Chapter 52: Introduction to the Reproductive System

A client has undergone Papanicolaou screening, and the findings show no atypical or abnormal cells. What class would the nurse document these findings?

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Which diagnostic test is indicated for postmenopausal bleeding? a. Endometrial biopsy b. Computed tomography c. Ultrasound d. Magnetic resonance imaging

a For postmenopausal bleeding, an endometrial biopsy or D&C is indicated.

A premenopausal client is complaining of vaginal spotting and sharp, colicky lower abdominal pain. She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this client to be investigated for what health problem? a. Trichomonas vaginalis b. Ectopic pregnancy c. Cervical cancer d. Fibromyalgia

b Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal infection. Cervical cancer and fibromyalgia do not affect menstruation.

A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the client? a. Sodium restriction b. Adopting a vegan diet c. Massage therapy d. Vitamin supplements

d For some women, vitamins B6 and E have proven beneficial for the treatment of hot flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.

A 15-year-old girl is brought to the clinic by her mother to see her primary provider. The mother states that her daughter has not started to develop sexually. The physical examination shows that the client has no indication of secondary sexual characteristics. What diagnosis should the nurse suspect? a. Primary amenorrhea b. Dyspareunia c. Vaginal atrophy d. Secondary dysmenorrhea

a Primary amenorrhea (delayed menarche) refers to the situation in which young women older than 16 years of age have not begun to menstruate but otherwise show evidence of sexual maturation, or in which young women have not begun to menstruate and have not begun to show development of secondary sex characteristics by 14 years of age. In secondary dysmenorrhea, pelvic pathology such as endometriosis, tumor, or pelvic inflammatory disease (PID) contributes to symptoms. Dyspareunia is painful intercourse and vaginal atrophy would not contribute to the delayed onset of puberty.

Reproductive systems form during: a. embryonic development. b. the toddler years. c. puberty. d. late adolescence.

a The reproductive systems of females and males form during embryonic development but do not become active and functional until puberty.

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

b 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 Class 5 Pap smear would be interpreted as which of the following? a. Malignant b. Normal c. Probably normal d. Suspicious

a A class 5 Pap smear, according to the Bethesda Classification, indicates squamous cell carcinoma. A class 1 Pap smear is interpreted as normal. A class 2 Pap smear is interpreted as probably normal. A class 3 Pap smear is interpreted as suspicious.

A female patient is scheduled to undergo a Papanicolaou test. The nurse should advise the patient of which of the following? a. Avoid intercourse for 2 days prior to the procedure. b. Have a douche prior to the procedure. c. Do not discontinue the use of vaginal medications if any. d. Avoid consuming food containing iodine 48 hours prior to the procedure.

a When a patient is scheduled for a Papanicolaou test, the nurse advises the patient to avoid intercourse for 2 days, refrain from douching for 1 day, and avoid vaginal medications for at least 48 hours. Consuming food containing iodine is not contraindicated for a Papanicolaou test.

The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new client. According to this model, the nurse should begin with what action? a. Conducting a preliminary assessment b. Addressing the client's psychosocial status c. Asking the client's permission to discuss sexuality d. Assessing for physiologic problems

c The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.

A 21-year-old woman has sought care because of "heavy periods" and has subsequently been diagnosed with menorrhagia. The nurse should recognize which of the following as the most likely cause of the client's health problem? a. Hormonal disturbances b. Cervical or uterine cancer c. Pelvic inflammatory disease d. A sexually transmitted infection (STI)

a Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. In young women, the cause is usually related to endocrine disturbance; in later life, it usually results from inflammatory disturbances, tumors of the uterus, or hormonal imbalance. STIs, pelvic inflammatory disease, and cancer are less likely causes.

