NCLEX family planning, women's health, menopause, STIs, Women's Health

A nurse is teaching a female client about the side effects of estrogen in an oral contraceptive. Which common side effect identified by the client indicates to the nurse that the teaching was effective? 1 Nausea 2 Lethargy 3 Amenorrhea 4 Hypomenorrhea

-Nausea Nausea is related to the amount of hormone in the contraceptive. There may be an excess of estrogen; this symptom usually can be controlled by reducing the dose or by changing to another oral contraceptive. Lethargy can be related to excessive estrogen and progesterone, but they are not common side effects. Amenorrhea is associated with pregnancy; breakthrough bleeding is a more common response to estrogen. Hypomenorrhea is caused by estrogen deficiency.

The nurse warns that the effectiveness of oral contraceptives is decreased in women who are taking: a. antihistamines for seasonal allergies. b. iron preparations for treatment of anemia. c. appetite suppressants for weight reduction. d. anticonvulsants for treatment of epilepsy.

ANS: D Anticonvulsants decrease the effectiveness of oral contraceptives.

At her 6-week postpartum checkup, a woman states, "I am wondering about birth control. I used oral contraceptives before, and I'm breastfeeding now. Can I use the pill again?" The nurse's best response is: a. "You should know that oral contraceptives increase your milk production." b. "Oral contraceptives can be taken once lactation is well established." c. "You don't need to use any form of birth control as long as you are breastfeeding." d. "Oral contraceptives are contraindicated for the lactating woman."

ANS: B Oral contraceptives decrease breast milk production and are contraindicated until lactation is well established. Women who breastfeed their infants usually will not ovulate for 10 weeks and do not need contraception until that time.

The nurse instructing a man considering a vasectomy should state that after a vasectomy: a. intercourse should be delayed for 6 weeks. b. sperm will still be ejaculated for a month. c. erections will be difficult to maintain. d. monthly sperm counts for a year will be necessary.

ANS: B Because sperm are distal to the severed vas deferens, sperm will be in the ejaculate for about a month. A sperm count after that period of time should be performed to confirm the absence of sperm. Intercourse does not have to be delayed, but an alternate method of contraception should be used. Erections and sexual pleasure are not affected by a vasectomy.

A thin older adult client is found to have osteoporosis. What should the nurse include in the discharge plan for this client? 1 Encouraging gradual weight gain 2 Monitoring for decreased urine calcium 3 Providing instructions relative to diet and exercise 4 Teaching about safety factors in the use of opioids and nonsteroidal antiinflammatory drugs

-Providing instructions relative to diet and exercise A diet high in calcium and exercise, which helps deposit calcium into bone, are the most important factors in limiting the extent of osteoporosis. Weight gain should be discouraged to limit stress on the client's bones. Increased, not decreased, urine calcium should be monitored because it reflects demineralization of bone. Opioids are usually not prescribed; other analgesics are used for pain

The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching? 1 "I know not to lift anything heavier than 5 lb." 2 "I'll limit my stair climbing to four times a day." 3 "I'll avoid crossing my legs at the knees when I sit." 4 "I'm glad I'll be able to get back into my jogging routine next week."

-"I'm glad I'll be able to get back into my jogging routine next week." Discharge instructions after abdominal hysterectomy includes avoiding jogging, aerobic exercise, participating in sports, and other any strenuous activity for 2 to 6 weeks after the surgery. The statement indicating that the client plans to start jogging again next week means that the client requires more teaching. Stair climbing should be limited to fewer than five times per day. Nothing heavier than 5 to 10 lb should be lifted. The client should not cross her legs at the knees when sitting. Those three statements by the client are accurate and indicate understanding of the teaching.

A female client who has been sexually active for 5 years is found to have gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective? 1 "I'll douche after each time I have sex." 2 "Having sex is a thing of the past for me." 3 "My partner has to use a condom all the time." 4 "I'll be using a spermicidal cream from now on."

-"My partner has to use a condom all the time." Although not 100% effective, a condom is the best protection against gonorrhea in a sexually active person. Douching has no proven protective effect against sexually transmitted infections; excessive douching can alter the natural environment of the vagina and may even promote an ascending infection. Although abstaining from sex is the best way to prevent a sexually transmitted infection, it is not the most realistic response for a sexually active person. Once people become sexually active, they usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy.

What instruction should a nurse include when teaching about the correct use of a female condom? 1 "Remove the condom before standing up." 2 "Insert the condom within 1 hour before intercourse." 3 "Have your partner wear a male condom at the same time." 4 "Cleanse the condom with warm water when preparing it for future use."

-"Remove the condom before standing up." Removing the condom before standing up keeps the semen in the female condom and prevents the inadvertent contact of semen with vaginal tissues. The female condom may be inserted as long as 8 hours before intercourse. Having the partner wear a male condom at the same time is unnecessary; this will increase friction that could tear the female condom. Female condoms should be used once and discarded.

While being admitted for a lumpectomy the client begins to cry and says, "I found the lump a few months ago, but I didn't go to the doctor because of what it could be." How should the nurse reply? 1 "This has been frightening for you." 2 "About 80% of breast lumps are benign." 3 "Cry as long as you like and get it out of your system." 4 "More than 95% of breast lumps are discovered by the woman herself."

