Ch. 27: Women's Health

While interviewing a 48-year-old patient during her annual physical examination, the nurse learns that she has never had a mammogram. The American Cancer Society recommends annual mammography screening starting at age 40. Before the nurse encourages this patient to begin annual screening, it is important for her to understand the reasons why women avoid testing. These reasons include which of the following? (Select all that apply.) a. Fear of x-ray exposure b. Expense of the procedure c. Reluctance to hear bad news d. Having heard that the test is painful e. Belief that lack of family history makes this test unnecessary

A, B, C, D Fear of x-ray exposure, expense, reluctance to hear bad news, and fear of pain are reasons women avoid having a mammogram done. Although the test is expensive, it is usually covered by health insurance. Many communities offer low-cost or free screening to women without insurance. It is important to acknowledge that some discomfort occurs with screening. Scheduling the test immediately at the end of a period makes it less painful. The risk of radiation exposure is minimal to none. Nurses play a vital role in providing information and reassurance to help women overcome these fears. Even patients with no family history should have a regular screening done. The nurse should emphasize that a combination of breast self-examination and mammography needs to be performed at regular intervals. Women with a family history may need to begin screening at a younger age and have additional testing such as ultrasound performed.

Healthy People 2020 goals directed at women's health issues focus on which areas? (Select all that apply.) a. Increased screening for cervical and colorectal cancers b. Reduction of cancer survivor rate based on clinical management treatment c. Decreased morbidity and mortality related to breast cancer d. Reduction in hospitalization for hip fractures in the older female population e. Reduction in deaths associated with cardiovascular causes such as stroke and coronary artery disease (CAD)

A, C, D, E Healthy People 2020 goals directed at women's health focus on increased access to screening for cervical and colorectal cancers, decreased deaths occurring from breast cancer and heart disease, and decreased hospitalization for hip fractures. A reduction of the cancer survival rate would reflect increased morbidity and mortality.

A 38-year-old patient presents to the clinic office complaining of increased tenderness of her breasts prior to the onset of menses. On questioning the patient, this presentation has occurred off and on for several years; however, the pain has increased. Physical examination reveals lumpy areas bilaterally on the upper outer quadrants of each breast tissue. The areas of concern are approximately 2 cm in size. Based on this assessment, which diagnostic testing would be necessary? (Select all that apply.) a. Ultrasound examination b. Open biopsy c. Fine-needle aspiration (FNA) biopsy d. CBC with differential e. Mammogram

A, C, E Based on the clinical presentation, the patient may have fibrocystic breast disease. Although this condition is typically benign, the fact that the patient has noted a change in tenderness should be evaluated. Ultrasound, FNA, and mammography may be indicated to provide a baseline for comparison and rule out any malignancy. An open or surgical biopsy is not indicated at the present time but may be needed if the other test results indicate any pathology. Blood work is not indicated at this time relative to the diagnosis.

An 18-year-old has been diagnosed with primary dysmenorrhea. Prostaglandin inhibitors have been prescribed. The nurse recognizes that teaching concerning the use of prostaglandin inhibitors has been effective when the woman states: A. "I will take ibuprofen as soon as my period starts and will continue around the clock for about 2 or 3 days." B. "I will take ibuprofen once a day starting 2 days before when my period should begin." C. "I will take naproxen once a day every day." D. "I will take naproxen around the clock every day that I am bleeding."

A. "I will take ibuprofen as soon as my period starts and will continue around the clock for about 2 or 3 days." The most effective prostaglandin inhibitors are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. To be effective, the NSAID should be taken around the clock for at least 48 to 72 hours, beginning when menstrual flow starts.

A 55-year-old woman has a body mass index of 35. She is at high risk for which of the following? (Select all that apply). A. Diabetes mellitus B. Pulmonary disease C. Hypertension D. Neurologic disorders E. Coronary artery disease F. Some cancers of the breast

A. Diabetes mellitus C. Hypertension E. Coronary artery disease F. Some cancers of the breast

The recommended medication for the treatment of chlamydia would be: A. Doxycycline. B. Podofilox. C. Acyclovir. D. Penicillin.

A. Doxycycline. Doxycycline is effective for treating chlamydia but should be avoided if the woman is pregnant. Penicillin is not recommended for chlamydia; it is the preferred medication for syphilis. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papillomavirus infection. Acyclovir is used to treat genital herpes simplex virus infection.

