AH1 - Ch 69 Assessment of the Reproductive System

Decreased estriol levels in a pregnant client are frequently associated with which condition? A. An impending miscarriage B. Impending birth of multiples (twins, etc.) C. Infertility problems D. Normal pregnancy

ANS: A Decreased levels of estradiol, total estrogens, and estriol in women indicate possible amenorrhea, climacteric, impending miscarriage, or hypothalamic disorders. Decreased estriol levels in the pregnant client do not indicate impending birth of multiples or infertility.

The prostate-specific antigen (PSA) test is used in screening for prostate cancer. Which statement is true regarding this test? A. The PSA test can be used to monitor the disease after prostate cancer treatment. B. PSA levels less than 7.5 ng/mL may be considered normal. C. Elevated PSA levels are diagnostic for prostate cancer. D. Younger men, particularly African Americans, often have a higher normal PSA.

ANS: A The PSA test is used to screen for prostate cancer and to monitor the disease after cancer treatment. PSA levels less than 2.5 ng/mL may be considered normal, although there is no agreement on that value and how it is affected by age. Elevated PSA levels may be associated with prostate cancer. Older men, particularly African-American men, often have a higher normal PSA, especially as they age.

The nurse is educating an 18-year-old girl about the Papanicolaou (Pap) test. Which client statement indicates that further teaching is needed? A. "I can have sexual intercourse the night before the test." B. "It is recommended that women up to age 30 have an annual Pap test." C. "Pap smears help detect precancerous and cancerous cells." D. "The specimen will be sent to a laboratory for evaluation."

ANS: A The client should not have sexual intercourse for at least 24 hours before the test. Annual screening is recommended to 30 years of age with the conventional Pap test. After age 30 and three or more consecutive negative test results, Pap tests may be performed less frequently until 70 years of age. The Pap smear is a cytologic study that is effective in detecting precancerous and cancerous cells in the cervix. The specimen-containing slides from a Pap smear are sent to a laboratory for evaluation.

A client scheduled for a hysterosalpingogram is interviewed by the nurse. What interview information is critical for the nurse to report to the health care provider before the procedure? A. Allergy to shellfish B. Abortion 2 months ago C. Menstrual period that ended 3 days ago D. Administration of a rectal suppository 4 hours ago

ANS: A The contrast medium used during hysterosalpingography is iodine-based, so the client will need premedication with an antihistamine and/or corticosteroid before the procedure. Obstetric history, menstrual history, and recent medications are communicated to the provider, but do not require any change in the procedure. Two months between an abortion and this procedure is adequate. This test is done just at the completion of menses so that it would not interrupt a pregnancy, should there be one, in the uterus or the fallopian tube.

The nurse is conducting a reproductive assessment of a young adult client. What assessment questions does the nurse ask? (Select all that apply.) A. "Have you had any sexually transmitted diseases?" B. "How would you describe yourself?" C. "If you engage in sexual activities, do you practice 'safe' sex?" D. "What changes would you like to see in your appearance?" E. "When did you first start menstruating?"

ANS: A, B, C, E Asking the client about a history of sexually transmitted diseases is a question included in the health perception/health management pattern for performing a reproductive assessment. If the answer is "yes," the nurse continues with "When?" and "What type?" Asking the client to describe him- or herself is also included in the self-perception/self-concept pattern. The nurse follows with "Do you feel good or not-so-good about yourself?" It is important to note, if the client is sexually active, that he or she practices (and understands) "safe" sex. This might include the use of condoms, being tested for human immunodeficiency virus, and other measures to keep from acquiring sexually transmitted diseases. The age of onset of menses in women is important to note. Either early or late onset may indicate a problem or the increased likelihood for one to develop. Although the nurse might inquire whether a client has experienced changes in his or her body appearance or function, asking about changes the client might want to see is not important in doing a reproductive assessment.

A newly graduated RN is orienting to a same-day surgery unit. Which client does the charge nurse assign to the new graduate? A. A 25-year-old with infertility having a laparoscopy under general anesthesia B. A 32-year-old with a breast lump scheduled for a needle biopsy under local anesthesia. C. A 40-year-old with possible cervical cancer having a laser excision conization D. A 66-year-old with prostatic enlargement scheduled for a transrectal needle biopsy

ANS: B A needle biopsy of the breast has the least risk for possible complications and the least complex client teaching of the listed procedures. A laparoscopy under general anesthesia, laser excision conization, and transrectal needle biopsy are all procedures that will require complex client teaching and postoperative monitoring.

A client with possible prostate cancer has a transrectal ultrasound and needle biopsy. The next day, which client statement is of greatest concern to the nurse? A. "I am really worried about the test results." B. "I feel like I have a fever and my back aches." C. "I had some bright-red spotting after the procedure." D. "I haven't had a bowel movement since the biopsy."

ANS: B Low back pain and fever are indications of infection, a potentially life-threatening complication. Worrying about test results, some bright-red spotting, and having no bowel movement since the biopsy are not abnormal for a client who had a transrectal biopsy.

A client with pelvic pain is admitted to the same-day surgery unit for a laparoscopic procedure. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Educating the client about analgesic use for referred pain B. Inserting a retention catheter using sterile technique C. Taking the client's admission blood pressure and heart rate D. Teaching the client about postoperative activity restrictions

ANS: C Although most of the admission assessment and history will be completed by the RN, the admission vital signs can be delegated to UAP. Client teaching is a higher-level skill and should be done by the RN. Catheter insertion is also a higher-level skill and should be done by the RN, unless the UAP has had specialized training to perform this skill safely.

