Chapter 39: Care of Women with Reproductive Disorders My Nursing Test Banks

Chapter 39: Care of Women with Reproductive Disorders

MULTIPLE CHOICE

1. The patient complains to the nurse about a sharp pain in the lower quadrants every month at midcycle that lasts for several hours. The nurse clarifies that this phenomenon is related to:

a.

the stretching of the round ligaments supporting the uterus.

b.

Mittelschmerz, a pain associated with ovulation.

c.

the premenstrual uterine enlargement.

d.

endometrial changes.

ANS: B

Mittelschmerz is a pain in either lower quadrant associated with ovulation. There is no stretching of the round ligaments during the midcycle period. Premenstrual uterine changes do not produce discomfort.

DIF: Cognitive Level: Knowledge REF: 883 OBJ: 3 (theory)

TOP: Mittelschmerz: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse is aware that the normal acidic pH of the vaginal vault provides:

a.

support to vaginal muscle tone.

b.

vaginal lubrication.

c.

a hostile environment to sperm.

d.

protection against infection.

ANS: D

The acidic pH of the vagina, provided by lactic acid, is a defense against infection. The low pH is a hostile environment for pathogens. Muscle tone in the vagina is not affected by the pH level. The vagina is not a hostile environment to the sperm.

DIF: Cognitive Level: Comprehension REF: 883 OBJ: 1 (theory)

TOP: Vaginal pH: Purpose KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse speaking to a group of junior high girls cautions them that their breasts may feel tender:

a.

at midcycle at ovulation.

b.

at intracycle on the first day of flow.

c.

at intracycle as the flow begins to slow.

d.

after menstrual flow has stopped.

ANS: A

Hormonal changes during the midportion of the cycle may increase breast tenderness.

DIF: Cognitive Level: Comprehension REF: 883 OBJ: 3 (theory)

TOP: Breast Tenderness: Timing KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse is aware that the premenstrual syndrome (PMS) with its behavioral symptoms occurs during the:

a.

follicular ovarian cycle phase.

b.

luteal ovarian cycle phase.

c.

dismantling stage of the menstrual cycle.

d.

proliferative stage of the stage of the menstrual cycle.

ANS: B

The luteal stage (from the 15th to the 28th day of the cycle), when the uterus is being prepared to receive the fertilized ovum, is the time that PMS occurs. The follicular phase includes the first 14 days of a 28-day cycle. During this phase the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the maturation of immature ova in preparation for fertilization. Estrogen peaks when the ovum is released (ovulation) about 14 days before the next menstrual period. The ovum lives up to 24 hours after fertilization. The menstrual cycle refers to the dismantling state. During this time the endometrial layer sloughs away and menstrual flow begins. The levels of estrogen and progesterone fall. During the proliferative stage of the menstrual cycle the follicle grows and the egg matures. The endometrium returns to normal state and then begins to thicken in response to estrogen.

DIF: Cognitive Level: Application REF: 902 OBJ: 3 (theory)

TOP: PMS: Etiology KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse suggests to a patient suffering with premenstrual dysphoric disorder (PMDD) that the patient might be able to reduce the symptoms by:

a.

using stress management exercises.

b.

drinking 4 ounces of red wine with the evening meal.

c.

including red meat in the diet at least 3 times a week.

d.

switching to sugar rather than artificial sweeteners.

ANS: A

PMDD is thought to be related to the inability to deal with normal stressors. Red meat, alcohol, and sugar exacerbate the symptoms of PMDD.

DIF: Cognitive Level: Application REF: 902 OBJ: 3 (theory)

TOP: PMDD: Self-Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

6. The nurse is aware that primary dysmenorrhea may cause the young female to develop:

a.

exaggerated perceptions of the severity of the symptoms.

b.

nonreliance on medications for relief.

c.

negative attitude toward her own sexuality.

d.

inappropriate coping skills.

ANS: C

Unresolved dysmenorrhea in the young woman can cause negative attitudes related to sexuality and self-worth.

