Chapter 27 Female Genitourinary System PDF

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Practice questions to chapter 27 of health assessment. It explains the female genitalia system...

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

413

Chapter27:FemaleGenitourinarySystem MULTIPLECHOICE 1.Duringahealthhistory,a22-yearoldwomanasks,CanIgetthatvaccineforhumanpapillomavirus (HPV)?IhavegenitalwartsandIdlikethemtogoaway!Whatisthenursesbestresponse? a.

TheHPVvaccineisforgirlsandwomenages9to26years,sowecanstartthattoday.

b.

Thisvaccineisonlyforgirlswhohavenotyetstartedtobecomesexuallyactive.

c.

Letscheckwiththephysiciantoseeifyouareacandidateforthisvaccine.

d.

ThevaccinecannotprotectyouifyoualreadyhaveanHPVinfection.

ANS:D TheHPVvaccineisappropriateforgirlsandwomenage9to26yearsandisadministeredtopreventcervical cancerbypreventingHPVinfectionsbeforegirlsbecomesexuallyactive.However,itcannotprotectthe womanifanHPVinfectionisalreadypresent. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:General 2.Duringanexamination,thenurseobservesafemalepatientsvestibuleandexpectstoseethe: NURSINGTB.COM a.

Urethralmeatusandvaginalorifice.

b.

Vaginalorificeandvestibular(Bartholin)glands.

c.

Urethralmeatusandparaurethral(Skene)glands.

d.

Paraurethral(Skene)andvestibular(Bartholin)glands.

ANS:A Thelabialstructuresencircleaboat-shapedspace,orcleft,termedthevestibule.Withinthevestibuleare numerousopenings.Theurethralmeatusandvaginalorificearevisible.Theductsoftheparaurethral(Skene) glandsandthevestibular(Bartholin)glandsarepresentbutnotvisible. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 3.Duringaspeculuminspectionofthevagina,thenursewouldexpecttoseewhatattheendofthevaginal canal? a.

Cervix

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

b.

Uterus

c.

Ovaries

d.

Fallopiantubes

414

ANS:A Attheendofthecanal,theuterinecervixprojectsintothevagina. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 4.Theuterusisusuallypositionedtiltingforwardandsuperiortothebladder.Thispositionisknownas: a.

Antevertedandanteflexed.

b.

Retrovertedandanteflexed.

c.

Retrovertedandretroflexed.

d.

Superiorvertedandanteflexed. NURSINGTB.COM

ANS:A Theuterusisfreelymovable,notfixed,andusuallytiltsforwardandsuperiortothebladder(apositionlabeled asantevertedandanteflexed). DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:General 5.An11-year-oldgirlisintheclinicforasportsphysicalexamination.Thenursenoticesthatshehasbegunto developbreasts,andduringtheconversationthegirlrevealsthatsheisworriedaboutherdevelopment.The nurseshouldusewhichofthesetechniquestobestassisttheyounggirlinunderstandingtheexpectedsequenc fordevelopment?Thenurseshould: a.

UsetheTannerscaleonthefivestagesofsexualdevelopment.

b.

Describeherdevelopmentandcompareitwiththatofothergirlsherage.

c.

UsetheJacobsentableonexpecteddevelopmentonthebasisofheightandweightdata.

d.

Reassureherthatherdevelopmentiswithinnormallimitsandtellhernottoworryaboutthenext step.

ANS:A TheTannerscaleonthefivestagesofpubichairdevelopmentishelpfulinteachinggirlstheexpected

NURSINGTB.COM

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415

sequenceofsexualdevelopment.Theotherresponsesarenotappropriate. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 6.Awomanwhois8weekspregnantisintheclinicforacheckup.Thenursereadsonherchartthathercervix issoftenedandlookscyanotic.Thenurseknowsthatthewomanisexhibiting__________signand __________sign. a.

Tanner;Hegar

b.

Hegar;Goodell

c.

