Chapter 42. Nursing Care of Women With Reproductive System Disorders My Nursing Test Banks

Chapter 42. Nursing Care of Women With Reproductive System Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is assisting with a community education class on breast cancer prevention. Which risk factors should the nurse include in this training?
a. History of breastfeeding
b. Large or pendulous breasts
c. High-fat diet and alcohol intake
d. Early first pregnancy and late menarche
____ 2. The nurse is caring for a patient who had a mastectomy for breast cancer 2 days ago and is now developing pulmonary congestion. Why is a mastectomy patient at risk for pulmonary complications?
a. Breast cancer has often spread to the lungs before diagnosis.
b. Pathogens may have been introduced during the surgical procedure.
c. The chest incision makes the patient hesitant to deep breathe and cough.
d. Mastectomy patients must remain on bedrest for 48 to 72 hours postoperatively.
____ 3. The nurse is caring for a patient who had a left mastectomy earlier in the day and informs the nurse of several concerns. Which should the nurse attend to first?
a. Bowels have not moved in 48 hours.
b. Pain level of is 7 on a 0-to-10 scale.
c. A 3-cm area of blood is on the wound dressing.
d. Feels anxious about how her husband will react to the surgery.
____ 4. The nurse is assessing a patient after a mastectomy and thinks the patients affected arm appears swollen. What is the best way to verify this finding?
a. Measure and document the circumference of the arm.
b. Measure and compare the circumferences of both arms.
c. Press a finger into the arm and measure the indentation.
d. Ask the patient to hang the arm down for 3 minutes and check for increased swelling.
____ 5. The nurse enters the room of a patient with a new mastectomy and finds her crying. After confirming that the patient is crying because of the loss of her breast, which response by the nurse is best?
a. At least they got all the cancer. You are fortunate.
b. I know how you feel. It is difficult to lose a breast.
c. How have you coped with other problems in your life? Do you have someone you can talk to?
d. Here, have a tissue. I know you feel like crying now, but before you know it, you will feel much better, and this will all be behind you.
____ 6. A patient reports long, heavy, irregular menses accompanied by headache and back pain for the past several months. How should the nurse document these symptoms?
a. Polymenorrhea
b. Oligomenorrhea
c. Hypermenorrhea
d. Menometrorrhagia
____ 7. The nurse is teaching a woman with a menstrual disorder how to measure menstrual flow. Which instruction should the nurse include?
a. Use a perineal collection system.
b. Use a vaginal catheter and collection bag.
c. Weigh her perineal pads before and after use.
d. Weigh the woman before and after her menses.
____ 8. A woman tells the nurse, I am having terrible pain with my period. This has never happened before. What should I do? What is the best response by the nurse?
a. Sometimes getting into a kneechest position is helpful.
b. You should notify your doctor if this is a new experience for you.
c. Dysmenorrhea is a common occurrence; NSAIDs or aspirin may help.
d. The best way to combat painful menses is to exercise and drink plenty of fluids.
____ 9. A patient comes to an outpatient clinic because of premenstrual syndrome (PMS) symptoms. What advice from the nurse may help her reduce her symptoms?
a. There is no treatment for PMS other than rest and fluids.
b. Ask the physician about a mild antianxiety agent.
c. Avoidance of alcohol and caffeine may help reduce your discomfort.
d. Avoid strenuous exercise for several days before and after your period.
____ 10. A 50-year-old woman states, It is such a relief not to need birth control any more. I havent had a period in 3 months. How should the nurse respond?
a. Birth control is usually unnecessary after age 50, even if you are still having periods.
b. It is still possible for you to get pregnant. You should consider having a tubal ligation.
c. You should continue to use birth control for at least 6 months after cessation of your periods.
d. You may still be fertile for several months after your last period. You should consult with your physician to know when to stop using birth control.
____ 11. The nurse is reviewing the health histories of several patients scheduled for appointments in the health clinic. Which patient should the nurse recognize as being predisposed to developing a vaginal yeast infection?
a. A 23-year-old who eats a high-protein diet
b. A 31-year-old woman who runs 2 miles every day
c. A 38-year-old woman who frequently uses NSAIDs
d. A 28-year-old woman who sits at a desk 5 days a week
____ 12. The nurse is assisting with teaching a patient who has been placed on metronidazole (Flagyl) for bacterial vaginosis. What instruction by the nurse is appropriate?
a. Take the Flagyl whenever you feel vaginal itching or irritation.
b. Take the Flagyl until the discharge is gone for at least 24 hours.
c. Take the Flagyl as prescribed, even if your symptoms are gone.
d. You will need to take Flagyl for an extended period. This prescription has several refills.
____ 13. A patient is seen in a clinic for contact vaginitis. What information from her history helps the nurse to plan teaching for the patient?
a. She has been under stress at work.
b. She takes bubble baths every night.
c. She has had a urinary tract infection (UTI).
d. She has been on oral antibiotics for a sinus infection.
____ 14. The nurse is teaching a patient how to use a daily vaginal suppository. Which statement indicates that teaching has been effective?
a. I should put the suppository in at night after I get into bed.