DIF: Cognitive Level: Comprehension REF: 902 OBJ: 3 (theory)

TOP: Dysmenorrhea: Negative Attitude KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

7. In discussing the advantages of oral contraceptives, the nurse mentions such benefits as:

a.

decreased breast tenderness.

b.

weight loss.

c.

heightened sexual pleasure.

d.

decrease of opportunistic vaginitis.

ANS: A

Decreased breast tenderness is a benefit of oral contraceptives.

DIF: Cognitive Level: Application REF: 883 OBJ: 4 (theory)

TOP: Oral Contraception: Benefits KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. The nurse introduces the consideration of a new oral contraceptive, Seasonale, the protocol of which allows only _____ menstrual period(s) a year.

a.

1

b.

2

c.

3

d.

4

ANS: D

Seasonale is a popular oral contraceptive that provides delayed menstruation, so that a woman has only four menstrual periods a year.

DIF: Cognitive Level: Comprehension REF: 886 OBJ: 4 (theory)

TOP: Contraception: Seasonale KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The nurse evaluates the need for additional instruction about the morning-after pill, levonorgestrel, when the patient says:

a.

I must take levonorgestrel within 72 hours of having had unprotected sex.

b.

I will take an antiemetic before I take levonorgestrel.

c.

I only need to take one dose of levonorgestrel.

d.

Depending on the state, I may or may not need to get a prescription for levonorgestrel.

ANS: C

Known as the morning-after pill, emergency contraception is indicated after unprotected intercourse. It is not meant to be used on a regular basis, but was developed to decrease the number of unwanted pregnancies and elective abortions. Emergency contraception prevents pregnancy in one of three ways: by preventing ovulation or fertilization, slowing transport of the sperm and egg, or altering the uterine lining to prevent implantation. Plan B one-step is one tablet of levonorgestrel only, taken within 72 hours of unprotected sex; the tablet was approved in July 2009 and is available without prescription to women over 17 years of age.

DIF: Cognitive Level: Application REF: 887 OBJ: 4 (theory)

TOP: Levonorgestrel: Protocol KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. The nurse is aware that a copper intrauterine device (IUD) can be used as an emergency contraceptive measure if it is inserted within a maximum of ____ days after unprotected sex.

a.

7

b.

8

c.

9

d.

10

ANS: A

A copper intrauterine device (IUD) can be inserted up to 7 days after unprotected sexual intercourse to prevent implantation of the zygote in women who prefer long-term contraception.

DIF: Cognitive Level: Comprehension REF: 888 OBJ: 4 (theory)

TOP: IUD: Emergency Contraception KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. The nurse explains that the difference between primary infertility and secondary infertility is that primary infertility describes the inability to:

a.

maintain a pregnancy past the first trimester.

b.

conceive after 1 year of active unprotected sex.

c.

deliver a viable infant after two pregnancies.

d.

conceive after using a follicle stimulator for 1 year.

ANS: B

Primary infertility is defined as inability to conceive after 1 year of active unprotected sex. Secondary infertility is the inability to conceive after having once conceived, or the inability to maintain a pregnancy long enough to deliver a viable infant. Approximately 10% to 20% of U.S. couples have infertility, and today more couples are seeking medical intervention.

DIF: Cognitive Level: Comprehension REF: 889 OBJ: 5 (theory)

TOP: Primary Infertility: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse suggests to a couple trying to conceive that conception might be enhanced by:

a.

relaxing together in a sauna or hot tub.

b.

stimulation of the scrotum with a vibrator.

c.

increased time spent in foreplay.

d.

using water-soluble lubricant.

ANS: D

Water-soluble lubricant has no spermicidal properties. Heat to the scrotum depresses spermatogenesis. Foreplay and vibrators do not increase spermatogenesis. Increases in foreplay time will not increase the chances of conception.

