OB Exam 6 Practice Questions

A woman calls the clinic to report that she has had some cramping and spotting since the insertion of her IUD three days ago. Which instruction would be most appropriate? "You'll have to change your method of birth control." "Come to the clinic as soon as possible." "Take your blood pressure daily for the rest of the month." "Consider this normal, because your IUD is newly inserted."

"Consider this normal, because your IUD is newly inserted." A woman may notice some spotting or uterine cramping the first 2 or 3 weeks after IUD insertion. Ibuprofen, a prostaglandin inhibitor, is helpful in relieving the pain.

The nurse is providing care to a female client and spouse who has completed several rounds of unsuccessful in vitro fertilization. The client still desires to have a child. Which response by the nurse is appropriate? "It would be wise for you and your spouse to consider life without children." "Have you and your spouse considered using a surrogate mother?" "I recommend you continue trying in vitro fertilization if you desire to have a child." "Can you tell me more about your desire to have children?"

"Have you and your spouse considered using a surrogate mother?"

Which statement would be most appropriate when explaining endometriosis as a cause of a woman's infertility? "Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum." "Menstrual sloughing does not occur, so there is never a new base for embryo growth." "You do not ovulate because of endometrial implants on the ovaries." "Your uterine cervix fails to close because it is engorged with tissue."

"Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum." With endometriosis, endometrial tissue migrates into the fallopian tubes and peritoneum or other sites outside of the uterus. Ovulation occurs, but the egg may be trapped by the misplaced tissue.

A 52-year-old client reports to the nurse the recent onset of hot flashes, fatigue, and vaginal dryness. Which response by the nurse is most appropriate? "Tell me what you are currently doing to manage these symptoms?" "I will schedule you an appointment with your gynecologist." "I will request you have your calcium level checked today." "Is this causing any issues between you and your partner?"

"Tell me what you are currently doing to manage these symptoms?" The client is exhibiting signs of perimenopause, which is managed by treating the symptoms. The nurse first needs to know what, if anything, the client is doing to manage the symptoms. The nurse would then make recommendations for the client to manage symptoms. Once the client provides information on current treatment options, the nurse may determine if there are concerns with the client's sexual relationship. There is no need for the client to be referred to a specialist to treat perimenopausal symptoms, because the client is having expected symptoms. Osteoporosis can occur in clients during menopause. A bone mineral density (BMD) test, however, is the primary test used to identify osteoporosis, not calcium levels.

A nurse is reviewing the medical record of a client who has come to the clinic for an evaluation and reproductive life planning with oral contraceptives. Which information, if found on the client's medical record, would alert the nurse to a possible contraindication for oral contraceptive pills (OCPs)? Select all that apply. 31 years of age sertraline 50mg daily history of migraine headaches with an aura diabetic retinopathy history of deep vein thrombosis

-history of migraine headaches with an aura -diabetic retinopathy -history of deep vein thrombosis The nurse is correct to review the client's medical record when initiating a new plan of care. Contraindications to the use of oral contraceptive pills include age of 35 or older, smoking 15 or more cigarettes per day, history of deep vein thrombosis, history of migraine headaches with aura, and diabetic retinopathy. There is no drug interaction between oral contraceptives and antidepressants such as sertraline.

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. ovulation monitoring fertility drugs tubal patency in vitro fertilization counseling semen analysis

-ovulation monitoring -tubal patency -semen analysis Today, a subfertility investigation usually is limited to three assessments: semen analysis, ovulation monitoring, and tubal patency.

Which of the following would a provider diagnose with infertility? A. A 37-year-old woman trying to get pregnant for 7 months B. A 24-year-old woman trying to get pregnant for 11 months C. A 30-year-old woman trying to get pregnant for 6 months D. None of the above

A. A 37-year-old woman trying to get pregnant for 7 months Infertility is diagnosed after one year of well-timed intercourse for women under 35 years old. Infertility is diagnosed after 6 months for women over 35

The nurse counsels a patient recently diagnosed with PCOS. Which of the following should be included in the patient education. A. The need to use reliable birth control B. The importance of annual testing for STIs C. Lifestyle behaviors to manage urinary incontinence D. self-care measures for secondary dysmenorrhea