b. I should put the suppository in each morning before I get out of bed.
c. It is best to insert the suppository each morning after a shower or bath.
d. The suppository should be put in late in the day when Im less likely to be active.
____ 15. A 16-year-old girl is admitted to the hospital with toxic shock syndrome (TSS). Which action by the nurse should take priority?
a. Teach the girl risk factors for TSS.
b. Teach the girls mother risk factors for TSS.
c. Educate the girl on signs and symptoms of TSS.
d. Determine what the girl understands about risk factors for TSS.
____ 16. A patient is being seen for the urinary bladder sagging into the vagina. How should the nurse document this health problem?
a. Rectocele
b. Cystocele
c. Dyspareunia
d. Bladder fistula
____ 17. The nurse is assisting with teaching a woman who is having difficulty conceiving. What instruction should the nurse provide about keeping a basal body temperature chart?
a. Record your temperature in the late afternoon each day for 3 months.
b. Record your temperature every 4 hours, starting the first day of each month.
c. Record your temperature three times each day of your period, then once a day thereafter.
d. Starting with the first day of your period, record your temperature first thing each morning.
____ 18. A female patient has just learned that she is infertile. She says, All I ever wanted in life was to have a baby. My life is over. What is the best response by the nurse?
a. You are overreacting because you are upset. Your life really is not over.
b. You have a wonderful husband. Maybe you should think about adoption.
c. There is an infertility clinic I just heard about in Mexico. Do you want the address?
d. A baby must have been very important to you. When you feel ready, we can talk about other alternatives.
____ 19. A patient at a walk-in clinic requests oral contraceptives (OCs) because she heard they can prevent sexually transmitted infections (STI). What information should the nurse use to base a response to this patient?
a. OCs provide excellent protection against most STIs.
b. There is no connection between OC use and risk of STIs.
c. Only OCs with estrogen and progestin can prevent STIs.
d. Not enough research has been done to prove that OCs can prevent STIs.
____ 20. A patient must prevent pregnancy while receiving chemotherapy that could harm a fetus. About which type of birth control should the nurse anticipate teaching the patient?
a. Condom
b. Depot medication
c. Oral contraceptive
d. Diaphragm with spermicide
____ 21. The nurse is assisting a new mother who returns to a clinic for a 6-week visit. What instructions about birth control should the nurse provide?
a. Breastfeeding has no effect on your ability to conceive.
b. As long as you are breastfeeding, you will not get pregnant.
c. You should avoid having intercourse until you are finished breastfeeding.
d. You should plan to use birth control; breastfeeding is not a reliable form of contraception.
____ 22. A patient is scheduled for a hysterectomy and bilateral salpingo-oophorectomy. She asks what this means. How should the nurse respond?
a. You will have your uterus removed and your bladder suspended.
b. You are going to have your uterus, fallopian tubes, and ovaries removed.
c. You will have your uterus removed and your fallopian tubes and ovaries sutured in place.
d. You will have your uterus and fallopian tubes removed, but your ovaries will remain intact.
____ 23. The nurse is caring for a patient recovering from a hysterectomy earlier in the day. Four hours later, the woman is unable to urinate. What assessment should the nurse use to determine bladder distention and be comfortable for the patient?
a. Perform a scratch test.
b. Palpate for bladder distention.
c. Palpate for rebound tenderness.
d. Percuss the bladder for fullness.
____ 24. A 42-year-old woman is tearful after a hysterectomy. What information should the nurse use to respond appropriately to the patient?
a. Loss of reproduction function may cause grieving.
b. Most women are done bearing children by age 42.
c. Hysterectomy is more traumatic for younger women.
d. Most women are happy not to have periods after a hysterectomy.
____ 25. The nurse is caring for a patient with primary dysmenorrhea. Which medication should the nurse anticipate being prescribed because it blocks prostaglandin synthesis?
a. NSAIDs
b. Antacids
c. Vitamins
d. Morphine
____ 26. A patient is diagnosed with polycystic ovary syndrome. When preparing teaching for this patient, which hormone should the nurse explain as being too abundant in the patients body?
a. Insulin
b. Thyroxine
c. Growth hormone (GH)
d. Antidiuretic hormone (ADH)
____ 27. An adolescent comes into the emergency department requesting the morning-after pill. What should the nurse assess in this patient?
a. Age of the patient
b. Time of intercourse
c. Use of contraception
d. Location of the parents
____ 28. A health care provider (HCP) is anticipating the use of RU-486 to provide a chemically induced abortion for a patient. What information should the nurse obtain from the patient before this medication is provided?
a. Type of contraception used
b. Date of the first day of the patients last period
c. Date of the first day of the patients first missed period
d. Average number of times the bladder is emptied in one day
____ 29. The nurse notes that a female patient has been treated for vaginal yeast infections 6 times in one year. For which additional health problem should the nurse suspect the patient should be evaluated?
a. HIV
b. Hepatitis B
c. Tuberculosis
