Chapter 33: Preventive Care for Women My Nursing Test Banks

Chapter 33: Preventive Care for Women

MULTIPLE CHOICE

1. Which piece of the usual equipment setup for a pelvic examination is omitted with a Pap smear?

a.

Lubricant

b.

Speculum

c.

Fixative agent

d.

Gloves and eye protectors

ANS: A

Lubricants interfere with the accuracy of the cytology report. A speculum is needed to see the cervix. A fixative agent is applied to the slide to prevent drying or disruption of the specimen. The examiner should always use standard precautions.

PTS: 1 DIF: Cognitive Level: Application REF: 722

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

2. A 45-year-old client asks how often she should have a mammogram. The most appropriate answer is:

a.

whenever she feels a lump.

b.

every year beginning at age 40.

c.

they are unnecessary until age 50.

d.

every year if you have risk factors.

ANS: B

The American Cancer Society recommends that women have an annual mammogram after 40 years of age. Mammography should be done routinely following the American Cancer Society guidelines. Mammograms are necessary when a woman is in her 40s. Women with high-risk factors may need them more often.

PTS: 1 DIF: Cognitive Level: Understanding REF: 722

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. While performing a self-breast exam, the client notes an area on the right breast that is nodular, with some associated tenderness. This is a new onset finding because the exams were not problematic in the past,. The left breast examination is unremarkable. The client calls to report her findings to the clinical nurse because this is not her typical result. What action should the nurse take next?

a.

Refer the client to an oncologist because the results sound suspicious.

b.

Ask the client to come in for an office visit so that the findings can be validated but tell her that this information is within the normal range of presentation.

c.

Have the client wear a tight-fitting bra and tell her that the tenderness is associated with ovulation and will pass.

d.

Have the client repeat the self-breast exam in 2 weeks and call back with findings to provide a basis for comparison.

ANS: B

Although these findings are within the normal range of presentation for breast tissue, they are not in the normal presentation for this client. The client has called to express concern; therefore, the nurse should have the client schedule an appointment for assessment and evaluation. There is no need for referral to a specialist at this time. Wearing a tight fitting bra may help provide support but does not address the physical findings and concern of the client. Repeating the self-breast exam may be required but it does not address the clients current concerns; therefore, the client should be seen by a health care provider.

PTS: 1 DIF: Cognitive Level: Application REF: 720, 721

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

4. Findings of a Pap smear exam denote atypical cells of undetermined significance (ASCUS). The Pap test is repeated at 6 months and the same finding of ASCUS are reported. Which therapeutic treatment option would the nurse expect the practitioner to order?

a.

Mammography

b.

Bone scan

c.

Transvaginal ultrasound

d.

Biopsy

ANS: D

Based on the standard of care, a colposcopy or biopsy of the cervix is indicated. A Pap smear is done to evaluate the cervix. There is no indication that mammography, which is used to assess and evaluate breast tissue, is required. There is no evidence to warrant a bone scan. Although a transvaginal ultrasound might be included in the treatment plan, the Pap smear indicates cervical pathology so a colposcopy or biopsy is indicated.

PTS: 1 DIF: Cognitive Level: Analysis REF: 724

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

5. Which administration concern is included in the plan of care for the HPV (human papillomavirus) vaccine?

a.

It is available in liquid form.

b.

It involves a series of two injections.

c.

Injections should be given over a 3-month period.

d.

The individual should sit down for 15 minutes following the injection.

ANS: D

There is a possibility that the client can faint in reaction to this type of immunization, so a safety concern should be included in the plan of care. It is available only in injection form. It is given as a series of three injections. The series of three injections should be given over a 6-month period according to Centers for Disease Control and Prevention (CDC) recommendations.

PTS: 1 DIF: Cognitive Level: Analysis REF: 726

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity/Pharmacologic and Parenteral Therapies

MULTIPLE RESPONSE

6. While interviewing a 48-year-old client during her annual physical examination, the nurse learns that she has never had a mammogram. The American Cancer Society recommends annual mammography screening starting at age 40. Before the nurse encourages this client to begin annual screening, it is important for her to understand the reasons why women avoid testing. These reasons include which of the following? (Select all that apply.)

a.

Fear of x-ray exposure

b.

Expense of the procedure

c.

Reluctance to hear bad news

d.

Having heard that the test is painful

e.

Belief that lack of family history makes this test unnecessary

ANS: A, B, C, D

Fear of x-ray exposure, expense, reluctance to hear bad news, and fear of pain are reasons women avoid having a mammogram done. Although the test is expensive, it is usually covered by health insurance, and many communities offer low-cost or free screening to women without insurance. It is important to acknowledge that some discomfort occurs with screening. Scheduling the test immediately at the end of a period makes it less painful. The risk of radiation exposure is minimal to none. Nurses play a vital role in providing information and reassurance to help women overcome these fears. Even clients with no family history should have a regular screening done. The nurse should emphasize that a combination of breast self-examination and mammography needs to be performed at regular intervals. Women with a family history may need to begin screening at a younger age and have additional testing such as ultrasound performed.

PTS: 1 DIF: Cognitive Level: Analysis REF: 722

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

7. Healthy People 2020 goals directed at womens health issues focus on which areas? (Select all that apply.)

a.

Increased screening for cervical and colorectal cancers

b.

Reduction of cancer survivor rate based on clinical management treatment

c.

Decreased morbidity and mortality related to breast cancer

d.

Reduction in hospitalization for hip fractures in the older female population

e.

Reduction in deaths associated with cardiovascular causes such as stroke and coronary artery disease (CAD)

ANS: A, C, D, E

Healthy People 2020 goals directed at womens health focus on increased access to screening for cervical and colorectal cancers, decreased deaths occurring from breast cancer and heart disease, and decreased hospitalization for hip fractures. A reduction of the cancer survival rate would reflect increased morbidity and mortality.

PTS: 1 DIF: Cognitive Level: Application REF: 718, 719

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

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