A. The need to use reliable birth control

A nurse is preparing a presentation for a local community women's group about menopause. When descfribing the body system changes that occur, the nurse would include which changes? Select all that apply. A. Hot flashes B. Increased abdominal fat C. Moist, supple skin D. Vaginal dryness E. decreased bone density F. Decreased waist size

A. hot flashes B. Increased abdominal fat D. Vaginal dryness E. Decreased bone density

What contraceptive am I? Packaged together in groups of 21 or 28 Swallow one per day, at the same time each day Contains hormones Need a prescription from your health provider

Birth control pills

Which of the following statements is false? A. Risks for pelvic prolapse include obesity and having a baby B. Symptoms include vaginal pressure and pelvic pain C. Treatment is indicated when a woman experiences distressing syndromes D. Treatment always involves surgery

D. Treatment always involves surgery Treatment often involves the use of pessaries to help support pelvic organs

A 56-year old patient who experienced menopause 4 years ago calls the clinic regarding uterine bleeding.The nurse expects the provider to evaluate the patient for: A. Ovarian cancer B. Abnormal cervical cells C. Perimenopausal symptoms D. Uterine cancer

D. Uterine cancer After menopause, vaginal bleeding is indicative of uterine cancer

What contraceptive am I? These can be used after penis-vagina sex if you suspect a chance of pregnancy Use as soon as possible after sex; up to 5 days after These are hard on your stomach, so only use as a last option and gets lots of rest You don't need a prescription, and can buy these at many pharmacies or get them at a Community Health Centre

Emergency contraceptive

What contraceptive am I? Usually made of thin latex Fits over the penis and keeps sperm from entering the uterus Can usually get them at community health centers, online, or at many pharmacies

External condom

A young woman has just received an IUD. The nurse is doing post procedural teaching and discusses the importance of the patient reporting which of the following as possible complications of the IUD? Select all that apply. A. Fever B. Unusual bleeding C. Leg cramping D. A missing IUD string E. Late period

Fever Unusual bleeding Missing IUD string Late period

What contraceptive am I? A small device that is placed into the uterus Can be hormone-based or copper-based Lasts between 3 and 5 years Must be inserted by a health care provider, and may be expensive

IUD

What contraceptive am I? Need one dose every three months Contains hormones A health care provider must inject this into your hip, so you usually need to make an appointment each time

Injection

What contraceptive am I? Usually made of thin latex Insert into the vagina up to 4 hours before penis-vagina sex Creates a barrier so the sperm can't get into the uterus Can usually get them at a community health center or online. Some pharmacies carry them

Internal condom

Care for the patient w/ endometriosis includes several factors. What is one aspect of care for a woman w/ endometriosis? Explain that this is "just part of being a woman." Assist client with decision about birth control options. Provide information on likely outcomes of treatment options. Explain to client that if she got pregnant her pain would stop.

Provide information on likely outcomes of treatment options.

The nurse is developing a presentation about urinary incontinence for a local women's group. Which of the following would the nurse be least likely to include in the discussion? Urinary incontinence can be treated. Urinary incontinence is a normal part of aging. Urinary incontinence can be prevented. Urinary incontinence can often be cured.

Urinary incontinence is a normal part of aging. Urinary incontinence is not considered a normal and expected part of aging. It is preventable, treatable, and often curable.

When describing polycystic ovary syndrome (PCOS) to a client, which areas would the nurse need to address? Select all that apply. follicular hyperplasia anovulation hyperinsulinemia elevated androgen levels decreased levels of luteinizing hormones

anovulation hyperinsulinemia elevated androgen levels Polycystic ovary syndrome (PCOS) is associated with obesity, hyperinsulinemia, elevated luteinizing hormone levels, elevated androgen levels, hirsutism, follicular atresia, ovarian growth and cyst formation, anovulation, and amenorrhea.

A client is diagnosed with an enterocele. The nurse interprets this condition as: descent of the uterus through the pelvic floor into the vagina. bulging of the small intestine through the posterior vaginal wall. protrusion of the posterior bladder wall downward through the anterior vaginal wall. sagging of the rectum with pressure exerted against the posterior vaginal wall.

bulging of the small intestine through the posterior vaginal wall.

