Chapter 6 Womens Health Problems My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 6 Womens Health Problems

1) The nurse receives a phone call from a 25-year-old woman experiencing breast tenderness in the week prior to her menses, with palpable breast nodularity, without nipple discharge. What is the best response by the nurse?

1. Please make an appointment at the breast cancer center as soon as possible.

2. How much salty food do you regularly consume?

3. As long as you dont have nipple discharge, it isnt a serious condition.

4. Eliminate caffeine and chocolate from your diet.

Answer: 2

Explanation: 2. The client is describing fibrocystic breast changes. A salt restriction with a mild diuretic taken the week before menstrual bleeding often improves the condition.

Page Ref: 92

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

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2) A client describes breast swelling and tenderness. What piece of data would be most important for the nurse to gather initially?

1. Timing of the symptoms

2. Birth control method

3. Method of breast self-examination

4. Diet history

Answer: 1

Explanation: 1. The breast undergoes regular cyclical changes in response to hormonal stimulation. The nurse will want to determine when the swelling and tenderness occur within the menstrual cycle.

Page Ref: 88, 89

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessment of health and illness parameters in patient, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

3) A client is concerned about her risk for breast cancer. Following the initial history, the nurse identifies which of the following as a high risk factor for breast cancer?

1. History of late menarche and early menopause

2. Sister who has had breast cancer

3. Mother with fibrocystic breast disease

4. Multiparity

Answer: 2

Explanation: 2. Family history of first-degree relative (mother, sister, or daughter) with breast cancer increases the risk of breast cancer with the number of first-degree relatives with breast cancer.

Page Ref: 94

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: VII. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

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4) The nurse is educating a group of women about the manifestations of benign breast conditions. What information topics will the nurse include?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Masses rapid in appearance or disappearance

2. Galactorrhea is common

3. Galactorrhea is seen with some psychiatric medications

4. Ulcerations or skin erosions are possible

5. An increased breast size with dimpling

Answer: 1, 2, 3

Explanation: 1. Fluctuations in size and rapid appearance or disappearance of breast masses are common in fibrocystic breasts.

2. Galactorrhea is a benign change often associated with hormone therapy.

3. Galactorrhea is often seen in women who have nursed, who have fibrocystic changes in the breast, or are on some types of psychiatric medication.

Page Ref: 93

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients and designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

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5) A nurse is providing a client with instructions regarding breast self-examination (BSE). Which of the following statements by the client would indicate that the teaching has been successful?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. I should perform BSE 1 week prior to the start of my period.

2. When I reach menopause, I will perform BSE every 2 months.

3. Knowing the density of my breast tissue is important.

4. I should inspect my breasts while standing with my arms down at my sides.

5. I should inspect my breasts while in a supine position with my arms at my sides.

Answer: 3, 4

Explanation: 3. The effectiveness of BSE is determined by the womans ability to perform the procedure correctly, by her knowledge of her own breast tissue, and by the density of her breast tissue.

4. The breasts should be inspected while standing with arms at sides.

Page Ref: 89-92

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Contrast the common benign and malignant breast disorders.

6) The nurse is working with a woman who is undergoing chemotherapy for breast cancer. The client states, First, the cancer seemed unreal. Now I feel like I can cope. What is the nurses best response?

1. Women with breast cancer often go through several stages of adjustment.

2. Women with breast cancer cope better than their partners cope.

3. Women with breast cancer seek multiple opinions before starting treatment.

4. Women with breast cancer become angry after treatment begins.

Answer: 1

Explanation: 1. The course of adjustment confronting the woman with cancer has been described in four phases: shock, reaction, recovery, and reorientation. The clients statement indicates shock followed by reaction.

Page Ref: 95

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I. C. 1. Value seeing health care situations through patients eyes. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Describe the emotional reactions a woman may experience in regard to a

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diagnosis of breast cancer.

7) A nurse is caring for a client admitted preoperatively for a bilateral mastectomy. Which statement indicates that this client is still in the shock phase of adjustment to her diagnosis?

1. I cant understand why this is happening to me.

2. I am so happy that my daughter graduates from high school this year.

3. I know that breast cancer is now part of my life.

4. I cant believe that I need to lose both of my breasts.

Answer: 1

Explanation: 1. In the shock phase, a client makes statements such as this.

Page Ref: 95

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed need. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination and his or her own power of self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Describe the emotional reactions a woman may experience in regard to a diagnosis of breast cancer.

