Chapter 52 Intro to the Reproduction System

Which of the following would the nurse expect to be done to assess the size of the prostate? A) Digital rectal examination B) Transillumination C) Pelvic examination D) Bladder percussion

Ans: A Feedback: A digital rectal examination is performed to assess the prostate for size as well as evidence of tumor. Transillumination is used to determine the density of scrotal tissue. Pelvic examination is performed to evaluate female reproductive structures. Bladder percussion reveals information about the status of the bladder.

The nurse is assisting a 30-year-old client in scheduling an appointment for a cervical biopsy. The nurse would recommend that the client schedule the testing at which time? A) 1 week after completion of the client's menstrual cycle B) 2 weeks before the onset of the client's menstrual cycle C) 3 weeks after the onset of the client's menstrual cycle D) 2 weeks after the cessation of the client's menstrual cycle

Ans: A Feedback: Because the client is premenopausal, the nurse would recommend scheduling the cervical biopsy for 1 week after the end of a menstrual period, when the cervix is least vascular. Scheduling the test for any other time would be inappropriate.

The nurse is preparing the female client for a pelvic examination. In which position will the nurse assist the client? A) Lithotomy position B) Supine position C) Trendelenburg's position D) Lateral recumbent

Ans: A Feedback: For a pelvic examination, the nurse is most correct to assist the client to the lithotomy position. In this position, the client lies on her back with the legs bent and spread. Many times, the feet are in lithotomy stirrups. The supine position is flat on the back. The Trendelenburg's position provides the feet higher than the head at a 15° to 30° angle. The lateral recumbent position is a side-lying position.

The nurse is caring for a client scheduled for a transrectal ultrasonography. Which instruction is essential in obtaining an accurate test? A) Administer an enema prior to arrival. B) Administer a low-dose sedative prior to arrival. C) Avoids fluids after midnight. D) Empty the bladder prior to the exam.

Ans: A Feedback: The client will need to have an enema to remove stool from the rectum so that the ultrasound can penetrate through the tissues to visualize structures of the prostate. The nurse is also correct to instruct that the test is not painful. Typically, a sedative is not needed as the client uses normal relaxation techniques. Urine status is not the focus of the exam requiring that fluids be withheld.

The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening? A) Labia majora and minora B) Meatus C) Clitoris D) Fourchette

Ans: A Feedback: The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.

When instructing clients at a prenatal class, the nurse is most correct to state which medical name as being removed during circumcision? A) The prepuce B) The glans C) The shaft D) The corpora cavernosa

Ans: A Feedback: The prepuce or foreskin is removed during circumcision. The prepuce covers the glans. The shaft is tubular and composed of erectile tissue. The corpora cavernosa is a column of erectile tissue.

Which of the following would be most important for the nurse to include to ensure a thorough baseline history related to the reproductive system? A) Age of menarche B) Nutritional history C) Exercise and fitness routine D) Cultural history

Ans: A Feedback: To ensure a thorough baseline history, the nurse obtains information on the client's general health and family history, age of menarche, and menstrual history. Although the client's nutritional history, exercise and fitness routines, and cultural history are important, they are part of the overall client health history and not specific to the reproductive system

The physician and nurse are completing a physical examination of the male genitalia. Which assessment findings are documented? Select all that apply. A) Inspection for urethral drainage B) Cultures C) Digital rectal examination D) Transillumination E) Palpation of the testes F) Prostate-specific antigen level

Ans: A, C, D, E Feedback: The nurse and physician document the physical assessment including inspection of external genitalia and noting any drainage. A digital rectal examination and transillumination also provides physical assessment data of the status of the prostate gland. Cultures and prostate-specific antigen levels provide diagnostic information.

A nurse is caring for a client following a culdoscopy. Which assessment data would the licensed practical nurse report to the registered nurse? A) Pain level of 7 on the 0-to-10 pain scale B) Skin, cold; pulse, 110 beat/minute; blood pressure, 104/64 mm Hg C) Dark drainage noted on surgical pad D) Fleshy smell noted to perineal region

Ans: B Feedback: Culdoscopy is performed to visualize the uterus, broad ligaments, and fallopian tubes. An endoscope is inserted through a small incision made in the posterior vaginal wall. Afterward, the nurse must observe for signs of internal bleeding and shock. A client with cold and clammy skin, a rapid pulse, and low blood pressure indicates shock and the need to consult the registered nurse and even the physician. All of the other symptoms are able to be addressed by the licensed practical nurse. The client is to be medicated. Dark drainage and a fleshy smell to the perineal area are normal for old surgical drainage.