DIF: Cognitive Level: Analysis REF: 889 OBJ: 5 (theory)

TOP: Infertility: Techniques to Enhance Conception

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. An infertile couple is considering zygote intrafallopian transfer (ZIFT) and ask how it differs from in vitro fertilization (IVF). The nurse clarifies that in ZIFT the:

a.

fallopian tubes are artificially lined with material that nourishes the gamete.

b.

fertilized egg is placed in the fallopian tube.

c.

fallopian tubes are cleared with injected air.

d.

fallopian tube is implanted with unfertilized ova and sperm.

ANS: B

The zygote intrafallopian transfer (ZIFT) refers to the placement of the fertilized ovum into the fallopian tube at the zygote stage of development. During in vitro fertilization (IVF-ET) the womans eggs are collected from the ovary, fertilized in the laboratory, and transferred into the uterus at the embryo stage of development.

DIF: Cognitive Level: Analysis REF: 890 OBJ: 5 (theory)

TOP: GIFT vs. IVF KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. The nurse cautions a patient who is using estrogen cream to restore vaginal moisture not to use the cream as a lubricant for sexual intercourse because:

a.

her partner will absorb estrogen.

b.

cream numbs the clitoris.

c.

cream will alter condom integrity.

d.

friction of intercourse will irritate vaginal wall.

ANS: A

The partner can absorb estrogen from estrogen cream used as a lubricant for sexual intercourse.

DIF: Cognitive Level: Comprehension REF: 890 OBJ: 6 (theory)

TOP: Estrogen Cream: Precaution KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The patient who is on long-term estrogen replacement for the prevention of osteoporosis is counseled to have an annual:

a.

pelvic examination.

b.

bone density study.

c.

liver scan.

d.

lower GI study.

ANS: A

Estrogen therapy increases the incidence of endometrial cancer and breast cancer. An annual pelvic examination is recommended, as well as monthly breast self-examinations.

DIF: Cognitive Level: Application REF: 890 OBJ: 6 (theory)

TOP: Estrogen Therapy: Precautions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. The nurse suggests to the menopausal patient who is experiencing troubling hot flashes to include in her diet such foods as cherries and black beans because these foods are:

a.

high in protein.

b.

phytoestrogens.

c.

antioxidants.

d.

natural tranquilizers.

ANS: B

Phytoestrogens, substances found in plants that may act like normally produced estrogen, can be found in cherries, yams, and black beans.

DIF: Cognitive Level: Application REF: 891 OBJ: 6 (theory)

TOP: Phytoestrogens: Sources KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. The nurse reminds a patient that monthly breast self-examination (BSE) should be conducted one:

a.

day after menses has begun.

b.

day after menses has stopped.

c.

week after menses has begun.

d.

week after menses has stopped.

ANS: C

The examination should be performed 1 week after the period has begun, or on a specific date if menses has stopped.

DIF: Cognitive Level: Comprehension REF: 892 OBJ: 1 (clinical)

TOP: BSE: Timing KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. After having a right total mastectomy, the patient confides that her husband has voiced his concern about her disfigurement. The nurses most therapeutic response would be:

a.

What a jerk he must be!

b.

Many husbands feel that way.

c.

I wouldnt worry. He will adjust.

d.

What was your reaction to his statement?

ANS: D

Using open-ended and matter-of-fact tactful questions will help the patient express feelings. Option a reflects sympathy; options b and c belittle the patients feelings.

DIF: Cognitive Level: Analysis REF: 913 OBJ: 8 (theory)

TOP: Mastectomy: Therapeutic Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

19. The nurse explains that BRCA1 and BRCA2 are:

a.

genes involved with the inherited form of breast cancer.

b.

enzymes that are markers for breast cancer.

c.

particular proteins attached to the RBCs indicating presence of breast cancer.

d.

laboratory tests performed on a breast biopsy to detect breast cancer.

ANS: A

BRCA1 and BRCA2 are genes that are involved in the inherited form of breast cancer. It should be noted that not all people who have a BRCA gene get cancer, and people without it may get cancer.