8) A client is at a physicians office following the end of treatment for breast cancer. The client is not scheduled to receive any more radiation or chemotherapy at this time. With treatment behind her, the client can now look again to the future. Which phase of psychological adjustment is this client experiencing?

1. Shock

2. Reaction

3. Recovery

4. Reorientation

Answer: 3

Explanation: 3. The recovery phase begins during convalescence following the completion of medical treatment.

Page Ref: 95

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Developmental Stages and Transitions

Standards: QSEN Competencies: I. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Describe the emotional reactions a woman may experience in regard to a diagn

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osis of breast cancer.

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9) The nurse interviews a 28-year-old client with a new medical diagnosis of endometriosis. Which question asked by the nurse is appropriate?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Are you having hot flashes?

2. Are you experiencing pain during intercourse?

3. Is a vaginal discharge present?

4. Are you having pain during your period?

5. Have you noticed any skin rashes?

Answer: 2, 4

Explanation: 2. The primary symptoms of endometriosis include dyspareunia.

4. The primary symptoms of endometriosis include dysmenorrhea.

Page Ref: 105

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients using developmentally and culturally appropriate approaches. | NLN Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

10) The client has been found to have vitiligo on her vulva. Which client statement indicates that the client requires additional teaching on this condition?

1. This can occur in other places on my body.

2. Vitiligo is only a decrease of pigmentation.

3. Other serious health conditions are common with vitiligo.

4. There usually are no other symptoms of this condition.

Answer: 3

Explanation: 3. Vitiligo is an absence of melanin, which results in white patches that are especially noticeable on dark-skinned individuals. It can occur in multiple areas on the body, and has no associated symptoms or health conditions.

Page Ref: 98

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively;

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listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Summarize behaviors that help to minimize recurrence of some of the common lesions of the vulva.

11) The nurse is teaching a client who has been diagnosed with vulvitis. Which statement by the client indicates that the nurses instruction has not been effective?

1. I should stop having sexual intercourse.

2. Non-deodorized tampons could make this condition recur.

3. Wearing pantyhose daily will improve the problem.

4. A different brand of soap might eliminate the irritation.

Answer: 3

Explanation: 3. Vulvitis is inflammation of the vulva. Tight clothing, especially if made of synthetic fibers, can predispose women to the condition. Pantyhose should not be worn.

Page Ref: 96, 97

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Summarize behaviors that help to minimize recurrence of some of the common lesions of the vulva.

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12) The 22-year-old client is scheduled for her first gynecologic examination. What can the nurse do to make the client more comfortable during this exam?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Create a trusting atmosphere.

2. Show the client what the speculum looks like.

3. Avoid telling the client what the exam involves.

4. Ask the client why she has delayed her first Pap test this long.

5. Provide a mirror for the client.

Answer: 1, 2, 5

Explanation: 1. It is important to create a trusting atmosphere and incorporate practices that help the client maintain a sense of control.

2. Show the client all of the equipment to be used.

5. Provide a mirror to increase learning about anatomy and to create a trusting atmosphere.

Page Ref: 96

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Screening

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

13) The 12-year-old client reports that menarche occurred 5 months ago. She has had bleeding every day this month, and is very worried. The nurse should explain that the most common cause of this bleeding is which of the following?

1. Dysfunctional uterine bleeding (DUB)

2. Diabetes mellitus (DM)

3. Pregnancy

4. Von Willebrands disease

Answer: 1

Explanation: 1. Adolescents often experience DUB during the first 2 years following menarche due to hypothalamic immaturity after menarche.

Page Ref: 102

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Personal and Pr

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ofessional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

14) The nurse is scheduling an ultrasound for a 51-year-old client with a suspected uterine tumor. The nurse includes in the clients teaching that the most common benign uterine tumor seen in women in their 50s is which of the following?

1. Fibroid tumor

2. Fibroadenoma

3. Fibrocystic tumor

4. Lymphoma

Answer: 1

Explanation: 1. By the age of 50, 70% of Caucasian women and 80% of African American women have fibroids.

Page Ref: 103

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

15) A nurse is teaching a class on the different types of uterine bleeding. The nurse explains that which of the following is one of the causes of abnormal uterine bleeding?

1. Iron-deficiency anemia

2. Polyps

3. Heavy periods every 2 months

4. Spotting between periods

Answer: 2

Explanation: 2. A classification system has been developed for the causes of AUB using the acronym PALM-COEIN. The P stands for Polyps.

