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Chapter 42. Nursing Care of Women With Reproductive System Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse is assisting with a community education class on breast cancer prevention. Which risk factors should the nurse include in this training? a. History of breastfeeding b. Large or pendulous breasts c. High-fat diet and alcohol intake d. Early first pregnancy and late menarche

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2. The nurse is caring for a patient who had a mastectomy for breast cancer 2 days ago and is now developing pulmonary congestion. Why is a mastectomy patient at risk for pulmonary complications? a. Breast cancer has often spread to the lungs before diagnosis. b. Pathogens may have been introduced during the surgical procedure. c. The chest incision makes the patient hesitant to deep breathe and cough. d. Mastectomy patients must remain on bedrest for 48 to 72 hours postoperatively.

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3. The nurse is caring for a patient who had a left mastectomy earlier in the day and informs the nurse of several concerns. Which should the nurse attend to first? a. Bowels have not moved in 48 hours. b. Pain level of is 7 on a 0-to-10 scale. c. A 3-cm area of blood is on the wound dressing. d. Feels anxious about how her husband will react to the surgery.

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4. The nurse is assessing a patient after a mastectomy and thinks the patient’s affected arm appears swollen. What is the best way to verify this finding? a. Measure and document the circumference of the arm. b. Measure and compare the circumferences of both arms. c. Press a finger into the arm and measure the indentation. d. Ask the patient to hang the arm down for 3 minutes and check for increased swelling.

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5. The nurse enters the room of a patient with a new mastectomy and finds her crying. After confirming that the patient is crying because of the loss of her breast, which response by the nurse is best? a. “At least they got all the cancer. You are fortunate.” b. “I know how you feel. It is difficult to lose a breast.” c. “How have you coped with other problems in your life? Do you have someone you can talk to?” d. “Here, have a tissue. I know you feel like crying now, but before you know it, you will feel much better, and this will all be behind you.”

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6. A patient reports long, heavy, irregular menses accompanied by headache and back pain for the past several months. How should the nurse document these symptoms? a. Polymenorrhea b. Oligomenorrhea c. Hypermenorrhea d. Menometrorrhagia

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7. The nurse is teaching a woman with a menstrual disorder how to measure menstrual flow. Which instruction should the nurse include? a. Use a perineal collection system.

b. Use a vaginal catheter and collection bag. c. Weigh her perineal pads before and after use. d. Weigh the woman before and after her menses. ____

8. A woman tells the nurse, “I am having terrible pain with my period. This has never happened before. What should I do?” What is the best response by the nurse? a. “Sometimes getting into a knee–chest position is helpful.” b. “You should notify your doctor if this is a new experience for you.” c. “Dysmenorrhea is a common occurrence; NSAIDs or aspirin may help.” d. “The best way to combat painful menses is to exercise and drink plenty of fluids.”

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9. A patient comes to an outpatient clinic because of premenstrual syndrome (PMS) symptoms. What advice from the nurse may help her reduce her symptoms? a. “There is no treatment for PMS other than rest and fluids.” b. “Ask the physician about a mild antianxiety agent.” c. “Avoidance of alcohol and caffeine may help reduce your discomfort.” d. “Avoid strenuous exercise for several days before and after your period.”

____ 10. A 50-year-old woman states, “It is such a relief not to need birth control any more. I haven’t had a period in 3 months.” How should the nurse respond? a. “Birth control is usually unnecessary after age 50, even if you are still having periods.” b. “It is still possible for you to get pregnant. You should consider having a tubal ligation.” c. “You should continue to use birth control for at least 6 months after cessation of your periods.” d. “You may still be fertile for several months after your last period. You should consult with your physician to know when to stop using birth control.” ____ 11. The nurse is reviewing the health histories of several patients scheduled for appointments in the health clinic. Which patient should the nurse recognize as being predisposed to developing a vaginal yeast infection? a. A 23-year-old who eats a high-protein diet b. A 31-year-old woman who runs 2 miles every day c. A 38-year-old woman who frequently uses NSAIDs d. A 28-year-old woman who sits at a desk 5 days a week ____ 12. The nurse is assisting with teaching a patient who has been placed on metronidazole (Flagyl) for bacterial vaginosis. What instruction by the nurse is appropriate? a. “Take the Flagyl whenever you feel vaginal itching or irritation.” b. “Take the Flagyl until the discharge is gone for at least 24 hours.” c. “Take the Flagyl as prescribed, even if your symptoms are gone.” d. “You will need to take Flagyl for an extended period. This prescription has several refills.” ____ 13. A patient is seen in a clinic for contact vaginitis. What information from her history helps the nurse to plan teaching for the patient? a. She has been under stress at work. b. She takes bubble baths every night. c. She has had a urinary tract infection (UTI). d. She has been on oral antibiotics for a sinus infection. ____ 14. The nurse is teaching a patient how to use a daily vaginal suppository. Which statement indicates that teaching has been effective? a. “I should put the suppository in at night after I get into bed.” b. “I should put the suppository in each morning before I get out of bed.” c. “It is best to insert the suppository each morning after a shower or bath.”

