Week 3 Chapters 8-11

Importantly, the nurse must be aware of which information related to the use of IUDs?

IUDs containing copper can provide emergency contraception if inserted within a few days of unprotected intercourse

What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

The blood pressure cuff should not be applied to the affected arm

What is the most common reproductive tract cancer associated with pregnancy?

Cervical

Which client is most at risk for fibroadenoma of the breast?

16-year old girl

Which woman is at the greatest risk for psychologic complications after hysterectomy?

19 year old woman who had a ruptured uterus after giving birth to her first child

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determines after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24-30 days, then her fertile period would be day____ through day____?

6;19 (To avoid pregnancy the couple must abstain from intercourse on days 6-19. Ovulation occurs on day 12 plus or minus 2 days either way)

In the acronym BRAIDED, which letter is used to identify key components of informed consent that the nurse must document?

A stands for alternatives

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas?

Abnormal uterine bleeding

Which benefit regarding FAMS makes it an appealing choice for some women?

Absence of chemicals and hormones

The client has undergone hysteroscopic uterine ablation to destroy a number of smaller fibroids. The nurse is preparing to provide the discharge instructions. Which information is a priority for the patient and should be included in the teaching plan?

Analgesics and non steroidal anti-inflammatory drugs can be used for pain control Next menstrual period will be irregular Provider should be notified if heavy bleeding occurs

A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate? a.Anorexia b.Hirsutism c.Irregular menses d.Infertility

Anorexia

Leiomyomas (also known as fibroid tumors) are benign tumors arising from the muscle tissue of the uterus. Which information related to these tumors is accurate? (Select all that apply.) a.Are rapid growing b.Are more common in African-American women c.Are more common in women who have never been pregnant d.Obesity is a risk factor with leiomyomas e.Become malignant if left untreated

Are rapid growing Are more common in women who have never been pregnant Obesity is a risk factor with leiomyomas

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.

Barrier methods

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? a. Pelvic floor support devices b. Bladder training and pelvic muscle exercises c. Surgery d. Medications

Bladder training and pelvic muscle exercises

Macromastia, or breast hyperplasia, is a condition in which women have very large and pendulous breasts. Breast hyperplasia can be corrected with a reduction mammoplasty. Which statement regarding this procedure is themost accurate? a.Breast reduction surgery is covered by insurance. b.Breastfeeding might be difficult. c.No sequelae after the procedure is known. d.Pain in the back and shoulders may not be relieved.

Breastfeeding might be difficult

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a. Fever higher than 39 C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than four pads in 2 hours e. Severe abdominal pain

Chills Foul smelling vaginal discharge Severe abdominal pain

Guidelines for breast cancer screening continue to evolve as new evidence is generated. Which examination procedure and frequency would be recommended for a 31 year old asymptomatic client?

Clinical breast exam every 3 years Breast self examination

Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. Which factors are possible causes for female infertility? (Select all that apply.) a. Congenital or developmental b. Hormonal or ovulatory c. Tubal or peritoneal d. Uterine e. Emotional or psychologic

Congenital or developmental Hormonal or ovulatory Tubal or peritoneal Uterine

A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition? a.Cryosurgery b.Colposcopy c.Hysterectomy d.Internal radiation

Cryosurgery

A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report? a.Pelvic relaxation b.Cystoceles and/or rectoceles c.Uterine prolapse d.Genital fistulas

Cystoceles and/or rectoceles

Which statement regarding emergency contraception is correct?

Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse

Which ovarian neoplasm is described as a growth that contains hair, teeth, and sebaceous secretions? a.Ovarian fibroma b.Dermoid cyst c.Uterine polyp d.Follicular cyst

Dermoid cyst

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the woman's level of knowledge about contraception and commitment to any particular method. c. Assess the woman's willingness to touch her genitals and cervical mucus. d. Evaluate the woman's contraceptive life plan.

Determine the woman's level of knowledge concerning contraception and her commitment to any particular method

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester?

Dilation and evacuation (D%E)

Breast pain occurs in many women during their perimenopausal years. Which information is a priority for the nurse to share with the client? a.Breast pain is an early indication of cancer. b.Pain is almost always an indication of a solid mass. c.Distinguishing between cyclical and noncyclical pain is important. d.Breast pain is most often treated with narcotics.

Distinguishing between cyclical and non cyclical pain is important

Fibrocystic changes in the breast most often appear in women in their 20s and 30s. Although the cause is unknown, an imbalance of estrogen and progesterone may be the cause. The nurse who cares for this client should be aware that treatment modalities are conservative. Which proven modality may offer relief for this condition?

Diuretic administration

Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are accurate?

Donor eggs are fertilized with the male partners sperm Donor eggs are under 35 years of age Recipient undergoes hormonal stimulation

Male fertility declines slowly after age 40 years; however, no cessation of sperm production analogous to menopause in women occurs in men. What condition is to associated with advanced paternal age?

Down syndrome

Nurses should be cognizant of what information with regard to the non contraceptive medical effects of combination oral contraceptives (COCs)?

