Chapter 54: Nursing Management: Female Reproductive Problems My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 54: Nursing Management: Female Reproductive Problems

Test Bank

MULTIPLE CHOICE

1. A 33-year-old woman who uses oral contraceptives tells the nurse, I want to have children in a few years. Which response by the nurse is appropriate?

a.

You may have more difficulty becoming pregnant after about age 35.

b.

You have many years of fertility left, so there is no rush to have children.

c.

You should plan to stop taking oral contraceptives several years before you want to become pregnant.

d.

If you do not have children within the next few years, it will be very difficult for you to become pregnant.

ANS: A

The probability of successfully becoming pregnant decreases after age 35, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving.

DIF: Cognitive Level: Application REF: 1345-1346

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the nurse that they cannot afford IVF on her husbands salary, and the husband replies that if the wife would get a job, they would have enough money. Which nursing diagnosis is appropriate?

a.

Decisional conflict related to inadequate financial resources

b.

Ineffective sexuality patterns related to psychological stress

c.

Defensive coping related to anxiety about lack of conception

d.

Ineffective denial related to frustration about continued infertility

ANS: C

The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data do not provide information indicating that the finances are inadequate.

DIF: Cognitive Level: Application REF: 1347 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

3. A patient who is trying to become pregnant asks the nurse about ways to determine when she is most likely to conceive. The nurse explains that

a.

ovulation prediction kits provide accurate information about ovulation.

b.

ovulation is difficult to predict unless she has regular menstrual periods.

c.

she will need to bring a specimen of cervical mucus to the clinic for testing.

d.

she should take her body temperature daily and have intercourse when it drops.

ANS: A

Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.

DIF: Cognitive Level: Application REF: 1346

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

4. A woman has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient?

a.

Heavy vaginal bleeding is expected for about 2 weeks.

b.

You should abstain from sexual intercourse for 2 weeks.

c.

Irregular menstrual periods are expected for the next few months.

d.

Use of contraceptives should be avoided until your reexamination.

ANS: B

Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected.

DIF: Cognitive Level: Application REF: 1348-1349

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

5. A woman is scheduled for an induced abortion using instillation of hypertonic saline solution. Before the procedure, which information will the nurse discuss with the patient?

a.

The expulsion of the fetus may take up to a day or longer.

b.

There is a possibility that the patient may deliver a live fetus.

c.

The patient will require a general anesthetic for the procedure.

d.

The procedure may be unsuccessful in terminating the pregnancy.

ANS: A

Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure.

DIF: Cognitive Level: Application REF: 1348

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

6. A 31-year-old woman tells the nurse that she has noticed increasing headaches with dizziness, abdominal bloating, and unexplained anxiety occurring before her menstrual periods. Which action is best for the nurse to take at this time?

a.

Ask the patient to write down her symptoms in a diary for 3 months.

b.

Suggest that the patient try aerobic exercise to decrease her symptoms.

c.

Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms.

d.

Advise the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) to control symptoms.

ANS: A

The patients symptoms indicates possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made.

DIF: Cognitive Level: Application REF: 1349

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

7. When teaching a patient about ways to prevent primary dysmenorrhea, the nurse will suggest that the patient

a.

avoid aerobic exercise during her menstrual period.

b.

use cold packs on the abdomen and back for pain relief.

c.

talk with her health care provider about antidepressant therapy.

d.

start taking nonsteroidal antiinflammatory drugs (NSAIDs) regularly when her menstrual period starts.

ANS: D

NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.

DIF: Cognitive Level: Application REF: 1350

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

8. A 26-year-old who was admitted to the hospital with increasing abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next?

a.

Stay with the patient and encourage her to discuss her feelings.

b.

Explain the reason for taking vital signs every 15 to 30 minutes.

c.

Close the door to the patients room and minimize disturbances.

d.

Provide teaching about options for termination of the pregnancy.

