OB FINAL STACK 11

___ 6. The nurse is assessing a 59-year-old female patient for her annual examination. The patient had a full hysterectomy, bilateral salpingo-oophorectomy 1 year ago for a noncancerous condition. The patient states that she wants to stop her menopausal hormone therapy at this time, and she will try black cohosh if the symptoms persist. Which response by the nurse is most appropriate? 1. "Hormone therapy is the most effective treatment for menopausal symptoms." 2. "Hormone therapy becomes less effective within 2 years of treatment." 3. "Hormone therapy is most effective with alternative medicines use." 4. "Hormone therapy is most effective when combined with lifestyle changes."

1 This is correct. Per the North American Menopause Society, hormone therapy is the most effective treatment for menopausal symptoms.

13. The nurse is assessing a 64-year-old female patient. The patient states that she is able to reduce the risk of urinary tract infections (UTIs) by drinking a quart of cranberry juice a day. Which health condition, if present in this patient, contraindicates the use of cranberry juice? 1. Hypertension, managed with lisinopril 2. Diabetes type 1, managed with insulin 3. Atrial fibrillation, managed with warfarin 4. COPD, managed with inhaled steroids

3 This is correct. Studies have shown that cranberry juice can affect the liver and interfere with warfarin (Coumadin) levels. Cranberry juice should not be taken with warfarin (Coumadin), aspirin, or medications that effect the liver.

11. What is the common risk factor for hypertension, abnormal menstrual cycles, osteoarthritis, and high-risk pregnancies? 1. Polycystic ovarian syndrome 2. Diabetes mellitus 3. Body mass index over 32 4. Sedentary lifestyle

3 This is correct. A BMI of >30 indicates obesity, which could cause the listed symptoms.

14. Which specific instruction should the nurse teach to assist a patient to regain control of her urinary sphincter? a. Perform 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; however, every hour is too frequent. Restricting fluids will cause bladder irritation, which exacerbates the problem. Drinking adequate fluids will decrease the concentration of urine; however, this intervention will not improve sphincter control. Overdistention of the bladder will result in further stress incontinence.

10. 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 in the patient with PMS. The patient should drink at least 2000 mL of water per day. Six smaller meals a day will help maintain glucose levels and reduce symptoms.

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

ANS: A Lubricants other than water or water-based lubricants on the cervix interfere with the accuracy of the cytology report. A speculum is necessary to visualize 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 including gloves and eye protection

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

7. Which sexually transmitted disease can be treated and eradicated? a. Herpes b. AIDS c. Chlamydia d. Venereal warts

ANS: C Treatment options chlamydial bacterial infection include: azithromycin, doxycycline, ofloxacin, levofloxacin, or erythromycin. Concurrent treatment of all sexual partners is necessary 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 (HPV). No treatment eradicates the virus; however, there is a vaccine available.

9. 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 Primary dysmenorrhea is menstrual pain without identified pathology. Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. Contrary to popular belief, primary dysmenorrhea is not experienced by all women. Oral contraceptives can be a treatment choice if cramps associated with primary dysmenorrhea are debilitating. It most often occurs in young nulliparous women.

8. Which nursing interventions would best correlate with the nursing diagnosis of At risk for disturbed sleep patterns related to night sweats? 1. Take a cool shower before bedtime. 2. Avoid medications such as fluoxetine. 3. Eat a consistent carbohydrate prior to bedtime. 4. Avoid liquid intake 2 hours prior to bedtime.