A 65-year-old woman calls the clinic for an appointment stating that she has developed weakness, fatigue, and nausea over the past 2 weeks. The nurse should: A. Have her come in immediately or go to the local emergency department. B. Make an appointment for later in the day. C. Make an appointment within 1 week. D. Discuss with her the need for referral to a hematologist. Rationale:

A. Have her come in immediately or go to the local emergency department. Recognition of coronary artery disease in women is important because they are more likely to die from a myocardial infarction (MI) than men. MIs tend to present with atypical vague symptoms in women that can delay recognition and treatment. Women may report having some vague symptoms that signal an imminent acute MI, such as fatigue, for several weeks before seeking care. Other symptoms may include nausea, vomiting, sweating, and dizziness.

When teaching adolescents about sexually transmitted diseases, it is important to emphasize prompt treatment when symptoms first appear to prevent complications. One example that may be used is that untreated gonorrhea may be associated with: A. Infertility. B. Skin eruptions. C. Paralysis. D. Psychosis.

A. Infertility. Gonorrhea is associated with pelvic inflammatory disease, which increases the risk of tubal scarring and can result in infertility. The other choices are associated with syphilis.

Which measures provide comfort and prevent secondary infections when a sexually transmitted disease has been diagnosed? (Select all that apply). A. Keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider. B. Keep the vulva dry. C. Take analgesics (aspirin or acetaminophen) as directed by the health care provider. D. Hot sitz baths may provide relief from itching. E. Wipe the vulva from back to front after urination or defecation.

A. Keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider. B. Keep the vulva dry. C. Take analgesics (aspirin or acetaminophen) as directed by the health care provider.

The simple procedure a nurse in a gynecologic clinic can do to assist clients with early detection of osteoporosis is to: A. Measure the height of the client at each annual appointment. B. Assess the spinal column for changes at each annual appointment. C. Recommend that the client have serum calcium levels checked twice a year. D. Recommend that the client have a bone mineral analysis done once a year.

A. Measure the height of the client at each annual appointment. The first noticeable evidence of bone mass loss is the loss of height. Later signs include the dowager's hump on the spinal column. Serum calcium levels will not assist in determining osteoporosis. A bone mineral analysis is done to diagnose osteoporosis.

A woman with premenstrual syndrome (PMS) may benefit from which of the following management techniques? A. Relaxation therapy B. Increasing caffeine C. High-protein diets D. One alcoholic drink at night during the luteal phase

A. Relaxation therapy Relaxation therapy has shown benefits for women with more severe PMS symptoms. Avoiding alcohol and caffeine can help, and carbohydrate-rich foods can also help relieve PMS symptoms.

A 48-year-old woman has just been diagnosed with breast cancer in her right breast, and a simple mastectomy has been recommended. The nurse assesses the client teaching on the surgery to be effective when the woman states: A. "They are going to take only the tumor out and a couple of the lymph nodes." B. "They will remove my entire right breast." C. "They are going to take the right breast, some nodes, and even some chest D. "They will be removing only some lymph nodes."

B. "They will remove my entire right breast." A simple mastectomy involves the removal of the entire breast. Axillary dissection is omitted. A lumpectomy is the removal of only the tumor. A modified radical mastectomy involves the removal of the breast tissue, axillary nodes, and some chest muscles. A sentinel lymph node biopsy is a technique to remove a few key lymph nodes to evaluate the spread of the cancer.

Women who are past menopause are at higher risk for cardiovascular disease. One of the physiologic changes that occurs with menopause that might lead to cardiovascular disease is: A. Atrophy of the heart. B. A rise in the low-density lipoproteins. C. A rise in the high-density lipoproteins. D. Spasms of the vascular system.

B. A rise in the low-density lipoproteins. Absence of estrogen is associated with an adverse change in serum lipid levels. Serum levels of low-density lipoproteins increase. Levels of high-density lipoproteins decrease.

