MED- SURG 2 EAQ CH. 49

A patient recently had surgery to the perineum. The health care provider ordered a sitz bath two times daily. The nurse is conducting patient teaching on a sitz bath. Which statement made by the patient indicates a need for further teaching? 1. "I should use the sitz bath for up to 35 minutes." 2. "I need to have a water temperature of 38° C to 45° C (100° F to 115° F)." 3. "I should have someone close by because my blood pressure might drop." 4. "The sitz bath will help relieve my pain, cleanse the area, and promote healing."

1. "I should use the sitz bath for up to 35 minutes." The sitz bath provides heat to the perineal area to relieve pain, cleanse the area, promote healing and drainage, or stimulate urination. Water temperature should be maintained within 38°C to 45°C (100°F to 115°F), and it should be used for a maximum of 25 minutes. Monitor for signs of complications such as faintness, shock, or severe pain. Hypotension may occur because of dilation of large pelvic blood vessels, so the patient should be monitored.

A married couple have had unprotected sexual intercourse for the last year and have been unable to conceive. Which individual(s) will be the initial focus of the diagnostic procedures? 1. Male 2. Female 3. Male and female 4. Neither the male nor the female

1. Male The male partner is the initial focus because associated infertility problems are generally easier, less invasive, less expensive, and not cycle dependent. Female workups are more difficult, more invasive, more expensive, and cycle dependent.

Which considerations are important when heat is used in the treatment for symptoms of the reproductive system? Select all that apply. 1. A health care provider's order is required. 2. Sitz baths are intended to be used for 30 to 60 minutes. 3. Sitz baths are a form of heat application to the perianal area. 4. A barrier should be used between the heating device and the skin. 5. Health care provider's orders dictate temperature and duration of the heat application.

1. A health care provider's order is required. 3. Sitz baths are a form of heat application to the perianal area. 4. A barrier should be used between the heating device and the skin. 5. Health care provider's orders dictate temperature and duration of the heat application. An order from the health care provider is required, which should include instructions for the temperature and duration of the heat application. Sitz baths are a form of heat application to the perianal area. A barrier should be used between the heating device and the skin. The treatments should be used for less than 25 minutes.

The nurse is teaching a patient about breast self-examination. Which statement made by the nurse should be included in the teaching? Select all that apply. 1. Both breasts should be examined. 2. Breast self-examination should be done once a month. 3. Visually inspect the breast while sitting or standing before a mirror. 4. You should look for dimpling, puckering, or texture changes of the skin 5. The examination should be done at the beginning of the menstrual cycle. 6. While lying on the bed, palpate the breast from the nipple to armpit moving in circular motion.

1. Both breasts should be examined. 2. Breast self-examination should be done once a month. 3. Visually inspect the breast while sitting or standing before a mirror. 4. You should look for dimpling, puckering, or texture changes of the skin 6. While lying on the bed, palpate the breast from the nipple to armpit moving in circular motion. Breast self-examination (BSE) should be done once a month at the end of the menstrual cycle or on the same day for those who have finished menstruation. Both breasts should be examined. The BSE begins with inspection of the breast while the woman is sitting or standing before a mirror. She looks for changes in her breasts as she assumes each of four positions: (1) with her arms relaxed at her sides, (2) with her arms held straight above her head, (3) with her hands pressed against her waist or hips and her elbows brought forward, and (4) leaning forward. She looks for any changes from the previous examination: for dimpling, puckering, or texture changes of the skin; for elevation or enlargement of one breast when she leans forward or when she brings her elbows forward in the third position; and for other, new differences between the breasts. The second step of the BSE is palpation of the breasts and the axillary area. Firm pressure is used, beginning at the nipple and traveling in a circular track around and around the breast until the breast has been covered. The process is repeated on the opposite side.

A patient who has been diagnosed with endometriosis is in need of drug therapy. Which drug is used most often in the treatment of endometriosis? 1. Danazol 2. Progestin 3. Urofollitropin 4. Clomiphine citrate

1. Danazol Danazol is used to treat endometriosis. Progestin is used to prevent pregnancy by suppressing ovulation and altering the endometrium and cervical mucus. Urofollitropin is used to stimulate ovarian follicular growth and to treat patients who have not responded to Clomiphine citrate Clomiphine citrate is used to stimulate or mimic the actions of natural pituitary gonadotropins.