1 This is correct. This would facilitate a cooler body core prior to going to bed and may decrease hot flashes

3. The telephone triage nurse receives a call from a patient who is 5 days postoperative total abdominal hysterectomy. The patient states that her pain is not relieved with the medications and that she has noticed blood in her urine. The nurse instructs the patient to report immediately to the emergency department. What does the nurse suspect as the surgical complication? 1. Possible complication related to the anesthesia 2. Possible injury to the ureters or bladder 3. Possible hemorrhage from the internal incision 4. Possible peritoneal venous thromboembolism

2 This is correct. Bloody urine and unmanaged pain could indicate a ureter injury from the surgery.

5. During the nurse's assessment of a 44-year-old female patient in the family medicine clinic, the patient becomes tearful and states she may be pregnant, as she has some unintentional weight gain, mood swings, and irregular menstrual cycles. The urine hCG reveals that the patient is not pregnant. What is the possible reason for her symptoms at this time? 1. The patient has a false pregnancy. 2. The patient is menopausal. 3. The patient is perimenopausal. 4. The patient may be pregnant.

3 This is correct. The patient's age and symptoms are indicative of perimenopause.

1. The nurse is assessing a 70-year-old female patient in the family practice clinic. The patient states that she has been experiencing sudden heavy vaginal bleeding the past 3 months. What is the expected diagnostic procedure for this patient? 1. Cervical conization 2. Colposcopy 3. Dilation and curettage 4. Endometrial biopsy

4 This is correct. The patient will need to have an endometrial biopsy to determine the cause of postmenopausal bleeding. The patient's age is past the average age of menopause.

17. The nurse is arranging education for the menopausal support group regarding the approaches to treat the symptoms. Which of the following would be components of current treatments? Select all that apply. 1. Moderately intense exercises 2. Balanced diet, rich in calcium 3. Alternative medicine such as black cohosh 4. Over-the-counter sleep aid 5. Hormone therapy

17. ANS: 1, 2, 5 1 This is correct. Moderately intense exercise will promote overall health. 2 This is correct. A balanced diet rich in calcium will help maintain bone strength (due to the risk of osteoporosis). 5 This is correct. Studies have shown that hormone therapy can decrease the symptoms of menopause effectively.

14. The nurse is providing care to a 72-year-old female patient. While providing care, the nurse instructs the patient to slowly rise from a sitting or prone position. What is the pathophysiological reason for this instruction? 1. The patient is at higher risk for fractures due to postmenopausal osteoporosis. 2. The patient is at higher risk for hypotension due to decreased baroreceptor sensitivity. 3. The patient is at higher risk for falls due to decreased muscle strength and balance. 4. The patient is at higher risk for adverse drug reactions due to decreased hepatic function.

2 This is correct. The normal physiological changes of aging include decreased baroreceptor sensitivity, thus increasing the risk for falls due to hypotension.

3. A 48-year-old female patient presents to the OB/GYN clinic for her annual examination. She states that she has had the following symptoms: mood swings, irregular menstrual cycles, forgetfulness, food cravings, and a decrease in libido. Which of the following does the nurse suspect the patient is experiencing? 1. Menopause 2. Perimenopause 3. Postmenopause 4. Pregnancy

2 This is correct. Given the patient's age and current symptoms, the patient is experiencing perimenopause

6. Which are the most common sites of breast cancer metastasis? a. Kidneys b. Bones and liver c. Heart and blood vessels d. Skin

ANS: B Metastasis occurs when the cancer cells spread by both blood and lymph system to distant organs and to vascular sites, commonly the lungs, liver, bones, and brain. Kidney metastasis is uncommon. Metastasis to the heart and blood vessels is uncommon. Skin cancer is not associated with breast cancer metastasis.

_ 5. The nurse is providing care to the 24-year-old patient in the OB/GYN clinic. The patient states that she thinks she may be pregnant because she has missed three menstrual cycles. The patient says, "This couldn't be happening at a worse time. I have been training heavily for a triathlon in 4 months." Which response by the nurse is most appropriate? 1. "Secondary amenorrhea, or no menses for 3 months, is not always a sign of pregnancy; it may be due to your heavy athletic activity." 2. "Pregnancy during times of stress such as heavy athletic activity can occur when precautions are not followed." 3. "If the pregnancy test is negative, the physician will need to perform a diagnostic laparoscopy to rule out a neoplasm." 4. "Amenorrhea may occur at times of nutritional disturbances. Are you eating a well-balanced diet?"

