OB Ch. 6
13) The nurse obtains a health history from four clients. To which client should she give priority for teaching about cervical cancer prevention? A) Age 37, multiple partners B) Age 22, abstains from sexual intercourse C) Age 32, pregnant with twins D) Age 27, uses female condom
Answer: A Explanation: A) Having multiple partners increases the client's risk of contracting sexually transmitted infections, including possible exposure to human papilloma virus (HPV). Contracting HPV increases the risk of abnormal cervical cell changes and cervical cancer. B) Practicing abstinence does not increase risks of cervical cancer. C) Pregnancy of any type does not increase risks of cervical cancer. D) Use of a female condom does not increase risks of cervical cancer. Page Ref: 98
25) During a routine physical examination a female patient asks the nurse what can be done to prevent the development of breast cancer. What should the nurse review with the patient? Select all that apply. 1. Exercise regularly 2. Discuss starting tamoxifen 3. Reduce the intake of red meat 4. Maintain a normal body weight 5. Reduce the intake of dietary fat
Answer: 1, 3, 4, 5 Explanation: Actions to reduce modifiable risks for breast cancer include exercising regularly, reducing the intake of red meat, avoiding obesity, and reducing dietary fat. Women at high risk of breast cancer may choose to begin chemoprevention using tamoxifen.
23) Which of the following systems provides a uniform format and classification of terminology based on current understanding of cervical disease? A) Levonorgestrel intrauterine B) PALM-COEIN C) Bethesda D) BSE
Answer: C Explanation: A) Levonorgestrel intrauterine system is for contraception and control of excessive menstrual bleeding by suppression of endometrial growth. B) PALM-COEIN is a classification system developed for the causes of AUB. C) The Bethesda System for classifying Pap smears is a standardized method of reporting cytologic Pap smear findings and is the most widely used method in the United States. D) BSE is the acronym for breast self-examination and is not considered a system. Page Ref: 98
24) The nurse is preparing teaching materials for female clients who wish to perform breast self-examination. In which order should the nurse ensure that the teaching materials present the process of inspection? 1. Compare the breasts 2. Study the skin surface 3. Analyze for symmetry 4. Study the shape and direction 5. Look at color, thickening, edema, and venous patterns
Answer: 1, 3, 4, 5, 2 Explanation: When inspecting the breasts, the breasts should be first compared, then analyzed for symmetry. Next the shape and direction should be studied, followed by looking at color, thickening, edema, and venous pattern. Lastly, the skin surface should be studied.
28) The nurse is reviewing data collected during a health history and physical assessment and suspects that the patient could be experiencing polycystic ovarian syndrome (PCOS). What information did the nurse use to make this clinical determination? Select all that apply. 1. Body mass index 31 2. Hair loss and warm moist skin 3. Periods occur every 3 to 4 months 4. Fasting capillary blood glucose 123 mg/dL 5. Inability to become pregnant after 2 years of unprotected intercourse
Answer: 1, 3, 4, 5 Explanation: The most common clinical signs and symptoms of PCOS include obesity since half of women with PCOS are clinically obese. Irregular menses is the hallmark of PCOS. Hyperinsulinemia is associated with PCOS. The majority of women with PCOS struggle with some degree of infertility. Hair loss and warm moist skin are not manifestations of PCOS. Page Ref: 104—105
27) During an interview the nurse learns that a patient's sister was recently diagnosed with endometrial cancer. What should the nurse review to reduce the patient's risk for developing the same disease process? Select all that apply. 1. Smoking cessation 2. Maintain a normal body mass index 3. Consider birth control without estrogen 4. Limit the intake of alcohol to one drink per day 5. Increase exercise to 30 minutes most days of the week
Answer: 2, 3 Explanation: Risk factors for endometrial cancer include obesity and long-term use of unopposed estrogen. Smoking, alcohol, and limited exercise are not risk factors for the development of endometrial cancer. Page Ref: 102—103