d. Chronic inflammation
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 30. The nurse is caring for a patient who is breastfeeding and receiving antibiotics for mastitis. What should be included in the patients teaching? (Select all that apply.)
a. Wash hands before handling the breast.
b. NSAIDs may be used to help control pain.
c. Apply cool packs to the breast to ease pain.
d. Stop breastfeeding, and switch to bottle feeding.
e. Wear a bra to support the swollen painful breast.
f. Change the infants feeding position on the breast frequently.
____ 31. The nurse is assisting in the preparation of an educational seminar about breast pathology. What characteristics of cancerous breast lesions should the nurse include in this teaching? (Select all that apply.)
a. They tend to be harder.
b. They tend to be less mobile.
c. They tend to be more painful.
d. They tend to be more irregularly shaped.
e. They tend to have more clearly defined borders.
____ 32. A female patient approaching menopause asks about the use of hormone replacement therapy. Which findings from a study on hormone replacement therapy should the nurse explain to the patient? (Select all that apply.)
a. A decrease in strokes
b. A decrease in breast cancer
c. An increase in heart attacks
d. A reduction in total fractures
e. A decrease in colorectal cancer
f. An increase in thromboembolism
____ 33. The nurse is providing care for a patient after a hysterectomy. Which interventions are appropriate to prevent constipation? (Select all that apply.)
a. Encourage ambulation.
b. Increase protein intake.
c. Increase oral fluid intake.
d. Provide a high-fiber diet.
e. Withhold pain medication.
f. Provide stool softener as ordered.
____ 34. A patient who is 6 weeks pregnant is contemplating having an abortion. What methods of abortion should the nurse explain as most commonly used to terminate a pregnancy of less than 14 weeks? (Select all that apply.)
a. Vacuum suction
b. Saline induction
c. Menstrual extraction
d. Dilation and curettage (D&C)
e. Dilation and evacuation (D&E)
____ 35. The nurse is caring for a woman who has just had an uncomplicated abortion. What instructions should the nurse provide? (Select all that apply.)
a. Call if you bleed for more than 3 days.
b. Call if you have more bleeding than you would during a heavy period.
c. The discharge often has a foul odor due to the procedure.
d. Dont be surprised if you pass clots. Call if they are larger than a golf ball.
e. You can expect moderate bleeding and a low-grade fever for about a week.
f. You should abstain from sexual intercourse as directed by your physician.
____ 36. The nurse is concerned that a female patient is at risk for developing cervical cancer. What risk factors for cervical cancer did the nurse assess in the patient? (Select all that apply.)
a. Smoking
b. Being nulliparous
c. Using barrier contraceptives
d. Having multiple sexual partners
e. Being infected with herpes simplex virus type II
f. Being infected with human papillomavirus
____ 37. The nurse is providing care for a woman with trichomoniasis who is being treated with metronidazole (Flagyl). Which patient statements indicate that teaching has been effective? (Select all that apply.)
a. I might notice a metallic taste with this medication.
b. This medication should be taken on an empty stomach.
c. I should take this medication until the symptoms are gone.
d. I may have some vaginal dryness while taking this medication.
e. My partner should see a physician for treatment as well.
f. Drinking alcohol while taking this medication will cause nausea and vomiting.
____ 38. The nurse is providing care for a woman experiencing premenstrual syndrome (PMS). Which nursing actions should be included in the plan of care? (Select all that apply.)
a. Encourage the client to stop smoking.
b. Teach client to limit alcohol consumption.
c. Provide small, frequent meals to reduce food cravings.
d. Encourage the client to develop a regular exercise regimen.
e. Provide food that promotes increased intake of simple sugars.
f. Instruct client to increase intake of products containing caffeine.
____ 39. A female patient asks what can be done to reduce symptoms associated with menopause. What should the nurse suggest to this patient? (Select all that apply.)
a. Eat a healthy diet.
b. Reflect on past experiences and challenges.
c. Dress in layers so clothing can be removed.
d. Reduce intake of caffeine, sugar, and alcohol.
e. Use an oil-based vaginal lubricant to ease vaginal dryness.
____ 40. After collecting data the nurse suspects that a young female patient is experiencing manifestations of toxic shock syndrome. What findings did the nurse use to make this decision? (Select all that apply.)
a. Sore throat
b. Skin peeling
c. Fluid retention
d. Red palm and soles of feet
e. Muscle pain and weakness
____ 41. The nurse is assisting in the development of a program to instruct female high school students on ways to prevent the development of toxic shock syndrome. What should the nurse include in this program? (Select all that apply.)
a. Increase oral fluid intake.
b. Change tampons every 4 hours.
c. Wash hands before inserting a new tampon.
d. Take over-the-counter aspirin while menstruating.
e. Use sanitary pads instead of tampons overnight when menstruating.
____ 42. A female patient is diagnosed with mild uterine prolapse into the vagina. For which areas should the nurse prepare to reinforce teaching to help this patient? (Select all that apply.)
a. Avoid weight gain
b. Take care of the pessary
c. Consume a healthy diet
d. Perform Kegel exercises
e. Perform vaginal douches
Completion
Complete each statement.