1 This is correct. Heavy athletic activity may cease ovulation and menstrual cycles

_ 14. The nurse is assessing a 72-year-old female patient in the women's health clinic. The mildly obese patient's history includes 7 vaginal births, 2 of which necessitated forceps deliveries, type 2 diabetes, and hypertension. The patient states that she has become incontinent of urine, has a history of frequent urinary tract infections (UTIs), and has a sense of fullness "down there." What would be an appropriate nursing intervention to help the patient with her symptoms? 1. Instruct the patient to stop urinating midstream at least twice a day. 2. Instruct the patient to eat a high-fiber diet and increase fluid intake. 3. Instruct the patient to add probiotics to their diet while taking antibiotics. 4. Instruct the patient to bear down effectively while having a bowel movement.

1 This is correct. This is the Kegel exercise, which helps improve pelvic muscle strength for a mild cystocele. Key words in this question are frequent UTIs, urinary incontinence, multiple births, two of which were forceps deliveries, which further traumatizes the pelvic floor.

15. The nurse at a family practice clinic is providing care to a 47-year-old obese patient. The patient states that she realizes that she has put on extra weight but is reluctant to go to any exercise classes. She states that she often has to cross her legs when she sneezes and cannot do any exercises with her legs crossed. The health care provider has prescribed tolterodine (Detrol). What is the rationale for this medication? 1. Tolterodine is used to treat overactive bladders and to decrease urinary frequency, urgency, and urge incontinence. 2. Tolterodine is used to improve the tone and tissue in the urethral and vaginal areas. 3. Tolterodine is used to facilitate weight loss by acting as an appetite suppressant. 4. Tolterodine is used to improve blood flow to the pelvic muscles to decrease urinary tract infections.

1 This is correct. Tolterodine (Detrol) inhibits cholinergic bladder contractions, thereby decreasing urinary frequency, urgency, and urge incontinence.

10. The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis? 1. "I realize that this is not a cure for the issue, but I want to have more children within the next year." 2. "I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy." 3. "I realize that my type 2 diabetes will be cured now that I have those lesions removed." 4. "I understand that I will not have to have a colostomy now that the growths were removed from my bowels."

1 This is correct. Endometriosis may recur after surgical interventions, but the laparoscopic surgery is used for women with severe symptoms who are infertile and desire pregnancy.

8. The nurse is preparing a teaching plan for a polycystic ovary syndrome (PCOS) support group. One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What is the reasoning for this rationale? 1. Diet and exercise will promote weight loss, which will decrease hyperandrogenemia. 2. Diet and exercise will decrease the risk of type 2 diabetes and gestational diabetes. 3. Diet and exercise will decrease serum lipid levels and lower the risk for cardiovascular disease. 4. Diet and exercise will increase the frequency of ovulation and menstruation and increase fertility.

1 This is correct. Hyperandrogenemia can lower testosterone levels, which can reduce the degree of acne and hirsutism.

6. The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment? 1. This condition is often associated with use of oral contraceptives and may subside upon discontinuation. 2. This condition is often associated with type 2 diabetes and must be controlled with a different type of birth control. 3. This condition is often associated with hyperplasia of the endometrial tissue, which is exacerbated with oral contraceptives. 4. This condition is often associated with ovarian cysts, which are exacerbated with the use of oral contraceptives.

1 This is correct. Metrorrhagia is the most significant form of menstrual disorder. If not caused by endometrial cancer, it is typically associated with use of an IUD and use of oral contraceptives.

7. A patient arrives to the family practice clinic for her annual examination. The nurse's assessment data includes thin, 35-year-old female, history of weight loss surgery and total hysterectomy, BMI is 19, patient has been taking corticosteroids for severe asthma. Which of the following is an expected diagnostic screening for a potential health problem? 1. Dual-energy x-ray absorptiometry scan 2. Serum electrolyte levels and vitamin D 3. Serum cholesterol and diabetic screening. 4. Papanicolaou (Pap) Smear

1 This is correct. The dual-energy x-ray absorptiometry (DXA) is indicated for this patient because she has the following risk factors: corticosteroid use, low BMI, and surgical menopause.