The nurse cares for a client who desires to use a hormone-based contraception. Which type(s) of contraception will the nurse identify as acceptable for use by this client, based on the client's chart (above)? Select all that apply. a. vaginal ring b. transdermal patch c. progestin-only pill d. combined oral contraceptive e. depot medroxyprogesterone acetate

c. progestin-only pill d. combined oral contraceptive

A client is diagnosed with uterine fibroids. When reviewing the client's health history, the nurse would identify which finding as associated with the client's condition? diarrhea upper back pain amenorrhea chronic pelvic pain

chronic pelvic pain

An obese 37-year-old woman is dx w/ uterine fibroids. The RX prescribed is GnRH. Which side effect will the RN review? menopause depression increased vaginal discharge osteoarthritis

depression GnRH is used in the RX of uterine fibroids to reduce the size of the tumors and treat the sx. Side effects: depression, migraine, bone loss, hot flashes, mood changes, and vaginal dryness.

A 67-year-old woman comes into the clinic and reports to the nurse that she has started her periods again after 15 years of menopause. After discussing the situation with her, the nurse recognizes that her symptoms are suspicious for: cervical cancer. endometrial cancer. ovarian cancer. vaginal cancer.

endometrial cancer Any episode of bright-red bleeding that occurs after menopause should be investigated. It should be regarded with suspicion for endometrial cancer

A nurse assesses and suspects vulvar cancer based on which assessment finding? vulvar itching that responds to creams fleshy, ulcerated mass on the labia majora vulvar bleeding dysuria

fleshy, ulcerated mass on the labia majora

A woman comes to the clinic for a routine checkup. After obtaining the client's history, the nurse identifies that the client is at increased risk for cervical cancer based on her history of exposure to which virus? Epstein-Barr virus human papillomavirus hepatitis cytomegalovirus

human papillomavirus

A client with severe dysmenorrhea is given a presumptive diagnosis of endometriosis. Which treatment(s) will the nurse anticipate being prescribed for this client as first-line therapy? Select all that apply. nonsteroidal anti-inflammatory drug levonorgestrel intrauterine system medroxyprogesterone injection contraceptive implant combined oral contraceptive

nonsteroidal anti-inflammatory drug combined oral contraceptive

Which nursing action is most important when caring for a sexually active female client requesting contraceptive education?

obtaining a urine specimen to determine if the client is currently pregnant

"I feel like there is a lump in my vagina. It feels like it is sometimes dragging." Which disorder does the RN suspect? urinary incontinence pelvic organ prolapse endocervical polyps uterine fibroids

pelvic organ prolapse

The nurse is preparing a teaching tool about abnormal uterine bleeding. Which condition(s) will the nurse identify as being caused by a structural problem? Select all that apply. ovarian dysfunction polyps coagulopathy hyperplasia leiomyoma

polyps hyperplasia leiomyoma

A client with polycystic ovary syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. When discussing this treatment with the client, the nurse would discuss which rationale for this therapy? improve insulin uptake restore menstrual regularity alleviate hirsutism induce ovulation

restore menstrual regularity Oral contraceptives are used as treatment for PCOS to restore menstrual irregularities and treat acne. Ovulation induction agents such as clomiphene are used to induce ovulation. Metformin is used to improve insulin uptake. Mechanical hair removal methods are used to treat hirsutism.

When assessing a client, a nurse determines that the client has a rectocele based on which finding? downward movement of the uterus through the pelvic floor and into the vagina sagging of the rectum, which pushes against or into the posterior vaginal wall protrusion of the bladder wall through the anterior vaginal wall bulging of the small intestine through the posterior vaginal wall

sagging of the rectum, which pushes against or into the posterior vaginal wall

A woman is admitted for repair of cystocele/rectocele. She has 9 children. In taking her hx, what would the RN expect? sporadic vaginal bleeding accompanied by chronic pelvic pain menstrual irregularities and hirsutism on the chin heavy leukorrhea with vulvar pruritus stress incontinence with feeling of low abdominal pressure

stress incontinence with feeling of low abdominal pressure

A client is diagnosed with stress incontinence. Which finding does the nurse expect to assess in this client? strong urge to void before an involuntary loss of urine strong urge to void before an involuntary loss of urine urine leaking with coughing, laughing, or sneezing frequent awakening at night to urinate

urine leaking with coughing, laughing, or sneezing

A pregnant client states she is interested in having a tubal ligation following the birth of her child. Which statement by the nurse is a priority at this time? "There are risks and complications associated with having this procedure." "You need to discuss other forms of birth control with your health care provider first." "A tubal ligation is an effective method for permanent sterilization in women." "Your partner needs to understand the permanence of this procedure as well."

