Chapter 27 Questions

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

ANS: A Lubricants interfere with the accuracy of the cytology report. A speculum is needed to see the cervix. A fixative agent is applied to the slide to prevent drying or disruption of the specimen. The examiner should always use standard precautions. PTS: 1 DIF: Cognitive Level: Application REF: 722

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

ANS: A Caffeine increases irritability, insomnia, anxiety, and nervousness. Alcohol aggravates depression and should be avoided. Fluid intake should not be decreased. Six smaller meals a day will help maintain glucose levels.

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

ANS: A Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. A prescribed schedule may help, but every hour is too frequent. Restricting fluids will cause bladder irritation, which exacerbates the problem. Drinking adequate fluids will not help the problem. Overdistention of the bladder will cause incontinence.

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

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

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

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

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

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

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

ANS: B Although these findings are within the normal range of presentation for breast tissue, they are not in the normal presentation for this client. The client has called to express concern; therefore, the nurse should have the client schedule an appointment for assessment and evaluation. There is no need for referral to a specialist at this time. Wearing a tight fitting bra may help provide support but does not address the physical findings and concern of the client. Repeating the self-breast exam may be required but it does not address the client's current concerns; therefore, the client should be seen by a health care provider.

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

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

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

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

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

ANS: B Loss of lubrication, with resulting discomfort in intercourse, is a symptom of estrogen deficiency. It is part of the aging process, but the use of lubrication will help relieve the symptoms. This is a normal occurrence with the aging process and does not indicate an STD. It is caused by loss of lubrication with the decrease in estrogen. Scar tissue problems would have occurred earlier.

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

ANS: B Metastasis occurs when the cancer cells spread to the vascular sites, commonly the lungs, liver, and bones. Kidney metastasis is uncommon. Metastasis to the heart and blood vessels is uncommon. The brain is one of the final areas to be reached by metastasis.

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

ANS: B Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Weight-bearing exercises have been shown to increase bone density. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D

3. Which statement by a client diagnosed with premenstrual syndrome indicates that further health teaching is needed? a. "I will not eat chips or pickles." b. "I'll eat only three meals per day." c. "Drinking alcohol makes me more depressed." d. "Coffee and chocolate can make me more irritable and nervous."

ANS: B The client should be encouraged to eat six small meals a day to decrease the risk of hypoglycemia. Less intake of salty foods helps decrease fluid retention. Alcohol consumption aggravates depression. Caffeine consumption increases irritability, insomnia, anxiety, and nervousness.

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

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

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

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

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

ANS: C Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin G is used to treat syphilis. Tetracycline is used to treat chlamydial infections. Acyclovir is used to treat herpes genitalis.

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

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

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

ANS: C The presence of genetic markers (BRCA1, BRCA2, and CHEK2) provides strong indicators of the increased risk for the development of breast cancer in males and females and ovarian cancer. It is important to obtain additional information so that a treatment plan can be developed and implemented to improve client outcomes. There is an increased likelihood that the client will develop breast or ovarian cancer, but stating that there is an increased likelihood only for the development of breast cancer in a woman fails to include that men are also at risk of developing breast cancer. At this point, surgical intervention is speculative because the presence of biomarkers does not indicate that sub-metastasis has occurred or that the cancer has even developed.

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

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

2. Which sexually transmitted disease can be cured? a. Herpes b. AIDS c. Chlamydia d. Venereal warts

ANS: C The usual treatment for chlamydial bacterial infection is doxycycline hyclate or tetracycline. Concurrent treatment of all sexual partners is needed to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the main focus. Condylomata acuminata is caused by the human papillomavirus. No treatment eradicates the virus.

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

ANS: C Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Back pain is a symptom of uterine prolapse. Constipation may be a problem with rectoceles. Involuntary loss of urine during coughing is stress incontinence and is not an emergency.

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

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

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

ANS: D Because the client is reporting mild pain, NSAIDs may provide adequate pain relief and comfort. It is recommended that tea, coffee, and/or other stimulants be limited or restricted for clients with fibrocystic breast disease. Danazol is typically used for moderate to severe pain for clients with fibrocystic breast disease because its use is associated with more serious side effects. The client reports mild pain so this would not be warranted. Tamoxifen is a selective estrogen receptor modulator (SERM) used for the treatment of breast cancers and also for moderate to severe pain in fibrocystic breast disease. The client reports mild pain, so this would not be warranted.

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

ANS: D Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. Primary dysmenorrhea is not experienced by all women. Oral contraceptives can be a treatment choice. It occurs in young nulliparous women.

7. A client states, "I'm sure that I am suffering from PMS. How can I get my doctor to take this seriously?" The nurse's best response is: a. "Men are not usually sympathetic to PMS sufferers." b. "You are probably right. You should remind your doctor of your symptoms every time you visit." c. "Since you feel certain you are right, you should just treat yourself with over-the-counter medications." d. "You should keep a daily record of the occurrence and severity of your symptoms for 3 months."

ANS: D Symptom charting for at least 3 months is necessary to make an accurate diagnosis of PMS. Suggesting lack of sympathy from men is an inaccurate statement and will not help the client with the present problem. Reminding the physician of the symptoms will not assist in making a diagnosis. Listing symptoms for 3 months will help the physician make the diagnosis better. The client should not treat herself with over-the-counter medications.