12. The nurse is providing care to a 46-year-old female patient. The patient appears hesitant when asked of her sexual history, and the nurse discovers that the patient is a lesbian. What education should the nurse provide to this patient pertaining to her health? 1. Lesbians often are at higher risk for menstrual disorders, abnormal insulin production, and infertility. 2. Lesbians often are at higher risk due to lower socioeconomic disparities than their heterosexual counterparts. 3. Lesbians often refuse choices in health care such as the HPV vaccine as many feel they are not at risk. 4. Lesbians often have fewer health issues than their heterosexual counterparts due to their strong support systems.

1 This is correct. These are signs and symptoms of polycystic ovarian syndrome, which lesbians are at higher risk for than are their heterosexual counterparts

15. The nurse is providing education on the prevention of heart disease for adult females ages 35 to 44 years old. Which of the following would be most appropriate for this disease process? Select all that apply. 1. Taking a brisk walking for 50 minutes three times a week 2. Consuming a diet rich in vegetables, fruits, and whole grains 3. Obtaining a varicella vaccine, if no evidence of immunity 4. Recognizing the importance of smoking cessation 5. Taking calcium supplements, if lactose intolerant

15. ANS: 1, 2, 4 1 This is correct. Getting at least 150 minutes of moderate intensity physical activity per week helps reduce risk potential for heart disease. 2 This is correct. Consuming a nutrient rich diet helps reduce the risk potential for heart disease, as well as other disease processes, such as cancer 4 This is correct. Smoking cessation is another risk factor for many disease processes, including cardiac disease. It is a leading cause of heart disease and cancer.

16. The nurse is providing postoperative care to a patient who underwent a total abdominal hysterectomy 12 hours ago. Which of the following are appropriate nursing interventions? Select all that apply. 1. Assist the patient with ambulation. 2. Maintain the Foley catheter for 48 to 72 hours postoperatively. 3. Monitor intake and output and characteristics of urine. 4. Maintain bedrest while taking narcotic pain medications. 5. Initiate antiembolism therapy as ordered.

16. ANS: 1, 3, 5 1 This is correct. Ambulation decreases the risk for deep vein thrombosis and facilitates return of peristalsis, which decreases the amount of gas buildup. 3 This is correct. Monitoring intake and output, as well as the characteristics of the urine, will facilitate monitoring for signs/symptoms of fluid imbalances and injury to the ureters or bladder. 5 This is correct. A risk related to surgical procedures is deep vein thrombosis or venous thromboembolism. This may include antiembolism stockings, ambulation, and/or anti-coagulant therapy.

16. The nurse is providing care to the 35-year-old female patient at the family practice clinic who is in the office for her annual physical examination. Which tests should the nurse recommend are the most appropriate for this patient? Select all that apply. 1. Papanicolaou test every 5 years 2. Mammogram every 2 years 3. DEXA screen every 2 years 4. HPV every 5 years 5. HIV testing every 5 years.

16. ANS: 1, 4 1 This is correct. According to Healthy People 2020, the Pap test along with the HPV is recommended every 5 years for women ages 30 to 65. 4 This is correct. According to Healthy People 2020, the Pap test along with the HPV is recommended every 5 years for women ages 30 to 65.