Several steps are involved in preparation for and performing a pelvic examination. Which steps may be taken to decrease the vulnerability a patient may feel? Select all that apply. 1. Drape the patient to preserve modesty. 2. Encourage the patient to remove her socks if she is wearing socks. 3. Position the patient as close as possible to when the examination begins. 4. While waiting for the examiner, place the patient in the lithotomy position.

1. Drape the patient to preserve modesty. 3. Position the patient as close as possible to when the examination begins. A pelvic examination is uncomfortable for many women due to the position and the feeling of exposure and vulnerability. Positioning the patient as close as possible to the time of the examination can relieve feelings of anxiety about the examination. Draping the patient preserves modesty. The patient should be encouraged to wear socks if she prefers. Text Reference - pp. 1093-1094

The nurse is providing care for a 14-year-old patient with menorrhagia. The nursing diagnosis of anxiety had been added to her plan of care. Which intervention by the nurse is priority for the nursing diagnosis of anxiety? 1. Encourage the patient to express her feelings. 2. Teach the patient her role in the treatment process. 3. Assess the number of sexual partners the patient has encountered. 4. Instruct the patient to change perineal pads frequently during menses.

1. Encourage the patient to express her feelings. Menorrhagia is excessive bleeding during menstruation. Anxiety can develop due to the excessive bleeding and not knowing the cause. Supportive measures such as encouraging the patient to express her feelings, use of touch, and listening convey concern to the patient. Teaching the patient her role in the treatment process addresses knowledge deficit. Assessing the number of sexual partners should be part of the health history and could increase the patient's anxiety. Instructing the patient to change the perineal pad frequently is practicing good perineal hygiene. Text Reference - p. 1105

A 40-year-old patient with a diagnosis of uterine fibroid tumor is admitted to the hospital for a total abdominal hysterectomy with bilateral salphingo-oophorectomy. Which aspects should be included in postoperative teaching regarding resuming a satisfactory sexual relationship with her husband after recovery from surgery? 1. Explain that vaginal numbness could occur for a short period of time. 2. Emphasize that sexual activity will not be as pleasurable as before surgery. 3. Emphasize that physical healing must take place before any sexual activity. 4. Explain that estrogen replacement therapy always causes increased fluid retention.

1. Explain that vaginal numbness could occur for a short period of time. One of the effects of surgery may be vaginal numbness. This could interfere with the patient's self-image because she may feel that something is wrong with her. It is not accurate that sexual activity will not be as pleasurable as before surgery. Vaginal sexual intercourse can usually resume in 6 weeks. Oral sex and masturbation can be resumed immediately after surgery. Estrogen replacement therapy will not always cause increased fluid retention. Text Reference - p. 1113

Pelvic inflammatory disease (PID) is a major female reproductive health problem in the United States that is associated with which complication? 1. Infertility 2. Increase in unplanned pregnancy 3. Limitation of multiple sexual partners 4. Increase in sexually transmitted diseases

1. Infertility Any or all structures in the pelvic portion of the reproductive tract and the peritoneal cavity are affected as microorganisms migrate upward from the vagina. Obstruction caused by scarring and adhesions in the fallopian tubes results in infertility. PID does not cause an increase in unplanned pregnancy or a limitation of multiple sexual partners. A majority of cases are caused by sexually transmitted organisms, but this does not necessarily mean that there is an increase in sexually transmitted diseases as a result of PID.

A 40-year-old patient presents to the clinic with hot flashes, absence of menstrual period, emotional instability, and irritability. The patient also reports vaginal dryness. The nurse associates these symptoms with which condition? 1. Menopause 2. Amenorrhea 3. Menorrhagia 4. Metrorrhagia

1. Menopause Menopause may include signs and symptoms of hot flashes, cessation of menstruation, vaginal dryness, insomnia, joint pain, headaches, nausea, loss of breast firmness, sparse pubic and axillary hair, stress incontinence, emotional instability, irritability, and depression. The symptoms the woman will experience are very individualized. Amenorrhea is the absence of a period and can have other causes besides menopause. Menorrhagia and metrorrhagia are excessive bleeding.

What are the three major types of breast cancer? Select all that apply. 1. Nipple 2. Ductal 3. Lobular 4. Oat cell 5. Multicellular

1. Nipple 2. Ductal 3. Lobular Breast cancer can affect any part of the breast. Lumps can be found in the nipple, duct, or lobule. Oat cell cancer is associated with lung cancer. The term multicellular has no relevance to breast cancer.