-"This has been frightening for you." The correct response involves the use of reflective technique to acknowledge the client's feelings. Providing statistics does not acknowledge the client's feelings and may cut off communication. Providing false reassurance that crying will ease her concerns is inappropriate

The nurse teaches a high school sex education class that herpes genitalis infection cannot be cured but that the disease is marked by remissions and exacerbations. What else should the students be taught about this infection? 1 A healthy lifestyle will prevent exacerbations. 2 Once the infection is effectively treated, exacerbations are rare. 3 Although exacerbations occur they are not as severe as the initial episode. 4 The most effective way to prevent exacerbations is to abstain from sexual activity

-Although exacerbations occur they are not as severe as the initial episode. The initial infection is both local and systemic; exacerbations are milder and localized. Although optimum health habits may limit exacerbations, they will not prevent them. There is no treatment that will limit the number of exacerbations. Exacerbations are precipitated by physical and emotional stress, not by sexual activity.

A client at the women's health clinic complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse. For what condition does the nurse anticipate the client will be treated? 1 Urethritis 2 Bartholinitis 3 Vaginal hematoma 4 Inflamed Skene glands

-Bartholinitis The Bartholin glands are located beneath the vaginal vestibule; if cysts form and they become infected they cause labial, vaginal, or pelvic pain particularly during or after intercourse (dyspareunia). Urethritis causes painful urination. A vaginal hematoma causes swelling in the vaginal wall, not the labia. The Skene glands are located in the urethra, not the labia.

A nurse is teaching a group of women about the side effects of different types of contraceptives. What frequent side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session? 1 Tubal pregnancy 2 Rupture of the uterus 3 Expulsion of the device 4 Excessive menstrual flow

-Excessive menstrual flow After IUD insertion there may be excessive menstrual flow for several cycles. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process. There is no documentation of a tubal pregnancy. Rupture of the uterus may occur on insertion but is uncommon. Expulsion of the device may occur, but it is not classified as a side effect.

A nurse evaluates that a client who is taking oral contraceptives understands the related dietary teaching when the client states, "While I'm taking birth control pills I should increase my intake of foods containing: 1 Calcium" 2 Folic acid" 3 Vitamin A" 4 Vitamin D"

-Folic acid" Oral contraceptives are thought to cause deficiencies of folic acid, vitamin C, vitamin B6 and vitamin B12. It is unnecessary to increase calcium intake when taking oral contraceptives. There is no clinical evidence to link oral contraceptives to a deficiency of vitamin A. There is no clinical evidence to link oral contraceptives to a deficiency of vitamin D

A strict vegetarian (vegan) becomes pregnant and asks the nurse whether there is anything special she should do in regard to her diet during pregnancy. What is most the important measure for the nurse to instruct the client to take? 1 Eat at least 40 g/day of protein. 2 Drink at least 1 quart/day of milk. 3 Take a vitamin supplemented with iron every day. 4 Plan to eat from specific groups of vegetable proteins each day

-Plan to eat from specific groups of vegetable proteins each day A variety of incomplete proteins (vegetable proteins) can be combined to provide all of the essential amino acids. The pregnant client should eat at least 60 g/day of protein. Vegans do not drink milk. Taking a vitamin supplemented with iron each day is not the most important factor in diet planning; other nutrients also must be provided.

A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? 1 Estrogen therapy 2 Hypoparathyroidism 3 Prolonged immobility 4 Excessive calcium intake

-Prolonged immobility Prolonged immobility results in bone demineralization because there is decreased bone production by osteoblasts and increased resorption by osteoclasts. Estrogen helps prevent bone demineralization. Hypoparathyroidism decreases mobilization of calcium from the bones, thereby reducing the serum level of calcium. Decreased calcium intake or absorption may precipitate osteoporosis.

The nurse would tell the patient to expect what after she had an intrauterine device (IUD) inserted? a. Menstrual flow will be lighter. b. Menstrual cramps will be eliminated. c. A string should be felt in the vagina. d. The device should be changed every 2 years

ANS: C A woman should feel for the string periodically, especially after her period, to confirm the presence of the IUD.

At her regular gynecological examination, a woman tells the nurse that she is concerned about osteoporosis. The nurse could suggest to the patient to: a. take a vitamin E supplement daily. b. do isometric exercises that can be practiced every day. c. include more dairy products and green, leafy vegetables in her diet. d. try to limit her intake of caffeine. .

ANS: C Foods rich in calcium include milk, dairy products, and green, leafy vegetables.

The nurse realizes that a man considering a vasectomy needs further information if he says: a. "Sterility does not occur immediately after the procedure." b. "We will need to use some form of birth control for about a month afterward." c. "The procedure involves the use of local anesthesia." d. "I'll need to remain in the hospital for a few days."

ANS: D A vasectomy takes about 20 minutes and is performed on an outpatient basis under local anesthesia.

When a woman starts hormone replacement therapy (HRT), the nurse would instruct her to look for the side effect of: a. fatigue. b. headache. c. weight loss. d. amenorrhea.

ANS: B Patients initiating HRT are reminded to have regular follow-up care and report headaches, vision changes, and symptoms of thrombophlebitis or cardiac symptoms.

A nurse in a campus health clinic is assessing female students for risk factors associated with the future development of osteoporosis. What factors are included in this assessment? Select all that apply. 1 Cigarette smoking 2 Moderate exercise 3 Use of street drugs 4 Familial predisposition 5 Inadequate intake of dietary calcium

-1,4,5 Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. Moderate exercise is not considered a risk factor for the development of osteoporosis, although a sedentary lifestyle is. Use of street drugs is not considered a risk factor for osteoporosis.