Which of the following women is at greatest risk for osteoporosis? A. African-American, weight 165 pounds, height 5'3"; does not smoke cigarettes or drink alcohol B. Asian, weight 105 pounds, height 4'14"; smokes two packs of cigarettes a day C. White, weight 145 pounds, height 5'8"; had a hysterectomy with removal of ovaries at age 45. D. Native American, weight 165 pounds, height 5'7"; alcoholic for 15 years, has been without a drink for the past 2 years

B. Asian, weight 105 pounds, height 4'14"; smokes two packs of cigarettes a day Small-boned, fair-skinned, white, and Asian women are at greatest risk for osteoporosis. Other risk factors include early menopause, smoking, and alcohol intake. The more risk factors, the higher the risk for developing osteoporosis. The Asian woman is small-boned and smokes, which gives her three risk factors. All the other women had zero to two risk factors.

A woman is undergoing chemotherapy for breast cancer. During the discharge teaching, it is important that the nurse teach the woman to: A. Not wash off the marks on her skin made by the technician. B. Avoid crowds and anyone who is sick. C. Take the medication before her menstrual period. D. Have her calcium levels checked every 2 months.

B. Avoid crowds and anyone who is sick. Chemotherapeutics may kill off normal cells along with the cancer cells, especially rapidly dividing cells such as those in blood cells. Therefore, the woman may be more susceptible to infection during the treatment.

A woman is trying to decrease her urinary incontinence without medication or surgery. The nurse can recommend that the woman: A. Decrease fluid intake at night. B. Decrease alcohol and caffeine intake. C. Decrease 10% of her average weight. D. Increase fluid intake in the morning and decrease the intake in the afternoon.

B. Decrease alcohol and caffeine intake. Alcohol and caffeine can irritate the bladder and worsen incontinence. Obesity is associated with urinary incontinence, and the woman should attempt to be at her ideal weight range. Decreased fluid intake can lead to concentrated urine, which can irritate the bladder's mucous membranes and increase the urge to void.

A woman calls the clinic concerned that a neighbor has been diagnosed with herpes genitalis type 2. The woman is upset and tells the nurse that this neighbor "used my toilet last week, so what should I do?" The nurse's response should be based on knowledge that herpes genitalis type 2 is transmitted only through: A. Sexual intercourse. B. Direct contact. C. Blood contamination. D. Blood or body fluid contamination.

B. Direct contact. Transmission occurs only through direct contact with an infected person.

A woman who has had a hysterectomy has been prescribed hormone replacement therapy. The nurse can anticipate which type of hormones that will be prescribed to this woman? A. Combination of estrogen and progesterone B. Estrogen therapy alone C. Hormone therapy is not recommended for women after hysterectomies. D. Progesterone therapy alone

B. Estrogen therapy alone Estrogen therapy alone can be given to women who have had a hysterectomy because uterine hyperplasia is not a risk. Estrogen and progesterone are given to women with a uterus to prevent hyperplasia.

A 49-year-old woman has come to the nurse practitioner for an examination, stating, "I haven't been for a physical examination since my last child was born 20 years ago and thought I should have one since I have gone through menopause." When taking the health history from this woman, it is important to include questions concerning: A. Problems that may had occurred with her labor and birth. B. Family history of heart disease. C. History of childhood immunizations. D. History of infertility or problems conceiving.

B. Family history of heart disease. A family history of heart disease is especially important when the woman is postmenopausal because estrogen, which provides some protection against coronary artery disease, decreases after menopause and obesity may increase. If there is a family history of heart disease, or other signs of heart disease, the woman needs further screening.

A 22-year-old woman has come to the clinic complaining of a "mass in my breast." The nurse practitioner notes two firm, freely mobile nodules in the upper outer quadrant of the right breast. The nurse is aware that the nurse practitioner will: A. Refer the client for a needle biopsy. B. Have the client return during her menstrual period to reevaluate the masses. C. Schedule the woman for a mammography. D. Do nothing. Masses at this age are always benign.

B. Have the client return during her menstrual period to reevaluate the masses. Fibroadenomas are benign tumors of the breast and are most common during the teenage years and the 20s. Fibroadenomas are firm, freely mobile nodules that may or may not be tender when palpated. Fibroadenomas do not change during the menstrual cycle. They are generally located in the upper outer quadrant of the breast, and more than one is often present. Treatment may involve careful observation for a few months to determine if the mass is stable. If the mass enlarges, a biopsy is done.