ANS: B

Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Since the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.

DIF: Cognitive Level: Application REF: 1353-1354

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. When caring for a 60-year-old patient with persistent menorrhagia, the nurse will plan to monitor the

a.

estrogen level.

b.

complete blood count (CBC).

c.

gonadotropin-releasing hormone (GNRH) level.

d.

serial b-human chorionic gonadotropin (hCG) results.

ANS: B

Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial b-hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.

DIF: Cognitive Level: Application REF: 1349-1353 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

10. A 46-year-old woman tells the nurse that she has not had a menstrual period for 3 months and asks whether she is going into menopause. The best response by the nurse is,

a.

Have you thought about using hormone replacement therapy?

b.

Most women feel a little depressed about entering menopause.

c.

What was your menstrual pattern before your periods stopped?

d.

Since you are in your mid-40s, it is likely that you are menopausal.

ANS: C

The initial response by the nurse should be to assess the patients baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone replacement therapy (HRT) may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.

DIF: Cognitive Level: Application REF: 1354-1357

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

11. Which information will the nurse include when teaching a 51-year-old woman who is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause?

a.

Use of estrogen-containing vaginal creams provides most of the same benefits as oral HRT.

b.

Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

c.

HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.

d.

Increased incidence of colon cancer in women taking HRT requires frequent stool assessment for occult blood.

ANS: C

Data from the Womens Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

DIF: Cognitive Level: Application REF: 1354-1355

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

12. Six months after being sexually assaulted, a woman tells the nurse that she has nightmares about the incident and develops acute anxiety if she finds herself alone in situations where several men are present. The most appropriate nursing diagnosis for the patient is

a.

anxiety related to effects of being raped.

b.

sleep deprivation related to frightening dreams.

c.

rape-trauma syndrome related to rape experience.

d.

ineffective coping related to inability to resolve incident.

ANS: C

The patients symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patients symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis.

DIF: Cognitive Level: Application REF: 1373 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

13. A patient is diagnosed with vaginal candidiasis and an antifungal vaginal cream is prescribed. Which statement by the patient indicates that the nurses teaching about the treatment plan has been effective?

a.

I will tell my husband that we cannot have sex for the next month.

b.

I should clean carefully after each urination and bowel movement.

c.

I can douche daily with warm water if the itching continues to bother me.

d.

I will insert the cream using the applicator before I get up in the morning.

ANS: B

Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer.

DIF: Cognitive Level: Application REF: 1357 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

14. A 22-year-old woman who is scheduled for a Pap test tells the nurse that she has had intercourse during the last year with several men. The nurse will plan to teach about the reason for

a.

contraceptive use.

b.

antibiotic therapy.

c.

chlamydia testing.

d.

pregnancy testing.

ANS: C

Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy.

DIF: Cognitive Level: Application REF: 1358 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

15. When the nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization, which nursing intervention will be included in the plan of care?

a.

Monitor liver function tests.

b.

Use cold packs PRN for pelvic pain.

c.

Teach the patient how to perform Kegel exercises.

d.

Elevate the head of the bed to at least 30 degrees.

ANS: D

The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.

DIF: Cognitive Level: Application REF: 1358-1359 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

16. A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral antibiotics. Which instruction will be included in patient teaching?

a.

Return for a follow-up appointment in 2 days.

b.

Abdominal pain may persist for several weeks.

c.

Sexual intercourse should be avoided for 1 week.

d.

Nonsteroidal antiinflammatory drug (NSAID) use may prevent scarring of pelvic organs.

ANS: A

The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring.

DIF: Cognitive Level: Application REF: 1358-1359

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

17. When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the patient to

a.

expect to experience side effects such as facial hair.

b.

take the medication every day for the next 9 months.

c.

use a second method of contraception to ensure that she will not become pregnant.

d.

take calcium supplements to prevent osteoporosis from developing during therapy.