A 21-year-old college student has come to see the nurse practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva, and vaginal discharge has a cottage cheese appearance. These findings are consistent with: a. candidiasis. b. trichomoniasis. c. bacterial vaginosis. d. Chlamydia.

ANS: A The signs and symptoms of candidiasis include inflammation of the vagina and vulva and a cottage cheese appearance to the vaginal discharge

The nurse cautions that women with a history of which disorders are not candidates for HRT? Select all that apply. a. Melanoma b. Estrogen-dependent breast cancer c. Hepatitis C d. Thromboembolic disease e. Hyperthyroidism

ANS: A, B, C, D Persons who are absolutely restricted from HRT are those with melanoma, estrogen-dependent breast cancers, chronic liver disorders, thromboembolic disease, and seizure disorders

In the week before her menstrual period, a woman experiences irritability, anxiety, and difficulty concentrating. The nurse suggests that a remedy to relieve these symptoms is to: a. drink tea or hot chocolate before going to bed. b. take a daily folic acid and vitamin C supplement. c. include complex carbohydrates and fiber in the diet. d. avoid exercise when symptoms occur.

ANS: C A diet rich in complex carbohydrates and fiber is recommended for premenstrual dysmorphic disorder.

A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have exploratory surgery. How should the nurse respond? "What has the physician told you?" 2 "I don't know the answer to that question." 3 "I'm not allowed to give you that information." 4 "Have you talked to your wife about your concerns?"

-"Have you talked to your wife about your concerns?" The correct response protects the wife's confidentiality while fostering open communication between the couple. Asking about communication with the physician does not foster communication between the client and the client's husband. Claiming not to know the answer to the question or claiming not to be able to supply the information in question supports neither the wife nor the husband.

After a mastectomy or hysterectomy, the client may feel incomplete as a woman. Which statement causes the nurse to realize that a client may be experiencing this concern? 1 "I can't wait to see my friends." 2 "I want to go home soon to see my grandchild." 3 "I feel washed out; there isn't much left for my family." 4 "My husband arranged for me to recuperate at our daughter's home."

-"I feel washed out; there isn't much left for my family." The client's statement of feeling "washed out" connotes a feeling of emptiness and loss. Resumption of social activities indicates acceptance and a willingness to move on with life. Expressing desire to see a grandchild is a response typical of a grandparent anxious to resume life. The client is planning for rehabilitation by stating her intention to recuperate at her daughter's home, not expressing a sense of loss. Topics

A client who wishes to postpone having children until she and her husband are financially sound tells the nurse she has been taking oral contraceptive pills for several years. What finding indicates a potential risk in regard to continued use of birth control pills? 1 Dysmenorrhea 2 Lack of ovulation 3 Midcycle bleeding 4 Increased blood pressure

-Increased blood pressure The estrogen and/or progesterone in birth control pills increases the amount of renin produced in the kidneys. Increased renin will stimulate the production of angiotensin, a potent pressor substance, resulting in hypertension. Dysmenorrhea does not occur. Anovulation is the desired effect of oral contraceptives. Midcycle bleeding may indicate a low hormone level; it is corrected by changes in the type of medication prescribed.

A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. 1 Obesity 2 Multiparity 3 Cigarette smoking 4 Early onset of menopause 5 Family history of endometrial cancer 6 Previous hormone replacement therapy

-Obesity,Family history of endometrial cancer, Correct 6 Previous hormone replacement therapy. Obesity is a risk factor for endometrial cancer because adipose cells store estrogen; the extent of exposure to estrogen is the most significant risk factor. Nulliparity, not multiparity, is a risk factor for endometrial cancer because of the increased exposure to estrogen. Cigarette smoking has not been identified as a risk factor for endometrial cancer. Late, not early, onset of menopause is a risk factor for endometrial cancer because of the increased exposure to estrogen. Although endometrial cancer has not been proved to have a genetic predisposition, it is more common in families who have gene mutations for hereditary nonpolyposis colon cancer.

nurse is planning care with a client for the recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included among the changes that the client should expect after surgery? 1 Depression 2 Weight gain 3 Urine retention 4 Surgical menopause

-Surgical menopause When bilateral oophorectomy is performed, both ovaries are excised, eliminating ovarian hormones and initiating menopause. Although depression may occur, it is not expected; if it does occur, intervention is required. There is no physiological reason for weight gain after hysterectomy. Urine retention is not an expected concern because a urine retention catheter is inserted before surgery and left in place generally for 24 hours, regardless of the type of hysterectomy (e.g., laparoscopic, abdominal, vaginal).

The woman using a diaphragm correctly would tell the nurse that the diaphragm: a. does not require the use of a spermicidal cream or jelly with it. b. should be left in place for at least 6 hours after intercourse. c. is removed immediately after intercourse for douching. d. is effective for up to 48 hours if positioned properly.

ANS: B To act as a barrier, the diaphragm must be left in place for at least 6 hours after intercourse and can be left in place up to 24 hours.

During an assessment interview the nurse concludes that the client has been experiencing menorrhagia. What client statement led to this conclusion? 1 "It hurts when I have intercourse." 2 "I have a foul-smelling vaginal discharge." 3 "I have bleeding between my menstrual periods." 4 "I have severe bleeding during my menstrual periods."

