breast cancer? Multiple choice question 1. The TNM system is the relative location of malignant lesions of the breasts. 2. The TNM system sorts stage by size of tumor, lymph node involvement, and whether metastasis is involved. 3. The TNM system is the clinical stage that helps surgeons decide how extensive the breast surgery will be. 4. The TNM system is the pathologic stage determined before surgery, which really correlates with prognosis and no risk for recurrence.

2

A client taking tamoxifen (Nolvadex) experiences severe sweating and an increased heart rate. The client's lab reports show diminished estrogen and progesterone levels. Which intervention would be best to relieve the client's symptoms? 1. Ask the client to wear only lightweight clothing. 2. Administer systemic gabapentin (Gralise) as prescribed. 3. Suggest that the client keep the room temperature very low. 4. Administer estrogen (Estrace) and progesterone (Prometrium) as prescribed.

2 Hormonal therapy usually results in vasomotor symptoms like hot flashes, which manifest as severe sweating and a rapid heart rate. Anticonvulsants like gabapentin (Gralise) are prescribed to reduce the vasomotor symptoms

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. The nurse realizes that the woman most likely is suffering from what? Multiple choice question 1. Pelvic relaxation 2. Cystoceles and/or rectoceles 3. Uterine prolapse 4. Genital fistulas

2 Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.

The nurse is assessing a client with fibroids on the outer wall of the uterus. Which treatment strategy would be most beneficial if the client wants to conceive in the future? Multiple choice question 1. Hysterectomy 2. Myomectomy 3. Laser surgery 4. Estrogen therapy

2 Myomectomy is a surgical procedure that helps to remove fibroids while leaving the uterine muscle walls intact. It does not affect a woman's fertility.

The nurse is caring for a client who has increased urinary frequency and reports, "Something is in my vagina." For what should the nurse assess in this client? Multiple choice question 1. Rectocele 2. Cystocele 3. Vaginal fistulas 4. Uterine displacement

2 The client with cystocele feels as if something is present in her vagina and reports a bearing-down sensation.

A pregnant client has ovarian cysts and reports a feeling of pelvic fullness. Which type of functional ovarian cysts could this client have, given the description of symptoms? Multiple choice question 1. Follicular cysts 2. Theca-lutein cysts 3. Corpus luteum cysts 4. Polycystic ovary syndrome (PCOS)

2 Theca-lutein cysts are associated with hydatidiform mole and may occur if the woman has taken ovulation-inducing drugs. These cysts may also be seen in a pregnant woman with a large placenta. The pregnant woman also experiences a feeling of fullness around the pelvic region due to these cysts and the growing fetus.

What interventions should the nurse provide to alleviate soreness and skin irritation at the site of radiation therapy? Multiple selection question 1. Instruct the client to apply a moisturizer. 2. Notify the primary health care provider. 3. Suggest that the client maintain good skin care. 4. Instruct the client to irrigate the site with warm water. 5. Instruct the client to apply talcum powder to keep the site dry.

2, 3, 4

The nurse is caring for a client who had a right mastectomy for breast cancer. What nursing interventions should be implemented immediately postoperatively? Multiple selection question 1. Breath sounds are auscultated every 8 hours. 2. Wound care involves observing for signs of hemorrhage. 3. Active range-of-motion (ROM) exercise of the legs is encouraged. 4. The woman is asked to turn, cough, and deep-breathe every 4 hours. 5. Emotional support is given and continued throughout her hospitalization. 6. The affected arm is elevated with pillows above the level of the right atrium.

2, 3, 5, 6 Breath sounds are auscultated every 4 (not 8) hours, and the woman is asked to turn, cough, and deep-breathe every 2 (not 4) hours.

A client asks about fibroid tumors and the likelihood of her getting this type of tumor. The nurse correctly responds when her assessment reveals which of the most common risks or contributing factors? Multiple selection question 1. Single 2. Obese 3. Caucasian race 4. Over age 50 5. Multiparous

2, 4

A 23-year-old client reports having severe pain in her breasts during and up to a week after menstruation." What does the nurse infer from the client's condition? Multiple choice question 1. The client has micromastia. 2. The client has macromastia. 3. The client has fibrocystic changes. 4. The client has mammary duct ectasia.

