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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter56:AssessmentandManagementofPatientsWithFemale PhysiologicProcesses  1.

Aschoolnurseispresentinginformationonhumandevelopmentandsexuality.Whendescribingthe roleofhormonesinsexualdevelopment,whichhormonedoesthenurseteachtheclassisthemost importantonefordevelopingandmaintainingthefemalereproductiveorgans?

A)

Estrogen

B)

Progesterone

C)

Androgens

D)

Follicle-stimulatinghormone

Ans:

A Feedback: Estrogensareresponsiblefordevelopingandmaintainingthefemalereproductiveorgans.Progesterone isthemostimportanthormoneforconditioningtheendometriuminpreparationforimplantationofthe fertilizedovum.Androgens,secretedbytheovariesinsmallamounts,areinvolvedintheearly developmentofthefollicleandaffectthefemalelibido.Follicle-stimulatinghormoneisresponsiblefor stimulatingtheovariestosecreteestrogen.

2.

Thenurseistakingthesexualhistoryofanadolescentwhohascomeintothefreeclinic.Whatquestion bestassessesthepatientsneedforfurtherinformation?

A)

Areyouinvolvedinanintimaterelationshipatthistime?

B)

Howmanysexualpartnershaveyouhad?

C)

Whatquestionsorconcernsdoyouhaveaboutyoursexualhealth?

D)

Haveyoueverbeendiagnosedwithasexuallytransmittedinfection?

Ans:

C Feedback: Anopen-endedquestionrelatedtothepatientsneedforfurtherinformationshouldbeincludedwhile obtainingasexualhistory.Noneoftheotherlistedquestionsareopen-ended.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

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Thenurseisbeingtrainedtoperformassessmentscreeningsforabuseonpatientswhocomeintothe walk-inclinicwherethenurseworks.Whichofthefollowingassessmentquestionsismostappropriate?

A)

Wouldyoudescribeyourrelationshipashealthyandfunctional?

B)

Haveyoueverbeenforcedintosexualactivity?

C)

Doyoumakeyourhusbanduncontrollablyangry?

D)

Howisconflictusuallyhandledinyourhome?

Ans:

B Feedback: Askingaboutabusedirectlyiseffectiveinidentifyingthepresenceofabuseandshouldbeincludedin thehealthhistoryofallwomen.Obliquequestionsthatrelatetothecharacteroftherelationshipor conflictresolutionarelessusefulclinically.Askingaboutmakingapartnerangryisnotanappropriate waytoscreenforfamilyviolencebecauseitdoesnotdirectlyaddresstheproblem.

4.

Apremenopausalpatientiscomplainingofvaginalspottingandsharp,colickylowerabdominalpain. Sheinformsthenursethatherperiodis2weekslate.Thenurseshouldrecognizeaneedforthispatient tobeinvestigatedforwhathealthproblem?

A)

Trichomonasvaginalis

B)

Ectopicpregnancy

C)

Cervicalcancer

D)

Fibromyalgia

Ans:

B Feedback: Clinicalsymptomsofanectopicpregnancyincludedelayinmenstruationof1to2weeks,vaginal spotting,andsharp,colickypain.Trichomonasvaginaliscausesavaginalinfection.Cervicalcancerand fibromyalgiadonotaffectmenstruation.

5.

A)

Afemalepatientwhohascognitiveandphysicaldisabilitieshascomeintotheclinicforaroutinecheckup.Whenplanningthispatientsassessment,whatactionshouldthenursetake? Ensurethatachaperoneisavailabletobepresentduringtheassessment.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Limitthelengthandscopeofthehealthassessment.

C)

Avoidhealthpromotionordiseasepreventioneducation.

D)

Avoidequatingthepatientwithherdisabilities.

Ans:

D

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Feedback: Whenworkingwithwomenwhohavedisabilities,itisimportantthatthenurseavoidequatingthe womanwithherdisability;thenursemustmakeanefforttounderstandthatthepatientandthedisability arenotsynonymous.Achaperoneisnotnecessarilyrequiredandtheremayormaynotbeaneedto abbreviatetheassessment.Thenurseshouldprovideeducationasneeded. 6.

Apatientcallstheclinicandtellsthenurseshehasthickwhite,curd-likedischargefromhervagina. Howshouldthenursebestinterpretthispreliminarydata?

A)

Thedrainageisphysiologicandnormal.

B)

ThepatientmayhaveaCandidaspeciesinfection.