17. The nurse is educating a 24-year-old female patient who was newly diagnosed with polycystic ovary syndrome (PCOS). The patient was prescribed an antidiabetic medication. Which medication effects should the nurse educate the patient about? Select all that apply . 1. A period of initial weight gain 2. A change in her integumentary system 3. Low blood sugar until her hormones stabilize 4. Decreased likelihood of pregnancy 5. A decrease in abdominal obesity and weight

17. ANS: 2, 3, 5 2 This is correct. The patient may notice loss of hirsutism and acne while taking the antidiabetic medication. This is because this medication decreases testosterone levels. 3 This is correct. The nature of the antidiabetic medication can cause lower blood sugar, and the patient will need to take the proper precautions. 5 This is correct. This may lower the testosterone level, which may decrease the degree of acne, hirsutism, and abdominal obesity.

18. A college-aged female patient states that she understands the risk of sexual assault with overdrinking. She asks the nurse what health risks are associated with excessive alcohol intake for her age. What diseases or conditions should the nurse include in her response? Select all that apply. 1. Infertility 2. Cancer of mouth 3. Hypertension 4. Brain shrinkage 5. Osteoporosis

18. ANS: 1, 2, 4 1 This is correct. Per the CDC, excessive alcohol intake at this age can increase a woman's risk for infertility. 2 This is correct. Per the CDC, excessive alcohol intake at this age can increase a woman's risk for cancer of the mouth. 4 This is correct. Per the CDC, excessive alcohol intake at this age can increase a woman's risk for memory loss and brain shrinkage.

18. The nurse is assessing a 42-year-old patient who presents to the gynecology office with complaints of pelvic pressure, backaches, menorrhagia, and urinary frequency. The health care provider has diagnosed the patient with leiomyoma of the uterus. What are the treatment options for this condition? Select all that apply. 1. Routine pelvic examinations to assess rate of disease process 2. Oral contraceptives to control the bleeding and pain 3. Myomectomy for women who desire pregnancy 4. Hysterectomy for women who do not desire pregnancy 5. Antibiotic therapy with NSAIDS for symptom management

18. ANS: 1, 3, 4 1 This is correct. Routine pelvic examinations may be performed to assess the rate of growth of the leiomyomas (fibroids). A pelvic ultrasound to confirm the diagnosis of tumors and rule out pregnancy is another option of diagnosis. 3 This is correct. A myomectomy may be a surgical intervention to remove the fibroids, while leaving the uterus intact for those that desire pregnancy. 4 This is correct. Hysterectomy is recommended for women who do not desire pregnancy and who are experiencing excessive bleeding. Leiomyomas are the main indicator for hysterectomy.

19. The nurse is assessing a 25-year-old female patient when the patient becomes tearful. The patient states that she has thin milky discharge from her nipples and two small masses on her left breast. She has lost over 40 pounds in the past year due to intensive exercises and finds that she needs to wear a sports bra during her sessions. The patient states that she is afraid that she will become the first member of her family to have breast cancer. Besides a negative mammogram, what other symptoms would correlate with this being a benign finding? Select all that apply. 1. Milky discharge from nipples 2. Extensive weight loss 3. Painful masses 4. Mood swings 5. Multiple masses

19. ANS: 1, 3, 5 1 This is correct. Discharge from nipples that are milky may be due to the elicited response from compression (resulting from the sports bra). 3 This is correct. Fewer than 10% of women with breast cancer will present with pain. NUMBER 5 says incorrect so please follow up with this question.

19. The nurse is providing education to the patient that is receiving a bisphosphate medication for osteoporosis. Which instructions should the nurse include in the teaching plan to reduce side effects and enhance absorption while taking bisphosphates? Select all that apply. 1. Take the medication with a small meal at the same time. 2. Take the medication with at least 8 oz. of water. 3. Remain upright for at least 30 minutes after taking a dose. 4. Take the medication on an empty stomach. 5. Take the medication with a calcium supplement

19. ANS: 2, 3, 4 2 This is correct. This medication should be given on an empty stomach 30 minutes before breakfast. The patient must follow it with at least 8 oz. of only water and remain upright for 30 minutes. 3 This is correct. This medication should be given on an empty stomach 30 minutes before breakfast. The patient must follow it with at least 8 oz. of only water and remain upright for 30 minutes. 4 This is correct. This medication should be given on an empty stomach 30 minutes before breakfast. The patient must follow it with at least 8 oz. of only water and remain upright for 30 minutes.