d. “The suppository should be put in late in the day when I’m less likely to be active.” ____ 15. A 16-year-old girl is admitted to the hospital with toxic shock syndrome (TSS). Which action by the nurse should take priority? a. Teach the girl risk factors for TSS. b. Teach the girl’s mother risk factors for TSS. c. Educate the girl on signs and symptoms of TSS. d. Determine what the girl understands about risk factors for TSS. ____ 16. A patient is being seen for the urinary bladder sagging into the vagina. How should the nurse document this health problem? a. Rectocele b. Cystocele c. Dyspareunia d. Bladder fistula ____ 17. The nurse is assisting with teaching a woman who is having difficulty conceiving. What instruction should the nurse provide about keeping a basal body temperature chart? a. “Record your temperature in the late afternoon each day for 3 months.” b. “Record your temperature every 4 hours, starting the first day of each month.” c. “Record your temperature three times each day of your period, then once a day thereafter.” d. “Starting with the first day of your period, record your temperature first thing each morning.” ____ 18. A female patient has just learned that she is infertile. She says, “All I ever wanted in life was to have a baby. My life is over.” What is the best response by the nurse? a. “You are overreacting because you are upset. Your life really is not over.” b. “You have a wonderful husband. Maybe you should think about adoption.” c. “There is an infertility clinic I just heard about in Mexico. Do you want the address?” d. “A baby must have been very important to you. When you feel ready, we can talk about other alternatives.” ____ 19. A patient at a walk-in clinic requests oral contraceptives (OCs) because she heard they can prevent sexually transmitted infections (STI). What information should the nurse use to base a response to this patient? a. OCs provide excellent protection against most STIs. b. There is no connection between OC use and risk of STIs. c. Only OCs with estrogen and progestin can prevent STIs. d. Not enough research has been done to prove that OCs can prevent STIs. ____ 20. A patient must prevent pregnancy while receiving chemotherapy that could harm a fetus. About which type of birth control should the nurse anticipate teaching the patient? a. Condom b. Depot medication c. Oral contraceptive d. Diaphragm with spermicide ____ 21. The nurse is assisting a new mother who returns to a clinic for a 6-week visit. What instructions about birth control should the nurse provide? a. “Breastfeeding has no effect on your ability to conceive.” b. “As long as you are breastfeeding, you will not get pregnant.” c. “You should avoid having intercourse until you are finished breastfeeding.” d. “You should plan to use birth control; breastfeeding is not a reliable form of contraception.”