A middle-aged client is scheduled for her first mammogram. What does the nurse tell the client before the test? A. "A mammogram will x-ray the hard tissue of your breasts." B. "Do not eat anything for 12 hours before having your mammogram." C. "You should not wear deodorant the day of your mammogram." D. "You will not feel any discomfort during the mammography procedure."

ANS: C Deodorant may not be worn before a mammogram because it can show up on the x-ray. Mammography is an x-ray of the soft tissue of the breast. Dietary restrictions are not necessary before a mammogram. The client may experience some temporary discomfort when the breast is compressed during positioning and the test itself.

The nurse is teaching a group of young women about the risks for developing cervical cancer. What cancer risk is included in the content of the nurse's presentation? A. Eating a diet that is high in fat content. B. Having more than six pregnancies C. Starting to have sexual intercourse at a very early age D. Using a diaphragm with spermicidal jelly as a contraceptive device

ANS: C Having intercourse at a very early age and /or multiple sex partners places a woman at high risk for the development of cervical cancer. Eating a diet that is high in fat content, the number of pregnancies, and using a diaphragm have not been identified as increasing the risk for cervical cancer.

The nurse is obtaining a personal health history on a 24-year-old male whose male partner is present. How does the nurse approach questions about his sexual practices? A. Defer questions about his sexual practices to the health care provider. B. Direct questions about sexual and reproductive practices to both the client and his partner. C. Respect the client's choice to answer or refuse to answer questions about sexual practices. D. Skip the assessment questions about his sexual and reproductive practices.

ANS: C Respecting the client's choice to answer or not answer questions about sexual practices is an important part of the process of taking the sexual/reproductive history. The nurse must be sensitive about knowing when to ask and when to permit the client his or her privacy. Deferring questions about sexual practices to the health care provider or skipping questions is missing potentially important data; the nurse must establish trust with the client and then proceed with data collection. The nurse is collecting data on the client only, not on the partner or the client's relationship with his partner; directing questions to both of them could be very uncomfortable.

The human papilloma virus (HPV) test may be collected at the same time as the Papanicolaou (Pap) test for screening. Which finding indicates the highest risk for development of cervical cancer? A. Normal Pap results and no HPV infection B. Abnormal Pap results and no HPV infection C. Abnormal Pap results and positive HPV test D. Normal Pap results and positive HPV results

ANS: C The HPV test can identify many high-risk types of HPV infection associated with the development of cervical cancer and can be done at the same time as the Pap test for women older than 30 years and for women of any age who have had an abnormal Pap test result. Women with an abnormal Pap result and a positive HPV test are at higher risk if not treated. Women who have normal Pap test results and no HPV infection are at very low risk for developing cervical cancer.

An older client tells the nurse about vaginal dryness. What does the nurse suggest? A. "Be sure to tell your health care provider about this." B. "I think that you should have additional pelvic examinations." C. "Let me teach you how to do Kegel exercises." D. "Products such as water-soluble lubricants are helpful with this problem."

ANS: D Information about vaginal estrogen therapy and water-soluble lubricants should be provided to the older woman with vaginal dryness. There is no need to inform the health care provider because vaginal dryness is normal with aging. Additional pelvic examinations are not indicated for this client. Kegel exercises are used for clients with incontinence.

A 68-year-old client has recently undergone a prostate biopsy. Which symptom would indicate immediate referral to the health care provider? A. Slight rectal bleeding B. Small amount of blood in the toilet after urinating C. Mild pain and soreness at the site D. Temperature of 101.6° F (38.7° C)

ANS: D Rarely, sepsis can develop after a prostate biopsy. Clients should contact their health care provider immediately if they experience fever, pain when urinating, or penile discharge. Expected findings may include slight soreness, light rectal bleeding, and blood in the urine or stools for a few days. Semen may be red or rust-colored for several weeks.

A 12-year-old girl says to the nurse, "I've had my first period, so can I have a baby now?" How does the nurse respond? A. "A boy's sperm must unite with your egg to make a baby." B. "Technically yes you can; but how can you take care of a baby?" C. "Yes, you can." D. "You are physically able to, but let's discuss becoming a parent."

ANS: D Telling the client that she is able to have a baby and encouraging her to discuss it address the physiologic, psychological, and developmental facts related to the client's question. Telling the client that a boy's sperm must unite with her egg addresses physiologic facts but does not relate to the psychological issues involved with pregnancy and parenthood. Asking the client how she will take care of a baby projects the nurse's own values; it is accusative and could place the girl on the defensive. Simply telling the client that she is able to have a baby is too simple and uninformative.

The certified nurse-midwife (CNM) completes a cervical biopsy on a client and performs postprocedure teaching. What does the CNM tell the client? A. "Do not have intercourse for 24 hours after the procedure." B. "Rest for at least 6 hours after the procedure." C. "There is no limit on weight lifting; do what you normally do." D. "Use the antiseptic solution rinses to clean your perineum."

ANS: D The client must keep the perineum clean and dry by using antiseptic solution rinses as directed by the health care provider, and should change pads frequently. The client should not have intercourse or lift heavy objects for about 2 weeks after the procedure. The client should rest for 24 hours after the procedure.

The RN working at the college health clinic is caring for a sexually active 19-year-old female who is having a routine checkup. What information is of greatest concern to the nurse? A. Report of irregular menstrual periods B. Left breast is slightly smaller than the right breast C. No history of rubella vaccination or infection D. Bruising on the vulvar and inner thigh areas

ANS: D Vulvar and inner thigh bruising may indicate that the client is involved in an abusive relationship; this assessment information requires further follow-up by the nurse and health care provider. Irregular periods, disparity in the size of the client's breasts, and the lack of history on rubella status may require further investigation, but are not as high a priority as the possibility that the client may be in danger.