Page Ref: 102

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

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Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

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16) The nurse is writing a care plan for a client with abnormal uterine bleeding (AUB). Which goals does the nurse include?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Preventing or treating anemia

2. Preventing endometrial hyperplasia

3. Restoring quality of life

4. Conducting pelvic exams monthly

5. Analyzing liver and kidney function

Answer: 1, 2, 3

Explanation: 1. One goal for the client with AUB is to prevent or treat anemia.

2. One goal for the client with AUB is to prevent endometrial hyperplasia.

3. One goal for a client with AUB is to restore quality of life.

Page Ref: 102

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all health care settings. | NLN Competencies: Quality and Safety: Carefully maintain and use electronic and/or written health records. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Discuss abnormal uterine bleeding and abdominal masses.

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17) The nurse walks in to find the client crying after the physician informed her of her diagnosis of human papilloma virus (HPV). Which statement by the nurse conveys an attitude of acceptance toward the client with a sexually transmitted infection?

1. Dont worry about it. In a few weeks, with treatment, the lesions will disappear.

2. You seem upset. Ill get the doctor.

3. You seem upset. Can I help answer any questions?

4. I think you need to see a therapist.

Answer: 3

Explanation: 3. The nurses attitude of acceptance and matter-of-factness conveys to the client that she is still an acceptable person who happens to have an infection.

Page Ref: 96

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: QSEN Competencies: I. C. 8. Appreciate the role of the nurse in relief of all types and sources of pain or suffering. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.

18) The nurse obtains a health history from four clients. To which client should she give priority for teaching about cervical cancer prevention?

1. Age 37, multiple partners

2. Age 22, abstains from sexual intercourse

3. Age 32, pregnant with twins

4. Age 27, uses female condom

Answer: 1

Explanation: 1. Having multiple partners increases the clients risk of contracting sexually transmitted infections, including possible exposure to human papilloma virus (HPV). Contracting HPV increases risk of abnormal cervical cell changes and cervical cancer.

Page Ref: 100

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Teamwork: Clarify roles and integrate the contributions of others who play a role in helping the patient/family achieve health goals. | Nursing/Integrated Concepts: Nursing Process: Planning

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Learning Outcome: 6 Describe the role that human papilloma virus plays in abnormal Pap smears.

MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.

19) The nurse is about to tell a client that her Pap smear result was abnormal. Which statement should the nurse include?

1. The Pap smear is used to diagnose cervical cancer.

2. A loop electrosurgical excision procedure (LEEP) is needed.

3. Colposcopy to further examine your cervix is the next step.

4. Your cervix needs to be treated with cryotherapy.

Answer: 3

Explanation: 3. Colposcopy is an examination of the cervix through a magnifying device.

Page Ref: 101

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 1. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

20) The clients Pap smear result is ASC-US. Which statement is the best way for the nurse to explain this ASC-US result?

1. Abnormal squamous cells of undetermined significance.

2. Cancer has invaded the upper cervix.

3. High-grade squamous intraepithelial lesion (HSIL), which includes CIN.

4. The focus of the Pap smear is the detection of high-risk pregnancy.

5. The cervical cells are abnormal and the reason why is severe dysplasia and carcinoma in situ.

Answer: 1

Explanation: 1. ASC-US stands for abnormal squamous cells of undetermined significance. Preferred management is HPV testing; if positive, refer for colposcopy; if negative, repeat HPV co-testing in 3 years.

Page Ref: 101

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; li

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sten openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

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21) The nurse has presented a community education class on recommended health screenings for women. Which statement about the Pap smear by a class member indicates that additional teaching is necessary?

1. It is recommended for women 21 years of age and older.

2. It diagnoses cervical cancer.

3. Intercourse at a young age is a risk factor for an abnormal Pap smear.

4. Detects abnormal cells.

Answer: 2

Explanation: 2. The focus of the Pap smear is the detection of high-grade cervical disease. It does not diagnose cervical cancer.

Page Ref: 101

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 10. Engage patient or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe the role that human papilloma virus plays in abnormal Pap smears.

22) Which client in the gynecology clinic should the nurse see first?

1. 22-year-old with fever, hypotensive, using tampons

2. 15-year-old, no menses for past 4 months

3. 18-year-old seeking information on contraception methods

4. 31-year-old, reports increasing dyspareunia

Answer: 1

Explanation: 1. A client using tampons who has a fever, is dizzy, and hypotensive might have toxic shock syndrome.