ANS: B

When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

DIF: Cognitive Level: Application REF: 1360

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

18. A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse explains that this therapy

a.

suppresses the menstrual cycle by mimicking pregnancy.

b.

may cause symptoms such as vaginal atrophy and hot flashes.

c.

is associated with loss of bone density and increased fracture risk.

d.

will lead to permanent suppression of abnormal endometrial tissues.

ANS: A

Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss.

DIF: Cognitive Level: Comprehension REF: 1360

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

19. When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most important for the nurse to teach the patient

a.

reasons for a total hysterectomy.

b.

how to decrease facial hair growth.

c.

ways to reduce the occurrence of acne.

d.

methods to maintain appropriate weight.

ANS: D

Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse also will address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, this is usually performed only after other therapies have been unsuccessful.

DIF: Cognitive Level: Application REF: 1362-1363

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

20. A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate teaching the patient about

a.

endometrial biopsy.

b.

uterine balloon therapy.

c.

laser endometrial ablation.

d.

dilation and curettage (D&C).

ANS: A

A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

DIF: Cognitive Level: Application REF: 1364 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

21. Stage III ovarian cancer is diagnosed in a 63-year-old woman. A nursing diagnosis that is likely to be appropriate is

a.

sexual dysfunction related to loss of vaginal sensation.

b.

risk for infection related to impaired immune function.

c.

situational low self-esteem related to guilt about delaying medical care.

d.

anxiety related to cancer diagnosis and need to make treatment decisions.

ANS: D

The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

DIF: Cognitive Level: Application REF: 1365-1366 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity

22. When caring for a patient who has a radium implant for treatment of cancer of the cervix, the nurse will

a.

maintain the patient on complete bed rest.

b.

use gloves when changing the patients bed.

c.

allow extra time for patient discussion of concerns.

d.

flush the toilet several times after the patient voids.

ANS: A

To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant. The nurse should spend minimal time in the patients room to avoid exposure to radiation.

DIF: Cognitive Level: Application REF: 1363-1364

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

23. Which information about a 48-year-old patient indicates that the nurse will need to teach the patient about endometrial biopsy?

a.

The patient has had 6 full-term pregnancies.

b.

The patient has 3 to 4 alcoholic drinks daily.

c.

The patient has used various oral contraceptives since she was 20 years old.

d.

The patient has a family history of hereditary nonpolyposis colorectal cancer.

ANS: D

Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

DIF: Cognitive Level: Application REF: 1363-1364

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

24. A 45-year-old patient is diagnosed with stage 0 cervical cancer using a punch biopsy. The nurse will plan to teach the patient about

a.

radiation.

b.

conization.

c.

chemotherapy.

d.

radial hysterectomy.

ANS: B

Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

DIF: Cognitive Level: Application REF: 1363-1364 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

25. Which topic will the nurse include in patient teaching for a 29-year-old patient who has been diagnosed with human papilloma virus (HPV) infection and who smokes cigarettes, uses oral contraceptives, and has a history of candidiasis?

a.

Use of water soluble lubricants

b.

Antifungal cream administration

c.

Importance of smoking cessation

d.

Possible difficulties with conception

ANS: C

Because smoking and HPV infection are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease ability to conceive, or require the use of antifungal creams.

DIF: Cognitive Level: Application REF: 1362-1363 | 1368

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

26. A patient with multiple uterine leiomyomas is admitted for an abdominal hysterectomy. Which topic will the nurse include in patient teaching?

a.

Leg exercises and the purpose of frequent ambulation

b.

Temporary decrease in vaginal sensation after surgery

c.

Adverse effects of systemic chemotherapy or radiation

d.

Symptoms caused by the sudden drop in estrogen level

ANS: A

Venous thromboembolism (VTE) is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Leiomyomas are benign tumors, so chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, the estrogen level will not decrease.