Chadwick;Hegar

d.

Goodell;Chadwick

ANS:D Shortlyafterthefirstmissedmenstrualperiod,thefemalegenitaliashowsignsofthegrowingfetus.Thecervix softens(Goodellsign)at4to6weeks,andthevaginalmucosaandcervixlookcyanotic(Chadwicksign)at8 to12weeks.Thesechangesoccurbecauseofincreasedvascularityandedemaofthecervixandhypertrophy andhyperplasiaofthecervicalglands.Hegarsignoccurswhentheisthmusoftheuterussoftensat6to8 weeks.Tannersignisnotacorrectresponse. NURSINGTB.COM DIF:CognitiveLevel:Understanding(Comprehension)

MSC:ClientNeeds:HealthPromotionandMaintenance 7.Generally,thechangesnormallyassociatedwithmenopauseoccurbecausethecellsinthereproductivetract are: a.

Aging.

b.

Becomingfibrous.

c.

Estrogendependent.

d.

Abletorespondtoestrogen.

ANS:C Becausecellsinthereproductivetractareestrogendependent,decreasedestrogenlevelsduringmenopause bringdramaticphysicalchanges.Theotheroptionsarenotcorrect. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:HealthPromotionandMaintenance 8.Thenurseisreviewingthechangesthatoccurwithmenopause.Whichchangesareassociatedwith menopause?

NURSINGTB.COM

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a.

Uterineandovarianatrophy,alongwithathinningofthevaginalepithelium

b.

Ovarianatrophy,increasedvaginalsecretions,andincreasingclitoralsize

c.

Cervicalhypertrophy,ovarianatrophy,andincreasedacidityofvaginalsecretions

d.

Vaginalmucosafragility,increasedacidityofvaginalsecretions,anduterinehypertrophy

416

ANS:A Theuterusshrinksbecauseofitsdecreasedmyometrium.Theovariesatrophyto1to2cmandarenotpalpable aftermenopause.Thesacralligamentsrelax,andthepelvicmusculatureweakens;consequently,theuterus droops.Thecervixshrinksandlookspalerwithathickglisteningepithelium.Thevaginalepithelium atrophies,becomingthinner,drier,anditchy.ThevaginalpHbecomesmorealkaline,andsecretionsare decreased,whichresultsinafragilemucosalsurfacethatisatriskforvaginitis. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 9.A54-year-oldwomanwhohasjustcompletedmenopauseisintheclinictodayforayearlyphysical examination.Whichofthesestatementsshouldthenurseincludeinpatienteducation?Apostmenopausal woman: a.

Isnotatanygreaterriskforheartdiseasethanayoungerwoman. NURSINGTB.COM

b.

Shouldbeawarethatsheisatincreasedriskfordyspareuniabecauseofdecreasedvaginal secretions.

c.

Hasonlystoppedmenstruating;therereallyarenoothersignificantchangeswithwhichsheshould beconcerned.

d.

Islikelytohavedifficultywithsexualpleasureasaresultofdrasticchangesinthefemalesexual responsecycle.

ANS:B Decreasedvaginalsecretionsleavethevaginadryandatriskforirritationandpainwithintercourse (dyspareunia).Theotherstatementsareincorrect. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 10.Awomanisintheclinicforanannualgynecologicexamination.Thenurseshouldplantobeginthe interviewwiththe: a.

Menstrualhistory,becauseitisgenerallynonthreatening.

b.

Obstetrichistory,becauseitincludesthemostimportantinformation.

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c.

Urinarysystemhistory,becauseproblemsmaydevelopinthisareaaswell.

d.

Sexualhistory,becausediscussingitfirstwillbuildrapport.

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ANS:A Menstrualhistoryisusuallynonthreateningandthereforeagoodtopicwithwhichtobegintheinterview. Obstetric,urinary,andsexualhistoriesarealsopartoftheinterviewbutnotnecessarilythebesttopicswith whichtostart. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 11.Apatienthashadthreepregnanciesandtwolivebirths.Thenursewouldrecordthisinformationasgrav _____,para_____,AB_____. a.