Effectiveness of COCs can be altered by some OTC medications and herbal supplements

Significant advances have been made with most reproductive technologies. Which improvement has resulted in increased success related to preimplantation genetic diagnosis?

Embryos are transferred at the blastocyst stage

Which condition is the most common malignancy of the reproductive system?

Endometrial cancer

The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, deficient knowledge, related to a lack of understanding of the reproductive process with regard to conception. Which nursing intervention does not apply to this diagnosis?

Evaluate the couples support system

What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy?

Expect no changes in her hormone levels

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate?

FAMs can be very effective for many couples; however, they require motivation

Researchers have found a number of common risk factors that increase a womans chance of developing a breast malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors?

Family history Race Nulliparity or first pregnancy after age 40 years

Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse?

Family planning

A woman has arrived for her preoperative testing appointment. She is scheduled for a myomectomy the following day. What condition would require the client to undergo this procedure for symptom relief?

Fibroid tumors near the outer wall of the uterus with a uterine size of no larger than at 12 weeks of gestation

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? a. Risks of multiple gestation b. Whether or how to disclose the facts of conception to offspring c. Freezing embryos for later use d. Financial ability to cover the cost of treatment

Financial ability to cover the cost of treatment

A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? a. Testicular biopsy b. Antisperm antibodies c. Follicle-stimulating hormone (FSH) level d. Examination for testicular infection

Follicle-stimulating hormone (FSH) level

A client is concerned because she has been experiencing some milk, sticky breast discharge. Which nonmalignant condition is exhibited with this finding?

Galactorrhea

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs?

Gallbladder disease Myocardial infarction Breast tenderness and fluid retention

A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurses most appropriate response?

Get involved with a support group, I will give you some names

Chemotherapy with multiple drug agents is used in the treatment of recurrent and advanced breast cancer with positive results. Which side effects would the nurse anticipate for the client once treatment has begun? (Select all that apply.) a.Hair loss b.Severe constipation c.Anemia d.Leukopenia e.Thrombocytopenia

Hair loss Anemia Leukopenia Thrombocytopenia

A nurse is providing breast care education to a client after a mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share?

Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles

A 48 year old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed?

I know that the surgery saved my life, but I will miss having sex with my husband

Which procedure falls into the category of micro manipulation techniques of the follicle?

Intracytoplasmic sperm injection (ISCI) Assisted hatching

A woman has a breast mass that is not well delineated and is non palpable, immobile, and contender. Which condition is this client experiencing?

Intraductal papilloma

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: A. Intranasal spray. B. Vaginal suppository. C. Intramuscular injection. D. Tablet.

Intramuscular injection (IM)

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share?

It is highly unlikely that you will become pregnant after this procedure Sterilization offers no protection against STIs

To provide adequate care, the nurse should be cognitive of which important information regarding infertility?

It is perceived differently by men and women

Which statement regarding the term contraceptive failure rate is the most accurate?

It varies from couple to couple depending on the method and the users

Which precaution should the nurse take while caring for a client who is undergoing internal radiation therapy for cervical cancer?

Limit staff or visitor exposure to 30 minutes or less in an 8-hour period

If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate?

Male condoms

What is the correct name describing a benign breast condition that includes dilation and inflammation of the collecting ducts?

Mammary duct ectasia

The nurse provides education to a client about to undergo external radiation therapy. Which statement by the client reassures the nurse that the teaching has been effective?

My diet is high in protein, and I drink at least 2000 mL of fluid a day

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?

Needle localization biopsy

Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.) a.Nipple piercing may be the cause of a recent infection. b.Treatment for cellulitis will include antibiotics. c.Streptococcus aureus is the most common pathogen. d.Obesity, smoking, and diabetes are risk factors. e.Breast is pale in color and cool to the touch.

Nipple piercing may be the cause of a recent infection Treatment for cellulitis will include antibiotics Obesity, smoking, and diabetes are risk factors

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate?

Nonoxynol-9 does not provide protection against STIs as originally thought. It has also been linked to an increase in the transmission of HIV and can cause genital lesions

A woman has chosen the calendar method of conception control. During the assessment process it is most important that the nurse: a. Obtain a history of menstrual cycle lengths for the past 6 to 12 months. b. Determine the client's weight gain and loss pattern for the previous year. c. Examine skin pigmentation and hair texture for hormonal changes. d. Explore the client's previous experiences with conception control.

Obtain a history of menstrual cycle lengths for the past 6-12 months

Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate?

Ova and sperm are transferred to one tube

Probable cause for increasing infertility is the societal delay in pregnancy until later in life. What are the natural reasons for the decrease in female fertility?

Ovulation dysfunction Organ damage from toxins Endometriosis Tubal infections

Having a genetic mutation may create an 85% chance of developing breast cancer in a woman's lifetime. Which condition does not increase a client's risk for breast cancer? a.BRCA1 or BRCA2 gene mutation b.Li-Fraumeni syndrome c.Paget disease d.Cowden syndrome

Paget disease

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include?