A 32-year-old woman complains of excessive bleeding with menses for the past 3 months. With a chart review, the nurse notes that the woman had a urinary tract infection 3 months ago that was treated with an antibiotic, has hypothyroidism, uses condoms with foam for contraception, and uses antidepressants. Which of these is the most likely cause of the woman's excessive bleeding? A. Urinary tract infections treated with an antibiotic B. Hypothyroidism C. Use of condoms with foam for contraception D. Use of antidepressants

B. Hypothyroidism Systemic disorders such as hypothyroidism may be a cause of dysfunctional bleeding.

A woman who is 17 weeks pregnant because of incest asks the nurse about having a therapeutic abortion. The nurse's best response should be based on the knowledge that: A. Therapeutic abortions are not available in this country for a woman more than 14 weeks pregnant. B. Mifepristone (RU486) can be used up to week 20 of pregnancy. C. Methotrexate (Folex, Mexate) can be used up to week 24 of pregnancy. D. A dilation with removal of the fetus and placenta can be performed during the 17th week of pregnancy.

B. Mifepristone (RU486) can be used up to week 20 of pregnancy. Medications such as mifepristone and methotrexate are used for early abortions. For second-trimester abortions, dilation with removal of the fetus and placenta is performed.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease (PID), the nurse should: A. Point out that inappropriate sexual behavior caused the infection. B. Prepare the woman for the need of IV antibiotics for the next 48 hours. C. Explain to the woman that infertility is a likely outcome of this type of infection. D. Tell her that antibiotics need to be taken until the pelvic pain is relieved.

B. Prepare the woman for the need of IV antibiotics for the next 48 hours. Acute PID is often treated with IV administration of broad-spectrum antibiotics. The IV antibiotics can be changed to oral treatment after 48 hours. Although sexual behavior may well have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been successfully treated.

A 25-year-old woman comes to the clinic for her regular annual gynecologic examination. When taking the history, the woman tells the nurse that she has been dieting for the past year and has lost 150 pounds (from 250 to 100 pounds). Her menstruation stopped 6 months ago. A chart review indicates that prior to this visit her menses had been regular every 28 days. The nurse can classify this woman with: A. Primary amenorrhea. B. Secondary amenorrhea. C. Amenorrhea of unknown origin. D. Possible pregnancy.

B. Secondary amenorrhea. Secondary amenorrhea is the cessation of menstruation for at least 6 months in a woman who has established a pattern of menstruation. Low weight is one reason for secondary amenorrhea.

After teaching a woman about Kegel exercises, the nurse assesses that the teaching has been effective when the woman states: A. "Once I can contract the muscles for 10 seconds at a time I can stop the exercise." B. "I will need to do these exercises until I get up to 45 daily repetitions." C. "I will need to do these exercises for the rest of my life." D. "If I can stop the stream of urine I don't need to do the exercises." Rationale:

C. "I will need to do these exercises for the rest of my life." Kegel exercises involve conscious contracting and relaxing of the pelvic muscles. To maintain pelvic muscle tone, the woman should continue Kegel exercises for the rest of her life.

A woman who was diagnosed with breast cancer 1 month ago is making an appointment for a follow-up appointment with the physician. During the conversation with the nurse, the woman becomes angry and yells, "You never have any appointments available when I can come. I always have to rearrange my day to agree with your schedule." The best response by the nurse is: A. "We have so many clients and there are few available times for an appointment. I am sorry it is inconvenient for you." B. "Let's look to see if we have another time that is better for you." C. "You seem to be upset today." D. "I am doing the best job I can. Tell me when you can come and I will try and work you in at that time."

C. "You seem to be upset today." During the stages of cancer, women think that they have lost control and that their lives have been taken over by cancer. The nurse should provide time and demonstrate genuine interest in the woman's concerns using communication techniques, such as reflecting feelings, and open-ended statements to encourage her to express her concerns.