C)

ThepatientneedsaPapsmearassoonaspossible.

D)

ThepatientmayhaveaTrichomonasinfection.

Ans:

B Feedback: DrainagecausedbyCandidaistypicallycurd-likeandwhite.Trichomonasinfectionsusuallycause copious,frothyyellowish-greendischarge.ThereisnoimmediateneedforaPapsmear,asmalignancy isanunlikelycause.

7.

Anursepresentinganeducationaleventforalocalcommunitygroupisaddressingpremenstrual syndrome(PMS).Whattreatmentguidelineshouldthenurseteachthisgroup?

A)

Avoidexcessivefluidintake.

B)

Increasethefrequencyandintensityofexercise.

C)

Limitpsychosocialstressorsinordertoreducesymptoms.

D)

Takeopioidanalgesicsasordered.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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B Feedback: Ingeneral,thepatientisencouragedtoincreaseorinitiateanexerciseprogramtohelprelievesymptoms ofPMS.Fluidintakeshouldbeincreased.OpioidsarenotusedtotreatPMS.Stressreductionhas multiplebenefits,butitisnotnotedtoalleviatethesymptomsofPMS.

8.

Anurseiscollectingassessmentdatafromapremenopausalpatientwhostatesthatshedoesnothave menses.Whattermshouldthenurseusetodocumenttheabsenceofmenstrualflow?

A)

Amenorrhea

B)

Dysmenorrhea

C)

Menorrhagia

D)

Metrorrhagia

Ans:

A Feedback: Amenorrheareferstoabsenceofmenstrualflow,whereasdysmenorrheaispainfulmenstruation. Menorrhagia,alsocalledhypermenorrhea,isdefinedasprolongedorexcessivebleedingatthetimeof theregularmenstrualflow.Metrorrhagiareferstovaginalbleedingbetweenregularmenstrualperiods.

9.

Anewpatienthascometotheclinicseekinganappropriatemethodofbirthcontrol.Whatwouldthe nurseteachthispatientaboutadiaphragm?

A)

Onesizefitsallfemales.

B)

Thediaphragmmaybecleanedwithsoapandwaterafteruse.

C)

Adiaphragmeliminatestheneedforspermicidaljelly.

D)

Thediaphragmshouldberemoved1hourfollowingintercourse.

Ans:

B Feedback: Thediaphragmmaybecleanedwithsoapandwaterafteruse.Itmustbeleftin6hoursafterintercourse andshouldbeusedwithspermicidaljelly.Therearedifferentsizesofdiaphragmsandthepatientneeds tobefittedbythehealthcarepractitioner.

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10. Apatientwhoisinthefirsttrimesterofpregnancyhasexperiencedanincompleteabortion.The obstetricnurseshouldpreparethepatientforwhatpossibleintervention? A)

Dilationandevacuation

B)

Severaldaysofbedrest

C)

Administrationofhydromorphone

D)

IVadministrationofclomiphene

Ans:

A Feedback: Ifonlysomeofthetissueispassed,theabortionisreferredtoasincomplete.Anemptyingorevacuation procedure(D&C,ordilationandevacuation[D&E])oradministration oforalmisoprostol(Cytotec)isusuallyrequiredtoremovetheremainingtissue.Bedrestwillnot necessarilyresultinthepassingofallthetissue.Clomipheneandhydromorphoneareofnotherapeutic benefit.

11. Apatientinherlatefiftieshasexpressedtothenurseherdesiretoexplorehormonereplacementtherapy (HRT).BasedonwhataspectofthepatientshealthhistoryisHRTcontraindicated? A)

Historyofvaginaldryness

B)

Historyofhotflashesandnightsweats

C)

Historyofvascularthrombosis

D)

Familyhistoryofosteoporosis

Ans:

C Feedback: TheuseofHRTiscontraindicatedinwomenwithahistoryofvascularthrombosis,activeliverdisease, somecasesofuterinecancer,andundiagnosedvaginalbleeding.HRTisbeneficialinwomenwitharisk forosteoporosis.Vaginaldryness,hotflashes,andnightsweatsaresymptomsofmenopausethatmaybe relievedwithHRT.

12. Theschoolnurseispresentingaclassonfemalereproductivehealth.Thenurseshoulddescribewhat aspectofPapsmears?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Thetestmaybeperformedatanytimeduringthepatientsmenstrualcycle.

B)

Thesmearshouldbedoneevery2years.