2;2;1

b.

3;2;0

c.

3;2;1

d.

3;3;1 NURSINGTB.COM

ANS:C Gravida(grav)isthenumberofpregnancies.Paraisthenumberofbirths.Abortionsareinterrupted pregnancies,includingelectiveabortionsandspontaneousmiscarriages. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 12.Duringtheinterviewwithafemalepatient,thenursegathersdatathatindicatethepatientis perimenopausal.Whichofthesestatementsmadebythispatientleadstothisconclusion? a.

IhavenoticedthatmymusclesacheatnightwhenIgotobed.

b.

IwillbeveryhappywhenIcanstopworryingabouthavingaperiod.

c.

IhavebeennoticingthatIsweatalotmorethanIusedto,especiallyatnight.

d.

Ihaveonlybeenpregnanttwice,butbothtimesIhadbreasttendernessasmyfirstsymptom.

ANS:C Hormoneshiftsoccurduringtheperimenopausalperiod,andassociatedsymptomsofmenopausemayoccur, suchashotflashes,nightsweats,numbnessandtingling,headache,palpitations,drenchingsweats,mood swings,vaginaldryness,anditching.Theotherresponsesarenotcorrect.

NURSINGTB.COM

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418

DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:HealthPromotionandMaintenance 13.A50-year-oldwomancallstheclinicbecauseshehasnoticedsomechangesinherbodyandbreastsand wondersifthesechangescouldbeattributabletothehormonereplacementtherapy(HRT)shestarted3months earlier.Thenurseshouldtellher: a.

HRTisatsuchalowdosethatsideeffectsareveryunusual.

b.

HRThasseveralsideeffects,includingfluidretention,breasttenderness,andvaginalbleeding.

c.

VaginalbleedingwithHRTisveryunusual;Isuggestyoucomeintotheclinicimmediatelytohave thisevaluated.

d.

Itsoundsasifyourdoseofestrogenistoohigh;Ithinkyoumayneedtodecreasetheamountyou aretakingandthencallbackinaweek.

ANS:B SideeffectsofHRTincludefluidretention,breastpain,andvaginalbleeding.Theotherresponsesarenot correct. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PharmacologicandParenteralTherapies NURSINGTB.COM

14.A52-year-oldpatientstatesthatwhenshesneezesorcoughsshewetsherselfalittle.Sheisveryconcerned thatsomethingmaybewrongwithher.Thenursesuspectsthattheproblemis: a.

Dysuria.

b.

Stressincontinence.

c.

Hematuria.

d.

Urgeincontinence.

ANS:B Stressincontinenceisinvoluntaryurinelosswithphysicalstrain,sneezing,orcoughing.Dysuriaispainor burningwithurination.Hematuriaisbleedingwithurination.Urgeincontinenceisinvoluntaryurinelossthat occursasaresultofanoveractivedetrusormuscleinthebladderthatcontractsandcausesanurgentneedto void. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 15.Duringtheinterview,apatientrevealsthatshehassomevaginaldischarge.Sheisworriedthatitmaybea sexuallytransmittedinfection.Thenursesmostappropriateresponsetothiswouldbe:

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

a.

Oh,dontworry.Somecyclicvaginaldischargeisnormal.

b.

Haveyoubeenengaginginunprotectedsexualintercourse?

c.

Idlikesomeinformationaboutthedischarge.Whatcolorisit?

d.

Haveyouhadanyurinaryincontinenceassociatedwiththedischarge?

419

ANS:C Questionsthathelpthepatientrevealmoreinformationabouthersymptomsshouldbeaskedina nonthreateningmanner.Askingabouttheamount,color,andodorofthevaginaldischargeprovidesthe opportunityforfurtherassessment.Normalvaginaldischargeissmall,clearorcloudy,andalways nonirritating. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 16.Awomanstatesthat2weeksagoshehadaurinarytractinfectionthatwastreatedwithanantibiotic.Asa partoftheinterview,thenurseshouldask,Haveyounoticedany: a.