Which of the following women is at highest risk for cardiovascular disease? A. 55-year-old who is overweight and participates in no physical activity during the week B. 65-year-old who has type 2 diabetes C. 45-year-old with type 2 diabetes, hypertension, overweight, and smokes D. 70-year-old in good health but with a family history of cardiovascular disease

C. 45-year-old with type 2 diabetes, hypertension, overweight, and smokes Age, being overweight, no physical activity, type 2 diabetes, hypertension, family history, and smoking are all risk factors for cardiovascular disease. The more risk factors a woman has, the higher her risk for developing cardiovascular disease. The 45-year-old is the youngest in the choices shown, but she has the most risk factors

A 57-year-old woman eats two servings of calcium-rich food a day, usually in the form of 8 oz of skim milk or yogurt. To meet her calcium needs, she would need to take a calcium supplement that contains how much calcium? A. 400 mg B. 500 mg C. 600 mg D. 800 mg

C. 600 mg 8 oz of skim milk or yogurt contain between 300 and 350 mg of calcium. Two servings would give this woman at least 600 mg. A woman older than 50 years needs 1200 mg of calcium daily, so she would need to take 600 mg in a supplement.

A 65-year-old woman, gravida 6, para 6, is complaining of increasing stress incontinence and pelvic pressure and fullness. Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing: A. Uterine prolapse. B. Rectocele. C. Cystocele. D. Vesicovaginal fistula.

C. Cystocele. The classic clinical manifestations of cystocele are described in the question. Prolapse or downward displacement of the uterus could result in protrusion of the uterus through the vagina. Rectocele results in herniation of the rectal wall through the posterior vagina. Clinical manifestations relate to alterations in bowel elimination. A vesicovaginal fistula is an abnormal passage between the bladder and vagina, resulting in urinary incontinence and excoriation of the vaginal mucosa.

During an annual gynecologic examination, the physician notes an enlarged left ovary in a 28-year-old woman. The woman has no complaints of pain or tenderness. The nurse can anticipate: A. An appointment for an ultrasound. B. Scheduling the woman for a laparoscopy. C. Scheduling the woman for a follow-up examination after her next menses. D. Nothing. The finding is insignificant.

C. Scheduling the woman for a follow-up examination after her next menses. Follicle ovarian cysts are usually asymptomatic and generally regress during the subsequent menstrual cycle. If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again.

A woman confides in the nurse about a painless chancre that developed next to her vaginal opening about 8 weeks ago. The woman is not concerned because it has gone away. The nurse should teach this woman: A. To wash the perineum with mild soap and water after intercourse to prevent recurrences. B. That the use of condoms will decrease chances of this developing again. C. That a serologic test is indicated. D. That a vaginal culture is indicated.

C. That a serologic test is indicated. The first sign of primary syphilis is a painless chancre that heals in about 6 weeks. About 2 months after the initial infection, serologic tests are generally positive for syphilis. The infection does not heal but moves into the secondary stage of syphilis.

When assisting a woman into the lithotomy position for a pelvic examination, the nurse notes a frothy, malodorous, yellow-green vaginal discharge. The nurse should anticipate the need for a: A. Culture and sensitivity test of the discharge. B. Serologic test. C. Wet mount preparation test. D. Biopsy.

C. Wet mount preparation test. A frothy, malodorous, and yellow-green discharge is an indication of trichomoniasis. The diagnosis is made by identifying the organism in a wet mount preparation.

The nurse should refer the patient for further testing if which of the following is noted on inspection of the breasts of a 55-year-old woman? A. Left breast slightly smaller than the right breast B. Eversion (elevation) of both nipples C. Bilateral symmetry of venous network that is faintly visible D. Small dimple located in the upper outer quadrant of the right breasts

D. Small dimple located in the upper outer quadrant of the right breasts Dimpling or retraction is often associated with an underlying mass or tumor. The other choices are all expected findings.

A 50-year-old woman is trying to decrease her chances of developing osteoporosis. Which exercise can the nurse recommend that will be beneficial? A. Swimming B. Water aerobics C. Walking D. Yoga

D. Yoga Weight-bearing and resistance exercise have been shown to be beneficial in slowing loss of bone mass to maintain bone density. Water-based exercises such as swimming do not help limit bone loss.

Which information should the nurse stress in teaching a patient how best to relieve the symptoms of premenstrual syndrome (PMS)? a. Decrease her consumption of caffeine. b. Drink a small glass of wine with her evening meal. c. Decrease her fluid intake to prevent fluid retention. d. Eat three large meals a day to maintain glucose levels.

a. Decrease her consumption of caffeine. Caffeine increases irritability, insomnia, anxiety, and nervousness. Alcohol aggravates depression and should be avoided in the patient with PMS. The patient should drink at least 2000 mL of water per day. Six smaller meals a day will help maintain glucose levels and reduce symptoms.

Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap test? a. Lubricant b. Speculum c. Fixative agent d. Gloves and eye protectors

a. Lubricant Lubricants other than water or water-based lubricants on the cervix interfere with the accuracy of the cytology report. A speculum is necessary to visualize the cervix. A fixative agent is applied to the slide to prevent drying or disruption of the specimen. The examiner should always use standard precautions including gloves and eye protection.

Which specific instruction should the nurse teach to assist a patient to regain control of her urinary sphincter? a. Perform Kegel exercises. b. Void every hour while awake. c. Drink 8 to 10 glasses of water each day. d. Allow the bladder to become distended before voiding.

a. Perform Kegel exercises. Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. A prescribed schedule may help; however, every hour is too frequent. Restricting fluids will cause bladder irritation, which exacerbates the problem. Drinking adequate fluids will decrease the concentration of urine; however, this intervention will not improve sphincter control. Overdistention of the bladder will result in further stress incontinence.

A patient, age 49, confides in the nurse that she has started experiencing pain with intercourse. The patient asks, "Is there anything I can do about this?" The nurse's best response is a. "No, it is part of the aging process." b. "Water-soluble vaginal lubricants may provide relief." c. "You need to be evaluated for a sexually transmitted disease." d. "You may have vaginal scar tissue that is producing the discomfort."

b. "Water-soluble vaginal lubricants may provide relief." Loss of lubrication, with resulting discomfort in intercourse, is a symptom of estrogen deficiency. It is part of the aging process; however, the use of lubrication will help relieve the symptoms. This is a normal occurrence with the aging process and does not indicate an STD. It is caused by loss of lubrication with the decrease in estrogen. Scar tissue problems would have occurred earlier.

Which patient is most likely to develop osteoporosis? a. A 50-year-old patient on estrogen therapy b. A 55-year-old patient with a sedentary lifestyle c. A 65-year-old patient who walks 2 miles each day d. A 60-year-old patient who takes supplemental calcium

b. A 55-year-old patient with a sedentary lifestyle Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Several drug therapies are available to reduce the progression of osteoporosis. Weight-bearing exercises have been shown to increase bone density. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D.

While performing a self-breast exam, the patient notes an area on the right breast that is nodular, with some associated tenderness. This is a new onset finding because the exams were not problematic in the past. The left breast examination is unremarkable. The patient calls to report her findings to the clinical nurse because this is not her typical result. What action should the nurse perform next? a. Refer the patient to an oncologist because the results are suspicious. b. Ask the patient to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation. c. Have the patient wear a tight-fitting bra and tell her that the tenderness is associated with ovulation and will pass. d. Have the patient repeat the self-breast exam in 2 weeks and call back with findings to provide a basis for comparison.

b. Ask the patient to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation. Although these findings are within the normal range of presentation for breast tissue, they are not in the normal presentation for this patient. The patient has called to express concern; therefore, the nurse should have the patient schedule an appointment for assessment and evaluation. There is no need for referral to a specialist currently. Wearing a tight-fitting bra may help provide support; however, does not address the physical findings and concern of the patient. Repeating the self-breast exam may be required; however, it does not address the patient's current concerns.

Which are the most common sites of breast cancer metastasis? a. Kidneys b. Bones and liver c. Heart and blood vessels d. Skin

b. Bones and liver Metastasis occurs when the cancer cells spread by both blood and lymph system to distant organs and to vascular sites, commonly the lungs, liver, bones, and brain. Kidney metastasis is uncommon. Metastasis to the heart and blood vessels is uncommon. Skin cancer is not associated with breast cancer metastasis.

You are taking care of a patient who has had a colporrhaphy. Which option would indicate a priority assessment during the postoperative period? a. Documentation of a pessary in the operative procedure notes by the physician b. Removal of vaginal packing as ordered by the physician c. Use of a cell saver for transfusion therapy in the postoperative period d. Order for removal of staples 2 to 3 days post-procedure

b. Removal of vaginal packing as ordered by the physician Vaginal packing is typically used in this type of pelvic surgery. The removal of the packing should be verified and documented. This is the priority assessment. A pessary would be utilized as a nonsurgical intervention for a patient who has had uterine prolapse and was not a surgical candidate based on medical history. A cell saver is used in orthopedic surgeries that are at risk for blood loss so that the patient's own blood can be re-infused based on established protocol. There are no staples used in this type of surgical procedure, which is also known as an A & P (anterior and posterior) repair.