Page Ref: 104

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making modes. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 8 Identify the risk factors, treatment options, and nursing interventions for a woman with toxic shock syndrome.

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23) The nurse in the emergency department is admitting a 22-year-old woman who complains of watery diarrhea, dizziness, and vomiting. She is in the middle of her period, and has a tampon in place. The nurse suspects toxic shock syndrome, and assesses for the manifestations of which symptom?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Fever

2. Rash

3. Desquamation of skin

4. Bloating

5. Urinary frequency and urgency

Answer: 1, 2, 3

Explanation: 1. A fever presents initially.

2. A rash on the trunk presents initially.

3. The fever and rash on the trunk present initially, followed by desquamation of the skin, especially the palms and soles, which usually occurs 1 to 2 weeks after the onset of symptoms.

Page Ref: 104

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Personal and Professional Development: Identify problems. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Identify the risk factors, treatment options, and nursing interventions for a woman with toxic shock syndrome.

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24) The nurse is caring for a client diagnosed with endometriosis. Which statement by the client would require a need for perhaps another treatment option?

1. I am having many hot flashes since I had the Lupron injection.

2. The pain I experience with intercourse is becoming more severe.

3. I have vaginal dryness, reduced libido, and my clitoris has become larger since taking danazol. Is this normal?

4. Ive noticed I have not had my period on a regular basis since being on the GnRH analogs.

Answer: 3

Explanation: 3. Danazol is a testosterone derivative that suppresses ovulation and causes amenorrhea. It is intended for short-term therapy. Because of adverse effects, many clinicians have moved away from danazol to other treatment options.

Page Ref: 105

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Self-Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

25) The client diagnosed with endometriosis asks the nurse whether there are any long-term health risks associated with this condition. The nurse should include which statement in the client teaching about endometriosis?

1. There are no other health risks associated with endometriosis.

2. Pain with intercourse rarely occurs as a long-term problem.

3. You are at increased risk for ovarian and breast cancer.

4. Most women with this condition develop severe migraines.

Answer: 3

Explanation: 3. An increased risk for cancer of the ovary and breast is associated with endometriosis.

Page Ref: 106

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9 Discuss the signs and symptoms, medical therapy, and implications for fertility of endometriosis.

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26) The client is undergoing lab work and ultrasound for a possible diagnosis of polycystic ovarian syndrome (PCOS). Which problem does the nurse expect to find in the clients history?

1. Multiple first-trimester fetal losses

2. Dyspareunia

3. Vulvitis

4. Oligomenorrhea

Answer: 4

Explanation: 4. Irregular menses, ranging from total absence of periods (amenorrhea) to intermittent or infrequent periods (oligomenorrhea) are the hallmarks of PCOS.

Page Ref: 106

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

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27) The client with polycystic ovarian syndrome (PCOS) has been prescribed metformin (Glucophage). The nurse tells the client that the medication will do which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Decrease your excessive hair growth.

2. Make it easier to lose weight.

3. Increase your acne.

4. Improve your chances of pregnancy.

5. Make your menstrual periods irregular.

Answer: 1, 2, 4

Explanation: 1. Polycystic ovarian syndrome (PCOS) treatment with metformin decreases hirsutism.

2. Polycystic ovarian syndrome (PCOS) treatment with metformin improves weight loss success.

4. Polycystic ovarian syndrome (PCOS) treatment with metformin increases ovulation and therefore menstrual regularity and fertility.

Page Ref: 106

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

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28) A nurse is examining a client with a potential of polycystic ovarian syndrome. The nurse knows that which diagnostic is the most important indicator to support a diagnosis of polycystic ovarian syndrome?

1. Total estrogen level

2. Waist to chest ratio

3. Hyperandrogenism

4. Hypoinsulinemia

Answer: 3

Explanation: 3. Hyperandrogenism, as women with PCOS consistently have elevated serum androgen levels. These elevated androgen levels often lead to clinical manifestations such as hirsutism (excessive hair growth), acne, deepening voice, and increased muscle mass.

Page Ref: 106

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10 Discuss the signs and symptoms, diagnosis criteria, treatment options, and health implications of polycystic ovarian syndrome.

29) A 56-year-old client comes into the gynecology clinic with the complaints of constipation and a protrusion from her vagina. What does this client most likely have?