The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history? A) Asthma with beta-adrenergic inhaler use B) Angina with nitrate use C) Chronic pain with narcotic use D) Arthritis with corticosteroid use

Ans: B Feedback: Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, option B has the most serious side effects.

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? A) Bronchodilators B) Antihypertensives C) Cardiac dysrhythmics D) Antibiotics

Ans: B Feedback: 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

5. During a physical examination, the nurse inspects the eternal genitalia of a male client. Which of the following would the nurse identify as an abnormality? A) Absence of urethral discharge B) Skin lesions C) Prepuce covering the glans penis D) Slightly pendulous scrotum

Ans: B Feedback: During a physical examination, the nurse inspects the external genitalia, looking for abnormalities such as skin lesions and urethral discharge. Prepuce covering the glans penis is a normal finding in an uncircumcised male. The scrotum is normally pendulous, and with increasing age, it becomes more pendulous.

The nurse is completing community education when asked by a client without health insurance why a mammogram is needed if the women are completing breast self-examinations at home. The nurse is most correct to respond stating which of the following? A) "Mammograms are just better." B) "Mammograms can detect cysts or tumors too small to palpate." C) "Mammograms provide a baseline that shows changes in breast tissue." D) "Mammograms provide a reassurance that the breast is free of cancer."

Ans: B Feedback: During community instruction, it is most important to relay facts in a clear, factual, and nonjudgmental way. Stating the need for mammograms to detect small cysts or tumors is clear and factual. Stating the mammograms are "better" is vague and provides no better understanding. Although a mammogram does provide a baseline and reassurance of breast health, the most clear and factual reason why the mammogram is completed is its ability to detect cancerous tumors at an early stage.

The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following? A) Transrectal ultrasonography B) Tissue biopsy C) Tumor marker studies D) Digital rectal exam

Ans: B Feedback: Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provided data on the shape, size, and texture of the prostate gland.

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? A) Bartholin glands B) Prostate gland C) Cowper's glands D) Vas deferens

Ans: B Feedback: 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.

The nurse is instructing a couple in the early stages of infertility testing who has just found that the male has a slightly low sperm count. Which easy change can a nurse suggest to a male client? A) Avoid riding on motorcycles. B) Wear loose fitting underwear instead of tight ones. C) Take a general multivitamin. D) Increase sexual intercourse to every day.

Ans: B Feedback: Wearing loose fitting underwear allows the scrotum to pull the testes closer to the body to maintain proper temperature for sperm production or allow the testes to be farther from the body. Because the testes cannot produce viable sperm when temperatures are at or above body temperature, their location within the scrotal sac ensures optimal conditions. There is no evidence that the client cannot ride motorcycles. Taking a general multivitamin is encouraged for overall health. Daily sexual intercourse is not encouraged because it is most important to have sufficient sperm present during a female's ovulation period.

The nurse is providing teaching to a client who is scheduled for a mammogram. Which of the following would the nurse include as a way to avoid artifacts on the x-ray film? A) "Don't wear any jewelry around your neck on the day of the test." B) "Avoid using a deodorant with aluminum hydroxide." C) "Make sure not to eat or drink for 4 hours before the test." D) "Drink at least 1 quart of water 45 minutes to 1 hour before the test."

Ans: B Feedback: When a mammogram is scheduled, the nurse explains the radiographic procedure and instructs the client to avoid using a deodorant with aluminum hydroxide or body talc on the day of the test to avoid artifacts on the x-ray film. Not wearing jewelry is a precaution for any radiographic test. Fasting is not required before a mammogram. Drinking water before the test is appropriate for an abdominal ultrasound.

A client presents with symptoms of menstrual difficulties and infertility. Which hormone is essential in the maintenance of the endometrium? A) Estrogen B) Progesterone C) Testosterone D) Prolactin

Ans: B Feedback: Without a high level of progesterone, the endometrium (uterine lining) degenerates and shreds. Estrogen is a hormone that is essential for menstruation and prepares the uterus for pregnancy. Women produce testosterone, which maintains muscle mass, bone strength, and sex drive. Prolactin is produced by the pituitary gland and stimulates lactation.