DIF: Cognitive Level: Application REF: 1368-1369

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

27. Which assessment finding for a patient who is on the surgical unit after a radical abdominal hysterectomy is most important to report to the health care provider?

a.

Decreased bowel sounds in all four abdominal quadrants

b.

Urine output of 100 mL in the first 8 hours after surgery

c.

One inch area of bloody drainage on the abdominal dressing

d.

Complaints of abdominal pain at the incision site with coughing

ANS: B

The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. The other findings are not unusual after this surgery.

DIF: Cognitive Level: Application REF: 1368-1369

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

28. A 56-year-old woman undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan?

a.

Teach the patient correct pessary use.

b.

Perform indwelling catheter care daily.

c.

Repack the vaginal wound daily with gauze.

d.

Provide patient teaching about a high fiber diet.

ANS: B

The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy.

DIF: Cognitive Level: Application REF: 1371-1372 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

29. A 54-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which initial response by the nurse is most appropriate?

a.

A frequent cause of spotting is endometrial cancer.

b.

How long has it been since your last menstrual period?

c.

Breakthrough bleeding is not unusual in women your age.

d.

Are you using prescription hormone replacement therapy?

ANS: D

In postmenopausal women, a common cause of spotting is hormone replacement therapy (HRT). Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patients symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

DIF: Cognitive Level: Application REF: 1351-1352

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

30. An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which question should the nurse ask?

a.

Do you use any illegal substances?

b.

Have you ever had sexual intercourse?

c.

How old were you when your menstrual periods started?

d.

Do you have any cramping with your menstrual periods?

ANS: B

The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21. The information about menstrual periods and substance abuse will not help to determine whether the patient requires a Pap test.

DIF: Cognitive Level: Application REF: 1363

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

31. Which information will the nurse include when developing a patient teaching plan for a 48-year-old patient with uterine bleeding caused by a leiomyoma?

a.

Aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) may be used to control mild to moderate pain.

b.

The tumor size is likely to increase throughout the patients lifetime.

c.

The symptoms may decrease after the patient undergoes menopause.

d.

The patient will need frequent monitoring to detect any malignant changes.

ANS: C

Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

DIF: Cognitive Level: Application REF: 1361 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

32. A female patient who is seen in the health clinic is diagnosed with genital warts. The nurse will plan to teach the patient about

a.

the need for regular Pap tests.

b.

increased risk for endometrial cancer.

c.

appropriate use of oral contraceptives.

d.

symptoms of pelvic inflammatory disease.

ANS: A

Genital warts are caused by the human papilloma virus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer.

DIF: Cognitive Level: Application REF: 1362-1363 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

33. Which statement by a patient who has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection indicates that the nurses teaching has been effective?

a.

I can purchase an over-the-counter medication to treat this infection.

b.

The symptoms are due to the overgrowth of normal vaginal bacteria.

c.

The medication will need to be inserted once daily with an applicator.

d.

Both my partner and I will need to take the medication for a full week.

ANS: D

Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection.

DIF: Cognitive Level: Application REF: 1357 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

34. Which action by the nurse will be most important in maintaining the medicolegal chain of evidence for a patient who has been sexually assaulted?

a.

Label all specimens and materials obtained from the patient.

b.

Educate the patient about the reason for baseline sexually transmitted disease (STD) testing.

c.

Assist the patient in filling out the application for financial compensation.

d.

Discuss the availability of the morning-after pill for pregnancy prevention.

ANS: A

All of the interventions are appropriate, but only the careful labeling of specimens and materials will assist in maintaining the chain of evidence.

DIF: Cognitive Level: Application REF: 1373-1374

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

35. A 32-year-old patient has minor changes on her Pap test. Which action should the nurse take?

a.

Teach the patient about colposcopy.

b.

Teach the patient about punch biopsy.

c.

Schedule another Pap test in 4 months.

d.

Administer the human papilloma virus (HPV) vaccine.

ANS: C

Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26.