The nurse is caring for a couple trying to get pregnant and have not been able to for over a year. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? a. "Men can have increased prolactin levels that decrease sperm viability." b. "Men can have problems that increase the temperature around their testicles and decrease the quality of their semen." c. "Men may inherit the gene that causes low sperm production." d. "Men may produce sperm that are incompatible with the shape of the egg."

b Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Low prolactin levels may contribute to the problem. Genetic factors are not noted to relate to male infertility. Infertility is not normally linked to sperm that are incompatible with the shape of the egg.

A nurse practitioner is teaching a woman how to do a BSE. While inspecting the breasts, the nurse notes this abnormal sign. Which of the following is considered an abnormal sign? a. Unevenness in size b. Asymmetry c. Dimpling or retraction d. Nipple inversion that has been present for >10 years.

c Dimpling or retraction observed during position changes suggests an underlying mass. Deep, pin-point dimpling, similar to the skin of an orange, is associated with carcinoma.

The nurse is working with a couple who is being evaluated for infertility. What nursing intervention would be most appropriate for this couple's likely needs? a. Educating them about parenting techniques in order to foster hope b. Educating them about the benefits of child-free living c. Choosing the most appropriate reproductive technology d. Referring them to appropriate community resources

d Nursing interventions appropriate when working with couples during infertility evaluations include referring the couple to appropriate resources when necessary. It would likely be considered offensive and insensitive to focus the couple on parenting skills or the benefits of child-free living. Choosing particular reproductive technologies is beyond the nurse's scope of practice.

A 17-year-old girl has come to the free clinic for her annual examination. She tells the nurse she uses tampons and asks how long she may safely leave her tampon in place. What is the nurse's best response? a. "You may leave the tampon in overnight." b. "The tampon should be changed at least twice per day." c. "Tampons are dangerous and, ideally, you should not be using them." d. "Tampons need to be changed every 4 to 6 hours."

d Tampons should not be used for more than 4 to 6 hours, nor should superabsorbent tampons be used because of the association with toxic shock syndrome. If used appropriately, it is acceptable and safe for the client to use tampons.

The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as? a. Dysmenorrhea b. Dyspareunia c. Dysuria d. Dysthymia

b Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or secondary and may occur at the beginning of, during, or after intercourse.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder? a. Candida b. Eschar c. Trichomonas d. Escherichia coli

c A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curd-like, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

The nurse educator is teaching a group of nursing students in a reproductive health class. The students are correct in identifying that a woman is most likely to be unable to become pregnant at what age? a. 49 years old b. 35 years old c. 40 years old d. 18 years old

a Menopause marks the end of a woman's reproductive capacity, which typically occurs between 45 and 52 years of age. The alternate options are ages that are under the typical age of onset for menopause.

A Class 2 Pap smear would be interpreted as which of the following? a. Probably normal b. Malignant c. Normal d. Suspicious

a A class 2 Pap smear is interpreted as probably normal. A class 5 Pap smear, according to the Bethesda Classification, indicates squamous cell carcinoma. A class 1 Pap smear is interpreted as normal. A class 3 Pap smear is interpreted as suspicious.

A couple that has been married for 5 years is unable to conceive a child. Diagnostic test results indicate that the husband has a low sperm count. What sperm count indicates infertility? a. less than 20 million sperm per milliliter b. less than15 million sperm per milliliter c. less than 30 million sperm per milliliter d. less than 10 million sperm per milliliter

a A count of fewer than 20 million spermatozoa per milliliter results in infertility.

Hormone therapy decreases the risk of a. hot flashes. b. stroke. c. heart attack. d. blood clots.

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

A nurse educator explains to a group of young male students that ejaculation is the discharge of semen, or fluid that contains sperm, from the penis. The normal volume of ejaculate is _______, which contains an average of ________ spermatozoa per milliliter. a. 2 to 6 mL; 60 to 100 million b. 8 to 10 mL; 40 to 60 million c. 2 to 4 mL; 80 to 100 million d. 12 to 16 mL; 60 to 100 million

a The normal volume of ejaculate is 2 to 6 mL, which contains an average of 60 to 100 million spermatozoa per milliliter.