The health care provider has ordered a pelvic examination for a patient. Which interventions is the licensed vocational nurse/licensed practical nurse (LVP/LPN) able to perform? Select all that apply. 1. Providing privacy for the patient 2. Explaining the procedure to the patient 3. Providing verbal and nonverbal support 4. Bimanual palpation of the vagina and abdomen 5. Positioning the patient in the knee-chest position for the procedure 6. Warming the speculum in water or by wrapping the packaged speculum in a heating pad

1. Providing privacy for the patient 2. Explaining the procedure to the patient 3. Providing verbal and nonverbal support 6. Warming the speculum in water or by wrapping the packaged speculum in a heating pad Privacy should be provided for a patient receiving a pelvic examination. The LPN/LVN can explain the procedure and provide verbal and nonverbal support. Warming the speculum for the examination can relieve the discomfort of the cold speculum. The nurse would need to make sure it is not too hot. The health care provider will conduct the bimanual exam. The patient is placed in the lithotomy position for a vaginal examination. Text Reference - pp. 1093-1094

Which is the drug that is most used and approved only to prevent osteoporosis? 1. Raloxifene 2. Tamoxifen 3. Toremifene 4. Norethindrone acetate

1. Raloxifene Of all the drugs listed to treat disorders of the female reproductive system raloxifene is the only drug approved only to prevent osteoporosis. Tamoxifen is used to protect against osteoporosis and is also used to treat breast cancer. Toremifene is in the same class as Tamoxifen but is not specified to protect against osteoporosis. Norethindrone acetate is used to treat a variety of female reproductive system disorders but is not specified for prevention and treatment of osteoporosis. Text Reference - p. 1101, Table 49-2

Descent of the uterus during uterine prolapse is rated in degrees. Which statement is most descriptive of second-degree uterine prolapse? 1. The cervix protrudes from the introitus. 2. The cervix is above the vaginal introitus. 3. The vagina is totally inverted with the bladder and the rectum adjacent. 4. The vagina is inverted and the cervix and body of the uterus protrude from the introitus.

1. The cervix protrudes from the introitus. During uterine prolapse, the uterus descends into the vagina from its normal position to various levels within the cervix and beyond. The levels are staged in degrees and described. In first-degree uterine prolapse, the cervix is above the vaginal introitus. Second-degree uterine prolapse occurs when the cervix protrudes from the introitus. Third-degree uterine prolapse occurs when the vagina is inverted and the cervix and body of the uterus protrude from the introitus.

The nurse educator in a gynecology clinic is explaining the menstrual cycle to a new patient. The nurse educator wants to present simple information before reviewing more details in a pamphlet she will provide to the patient. Which statements could the nurse educator use as an introduction to the menstrual cycle? Select all that apply. 1. The menstrual cycle may be affected by illness, physical activity, and stress. 2. Menstruation occurs after the fertilized ovum implants in the uterine lining. 3. Progesterone is produced on days 6 to 14 before estrogen production occurs. 4. The menstrual cycle may range from 21 to 40 days but may average 28 to 30 days. 5. The menstrual cycle begins with the onset of menstruation, which is day 1 through days 4 to 7.

1. The menstrual cycle may be affected by illness, physical activity, and stress. 4. The menstrual cycle may range from 21 to 40 days but may average 28 to 30 days. 5. The menstrual cycle begins with the onset of menstruation, which is day 1 through days 4 to 7. Several factors affect the menstrual cycle, including illness, physical activity, and stress. The menstrual cycle begins on day 1 and lasts through days 4 to 7. The cycle ranges from 21 to 40 days and may average 28 to 30 days. Menstruation does not occur after the fertilized ovum implants in the uterine lining. Estrogen is produced on days 6 to 14 before progesterone is produced. Text Reference - pp. 1089, 1092

The nurse is assisting with data collection on a patient at the clinic. The woman states she douches daily. The nurse recognizes that this is an opportunity to do patient teaching. Which information should be included in the teaching for this patient? Select all that apply. 1. The vagina has an acidic pH which is normal. 2. Douching is recommended for regular hygiene. 3. Polyester and silk underwear are recommended. 4. Irritation and allergic reactions can occur from douching agents. 5. It is possible for douching to introduce microorganisms into the uterus. 6. Washing the external genitals with plain soap and water once a day is a good practice.

1. The vagina has an acidic pH which is normal. 4. Irritation and allergic reactions can occur from douching agents. 5. It is possible for douching to introduce microorganisms into the uterus. 6. Washing the external genitals with plain soap and water once a day is a good practice. Daily douching is not recommended because it washes away the normal acidic pH. Irritation and allergic reactions can occur from douching agents related to the perfumes and chemicals added. Douching can also introduce microorganisms into the uterus. Genital hygiene teaching should include washing the external genitalia with soap and water at least once a day, keeping the genitalia area clean and dry, wearing cotton underwear to allow the skin to breathe, and not douching unless recommended by the health care provider for a procedure.