The client is asking the nurse to explain the typical treatment expected when a class 4 Papanicolaou test is reported. The nurse is most correct to state which of the following? A) No further treatment is considered. B) The test will need repeated in 3 months. C) Further evaluation is needed for potential malignancy. D) Chemotherapy is needed and radiation is suggested.

Ans: C Feedback: A class 4 Papanicolaou test (Pap test) is strongly suggestive of malignancy. Further testing is needed to confirm the type and extent of cancer. The nurse would not suggest that no treatment is needed or to wait for 3 months. The nurse would also not suggest a typical treatment without further diagnostic testing.

A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct? A) "The office staff can schedule your clinical breast examination twice a year." B) "The diagnostic center will send you a reminder card to complete the annual examination." C) "The clinical breast evaluation will be completed with annual gynecologic examination." D) "You can complete the examination at home and report if you found anything abnormal."

Ans: C Feedback: A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.

Which of the following instructions would be appropriate to include when preparing a woman for an abdominal ultrasound? A) Restrict solid food intake for 2 hours before the test. B) Refrain from douching for at least 1 week before the test. C) Drink at least 1 quart of water an hour before the test. D) Empty the bladder immediately before the test.

Ans: C Feedback: Drinking at least 1 quart of water 45 minutes to 1 hour before the test and no voiding until after the test ensures a full bladder and facilitates transmission of the ultrasound waves. It also elevates the bowel away from the other pelvic organs. The client should restrict solid food intake for 6 to 8 hours before the test to avoid having images of her test obscured by gas and intestinal contents. There is no restriction on douching for this test. A full bladder, not an empty one, facilitates this test.

The nurse is describing various terms related to the male reproductive system. Which term would the nurse use to describe the discharge of semen from the penis? A) Erection B) Emission C) Ejaculation D) Engorgement

Ans: C Feedback: Ejaculation refers to the discharge of semen from the penis. Erection refers to the state in which the penis becomes elongated and rigid. Dilation of the penile arteries compresses the veins within the penis causing engorgement of blood within the tissue. Emission refers to the movement of sperm and their mixture with fluid forms the seminal vesicles and prostate gland into the urethra.

The nurse is relating health education to male students when asked where sperm is actually made. Which location is most correct? A) In the male reproductive system B) Sperm are present from birth. C) In the testes within the scrotum D) In the seminiferous tubules

Ans: C Feedback: Health instruction should be clear, specific, and factual. The specific location for sperm production is in the testes, which lie in the scrotum. More general information is that the sperm are produced in the male reproductive system and immature spermatozoa are formed in the seminiferous tubules. Sperm are not present from birth.

What information would the nurse give the client when the client inquires what makes breast milk production? A) Estrogen B) Progesterone C) Prolactin D) Testosterone

Ans: C Feedback: Prolactin promotes the production of breast milk. Estrogen secreted by the ovaries at the onset of puberty causes the development of the mammary system. Progesterone, secreted by the placenta, stimulates the development of alveoli, which secrete the milk. Testosterone does not impact milk production.

Which of the following client statements indicates successful teaching of a client who is scheduled to have a Pap test? A) "I'll schedule the test for the time when I have my next menstrual period." B) "I need to refrain from sexual intercourse for at least 1 week before the test." C) "I will stop using any vaginal medications at least 48 hours before the test." D) "I need to use a vinegar and water douche the morning of the test."

Ans: C Feedback: Teaching is effective when the client schedules an appointment at a time other than during menstruation and does the following before the appointment: (1) avoids intercourse for 2 days, (2) refrains from douching for 1 day, and (3) ceases the use of vaginal medications for at least 48 hours.

A mother of an adolescent female is asking the nurse for guidelines of when her daughter should have her first Papanicolaou test (Pap test) and then the subsequent frequency. The nurse is most correct to state which? A) The first Pap test should be at age 16 years and then annually thereafter. B) The first Pap test should be no later than 18 years of age and then every other year afterward. C) The first Pap test should be no later than age 21 years and then every 3 to 5 years afterward. D) The first Pap test should be within the first year of menstruation and annually afterward.

