WEEK 2: CHAPTER 56: Assessment and Management of Patients with Female Physiologic Processes

A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse? "This will have no bearing on your test today." "We will proceed with the examination and reschedule your Pap smear for next week." "We will reschedule your examination when you have finished menstruating." "We will do the test and take into consideration that you are menstruating."

"We will reschedule your examination when you have finished menstruating." Explanation: The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.

Which patient in the ED should the advance nurse practitioner treat first? A 32-year-old woman with bloating, headache, and reported depression A 48-year-old woman presenting with irregular menses, breast tenderness, and profuse sweating A 19-year-old woman with vaginal irritation, malodorous, copious frothy/yellow-green discharge A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness

A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness Explanation: The client with sharp, colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority client at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, copious malodorous and frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority.

A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception? Sterilization Hormonal contraception Barrier methods Abstinence

Abstinence Explanation: Abstinence is the only completely effective means of contraception. It is followed by sterilization. Hormonal contraceptives and barrier methods are effective but they must be used consistently to be effective.

The nurse is obtaining a history from a male client who states having difficulty achieving and sustaining an erection. When reviewing the medication history, which medication classification does the nurse anticipate? Bronchodilators Antihypertensives Cardiac dysrhythmics Antibiotics

Antihypertensives Explanation: Due to the therapeutic effect of antihypertensive medications decreasing blood pressure, the nurse is correct to anticipate a side effect of a male client having difficulty achieving or sustaining an erection. The other medication classifications do not typically have an effect on the male reproductive system.

Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected? Colporrhaphy Cone biopsy (conization) Cryotherapy Perineorrhaphy

Cone biopsy (conization) Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. Colporrhaphy refers to repair of the vagina. Cryotherapy refers to destruction of tissue by freezing. Perineorrhaphy refers to sutural repair of perineal lacerations.

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans? Cottage cheese-like discharge Yellow-green discharge Gray-white discharge Discharge with a fishy odor

Cottage cheese-like discharge Explanation: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.

A female client severely reduced her body fat through extreme caloric restriction and exercise. Which reproductive abnormalities could she acquire as a result of the reduction in body fat? Delay or cessation of menstruation Higher risk of fibrocystic breast disease Polycystic ovarian syndrome Small breasts

Delay or cessation of menstruation Explanation: She could acquire reproductive abnormalities, such as delay or cessation of menstruation. A cause of infertility in women is polycystic ovarian syndrome a multiendocrine disorder linked to insulin resistance. High caffeine consumption may also put a client at risk for fibrocystic breast disease.

Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele? Dyspareunia Irregular menses Decreased pH of the vagina Atrophic vaginitis

Dyspareunia Explanation: A cystocele can cause dyspareunia and incontinence. See Table 32-2 in the text for a complete list of both structural and functional age-related changes.

A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate? Giving the client a mild sedative before the procedure Administering laxatives and an enema prior to the procedure Ensuring that the client has a full bladder Checking that it has been 5 days since the end of her menses

Ensuring that the client has a full bladder Explanation: An abdominal ultrasound is a simple procedure that requires no specific preparation other than ensuring that the client has a full bladder to enhance visualization of abdominal area. A mild sedative, laxatives, and an enema would be used prior to a hysterosalpingography. A hysteroscopy should be done about 5 days after menstruation ceases.

The nurse is providing teaching to a group of older adolescent girls about menstruation and the use of tampons. The nurse would instruct the girls to change tampons at which frequency? Every 2 to 4 hours Every 4 to 6 hours Every 6 to 8 hours Every 8 to 10 hours

Every 4 to 6 hours Explanation: Tampons should not be used for more than 4 to 6 hours to reduce the risk of infection and possible toxic shock syndrome.

A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle? January 27 January 30 February 5 February 8

February 5 Explanation: February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? It's normal and requires no action. It calls for a repeat Pap test in 3 months. It calls for a repeat Pap test in 6 weeks. It calls for a biopsy as soon as possible.

It calls for a biopsy as soon as possible. Explanation: A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.

Which statement is true regarding hormonal contraception? It increases the risk of benign breast cancer. It increases the risk for venous thromboembolism. Fetal anomalies are a concern. It increases the risk of uterine cancer.

It increases the risk for venous thromboembolism. Explanation: Clients taking hormonal contraception have an increased risk for venous thromboembolism, but their risk for benign breast cancer and uterine cancer is decreased. Fetal anomalies are not a concern.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone? Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Methotrexate is used only in early pregnancy to terminate a pregnancy nonsurgically. Clomiphene (Clomid) is used only in early pregnancy to terminate a pregnancy nonsurgically. Birth control pills can be used to terminate the pregnancy.

Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Explanation: Mifepristone (Mifeprex), formerly known as RU-486, is a medication used only in early pregnancy (up to 49 days from the last menstrual period) to induce abortion. It works by blocking progesterone.