C)

Thetestcandetectearlyevidenceofcervicalcancer.

D)

FalsepositivePapsmearresultsoccurmostlyfromnotdouchingbeforetheexamination.

Ans:

C

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Feedback: Thetestshouldbeperformedwhenthepatientisnotmenstruating.Douchingwashesawaycellular material.Thetestdetectscervicalcancer,andfalsenegativePapsmearresultsoccurmostlyfrom samplingerrorsorimpropertechnique.Formostwomen,aPapsmearshouldbedoneannually. 13. AnursepractitionerispreparingtoperformapatientsscheduledPapsmearandthepatientasksthe nursetoensurethatthespeculumiswell-lubricated.Howshouldthenurseproceedwithassessment? A)

Reassurethepatientthatamplepetroleumjellywillbeused.

B)

Reassurethatpatientthatawater-basedlubricantwillbeused.

C)

Explaintothepatientthatwateristheonlylubricantthatcanbeused.

D)

Explaintothepatientwhythespeculummustbeintroduceddry.

Ans:

C Feedback: BecauselubricantsmayobscurecellsonaPapsmear,warmwateristheonlylubricantthatcanbeused.

14. Aclinicnurseismeetingwitha38-year-oldpatientwhostatesthatshewouldliketoresumeusingoral contraceptives,whichsheusedforseveralyearsduringhertwenties.Whatassessmentquestionismost likelytorevealapotentialcontraindicationtooralcontraceptiveuse? A)

Haveyoueverhadsurgery?

B)

Haveyoueverhadasexuallytransmittedinfection?

C)

Whendidyoulasthaveyourbloodsugarlevelschecked?

D)

Doyousmoke?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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D Feedback: Womenwhosmokeandwhoare35yearsofageoroldershouldnottakeoralcontraceptivesbecauseof anincreasedriskforcardiacproblems.Previoussurgeries,STIs,andbloodsugarinstabilitydonot necessarilycontraindicatetheuseoforalcontraceptives.

15. A17-year-oldgirlhascometothefreeclinicforherannualexamination.Shetellsthenursesheuses tamponsandaskshowlongshemaysafelyleavehertamponinplace.Whatisthenursesbestresponse? A)

Youmayleavethetamponinovernight.

B)

Thetamponshouldbechangedatleasttwiceperday.

C)

Tamponsaredangerousand,ideally,youshouldnotbeusingthem.

D)

Tamponsneedtobechangedevery4to6hours.

Ans:

D Feedback: Tamponsshouldnotbeusedformorethan4to6hours,norshouldsuper-absorbenttamponsbeused becauseoftheassociationwithtoxicshocksyndrome.Ifusedappropriately,itisacceptableandsafefor thepatienttousetampons.

16. A51-year-oldwomanhascometotheOB/GYNclinicforherannualphysical.Shetellsthenursethat shehasbeenexperiencingseverehotflashes,butthatsheisreluctanttobeginhormonetherapy(HT). Whatpotentialsolutionshouldthenursediscusswiththepatient? A)

Sodiumrestriction

B)

Adoptingavegandiet

C)

Massagetherapy

D)

Vitaminsupplements

Ans:

D Feedback: Forsomewomen,vitaminsB6andEhaveprovenbeneficialforthetreatmentofhotflashes.Sodium

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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restriction,vegandiet,andmassagehavenotbeennotedtorelievethissymptomofperimenopause. 17. Anewlypregnantpatientisbeingassessedinanobstetricclinic.Thepatientstatesthatshehasbeen experiencingintenseabdominalpainandthenurseanticipatesthatthepatientwillbeassessedfor ectopicpregnancy.Inadditiontoultrasonography,whatdiagnostictestshouldthenurseanticipate? A)

Computedtomography

B)

Humanchorionicgonadotropin(hCG)testing

C)

Estrogenandprogesteronetesting

D)

Abdominalx-ray

Ans:

B Feedback: Ifanectopicpregnancyissuspected,thepatientisassessedusingultrasoundandhCGtesting.CTandxraysarecontraindicatedduringpregnancyandestrogenandprogesteronelevelsarenotdiagnosticof ectopicpregnancy.