Ans: C Feedback: The American Cancer Society (ACS) recommends that all women have an initial Pap test by 21 years of age. According to the American College of Obstetricians and Gynecologists, most women do not need cervical cancer screening more frequently than every 3 to 5 years.

The nurse is caring for a client who states having an irregular menstrual period. Which diagnostic test provides information of the body's ability to ovulate? A) Thyroid level B) Serum luteinizing hormone C) Serum follicle-stimulating hormone D) Estrogen level

Ans: C Feedback: The anterior pituitary hormone known a follicle-stimulating hormone (FSH) initiates ovulation monthly. Monitoring the FSH level provides information about the timing of ovulation. Thyroid level, estrogen level, and serum luteinizing hormone do not give information about the ability to ovulate.

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? A) The nurse would highlight the uterus. B) The nurse would highlight the cervix. C) The nurse would highlight the fallopian tube. D) The nurse would highlight the ovaries.

Ans: C Feedback: 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.

A group of students are reviewing information related to the male reproductive system structures. The students demonstrate understanding of the information when they identify which structure as an accessory organ? A) Vas deferens B) Epididymis C) Scrotum D) Seminal vesicles

Ans: D Feedback: Accessory structures include the seminal vesicles, which join with the ductus deferens to become the ejaculatory duct, the prostate gland, and the bulbourethral glands. The vas deferens and epididymis are internal male reproductive structures. The scrotum is an external male reproductive structure.

Which nursing question is essential when caring for a client prior to a pelvic examination? A) "Are you sexually active?" B) "Do you have any sexually transmitted diseases?" C) "Would you like to have assistance to get in position for the exam?" D) "Would you like to void at this time?"

Ans: D Feedback: Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.

The nurse is conducting a health history when the client states that her last menstrual period was 6 months ago. Upon further questioning, the client also states that symptoms of hot flashes and mood fluctuations. Which question should the nurse ask next? A) "Do you feel like hurting yourself?" B) "Are you finished having children?" C) "When was your first menstrual period?" D) "Are you taking any hormone replacement therapy?"

Ans: D Feedback: To ensure a thorough health history, a client who exhibits symptoms of perimenopause should be assessed for the use of hormone replacement therapy to alleviate the symptoms. This information adds to the data reported by the client. Asking if the client feels like hurting herself may be extreme with the report of mood fluctuations. Asking if the client is finished having children produces little additional data. Asking the first menstrual period is part of the health history but not the best question to ask after the client's statement.

A nurse is caring for a client who is being evaluated for a lump found on the lateral aspect of the right breast. The client is anxious and asks the nurse if the next step is to have a mastectomy. Which is the nurse's best response? A) "Yes, breast lumps are abnormal and will need to be removed." B) "The doctor will need a biopsy first to see if the lump is cancerous." C) "The doctor will answer your questions when he or she arrives." D) "Many times, an ultrasound is done to distinguish between a tumor and cyst."

Ans: D Feedback: Ultrasonography is often used with a mammogram or after a breast lump is found to provide additional data on the breast lump. An ultrasound can differentiate if the lump is a fluid filled cyst or other types of breast lesions. This step may be used before a mastectomy is performed or even a biopsy is completed. The nurse is able to provide factual information on common treatment paths, understanding that it is the physician who prescribes the medical care.

An instructor is preparing a teaching plan for a group of students about reproductive structures and sexual arousal. Which female reproductive structure would the instructor include? A) The mons pubis B) The clitoris C) Labia minora D) Labia majora

Ans: B Feedback: At the superior junction of the labia, there is a fleshy protrusion of tissue called the clitoris. The clitoris is an erectile tissue that enlarges and becomes sensitive when stimulated by the penis or touching that accompanies sexual foreplay. The mons pubis, labia minora, and labia majora are female reproductive structures but do not play as prominent a role in sexual arousal.

The nurse is obtaining a health history at the client's annual gynecologic exam. Which of the following statements regarding a Papanicolaou test (Pap test) for cancer screening would delay the exam? A) "I had sexual intercourse several days ago." B) "I voided before entering the exam room." C) "My menstrual period began yesterday." D) "I use no vaginal sprays or creams."

Ans: C Feedback: The nurse advises that the Pap test be rescheduled to a time other than during the menstrual period. The other options are acceptable to continue the test procedure.