"A tubal ligation is an effective method for permanent sterilization in women."

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching? "The primary care provider will harvest eggs from my ovary." "The primary care provider will transfer my fertilized eggs into the uterus." "The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." "I will receive fertility drugs to stimulate ovulation."

"The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." IVF is a procedure used when the woman has absent or blocked fallopian tubes, when the man has a low sperm count, or when the etiology of infertility is unknown. Oocytes are fertilized in the lab and transferred to the uterus

A patient is interested in emergency contraception due to unprotected intercourse that occurred 1 week ago. What is the best response by the nurse? A. "Emergency contraception may include a progestin intrauterine device." B. "Emergency contraception is only available after a sexual assault." C. "Emergency contraception should be taken within 72 to 120 hours to be effective." D. "A copper intrauterine device may be inserted at this time for emergency contraception."

C. "Emergency contraception should be taken within 72 to 120 hours to be effective." Emergency contraception may include medications or a copper IUD.

A couple plans to try for a baby after they get married in 3 months. Based on their situation, what method of birth control might be best for them? A. A progestin intrauterine device B. A Depo Provera injection C. Condoms D. None of the above

C. Condoms Progestin intrauterine devices are long-acting reversible contraception likely not cost effective if removed in 3 months. It may take several months for women who use Depo Provera to become fertile and therefore, not a good choice for this couple.

A group of nurses are preparing a presentation about reproductive tract polyps for a local women's group. Which information would the nurses include in the presentation? Polyps are rarely the result of an infection. Endocervical polyps are most common in women in their 50s. Cervical polyps are more common than endocervical polyps. Endocervical polyps commonly appear after menarche.

Endocervical polyps are most common in women in their 50s. Endometrial polyps are solitary, and they rarely occur in women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause. The exact cause of polyps is unknown, but they are frequently the result of infection. Cervical polyps often appear after menarche. Endocervical polyps are more common than cervical polyps and are commonly found in multiparous women ages 40 to 60.

Client is a 23 yo F experiencing upper thigh and lower back pain prior to menstruation. Client reports monthly cyclical periods of fatigue, HA, nausea, and diarrhea. The nurse in the women's health clinic reviews the chart note (above) about a client before conducting an assessment. Which nonpharmacologic recommendation(s) should the nurse make to help with this client's symptoms? Select all that apply. Exercise regularly. Apply heat to the lower abdomen. Reduce the intake of fat in the diet. Rest in bed when menses begin. Increase the intake of dairy products.

Exercise regularly. Apply heat to the lower abdomen. Reduce the intake of fat in the diet. Increase the intake of dairy products

A young newly married woman comes to the clinic and asks about ways to prevent pregnancy. When the nurse begins to talk about oral contraceptives, the client says that her religion does not allow oral contraceptives. What can the nurse recommend for this client? Condoms Transdermal patch Rhythm method intrauterine device (IUD)

Rhythm method

A client with abnormal uterine bleeding is diagnosed with small ovarian cysts. The nurse has to educate the client on the importance of routine checkups. Which assessment is most appropriate for this client's condition? Schedule an ultrasound every 3 to 6 months. Schedule periodic Papanicolaou tests. Monitor blood sugar level every 15 days. Monitor gonadotropin level every month.

Schedule an ultrasound every 3 to 6 months.

A nurse is providing medication education to a teen client who is being prescribed oral contraceptive pills (OCPs). Which of the side effects are more important for the nurse to discuss with the client? Select all that apply. Nausea Weight gain Breast tenderness Breakthrough bleeding Depression

Weight gain Breakthrough bleeding Depression When working with adolescents, the nurse must recognize their growth and developmental stage and understanding of health processes. It would be most important for the nurse to discuss with the client weight gain, breakthrough bleeding, and depression. Increased weight gain in the adolescent may cause self-image issues. Without an understanding for the potential for breakthrough bleeding, the client may become worried. With an increased chance for depression while taking OCPs, this may exacerbate depression symptoms that are already present.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? an ovulation suppressant a spermicidal suppository a diaphragm and spermicide the rhythm (calendar) method

a diaphragm and spermicide Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.