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

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

2. A woman will have screening for fecal occult blood. Choose the correct instructions. a. Do not take nonsteroidal antiinflammatory drugs (NSAIDs) for 1 week before collecting the samples. b. Eat two servings of red meat each day for 3 days before obtaining the samples. 0. Collect a small sample of stool from the first stool expelled each morning for 3 days. (1. Refrigerate the samples until they can be returned to the laboratory for testing.

a

A 45-year-old woman is having a WWE. Her last menstrual period was 2 years ago. In addition to giving the Pap test, the nurse practitioner plans to draw blood for a complete blood count (CBC), complete metabolic profile (CMP), and lipid profile. The woman asks why the lipid profile has been added to her usual annual laboratory tests. The best reply of the nurse practitioner is that: a. The risk for coronary artery disease is higher after menopause, and measures to reduce the risk may be needed. b. Excess weight after menopause may occur if the lipids are not well balanced, and diet changes may be indicated. c. High triglyceride levels reduce her risk for osteoporosis, and she can delay the bone density tests another year. d. Women often have a high cholesterol level after menopause that increases their risk for breast cancer.

a

Your friend is having hot flashes as she enters menopause. She is interested in hormone replacement therapy to improve these symptoms but is fearful of breast cancer. As a nurse, you should tell her that: a. Her physician or nurse practitioner can evaluate her risk and help her make a better decision. b. The risk of breast cancer is very low for women who are younger than 60 years when menstrual periods stop. c. Taking the estrogen with progestin will reduce the risk for estrogen-induced breast cancer. (1. The benefits of estrogen replacement therapy far outweigh any risks associated with it.

a

The recommended medication for the treatment of chlamydia would be A doxycycline. B podofilox. C acyclovir. D penicillin.

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

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

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

4. Which one of the following is correct concerning the performance of a Pap test? A The woman should not douche, use vaginal medications, or have intercourse for at least 48 hours before the test. B It should be performed once a year, beginning with the onset of puberty. C A lubricant such as petroleum jelly should be used to ease speculum insertion. D The specimen for the Pap test should be obtained after a specimen is collected to test for cervical infection.

a Pap tests are performed annually for sexually active women or by age 21, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women between the ages of 21 and 29. No lubricant other than warm water should be used because accuracy of the test can be affected. The cytologic specimen should be obtained first.

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

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

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

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

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

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

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

a The most effective prostaglandin inhibitors are nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and naproxen. To be effective, the NSAID should be taken around the clock for at least 48 to 72 hours, beginning when menstrual flow starts.

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

a,b,c To provide comfort and prevent secondary infections, keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider, keep the vulva dry; using a hair dryer on low heat is helpful, wear absorbent cotton underwear and avoid pantyhose and tight pants as much as possible, take analgesics (aspirin or acetaminophen) as directed by the health care provider, cool or tepid sitz baths may provide relief from itching, wipe vulva from front to back after urination or defecation, and then carefully wash hands.

Which risk factors would necessitate performing a bone density scan on a woman younger than 65 years? (Select all that apply.) A Family history of osteoporosis B Fall history C Active life style D Chronic steroid use E Normal levels of estrogen F Overweight

a,b,d A bone density scan should be performed on a woman younger than 65 years when there is a family history of osteoporosis, history of falls, underweight, estrogen deficiency, or chronic steroid use.

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

a,c,e,f A 55-year-old woman with a body mass index of 35 is at high risk for diabetes mellitus, hypertension, coronary artery disease, and some cancers of the breast and reproductive organs.

To relieve her menstrual cramps, a woman should be taught to take ibuprofen: a. Within 8 hours of the onset of menstruation. b. During the week before the expected onset of her period. c. Around the clock for 2 to 3 days at the onset of menstruation. d. On an empty stomach before the pain becomes severe.

c

To reduce the risk for toxic shock syndrome, women should be taught to: a. Avoid changing tampons until they are thoroughly saturated. b. Use a diaphragm with spermicidal jelly during her menstrual period. c. Wash hands thoroughly before inserting a tampon or diaphragm into the vagina. d. Limit the use of superabsorbent tampons to the times when flow is heavy.

c

1. The nurse practitioner is seeing a 58-year-old woman for her annual well-woman examination (WWE). The woman complains that "I'm getting wider with age, I guess, but I haven't gained any weight. I just have more trouble buttoning my pants and skirts now." The nurse practitioner should initially: a. Encourage the woman to develop an exercise plan that will work for her. b. Determine whether the woman's height has changed since the previous year. 0. Ask the woman whether she has any persistent gastrointestinal or chest discomfort. d. Calculate the woman's BMI and compare with her previous visit.

b

Preoperative nursing care for the woman anticipating a modified radical mastectomy for breast cancer includes teaching about: a. Restricted arm movement on the operative side for 2 weeks after surgery. b. Drainage tubes that will remove fluid that accumulates under the operative area. c. A small dressing applied to the operative site. (1. A hospital stay of 3 to 4 days.

b

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

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

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

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

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

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

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

b Acute PID is often treated with IV administration of broad-spectrum antibiotics. The IV antibiotics can be changed to oral treatment after 48 hours; total duration of antibiotic therapy should be 14 days. Although sexual behavior may well have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested.