43. The nurse is weighing the perineal pads of a patient bleeding after having an abortion. The weight of one pad increased in weight by 20 grams. How many mL of blood has this patient lost?

Chapter 42. Nursing Care of Women With Reproductive System Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: C
Factors that increase the risk of development of breast cancer include increasing age, personal or family history of breast cancer, high-fat diet, high alcohol intake, treatment with estrogens (especially when used without progestins), early menarche, late menopause, no pregnancy or late first pregnancy, and no breastfeeding or breastfeeding for short periods of time following delivery.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

2. ANS: C
Patients can have ineffective breathing patterns and difficulty coughing because of pain with chest movement. D. Bedrest is not necessary. B. Pathogens should not be introduced during surgery, and the mastectomy site is not the same as the lungs. A. Breast cancer does not often spread to the lungs before diagnosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

3. ANS: B
Pain, constipation, and bleeding are all physiological needs which are a priority according to Maslows hierarch. D. Psychosocial needs can be addressed later. A. C. Because 3 cm of blood is not urgent, and a few more minutes of constipation will not make a difference in the outcome, the pain should be treated first.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

4. ANS: B
The best way to verify if the affected arm is swollen is to measure and comparing the affected side with the patients opposite side. A. C. Measuring, checking for pitting edema and documenting are not as significant if not compared with the normal side. D. Hanging the arm down will not help and may worsen the swelling.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

5. ANS: C
The nurse should help the patient remember previous successes in coping and strategies used since the memory of prior successes can encourage hope for future successes. A, B, and D all belittle the patients concerns. The nurse does not know how the patient feels.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis

6. ANS: D
Menometrorrhagia is long, heavy, irregular menses. A. Polymenorrhea is frequent menses. B Oligomenorrhea refers to cycles longer than 35 days. C. Hypermenorrhea is menses lasting longer than 7 days.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

7. ANS: C
Estimation of the amount of blood lost during menses may be difficult because pad counts can vary widely, depending on the frequency of pad changes and the portion of the pad that contains blood. The only accurate way to estimate menstrual flow is by weighing the pads (sealed in a biohazard bag) and then subtracting the weight of the original pads. D. Weighing the woman is inaccurate because there are too many other factors affecting weight. A. B. Catheters and collection systems may be used for urinary drainage but not for vaginal collection.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

8. ANS: B
The nurse should never give advice until a diagnosis is known. A. C. D. Once a diagnosis is known, it may be appropriate to teach measures to increase comfort during periods such as NSAIDs, exercise, or positioning.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

9. ANS: C
The nurse can provide educational materials on lifestyle measures, such as restriction of alcohol, caffeine, nicotine, salt, and simple sugars; participation in regular exercise; and development of stress management skills. B. Antianxiety agents are generally not used and would not be considered until nonpharmacological interventions are tried. A. Rest and fluids are not necessary to reduce the symptoms. D. Exercise is encouraged.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

10. ANS: D
It is important to remind perimenopausal women that they may still be fertile after several months of amenorrhea. A. To prevent conception, they need to continue to practice birth control until they receive confirmation from their primary care provider that menopause is complete. C. Six months is not a magic number. B. A tubal ligation is not necessary, because only a brief time of needing protection remains.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

11. ANS: D
Several conditions can predispose patients to an overgrowth of resident microbes: poor nutrition (especially diets high in simple sugars); inconsistent control of blood glucose levels in patients with diabetes, stress, pregnancy, marked hormonal fluctuations, pH changes, prolonged overheating of the genital area with little aeration (as happens with sitting still for long periods in overly restrictive clothing); and changes in the balance of vaginal flora types because of antibiotic (not NSAID) treatment or douching. A. Eating a high-protein diet, exercising daily, and using NSAIDs do not increase the risk of developing a vaginal yeast infection.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

12. ANS: C
Teach the patient to use the medication as directed, even if symptoms cease. A. The medication should be taken when prescribed and not whenever vaginal itching or irritation occurs. B. The medication should be taken as directed, which might be longer than 24 hours after symptoms cease. D. Antibiotics are not usually needed for extended periods.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

13. ANS: B
Contact vulvovaginitis can be related to contact with allergens or irritating chemicals such as contraceptive creams or bubble baths. D. Vaginitis is inflammation, not infection. C. UTI does not predispose to vaginitis. A. Stress and antibiotics are more likely to place the patient at risk of infection, not inflammation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

14. ANS: A
Application of vaginal medication is easiest when the patient is lying down ready to sleep, because vaginal medications tend to run out when the patient stands or sits. B. C. D. Using it at other times risks losing much of the medication and its effect.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

15. ANS: D
At 16, the girl is at an age at which she needs to understand the risk factors, not her mother. Assessment of baseline knowledge should always take place before teaching risk factors or signs and symptoms.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

16. ANS: B
Cystocele occurs when the bladder sags into the vaginal space because of inadequate support. A. Rectocele occurs when a portion of the rectum sags into the vagina because of inadequate support. C. Dyspareunia refers to pain with intercourse. D. Bladder fistula is a tract from the bladder to another location.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

17. ANS: D
The nurse teaches the patient to keep a precise record of her oral temperatures with a basal thermometer each morning on awakening, before any other activity. The first day of her menses is day 1 on the temperature chart. Changing levels of hormones result in slight temperature changes, which can be used to identify when ovulation seems to be occurring and when particular hormone levels should be tested. A. B. C. These are incorrect methods to measure basal body temperature.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

18. ANS: D
The nurse needs to reflect the patients feelings and offer information about options when the patient is ready. A. B. These responses belittle the patients feelings and offer advice, which is inappropriate. C. Referring the patient to another country for treatment is dangerous and not the role of the nurse.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