26) A female patient is anxious about having a pelvic examination. To help reduce the patient's fears in which order should the nurse explain that the examination will be performed? 1. The speculum is inserted 2. The speculum is removed 3. The perineum is inspected 4. The rectal examination is performed 5. The healthcare provider applies gloves 6. The bimanual examination is performed
Answer: 5, 3, 1, 2, 6, 4 Explanation: For a pelvic examination, the examiner dons gloves for the procedure. Let the woman know that the examiner begins with an inspection of the external genitalia. The speculum is then inserted to allow visualization of the cervix and vaginal walls and to obtain specimens for testing. After the speculum is withdrawn the examiner performs a bimanual examination of the internal organs using the fingers of one hand inserted in the woman's vagina while the other hand presses over the woman's uterus and ovaries. The final step of the procedure is generally a rectal examination. Page Ref: 95—96
32) The nurse is caring for a female client with a history of pelvic inflammatory disease (PID) who reports having difficulty conceiving after unprotected sex for over 2 years. Which deviation from the norm does the nurse recognize is most likely the cause of the client's infertility? A) Non-patent fallopian tube B) Unfavorable cervical mucus C) Absence of ovulation D) Abnormal endometrial preparation
Answer: A Explanation: Women with a history of pelvic inflammatory disease (PID) have the risk of developing infertility. Specifically, obstruction and non-patent fallopian tubes often occur in PID and are a common source of infertility among women with the disease. Unfavorable cervical mucus, absence of ovulation, and abnormal endometrial preparation may all lead to infertility; however, these are not most common among women diagnosed with PID.
15) The client's Pap smear result is ASC-US. Which statement is the best way for the nurse to explain this ASC-US result? A) "Abnormal cells of an unknown cause." B) "Cancer has invaded the upper cervix." C) "High-grade squamous intraepithelial lesion (HSIL), which includes CIN." D) "The focus of the Pap smear is the detection of high-risk pregnancy." E) "The cervical cells are abnormal and the reason why is severe dysplasia and carcinoma in situ."
Answer: A Explanation: A) ASC-US stands for abnormal squamous cells of undetermined significance. The nurse should tell the client that these are abnormal cells of an unknown cause. Preferred management is HPV testing; if positive, refer for colposcopy; if negative, repeat HPV co-testing in 3 years. B) ASC-US does not indicate cancer. C) CIN refers to a lesion that may progress to invasive carcinoma (cancer). ASC-US does not indicate cancer. D) The focus of the Pap smear is the detection of high-grade cervical disease, especially cervical intraepithelial neoplasia (CIN). E) ASC-US stands for abnormal squamous cells of undetermined significance. The cervical cells are abnormal, but the reason why is unknown. Page Ref: 100
22) Abdominal hysterectomy is generally recommended for which condition? A) Severe endometriosis B) Removal of the ovaries C) Suspected or confirmed cancer removal D) Abnormal uterine bleeding
Answer: A Explanation: A) Abdominal hysterectomy is recommended for severe endometriosis. B) Removal of the uterus through an abdominal incision is called a total abdominal hysterectomy (TAH), and removal of both fallopian tubes and ovaries is called a bilateral salpingo-oophorectomy (BSO); when both procedures are done at the same time it is termed a TAH-BSO. C) Total abdominal hysterectomy (TAH) is preferred when cancer is suspected or confirmed because it permits easier exploration of the abdomen and pelvis to determine the degree and extent of involvement. D) Vaginal hysterectomy is generally done for pelvic relaxation, abnormal uterine bleeding, or small fibroids. Page Ref: 106
10) The 12-year-old client reports that menarche occurred 5 months ago. She has had bleeding every day this month, and is very worried. The nurse should explain that the most common cause of this bleeding is which of the following? A) Dysfunctional uterine bleeding (DUB) B) Diabetes mellitus (DM) C) Pregnancy D) Von Willebrand's disease