Which is the best method of contraception for a patient who has fibroid tumors? 1. Diaphragms 2. Intrauterine devices 3. Estrogen-only oral contraceptives 4. Progestin-only oral contraceptives

4. Progestin-only oral contraceptives Progestins-only oral contraceptives would not affect tumor growth. Diaphragms may be uncomfortable because of the size of the fibrous tumors. Intrauterine devices are contraindicated because of the growth of the tumors. Estrogen-only oral contraceptives may stimulate growth of the tumors.

A married couple have had unprotected sexual intercourse for the last year and have been unable to conceive. The nurse is conducting an assessment of the couple. Which factor may contribute to the couple's inability to conceive? Select all that apply. 1. Viability of sperm 2. Sperm cell count approximately 50,000 3. Patent fallopian tubes with active fimbriated ends 4. Scheduling of intercourse 72 hours after ovulation 5. Scheduling intercourse within 24 hours of ovulation 6. Biochemical compatibility between female vaginal-cervical-fallopian environment and male ejaculation

1. Viability of sperm 3. Patent fallopian tubes with active fimbriated ends 5. Scheduling intercourse within 24 hours of ovulation 6. Biochemical compatibility between female vaginal-cervical-fallopian environment and male ejaculation Factors that can enhance conception are timing and techniques used for sexual intercourse, production and release of a healthy ovum by the woman and of numerous healthy sperm by the man (approximately 20-150 million per ejaculate), anatomically and physiologically correct female and male reproductive systems, and biochemical compatibility between female vaginal-cervical-fallopian environment and male ejaculate. Scheduling intercourse after 72 hours of ovulation would decrease the couples' ability to conceive because the ovum is less viable.

A patient with diabetes reports that she has been experiencing vaginal itching and burning. She brought three different vaginal douching products to her appointment to seek advice on which one to use. The nurse knows the woman needs education on genital hygiene. What should the nurse advise? Select all that apply. 1. Wear cotton panties. 2. Douche only if the doctor or nurse prescribes douching as it is potentially dangerous. 3. Douching increases the acidic environment of the vagina and has a contraceptive benefit. 4. It is best to wash the external genitalia with plain soap and water at least once a day, keeping the genital area clean and dry. 5. Douching is an important aspect of cleansing the genitalia for patients with diabetes.

1. Wear cotton panties. 2. Douche only if the doctor or nurse prescribes douching as it is potentially dangerous. 4. It is best to wash the external genitalia with plain soap and water at least once a day, keeping the genital area clean and dry. Douching fluids contain cleansing and perfumed agents that can wash away the elements that maintain the normal acidic pH of the vagina that fights off pathogenic organisms. Douching is potentially dangerous because it may force tissue and microorganisms into the vagina; therefore the nurse needs to educate the patient on the harm that may occur with douching. Additional problems with douching include irritation and allergic reactions. Douching is not an effective contraceptive practice, nor is it recommended specifically for patients with diabetes. Text Reference - p. 1099

Which statements are correct about estrogen and/or progesterone therapy? Select all that apply. 1. Women on estrogen alone were at increased risk for stroke. 2. Women who took estrogen alone reduced the risk for uterine cancer. 3. Estrogen had been used routinely for many years to treat menopausal symptoms. 4. Short-term use of high-dose hormone therapy is appropriate for the management of menopausal symptoms. 5. The Women's Health Initiative showed that the harmful effects of estrogen and progestin therapy were greater than the benefits.

1. Women on estrogen alone were at increased risk for stroke. 3. Estrogen had been used routinely for many years to treat menopausal symptoms. 5. The Women's Health Initiative showed that the harmful effects of estrogen and progestin therapy were greater than the benefits. For many years, estrogen was routinely used after menopause to treat menopausal symptoms and to decrease the risk for cardiovascular disease and osteoporosis. Further research and study has determined that estrogen alone in treatment increases the risk for uterine cancer. Authorities now agree that for most women the benefits of long-term hormone therapy for disease prevention do not outweigh the risks. Short-term use of low-dose hormone therapy to treat menopausal symptoms is still considered appropriate.