A benign breast condition that includes dilation and inflammation of the collecting ducts is known as a. fibroadenoma. b. ductal ectasia. c. intraductal papilloma. d. chronic cystic disease.

b. ductal ectasia. Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Fibroadenoma is evidenced by fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated.

A 45-year-old patient asks how often she should have a mammogram. The most appropriate answer is a. whenever she feels a lump. b. every year beginning at age 40. c. they are unnecessary until age 50. d. every year if you have risk factors.

b. every year beginning at age 40. The American Cancer Society recommends that women have an annual mammogram after 40 years of age. Mammography should be done routinely following the American Cancer Society guidelines. Mammograms are necessary when a woman is in her 40s. Women with high-risk factors may require them more often.

Which sexually transmitted disease can be treated and eradicated? a. Herpes b. AIDS c. Chlamydia d. Venereal warts

c. Chlamydia Treatment options chlamydial bacterial infection include: azithromycin, doxycycline, ofloxacin, levofloxacin, or erythromycin. Concurrent treatment of all sexual partners is necessary to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the main focus. Condylomata acuminata is caused by the human papillomavirus (HPV). No treatment eradicates the virus; however, there is a vaccine available.

Which client is most at risk for fibroadenoma of the breast? a. Janice, 38 years old b. Helen, 50 years old c. Mary, 16 years old d. Anna, 27 years old

c. Mary, 16 years old Although it may occur at any age, fibroadenoma is most common in the teenage years. Ductal ectasia becomes more common as a client approaches menopause. Intraductal papilloma develops most often just before or during menopause. Fibrocystic breast changes are more common during the reproductive years.

Which administration concern is included in the plan of care for the HPV (human papillomavirus) vaccine? a. It is available in liquid form. b. It involves a series of two injections. c. Injections should be given over a 3-month period. d. The individual should sit down for 15 minutes following the injection.

d. The individual should sit down for 15 minutes following the injection. There is a possibility that the client can faint in reaction to this type of immunization, so a safety concern should be included in the plan of care. It is available only in injection form. It is given as a series of three injections. The series of three injections should be given over a 6-month period according to CDC recommendations.

In reviewing genetic testing for a female patient, you note the presence of BRCA1, BRCA2, and CHEK2. How should these findings be interpreted? a. There is no increased likelihood that the patient will develop breast or ovarian cancer. b. There is an increased likelihood only for the development of breast cancer in a woman. c. More information is needed to interpret these findings based on the patient's family history and the patient's current and past medical history. d. A radical bilateral mastectomy is required as soon as possible since the cancer may have already undergone sub-metastasis.

c. More information is needed to interpret these findings based on the patient's family history and the patient's current and past medical history. The presence of genetic markers (BRCA1, BRCA2, and CHEK2) provides strong indicators of the increased risk for the development of breast cancer in males and females as well as ovarian cancer. It is important to obtain additional information in order that a treatment plan can be developed and implemented to improve patient outcomes. There is an increased likelihood that the patient will develop breast or ovarian cancer. Stating that there is an increased likelihood only for the development of breast cancer in a woman fails to include that men are also at risk of developing breast cancer. At this point, surgical intervention is speculative because the presence of biomarkers does not indicate that sub-metastasis has occurred or that the cancer has even developed.

Which treatment option minimizes the development of lymphedema in the surgical management of a patient with breast cancer? a. Radical mastectomy procedure b. Radiation therapy c. Sentinel lymph node mapping d. Ultrasound

c. Sentinel lymph node mapping The use of sentinel lymph node mapping identifies only those affected lymph node tissues that require surgical removal and helps minimize the development of lymphedema in the surgical management of a patient with breast cancer. Radical mastectomy is associated with lymphedema in the postsurgical breast cancer patient because of the removal of lymph node tissue. Radiation therapy is not associated with a decrease in lymphedema for the breast cancer patient. Ultrasound as an intervention does not affect the development of lymphedema.