DIF: Cognitive Level: Comprehension REF: 908 OBJ: 7 (theory)

TOP: BRCA: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

20. The nurse is caring for a patient with a tentative diagnosis of polycystic ovarian syndrome. When reviewing the patients health history, which finding will provide support for the diagnosis?

a.

Female pattern baldness

b.

Significant weight loss

c.

Menstrual periods every 33 days

d.

Elevations in serum glucose

ANS: D

Polycystic ovarian syndrome is a congenital condition in which many cysts develop on one or both ovaries and produce excess estrogen. High levels of testosterone and luteinizing hormone (LH) and low levels of follicle-stimulating hormone (FSH) occur. Signs and symptoms include irregular menstruation, infertility, hyperinsulinemia, and glucose tolerance problems. Excessive hair on the body (hirsutism) is common.

DIF: Cognitive Level: Application REF: 904 OBJ: 10 (theory)

TOP: Polycystic Ovarian Syndrome KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse is caring for a patient diagnosed with toxic shock syndrome. The patient is discussing what caused her condition. Which statement best indicates the patient has an adequate understanding?

a.

I may have contracted this infection as a result of an untreated sexually transmitted infection.

b.

An infection linked to my ovarian cyst may be the culprit.

c.

Using a diaphragm for birth control may have played a role.

d.

Taking steroids is associated with the condition.

ANS: C

Toxic shock syndrome (TSS) is a rare and potentially fatal disorder caused by strains of Staphylococcus aureus that produce toxins that cause shock, coagulation defects, and tissue damage if they enter the bloodstream. It is associated with the trapping of bacteria within the reproductive tract for a prolonged time. Risk factors include the prolonged use of high-absorbency tampons, cervical caps, or diaphragms.

DIF: Cognitive Level: Analysis REF: 906-907 OBJ: 10 (theory)

TOP: Toxic Shock Syndrome KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. A 25-year-old woman who is not sexually active questions the nurse about the recommended frequency of Pap smears. What information should be provided?

a.

Annual screening is recommended.

b.

Screening is not needed for women who are not sexually active.

c.

Screening in the woman who is not sexually active may be spaced every 5 to 7 years.

d.

In the woman with negative screenings, the Pap test may be repeated every 2 years.

ANS: D

ACOG recommends that cervical cancer screening should begin at age 21 and be repeated every 2 years between ages 21 and 29 in asymptomatic women. Women with three consecutive negative screenings at age 30 should have repeated testing every 3 years until age 65, when testing of asymptomatic women is no longer necessary. Women with cervical pathology or cancer should be screened annually for 20 years after treatment.

DIF: Cognitive Level: Application REF: 907 OBJ: 7 (theory)

TOP: Cervical Cancer KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

23. The nurse lists the age-related changes that occur in the woman after menopause, which include: (Select all that apply.)

a.

atrophy of uterus.

b.

vaginal dryness.

c.

decrease in bone mass.

d.

increase in vaginal elasticity.

e.

uterine prolapse.

ANS: A, B, C, E

Vaginal elasticity decreases after menopause. The remaining statements are correct changes associated with menopause.

DIF: Cognitive Level: Comprehension REF: 890 OBJ: 2 (theory)

TOP: Age-Related Changes: Postmenopause

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The nurse describes the signals of premenstrual syndrome (PMS), which include: (Select all that apply.)

a.

bloating.

b.

irritability.

c.

depression.

d.

excessive energy.

e.

fear of losing control.

ANS: A, B, E

PMS does not include depression or excessive energy. The patients with PMS are usually fatigued. Depression is part of the picture of premenstrual dysphoric disease (PMDD).

DIF: Cognitive Level: Comprehension REF: 902 OBJ: 3 (theory)

TOP: PMS: Signs and Symptoms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. The nurse explains to the patient suffering from dysmenorrhea that the pelvic rock exercise will decrease pain by: (Select all that apply.)

a.

releasing endorphins.

b.

generating abdominal heat.

c.

suppressing prostaglandins.

d.

making uterus drop forward.

e.

relieving pelvic congestion.