A nurse in a gynecology office is talking with a client who is scheduled to have a Papanicolaou test. What information should the nurse provide the client in preparation for a Papanicolaou test? a. Avoid intercourse for 2 days prior to the procedure. b. Have a douche prior to the procedure. c. Do not discontinue the use of vaginal medications. d. Avoid consuming food containing iodine 48 hours prior to the procedure.

a When a client is scheduled for a Papanicolaou test, the nurse advises the client to avoid intercourse for 2 days. The client should refrain from douching for at least 48 hours. The client should cease the use of vaginal creams, sprays, powders, or medications for at least 48 hours. Refraining from consuming foods with iodine is not a recommendation.

A client with anorexia experienced a severe reduction in body fat by extreme caloric restriction and exercise. Which female reproductive abnormalities could be acquired as a result of this reduction in body fat? Select all that apply. a. delay or cessation of menstruation b. impaired potential for the implantation of a fertilized ovum c. higher risk of fibrocystic breast disease d. polycystic ovarian syndrome

a, b Clients with anorexia can experience amenorrhea and reproductive abnormalities such as small breasts and impaired potential for implantation of a fertilized ovum. Fibrocystic breast disease and polycystic ovarian syndrome are not associated with low body fat.

A client in her late 50s has expressed to the nurse her desire to explore hormone therapy (HT). Based on what aspect of the client's health history is HT likely contraindicated? a. History of vaginal dryness b. History of hot flashes and night sweats c. History of vascular thrombosis d. Family history of osteoporosis

c The use of HT is contraindicated in women with a history of vascular thrombosis, active liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HT is beneficial in women with a risk for osteoporosis. Vaginal dryness, hot flashes, and night sweats are symptoms of menopause that may be relieved with HT.

A clinic nurse is meeting with a 38-year-old client who states that she would like to resume using oral contraceptives, which she used for several years during her 20s. What assessment question is most likely to reveal a potential contraindication to oral contraceptive use? a. "Have you ever had gynecologic surgery?" b. "Have you ever had a sexually transmitted infection?" c. "When did you last have your blood sugar levels checked?" d. "Do you smoke?"

d Women who smoke and who are 35 years of age or older should not take oral contraceptives because of an increased risk for cardiac problems. Previous surgeries, STIs, and blood sugar instability do not necessarily contraindicate the use of oral contraceptives.

A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation? a. Avoid intercourse for 7 days before the procedure b. Do not douche before the procedure c. Make sure the procedure is scheduled during menstruation d. Avoid consuming food that contains iodine 48 hours before the procedure

b To avoid washing away cellular material, the client should be instructed not to douche before having a Pap test. A Pap test should be performed when a client is not menstruating because blood usually interferes with interpretation. Consuming food that contains iodine is not contraindicated for a Papanicolaou test. The client should be instructed to avoid intercourse for 2 days prior to having the Pap test.

Fertility studies for men include a semen analysis to determine sperm count, sperm motility, and abnormal sperm. Which test can also be performed to determine infertility? a. Prostate-specific antigen (PSA) assay test b. Needle biopsy of prostatic tissue c. Blood test for luteinizing hormone (LH) d. Cystoscopy

c A decrease in the concentration of LH in the blood may be responsible for decreased testosterone production and infertility. A needle biopsy of prostatic tissue is obtained to diagnose a definitive cancer of the prostate. The PSA assay is a blood test that detects prostate cancer.

The nurse is taking the sexual history of an adolescent who has come into the free clinic. What question best assesses the client's need for further information? a. "Are you involved in an intimate relationship at this time?" b. "How many sexual partners have you had?" c. "What questions or concerns do you have about your sexual health?" d. "Have you ever been diagnosed with a sexually transmitted infection?"

c An open-ended question related to the client's need for further information should be included while obtaining a sexual history. None of the other listed questions are open-ended.

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort? a. Ibuprofen b. Petroleum jelly c. Water-based lubricant d. Aspirin

c For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.