-"I have severe bleeding during my menstrual periods." Menorrhagia is severe bleeding during a menstrual period. Painful intercourse is the definition of dyspareunia. Foul-smelling vaginal discharge is a sign of a vaginal infection. Metrorrhagia is uterine bleeding that occurs at any time other than during the menstrual period.

A nurse assesses a 35-year-old multiparous client who is scheduled for a tubal ligation to determine her emotional response to the planned procedure. What factor in the client's history will contribute most to the healthy resolution of any emotional problem associated with sterilization? 1 Belief that surgery will relieve her monthly dysmenorrheal 2 Knowledge that her partner does not want to have any more children 3 Feeling that her family is complete and she now has the children that were planned 4 Recovery from her previous complicated birth and does not want to experience another birth

- Feeling that her family is complete and she now has the children that were planned Many couples in their 30s who feel that their families are complete choose sterilization as their method of contraception. Sterilization by means of tubal ligation should have no effect on dysmenorrhea. The decision for sterilization should not be made by others, only by the woman herself. Decisions regarding sterilization should not be made when the client is under stress

A client with active genital herpes has a cesarean birth. The nurse teaches the mother how to limit transmission of the virus to her newborn. The nurse concludes that the instructions have been understood when the mother states: 1 "I should avoid kissing the baby on the lips." 2 "I have to wear gloves when I'm holding the baby." 3 "I should wash my clothes and my baby's clothes separately." 4 "I have to wash my hands with soap and water before handling the baby."

-"I have to wash my hands with soap and water before handling the baby." The herpes virus disintegrates rapidly on contact with soap used in meticulous handwashing. The lesion is in the genital area, not on the lips; kissing will not affect the infant. Wearing gloves when holding the infant is unnecessary; nor is washing the infant's clothes separately.

A nurse is counseling an obese postmenopausal client how to prevent bone loss. Which statements indicate understanding of the strategies to prevent bone loss? Select all that apply. 1 "I need to go on a strict diet." 2 "I'll take 400 mg of vitamin D every day." 3 "I should take 1200 mg of calcium every day." 4 "Swimming or bike riding five times a week is good for me." 5 "Going to an aerobics class three times a week will help my bones."

-"I should take 1200 mg of calcium every day.Going to an aerobics class three times a week will help my bones." The recommended daily intake of calcium for a postmenopausal woman is 1200 mg. Weight-bearing activities (e.g., walking, dancing, weightlifting, aerobic exercise) are best for building bone mass.Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. Eight hundred or more (up to 2,000), international units, not 400, of vitamin D are the recommended daily intake for a postmenopausal woman. Swimming and bike riding promote overall health and joint preservation but do not increase the strength or mass of bone.

A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond? 1 "It covers the entrance to the cervical os." 2 "The openings to the fallopian tubes are blocked." 3 "The sperm are kept from reaching the vagina." 4 "It produces a spermicidal intrauterine environment."

-"It produces a spermicidal intrauterine environment." Intrauterine devices produce a spermicidal intrauterine environment. A copper IUD (ParaGard T380A) inflames the endometrium, damaging or killing sperm and preventing fertilization and/or implantation; a Mirena IUD (LNG-IUS) releases levonorgestrel, damaging sperm and causing the endometrium to atrophy, thus preventing fertilization and/implantation. A diaphragm blocks the cervical os. The IUD does not act by blocking the openings to the fallopian tubes.Preventing sperm from reaching the vagina is the function of a condom.

A 45-year-old client is to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. What is the nurse's most appropriate response? 1 "You're right, but there are medicines you can take that will ease the symptoms." 2 "Sometimes that happens in women of your age, but you don't need to worry about it right now." 3 "You should probably talk to your surgeon, because I am not allowed to discuss this with you." 4 "Women may experience symptoms of menopause if their ovaries are removed with their uterus."

-"Women may experience symptoms of menopause if their ovaries are removed with their uterus. A hysterectomy involves only removal of the uterus. The ovaries, which secrete estrogen and progesterone, are not removed. Therefore menopause will not be precipitated but will occur naturally. Surgical menopause is precipitated by the removal of the ovaries, not the uterus. When the ovaries are removed, an older woman might have less severe symptoms than a younger woman; however, in this instance the ovaries are not removed. Telling the client that she needs to talk to her surgeon does not answer the question. The nurse should serve as a resource.

A woman visits the clinic for an annual physical examination, and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. How should the nurse reply? 1 "There's a sore in your vagina." 2 "There's a rash near your vagina." 3 "You have a typical discharge from your vagina." 4 "You have blisters on the skin around your vagina."

-"You have blisters on the skin around your vagina." Herpes genitalis is characterized by a cluster of vesicles, not one lesion or a rash or vaginal discharge. The characteristic sign of herpes genitalis is a cluster of vesicles (blisters) on the vulva, perineum, vagina, cervix, and/or perianal area. These rupture spontaneously, leaving painful erosions.

A young woman has been using oral contraceptives. When she misses her regular menstrual period, she visits the women's health clinic and tells the nurse that she may be pregnant because she missed taking her contraceptive pills for 1 week when she had the flu. How should the nurse respond? 1 "It's too late to worry about that now. You may want to consider having an abortion." 2 "Contraceptive pills are unpredictable. You probably would've become pregnant even if you had taken them regularly." 3 "You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective." 4 "That's the trouble with birth control pills. They're so effective that women tend to believe that they won't get pregnant even if they skip pills for a few days."

