C53 - ch 53 test bank PDF

Preview

Summary

ch 53 test bank ...

Description

Chapter 53: Female Reproductive and Genital Problems Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A 34-yr-old patient who is discussing contraceptive options with the nurse says, “I want to

have children but not for a few years.” Which response by the nurse is accurate? “If you do not become pregnant within the next few years, you never will.” “Women often have more difficulty becoming pregnant after about age 35.” “Stop taking oral contraceptives several years before you want to have a child.” “You have many more years of fertility left, so there is no rush to have children.”

a. b. c. d.

ANS: B

The probability of successfully becoming pregnant decreases after age 35 years, 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 Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant.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 fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving. DIF: Cognitive Level: Apply (application) REF: 1242 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The

woman tells the nurse that they cannot afford IVF on her husband’s salary. The man replies that if his wife worked outside the home, 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 quarreling about finances, the data do not provide information indicating that the finances are inadequate. DIF: Cognitive Level: Apply (application) REF: 1243 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 3. A young patient who is trying to become pregnant asks the nurse how to determine when she

is most likely to conceive. The nurse explains that ovulation is unpredictable unless there are regular menstrual periods. ovulation prediction kits can provide accurate information about ovulation. she will need to bring a specimen of cervical mucus to the clinic for testing. she should take her body temperature daily and have intercourse when it drops.

a. b. c. d.

ANS: B

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: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. A patient has an induced abortion with suction curettage at an ambulatory surgical center.

Which instructions will the nurse include when discharging the patient? a. “Avoid contraceptives until your reexamination.” b. “Heavy vaginal bleeding is expected for 2 weeks.” c. “Abstain from sexual intercourse for the next 2 weeks.” d. “Irregular menstrual periods are expected for a few months.” ANS: C

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: Apply (application) REF: 1243 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. A patient is scheduled for an induced abortion using instillation of hypertonic saline solution.

Which information will the nurse plan to discuss with the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in terminating the pregnancy. ANS: B

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: Apply (application) REF: 1244 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A 28-yr-old patient reports anxiety, headaches with dizziness, and abdominal bloating

occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of 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 antiinflammatory drugs (NSAIDs) such as

ibuprofen to control symptoms.

ANS: A

The patient’s symptoms indicate 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: Apply (application) REF: 1244 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. A 19-yr-old patient has been diagnosed with primary dysmenorrhea. How will the nurse

suggest that the patient manage discomfort? Avoid aerobic exercise during her menstrual period. Use cold packs on the abdomen and back for pain relief. Talk with her health care provider about beginning antidepressant therapy. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.

a. b. c. d.

ANS: D

NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame when 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: Apply (application) REF: 1245 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 8. A patient who was admitted to the emergency department with severe 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 patient’s 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. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination. DIF: Cognitive Level: Analyze (analysis) REF: 1247 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 9. When caring for a 58-yr-old patient with persistent menorrhagia, the nurse will plan to

monitor the estrogen level. complete blood count (CBC). gonadotropin-releasing hormone (GNRH) level. serial human chorionic gonadotropin (hCG) results.

a. b. c. d.

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 hCG levels are monitored in patients who may be pregnant, which is not likely for this patient. DIF: Cognitive Level: Apply (application) REF: 1246 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual

period for 3 months. Which response by the nurse is appropriate? “Have you thought about using hormone replacement therapy?” “Most women feel a little depressed about entering menopause.” “What was your menstrual pattern before your periods stopped?” “Because you are in your mid-40s, it is likely that you are menopausal.”

a. b. c. d.

ANS: C

The initial response by the nurse should be to assess the patient’s 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 therapy 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: Apply (application) REF: 1248 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. A patient is considering the use of combined estrogen-progesterone hormone replacement

therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT. b. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe. ANS: C

Data from the Women’s 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: Apply (application) REF: 1249 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

12. A female patient tells the nurse that she has been having nightmares and acute anxiety around

men since being sexually assaulted 3 months ago. 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 patient’s 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 patient’s symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis. DIF: Cognitive Level: Apply (application) REF: 1263 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 13. Which statement by the patient indicates that the nurse’s teaching about treating vaginal

candidiasis was effective? “I will tell my partner that we cannot have intercourse for a month.” “I should clean carefully after each urination and bowel movement.” “I can douche with warm water if the itching continues to bother me.” “I will insert the antifungal cream right before I get up in the morning.”

a. b. c. d.

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 periods of time. DIF: Cognitive Level: Apply (application) REF: 1250 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 14. A patient who is scheduled for a routine gynecologic examination tells the nurse that she has

had intercourse during the past year with several men. The nurse will plan to teach about the reason for a. contraceptive use. c. Chlamydia testing. b. antibiotic therapy. 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: Apply (application) REF: 1251 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. 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. Elevate the head of the bed at least 30 degrees. d. Teach the patient how to perform Kegel exercises. ANS: C

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 test results 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: Apply (application) REF: 1252 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 16. A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an

outpatient. Which instruction will be included in patient teaching? a. Abdominal pain may persist for several weeks. b. Return for a follow-up appointment in 2 to 3 days. c. Instruct a male partner to use a condom during sexual intercourse for the next

week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ

scarring ANS: B

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: Apply (application) REF: 1252 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 17. A 32-yr-old patient has oral contraceptives prescribed for endometriosis. The nurse will teach

the patient to expect to experience side effects such as facial hair. take the medication every day for the next 9 months. take calcium supplements to prevent developing osteoporosis during therapy. use a second method of contraception to ensure that she will not become pregnant.

a. b. c. d.

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: Apply (application) REF: 1253 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. A patient with endometriosis asks why she is being treated with medroxyprogesterone, a

medication that she thought was a contraceptive. The nurse explains that this therapy a. suppresses the menstrual cycle by mimicking pregnancy. b. relieves symptoms such as vaginal atrophy and hot flashes. c. prevents a pregnancy that could worsen the menstrual bleeding.

d. leads to permanent suppression of abnormal endometrial tissues. ANS: A

Medroxyprogesterone induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropinreleasing hormone agonists such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. DIF: Cognitive Level: Apply (application) REF: 1253 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. A patient was recently diagnosed with polycystic ovary syndrome. It is most important for the

nurse to teach the patient reasons for a total hysterectomy. how to decrease facial hair growth. ways to reduce the occurrence of acne. methods to maintain appropriate weight.

a. b. c. d.

ANS: D

Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also 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, it is usually performed only after other therapies have been unsuccessful. DIF: Cognitive Level: Analyze (analysis) REF: 1255 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 20. A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5

years of menopause. The nurse will anticipate teaching the patient about c. uterine balloon therapy. d. dilation and curettage (D&C).

a. endometrial biopsy. b. endometrial ablation. 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: Apply (application) REF: 1257 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 21. A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been

diagnosed with stage III ovarian cancer is sexual dysfunction related to loss of vaginal sensation. risk for infection related to impaired immune function. anxiety related to cancer diagnosis and need for treatment decisions. situational low self-esteem related to guilt about delaying medical care.

a. b. c. d.

ANS: C

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 s...