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

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

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

b Chemotherapeutics may kill off normal cells along with the cancer cells, especially rapidly dividing cells such as those in blood cells. Therefore the woman may be more susceptible to infection during the treatment.

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

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

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

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

3. When scheduling times for women to have a pelvic examination and Papanicolaou (Pap) test, what question is important to ask the woman? A When was her last examination? B On what date will her next menstrual period start? C Does she have insurance coverage of the examination? D Does she use any type of birth control?

b Pelvic examinations should be scheduled between menstrual periods.

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

b Secondary amenorrhea is the cessation of menstruation for at least 6 months in a woman who has established a pattern of menstruation. Poor nutrition is one reason for secondary amenorrhea.

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

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

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

b Transmission occurs only through direct contact with an infected person.

2. A school nurse is teaching a group of high school seniors about gynecologic care. It is important to include instructions on A. scheduling a mammogram within the next 3 years. B vulvar self-examination. C use of contraceptives by the menopausal woman. D breast self-examination.

b Vulvar self-examinations should begin in women 18 years old and in women younger than 18 if they are sexually active. Mammograms are routinely started at the age of 45. Due to lack of evidence of clear benefit, breast self-examinations are no longer recommended. Adolescents will not benefit from information about contraceptive use by menopausal women.

6. A nurse teaching adolescents concerning care during menses should include that A only perineal pads should be used until the woman is at least 24 years old to allow closure of the cervical os. B perineal pads should be worn at night. C tampons can be used around the clock. D tampons should be replaced every 6 to 8 hours.

b When using tampons, they should be changed at least every 4 hours to prevent excessive bacterial growth. Perineal pads should be used at night during sleep, which usually exceeds 4 hours.

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

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

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

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

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

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

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

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

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

c Follicle ovarian cysts are usually asymptomatic and generally regress during the subsequent menstrual cycle. If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again.

5. The nurse is reviewing laboratory reports from several patients who had Pap tests done 3 days ago. One result stated, "high-grade squamous intraepithelial lesion." The nurse is aware that this report indicates A negative results and no follow-up is required. B a negative result but a 3-month repeat Pap test should be done. C this result has a high likelihood of becoming cancerous, and a follow-up is necessary for treatment. D the results are inconclusive and the woman should have a repeat test done in 6 months.

c High-grade squamous intraepithelial lesion was previously categorized as carcinoma in situ. These cell changes are likely to become cancerous without definitive treatment. This woman requires immediate follow-up on the results.

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

c Kegel exercises involve conscious contracting and relaxing of the pelvic muscles. To maintain pelvic muscle tone, the woman should continue Kegel exercises for the rest of her life.

A 25-year-old woman is in for her first gynecologic examination. She is in good health and has no family history of cancer or reproductive diseases. She asks the nurse if a mammogram will be performed. The nurse is aware that this woman will A need a mammogram this year, and it should be repeated every 2 years. B need a mammogram this year, and it should be repeated every 5 years. C not need a mammogram until she is 45 years old. D not need a mammogram until she is 30 years old.

c The American Cancer Society and American College of Obstetricians and Gynecologists recommends that mammograms start at the age of 45 unless the woman is at high risk for breast cancer.

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

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

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

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

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

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

. Your friend calls to tell you that she noticed a small amount of nipple retraction in her right nipple when she was showering. As a nurse, you should advise her to: a. Perform a complete breast self-examination to determine whether any lumps are present. b. Wait until 1 week after her next menstrual period and then do a breast self-examination. c. Note for 2 weeks whether there is any change in the amount of nipple retraction. d. See her primary health care provider for a professional examination.

d

3. A 25-year-old woman is being seen for her first WWE at the clinic. Her vital signs are normal, height is 64 inches, and weight is 160 lb. Select the most important area of focus that is indicated by this basic information from her initial interview. a. Number of pregnancies and their outcome, mode of delivery b. Type and quantity of food eaten on an average day c. Personal history of sexually transmitted diseases and number of partners (1. Family history of weight problems, diabetes, or heart disease

d

If a woman is taking aspirin, 81 mg daily, after a myocardial infarction, the nurse should be observant for problems related to: a. Calcium loss and fractures. b. Urinary tract infection. c. Premature loss of memory function. d. Bruising and evidence of bleeding disorders.

d

When teaching a woman to take alendronate (Fosamax), the nurse should tell her to: a. Take the tablet with a full glass of milk to prevent gastric pain. b. Take the medication at night, just before bedtime, to promote absorption. c. Reduce her intake of calcium supplements after being on the drug for 1 month. d. Remain upright for at least 30 minutes after taking the drug each morning.

d

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

d Dimpling or retraction is often associated with an underlying mass or tumor. The other choices are all expected findings.

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

d Medications such as mifepristone and methotrexate are used for early abortions. For second-trimester abortions, dilation with removal of the fetus and placenta is performed.