12. The nurse is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection and now reports a milky discharge from her vagina and has a fishy odor. After microscopic examination of the vaginal discharge, the health care provider prescribed metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient? 1. The patient has gonorrhea due to lowered immunity after antibiotic therapy. 2. The patient has bacterial vaginosis due to recent disruption of normal vaginal flora. 3. The patient has genital condylomas due to the recent UTI treatment. 4. The patient has candida vaginitis due to recent disruption of normal vaginal flora

2 This is correct. Disruption of normal vaginal flora can increase the likelihood of bacterial vaginosis, and the symptoms are often described as milky vaginal discharge with a distinct "fishy" odor

4. A 55-year-old postmenopausal female patient presents to the family practice clinic for her annual examination. The nurse notes that the patient has lost inch in height. Upon further investigation, the nurse discovers that the patient has a slow-healing fracture of the left radius. What screening will most likely be initiated at this time for the patient? 1. Assessment for domestic violence 2. Dual-energy x-ray absorptiometry scan 3. Follicle-stimulating hormone 4. Serum levels of calcium and vitamin D

2 This is correct. The postmenopausal patient has experienced height loss and has a fracture. This indicates a need to screen for osteoporosis.

7. The nurse is assessing the 19-year-old female patient in the women's health clinic. She reports that for the past several months, she has had lower abdominal pain, elimination issues, and mood swings, and her acne is worse the week before menstruation. The health care provider has prescribed oral contraceptives. The patient asks the nurse for the reason for the prescription. Which response by the nurse is appropriate? 1. "Pregnancy should be avoided because the hormonal shift would place the fetus at risk for birth defects." 2. "The hormones in the oral contraceptives can maintain estrogen-progesterone hormones to alleviate discomfort." 3. "Oral contraceptives may provide an increase in the hormones to help with your possible infertility issues." 4. "Oral contraceptives may balance the chemical changes in your brain to alleviate the depression symptoms."

2 This is correct. PMS may be controlled, with oral contraceptives, as PMS might be related to hormonal changes related to the menstrual cycle. Estrogen-progesterone hormones found in oral contraceptives may provide relief from the symptoms.

10. The nurse is assembling data for an education session at the local women's shelter. The majority of the guests at the shelter are 25- to 35-year-old American Indian women with young children. What is the leading cause of death for this population? 1. Situational depression 2. Risk-taking behaviors 3. Poor prenatal care 4. Poor dietary choices

2 This is correct. This could increase the likelihood for accidents, such as not wearing seat belts. Native American women have a high risk for death from accidents at this age

9. The nurse is providing care to a 35-year-old female patient who complains of low back pain, pain with defecation, pelvic pressure, and premenstrual spotting. The health care provider has prescribed the hormonal therapy Lupron for this condition. What is the goal of this prescription? 1. To prevent pregnancy at this time to promote healing 2. To suppress menstruation and further growth of the tissue 3. To prevent retrograde menstruation outside the uterine cavity 4. To increase blood flow to decrease the endometrial lining

2 This is correct. This is the goal of GnRH agonists, which suppresses menstruation and further growth of tissue.

1. The nurse is providing care to the adult female patient who presents to the emergency department with a suspected myocardial infarction (MI). Which symptom indicates a possible MI for the female patient? 1. Chest pain that radiates to the right arm and jaw 2. Episodic nausea/indigestion and palpitations 3. Sudden onset of trouble walking, and loss of balance 4. Swelling of the feet and shortness of breath

2 This is correct. Often, the female patient will experience gastrointestinal issues as a sign of a MI and will often ignore these symptoms, believing them to be heartburn.