____ 22. A patient is scheduled for a hysterectomy and bilateral salpingo-oophorectomy. She asks what this means. How should the nurse respond? a. “You will have your uterus removed and your bladder suspended.” b. “You are going to have your uterus, fallopian tubes, and ovaries removed.” c. “You will have your uterus removed and your fallopian tubes and ovaries sutured in place.” d. “You will have your uterus and fallopian tubes removed, but your ovaries will remain intact.” ____ 23. The nurse is caring for a patient recovering from a hysterectomy earlier in the day. Four hours later, the woman is unable to urinate. What assessment should the nurse use to determine bladder distention and be comfortable for the patient? a. Perform a scratch test. b. Palpate for bladder distention. c. Palpate for rebound tenderness. d. Percuss the bladder for fullness. ____ 24. A 42-year-old woman is tearful after a hysterectomy. What information should the nurse use to respond appropriately to the patient? a. Loss of reproduction function may cause grieving. b. Most women are done bearing children by age 42. c. Hysterectomy is more traumatic for younger women. d. Most women are happy not to have periods after a hysterectomy. ____ 25. The nurse is caring for a patient with primary dysmenorrhea. Which medication should the nurse anticipate being prescribed because it blocks prostaglandin synthesis? a. NSAIDs b. Antacids c. Vitamins d. Morphine ____ 26. A patient is diagnosed with polycystic ovary syndrome. When preparing teaching for this patient, which hormone should the nurse explain as being too abundant in the patient’s body? a. Insulin b. Thyroxine c. Growth hormone (GH) d. Antidiuretic hormone (ADH) ____ 27. An adolescent comes into the emergency department requesting the “morning-after pill.” What should the nurse assess in this patient? a. Age of the patient b. Time of intercourse c. Use of contraception d. Location of the parents ____ 28. A health care provider (HCP) is anticipating the use of RU-486 to provide a chemically induced abortion for a patient. What information should the nurse obtain from the patient before this medication is provided? a. Type of contraception used b. Date of the first day of the patient’s last period c. Date of the first day of the patient’s first missed period d. Average number of times the bladder is emptied in one day

____ 29. The nurse notes that a female patient has been treated for vaginal yeast infections 6 times in one year. For which additional health problem should the nurse suspect the patient should be evaluated? a. HIV b. Hepatitis B c. Tuberculosis d. Chronic inflammation Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 30. The nurse is caring for a patient who is breastfeeding and receiving antibiotics for mastitis. What should be included in the patient’s teaching? (Select all that apply.) a. Wash hands before handling the breast. b. NSAIDs may be used to help control pain. c. Apply cool packs to the breast to ease pain. d. Stop breastfeeding, and switch to bottle feeding. e. Wear a bra to support the swollen painful breast. f. Change the infant’s feeding position on the breast frequently. ____ 31. The nurse is assisting in the preparation of an educational seminar about breast pathology. What characteristics of cancerous breast lesions should the nurse include in this teaching? (Select all that apply.) a. They tend to be harder. b. They tend to be less mobile. c. They tend to be more painful. d. They tend to be more irregularly shaped. e. They tend to have more clearly defined borders. ____ 32. A female patient approaching menopause asks about the use of hormone replacement therapy. Which findings from a study on hormone replacement therapy should the nurse explain to the patient? (Select all that apply.) a. A decrease in strokes b. A decrease in breast cancer c. An increase in heart attacks d. A reduction in total fractures e. A decrease in colorectal cancer f. An increase in thromboembolism ____ 33. The nurse is providing care for a patient after a hysterectomy. Which interventions are appropriate to prevent constipation? (Select all that apply.) a. Encourage ambulation. b. Increase protein intake. c. Increase oral fluid intake. d. Provide a high-fiber diet. e. Withhold pain medication. f. Provide stool softener as ordered. ____ 34. A patient who is 6 weeks pregnant is contemplating having an abortion. What methods of abortion should the nurse explain as most commonly used to terminate a pregnancy of less than 14 weeks? (Select all that apply.) a. Vacuum suction b. Saline induction c. Menstrual extraction d. Dilation and curettage (D&C)