18. Anadolescentisbroughttotheclinicbyhermotherbecauseofabnormaluterinebleeding.Thenurse shouldunderstandthatthemostlikelycauseofthisdysfunctionalbleedingpatterniswhat? A)

Lackofovulation

B)

Chronicvaginitis

C)

Asexuallytransmittedinfection

D)

Ectopicpregnancy

Ans:

A Feedback: Dysfunctionaluterinebleedingcanoccuratanyage,butismostcommonatoppositeendsofthe reproductivelifespan.Itisusuallysecondarytoanovulation(lackofovulation)andiscommonin adolescents.Itisnotsuggestiveofvaginitis,anSTI,orectopicpregnancy.

19. Thenurseisplanningthesexualassessmentofanewadolescentpatient.Thenurseshouldincludewhat assessmentcomponents?Selectallthatapply. A)

Physicalexaminationfindings

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Laboratoryresults

C)

Healthhistory

D)

Interpersonalskills

E)

Understandingofmenopause

Ans:

A,B,C

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Feedback: Asexualassessmentincludesbothsubjectiveandobjectivedata.Healthandsexualhistories,physical examinationfindings,andlaboratoryresultsareallpartofthedatabase.Asexualassessmentwouldnot normallyincludethepatientsinterpersonalskills.Itisnotlikelytonecessarytoassessanadolescents understandingofmenopause. 20. Byinitiatinganassessmentaboutsexualconcernswhatdoesthenurseconveytothepatient?Selectall thatapply. A)

Thatsexualissuesarevalidhealthissues

B)

Thatitissafetotalkaboutsexualissues

C)

Thatsexualissuesareonlyaminoraspectapersonsidentity

D)

Thatchangesorproblemsinsexualfunctioningshouldbediscussed

E)

Thatchangesorproblemsinsexualfunctioningarehighlyatypical

Ans:

A,B,D Feedback: Byinitiatinganassessmentaboutsexualconcerns,thenursecommunicatestothepatientthatissues aboutchangesorproblemsinsexualfunctioningarevalidandsignificanthealthissues.Thenurse communicatesthatitissafetotalkaboutsexualissuesandthatchangesorchallengesinsexualfunction arenotunusual.

21. ThenurseisutilizingthePLISSITmodelofsexualhealthassessmentduringaninteractionwithanew patient.Accordingtothismodel,thenurseshouldbeginwithwhataction? A)

Conductingapreliminaryassessment

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Addressingthepatientspsychosocialstatus

C)

Askingthepatientspermissiontodiscusssexuality

D)

Assessingforphysiologicproblems

Ans:

C

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Feedback: ThePLISSITmodelofsexualassessmentbeginswithpermissionandsubsequentlyincludeslimited information,specificsuggestions,andintensivetherapy. 22. Duringthenursesassessmentofafemalepatient,thepatientrevealsthatsheexperiencedsexualabuse whenshewasayoungwoman.Whatisthenursesmostappropriateresponsetothisdisclosure? A)

Reassureherthatthisinformationwillbekeptasecret.

B)

Begintheprocessofintensivepsychotherapy.

C)

Encouragethepatienttophone911.

D)

Facilitateappropriateresourcesandreferrals.

Ans:

D Feedback: Thenursesprimaryrolesinlightofthisdisclosurearetoprovideempathyandtoarrangeforappropriate resourcesandreferrals.Thereisnoneedtophone911andpsychotherapyisbeyondthenursesscopeof practice.Thepatientsconfidentialitywillberespected,butthisdoesnotmeanthatthenursecanpromise tokeepitasecret.

23. A15-year-oldgirlisbroughttotheclinicbyhermothertoseeherprimarycareprovider.Themother statesthatherdaughterhasnotstartedtodevelopsexually.Thephysicalexaminationshowsthatthe patienthasnoindicationofsecondarysexualcharacteristics.Whatdiagnosisshouldthenursesuspect? A)

Primaryamenorrhea

B)

Dyspareunia

C)

Vaginalatrophy

D)

Secondarydysmenorrhea

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

1065

A Feedback: Primaryamenorrhea(delayedmenarche)referstothesituationinwhichyoungwomenolderthan16 yearsofagehavenotbeguntomenstruatebutotherwiseshowevidenceofsexualmaturation,orin whichyoungwomenhavenotbeguntomenstruateandhavenotbeguntoshowdevelopmentof secondarysexcharacteristicsby14yearsofage.Insecondarydysmenorrhea,pelvicpathologysuchas endometriosis,tumor,orpelvicinflammatorydisease(PID)contributestosymptoms.Dyspareuniais painfulintercourseandvaginalatrophywouldnotcontributetothedelayedonsetofpuberty.

24. A36-year-oldwomancomestothecliniccom...