Chapter 34: Womens Health Problems My Nursing Test Banks

Chapter 34: Womens Health Problems

MULTIPLE CHOICE

1. Which are the most common sites of breast cancer metastasis?

a.

Kidneys

b.

Bones and liver

c.

Heart and blood vessels

d.

Central nervous system

ANS: B

Metastasis occurs when the cancer cells spread to the vascular sites, commonly the lungs, liver, and bones. Kidney metastasis is uncommon. Metastasis to the heart and blood vessels is uncommon. The brain is one of the final areas to be reached by metastasis.

PTS: 1 DIF: Cognitive Level: Understanding REF: 730

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

2. Which sexually transmitted disease can be cured?

a.

Herpes

b.

AIDS

c.

Chlamydia

d.

Venereal warts

ANS: C

The usual treatment for chlamydial bacterial infection is doxycycline hyclate or tetracycline. Concurrent treatment of all sexual partners is needed to prevent recurrence. Because no cure is known for herpes, treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the main focus. Condylomata acuminata is caused by the human papillomavirus. No treatment eradicates the virus.

PTS: 1 DIF: Cognitive Level: Understanding REF: 750

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

3. Which statement by a client diagnosed with premenstrual syndrome indicates that further health teaching is needed?

a.

I will not eat chips or pickles.

b.

Ill eat only three meals per day.

c.

Drinking alcohol makes me more depressed.

d.

Coffee and chocolate can make me more irritable and nervous.

ANS: B

The client should be encouraged to eat six small meals a day to decrease the risk of hypoglycemia. Less intake of salty foods helps decrease fluid retention. Alcohol consumption aggravates depression. Caffeine consumption increases irritability, insomnia, anxiety, and nervousness.

PTS: 1 DIF: Cognitive Level: Analysis REF: 739

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

4. A benign breast condition that includes dilation and inflammation of the collecting ducts is:

a.

fibroadenoma.

b.

ductal ectasia.

c.

intraductal papilloma.

d.

chronic cystic disease.

ANS: B

Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Fibroadenoma is evidenced by fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated.

PTS: 1 DIF: Cognitive Level: Understanding REF: 729

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

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

a.

Janice, 38 years old

b.

Helen, 50 years old

c.

Mary, 16 years old

d.

Anna, 27 years old

ANS: C

Although it may occur at any age, fibroadenoma is most common in the teenage years. Ductal ectasia becomes more common as a client approaches menopause. Intraductal papilloma develops most often just before or during menopause. Fibrocystic breast changes are more common during the reproductive years.

PTS: 1 DIF: Cognitive Level: Understanding REF: 729

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

6. Which statement is true about primary dysmenorrhea?

a.

Primary dysmenorrhea is experienced by all women.

b.

It is unaffected by oral contraceptives.

c.

It occurs in young multiparous women.

d.

It may be caused by excessive endometrial prostaglandin.

ANS: D

Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. Primary dysmenorrhea is not experienced by all women. Oral contraceptives can be a treatment choice. It occurs in young nulliparous women.

PTS: 1 DIF: Cognitive Level: Understanding REF: 737

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

7. A client states, Im sure that I am suffering from PMS. How can I get my doctor to take this seriously? The nurses best response is:

a.

Men are not usually sympathetic to PMS sufferers.

b.

You are probably right. You should remind your doctor of your symptoms every time you visit.

c.

Since you feel certain you are right, you should just treat yourself with over-the-counter medications.

d.

You should keep a daily record of the occurrence and severity of your symptoms for 3 months.

ANS: D

Symptom charting for at least 3 months is necessary to make an accurate diagnosis of PMS. Suggesting lack of sympathy from men is an inaccurate statement and will not help the client with the present problem. Reminding the physician of the symptoms will not assist in making a diagnosis. Listing symptoms for 3 months will help the physician make the diagnosis better. The client should not treat herself with over-the-counter medications.

PTS: 1 DIF: Cognitive Level: Application REF: 738, 739

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

8. Which should the nurse stress in teaching a client to deal with the symptoms of PMS?

a.

Decrease her consumption of caffeine.

b.

Drink a small glass of wine with her evening meal.

c.

Decrease her fluid intake to prevent fluid retention.

d.

Eat three large meals a day to maintain glucose levels.

ANS: A

Caffeine increases irritability, insomnia, anxiety, and nervousness. Alcohol aggravates depression and should be avoided. Fluid intake should not be decreased. Six smaller meals a day will help maintain glucose levels.