19. ANS: D
There is much debate about whether hormonal contraceptive agents may offer some protection against some STIs, based on lower statistical rates of STIs among oral contraceptive users. B. C. Cellular changes of the cervix seen with hormonal contraceptive use actually tend to be associated with higher rates of some STIs. A. Unless some specific mechanism of prevention is demonstrated by research, it seems irresponsible to suggest that OCs alone offer protection against anything other than pregnancy. Therefore, women should still be advised about the risks of contracting STIs while taking an OC.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

20. ANS: C
Oral contraceptives are the most effective for preventing pregnancy during chemotherapy. B. Depot medications are not immediately affective. A. D. Barrier methods are the least effective method of birth control.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

21. ANS: D
Breastfeeding is sometimes used as a method of birth control because the high blood levels of prolactin that occur with breastfeeding may suppress ovulation. This method costs nothing but is not very effective. A. Breastfeeding may suppress ovulation so the ability to conceive may be altered. B. Even when breastfeeding the patient may begin ovulating and pregnancy can occur. C. Avoiding intercourse while breastfeeding is unrealistic.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

22. ANS: B
Removal of the uterus, the tubes, and ovaries is called total abdominal hysterectomy with bilateral salpingo-oophorectomy, or panhysterectomy. C. Removal of the uterus alone is called hysterectomy. A. Bladder suspension is a separate procedure. D. The ovaries are removed with the fallopian tubes in a bilateral salpingo-oophorectomy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

23. ANS: A
Assess bladder fullness using Doppler monitoring or scratch test (listening with a stethoscope, lightly scratch abdomen as you move downward from xiphoid until you hear change in sound indicating the top of the bladder). B. C. D. Palpation and percussion can be uncomfortable near an incision and over a full bladder.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

24. ANS: A
Patients may grieve at the loss of reproductive status, regardless of age. D. Not having periods does not necessarily negate the pain of loss. B. Some women are able to have children after the age of 42. C. Hysterectomy is traumatic for any female patient of any age.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

25. ANS: A
Primary dysmenorrhea may be treated with drugs that inhibit prostaglandin synthesis, such as aspirin and NSAIDs. B. C. Vitamins and antacids will not relieve symptoms of dysmenorrhea. D. Morphine use is reserved for acute or severe pain, not generally for chronic conditions like dysmenorrhea.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

26. ANS: A
Many of the symptoms of PCOS are a result of excessive levels of insulin in the blood because of insulin resistance. Excess insulin, in turn, stimulates secretion of androgens. B. D. D. ADH, GH, and thyroxine are not believed to cause the symptoms.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

27. ANS: B
The morning-after pill, or emergency contraceptive treatment, consists of postcoital administration of sufficient estrogen or an estrogen/progestin combination to cause sudden sloughing of the endometrial lining of the uterus, preventing implantation of a possibly fertilized ovum. For this to be effective, the initial dose is generally given within 72 hours of intercourse. A. D. The patients age and location of the parents is not important at this time. C. If the patient used contraception, the morning-after pill would not be needed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

28. ANS: B
RU-486 is a progestin antagonist that prevents the binding of progestins at their receptors, resulting in a chemically induced abortion. It must be used within 63 days after the first day of the womans last period. Pregnancy must be confirmed along with how far pregnant a woman is prior to medical abortion. A. B. D. The type of contraception used, the date of the patients first missed period, and the average times the bladder is emptied in one day is not essential information to receive this medication for a chemical abortion.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

29. ANS: A
Frequent and persistent yeast infections can be one sign of HIV infection. B. C. D. Chronic vaginal yeast infections are not associated with hepatitis B, tuberculosis, or chronic inflammation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

30. ANS: A, B, E, F
Patient teaching should include instructions to wash hands carefully to prevent the spread of infection. D. If the patient is breastfeeding, breastfeeding is often continued to promote drainage of the breast, mother/infant bonding, and infant nutrition. The infant is often already colonized with the bacteria, so further exposure is not thought to be detrimental. Frequent changes in feeding positions can help empty the entire breast. C. Cool packs will reduce blood flow, which is not desirable. NSAIDs, warm packs, and breast supports are often used to control pain and swelling.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