2. A 32-year-old female patient arrives to the emergency department with heavy uterine bleeding. The nurse finds that the patient had a positive pregnancy test 1 month prior to the visit. What is the potential medical management for this patient's issue? 1. Endometrial biopsy 2. Dilation and curettage 3. Colposcopy 4. Laparoscopy

2 This is correct. The patient may be experiencing an incomplete abortion and will

20. The nurse is providing care for the 34-year-old patient diagnosed with polycystic ovarian syndrome. Which interventions would correlate to the common symptoms of this syndrome? Select all that apply. 1. The patient has been unsuccessful with the ability to conceive. 2. The patient has a history of painful and irregular menstrual cycles. 3. The patient has noticed a drastic weight loss and dry skin. 4. The patient has chronic back pain and gastrointestinal issues. 5. The patient has heart palpitations and hypertension.

20. ANS: 1, 2, 5 1 This is correct. Due to abnormal hormonal levels, the patient may have fertility issues. 2 This is correct. Due to abnormal hormonal levels, the patient may have issues with menstrual cycles. 5 This is correct. The patient may experience cardiac issues related to the hormonal fluctuations associated with polycystic ovarian syndrome.

_ 20. The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply. 1. Menopausal women with an intact uterus who receive hormonal therapy 2. Women who have undergone treatment for breast cancer 3. Women who have many pregnancies and nursed their infants 4. Women who smoke and have many sexual partners 5. Women with a long-standing history of polycystic ovarian syndrome

20. ANS: 1, 2, 5 1 This is correct. Unopposed estrogen therapy in women with a uterus can cause endometrial hyperplasia in the lining of the uterus. The second most common cancer of the female reproductive system is endometrial cancer. 2 This is correct. Tamoxifen is indicated for reducing risk for breast cancer in women or as a treatment of breast cancer. The medication competes with estrogen for binding sites in the breast but increases the risk for endometrial cancer. 5 This is correct. Polycystic ovarian syndrome increases the risk for endometrial cancer.

2. The nurse is providing education for disease prevention to the adult female patient. Which factor puts the patient at a higher risk for multisystem disease processes such as cardiac issues, gynecological issues, and cancers? 1. Consuming two glasses of wine a week 2. Smoking two packs of cigarettes a day 3. Having a body mass index of over 32 4. Having poor intake of calcium and vegetables

3 This is correct. A BMI of over 30 indicates obesity, which increases the risks for many disease processes, such as cardiac, endocrine, musculoskeletal issues, and gynecological disorders

11. The nurse is assessing a 16-year-old sexually active patient in the family practice clinic. The patient's symptoms include breakthrough vaginal bleeding, abdominal pain, nausea, and fever. The health care provider obtains cultures of the cervical epithelial cells during a Pap smear and orders doxycycline 100 mg orally twice a day for 7 days for her and her partner. The nurse understands that this prescription is consistent with the treatment of which medical diagnosis? 1. Herpes 2. Condylomas 3. Chlamydia 4. Gonorrhea

3 This is correct. Chlamydia is the most common bacterial STI in the United States and the leasing cause of preventable infertility. This is diagnosed by cultures of cervical epithelial cells and is treated with antibiotics. The partner needs to be treated to prevent reinfection.

13. The nurse is providing care to a 75-year-old female patient diagnosed with osteoporosis. Which of the following would be the priority nursing diagnosis? 1. At risk for falls related to impaired balance 2. Knowledge deficit related to new medication regimen 3. Impaired physical mobility related to pain and skeletal changes 4. Ineffective health maintenance related to continued immobility

3 This is correct. The patient will experience skeletal changes, and often pain due to pathological fractures. In order to prevent further exacerbation of the disease process, the nurse will need to develop a plan of care that includes increasing physical mobility, especially weight-bearing exercises to increase bone density.

4. The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure? 1. "I will use a mild douche solution to keep the surgical area clean." 2. "I'm relieved that I won't have any visible scars on my abdomen." 3. "I understand that there will be some light vaginal bleeding for several days." 4. "I understand that I must remain on bedrest until cleared by the surgeon."