Answer: A Explanation: A) Adolescents often experience DUB during the first 2 years following menarche due to hypothalamic immaturity after menarche. B) Uterine bleeding is not a symptom of DM. C) Uterine bleeding is not a symptom of pregnancy. D) Although von Willebrand's disease can cause irregular uterine bleeding, it is quite rare. Page Ref: 101
17) Which client in the gynecology clinic should the nurse see first? A) 32-year-old taking gonadotropins, reporting extremity edema B) 15-year-old, no menses for past 4 months C) 18-year-old seeking information on contraception methods D) 31-year-old, taking progestins, reports increasing dyspareunia
Answer: A Explanation: A) Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of ovulation induction by gonadotropin therapy, manifested by third-spacing. This client should be seen first. B) Secondary amenorrhea can be caused by pregnancy; teen pregnancy is a high risk. This client does not take priority of care. C) Unplanned pregnancy and sexually transmitted infections can be problematic in the future, but this client exhibits no signs or symptoms of a life-threatening condition at this time and does not need to be seen first. D) Although this client might have endometriosis, dyspareunia is not a life-threatening condition. Page Ref: 113
2) A client describes breast swelling and tenderness. What piece of data would be most important for the nurse to gather initially? A) Timing of the symptoms B) Birth control method C) Method of breast self-examination D) Diet history
Answer: A Explanation: A) The breast undergoes regular cyclical changes in response to hormonal stimulation. The nurse will want to determine when the swelling and tenderness occur within the menstrual cycle. B) The birth control method can contribute to the database, but does not have priority. C) The method of BSE can contribute to the database, but does not have priority. D) Diet history can contribute to the database, but does not have priority. Page Ref: 91
5) The nurse is working with a woman who is undergoing chemotherapy for breast cancer. The client states, "First, the cancer seemed unreal. Now I feel like I can cope." What is the nurse's best response? A) "Women with breast cancer often go through several stages of adjustment." B) "Women with breast cancer cope better than their partners cope." C) "Women with breast cancer seek multiple opinions before starting treatment." D) "Women with breast cancer become angry after treatment begins."
Answer: A Explanation: A) The course of adjustment confronting the woman with cancer has been described in four phases: shock, reaction, recovery, and reorientation. The client's statement indicates shock followed by reaction. B) Partners are often the primary support person during treatment, but might also have difficulty adapting to the diagnosis. C) Some clients seek multiple opinions; some do not. D) Anger is not a stage of adjustment. Page Ref: 94
21) The client with polycystic ovarian syndrome (PCOS) has been prescribed metformin (Glucophage). The nurse tells the client that the medication will do which of the following? Select all that apply. A) "Decrease your excessive hair growth." B) "Make it easier to lose weight." C) "Increase your acne." D) "Improve your chances of pregnancy." E) "Make your menstrual periods irregular."
Answer: A, B, D Explanation: A) Polycystic ovarian syndrome (PCOS) treatment with metformin decreases hirsutism. B) Polycystic ovarian syndrome (PCOS) treatment with metformin improves weight loss success. C) Polycystic ovarian syndrome (PCOS) treatment with metformin decreases acne. D) Polycystic ovarian syndrome (PCOS) treatment with metformin increases ovulation and therefore menstrual regularity and fertility. E) Polycystic ovarian syndrome (PCOS) treatment with metformin increases ovulation and therefore menstrual regularity and fertility. Page Ref: 105
9) The 22-year-old client is scheduled for her first gynecologic examination. What can the nurse do to make the client more comfortable during this exam? Select all that apply. A) Create a trusting atmosphere. B) Show the client what the speculum looks like. C) Avoid telling the client what the exam involves. D) Ask the client why she has delayed her first Pap test this long. E) Provide a mirror for the client.