A patient has endometriosis. The health care provider ordered danazol 800 mg PO in divided doses twice a day. The tablets are supplied in 200 mg per tablet. How many tablet(s) should the nurse administer to the patient in each dose? Record your answer using a whole number. _____ tablets

2 tablets Though there are 4 tablets total to be taken throughout the day, there should only be 2 given in each dose. 800/200 x 1 = 4 for the day, twice a day would be 4/2 = 2 tablets.

A patient has breast cancer and underwent a modified radical mastectomy and chemotherapy. One goal would be to improve body image. Which statement made by the patient would demonstrate that this goal has been met? 1. "I look so ugly, no one will want me." 2. "I am wearing my wig today; I feel sexy." 3. "Nothing I wear will improve my body image." 4. "My husband will not even look at me anymore."

2. "I am wearing my wig today; I feel sexy." Wearing her wig and feeling sexy demonstrates a positive body image. Clothing designed for women who have had mastectomies is available. It may improve the woman's body image. Expression of feeling ugly, not being wanted by anyone, or her husband not looking at her are indications of a disturbed body image. Text Reference - pp. 1122-1124

A patient presents to the clinic with complaints of abdominal pain and bloating, heavy feeling in the pelvis, unexplained and worsening back pain, gastrointestinal tract symptoms such as flatulence, and urinary tract complaints. The nurse is explaining to the patient that the health care provider will order a blood test to check for cancer markers. Which marker is the one used to identify for ovarian cancer? 1. PSA 2. CA-125 3. BRCA1 4. BRCA2

2. CA-125 Blood may be drawn to identify cancer markers. Cancer antigens are identified by markers for specific cancers. The CA125 test identifies ovarian cancer. The prostate-specific antigen (PSA) test identifies prostate cancer. BRCA1 and BRCA2 tests identify breast cancer.

Which statement is least likely to reflect characteristics of cervical cancer? 1. Cervical cancer grows slowly. 2. Cervical cancer is only treated with radical hysterectomy. 3. Having multiple sexual partners is a factor associated with cervical cancer. 4. Early cervical cancer can be detected in its early stages.

2. Cervical cancer is only treated with radical hysterectomy. Cervical cancer is treated by various methods besides radical hysterectomy. Cervical cancer does grow slowly. Having multiple sexual partners is a factor associated with cervical cancer. Early cervical cancer can be detected in its early stages.

Which drug, in the form of a patch, can be used to treat hot flashes? 1. Ergotamine/Belladonna/Phenobarbital 2. Clonidine 3. Venlafaxine 4. Gabapentin

2. Clonidine Clonidine can be given orally, transdermally, and epidurally. Bellergal-S, gabapentin, and venlafaxine are given orally. Knowing the route of delivery increases the safety of drug administration.

There are several types of diagnostic biopsies used. Which biopsy is a surgical procedure used to remove cancerous tissue? 1. Colposcopy 2. Cone biopsy 3. Cervical biopsy 4. Endometrial biopsy

2. Cone biopsy A cone biopsy is used when a large amount of cervical tissue needs to be removed, most often when removing cancerous tissue rather than diagnosing cancer. General anesthesia is necessary to ensure comfort and minimize pain during the procedure. Colposcopy, endometrial biopsy, and cervical biopsy may be used to collect smaller specimens for assessment of the endometrium, to diagnose uterine bleeding patterns, and to diagnose cancer.

The patient was diagnosed with breast cancer and underwent a radical mastectomy and received chemotherapy. Which intervention should the nurse implement in this patient's plan of care to reduce lymphedema? Select all that apply. 1. Measure the blood pressure on the affected arm. 2. Do not apply deodorant to or shave the affected arm. 3. Elevate the arm to a height above the level of the heart. 4. Frequently measure the circumference of the affected arm. 5. Use the affected arm for venipuncture, injections, or parental fluid administration. 6. Encourage the patient to use the arm for as many activities of daily living as possible.

2. Do not apply deodorant to or shave the affected arm. 3. Elevate the arm to a height above the level of the heart. 4. Frequently measure the circumference of the affected arm. 6. Encourage the patient to use the arm for as many activities of daily living as possible. Applying deodorant or shaving under the affected arm would apply pressure and may interfere with circulation. Elevating the arm increases circulation and prevents accumulation of fluids in the affected area. Frequently measuring the circumference of the affected arm would help the nurse assess for lymphedema. Movement can also increase circulation. Avoiding blood pressure checks, venipunctures, injections, and administration of parental fluids in the affected arm can minimize and prevent lymphedema in the affected area.

