WOMENS HEALTH - FINALA

7. 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? A. diarrhea B. chronic pelvic pain C. amenorrhea D. upper back pain

Answer: B Rationale: Findings associated with uterine fibroids include chronic pelvic pain, constipation, dysmenorrhea, and lower back pain.

8. A client with polycystic ovarian 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? A. restore menstrual regularity B. induce ovulation C. improve insulin uptake D. alleviate hirsutism

Answer: A Rationale: 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.

2. To assist the woman in regaining control of the urinary sphincter after bladder surgery, the nurse should teach the client to perform which action? A. Perform Kegel exercises daily. B. Void every hour while awake. C. Limit the intake of fluid. D. Take a laxative every night.

Answer: A Rationale: After bladder surgery, the client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.

3. 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? A. hepatitis B. human papillomavirus C. cytomegalovirus D. Epstein-Barr virus

Answer: B Rationale: Human papillomavirus is a major causative factor for cervical cancer. Hepatitis, cytomegalovirus, and Epstein-Barr virus are not associated with the development of cervical cancer.

19. A nurse is conducting an in-service program for a group of staff nurses. After teaching the group about ovarian cysts, the nurse determines that the teaching was successful when the group identifies which type of cyst as being associated with hydatidiform mole? A. theca-lutein cyst B. corpus luteum cyst C. follicular cyst D. polycystic ovarian syndrome

Answer: A Rationale: Although rare, theca-lutein cysts, which develop from prolonged abnormally high levels of human chorionic gonadotropin, are associated with hydatiform mole, choriocarcinoma, polycystic ovarian syndrome, and clomiphene therapy. Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Follicular cysts are caused by the failure of the ovarian follicle to rupture at the time of ovulation. Both types typically require no treatment. Polycystic ovarian syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function.

6. A woman is scheduled for an anterior and posterior colporrhaphy as treatment for a cystocele. When the nurse is explaining this treatment to the client, which description would be most appropriate to include? A. "This procedure helps to tighten the vaginal wall in the front and back so that your bladder and urethra are in the proper position." B. "Your uterus will be removed through your vagina, helping to relieve the organ that is putting the pressure on your bladder." C. "This is a series of exercises that you will learn to do so that you can strengthen your bladder muscles." D. "These are plastic devices that your primary care provider will insert into your vagina to provide support to the uterus and keep it in the proper position."

Answer: A Rationale: An anterior and posterior colporrhaphy tightens the anterior and posterior vaginal wall, and the supportive tissue between the vagina and bladder is folded and sutured to bring the bladder and urethra into proper position. Removal of the uterus through the vagina refers to a vaginal hysterectomy. Exercises to strengthen the bladder muscles are called Kegel exercises. Plastic devices inserted to provide support are called pessaries.

19. The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the client's statement that she is worried that she will not be the same. Which outcome would be appropriate for this client? A. Client will verbalize positive statements about self and sexuality. B. Client will demonstrate understanding of the condition and associated treatment. C. Client will exhibit positive coping strategies related to diagnosis. D. Client will identify misconceptions related to her diagnosis.

Answer: A Rationale: An appropriate outcome for disturbed body image would be that the client verbalizes positive statements about herself and her sexuality. Demonstrating understanding of the condition and treatment and identifying misconceptions would be appropriate for a nursing diagnosis of deficient knowledge. Exhibiting positive coping strategies would be appropriate for a nursing diagnosis of anxiety.

6. A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method? A. freezing B. cutting C. burning D. irradiating

Answer: A Rationale: Cryosurgery destroys abnormal cervical tissue by freezing. Conization involves cutting out a cone-shaped section of tissue. Laser therapy destroys cervical tissue by using highenergy light to burn it off. Radiation therapy involves irradiating the tissue for destruction.

11. The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate? A. "Currently there is no reliable screening test for ovarian cancer." B. "A Papanicolaou test is almost always helpful in identifying this type of cancer." C. "There's a blood test for a marker, CA-125, that if elevated indicates cancer." D. "A genetic test for two genes, if positive, will identify the ovarian cancer."