DIF: Cognitive Level: Application REF: 1363-1364

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

36. A 19-year-old requests a prescription for birth control pills to decrease abdominal cramping and headaches during her menstrual periods. Which of these actions should the nurse take first?

a.

Determine whether the patient is sexually active.

b.

Suggest that the patient use nonsteroidal antiinflammatory drugs (NSAIDs) for symptom relief.

c.

Take a personal and family health history from the patient.

d.

Teach the patient about the side effects of oral contraceptives.

ANS: C

Oral contraceptives may be appropriate to control this patients symptoms, but the patients health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Since the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time.

DIF: Cognitive Level: Application REF: 1350

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

37. Which assessment finding in a woman who recently started taking hormone replacement therapy (HRT) is most important for the nurse to report to the health care provider?

a.

Breast tenderness

b.

Weight gain of 3 lb

c.

Intermittent spotting

d.

Unilateral calf swelling

ANS: D

Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

DIF: Cognitive Level: Application REF: 1354-1355

OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

38. After being sexually assaulted, a woman is brought to the emergency department by a friend. The patient is confused and has a large laceration above the left eye. Which action should the nurse take first?

a.

Assess the patients neurologic status.

b.

Assist the patient in removing her clothing.

c.

Contact the sexual assault nurse examiner (SANE).

d.

Ask the patient to describe what occurred during the assault.

ANS: A

The first priority is to treat urgent medical problems associated with the sexual assault. The patients head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore her neurologic status should be assessed first. The other nursing actions also are appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury.

DIF: Cognitive Level: Application REF: 1372

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

39. A patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. The priority nursing diagnosis for the patient at this time is

a.

self-care deficit: bathing/hygiene related to pain and difficulty in moving.

b.

risk for infection related to contamination of the wound with urine and stool.

c.

imbalanced nutrition: less than body requirements related to low-residue diet.

d.

risk for ineffective sexual pattern related to disfiguration caused by the surgery.

ANS: B

Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The other nursing diagnoses also may be appropriate for the patient but are not the highest priority immediately after surgery.

DIF: Cognitive Level: Application REF: 1369-1370

OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity

40. A patient who has a large cystocele has not voided since admission 8 hours previously. Which action should the nurse take first?

a.

Insert a straight catheter per the PRN order.

b.

Encourage the patient to increase oral fluids.

c.

Notify the health care provider of the inability to void.

d.

Use an ultrasound scanner to check for urinary retention.

ANS: D

Since urinary retention is common with a large cystocele, the nurses first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings with the bladder scanner.

DIF: Cognitive Level: Application REF: 1370-1371

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

41. A patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information is most important to communicate to the health care provider?

a.

Chronic breast tenderness

b.

Frequent abdominal bloating

c.

History of migraine headaches

d.

Previous spontaneous abortion

ANS: C

Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other patient information would not prevent the patient from receiving oral contraceptives.

DIF: Cognitive Level: Application REF: 1350

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

42. The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first?

a.

A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain

b.

A patient in the fifteenth week of gestation who is experiencing uterine cramping and spotting

c.

A patient who has a radium implant in place to treat cervical cancer and is crying in her room

d.

A patient with ovarian cancer who is complaining of 5/10 pain after an abdominal hysterectomy

ANS: A

The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients also should be assessed as quickly as possible but do not have symptoms of life-threatening complications.

DIF: Cognitive Level: Analysis REF: 1353

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. When counseling a healthy perimenopausal woman who prefers not to use hormone replacement therapy (HRT), which nonhormonal therapies will the nurse suggest (select all that apply)?

a.

Reduce coffee intake.

b.

Exercise several times a week.

c.

Take black cohosh supplements.

d.

Have a glass of wine in the evening.

e.

Increase intake of dietary soy products.

ANS: A, B, C, E

Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.

DIF: Cognitive Level: Analysis REF: 1355-1356

OBJ: Special Questions: Alternate Item Format

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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