A couple with a diagnosis of ovarian failure discusses their infertility options with their physician. The nurse should recognize which of the following as the treatment of choice for a client with ovarian failure? a. Intracytoplasmic sperm injection b. Artificial insemination c. Gamete intrafallopian transfer d. In vitro fertilization

c Gamete intrafallopian transfer (GIFT), a variation of IVF, is the treatment of choice for clients with ovarian failure. In intracytoplasmic sperm injection (ICSI), an ovum is retrieved as described previously, and a single sperm is injected through the zona pellucida, through the egg membrane, and into the cytoplasm of the oocyte. The fertilized egg is then transferred back to the donor. ICSI is the treatment of choice in severe male factor infertility. IVF involves ovarian stimulation, egg retrieval, fertilization, and embryo transfer. Artificial insemination is the deposit of semen into the female genital tract by artificial means.

Which structure is referred to as the vulva? a. external female genitalia b. clitoris c. mons pubis d. vagina

a The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).

A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained? a. age of first ejaculate b. contraceptive practices c. pain during sexual intercourse d. premature ejaculation or other concerns of a sexual nature

a Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.

A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision? a. Prepuce b. Glans c. Corpora cavernosa d. Mons pubis

a In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.

By initiating an assessment about sexual concerns what information should the nurse convey to the client? Select all that apply. a. That sexual issues are valid health issues b. That it is safe to talk about sexual issues c. That sexual issues are a comparatively minor aspect of a person's identity d. That changes or problems in sexual functioning should be discussed e. That changes or problems in sexual functioning are highly atypical

a, b, d By initiating an assessment about sexual concerns, the nurse communicates to the client that issues about changes or problems in sexual functioning are valid and significant health issues. The nurse communicates that it is safe to talk about sexual issues and that changes or challenges in sexual function are not unusual.

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? a. Giving the client a mild sedative before the procedure b. Administering laxatives and an enema prior to the procedure c. Ensuring that the client has a full bladder d. Checking that it has been 5 days since the end of her menses

c 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 working with a couple who have been unable to conceive despite more than 2 years of trying to get pregnant. The couple has just learned that in vitro fertilization (IVF) was unsuccessful and they are both tearful. What nursing diagnosis is most likely to apply to this couple? a. Hopelessness related to failed IVF b. Acute confusion related to reasons for failed IVF c. Compromised family coping related to unsuccessful IVF d. Moral distress related to unsuccessful IVF

a Although further assessment is undoubtedly necessary, it is likely that the couple will be experiencing hopelessness at the news that a potentially promising intervention has failed. Acute confusion denotes a cognitive deficit, not a sense of despair. Sadness at this news is not necessarily suggestive of impaired coping. Moral distress is unlikely because this is not a situation involving morality.

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? a. Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. b. Methotrexate is used only in early pregnancy to terminate a pregnancy nonsurgically. c. Clomiphene (Clomid) is used only in early pregnancy to terminate a pregnancy nonsurgically. d. Birth control pills can be used to terminate the pregnancy.

a 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 conducting a health education class for a group of 12- to 14-year-old girls and describing the events of secretory phase. Which of the following would the nurse include? a. Thickening of the uterine wall b. Ovulation c. Disintegration of the ovum d. Shedding of the uterine lining

b The secretory phase occurs near the middle portion of the cycle, during which ovulation occurs. Thickening of the uterine wall occurs during the proliferative phase. Disintegration of the ovum and shedding of the uterine lining occur during the luteal phase.

A 51-year-old woman is experiencing perimenopausal symptoms and expresses confusion around the possible use of hormone therapy (HT). She explains that her mother and aunts used HT and she is unsure why few of her peers have been prescribed this treatment. What should the nurse explain to the client? a. Large, long-term health studies have revealed that HT is minimally effective. b. HT has been largely replaced by other nonpharmacologic interventions. c. Research has shown that significant health risks are associated with HT. d. HT has been shown to exacerbate symptoms of menopause in a minority of women.

c HT is effective, but has been associated with serious adverse effects. However, it does not exacerbate the symptoms of menopause. Nonpharmacologic interventions that address perimenopausal symptoms to the same degree as HT have not yet been identified.