Answer: A Rationale: Currently there are no adequate screening tests for ovarian cancer. A Papanicolaou test is used to screen for cervical cancer. The CA-125 marker may be elevated in women with ovarian cancer, but it is not specific for this cancer and may be elevated in other malignancies. Genetic testing via BRCA-1 and BRCA-2 provides information about a woman's risk but does not predict if the woman will develop cancer.

11. When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which information would the nurse include? A. care of the indwelling catheter at home B. emphasis on coughing to prevent complications C. return to usual activity level in a few days D. daily douching with dilute vinegar solution

Answer: A Rationale: Following surgery to repair a pelvic organ prolapse, the nurse would teach the woman about caring for the indwelling catheter, which will remain in place for approximately 1 week. Activities that increase intra-abdominal pressure, such as straining, sneezing, or coughing, should be avoided. The woman also should avoid heavy lifting or straining for several weeks. Pelvic rest is prescribed until the operative area is healed in 6 weeks. Douching is indicated if the woman had a pessary inserted, not surgery.

4. A nurse is conducting a presentation for a local women's group about pelvic floor disorders. Which instruction would the nurse include about preventing pelvic support disorders? A. performing Kegel isometric exercises B. consuming low-fiber diets C. using hormone replacement D. voiding every 2 hours

Answer: A Rationale: Kegel exercises are an effective preventive measure for pelvic support disorders. They may limit the progression of a mild prolapse and alleviate mild prolapse symptoms. High-fiber rather than low-fiber diets are appropriate to reduce straining associated with constipation. Hormone replacement therapy must be highly individualized and is not an appropriate option for every woman. Normal voiding patterns typically are every 3 to 5 hours. Too frequent or too infrequent voiding can lead to problems.

25. The nurse is caring for a client with polycystic ovarian syndrome (PCOS) who is receiving oral contraceptives as part of her treatment plan. The nurse teaches the client about the drug therapy and how it will help her. The nurse determines that the teaching was successful when the client states which reason for the drug? A. "It will help regulate my menstrual cycle." B. "It will help me to ovulate." C. "My body will be able to use insulin better." D. "It will help decrease my hair growth."

Answer: A Rationale: 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.

26. A client is experiencing urinary incontinence. The nurse is teaching the client measures to regain control of the urinary sphincter. The nurse determines that the teaching was effective when the client states she will perform which action? A. Perform Kegel exercises daily. B. Urinate every hour while awake. C. Limit the intake of fluids. D. Use a laxative every night.

Answer: A Rationale: The client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.

29. A client is diagnosed with urinary incontinence. The nurse teaches the client about the condition and ways to manage it. The nurse determines that the teaching was successful based on which client statement? A. "I will limit my daily fluid intake to about 1.5 liters." B. "I can continue to drink coffee, but I must avoid drinking tea." C. "I can use a feminine deodorant spray to help control the odor." D. "I should perform Kegel exercises about once a week."

Answer: A Rationale: The client with urinary incontinence must avoid drinking too much fluid, typically limiting fluid intake to about 1.5 liters/day. The client also should avoid caffeine which includes tea as well as coffee. The client should use a mild soap and water for perineal care. Feminine hygiene sprays are not indicated and can be irritating. Kegel exercises should be done at least 5 times each day.

14. When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area? A. labia majora B. labia minora C. clitoris D. prepuce

Answer: A Rationale: The diagnosis of vulvar cancer is made by biopsy of the suspicious lesion, which is most commonly found on the labia majora.

12. A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head, but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would the nurse identify as the priority? A. situational low self-esteem related to masculinization effects of the disease B. social isolation related to feelings about appearance C. risk for suicide related to effects of condition and fluctuating hormone levels D. ineffective peripheral tissue perfusion related to effects of disease on vasculature

Answer: A Rationale: The woman is verbalizing how she sees herself in light of the manifestations of PCOS. She is exhibiting a negative self-image. Therefore, the nursing diagnosis of situational low self-esteem would be a priority. There is no information about the woman's participation in social activities. Her statements do not reflect that she might hurt herself. PCOS is associated with long-term health problems, but this is not evidenced by the scenario.