-"You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective." Monophasic, biphasic, and triphasic oral contraceptives are available; regardless of the type that is prescribed, the regimen should be followed exactly. Interruption in the schedule permits release of luteinizing hormone, resulting in ovulation and possible pregnancy. Telling the client that it is too late to worry about that now is callous, and giving advice is inappropriate; all options may be explored after a pregnancy has been confirmed. When taken as prescribed, oral contraceptives have a high rate of success. Stating that women tend to believe that they won't become pregnant even if the pills are skipped for a few days is judgmental; it is a generalization about women who take the pills and indicates that the nurse assumes that the client is similarly irresponsible.

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response? Select all that apply. 1 Expulsion of the device 2 Occasional dyspareunia 3 Delay of return to fertility 4 Risk for perforation of the uterus 5 Increased number of vaginal infections

-1,2,4 The presence of the IUD thread should be verified before coitus, because the device may be expelled during menses; if the IUD has been expelled, pregnancy can occur. Although dyspareunia is not common, if it does occur, it should be reported. Perforation may occur during insertion of the IUD. The IUD does not affect fertility, as does the oral contraceptive. Immediately after the device is removed the client may try to conceive. The incidence of vaginal infections is not increased with the use of an IUD unless there is unprotected sex with a partner who has a sexually transmitted infection.

Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. What does the nurse need to assess when a vaginal infection is suspected? Select all that apply. 1 Abdominal pain 2 Urinary frequency 3 Rising temperature 4 Decreased pulse rate 5 Decreased blood pressure

-1,3 A pelvic infection is suspected. One characteristic of this disorder is abdominal pain. A rising temperature is a sign of infection. Urinary frequency is associated with cystitis, not a pelvic infection. Increases, not decreases, in pulse rate and blood pressure are expected because the metabolic rate increases in the presence of an increased temperature.

The nurse is teaching a sex education course to high school students. What should the nurse teach them about why gonorrhea is difficult to control? Select all that apply. 1 Symptoms of the disease are vague. 2 Screening blood tests are expensive. 3 The incubation period is relatively short. 4 Causative organisms have become resistant to treatment. 5 Diagnostic tests for the causative organism are not yet available.

-1,3,4 Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains; at times backup secondary medications must be used. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.

Which client is most at risk for osteoporosis? 1 A nonsmoking 60-year-old woman, 5 foot 7 inches tall and 173 lb 2 A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal 3 A 68-year-old black woman, 5 foot 5 and 140 lb, who is a retired receptionist 4 A 62-year-old woman, 5 foot 4 inches tall and 135 lb, who takes calcium carbonate daily

-A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal A postmenopausal woman who is small-boned, thin, and relatively sedentary is at risk for osteoporosis; other risk factors are family history, and white or Asian ethnicity. The postmenopausal years are considered to be 65 years and older; however, each individual is unique. A perimenopausal woman who is relatively heavy and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. The perimenopausal years are considered to be 45 to 64 years of age; however, each individual is unique. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A perimenopausal woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.

The clinic nurse is planning care for a client found to have Chlamydia. Which treatment should the nurse plan to implement? 1 Administration of acyclovir (Zovirax) 250 mg orally in a single dose 2 Administration of azithromycin (Zithromax) 1 g orally in a single dose 3 Administration of ceftriaxone (Rocephin) 250 mg intramuscularly in a single dose 4 Administration of Benzathine penicillin G 2.4 million units intramuscularly in a single dose

-Administration of azithromycin (Zithromax) 1 g orally in a single dose The treatment of choice for chlamydial infection is azithromycin (Zithromax) 1 g orally in a single dose. The one-dose course is preferred because of its ease of completion. Acyclovir (Zovirax) may be prescribed in a 7-day course for a genital herpes outbreak. Ceftriaxone (Rocephin) 250 mg intramuscularly in a single dose is the drug therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million unit dose is the treatment for primary, secondary, and early latent syphilis.

Which client care activity may a nurse safely delegate to a nursing assistant? 1 Assessing a client's mastectomy incision for signs of inflammation 2 Assisting a client who is recovering from an abdominal hysterectomy to the bathroom 3 Providing information about side effects to a client receiving chemotherapy for breast cancer 4 Evaluating the effectiveness of an antiemetic that was administered to a client to relieve nausea

-Assisting a client who is recovering from an abdominal hysterectomy to the bathroom A nursing assistant is taught how to safely ambulate clients; this activity does not require extensive nursing knowledge or expert clinical judgment. Assessment, teaching, and evaluation of client responses to care all require clinical judgment and a license to practice nursing.

A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a "fishy" odor that both she and her husband have noticed. A wet smear is performed and the presence of "clue cells" confirmed. Which type of infection does the nurse suspect? 1 Candidiasis 2 Trichomoniasis 3 Bacterial vaginosis 4 Group B Streptococcus

-Bacterial vaginosis Signs of bacterial vaginosis include a milky gray vaginal discharge that has a characteristic fishy odor. "Clue cells" noted on wet smear are indicative of BV. Candidiasis is a yeast infection caused by the organism Candida albicans. The most common symptom of a yeast infection is vulvar and vaginal pruritus. Vaginal discharge in a candidal infection is thick, white, and lumpy. A woman with a trichomoniasis infection may present with a frothy yellowish-green vaginal discharge. Vulvar irritation, pruritus, and dyspareunia are usually present. Group B Streptococcus may be considered part of the normal vaginal flora in a woman who is not pregnant, and no treatment is necessary.

