Chapter 4: Reproductive System Concerns **

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? A) "I feel irritable and moody a week before my period is supposed to start." B) "I have lower abdominal pain beginning the third day of my menstrual period." C) "I have nausea and headaches after my period starts, and they last 2 to 3 days." D) "I have abdominal bloating and breast pain after a couple days of my period."

A) "I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

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

A) doxycycline. Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: A) it is most commonly caused by anovulation. B) it most often occurs in middle age. C) the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. D) the most effective medical treatment involves steroids.

A) it is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

46. Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (Select all that apply): a. Fellatio. b. Unprotected anal intercourse. c. Multiple sex partners. d. Dry kissing. e. Abstinence.

A, B, C

45. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose.

A, B, D, E

47. The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman's chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

A, D, E

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: A) it probably is the result of a hormone deficiency that can be treated with medication. B) it may be caused by stress or excessive exercise or both. C) it likely will require the client to eat less and exercise more. D) it often goes away on its own.

B) it may be caused by stress or excessive exercise or both. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: A) point out that inappropriate sexual behavior caused the infection. B) position the woman in a semi-Fowler position. 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 pelvic pain is relieved.

B) position the woman in a semi-Fowler position. Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? (Select all that apply) A) Bone loss from hypoestrogenism is not reversible. B) Side effects from the steroid danazol include masculinizing traits. C) Surgical intervention often is needed for severe or acute symptoms. D) Women without pain and who do not want to become pregnant need no treatment. E) Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

B, C, D B) Side effects from the steroid danazol include masculinizing traits, C) Surgical intervention often is needed for severe or acute symptoms and D) Women without pain and who do not want to become pregnant need no treatment. Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation.

The nurse should include which information when teaching a 15-year-old about genital tract infection prevention? (Select all that apply.) A) Wear nylon undergarments. B) Avoid tight-fitting jeans. C) Use floral scented bath salts. D) Decrease sugar intake. E) Do not douche. F) Limit time spent wearing a wet bathing suit

B, D, E, F B) Avoid tight-fitting jeans, D) Decrease sugar intake, E) Do not douche & F) Limit time spent wearing a wet bathing suit Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche.

Several noted health risks are associated with menopause. These risks include all except: A) osteoporosis. B) coronary heart disease. C) breast cancer. D) obesity.

C) Breast Cancer Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.

An effective relief measure for primary dysmenorrhea would be to: A) reduce physical activity level until menstruation ceases. B) begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C) decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D) use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

C) decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

Self-care instructions for a woman following a modified radical mastectomy would include that she: A) wears clothing with snug sleeves to support her affected arm. B) use depilatory creams instead of shaving the axilla of her affected arm. C) expect a decrease in sensation or tingling in her affected arm as her body heals. D) empty surgical drains once a day or every other day.

C) expect a decrease in sensation or tingling in her affected arm as her body heals. Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary.

3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. "I feel irritable and moody a week before my period is supposed to start." b. "I have lower abdominal pain beginning the third day of my menstrual period." c. "I have nausea and headaches after my period starts, and they last 2 to 3 days." d. "I have abdominal bloating and breast pain after a couple days of my period."

a. "I feel irritable and moody a week before my period is supposed to start."

23. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: a. Bacterial vaginosis (BV). b. Candidiasis. c. Trichomoniasis. d. Gonorrhea.

a. Bacterial vaginosis (BV)

39. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary.

a. Diuretic administration.

41. A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. b. Intraductal papilloma. c. Chronic cystic disease. d. Fibroadenoma.

a. Ductal ectasia.

4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. b. PMS. c. Primary dysmenorrhea. d. Secondary dysmenorrhea.

a. Endometriosis.

20. A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir

a. Fluconazole

25. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

a. Herpes simplex virus (HSV)-2

14. As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids.

a. It is most commonly caused by anovulation.

34. A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

a. Nausea, hot flashes, and vaginal bleeding

29. An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely.

a. Strategies to enhance condom use.

37. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the woman's side.

a. The blood pressure (BP) cuff should not be applied to the affected arm.