Answer: A, B, E Explanation: A) It is important to create a trusting atmosphere and incorporate practices that help the client maintain a sense of control. B) Show the client all of the equipment to be used. C) To reduce fear and improve the client's sense of control, create a trusting atmosphere by explaining everything involved in the exam. D) Asking why the client has delayed her first Pap test is being judgmental, which does not foster a therapeutic relationship. E) Provide a mirror to increase learning about anatomy and to create a trusting atmosphere. Page Ref: 95
3) A client is concerned about her risk for breast cancer. Following the initial history, the nurse identifies which of the following as a high risk factor for breast cancer? A) History of late menarche and early menopause B) Sister who has had breast cancer C) Mother with fibrocystic breast disease D) Multiparity
Answer: B Explanation: A) Early menarche combined with late menopause is a breast cancer risk. B) Family history of first-degree relative (mother, sister, or daughter) with breast cancer increases the risk of breast cancer with the number of first-degree relatives with breast cancer. C) Fibrocystic breast disease is not a breast cancer risk factor. D) Multiparity is not a breast cancer risk factor. Page Ref: 93
11) A nurse is teaching a class on the different types of uterine bleeding. The nurse explains that which of the following is one of the causes of abnormal uterine bleeding? A) Iron-deficiency anemia B) Polyps C) Heavy periods every 2 months D) Spotting between periods
Answer: B Explanation: A) Iron-deficiency anemia is a symptom of abnormal uterine bleeding, not a cause. B) A classification system has been developed for the causes of AUB using the acronym PALM-COEIN. The P stands for Polyps. C) Heavy periods every 2 months could be one of the symptoms of abnormal uterine bleeding, not a cause. D) Spotting between periods is a symptom of abnormal uterine bleeding, not a cause. Page Ref: 102
16) The nurse has presented a community education class on recommended health screenings for women. Which statement about the Pap smear by a class member indicates that additional teaching is necessary? A) "It is recommended for women 21 years of age and older." B) "It diagnoses cervical cancer." C) "Intercourse at a young age is a risk factor for an abnormal Pap smear." D) "Detects abnormal cells."
Answer: B Explanation: A) Pap smear screening is recommended for all women 21 years of age and older. B) The focus of the Pap smear is the detection of high-grade cervical disease. It does not diagnose cervical cancer. C) Several factors put a woman at high risk for an abnormal Pap: intercourse at a young age, multiple partners, history of immunotherapy, long-term combined oral contraceptive (COC) use, smoking, and previous history of dysplasia. D) The purpose of the Papanicolaou smear (Pap smear) is to screen for the presence of cellular abnormalities by obtaining a sample containing cells from the cervix and the endocervical canal. Page Ref: 98
1) The nurse receives a phone call from a 25-year-old woman experiencing breast tenderness in the week prior to her menses, with palpable breast nodularity, without nipple discharge. What is the best response by the nurse? A) "Please make an appointment at the breast cancer center as soon as possible." B) "How much salty food do you regularly consume?" C) "As long as you don't have nipple discharge, it isn't a serious condition." D) "Eliminate caffeine and chocolate from your diet."
Answer: B Explanation: A) Recommending that the client make an appointment at the breast cancer center is unnecessary and might frighten the client. B) The client is describing fibrocystic breast changes. A salt restriction with a mild diuretic taken the week before menstrual bleeding often improves the condition. C) Neither the absence nor presence of nipple discharge is an indicator of the seriousness of a breast condition. D) Research is inconclusive as to whether eliminating methylxanthines from the diet is effective at reducing the symptoms the client describes. Page Ref: 91
34) A patient with a rectocele is experiencing progressive pain and constipation. What should the nurse expect to be indicated for this patient? A) Enemas B) Surgery C) Laxatives D) Antibiotics
Answer: B Explanation: A) Surgery is often indicated for a rectocele. Enemas, laxatives, and antibiotics may help treat the symptoms but will not cure the problem.
6) The nurse interviews a 28-year-old client with a new medical diagnosis of endometriosis. Which question asked by the nurse is appropriate? Select all that apply. A) "Are you having hot flashes?" B) "Are you experiencing pain during intercourse?" C) "Is a vaginal discharge present?" D) "Are you having pain during your period?" E) "Have you noticed any skin rashes?"
Answer: B, D Explanation: A) Hot flashes are not a symptom of endometriosis. B) The primary symptoms of endometriosis include dyspareunia. C) Vaginal discharge is not a symptom of endometriosis. D) The primary symptoms of endometriosis include dysmenorrhea. E) Skin rashes are not a symptom of endometriosis. Page Ref: 103
30) During a pelvic examination, a patient is diagnosed with a Bartholin gland cyst. For which treatment should the nurse prepare this patient? Select all that apply. A) Pelvic ultrasound B) Antibiotic therapy C) Exploratory laparotomy D) Incision and drainage of the cyst E) Culture and sensitivity of the discharge
Answer: B, D, E Explanation: Treatment of a Bartholin gland cyst involves antibiotic therapy, incision and drainage of the abscess, and culture and sensitivity of the discharge. A pelvic ultrasound and exploratory laparotomy are not indicated for this health problem.