A nurse is reviewing a postmenopausal client's history, which reveals that the client previously received hormonal replacement therapy (HRT) as treatment for osteoporosis. For which problem does HRT increase the client's risk? 1 Breast cancer 2 Rapid weight loss 3 Accelerated bone loss 4 Vaginal tissue atrophy

-Breast cancer There is a relationship between HRT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HRT is weight gain with ankle and foot edema. Bone loss is retarded with HRT. Vaginal tissue maintains turgor and lubrication with HRT.

A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate (Depo-Provera) as a form of birth control. What important information should the nurse include when teaching the client about Depo-Provera? 1 Depo-Provera offers protection against the herpes simplex virus. 2 To continue the contraceptive effects the client will need to return for another injection in 6 months. 3 Women using Depo-Provera may lose more blood each month with their periods, so it is important to add iron-rich foods to the diet to help prevent anemia. 4 Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use

-Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use Loss of bone mineral density is a significant side effect of Depo-Provera, and increased calcium intake and exercise should be encouraged. Depo-Provera should be administered every 11 to 13 weeks; 6 months is too long before the next dose. Menstrual periods usually lighten or disappear over time. Depo-Provera confers no protection against herpes simplex virus.

A school nurse is teaching high school girls about the importance of immunizations. What newborn anomaly can occur if rubella is contracted during the first trimester of pregnancy? 1 Phocomelia 2 Hydrocephalus 3 Down syndrome 4 Cardiac anomalies

-Cardiac anomalies Heart development occurs between the second and eighth weeks of gestation; any type of maternal infection during this time may result in cardiac anomalies in the newborn. The congenital absence of the proximal portion of a limb is associated with the intake of teratogenic drugs, not with rubella infection. Hydrocephalus is a neural tube defect that is not associated with rubella; however, the infant may have microcephaly. Down syndrome is a chromosomal disorder; it is not caused by a maternal infection.

A nurse is caring for a client with tertiary syphilis. Which body system should the nurse monitor most closely? 1 Respiratory 2 Reproductive 3 Integumentary 4 Cardiovascular

-Cardiovascular Syphilis is primarily a vascular disease; aortitis, valvular insufficiency, and aortic aneurysms are the most prevalent problems in tertiary syphilis. Although lesions may occur around the mouth (chancre in primary syphilis, mucous patches in secondary syphilis), the structures of the respiratory tract are not the major structures involved in tertiary syphilis. Although lesions occur on the genitalia in primary and secondary syphilis, the reproductive system is not the major body system affected by tertiary syphilis. A gumma skin lesion is the least commonly occurring lesion associated with tertiary syphilis; skin lesions, such as macular and papular eruptions, most commonly occur in secondary syphilis.

What should the nurse teach a client about performing breast self-examination? 1 Compress the nipples to check for discharge. 2 Use the right hand to examine the right breast. 3 Press the palm against the breast to compress it to the chest wall. 4 Place a pillow under the shoulder opposite the side being examined.

-Compress the nipples to check for discharge. Serous or bloody discharge from the nipple is abnormal. The right hand should be used to examine the left breast because this allows the flattened fingers to palpate the entire breast, including the tail (upper outer quadrant toward the axilla) and axillary area. A small pillow or a rolled towel should be placed under the scapula of the side that is being examined. The flat part of the fingers, not the palm or fingertips, should be used for palpation.

A nurse is counseling a female client with type 1 diabetes who requests contraceptive information. What contraceptive method should the nurse recommend? 1 Oral contraceptive 2 Hormone replacement 3 Calendar/rhythm method 4 Diaphragm with spermicide

-Diaphragm with spermicide Diaphragm with spermicide is the preferred method for clients with diabetes because there are no physiologic side effects. Oral contraceptives have a diabetogenic effect; they alter carbohydrate metabolism, and insulin dosage must be adjusted. Calendar/rhythm method requires self-control and a strong desire to avoid pregnancy; it is not as effective as a diaphragm.

A woman visits the clinic because she has dysmenorrhea. What goal should the nurse identify for this client? 1 Reducing the pad saturation rate 2 Making intercourse less uncomfortable 3 Easing the pain of the client's menstruation 4 Eliminating bleeding between menstrual periods

-Easing the pain of the client's menstruation Dysmenorrhea is painful menstruation; the goal of care is making menstruation less painful. The other options are appropriate for a client who is experiencing excessive menstrual flow (menorrhagia) or dyspareunia (painful intercourse).

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes? 1 Uterine cancer 2 Lack of estrogen 3 Early cervical carcinoma 4 Expected menopausal changes

-Expected menopausal changes The adaptations described and the client's age suggest that the client is experiencing menopause. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.

When discussing future health management with a client who has had a total hysterectomy, the nurse advises regular physical examinations. The client agrees and adds, "It won't be so hard to go now that I won't need the pelvic examination and Pap smear." How should the nurse respond? 1 Discuss the need to have pelvic examinations and Pap smears until healing is complete. 2 Suggest that the client discuss the need for future pelvic examinations with her practitioner. 3 Agree that other components of the physical examination will be more important in the future. 4 Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future

-Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future Pelvic examinations and Pap smears will always be necessary to screen for atypical changes in vaginal tissue and will always remain a priority for this client. Suggesting that the client talk with her practitioner transfers the nurse's responsibility for client teaching to the practitioner.

After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse? 1 Avoid regular use of tampons. 2 Decrease intake of prune juice. 3 Increase daily fluid consumption. 4 Cleanse the perineum from back to front.