16. Vulvar cancer is suspected in a client. When reviewing the client's history which report would the nurse most likely find? Select all that apply. A. dyspareunia B. persistent vulvar itching C. history of herpes simplex D. lesion on the cervix E. abnormal Papanicolaou test result

Answer: A, B, C Rationale: Leading presenting reports of women with vulvar cancer include dyspareunia, long history of pruritis, ulcers on the "outside" genitalia, vulvar swelling, vulvar bleeding, and urinary problems. In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Papanicolaou test result are not associated with vulvar cancer.

28. A client comes to the clinic for an evaluation. After assessing the client, the nurse suspects that the client may be experiencing uterine prolapse. Which findings would the nurse report when notifying the primary care provider about the suspicion? Select all that apply. A. urge to defecate B. nocturnal urinary frequency C. abdominal pressure D. low back pain on sitting E. dyspareunia

Answer: A, B, C, E Rationale: Symptoms associated with pelvic organ prolapse including urgency of defecation, diurnal and nocturnal frequency, abdominal pressure and pain, low back pain on standing for long periods and dyspareunia.

29. A nurse is conducting a class for a group of young adult women at a local women's health clinic. The nurse is describing ovarian cancer and ways to reduce the risk. The nurse determines that the teaching was successful based on which statement(s) from the group? Select all that apply. A. "We should avoid using any kind of talc near our genitals." B. "Breastfeeding is better than bottle feeding to lower our risk." C. "We should eat foods that have a higher fat content." D. "Keeping our weight fairly even and at a healthy level is important." E. "Birth control with diaphragms is better than using birth control pills."

Answer: A, B, D Rationale: Ways to reduce the risk of ovarian cancer include getting pregnant, using oral contraceptives (for 3 years or longer), breastfeeding (before the age of 30), and avoiding the use of talc and hygiene sprays on the genitals. It is also important to maintain healthy lifestyles, including maintaining a healthy weight and eating a low-fat diet.

17. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as a risk factor for this cancer? Select all that apply. A. 55 years of age B. history of breast cancer C. monogamous sexual partner D. HSV-type 2 exposure E. obesity

Answer: A, B, D, E Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HSV type 2, history of breast cancer, multiple sex partners, obesity, hypertension, and diabetes.

27. A nurse is reading a journal article about treatment options for fibroids. Which information would the nurse most likely find as a disadvantage associated with uterine artery embolization? Select all that apply. A. The procedure often causes pain. B. It can negatively affect fertility. C. The fibroids can regrow after the procedure. D. The procedure is noninvasive. E. Radiation and contrast dye are used.

Answer: A, B, E Rationale: Uterine artery embolization is frequently painful, minimally invasive, and requires the use of radiation and contrast dye. In addition, although future fertility is possible, there is a possibility of a negative effect on fertility. Fibroids can regrow after treatment with hormones, a noninvasive treatment.

23. A nurse is teaching a client how to perform Kegel exercises. Which directives would the nurse include? Select all that apply. A. "Squeeze your rectal muscles as if you are trying to avoid passing flatus." B. "Tighten your pubococcygeal muscles for a count of 10." C. "Contract and relax your pubococcygeal muscles rapidly 10 times." D. "Try bearing down for about 10 seconds for no more than 5 times." E. "Do these exercises at least 5 times every hour."

Answer: A, C Rationale: To perform Kegel exercises, the nurse would tell the client to squeeze the muscles in her rectum as if she is trying to prevent passing flatus. Then the nurse would tell the client to stop and start urinary flow to help identify the pubococcygeus muscle. Once this is accomplished, the nurse would tell the client to tighten the pubococcygeus muscle for a count of 3, and then relax it. Next the nurse would tell the woman to contract and relax the pubococcygeus muscle rapidly 10 times and try to bring up the entire pelvic floor and bear down 10 times. Finally, the nurse would tell the client to repeat these exercises at least 5 times daily.