ANS: A, C, E

The exercise does not generate heat nor does it make the uterus drop forward.

DIF: Cognitive Level: Comprehension REF: 902 OBJ: 3 (theory)

TOP: Dysmenorrhea: Pelvic Rock Exercise

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. Because of the diuretic effect, the nurse suggests to a patient with primary dysmenorrhea to include in her diet: (Select all that apply.)

a.

watermelon.

b.

buttermilk.

c.

broccoli.

d.

asparagus.

e.

cranberries.

ANS: A, D, E

Broccoli and buttermilk do not have diuretic properties.

DIF: Cognitive Level: Comprehension REF: 902 OBJ: 3 (theory)

TOP: Dysmenorrhea: Diet KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. The nurse describes the morning-after pill, levonorgestrel, as a multipurpose pill that can: (Select all that apply.)

a.

prevent ovulation.

b.

cause immediate menses.

c.

interfere with fertilization.

d.

alter DNA of ova.

e.

prevent uterine implantation.

ANS: A, C, E

Levonorgestrel, depending on where in the menstrual cycle the woman is when she takes it, can prevent ovulation, interfere with fertilization, and prevent uterine implantation.

DIF: Cognitive Level: Application REF: 888 OBJ: 4 (theory)

TOP: Levonorgestrel KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

28. The nurse lists the signs and symptoms of menopause as: (Select all that apply.)

a.

hot flashes and flushes.

b.

cessation of estrogen production.

c.

vaginal dryness.

d.

night sweats.

e.

irregularity of menses.

ANS: A, B, C, D, E

All options listed except for the cessation of estrogen production are signs and symptoms of menopause. Estrogen production is reduced during menopause but does not cease.

DIF: Cognitive Level: Knowledge REF: 902 OBJ: 6 (theory)

TOP: Menopause: Signs and Symptoms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. The nurse is caring for a patient who has been diagnosed with a cystocele. The patient is not a surgical candidate. The plan of care includes noninvasive therapies. What may be included in the plan of care? (Select all that apply.)

a.

Kegel exercises

b.

Insertion of a pessary

c.

Hormone therapy

d.

Vitamin B12

e.

Increase in fluid intake

ANS: A, B, C, E

Nonsurgical management includes teaching the woman how to perform Kegel exercises in order to strengthen the pubococcygeal muscles that support the pelvic floor. Lifestyle changes include increasing fluid intake and a high-fiber diet to avoid constipation, avoiding heavy lifting, and maintaining an optimum weight. Hormone therapy may be prescribed. A pessary (a hard rubber or plastic ring) can be fitted into the vagina by the health care provider to provide support to the pelvic structures. The use of vitamin B12 is included in the care and treatment of a cystocele.

DIF: Cognitive Level: Application REF: 903 OBJ: 2 (theory)

TOP: Cystocele: Nonsurgical Management

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

30. The nurse explains that the portion of the menstrual cycle in which the ova are stimulated and matured is the ________ phase.

ANS:

follicular

The ova are stimulated and matured during the follicular phase of the menstrual cycle.

DIF: Cognitive Level: Comprehension REF: 882 OBJ: 1 (theory)

TOP: Menstrual Cycle: Follicular Stage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MATCHING

The nurse outlines the characteristics of primary or secondary dysmenorrhea to help the patient understand her condition. Match the options with the symptoms. (Options can be used once, more than once, or not at all.)

a.

Primary dysmenorrhea

b.

Secondary dysmenorrhea

31. Uterine contraction causing cramps

32. Caused by uterine polyps

33. Occurs within first menstruation past menarche

34. Lower abdomen pain progressing to back and thighs

35. Pain lasts throughout menstrual flow

36. Caused by release of high levels of prostaglandins

31. ANS: A DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

32. ANS: B DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

33. ANS: A DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

34. ANS: B DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

35. ANS: B DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

36. ANS: A DIF: Cognitive Level: Analysis REF: 902-903

OBJ: 3 (theory) TOP: Dysmenorrhea: Primary vs. Secondary

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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