Pain, bleeding and infection are possible complications Pregnancy may still be possible Secondary sex characteristics are unaffected

Which woman has the highest risk for endometrial cancer? a.Postmenopausal woman with hypertension b.Woman who has an intrauterine device (IUD) c.Client who has been on birth control for 15 years d.Perimenopausal woman who has a cystocele

Postmenopausal woman with hypertension

The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure?

Radiation

A client is scheduled for surgery after a recent breast cancer diagnosis. The nurse is discussing the procedure with the client. To allay her fears, which explanation best describes a skin sparing mastectomy?

Removal of the breast, nipple and areola, leaving only the skin

When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the womans knowledge of this disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders?

Risk for injury, related to lack of skill for self-care

A clients oncologist has just finished explaining the diagnostic workup results to her, and she still has questions. The woman states, "The physician says I have a slow growing cancer. Very few cells are dividing." How does she know this? What is the name of the test that gave the health care provider this information?

S-phase index

A healthcare provider performs a clinical breast examination on a woman diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma?

Single lump in one breast that can be expected to shrink as the woman ages

Which client should the nurse refer for further testing?

Small dimple located in the upper outer quadrant of the right breast

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse's most appropriate response is: a. "Your sperm count seems to be okay in the first semen analysis." b. "Only marijuana cigarettes affect sperm count." c. "Smoking can give you lung cancer, even though it has no effect on sperm." d. "Smoking can reduce the quality of your sperm."

Smoking can reduce the quality of your sperm

A couple arrives for their first appointment at an infertility center. Which of the following is a noninvasive test performed during the initial diagnostic phase of testing?

Sperm analysis

Which nonpharmacologic contraceptive method has a failure rate of less than 25%?

Standard days variation

The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof?

Stomatitis Constipation Diarrhea Nausea and Vomiting

A woman will be taking oral contraceptives using a 28 day pack. What advice should the nurse provide to protect this client from unwanted pregnancy?

Take one pill at the same time every day

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a. No spermicide is used with the cervical cap, so its less messy. b. The diaphragm can be left in place longer after intercourse. c. Repeated intercourse with the diaphragm is more convenient. d. The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.

The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later

A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group?

The exact cause of breast cancer remains unknown

With regard to the treatment plan for a pregnant woman with gynecologic cancer, which statement about timing or type of treatment is correct?

The fetus is most at risk during the first trimester

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice?

The ideal candidate has difficulty remembering to take oral contraceptives daily

With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information?

The investigation will take several months and can be very costly

What is the importance of obtaining informed consent for a number of contraceptive methods?

The method chosen has potentially dangerous side effects

In vitro fertilization embryo transfer (IVF-ET) is a common approach for some with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their pre procedural interview. Which explanation regarding this procedure is most accurate?

The procedure begins with collecting eggs from your wife's ovaries

An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share?

The risk of PID will be higher with the IUD

Which statement is the most complete and accurate description of medical abortions?

They can be either elective or therapeutic

An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurses most appropriate response? a. This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen. d. Ten percent is a very low risk, so you dont need to worry too much.

This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins

The lactational amenorrhea method (LAM) of birth control is popular among developing countries and has had limited use in the US. As breastfeeding rates increase, more women may rely on this method for birth control. Which information is most important to provide the client interested in using LAM for contraception?

This popular method of birth control works best if the mother is exclusively breastfeeding

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method?

This practice is the only contraceptive method acceptable to the Roman Catholic Church

Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)?

Thyroid dysfunction

Which test is performed around the time of ovulation to diagnose the basis of infertility?

Ultrasonography

A client has just returned from a uterine artery embolization (UAE) procedure. Before her discharge, a discussion concerning the symptoms that require a call to the provider post procedure is very important. Which symptom would reassure the client that the procedure went well with no reason to call the provider?

Urinary frequency

A woman who has just undergone a first trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what?

Use another method of contraception for 1 week after starting the pill

The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed?

Uterine fibroids

The nurse should be aware that a pessary is most effective in the treatment of which disorder?

Uterine prolapse

After a mastectomy, which activity should the client be instructed to avoid?

Wearing clothing with snug sleeves to support the tissue of the arm on the operative side

A client has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience?

Weigh gain, hot flashes, and blood clots

A healthy 60-year old African American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3 week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make this client?

Would you like me to make an appointment for you to have your mammogram here

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when informing the client on which herbal preparations may improve ovulation induction therapy?

You may want to try black cohosh or phytoestrogens

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." What is the nurses most appropriate response?

You probably did not ovulate during this cycle

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be mosthelpful in achieving this goal? a."You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash." b."You should remove your diaphragm right after intercourse to prevent TSS." c."It's okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS." d."Make sure you don't leave your diaphragm in for longer than 24 hours, or you may get TSS."

You should always remove your diaphragm 6 to 8 hours after intercourse. Don't use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4° C, hypotension, and a rash

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse's most appropriate response would be: a. "This is a highly effective method, but it has some side effects." b. "Your current medications will reduce the effectiveness of the pill." c. "The pill will reduce the effectiveness of your seizure medication." d. "This is a good choice for a woman of your age and personal history."

Your current medications will reduce the effectiveness of the pill