20. 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. A. rectocele B. fecal incontinence C. cystocele D. urinary incontinence E. enterocele

Answer: A, C, E Rationale: The four most common types of pelvic or genital prolapse are cystocele, rectocele, enterocele, and uterine prolapse. Urinary and fecal incontinence along with pelvic organ and genital prolapse are classified as pelvic support disorders.

9. Which description would the nurse include when teaching a client about a scheduled colposcopy? A. "A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas." B. "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument." C. "Scrapings of tissue will be obtained and placed on slides to be examined under the microscope." D. "After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples."

Answer: B Rationale: A colposcopy is a microscopic examination of the lower genital tract using a magnifying instrument. Use of a microphone-like device over the abdomen describes an ultrasound. Obtaining tissue scrapings that are examined under a microscope describes a Papanicolaou test. Insertion of a device under anesthesia near the umbilicus describes a biopsy obtained via laparoscopy.

21. A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which procedure? A. CA-125 testing B. transvaginal ultrasound C. Papanicolaou test D. mammography

Answer: B Rationale: A transvaginal ultrasound would be used to evaluate endometrial thickness to determine if an endometrial biopsy is needed. CA-124 testing is a nonspecific blood test used as a tumor marker. A Papanicolaou test is used to screen for cervical cancer. A mammography is used to screen for breast cancer.

3. When developing the plan of care for a woman who has had an abdominal hysterectomy, the nurse would identify which action as contraindicated? A. ambulating the client B. massaging the client's legs C. applying elasticized stockings D. encouraging range-of-motion exercises

Answer: B Rationale: After an abdominal hysterectomy, massaging the client's legs would be contraindicated because the woman is at risk for venous stasis, thrombophlebitis, and thromboembolism. Ambulation, elasticized stockings, and range-of-motion exercises would be appropriate to reduce the woman's risk for thrombophlebitis.

22. A nurse is conducting a class for a local woman's group about recommendations for a Papanicolaou test. One of the participants asks, "At what age should a woman have her first test?" The nurse responds by stating that a woman should have her first Papanicolaou test at which age? A. 18 B. 21 C. 25 D. 28

Answer: B Rationale: Although professional medical organizations disagree as to the recommended frequency of screening for cervical cancer, ACOG (2018b) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history), since women younger than age 21 are at very low risk of cancer.

1. 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? A. use of oral contraceptives between ages 18 and 25 B. onset of painless, bright red postmenopausal bleeding C. menopause occurring at age 46 D. use of intrauterine device for 3 years

Answer: B Rationale: Any episode of bright red painless bleeding occurring after menopause needs to be investigated. Abnormal uterine bleeding in postmenopausal women should be regarded with suspicion. Oral contraceptive use is associated with cervical cancer. Late menopause (after age 52) is associated with endometrial cancer. Use of an intrauterine device is not associated with endometrial cancer.

13. A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which information about the cancer? A. spread to the uterine muscle wall B. found on the endometrial surface C. spread to the cervix D. invaded the bladder

Answer: B Rationale: Carcinoma in situ is found only on the endometrial surface. In stage I, the cancer has spread to the uterine muscle wall. In stage II, it has spread to the cervix. In stage IV, it has invaded the bladder mucosa with distant metastases to the lungs, liver, and bone.

17. After undergoing diagnostic testing, a woman is diagnosed with a corpus luteum cyst. The nurse anticipates that the woman will require: A. biopsy. B. no treatment. C. oral contraceptives. D. metformin.

Answer: B Rationale: Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Typically these cysts appear after ovulation and resolve without intervention. Biopsy would be indicated if a malignancy was suspected. Oral contraceptives and metformin would be used to treat polycystic ovarian syndrome.

14. After teaching a woman with pelvic organ prolapse about dietary and lifestyle measures, which statement would indicate the need for additional teaching? A. "If I wear a girdle, it will help support the muscles in the area." B. "I should take up jogging to make sure I exercise enough." C. "I will try to drink at least 64 oz of fluid each day." D. "I need to increase the amount of fiber I eat every day."