A client has been diagnosed with an enlarged prostate. What information should the nurse explain to the client about the effects of an enlarged prostate? a. Painful erection b. Inability to defecate c. Retention of urine d. Lower sperm count

c One of the symptoms of an enlarged prostate is urine retention. An enlarged prostate results in an inability to have an erection, and not painful erection. Men with prostate may experience difficulty during urination, but they don't face difficulties in defecation. Low sperm count is also not directly associated with an enlarged prostate.

During the nurse's assessment of a female client, the client reveals that she experienced sexual abuse when she was a young woman. What is the nurse's most appropriate response to this disclosure? a. Reassure her that this information will be kept a secret. b. Begin the process of intensive psychotherapy. c. Encourage the client to phone 911. d. Facilitate appropriate resources and referrals.

d The nurse's primary roles in light of this disclosure are to provide empathy and to arrange for appropriate resources and referrals. There is no need to phone 911 because there is no immediate threat and psychotherapy is beyond the nurse's scope of practice. The client's confidentiality will be respected, but this does not mean that the nurse can promise to keep it a secret.

A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman? a. Serum progesterone b. Abdominal CT c. Oocyte viability test d. Urine testosterone

a Diagnostic studies performed to determine if ovulation is regular and whether the progestational endometrium is adequate for implantation may include a serum progesterone level and an ovulation index. None of the other listed tests is used to investigate infertility.

The nurse is caring for a client who has been admitted to hospital for uterine bleeding after incomplete miscarriage. The nurse knows what will be included in this client's treatment? a. Dilation and curettage b. Endometrial ablation c. Ultrasonography d. Hysteroscopy

a Dilation and curettage (D&C) can be used as a diagnostic or therapeutic tool. The cervical canal is dilated and the endometrium is scraped. D&C can be used to gather endometrial tissue for cytologic examination, control abnormal uterine bleeding, and as a therapeutic measure for incomplete miscarriage. In this case, D&C is being used as a therapeutic intervention to control bleeding from the incomplete passage of residual tissue in the uterus. Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. Performed in an outpatient setting under general, regional, or local anesthesia, the uterus is distended with a fluid infusion. Ultrasonography is useful adjunct to the physical examination for patients with abnormal pelvic findings but is not useful as a therapeutic treatment of uterine bleeding. A hysteroscopy allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument. It is used as a diagnostic tool, not a treatment for bleeding.

An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what? a. Lack of ovulation b. Chronic vaginitis c. A sexually transmitted infection d. Ectopic pregnancy

a Dysfunctional uterine bleeding can occur at any age, but is most common at opposite ends of the reproductive lifespan. It is usually secondary to anovulation (lack of ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or ectopic pregnancy.

The nurse is caring for a client who is being supplemented with the hormone responsible for developing and maintaining the female reproductive organs. This client is being treated with what hormone? a. Estrogen b. Progesterone c. Androgens d. Follicle-stimulating hormone

a Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.

A nursing instructor is giving a lecture on the reproductive system, and describes the process of the ovum being released from the ovary and then traveling into the end of a fallopian tube. If the production of progesterone by the corpus luteum begins to decrease until it changes from a yellow to a white spot on the ovary, it is most likely that the ovum: a. was not fertilized. b. was fertilized. c. didn't reach the fallopian tube. d. was not expelled from the ovary.

a If the ovum is not fertilized, the production of progesterone by the corpus luteum begins to decrease until it changes from a yellow to a white spot on the ovary (corpus albicans). Without a high level of progesterone, the endometrium degenerates and sheds, a process referred to as menstruation.

The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient? a. Calcium b. Iron c. Salt d. Vitamin K

a Postmenopausal women should be encouraged to observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow the process of osteoporosis. Iron and vitamin K need not be increased unless there are signs of deficiency. Salt should be eaten in moderation, not increased, to prevent hypertension.