A nurse is employed by a fertility clinic. Diagnostic testing is being completed to determine the source of the male not producing viable sperm to enable ovum fertilization. Which male structures does the nurse consider if the problem is narrowed to sperm survivability? Bartholin glands Prostate gland Cowper's glands Vas deferens

Prostate gland Explanation: The accessory structure of the prostate gland contains secretory cells that produce alkaline fluid. The prostatic fluid mixes with sperm. The alkalinity of the prostatic fluid neutralizes the acidic metabolic wastes released by the sperm and counteracts the acid pH within the vagina to ensure mass survival of the sperm. The Cowper's glands add lubrication for penetration of the vagina.

When the nurse places the patient in the stirrups for a pelvic exam she observes a bulge caused by rectal cavity protrusion. What does the nurse know this protrusion is called? Cystocele Rectocele Uterine prolapse Hemorrhoids

Rectocele Explanation: Childbirth trauma may have affected the posterior vaginal wall, producing a bulge caused by rectal cavity protrusion (rectocele). Trauma to the anterior vaginal wall during childbirth may have resulted in incompetency of the musculature, and a bulge caused by the bladder protruding into the submucosa of the anterior vaginal wall (cystocele) may be seen. The cervix and uterus may descend under pressure through the vaginal canal and be seen at the introitus (uterine prolapse). Hemorrhoids would not cause a bulge in the pelvic region.

A nurse is obtaining health history from a young adult woman. Which of the following would alert the nurse to a possible problem? Age of 13 years at menarche Menstrual cycle averaging 28 to 29 days Reports of dyspareunia Mucus-like vaginal discharge

Reports of dyspareunia Explanation: Dyspareunia, or pain with intercourse, is an abnormal finding associated with numerous potential problems. Onset of menarche is usually between 12 to 14 years but could be as early as age 10 or 11 years. The menstrual cycle typically averages 28 days but it can vary from 21 to 42 days. A mucus-like vaginal discharge is normal.

The nurse is outlining the female internal reproductive structures on a diagram. Where on the diagram would the nurse highlight the typical site of ovum fertilization? The nurse would highlight the uterus. The nurse would highlight the cervix. The nurse would highlight the fallopian tube. The nurse would highlight the ovaries.

The nurse would highlight the fallopian tube. Explanation: The nurse would highlight the fallopian tubes as the site of ovum fertilization. Once fertilized, the fertilized egg moves to the uterus for implantation. The cervix is the lower, narrowed neck portion leading to the center of the uterus. The ovaries release the ovum, which is swept into the fallopian tubes.

While examining the introitus, the nurse practitioner asks the client to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the client for which condition? Uterine prolapse Colorectal cancer Female genital mutilation Human papillomavirus

Uterine prolapse Explanation: The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the client to "bear down." Examinations for colorectal cancer or female genital mutilation do not improve when the client bears down. A Pap test reveals atypical cells; the liquid method allows for human papillomavirus testing. This procedure does not require the client to bear down.

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning? Vulva Labia majora Mon pubis Vagina

Vagina Explanation: The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.

Which dinner selection demonstrates an understanding of nutritional therapy used by women to decrease the signs and symptoms of menopause? Saltine crackers, fruit cocktail, lima beans, and meatloaf Wheat toast, apple slices, broiled chicken breast, and steamed carrots White toast, apple sauce, grilled chicken, and glazed carrots Corn chips, grapes, lean meat, and baked beans

Wheat toast, apple slices, broiled chicken breast, and steamed carrots Explanation: To decrease the signs and symptoms of menopause, women are encouraged to decrease their fat and caloric intake and increase their intake of whole grains, fiber, fruit, and vegetables. Saltine crackers, white toast, and corn chips are not good sources of fiber. Fruit cocktail, applesauce, and grapes are high in artificial and natural sugars. Meatloaf is high in fat. Glazed carrots and baked beans can be high in sugar content.

A patient has been diagnosed with a Trichomoniasis vaginal infection. The nurse would expect which color of discharge? Yellow-green White White, curd-like Gray

Yellow-green Explanation: Vaginal discharge associated with Trichomoniasis vaginal infection is copious and often frothy/yellow-green. Candida infection is associated with thin to thick, curd-like, white discharge. White discharge is associated with a normal discharge. Bacterial vaginosis is associated with thin and grayish or yellow discharge.

Within the female internal reproductive structures, where is the egg most commonly fertilized? fallopian tubes cervix fundus endometrium

fallopian tubes Explanation: One or the other fallopian tube receives an extruded ovum every month and serves as the place where the ovum is most commonly fertilized.

Because of a client's reluctance to begin hormone therapy, the advance nurse practitioner prescribes venlafaxine to decrease the risk of hot flashes. stroke. heart attack. blood clots.

hot flashes. Explanation: Problematic hot flashes have been treated with low-dose venlafaxine as an alternative to hormone therapy. Hormone therapy decreases the risk of hot flashes, but it increases the risk of stroke, heart attack, and blood clots.

Hormone therapy decreases the risk of hot flashes. stroke. heart attack. blood clots.

hot flashes. Explanation: Hormone therapy decreases the risk of hot flashes. It increases the risk of stroke, heart attack, and blood clots.