The nurse is assessing the laboratory test results of a client with abnormal uterine bleeding (AUB). Which finding should the nurse prioritize? negative pregnancy test serum cholesterol of 140 mg/dl (3.63 mmol/L) hemoglobin level of 10.1 g/dl (101 g/L) prothrombin time of 40 seconds

hemoglobin level of 10.1 g/dl (101 g/L) A negative pregnancy test, prothrombin time of 40 seconds, and a serum cholesterol level of 140 mg/dl (3.63 mmol/L) are within normal parameters.

A 58-year-old client comes to the clinic for evaluation. After obtaining the client's history, the nurse suspects endometrial cancer. Which information would lead the nurse to this suspicion? use of oral contraceptives between ages 18 and 25 menopause occurring at age 46 onset of painless, bright red postmenopausal bleeding use of intrauterine device for 3 years

onset of painless, bright red postmenopausal bleeding

A nurse is reading a journal article about female reproductive cancers. Which malignancy would the nurse expect to be described as a "silent killer"? ovarian cancer endometrial cancer vaginal cancer cervical cancer

ovarian cancer Ovarian cancer has been described as the "overlooked disease" or "silent killer" because women and/or health care practitioners often ignore or rationalize early symptoms. It is typically diagnosed in advanced stages.

The nurse is caring for an older adult female client diagnosed with an anterior uterine prolapse. For which conservative treatment(s) will the nurse plan teaching for this client? Select all that apply. hysterectomy pelvic floor exercises nonsteroidal anti-inflammatory drugs uterus suspension surgery vaginal pessary

pelvic floor exercises vaginal pessary Treatment is indicated when the client experiences obstructed urination resulting from a urethra kinked from an anterior wall prolapse. Conservative treatment for an anterior uterine prolapse includes a vaginal pessary and pelvic floor physical therapy

A 46-year-old female client develops irregular menstruation, vaginal dryness, and disturbed sleep. About which condition should the nurse provide teaching to the client? perimenopause dysmenorrhea endometriosis menopause

perimenopause Perimenopause is characterized by menstrual irregularities, endocrine changes, and the onset of symptoms commonly associated with menopause, including hot flashes, vaginal dryness, disturbed sleep, and mood symptoms. Menopause is achieved when a female has not menstruated for a full 12 months in the absence of any other reason. Endometriosis is associated with pelvic or abdominal pain and infertility. Dysmenorrhea is lower abdominal or pelvic pain associated with menstruation.

A patient came to the clinic to evaluate for an ovarian cyst. Which test would the nurse anticipate being done first? pregnancy test lipid levels chlamydia test ultrasound

pregnancy test

A client has presented to the clinic for testing to evaluate her for an ovarian cyst. Which test would the nurse anticipate being done first? lipid levels ultrasound pregnancy test chlamydia test

pregnancy test Diagnostic tests include a pregnancy test to rule out ectopic pregnancy. Typically this would be done first. Gonorrhea and chlamydia testing is warranted if an ovarian abscess is suspected. An ultrasound may be ordered to differentiate between functional or simple ovarian cysts and a solid tumor. Lipid levels may be done if polycystic ovary syndrome was suspected.

A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which disorder? Select all that apply. fecal incontinence rectocele urinary incontinence enterocele cystocele

rectocele enterocele cystocele

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find? heavy leukorrhea with vulvar pruritus menstrual irregularities and hirsutism on the chin sporadic vaginal bleeding accompanied by chronic pelvic pain stress incontinence with feeling of low abdominal pressure

stress incontinence with feeling of low abdominal pressure Cystocele and rectocele are examples of pelvic organ prolapse. Manifestations typically include stress incontinence and lower abdominal pressure or pain. Complaints of sporadic vaginal bleeding and chronic pelvic pain are associated with uterine fibroids. Leukorrhea and vulvar pruritus commonly are associated with an infection. Menstrual irregularities and hirsutism are associated with polycystic ovary syndrome (PCOS).