3 This is correct. There will be some light bleeding for several days, and the patient should be instructed to notify the surgeon if bleeding increases

9. The nurse is developing a plan of care for the 65-year-old obese female patient who states she wishes she could lose the weight but has no stamina for activity. Which nursing intervention would best correlate with the patient's statements? 1. Provide information on local gyms and exercise groups. 2. Provide information on choosemyplate.gov. 3. Provide information on the overall health risks of obesity. 4. Provide guidelines on how to increase daily activity as tolerated

4 This is correct. By facilitating an incremental increase in activity, the patient's stamina may increase, which was the statement made by the patient.

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.

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 differial 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.

8. A benign breast condition that includes dilation and inflammation of the collecting ducts is known as 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

11. A patient, age 49, confides in the nurse that she has started experiencing pain with intercourse. The patient 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; however, 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

19. You are taking care of a patient 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. The removal of the packing should be verified and documented. This is the priority assessment. A pessary would be utilized as a nonsurgical intervention for a patient 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 patient'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

3. While performing a self-breast exam, the patient 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 patient calls to report her findings to the clinical nurse because this is not her typical result. What action should the nurse perform next? a. Refer the patient to an oncologist because the results are suspicious. b. Ask the patient 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 patient wear a tight-fitting bra and tell her that the tenderness is associated with ovulation and will pass. d. Have the patient 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 patient. The patient has called to express concern; therefore, the nurse should have the patient 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; however, does not address the physical findings and concern of the patient. Repeating the self-breast exam may be required; however, it does not address the patient's current concerns

12. Which patient is most likely to develop osteoporosis? a. A 50-year-old patient on estrogen therapy b. A 55-year-old patient with a sedentary lifestyle c. A 65-year-old patient who walks 2 miles each day d. A 60-year-old patient 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. A number of drug therapies are available to reduce the progression of osteoporosis. Weight-bearing exercises have been shown to increase bone density. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D.

2. A 45-year-old patient 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 require them more often.

13. A patient 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 for the patient with a rectocele. Involuntary loss of urine during coughing is referred to as stress incontinence and is not an emergency.

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

ANS: C Additional drugs include cefixime (Suprate) or ciprofloxacin (Cipro). Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin G is used most commonly to treat syphilis. Tetracycline is prescribed to treat chlamydial infections. Acyclovir is most commonly used to treat herpes genitalis.

20. In reviewing genetic testing for a female patient, you note the presence of BRCA1, BRCA2, and CHEK2. How should these findings be interpreted? a. There is no increased likelihood that the patient 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 patient's family history and the patient's current and past medical history. d. A radical bilateral mastectomy is required as soon as possible, since 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 as well as ovarian cancer. It is important to obtain additional information in order that a treatment plan can be developed and implemented to improve patient outcomes. There is an increased likelihood that the patient will develop breast or ovarian cancer. 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

18. Which treatment option minimizes the development of lymphedema in the surgical management of a patient 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 and helps minimize the development of lymphedema in the surgical management of a patient with breast cancer. Radical mastectomy is associated with lymphedema in the postsurgical breast cancer patient because of the removal of lymph node tissue. Radiation therapy is not associated with a decrease in lymphedema for the breast cancer patient. Ultrasound as an intervention does not affect the development of lymphedema

15. The physician diagnoses a 3-cm cyst in the ovary of a 28-year-old patient. You expect the initial treatment to include a. initiating hormone therapy. b. scheduling a laparoscopy to remove the cyst. c. examining the patient 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.

17. Which option could be used for the treatment and management of a patient 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 patient 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 patients with fibrocystic breast disease. Danazol is typically used for moderate to severe pain for patients with fibrocystic breast disease because its use is associated with more serious side effects. Danazol should not be used longer than 4 to 6 months. The patient 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 patient reports mild pain, so this would not be warranted.

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 is 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 performed 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.

5. 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