What are the effects of hormones on breast tissue during pregnancy? a. Prolactin promotes the production of milk; progesterone stimulates the development of alveoli, which secrete the milk; and estrogen stimulates increased production of tubules and ducts to transport milk to the lactiferous ducts, which drain at the nipple. b. Luteinizing hormone promotes the production of milk; progesterone stimulates the development of alveoli, which secrete the milk; and estrogen stimulates increased production of tubules and ducts to transport milk to the lactiferous ducts, which drain at the nipple. c. Prolactin promotes the production of milk; estrogen stimulates the development of alveoli, which secrete the milk; and progesterone stimulates increased production of tubules and ducts to transport milk to the lactiferous ducts, which drain at the nipple. d. Luteinizing hormone promotes the production of milk; estrogen stimulates the development of alveoli, which secrete the milk; and progesterone stimulates increased production of tubules and ducts to transport milk to the lactiferous ducts, which drain at the nipple.

a Prolactin promotes the production of milk from elements in the blood. Progesterone, secreted by the placenta, stimulates the development of alveoli, which secrete the milk. Estrogen, also secreted by the placenta, stimulates increased production of tubules and ducts to transport milk to the lactiferous ducts, which drain at the nipple.

Which structure is involved in keeping the testes at the necessary temperature to ensure sperm production? a. scrotum b. testicles c. epididymis d. shaft

a To maintain the temperature of the testes 3 degrees cooler than body temperature, smooth and skeletal muscles in the scrotum pull the tissue toward the body when external temperatures are cold. On the other hand, the smooth muscles relax, causing the scrotum to become loose and hang away from the body when environmental temperatures are hot. The scrotum is the divided sac of skin that contains the right and left testes, also called testicles. The location of the testes within the scrotal sac ensures optimum conditions for sperm production.

A nurse in a gynecology office is talking with a client who is scheduled to have a Papanicolaou test. What information should the nurse provide the client in preparation for a Papanicolaou test? a. Avoid intercourse for 2 days prior to the procedure. b. Have a douche prior to the procedure. c. Do not discontinue the use of vaginal medications. d. Avoid consuming food containing iodine 48 hours prior to the procedure.

a When a client is scheduled for a Papanicolaou test, the nurse advises the client to avoid intercourse for 2 days. The client should refrain from douching for at least 48 hours. The client should cease the use of vaginal creams, sprays, powders, or medications for at least 48 hours. Refraining from consuming foods with iodine is not a recommendation.

The nurse, who is conducting a Papanicolaou (Pap) smear, performs which actions to promote client comfort during the procedure? Select all that apply. a. Ensure warming of the speculum b. Lubricate the blades of the speculum c. Use a quick motion to open the speculum once inserted d. Flush away any purulent material at the cervical os e. Explain to the client that some discomfort is normal

a, b, e Warming the speculum prior to insertion can be more comfortable for the client. Lubrication of the outer superior and inferior blade of the plastic vaginal speculum with a small amount of a water-soluble lubricant gel decreases the pain associated with insertion and opening of the vaginal speculum in both premenopausal and postmenopausal women, without affecting the quality of the cytology results during the collection of Pap test specimens. The nurse should share education about the pelvic examination with the client to proceed more smoothly and ensure the client knows what to expect. Along with other important information about the procedure, the nurse should tell the client it is normal to feel uncomfortable and apprehensive. During the pelvic examination, when the speculum is positioned properly, it should be opened slowly, not using a quick motion, to visualize the cervix as this would be uncomfortable to the client. If there is purulent drainage at the cervical os, this is an indication there could be an infection present. The nurse should obtain a culture of the drainage with a sterile applicator, not flushing the drainage away.