Answer: B Rationale: High-impact aerobics, jogging, or jumping repeatedly should be avoided to reduce the risk of increasing intra-abdominal pressure. Wearing a girdle or abdominal support helps to support the muscles surrounding the pelvic organs. The woman should consume at least eight 8- oz glasses of fluid daily and replace refined low-fiber foods with high-fiber foods.

15. When describing the various types of reproductive tract cancers to a local women's group, the nurse would identify which cancer as the least common type? A. vulvar B. vaginal C. endometrial D. ovarian

Answer: B Rationale: Of the cancers listed, vaginal cancer is the rarest. Only about one of every 1,100 women will develop vaginal cancer in her lifetime. Vulvar cancer represents approximately 4% of female genital cancers. Endometrial cancer is the fourth most common gynecologic malignancy in the United States and sixth most common cancer globally. It accounts for 7% of all cancers in women in the United States (one in 40 women). Ovarian cancer is the fifth most common cancer among women and the most common cause of cancer deaths for women in the United States.

5. Which finding obtained during a client history would the nurse identify as increasing a client's risk for ovarian cancer? A. multiple sexual partners B. consumption of a high-fat diet C. underweight D. grand multiparity (more than five children)

Answer: B Rationale: Risk factors for ovarian cancer include a high-fat diet, obesity, nulliparity, early menarche, late menopause, and increasing age. Having multiple sexual partners is a risk factor for cervical cancer.

25. When assessing a female client for the possibility of vulvar cancer, the nurse would most likely expect the client to report which symptoms? Select all that apply. A. abnormal vaginal bleeding B. persistent vulvar itching C. history of herpes simplex D. lesion on the cervix E. abnormal Papanicolaou test result

Answer: B, C Rationale: In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Papanicolaou test result are not associated with vulvar cancer.

20. During a routine health check-up, a young adult woman asks the nurse about ways to prevent endometrial cancer. Which actions would the nurse most likely include? Select all that apply. A. eating a high-fat diet B. having regular pelvic exams C. engaging in daily exercise D. becoming pregnant E. using estrogen contraceptives

Answer: B, C, D Rationale: Measures to prevent endometrial cancer include eating a low-fat diet, having regular pelvic exams after the age of 21, engaging in daily exercise, becoming pregnant (pregnancy serves as a protective factor), and asking the practitioner about the use of combination estrogen and progestin pills.

21. A nurse is reviewing the medical record of a client. Which finding would lead the nurse to suspect that the client is experiencing polycystic ovarian syndrome? Select all that apply. A. decreased androgen levels B. elevated blood insulin levels C. anovulation D. waist circumference of 32 inches E. triglyceride level of 175 mg/dL F. high-density lipoprotein level of 40 mg/dL

Answer: B, C, E Rationale: Polycystic ovarian syndrome is a multifaceted disorder, and central to its pathogenesis are hyperandrogenemia and hyperinsulinemia. PCOS is associated with obesity, hyperinsulinemia, elevated luteinizing hormone levels (linked to ovulation), elevated androgen levels (virilization), hirsutism (male-pattern hair growth), follicular atresia (ovarian growth failure), ovarian growth and cyst formation, anovulation (failure to ovulate), infertility, type 2 diabetes, sleep apnea, amenorrhea (absence of menstruation or irregular periods) and metabolic syndrome, which is characterized by abdominal obesity (waist circumference >35 in.), dyslipidemia (triglyceride level >150 mg/dL, high-density lipoprotein cholesterol [HDL-C] level <50 mg/dL), elevated blood pressure, a pro-inflammatory state characterized by an elevated Creactive protein level, and a prothrombotic state characterized by elevated PAI-1 and fibrinogen levels.

26. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as risk factors for this cancer? Select all that apply. A. age under 40 years B. HPV 16 exposure C. monogamous sexual partner D. hypertension E. diabetes

Answer: B, D, E Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HPV 16, multiple sex partners, hypertension, and diabetes.