3

Self-care instructions for a woman following a modified radical mastectomy include that she: Multiple choice question 1. Wear clothing with snug sleeves to support her affected arm 2. Use depilatory creams instead of shaving the axilla of her affected arm 3. Expect a decrease in sensation or tingling in her affected arm as her body heals 4. Empty surgical drains once a day or every other day

3

The nurse is assessing a client who has fibrocystic changes in her breasts during menstruation. What comfort measures might the nurse suggest? Multiple choice question 1. Minimize physical activities during the menstruation. 2. Consume a glass of cola once a day during menstruation. 3. Avoid consuming food containing sodium before menstruation. 4. Avoid consuming food containing vitamin E before menstruation.

3

The nurse is caring for a client with endometrial cancer who is undergoing chemotherapy. The nurse creates a diet plan for the client that includes nutmeg and potassium-rich foods, and restricts milk intake to less than 500 ml. What is the goal of this diet plan? Multiple choice question 1. To prevent nausea 2. To prevent anorexia 3. To prevent diarrhea 4. To prevent stomatitis

3

Which of the following, if found in both the male and female of a couple, could present an issue with regard to the couple's fertility? Multiple choice question 1. Male and female are the same age, 35. 2. Both partners have had children in their past marriage. 3. History of endocrine problems. 4. History of hypertension.

3

Which nursing interventions are beneficial for a client preparing for uterine polyps removal? Multiple selection question 1. Advise the client to use tampons. 2. Advise the client to douche regularly. 3. Advise the client to perform relaxation exercises. 4. Provide psychologic support to the client during the removal procedure. 5. Advise the client to avoid sexual intercourse for up to 1 week after surgery.

3, 4, 5

A client who has undergone several failed attempts at in vitro fertilization discusses her feelings with the nurse. If the client says that her inability to conceive does not affect her worth as a human being, what behavioral characteristic is the client showing? Multiple choice question 1. Guilt 2. Denial 3. Depression 4. Acceptance

4

A couple at the fertility center ask the nurse, "What is the optimal time in the menstrual cycle for us to try to conceive?" What is the best response by the nurse? Multiple choice question 1. In the luteal stage of the ovulation cycle 2. In the follicular stage of the ovulation cycle 3. 3 to 4 days before and also after ovulation 4. 12 to 24 hours before and after ovulation

4

A worried client says, "I had my first child two years ago, and I've been trying get pregnant again for the past six months." Which medical term does the nurse use to describe the client's condition? Multiple choice question 1. Sterility 2. Primary infertility 3. Idiopathic infertility 4. Secondary infertility

4

The nurse is assessing a couple for infertility problems. After reviewing the client's history and laboratory results, the nurse finds that the client is being treated with clomiphene (Milophene). However, there has not been an increase in the sperm count. What else could be added to the prescription that would help a client with decreased sperm count? Multiple choice question 1. Bromocriptine (Parlodel) 2. Progesterone (Prometrium) 3. Depot medroxyprogesterone acetate (DMPA) 4. Intracytoplasmic sperm injection (ICSI)

4

A 45-year-old woman reports, "I can feel lumps in my breast tissue, which get tender during my period." Further assessment shows the presence of solid lumps of 2.5 cm in the woman's right breast, with nominal symptoms. What instructions does the nurse anticipate from the primary health care provider? Multiple choice question 1. Prepare for a surgery to remove the solid masses. 2. Perform a physical examination after the menstrual period. 3. Change the client's dietary plan and start hormonal therapy. 4. Perform magnetic resonance imaging (MRI) periodically.

4 Fibroadenoma is characterized by the presence of small lumps, which get tender during the menstrual period. Periodic examination of the lumps with magnetic resonance imaging (MRI), ultrasonography, or mammography is suggested by the primary health care provider to determine the type of lesion. Surgical intervention is necessary when the symptoms of fibroadenoma are severe.

A 35-year-old client visits the clinic for a routine health checkup. The primary health care provider observes the presence of multiple lumps on the right breast that can be easily palpated. What interventions may prevent complications in the client? Multiple selection question 1. Increasing the client's intake of sodium 2. Administering antibiotics as prescribed 3. Telling the client to avoid the use of tight bras 4. Advising the client to avoid caffeine 5. Administering ibuprofen (Motrin) as prescribed 6. Administering tamoxifen (Nolvadex) as prescribed

4, 5, 6