Preparation of the uterine lining for implantation of the fertilized ovum is stimulated by which hormone(s)? 1. Luteinizing hormone 2. Estrogen and progesterone 3. Follicle-stimulating hormone 4. Human chorionic gonadotropin

2. Estrogen and progesterone Preparation of the uterine lining for implantation of the fertilized ovum is stimulated by estrogen and progesterone from the follicle and corpus luteum. Maturation of an ovarian follicle, with subsequent rupture and release of an ovum, occurs in response to luteinizing hormone and follicle-stimulating hormone from the anterior pituitary gland. The fertilized ovum implants in the uterine lining and secretes human chorionic gonadotropin, which maintains the corpus luteum, as well as estrogen and progesterone levels, indicating that pregnancy has occurred.

A patient who had abdominal hysterectomy surgery complains of constipation. What is the most appropriate step to take first? 1. Encourage ambulation. 2. Listen to the abdomen for bowel sounds. 3. Encourage intake of high-fiber foods and increased fluids. 4. Do nothing because the patient just had surgery and it can be 4 days before a bowel movement will occur.

2. Listen to the abdomen for bowel sounds. It is necessary to assess the patient for bowel sounds or abdominal distention. Ambulation helps prevent or treat constipation, but assessment of the bowel sounds takes precedence. If bowel sounds are present, then oral intake can be enhanced with an appropriate fiber regimen and increased fluids. It is inappropriate to do nothing Text Reference - p. 1114

The patient has come into the health care provider's office to have a pelvic examination. The nurse is reviewing patient teaching on how to prevent reproductive tract infections and pelvic inflammatory disease. Which instruction should be included? Select all that apply. 1. Condom use is optional. 2. Wipe the perianal area with one front-to back swipe per tissue. 3. Avoiding intercourse during treatment for reproductive tract infection is not necessary. 4. Maintain optimum health with adequate nutrition and sleep, and good stress management. 5. Routinely inspect the sexual partner's genitalia for signs of infection before each contact for sexual intercourse. 6. Wash the hands, penis, or other object that contacts the anus with soap and water before contact with the vagina and vulva.

2. Wipe the perianal area with one front-to back swipe per tissue. 4. Maintain optimum health with adequate nutrition and sleep, and good stress management. 5. Routinely inspect the sexual partner's genitalia for signs of infection before each contact for sexual intercourse. 6. Wash the hands, penis, or other object that contacts the anus with soap and water before contact with the vagina and vulva. Condoms should be used when a partner's sexual history is unknown to prevent the spread of disease. Wiping from front to back and only one time prevents contamination with fecal matter. Maintaining optimal health builds and maintains the immune system. Intercourse should be avoided while receiving treatment for reproductive tract infections. If unable to avoid it, a condom must be used. Inspecting the sexual partner's genitalia for signs of infection before each sexual contact could prevent the spread of infection if one does not engage in intercourse when symptoms are present. Text Reference - p. 1110

A patient has been diagnosed with advanced ovarian cancer. The nurse observes interactions between the patient and family. Which statement made by the family would demonstrate ineffective coping? 1. "I can help my mom with the chores around the house." 2. "My wife could die of cancer. I need to make some plans." 3. "I am so overwhelmed, and I'll never be able to deal with this." 4. "We may need some counseling to help us deal with the diagnosis and the treatments."

3. "I am so overwhelmed, and I'll never be able to deal with this." Being overwhelmed and not being able to cope does not demonstrate effective family coping. The husband expressing his fear, the child wanting to assist with household chores, and seeking counseling are all demonstrations of seeking support or positive coping. Text Reference - p. 1128-1129

Which statement made by the patient indicates a physiologic result of a reproductive tract infection? 1. "I feel so ashamed." 2. "People will judge me now." 3. "I can be infertile due to this infection." 4. "I cannot trust my sexual partner ever again."

3. "I can be infertile due to this infection." A physical result of a reproductive tract infection could be pain, discomfort, scarring of the Fallopian tube, or infertility. Psychologic effects might be changes in relationships, feelings of distrust toward partners, shame, embarrassment, and diminished self-esteem. The nurse needs to assess which effects are going on to help the patient cope effectively Text Reference - p. 1105

The nurse on the postpartum unit is conducting a follow-up phone call with the mother and baby who were discharged 2 days ago. The nurse is assessing the woman's breastfeeding knowledge and to see how breastfeeding is going. Which statement made by the mother would need additional follow-up? 1. "I wash my hands thoroughly before I breastfeed." 2. "I try to make sure the baby's mouth is around the areola." 3. "I have pain, tenderness, warmth, and hardness in my left breast." 4. "I break the suction before removing the nipple from my baby's mouth."