The drug of choice to treat a gonorrhea infection is a. penicillin G (Pfizerpen). b. tetracycline (Achromycin). c. ceftriaxone (Rocephin). d. acyclovir (Zovirax).

c. ceftriaxone (Rocephin). Additional drugs include cefixime (Suprate) or ciprofloxacin (Cipro). Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin G is used most to treat syphilis. Tetracycline is prescribed to treat chlamydial infections. Acyclovir is most used to treat herpes genitalis.

The physician diagnoses a 3-cm cyst in the ovary of a 28-year-old patient. You expect the initial treatment to include a. initiating hormone therapy. b. scheduling a laparoscopy to remove the cyst. c. examining the patient after her next menstrual period. d. aspirating the cyst and sending the fluid to pathology.

c. examining the patient after her next menstrual period. Most ovarian cysts regress spontaneously. Cysts in women of childbearing age may decrease within one cycle, so treatment is not necessary at this point. It is too early to anticipate removal of the cysts. Most ovarian cysts regress spontaneously within one cycle. A transvaginal ultrasound examination will help determine if the cyst is fluid-filled or solid. The cyst can then be removed if warranted.

A patient with a history of a cystocele should contact the physician if she experiences a. backache. b. constipation. c. urinary frequency and burning. d. involuntary loss of urine when she coughs.

c. urinary frequency and burning. Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Back pain is a symptom of uterine prolapse. Constipation may be a problem for patient with a rectocele. Involuntary loss of urine during coughing is referred to as stress incontinence and is not an emergency.

Findings of a Pap smear exam denote atypical cells of undetermined significance (ASCUS). The Pap test is repeated at 6 months and the same finding of ASCUS is reported. Which therapeutic treatment option would the nurse expect the practitioner to order? a. Mammography b. Bone scan c. Transvaginal ultrasound d. Biopsy

d. Biopsy Based on the standard of care, a colposcopy or biopsy of the cervix is indicated. A Pap smear is performed to evaluate the cervix. There is no indication that mammography, which is used to assess and evaluate breast tissue, is required. There is no evidence to warrant a bone scan. Although a transvaginal ultrasound might be included in the treatment plan, the Pap smear indicates cervical pathology so a colposcopy or biopsy is indicated.

Which statement regarding primary dysmenorrhea is most accurate? a. Primary dysmenorrhea is experienced by all women. b. It is unaffected by oral contraceptives. c. It occurs in young multiparous women. d. It may be caused by excessive endometrial prostaglandin.

d. It may be caused by excessive endometrial prostaglandin. Primary dysmenorrhea is menstrual pain without identified pathology. Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. Contrary to popular belief, primary dysmenorrhea is not experienced by all women. Oral contraceptives can be a treatment choice if cramps associated with primary dysmenorrhea are debilitating. It most often occurs in young nulliparous women.

Which option could be used for the treatment and management of a patient who reports mild pain associated with a clinical diagnosis of fibrocystic breast disease? a. Chamomile tea as a relaxant therapy b. Danazol (Danocrine) c. Tamoxifen (Nolvadex) d. Over-the-counter nonsteroidal anti-inflammatory drug (NSAID) therapy

d. Over-the-counter nonsteroidal anti-inflammatory drug (NSAID) therapy Because the patient is reporting mild pain, NSAIDs may provide adequate pain relief and comfort. It is recommended that tea, coffee, and/or other stimulants be limited or restricted for patients with fibrocystic breast disease. Danazol is typically used for moderate to severe pain for patients with fibrocystic breast disease because its use is associated with more serious side effects. Danazol should not be used longer than 4 to 6 months. The patient reports mild pain so this would not be warranted. Tamoxifen is a selective estrogen receptor modulator (SERM) used for the treatment of breast cancers and for moderate to severe pain in fibrocystic breast disease. The patient reports mild pain, so this would not be warranted.

Which concern is included in the plan of care for the patient who receives HPV (human papillomavirus) vaccine? a. It is available in oral form. b. It involves a series of two injections. c. Injections should be given over a 3-month period. d. The vaccine (Gardasil) should not be given to any patient with a sensitivity to yeast.

d. The vaccine (Gardasil) should not be given to any patient with a sensitivity to yeast. The vaccine should not be administered to any woman who has a sensitivity to any component of the yeast family. It is available only in injection form. It is given as a series of three injections. The series of three injections should be given over a 6-month period according to Centers for Disease Control and Prevention (CDC) recommendations. Side effects of the vaccine include: headache, fever, nausea, and dizziness.