30. A woman diagnosed with uterine fibroids is scheduled for a myomectomy. After reviewing this procedure with the client, the nurse determines that the client understands this procedure based on which statement? A. "This will help to reduce the size of my fibroids." B. "I will have tiny particles put in to shrink the fibroids." C. "The fibroid will be removed but new ones may grow." D. "I will not be able to have any more children."

Answer: C Rationale: A myomectomy involves removing the fibroid alone and leaves the healthy areas of the uterus intact to preserve fertility. Fertility is not jeopardized because this procedure leaves the uterine muscle walls intact. Myomectomy relieves symptoms but does not affect the underlying process; thus, fibroids grow back and further treatment will be needed in the future. Hormones are used to reduce the size of fibroids. Uterine artery embolization (UAE) is an option in which polyvinyl alcohol pellets are injected into selected blood vessels via a catheter to block circulation to the fibroid, causing it to shrink and producing symptom resolution. This procedure can affect fertility. A hysterectomy involves the removal of the uterus and loss of fertility.

15. A nurse is conducting an in-service program for a group of staff nurses working at the women's health center. After teaching the group about genital fistulas, the nurse determines that the teaching was successful when the group identifies which as a major cause of genital fistulas? A. radiation therapy B. congenital anomaly C. female genital cutting D. Bartholin's gland abscess

Answer: C Rationale: Although genital fistulas may be due to radiation therapy, congenital anomaly, or Bartholin's gland abscess, the majority of fistulas are caused by obstetric trauma and female genital cutting.

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

Answer: C Rationale: An enterocele occurs when the small intestine bulges through the posterior vaginal wall, especially when straining. A cystocele is a protrusion of the posterior bladder wall downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes against or into the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

27. A nurse is conducting an in-service program for a group of nurses about cervical cancer. The nurse determines that the teaching was successful when the group identifies which area as most commonly involved? A. internal cervical os B. junction of the cervix and fundus C. squamous-columnar junction D. external cervical os

Answer: C Rationale: Cervical cancer starts with abnormal changes in the cellular lining or surface of the cervix. Typically these changes occur in the squamous-columnar junction of the cervix. Here, cylindrical secretory epithelial cells (columnar) meet the protective flat epithelial cells (squamous) from the outer cervix and vagina in what is termed the transformation zone.

18. A nurse is assisting with the collection of a Papanicolaou test. When collecting the specimen, which action is done first? A. insertion of the speculum B. swabbing of the endocervix C. spreading of the labia D. insertion of the cytobrush

Answer: C Rationale: For a Papanicolaou test, the practitioner obtains a sample by spreading the labia; inserting the speculum; inserting the cytobrush and swabbing the endocervix; and inserting the plastic spatula and swabbing the cervix.

23. A client has an abnormal Papanicolaou test result that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which procedure? A. immediate colposcopy B. testing for human papillomavirus (HPV) C. repeat Papanicolaou test in 4 to 6 months D. cone biopsy

Answer: C Rationale: For the classification of ASC-US, the client would have a repeat Papanicolaou test in 4 to 6 months or be referred for a colposcopy. A referral for colposcopy with HPV testing is indicated if the results indicated ASC-H classification. An immediate colposcopy would be indicated for atypical glandular cells and adenocarcinoma in situ. A cone biopsy would be used to evaluate the lesion and may be used as treatment to remove any precancers and very early cancers.

9. When teaching a woman how to perform Kegel exercises, the client asks what muscles are being helped with these exercises. The nurse would include reference to which muscles in the response? A. gluteus B. lower abdominal C. pelvic floor D. diaphragmatic

Answer: C Rationale: Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse. They have no effect on the gluteal, lower abdominal, or diaphragmatic muscles.

12. After teaching a group of young women how to reduce their risk for ovarian cancer, the nurse determines that additional teaching is needed when the group identifies which element as a way to reduce risk? A. pregnancy B. use of oral contraceptives C. use of feminine hygiene sprays D. breastfeeding

Answer: C Rationale: Risk reduction strategies include pregnancy, use of oral contraceptives, and breastfeeding. Women should avoid using talc and hygiene sprays on the genital area.