29) A patient receiving chemotherapy for breast cancer writes in a journal during the treatments and reads devotional material. Which phase of psychologic adjustment should the nurse identify that this patient is experiencing? A) Shock B) Denial C) Reaction D) Recovery
Answer: C Explanation: Reaction occurs in conjunction with the initiation of treatment. Coping mechanisms become evident during this phase, and may include things like journaling and reading devotional material. Shock generally extends from the discovery of the lump through the process of diagnosis. Denial of the reality of the illness is a common response by the woman during the periods of diagnosis and treatment. Recovery begins during convalescence following the completion of medical treatment.
35) A 38-year-old female is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH) for severe endometriosis with the removal of both ovaries. What should the nurse expect to be prescribed for this patient postoperatively? A) Corticosteroid therapy B) Mineralocorticoid therapy C) Estrogen replacement therapy D) Progesterone replacement therapy
Answer: C Explanation: Supplemental estrogen replacement therapy is recommended in a premenopausal woman having both fallopian tubes and ovaries removed. Corticosteroid and mineralocorticoid therapies are indicated for adrenal gland dysfunction. Progesterone replacement therapy is not indicated for this patient's health problem.
18) The nurse is caring for a client diagnosed with endometriosis. Which statement by the client would require a need for perhaps another treatment option? A) "I am having many hot flashes since I had the Lupron injection." B) "The pain I experience with intercourse is becoming more severe." C) "I have vaginal dryness, reduced libido, and my clitoris has become larger since taking danazol. Is this normal?" D) "I've noticed I have not had my period on a regular basis since being on the GnRH analogs."
Answer: C Explanation: A) Hot flashes are expected, and not a complication. B) Dyspareunia is a common symptom of endometriosis, and therefore is not a complication. C) Danazol is a testosterone derivative that suppresses ovulation and causes amenorrhea. It is intended for short-term therapy. Because of adverse effects, many clinicians have moved away from danazol to other treatment options. D) GnRH analogs suppress the menstrual cycle through estrogen antagonism. Page Ref: 103—104
7) A woman with polycystic ovarian syndrome (PCOS) is prescribed clomiphene citrate for the treatment of infertility. Which statement does the nurse understand is true? A) The woman has abnormal ovaries B) The woman has low prolactin levels C) The woman's pituitary gland is intact D) The woman's thyroid gland is normal
Answer: C Explanation: A) In order to qualify for treatment with clomiphene citrate, the woman must have normal ovaries. B) In order to qualify for treatment with clomiphene citrate, the woman must have normal prolactin levels. C) In order to qualify for treatment with clomiphene citrate, the woman must have an intact pituitary gland. D) A normal-functioning thyroid gland is not essential for the client who takes clomiphene citrate; therefore, this statement may not be true. Page Ref: 113
8) The nurse is teaching a client who has been diagnosed with vulvitis. Which statement by the client indicates that the nurse's instruction has not been effective? A) "I should stop having sexual intercourse." B) "Non-deodorized tampons could make this condition recur." C) "Wearing pantyhose daily will improve the problem." D) "A different brand of soap might eliminate the irritation."
Answer: C Explanation: A) Intercourse can occur, but with adequate lubrication. B) Use of deodorized and heavily scented products that come in contact with the vulva (toilet paper, soap, bubble bath, pads, tampons, etc.) can cause the inflammation. C) Vulvitis is inflammation of the vulva. Tight clothing, especially if made of synthetic fibers, can predispose women to the condition. Pantyhose should not be worn. D) Use of deodorized and heavily scented products that come in contact with the vulva (toilet paper, soap, bubble bath, pads, tampons, etc.) can cause the inflammation. Page Ref: 96, 97
14) The nurse is about to tell a client that her Pap smear result was abnormal. Which statement should the nurse include? A) "The Pap smear is used to diagnose cervical cancer." B) "A loop electrosurgical excision procedure (LEEP) is needed." C) "Colposcopy to further examine your cervix is the next step." D) "Your cervix needs to be treated with cryotherapy."