27. A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" Your best response is: a. "It's just a little lump on your cervix. We can freeze it off." b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." c. "HPV is a type of early human immunodeficiency virus (HIV). You will die from this." d. "You probably caught this from your current boyfriend. He should get tested for this."

b. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer."

22. Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely would include: a. Oral antiviral therapy. b. Bed rest in a semi-Fowler position. c. Antibiotic regimen continued until symptoms subside. d. Frequent pelvic examination to monitor the progress of healing.

b. Bed rest in a semi-Fowler position.

9. During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. b. Dysmenorrhea. c. Dyspareunia. d. Premenstrual syndrome (PMS).

b. Dysmenorrhea.

21. To detect human immunodeficiency virus (HIV), most laboratory tests focus on the: a. virus. b. HIV antibodies. c. CD4 counts. d. CD8 counts.

b. HIV antibodies.

28. Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

18. The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).

b. Human papillomavirus (HPV).

6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days.

b. She describes her flow as very heavy.

19. The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client-applied: a. Miconazole ointment. b. Topical podofilox 0.5% solution or gel. c. Penicillin given intramuscularly for two doses. d. Metronidazole by mouth.

b. Topical podofilox 0.5% solution or gel.

26. The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. b. 2 to 4 weeks. c. 6 to 8 weeks. d. 6 months.

c. 6 to 8 weeks.

42. Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman b. A 50-year-old woman c. A 16-year-old girl d. A 27-year-old woman

c. A 16-year-old girl

43. The drug of choice for treatment of gonorrhea is: a. Penicillin G. b. Tetracycline. c. Ceftriaxone. d. Acyclovir.

c. Ceftriaxone.

17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. b. Syphilis. c. Chlamydia. d. Candidiasis.

c. Chlamydia.

31. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Fine-needle aspiration (FNA) d. CA 15.3

c. Fine-needle aspiration (FNA)

38. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. b. Lipoma. c. Intraductal papilloma. d. Mammary duct ectasia.

c. Intraductal papilloma.

12. With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility.

c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause.

1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. b. Type 1 diabetes mellitus. c. Lack of exercise. d. Hysterectomy.

c. Lack of exercise.

44. The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles

8. A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids increase in size during the perimenopausal period. c. Menorrhagia is a common finding. d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.

c. Menorrhagia is a common finding.

15. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin.

c. Nonsteroidal antiinflammatory drugs (NSAIDs).

7. When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. b. Excessive exercise. c. Pregnancy. d. Eating disorders.

c. Pregnancy.

11. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established.

c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms.

35. After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side.

32. A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. "Do you have transportation to the teaching hospital so that you can get your mammogram?" b. "I'm concerned that you missed your appointment; let me make another one for you." c. "It's very dangerous to skip your mammograms; your breasts need to be checked." d. "Would you like me to make an appointment for you to have your mammogram here?"

d. "Would you like me to make an appointment for you to have your mammogram here?"

36. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

d. A single lump in one breast that can be expected to shrink as the woman ages.

5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness.

d. Can cause her to experience some hot flashes and vaginal dryness.

40. The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

d. Chlamydia

33. The nurse must watch for what common complications in a patient who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap? a. Axillary edema and tissue necrosis b. Delayed wound healing and muscle contractions c. Delayed wound healing and axillary edema d. Delayed wound healing and hematoma

d. Delayed wound healing and hematoma

13. One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. b. Menorrhagia. c. Leiomyoma. d. Metrorrhagia.

d. Metrorrhagia.

10. With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women. b. It is more common in leaner women who exercise strenuously. c. Symptoms can begin at any point in the ovulatory cycle. d. Pain usually occurs in the suprapubic area or lower abdomen.

d. Pain usually occurs in the suprapubic area or lower abdomen.

16. The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors.

d. Risky sexual behaviors and inadequate preventive health behaviors.

30. The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

d. The exact cause of breast cancer is unknown.

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

d. Using a heating pad on the abdomen to relieve cramping

24. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. b. Ofloxacin. c. Podophyllin. d. Zidovudine.

d. Zidovudine.