24. The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which practice would the nurse include? A. blood pressure evaluation every 6 months B. yearly Papanicolaou test starting at age 40 C. yearly cholesterol screening starting at age 45 D. consumption of two to three glasses of red wine per day

Answer: C Rationale: Staying healthy is a major way to reduce one's risk for cancer. Cholesterol should be checked annually starting at age 45. Blood pressure should be evaluated at least every 2 years. A Papanicolaou test is recommended every 1 to 3 years for sexually active women, starting at age 21. Alcohol should be consumed in moderation (not more than one drink per day), if at all.

10. The nurse is preparing a presentation for a local women's group about methods to reduce the risk of reproductive tract cancers. Which action should the nurse include? A. blood pressure evaluation every 6 months B. yearly Papanicolaou test starting at age 40 C. condom use with every sexual encounter D. consumption of two to three glasses of red wine per day

Answer: C Rationale: Staying healthy is a major way to reduce one's risk for cancer. Current recommendations include: using a condom with every sexual encounter; having blood pressure evaluated at least every 2 years; undergo a Papanicolaou test every 1 to 3 years, if sexually active, starting at age 21; and consuming alcohol in moderation (not more than one drink per day), if at all.

16. A nurse is providing care to a female client receiving treatment for a Bartholin cyst. The client has had a small loop of plastic tubing secured in place to allow for drainage. The nurse instructs the client that she will have a follow-up appointment for removal of the plastic tubing at which time? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks

Answer: C Rationale: The follow-up visit for removal of the plastic tubing is in approximately 3 weeks. After the Word catheter is inserted, the balloon tip is inflated, and it is left in place for 4 to 6 weeks.

4. A client is scheduled to have a Papanicolaou test. After the nurse teaches the client about the Papanicolaou test, which client statement indicates successful teaching? A. "I need to douche the night before with a mild vinegar solution." B. "I will take a bath first thing that morning to make sure I'm clean." C. "I will not engage in sexual intercourse for 48 hours before the test." D. "I will get a clean urine specimen when I first wake up the morning of the test."

Answer: C Rationale: The woman should refrain from sexual intercourse for 48 hours before the test because sperm can obscure the specimen. Douching should be avoided for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Although a bath is an appropriate hygiene measure, it is not required before a Papanicolaou test. Collecting a urine specimen also is not necessary.

28. A client is scheduled to undergo a cone biopsy. When explaining this procedure to the client, the nurse understands that the specimen will be obtained from which area? A. clitoris B. uterine fundus C. transformation zone D. ovarian follicle

Answer: C Rationale: When a cone biopsy is performed, a cone-shaped section of the cervix is removed. The base of the cone is formed by the ectocervix (outer part of the cervix) and the point or apex of the cone is from the endocervical canal. The transformation zone is contained within the cone sample. A cone biopsy is not obtained from the clitoris, uterine fundus, or ovarian follicle.

8. A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis? A. transvaginal ultrasound B. colposcopy C. Papanicolaou test D. endometrial biopsy

Answer: D Rationale: An endometrial biopsy is the procedure of choice to make the diagnosis of endometrial cancer. A transvaginal ultrasound may be used to evaluate the endometrial cavity and measure the endometrial thickness to detect endometrial hyperplasia, but it does not confirm the diagnosis. Colposcopy is used to diagnose cervical cancer. A Papanicolaou test screens for abnormal cervical cells.

1. 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? A. sporadic vaginal bleeding accompanied by chronic pelvic pain B. heavy leukorrhea with vulvar pruritus C. menstrual irregularities and hirsutism on the chin D. stress incontinence with feeling of low abdominal pressure

Answer: D Rationale: 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 ovarian syndrome.

22. 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? A. Polyps are rarely the result of an infection. B. Endocervical polyps commonly appear after menarche. C. Cervical polyps are more common than endocervical polyps. D. Endocervical polyps are most common in women in their 50s.