PTS: 1 DIF: Cognitive Level: Application REF: 739

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

9. A client, age 49, confides in the nurse that she has started experiencing pain with intercourse. She asks, Is there anything I can do about this? The nurses best response is:

a.

No, it is part of the aging process.

b.

Water-soluble vaginal lubricants may provide relief.

c.

You need to be evaluated for a sexually transmitted disease.

d.

You may have vaginal scar tissue that is producing the discomfort.

ANS: B

Loss of lubrication, with resulting discomfort in intercourse, is a symptom of estrogen deficiency. It is part of the aging process, but the use of lubrication will help relieve the symptoms. This is a normal occurrence with the aging process and does not indicate an STD. It is caused by loss of lubrication with the decrease in estrogen. Scar tissue problems would have occurred earlier.

PTS: 1 DIF: Cognitive Level: Application REF: 741

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

10. Which client is most likely to have osteoporosis?

a.

A 50-year-old client on estrogen therapy

b.

A 55-year-old client with a sedentary lifestyle

c.

A 65-year-old client who walks 2 miles each day

d.

A 60-year-old client who takes supplemental calcium

ANS: B

Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet. Hormone therapy may prevent bone loss. Weight-bearing exercises have been shown to increase bone density. Supplemental calcium will help prevent bone loss, especially when combined with vitamin D.

PTS: 1 DIF: Cognitive Level: Understanding REF: 743

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

11. A client with a history of a cystocele should contact the physician if she experiences:

a.

backache.

b.

constipation.

c.

urinary frequency and burning.

d.

involuntary loss of urine when she coughs.

ANS: C

Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Back pain is a symptom of uterine prolapse. Constipation may be a problem with rectoceles. Involuntary loss of urine during coughing is stress incontinence and is not an emergency.

PTS: 1 DIF: Cognitive Level: Application REF: 745

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

12. Which should the nurse teach to assist a client to regain control of her urinary sphincter?

a.

Do Kegel exercises.

b.

Void every hour while awake.

c.

Drink 8 to 10 glasses of water each day.

d.

Allow the bladder to become distended before voiding.

ANS: A

Kegel exercises, tightening and relaxing the pubococcygeal muscle, will improve control of the urinary sphincter. A prescribed schedule may help, but every hour is too frequent. Restricting fluids will cause bladder irritation, which exacerbates the problem. Drinking adequate fluids will not help the problem. Overdistention of the bladder will cause incontinence.

PTS: 1 DIF: Cognitive Level: Application REF: 746

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

13. The physician diagnoses a 3-cm cyst in the ovary of a 28-year-old client. You expect the initial treatment to include:

a.

beginning hormone therapy.

b.

scheduling a laparoscopy to remove the cyst.

c.

examining the client after her next menstrual period.

d.

aspirating the cyst and sending the fluid to pathology.

ANS: C

Most ovarian cysts regress spontaneously. Cysts in women of childbearing age may decrease within one cycle, so treatment is not necessary at this point. It is too early to anticipate removal of the cysts. Most ovarian cysts regress spontaneously within one cycle. A transvaginal ultrasound examination will help determine if the cyst is fluid-filled or solid. The cyst can then be removed if warranted.

PTS: 1 DIF: Cognitive Level: Understanding REF: 748

OBJ: Nursing Process Step: Planning MSC: Client Needs: Physiologic Integrity

14. The drug of choice to treat gonorrhea is:

a.

penicillin G (Pfizerpen).

b.

tetracycline (Achromycin).

c.

ceftriaxone (Rocephin).

d.

acyclovir (Zovirax).

ANS: C

Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin G is used to treat syphilis. Tetracycline is used to treat chlamydial infections. Acyclovir is used to treat herpes genitalis.

PTS: 1 DIF: Cognitive Level: Understanding REF: 750

OBJ: Nursing Process Step: Planning MSC: Client Needs: Physiologic Integrity

15. Which option could be used for the treatment and management of a client who reports mild pain associated with a clinical diagnosis of fibrocystic breast disease?

a.

Chamomile tea as a relaxant therapy

b.

Danazol (Danocrine)

c.

Tamoxifen (Nolvadex)

d.

Over-the-counter nonsteroidal antiinflammatory drug (NSAID) therapy

ANS: D

Because the client is reporting mild pain, NSAIDs may provide adequate pain relief and comfort. It is recommended that tea, coffee, and/or other stimulants be limited or restricted for clients with fibrocystic breast disease. Danazol is typically used for moderate to severe pain for clients with fibrocystic breast disease because its use is associated with more serious side effects. The client reports mild pain so this would not be warranted. Tamoxifen is a selective estrogen receptor modulator (SERM) used for the treatment of breast cancers and also for moderate to severe pain in fibrocystic breast disease. The client reports mild pain, so this would not be warranted.