Answer: C Explanation: A) The Pap smear is a screening tool for cervical abnormalities; it is not diagnostic. B) Although LEEP (the removal of the surface tissue of the cervix) might be performed to treat cervical dysplasia or carcinoma in situ, this client has not had a diagnostic examination yet. C) Colposcopy is an examination of the cervix through a magnifying device. D) Cryotherapy, or freezing of the cervix, is one treatment option for precancerous cervical lesions. Page Ref: 100
19) The client diagnosed with endometriosis asks the nurse whether there are any long-term health risks associated with this condition. The nurse should include which statement in the client teaching about endometriosis? A) "There are no other health risks associated with endometriosis." B) "Pain with intercourse rarely occurs as a long-term problem." C) "You are at increased risk for ovarian and breast cancer." D) "Most women with this condition develop severe migraines."
Answer: C Explanation: A) There are long-term health risks associated with endometriosis. B) Dyspareunia is a common symptom of endometriosis. C) An increased risk for cancer of the ovary and breast is associated with endometriosis. D) Endometriosis is not associated with increased migraines. Page Ref: 103—104
12) The nurse walks in to find the client crying after the physician informed her of her diagnosis of human papilloma virus (HPV). Which statement by the nurse conveys an attitude of acceptance toward the client with a sexually transmitted infection? A) "Don't worry about it. In a few weeks, with treatment, the lesions will disappear." B) "You seem upset. I'll get the doctor." C) "You seem upset. Can I help answer any questions?" D) "I think you need to see a therapist."
Answer: C Explanation: A) This client needs a caring person to listen to her and convey acceptance of her. This statement does not convey this. B) The client does not need the doctor at this time. C) The nurse's attitude of acceptance and matter-of-factness conveys to the client that she is still an acceptable person who happens to have an infection. D) It is not up to the nurse to determine whether this client needs a therapist. Page Ref: 98
4) A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate that the teaching has been successful? Select all that apply. A) "I should perform BSE 1 week prior to the start of my period." B) "When I reach menopause, I will perform BSE every 2 months." C) "Knowing the density of my breast tissue is important." D) "I should inspect my breasts while standing with my arms down at my sides." E) "I should inspect my breasts while in a supine position with my arms at my sides."
Answer: C, D Explanation: A) BSE should be performed 1 week after the start of each menstrual period. B) BSE should be performed monthly, on the same day each month, during menopause. C) The effectiveness of BSE is determined by the woman's ability to perform the procedure correctly, by her knowledge of her own breast tissue, and by the density of her breast tissue. D) The breasts should be inspected while standing with arms at sides. E) Supine is not a correct position for BSE. Page Ref: 89—90
33) The nurse takes a telephone call from a women's health clinic patient. What information should cause the nurse to suspect that the patient is experiencing a cystocele? Select all that apply. A) Bloody urine B) Low back pain C) Onset of stress incontinence D) Feeling of fullness in the perineum E) Feels like something "fell out" of the vagina
Answer: C, D, E Explanation: Manifestations of a cystocele include symptoms of stress urinary incontinence (SUI), pelvic pressure and the perception of something "falling out" of the vagina. Hematuria and low back pain are not manifestations of a cystocele.
31) A patient is demonstrating manifestations of acute cervicitis. Which laboratory test should the nurse expect to be completed for this patient? A) Sedimentation rate B) Blood test for VDRL C) White blood cell count D) Vaginal smear for STIs
Answer: D Explanation: Acute inflammation of the cervix is usually the result of infection from Neisseria gonorrhoeae or Chlamydia trachomatis. A vaginal smear for STIs will most likely be done. Sedimentation rate, blood test for VDRL, and white blood cell count are not indicated in the diagnosis of acute cervicitis.
20) The client is undergoing lab work and ultrasound for a possible diagnosis of polycystic ovarian syndrome (PCOS). Which problem does the nurse expect to find in the client's history? A) Multiple first-trimester fetal losses B) Dyspareunia C) Vulvitis D) Oligomenorrhea
Answer: D Explanation: A) First-trimester fetal loss is not associated with polycystic ovarian syndrome (PCOS). B) Dyspareunia is not associated with polycystic ovarian syndrome (PCOS). C) Vulvitis is not associated with polycystic ovarian syndrome (PCOS). D) Irregular menses, ranging from total absence of periods (amenorrhea) to intermittent or infrequent periods (oligomenorrhea) are the hallmarks of PCOS. Page Ref: 104—105