-Increase daily fluid consumption. Increasing fluid intake flushes the urinary tract of microorganisms. Tampons do not increase the risk of cystitis. Fluids should be increased, not decreased; prune juice promotes acidic urine, which is desirable because it discourages the growth of microorganisms. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do? 1 Ask her partner to withdraw before ejaculating. 2 Make certain their relationship is monogamous. 3 Insist that her partner use a condom when having sex. 4 Seek counseling about various contraceptive methods

-Insist that her partner use a condom when having sex A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Pre-ejaculatory fluid carries HIV in an infected individual. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV-positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from the HIV.

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1 Obesity 2 High-fat diet 3 Hypertension 4 Late-onset menarche

-Late-onset menarche Early-onset, not late-onset, menarche is a risk factor for endometrial cancer. A high-fat diet, hypertension, and obesity are all risk factors

The day after a hysterectomy, the client asks for sanitary pads because she feels that she is going to menstruate. What information should influence the nurse's response? 1 Menstruation will not occur because the uterus has been removed. 2 It will take several weeks before regular menstruation is reestablished. 3 Abdominal cramping and menstruation are expected after surgery. 4 The appearance of frank vaginal bleeding is expected after this type of surgery

-Menstruation will not occur because the uterus has been removed. Menstruation is shedding of the endometrial lining of the uterus. A woman who has undergone a hysterectomy has had her uterus removed and will no longer menstruate. Abdominal pain is common after a hysterectomy, but menstruation is impossible after the surgery; additional symptoms are necessary before any conclusion can be made. Frank bleeding is not expected after a hysterectomy.

A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the health care provider will most likely prescribe? 1 Penicillin G 2 Gentian violet 3 Nystatin (Mycostatin) 4 Metronidazole (Flagyl)

-Metronidazole (Flagyl) Metronidazole (Flagyl) is a potent amebicide. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Gentian violet is a local antiinfective that is applied topically; it may cause discoloration of the skin. It is effective against Candida albicans. Nystatin (Mycostatin) is an antifungal for infections caused by C. albicans.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. 1 Fluid overload 2 Intermittent diarrhea 3 Pale mucous membranes 4 Difficulty emptying the bladder 5 High hemoglobin and hematocrit

-Pale mucous membranes, Difficulty emptying the bladder Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.

A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. The nurse explains that her parents will: Incorrect1 Need to know to sign a consent form for testing and treatment 2 Not be contacted, because treatment at the clinic is confidential 3 Be notified when the insurance company is billed for testing and treatment 4 Remain uninformed if the adolescent ensures that her sexual contacts will come for testing

-Not be contacted, because treatment at the clinic is confidential Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations; there is a concern that these teenagers will not seek or continue treatment if they fear disclosure. To maintain confidentiality, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Most family planning clinics receive funding and charge on a sliding scale based on income, thus encouraging adolescents to seek treatment. Telling the client that her parents will not be notified as long as she ensures that her sexual contacts come in for testing could be viewed as coercion; if the STI is reportable, follow-up of sexual partners is indicated, but the adolescent is not responsible for ensuring that they report for testing.

Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component? Select all that apply. 1 Oral drugs 2 Diaphragm 3 Cervical cap 4 Female condoms 5 Foam spermicide 6 Transdermal agents

-Oral drugs,Transdermal agents Oral agents have a hormonal component. Transdermal agents have a hormonal component. The diaphragm acts as a barrier. The cervical cap acts as a barrier. The female condom acts as a barrier. Foam spermicides kill the sperm; there is no hormonal effect.

A 25-year-old woman has a family history of breast cancer. The nurse reviews the procedure for breast self-examination (BSE) and tells her that the best time for a woman to perform a breast self-examination is: a. a few days before her period. b. during her menstrual period. c. on the last day of menstrual flow. d. one week after the beginning of her period.

. ANS: D The best time for BSE is 1 week after the beginning of the menstrual period.

The public health nurse presents a program on breast self-examination. After a return demonstration the nurse concludes that she needs to review certain aspects of the teaching program. Which behavior by one of the students supports this conclusion? 1 Palpating each breast while in the sitting position 2 Checking her breasts for any deviation from what is expected 3 Palpating each breast with the palmar surface of her extended fingers 4 Checking her breasts for symmetry while holding her arms above her head

-Palpating each breast while in the sitting position Breast palpation should be performed in the supine position with a small rolled towel under the shoulder of the palpated side; it may also be done standing in the shower, but the sitting position is not recommended. Checking the breasts for deviations from expected findings, palpating each breast with the palmar surfaces of the extended fingers, and checking the breasts for symmetry while holding the arms over the head are all correct procedures for breast self-examination.

A 37-year-old client with a nontender palpable breast mass has a questionable mammogram. She is undergoing further diagnostic tests to determine whether the mass is malignant. What information should the nurse take into consideration before planning health teaching for this client? 1 Squamous cell carcinomas are neoplasms arising from glandular tissues. 2 Results of a biopsy are necessary before a specific form of therapy is selected. 3 Mammographies should be repeated to confirm the presence of malignancies. 4 Waiting for several weeks before receiving confirmation of cancer is helpful to the client

-Results of a biopsy are necessary before a specific form of therapy is selected The therapy selected depends on whether there is a malignancy and, if so, the type of cancer cells, the extent of nodal involvement, and the presence and extent of metastasis. Adenocarcinomas, not squamous cell carcinomas, arise from glandular tissue; squamous cell carcinomas arise from epithelial tissue. Only a biopsy will confirm the diagnosis of a malignancy. Waiting several weeks for a diagnosis is not advisable; an extended waiting period increases the client's stress and anxiety.