1. A cystocele

2. A prolapsed uterus

3. Polycystic ovarian syndrome

4. A rectocele

Answer: 4

Explanation: 4. This is the correct answer. The client often complains of constipation, and the anterior wall of the rectum protrudes through the vagina.

Page Ref: 107

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 11 Compare the signs and symptoms and treatment options of the three forms of pelvic relaxationcystocele, rectocele, and uterine relaxation.

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30) A client is diagnosed with a cystocele. The nurse actively listens as the client talks about which treatment choice to make. The treatment options available to the client are which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Kegel exercises

2. Vaginal pessaries

3. Surgical intervention

4. Estrogen

5. Fine-needle aspiration

Answer: 1, 2, 3, 4

Explanation: 1. One treatment option is to use Kegel exercises.

2. A treatment choice the client has is to have a pessary or ring inserted.

3. Surgical intervention is one approach to helping the client with a cystocele.

4. Estrogen may improve the condition of vaginal mucous membranes, especially in menopausal women.

Page Ref: 107

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11 Compare the signs and symptoms and treatment options of the three forms of pelvic relaxationcystocele, rectocele, and uterine relaxation.

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31) Abdominal hysterectomy is generally recommended for which condition?

1. Severe endometriosis

2. Removal of the ovaries

3. Suspected or confirmed cancer removal

4. Abnormal uterine bleeding

Answer: 1

Explanation: 1. Abdominal hysterectomy is recommended for severe endometriosis.

Page Ref: 108

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12 Contrast laparoscope-assisted vaginal hysterectomy and abdominal hysterectomy with regard to indications for use and the advantages and disadvantages of each procedure.

32) The nurse educator is discussing abdominal and vaginal hysterectomy with the students. The nurse explains that the one main disadvantage of a vaginal hysterectomy is which of the following?

1. More blood loss with the surgery

2. Increased pain postoperatively

3. A longer recuperation period

4. Trauma to the bladder

Answer: 4

Explanation: 4. The chance of doing some trauma to the bladder is greater with the vaginal hysterectomy.

Page Ref: 108

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects development stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 12 Contrast laparoscope-assisted vaginal hysterectomy and abdominal hysterectomy with regard to indications for use and the advantages and disadvantages of each procedure.

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33) Which of the following systems provides a uniform format and classification of terminology based on current understanding of cervical disease?

1. Levonorgestrel intrauterine

2. PALM-COEIN

3. Bethesda

4. BSE

Answer: 3

Explanation: 3. The Bethesda System for classifying Pap smears is a standardized method of reporting cytologic Pap smear findings and is the most widely used method in the United States.

Page Ref: 99

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Discuss the importance of an annual Pap smear and appropriate follow-up for an abnormal finding.

34) The nurse working on a postoperative gynecology unit has to be knowledgeable of the psychological concerns of many of her clients. What will these concerns most often include?

1. Feelings of loss, grief, and anger

2. Feelings of euphoria and happiness

3. Feelings of control and calmness

4. Feelings of cheerfulness and satisfaction

Answer: 1

Explanation: 1. Many gynecological procedures have the potential to involve loss, so grieving, anger, sadness, and loss of control are just a few of the feelings the woman might experience.

Page Ref: 109

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I. C. 2. Respect and encourage individual expression of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 13 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

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35) The nurse has assessed a client who is to undergo gynecological surgery. Upon what will the nurse base the nursing diagnosis?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. The clients attitudes toward motherhood

2. The clients body image

3. The clients attitudes about sexuality

4. The clients long-term risk reduction

5. The clients use of acupuncture

Answer: 1, 2, 3

Explanation: 1. Reproductive surgery may also be seen as a threat to femininity in any social or cultural group that emphasizes childbearing and motherhood.

2. Surgery to alter or remove reproductive organs may be perceived as a threat to self-concept. Body image is affected whenever a body part is lost.

3. Many women fear postoperative changes such as masculinization, weight gain, loss of sexuality, and permanent loss of the ability to have a child.

Page Ref: 108

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: QSEN Competencies: I. B. 9. Assess level of patients decisional conflict and provide access to resources. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing processes. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 13 Delineate the psychosocial responses a woman may experience when facing any of the common gynecologic procedures.

MNL LO: 6.3.1 Examine the nurses role in preparing a woman for a gynecologic surgical procedure.

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