3. "I have pain, tenderness, warmth, and hardness in my left breast." Pain, tenderness, warmth, and hardness in the left breast may be a sign of mastitis. The treatment would be frequent emptying of the breast, heat application, rest, and administration of an analgesic agent. The patient should wash her hands before handling her breast to remove any germs. The baby's mouth should be around the areola and not just the nipple. If the mouth is just around the nipple, it may cause cracking. Breaking the suction before removing the nipple from the baby's mouth prevents cracking. Text Reference - p. 1107

A patient is to receive tamoxifen 20 mg every day. The nurse is conducting patient education for tamoxifen. Which statement made by the nurse should be included in the patient education? Select all that apply. 1. "Avoid excessive sun exposure." 2. "Double the dose if it is missed." 3. "Pain is evidence that the drug is effective." 4. "Report severe pain to the health care provider." 5. "Monitor for weight gain, edema, and dyspnea." 6. "Use a nonhormonal barrier method of contraception during and 1 month after therapy.

3. "Pain is evidence that the drug is effective." 4. "Report severe pain to the health care provider." 5. "Monitor for weight gain, edema, and dyspnea." 6. "Use a nonhormonal barrier method of contraception during and 1 month after therapy. Pain is an indication of effectiveness and generally subsides rapidly. Severe pain is a serious adverse effect and should be reported to the health care provider. Weight gain, edema, and dyspnea are common adverse effects that need to be monitored to prevent further complications. Becoming pregnant during or shortly after discontinuing the drug can increase the risk for teratogenic effects to the fetus. Sensitivity and exposure to the sun do not produce an adverse effect. Doubling the dose if one is missed can be toxic to the patient and should be avoided.

The nurse is preparing to assist with the annual gynecological examination for a patient. In which order will the nurse assist with the examination? 1. Assisting with and chaperoning during the pelvic examination 2. Assisting with and chaperoning during the physical examination 3. Collecting information about the chief complaint and history of illness or reason for visit 4. Collecting information about the medical history including menstrual history and obstetric-gynecologic history

3. Collecting information about the chief complaint and history of illness or reason for visit 4. Collecting information about the medical history including menstrual history and obstetric-gynecologic history 2. Assisting with and chaperoning during the physical examination 1. Assisting with and chaperoning during the pelvic examination The first piece of information the nurse would need to know is why the patient is being seen or why the patient made the appointment. This opens the information process for the patient to describe why he or she is there and gives direction to the nurse for further questioning. The medical history may provide information leading to the existing reason for the visit and should be investigated before assisting with the physical and pelvic examinations.

The LPN is caring for a patient who is being treated with micronized progesterone. The patient tells the nurse that she is concerned about her occasional episodes of vaginal bleeding that seem to occur for no reason. Which is the LPN's priority response? 1. Document the information in the chart. 2. Notify the pharmacist of this information. 3. Notify the health care provider of this information. 4. Ask the health care provider to order an antianxiety drug.

3. Notify the health care provider of this information. The nurse would notify the health care provider because the medication is contraindicated when undiagnosed vaginal bleeding is present. After the health care provider has been notified, the information should be documented in the patient's chart. The pharmacist should also be notified. Although the patient may require an antianxiety drug at some point, notifying the health care provider of the vaginal bleeding is the most important intervention. Text Reference - p. 1100, Table 49-2

Which organism is most associated with mastitis? 1. Candida albicans 2. Mycoplasma hominis 3. Staphylococcus aureus 4. Chlamydia trachomatis

3. Staphylococcus aureus Staphylococcus aureus is the organism identified as the cause of mastitis. Candida albicans is the organism identified as a cause of vaginitis. Mycoplasma hominis and Chlamydia trachomatis are sexually transmitted organisms most associated with pelvic inflammatory infection.

A patient who had a total abdominal hysterectomy complains of feeling a need to urinate but is unable to. The intravenous infusion has been discontinued and the catheter removed. The patient is taking oral fluids. Which is the best way to assist this patient to empty her bladder? 1. Administer prescribed opioid analgesic medication. 2. Assist the patient to sit on the bed pan until able to empty the bladder. 3. Ask the health care provider for an order to insert an indwelling catheter. 4. Assist the patient to assume a comfortable position on the commode in a private location.