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? a. Cystocele b. Rectocele c. Uterine prolapse d. Hemorrhoids

b 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 practitioner is conducting a history and physical on a 42-year-old woman. One of the questions asked of someone in this age group is the type of medications that the patient's mother took during her pregnancy. The nurse is assessing for a past history of ______ use. a. Immunosuppressive agents b. Diethylstilbestrol c. Cancer drugs d. Antibiotics

b Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.

A client calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data? a. The drainage is physiologic and normal. b. The client may have a Candida species infection. c. The client needs a Pap smear as soon as possible. d. The client may have a Trichomonas infection.

b Drainage caused by Candida is typically curd-like and white. Trichomonas infections usually cause copious, frothy yellowish-green discharge. There is no immediate need for a Pap smear, as malignancy is an unlikely cause.

Which test is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent? a. Laparoscopy b. Hysterosalpingography c. Hysteroscopy d. Endometrial ablation

b Hysterosalpingography is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows the pelvic structures to be visualized. A hysteroscopy allows direct visualization of all parts of the uterine cavity be means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.

A newly pregnant client is being assessed in an obstetric clinic. The client states that she has been experiencing intense abdominal pain and the nurse anticipates that the client will be assessed for ectopic pregnancy. In addition to ultrasonography, what diagnostic test should the nurse anticipate? a. Computed tomography b. Human chorionic gonadotropin (hCG) testing c. Estrogen and progesterone testing d. Abdominal x-ray

b If an ectopic pregnancy is suspected, the client is assessed using ultrasound and hCG testing. CT and x-rays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.

A nurse is providing patient education to a patient as part of her work in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception what will the nurse stress? a. Ova quickly degenerate and most are absorbed in the body before the age of 12 b. The ovaries contain all of the ova that a woman will have at birth c. Ova aggregate, causing millions to be contained in a storage site call a follicle d. Follicles produce only estrogen; the uterus produces progesterone

b It would be important to explain that the woman's ova are not increased or decreased from birth to child-bearing years. The nurse will stress that all of the ova that a woman will have will be present at birth. The patient should understand that if she does not ovulate one month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate overtime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone.

A nurse practitioner is preparing to perform a client's scheduled Pap smear, and the client asks the nurse to ensure that the speculum is well lubricated. How should the nurse proceed with assessment? a. Reassure the client that ample petroleum jelly will be used. b. Reassure the client that a water-based lubricant or warm water will be used. c. Reassure the client that she will probably not feel the insertion and opening of the speculum. d. Explain to the client why the speculum must be introduced without lubricant.

b Petroleum-based lubricants may obscure cells on a Pap smear. However, a water-based lubricant or warm water can be used. Warming the speculum can also reduce discomfort. The client will likely feel the insertion and manipulation of the speculum as a sensation of pressure or fullness.

A new client has come to the clinic seeking an appropriate method of birth control. What would the nurse teach this client about a diaphragm? a. One size fits all females. b. The diaphragm may be cleaned with soap and water after use. c. A diaphragm eliminates the need for spermicidal jelly. d. The diaphragm should be removed 1 hour following intercourse.

b The diaphragm may be cleaned with soap and water after use. It must be left in 6 hours after intercourse and should be used with spermicidal jelly. There are different sizes of diaphragms and the client needs to be fitted by the health care practitioner.

Which of the following hormones causes the ovary to release an ovum during ovulation? a. Adrenocorticotropic hormone (ACTH) b. Luteinizing hormone (LH) c. Prolactin d. Follicle-stimulating hormone (FSH)

b The hypothalamus releases GnRH at puberty to stimulate the anterior pituitary release of FSH and LH, thus stimulating the production and release of the sex hormones. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the "fight or flight" response. Prolactin is responsible for milk production and FSH in combination with LH stimulates follicles on the outer surface of the uterus to grow and develop and stimulates the release of estrogen and progesterone.

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? a. "This will have no bearing on your test today." b. "We will proceed with the examination and reschedule your Pap smear for next week." c. "We will reschedule your examination when you have finished menstruating." d. "We will do the test and take into consideration that you are menstruating."

b 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.