A 60-year-old woman is admitted for a vaginal hysterectomy and anterior and posterior repair of the vaginal wall. While taking the nursing history the nurse expects the client to state that one of the reasons she is having surgery is because she has been experiencing: 1 Hematuria 2 Dysmenorrhea 3 Pain on urination 4 Stress incontinence

-Stress incontinence Increased intraabdominal pressure associated with lifting, coughing, or laughing, in conjunction with a relaxed pelvic musculature and a bladder displaced into the vagina, results in inability to suppress urination. Hematuria is usually associated with urinary tract infection, bladder tumor, or renal calculi, not with cystocele or rectocele. Dysmenorrhea is usually associated with pelvic inflammatory disease, endometriosis, or cervical stenosis, not with cystocele or rectocele; the client is probably postmenopausal. Pain on urination is usually associated with urinary infection, not with cystocele or rectocele.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure? 1 The Pap smear can detect cancer of the cervix. 2 Vaginal bleeding is expected after a Pap smear. 3 Colposcopy will be used to visualize the cervix. 4 Scraping the cervix is the most uncomfortable part

-The Pap smear can detect cancer of the cervix. The Pap smear can detect cancer of the cervix by revealing atypical as well as cancerous cells. Scraping of the cells can cause a few drops of blood to be expelled; vaginal bleeding does not occur. A colposcopy is not part of a routine Pap smear. Insertion of the speculum usually is the most uncomfortable part of the test.

A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question? 1 User motivation 2 Simplicity of use 3 Reliability record 4 Identified risk factors

-User motivation Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method

The nurse reminds a group of high school students that the most effective choice of birth control for preventing pregnancy and sexually transmitted diseases is to: a. abstain from sex. b. use the male condom. c. use the female condom. d. use the barrier method.

ANS: A Abstinence is 100% effective in preventing pregnancy and sexually transmitted diseases.

The nurse instructs the woman taking oral contraceptives to report which possible side effect(s)? Select all that apply. a. Abdominal pain b. Weight gain c. Headache d. Eye or visual problems e. Speech disturbances

ANS: A, C, D, E The memory aid ACHES is helpful: Abdominal pain, Chest pain, Headaches, Eye problems, Speech disturbances. Weight gain is an expected side effect of oral contraceptives.

A 17-year-old girl comes to the emergency department complaining of severe pain in her left lower quadrant. When an ovarian cyst is suspected, the nurse explains that the diagnosis is confirmed by: a. laparotomy. b. oophorectomy. c. transvaginal ultrasound. d. hysteroscopy.

ANS: C Diagnosis of an ovarian cyst is made by transvaginal ultrasound.

A 37-year-old woman is admitted to the unit with severe menorrhagia. During assessment the nurse learns that she has a history of fibroids, menorrhagia, pelvic pain, and depression. The client has been undergoing hormone therapy in hopes of easing the symptoms and reducing the size of the fibroids, without success. The lab reports hemoglobin and hematocrit readings of 6.8 and 20.2, respectively. The client begins to sob and cries, "I don't know what to do—the doctor is recommending a hysterectomy, but I haven't had children yet!" What is the best response by the nurse? 1 "There are so many orphans looking for a mother." 2 "This must be so difficult for you. Children are really important to you?" 3 "You really have no choice but to follow the recommendation; the doctor is right." 4 "Believe me when I tell you that kids are so difficult to raise—you're better off without them."

-"This must be so difficult for you. Children are really important to you?" Validating the client's feelings and including an open-ended question will encourage further expression. Previous problems and health conditions could later be included in the conversation to help the client make the best decision. Adoption is certainly an option for this person, but this is not what she needs to hear at this time. This statement also closes down communication. The client does have a choice, and telling her that she does not could close down communication and cause anger and defensiveness. Telling the client that she's better off without children is not what the client needs to hear, especially when she is facing an operation that could end her chance of giving birth to children.

A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? 1 "As long as you aren't having periods, you won't need a contraceptive." 2 "It would be best to delay sexual relations until you have your first period." Correct3 "You should use contraceptives, because ovulation may occur without a period." 4 "Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy."

-"You should use contraceptives, because ovulation may occur without a period." Anovulation occurs in nursing mothers for varying periods; breastfeeding is not a reliable method of birth control. Periods may not occur for several months; sexual relations need not be delayed this long. Ovulation can occur without menstruation. Lactation may delay menses but does not reliably suppress ovulation.

The nurse planning to teach a woman about perimenopause would include that lowered estrogen levels: a. prevent osteoporosis. b. decrease vaginal lubrication. c. raise the level of low-density lipoproteins. d. raise the level of high-density lipoproteins.

ANS: C Estrogen increases the amount of high-density lipoproteins that carry cholesterol from body cells to the liver for excretion. With lowered levels of estrogen, low-density lipoproteins increase, causing an increase in the incidence of heart attacks and strokes.

3. A woman asks the nurse, "How do oral contraceptives prevent pregnancy?" The nurse explains that the combination of estrogen and progesterone in oral contraceptives: a. makes cervical mucus hostile to sperm. b. prevents ovul ation. c. prohibits implantation of the egg. d. acts as a barrier by destroying sperm.

ANS: B Oral contraceptives contain a combination of estrogen and progesterone that suppress ovulation.