4. Assist the patient to assume a comfortable position on the commode in a private location. The patient may not be able to void due to temporary sensory or motor impairment. Assistive measures may be employed to help the patient relax and void on her own. Opioid medications do not assist in bladder emptying. Sitting on the bedpan until able to void is not helpful. An indwelling catheter should only be inserted if the patient is unable to void a sufficient amount of urine on her own. Text Reference - p. 1114

A patient presents to the clinic complaining of sudden, severe genital pain. Upon assessment, unilateral swelling of the labia is visualized. This is most likely an abscess in which part of the female genitalia? 1. Uterus 2. Vagina 3. Ovaries 4. Bartholin glands

4. Bartholin glands The term vulva refers to the external female genitalia, which make up the mons pubis, labia majora, labia minora, clitoris, and pudendum. In addition, mucus-secreting glands are also included in the vulva. Bartholin glands are located on both sides of the posterior edge of the vaginal opening, and Skene glands are located just inside the urethral opening. An abscess in one of the Bartholin glands would lead to unilateral labial swelling and sudden, severe pain. The uterus, vagina, and ovaries are considered internal genitalia, and an abscess in any of these structures would not result in external swelling and pain. Text Reference - p. 1106

A patient is complaining of perineal pain, feels likes she has a fever, and is having a noticeable vaginal discharge. During the vaginal exam performed by the health care provider, the patient complained of extreme pain in the vaginal area. Which condition would be most related to the patient's symptoms and findings upon vaginal exam? 1. Vulvitis 2. Vaginitis 3. Candida albicans yeast Infection 4. Bartholin's gland abscess (bartholinitis)

4. Bartholin's gland abscess (bartholinitis) The Bartholin's glands are located on the side of the vaginal opening and are very vulnerable to infection. The pain associated with the abscess is the reason most patients seek treatment, although other symptoms can occur. Vulvitis and vaginitis are inflammatory reactions caused by various irritants, although they can be caused by infection. Candida albicans is the organism responsible for the Candida yeast infection. Text Reference - p. 1106

The school nurse is teaching a class about the menstrual cycle. The student demonstrates understanding of the menstrual cycle by saying that what is shed at the beginning of the menstrual cycle? 1. Cervix 2. Fundus 3. Myometrium 4. Endometrium

4. Endometrium The endometrium is the inner lining of the uterus and is shed at the beginning of the menstrual cycle. The cervix is the lower segment of the uterus. The fundus is the upper segment of the uterine body. The myometrium is the middle, muscular layer of the uterus, which plays a role in contractions during the labor and birth processes. Text Reference - p. 1089

The nurse is caring for a patient undergoing artificial insemination in a fertility clinic. The nurse knows that fertilization takes place in which part of the body? 1. Uterus 2. Vagina 3. Ovaries 4. Fallopian tubes

4. Fallopian tubes Fertilization, the union of sperm and ovum, takes place in the fallopian tubes. Implantation of the embryo occurs in the uterus. Birth occurs when the fetus is expelled from the vagina. The unfertilized egg is released from the ovaries. Text Reference - p. 1089

The nurse is gathering information on a new patient at an obstetrician/gynecologist office and documents diet history and health maintenance information under which category? 1. Family history 2. Review of systems 3. Physical examination 4. Functional assessment

4. Functional assessment The functional assessment includes diet history and health maintenance information. The patient's diet history and health maintenance information are not included in the family history, review of systems, or physical examination.

The health care provider informs a patient that her uterus is tilted backward with the cervix pointed downward toward the anterior vaginal wall. The nurse knows to provide additional education on which position of the uterus? 1. Anteflexion 2. Anteversion 3. Retroflexion 4. Retroversion

4. Retroversion Retroversion is a backward tilt of the uterus with the cervix pointed downward toward the anterior vaginal wall. With anteflexion, the uterus bends forward as if folding on itself. With anteversion, the entire uterus tilts forward at a sharp angle to the vagina. With retroflexion, the body of the uterus bends backward on itself. Text Reference - p. 1119

A patient seeking care at a family planning clinic has been diagnosed with cervicitis. The nurse knows that cervicitis is most often due to which factor? 1. Pregnancy 2. Sexual abuse 3. Chemical trauma 4. Sexually transmitted infections (STIs)

4. Sexually transmitted infections (STIs) Cervicitis is inflammation of the cervix; it may be acute or chronic. Cervicitis is not associated with pregnancy. Although cervicitis is usually the result of an infectious process associated with an STI, the inflammation may be associated with physical or chemical trauma.