Answer: D Rationale: 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.

24. A client is diagnosed with a leiomyoma. The client asks the nurse what this is. The nurse describes this as a: A. cyst. B. pelvic organ prolapse. C. fistula. D. fibroid.

Answer: D Rationale: Leiomyomas are also called uterine fibroids. Cysts are fluid-filled sac-like structures. A fistula is an abnormal opening. Pelvic organ prolapse is an abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.

13. After teaching a local woman's group about incontinence, the nurse determines that the teaching was successful when the group identifies which characteristic of stress incontinence? A. feeling a strong need to void B. passing a large amount of urine C. developing most often in women in their 30s D. sneezing as an initiating stimulus

Answer: D Rationale: Stress incontinence is characterized by the involuntary passage of a small amount of urine in response to an increase in intra-abdominal pressure, such as with sneezing, coughing, laughing, or physical exertion. It develops commonly in women in their 40s and 50s due to the weakening of the muscles and the ligaments in the pelvis after birth.

18. A nurse is assessing a female client and suspects that the client may have endometrial polyps based on which clinical manifestation? A. bleeding after intercourse B. vaginal discharge C. bleeding between menses D. irregular, acyclic bleeding

Answer: D Rationale: The most common clinical manifestation of endometrial polyps is irregular, acyclic uterine bleeding. Cervical and endocervical polyps are often asymptomatic, but they can produce mild symptoms such as abnormal vaginal bleeding (after intercourse or douching, between menses) or discharge.

2. A woman is to have a Papanicolaou test. When teaching the woman about this test, the nurse would emphasize which instruction to the client? A. "Refrain from sexual intercourse for 1 week before the test." B. "Wear cotton panties on the day of the test." C. "Avoid taking any medications for 24 hours." D. "Do not douche for 48 hours before the test."

Answer: D Rationale: The nurse should instruct the woman not to douche for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Sexual intercourse should be avoided for 48 hours before the test. Wearing cotton panties is unrelated to preparation for a Papanicolaou test. Medications do not need to be withheld before the test.

7. Which statement best indicates that a client has taken self-care measures to reduce her risk for cervical cancer? A. "I've really cut down on the amount of caffeine I drink every day." B. "I've thrown out all my bubble baths and just use soap and water now." C. "Every time I have sexual intercourse, I douche." D. "My partner always uses a condom when we have sexual intercourse."

Answer: D Rationale: Unprotected sexual intercourse is a risk factor for cervical cancer. Use of barrier methods of contraception such as condoms is a key measure for reducing the risk for cervical cancer. Cessation of smoking and drinking alcohol, not caffeine, also are effective measures for risk reduction. Eliminating irritants such as bubble baths is a general measure to reduce perineal irritation and urinary tract infections. Douching has no effect on risk reduction for cervical cancer.

10. A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? A. increased vaginal discharge B. urinary tract infection C. vaginitis D. vaginal ulceration

Answer: D Rationale: Use of a pessary can lead to pressure necrosis. Postmenopausal women with thin vaginal mucosa are highly susceptible to vaginal ulceration. Increased vaginal discharge, urinary tract infections, and vaginitis are possible side effects that could be seen in any woman fitted with a pessary.

30. A client is scheduled for a loop electrosurgical excision procedure (LEEP) to evaluate an abnormal Papanicolaou (Pap) test. After teaching the client about this procedure, the nurse determines that the teaching was successful based on which client statement? A. "I will have this procedure done in the outpatient surgery department." B. "I will need to get general anesthesia for this procedure." C. "I should expect the procedure to take about 1 to 2 hours." D. "I might have some mild cramping and bleeding for a few weeks."

Answer: D Rationale: With LEEP or LLETZ (large loop excision of the transformation zone), the abnormal cervical tissue is removed with a wire that is heated by an electrical current. For this procedure, a local anesthetic is used. It is performed in the health care provider's office in approximately 10 minutes. Mild cramping and bleeding may persist for several weeks after the procedure.