PTS: 1 DIF: Cognitive Level: Application REF: 729

OBJ: Nursing Process Step: Evaluation

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

16. Which treatment option minimizes the development of lymphedema in the surgical management of a client with breast cancer?

a.

Radical mastectomy procedure

b.

Radiation therapy

c.

Sentinel lymph node mapping

d.

Ultrasound

ANS: C

The use of sentinel lymph node mapping identifies only those affected lymph node tissues that require surgical removal so it helps minimize the development of lymphedema in the surgical management of a client with breast cancer. Radical mastectomy is associated with lymphedema in the postsurgical breast cancer client because of the removal of lymph node tissue. Radiation therapy is not associated with a decrease in lymphedema for the breast cancer client. Ultrasound as an intervention does not affect the development of lymphedema.

PTS: 1 DIF: Cognitive Level: Analysis REF: 731

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity/Physiologic Adaptation

17. You are taking care of a client who has had a colporrhaphy. Which option would indicate a priority assessment during the postoperative period?

a.

Documentation of a pessary in the operative procedure notes by the physician

b.

Removal of vaginal packing as ordered by the physician

c.

Use of a cell saver for transfusion therapy in the postoperative period

d.

Order for removal of staples 2 to 3 days post-procedure

ANS: B

Vaginal packing is typically used in this type of pelvic surgery so it is a priority assessment that its removal be verified and documented. A pessary would be used as a nonsurgical intervention for a client who has had uterine prolapse and was not a surgical candidate based on medical history. A cell saver is used in orthopedic surgeries that are at risk for blood loss so that the clients own blood can be re-infused based on established protocol. There are no staples used in this type of surgical procedure, which is also known as an A & P (anterior and posterior) repair.

PTS: 1 DIF: Cognitive Level: Analysis REF: 746

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Safe and Effective Care Environment/Establishing Priorities

18. In reviewing genetic testing for a female client, you note the presence of BRCA1, BRCA2, and CHEK2. How should these findings be interpreted?

a.

There is no increased likelihood that the client will develop breast or ovarian cancer.

b.

There is an increased likelihood only for the development of breast cancer in a woman.

c.

More information is needed to interpret these findings based on the clients family history and the clients current and past medical history.

d.

A radical bilateral mastectomy is required immediately because the cancer may have already undergone sub-metastasis.

ANS: C

The presence of genetic markers (BRCA1, BRCA2, and CHEK2) provides strong indicators of the increased risk for the development of breast cancer in males and females and ovarian cancer. It is important to obtain additional information so that a treatment plan can be developed and implemented to improve client outcomes. There is an increased likelihood that the client will develop breast or ovarian cancer, but stating that there is an increased likelihood only for the development of breast cancer in a woman fails to include that men are also at risk of developing breast cancer. At this point, surgical intervention is speculative because the presence of biomarkers does not indicate that sub-metastasis has occurred or that the cancer has even developed.

PTS: 1 DIF: Cognitive Level: Analysis REF: 748

OBJ: Nursing Process Step: Evaluation

MSC: Client Needs: Physiologic Integrity/Reduction of Risk Potential

MULTIPLE RESPONSE

19. A 38-year-old client presents to the clinic office complaining of increased bilateral tenderness of her breasts prior to the onset of menses. On questioning the client, this presentation has occurred off and on for several years, but the pain has increased. Physical examination reveals lumpy areas bilaterally on the upper outer quadrants of each breast tissue. The areas of concern are approximately 2 cm in size. Based on this assessment, what diagnostic testing would be required? (Select all that apply.)

a.

Ultrasound examination

b.

Open biopsy

c.

Fine-needle aspiration (FNA) biopsy

d.

CBC with differential

e.

Mammogram

ANS: A, C, E

Based on the clinical presentation, the client may have fibrocystic breast disease. Although this condition is typically benign, the fact that the client has noted a change in tenderness should be evaluated. Ultrasound, FNA, and mammography may be indicated to provide a baseline for comparison and rule out any malignancy. An open or surgical biopsy is not indicated at the present time but may be needed if the other test results indicate any pathology. Blood work is not indicated at this time relative to the diagnosis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 728

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity/Reduction of Risk Potential

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