31. ANS: A, B, D
Cancerous growths tend to be harder, less mobile, less painful, more irregularly shaped, and have less clearly defined borders than benign growths.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

32. ANS: C, D, E, F
Research on HRT has shown a 26% increase in breast cancer, a 41% increase in strokes, a 29% increase in heart attacks, doubling of venous thromboembolism rates, and an overall 22% increase in cardiovascular disease. Positive findings with HRT included a one-third reduction in hip fractures, a 24% reduction in total fractures, and a 37% decrease in colorectal cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

33. ANS: A, C, D, F
Fluids, fiber, and exercise all help relieve constipation. E. Opioid analgesics are constipating but should be given to control the patients pain and prevent additional complications related to pain and immobility. Stool softeners may be ordered if no complication related to the surgery is present. B. Increased protein intake will not help prevent constipation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

34. ANS: A, C, D
Early in a pregnancy (during approximately the first 13 weeks), there are three primary means of pregnancy terminationmenstrual extraction, vacuum aspiration, and D & C. B. E. D & E and saline induction may be used later in pregnancy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

35. ANS: A, B, F
The patient should be instructed to notify the physician if bleeding lasts longer than 3 days. Bleeding should not exceed that of a heavy period. The patient should abstain from sexual intercourse for the time specified by the HCP, usually 3 weeks. C. The discharge should not have a foul odor. D. Clots larger than a golf ball should be reported. E. A fever is not expected after an abortion and should be reported to the HCP.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

36. ANS: A, D, E, F
Some identified risk factors for development of cervical cancer include smoking, having multiple sexual partners, being infected with the herpes simplex virus type II, and being infected with human papillomavirus. B. Having no children does not increase the risk for this type of cancer. C. Using barrier contraceptives may reduce the risk of this type of cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

37. ANS: C, D, E, F
The patient should be instructed to avoid alcohol use while on medication and for 48 hours after completion because concurrent use of alcohol and metronidazole will induce severe nausea and vomiting. The patient should use the medication as directed, even if symptoms cease. The medication should be taken with meals, and the partner needs to be treated. A. B. A metallic taste is not identified as a side effect of this medication and it should be taken with meals.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

38. ANS: A, B, D
Measures to reduce the effects of PMS include avoiding nicotine, limiting alcohol intake, and participating in regular exercise. C. Small frequent meals are not necessary. E. Simple sugars should be limited. F. Caffeine should be restricted.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

39. ANS: A, C, D
The nurse should teach the patient who is perimenopausal to eat a healthy diet that is light in caffeine, sugar, and alcohol. The patient should also plan ahead for hot flashes by dressing in layers of clothing that may be removed. B. Looking forward to new challenges rather than toward the past may help to counteract hormone-related depressive tendencies. E. Vaginal symptoms can be treated with a water-soluble moisture restorer or lubricant, or with an estrogen cream if prescribed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

40. ANS: A, B, D, E
Individuals with toxic shock syndrome may experience a sore throat, rash, blisters, and petechiae, followed by peeling of the skin, redness of the palms and soles of the feet and muscle pain and weakness. C. Fluid retention is not a manifestation of toxic shock syndrome.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

41. ANS: B, C, E
Female patients can reduce the risk of developing toxic shock syndrome by changing tampons every 4 hours, washing hands before inserting a new tampon, and using sanitary pads instead of tampons overnight when menstruating. A. Increasing oral fluid intake will not reduce the risk of developing toxic shock syndrome. D. Taking over-the-counter aspirin while menstruating may increase bleeding since aspirin is an anticoagulant. Aspirin has no effect on the development of toxic shock syndrome.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

42. ANS: A, B, C, D
Prolapse of the pelvic organs into the vagina can be treated by instructing the patient to avoid weight gain, the use and care of a pessary, the importance of consuming a healthy diet, and performing Kegel exercises to strengthen the pubococcygeal muscle. E. Vaginal douches are not recommended treatment for a prolapsed uterus.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

COMPLETION

43. ANS:
20 mL
A 1-g increase in pad weight equals approximately 1 mL of blood loss. If the pads weight increased by 20 grams, 20 grams = 20 mL of blood loss.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

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