e. Dilation and evacuation (D&E) ____ 35. The nurse is caring for a woman who has just had an uncomplicated abortion. What instructions should the nurse provide? (Select all that apply.) a. “Call if you bleed for more than 3 days.” b. “Call if you have more bleeding than you would during a heavy period.” c. “The discharge often has a foul odor due to the procedure.” d. “Don’t be surprised if you pass clots. Call if they are larger than a golf ball.” e. “You can expect moderate bleeding and a low-grade fever for about a week.” f. “You should abstain from sexual intercourse as directed by your physician.” ____ 36. The nurse is concerned that a female patient is at risk for developing cervical cancer. What risk factors for cervical cancer did the nurse assess in the patient? (Select all that apply.) a. Smoking b. Being nulliparous c. Using barrier contraceptives d. Having multiple sexual partners e. Being infected with herpes simplex virus type II f. Being infected with human papillomavirus ____ 37. The nurse is providing care for a woman with trichomoniasis who is being treated with metronidazole (Flagyl). Which patient statements indicate that teaching has been effective? (Select all that apply.) a. “I might notice a metallic taste with this medication.” b. “This medication should be taken on an empty stomach.” c. “I should take this medication until the symptoms are gone.” d. “I may have some vaginal dryness while taking this medication.” e. “My partner should see a physician for treatment as well.” f. “Drinking alcohol while taking this medication will cause nausea and vomiting.” ____ 38. The nurse is providing care for a woman experiencing premenstrual syndrome (PMS). Which nursing actions should be included in the plan of care? (Select all that apply.) a. Encourage the client to stop smoking. b. Teach client to limit alcohol consumption. c. Provide small, frequent meals to reduce food cravings. d. Encourage the client to develop a regular exercise regimen. e. Provide food that promotes increased intake of simple sugars. f. Instruct client to increase intake of products containing caffeine. ____ 39. A female patient asks what can be done to reduce symptoms associated with menopause. What should the nurse suggest to this patient? (Select all that apply.) a. Eat a healthy diet. b. Reflect on past experiences and challenges. c. Dress in layers so clothing can be removed. d. Reduce intake of caffeine, sugar, and alcohol. e. Use an oil-based vaginal lubricant to ease vaginal dryness. ____ 40. After collecting data the nurse suspects that a young female patient is experiencing manifestations of toxic shock syndrome. What findings did the nurse use to make this decision? (Select all that apply.) a. Sore throat b. Skin peeling c. Fluid retention d. Red palm and soles of feet

e. Muscle pain and weakness ____ 41. The nurse is assisting in the development of a program to instruct female high school students on ways to prevent the development of toxic shock syndrome. What should the nurse include in this program? (Select all that apply.) a. Increase oral fluid intake. b. Change tampons every 4 hours. c. Wash hands before inserting a new tampon. d. Take over-the-counter aspirin while menstruating. e. Use sanitary pads instead of tampons overnight when menstruating. ____ 42. A female patient is diagnosed with mild uterine prolapse into the vagina. For which areas should the nurse prepare to reinforce teaching to help this patient? (Select all that apply.) a. Avoid weight gain b. Take care of the pessary c. Consume a healthy diet d. Perform Kegel exercises e. Perform vaginal douches Completion Complete each statement. 43. The nurse is weighing the perineal pads of a patient bleeding after having an abortion. The weight of one pad increased in weight by 20 grams. How many mL of blood has this patient lost?

Chapter 42. Nursing Care of Women With Reproductive System Disorders Answer Section MULTIPLE CHOICE 1. ANS: C Factors that increase the risk of development of breast cancer include increasing age, personal or family history of breast cancer, high-fat diet, high alcohol intake, treatment with estrogens (especially when used without progestins), early menarche, late menopause, no pregnancy or late first pregnancy, and no breastfeeding or breastfeeding for short periods of time following delivery. PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application 2. ANS: C Patients can have ineffective breathing patterns and difficulty coughing because of pain with chest movement. D. Bedrest is not necessary. B. Pathogens should not be introduced during surgery, and the mastectomy site is not the same as the lungs. A. Breast cancer does not often spread to the lungs before diagnosis. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis 3. ANS: B Pain, constipation, and bleeding are all physiological needs which are a priority according to Maslow’s hierarch. D. Psychosocial needs can be addressed later. A. C. Because 3 cm of blood is not urgent, and a few more minutes of constipation will not make a difference in the outcome, the pain should be treated first. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application 4. ANS: B The best way to verify if the affected arm is swollen is to measure and comparing the affected side with the patient’s opposite side. A. C. Measuring, checking for pitting edema and documenting are not as significant if not compared with the normal side. D. Hanging the arm down will not help and may worsen the swelling. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 5. ANS: C The nurse should help the patient remember previous successes in coping and strategies used since the memory of prior successes can encourage hope for future successes. A, B, and D all belittle the patient’s concerns. The nurse does not know how the patient feels. PTS: 1 DIF: Moderate KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis 6. ANS: D Menometrorrhagia is long, heavy, irregular menses. A. Polymenorrhea is frequent menses. B Oligomenorrhea refers to cycles longer than 35 days. C. Hypermenorrhea is menses lasting longer than 7 days. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application 7. ANS: C

Estimation of the amount of blood lost during menses may be difficult because pad counts c...