Changesinyoururinationpatterns?

b.

Excessivevaginalbleeding? NURSINGTB.COM

c.

Unusualvaginaldischargeoritching?

d.

Changesinyourdesireforintercourse?

ANS:C Severalmedicationsmayincreasetheriskofvaginitis.Broad-spectrumantibioticsalterthebalanceofnormal flora,whichmayleadtothedevelopmentofvaginitis.Theotherquestionsarenotappropriate. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PharmacologicandParenteralTherapies 17.Whichstatementwouldbemostappropriatewhenthenurseisintroducingthetopicofsexualrelationships duringaninterview? a.

Now,itistimetotalkaboutyoursexualhistory.Whendidyoufirsthaveintercourse?

b.

Womenoftenfeeldissatisfiedwiththeirsexualrelationships.Woulditbeokaytodiscussthis now?

c.

Womenoftenhavequestionsabouttheirsexualrelationshipandhowitaffectstheirhealth.Doyou haveanyquestions?

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

d.

420

Mostwomenyouragehavehadmorethanonesexualpartner.Howmanywouldyousayyouhave had?

ANS:C Thenurseshouldbeginwithanopen-endedquestiontoassessindividualneeds.Thenurseshouldinclude appropriatequestionsasaroutinepartofthehealthhistory,becausedoingsocommunicatesthatthenurse acceptstheindividualssexualactivityandbelievesitisimportant.Thenursescomfortwiththediscussion promptsthepatientsinterestand,possibly,reliefthatthetopichasbeenintroduced.Theinitialdiscussion establishesadatabaseforcomparisonwithanyfuturesexualactivitiesandprovidesanopportunitytoscreen sexualproblems. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PsychosocialIntegrity 18.A22-year-oldwomanhasbeenconsideringusingoralcontraceptives.Asapartofherhealthhistory,the nurseshouldask: a.

Doyouhaveahistoryofheartmurmurs?

b.

Willyoubeinamonogamousrelationship?

c.

Haveyoucarefullythoughtthischoicethrough?

d.

Ifyousmoke,howmanycigarettesdoyousmokeperday? NURSINGTB.COM

ANS:D Oralcontraceptives,togetherwithcigarettesmoking,increasetheriskforcardiovascularsideeffects.If cigarettesareused,thenthenurseshouldassessthepatientssmokinghistory.Theotherquestionsarenot appropriate. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PharmacologicandParenteralTherapies 19.Amarriedcouplehascometotheclinicseekingadviceonpregnancy.Theyhavebeentryingtoconceive for4monthsandhavenotbeensuccessful.Whatshouldthenursedofirst? a.

Ascertainwhethereitherofthemhasbeenusingbroad-spectrumantibiotics.

b.

Explainthatcouplesareconsideredinfertileafter1yearofunprotectedintercourse.

c.

Immediatelyreferthewomantoanexpertinpelvicinflammatorydiseasethemostcommoncause ofinfertility.

d.

Explainthatcouplesareconsideredinfertileafter3monthsofengaginginunprotectedintercourse andthattheywillneedareferraltoafertilityexpert.

ANS:B

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

421

Infertilityisconsideredafter1yearofengaginginunprotectedsexualintercoursewithoutconceiving.The otheractionsarenotappropriate. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PsychosocialIntegrity 20.Anurseisassessingapatientsriskofcontractingasexuallytransmittedinfection(STI).Anappropriate questiontoaskwouldbe: a.

Youknowthatitsimportanttousecondomsforprotection,right?

b.

Doyouuseacondomwitheachepisodeofsexualintercourse?

c.

Doyouhaveasexuallytransmittedinfection?

d.

Youareawareofthedangersofunprotectedsex,arentyou?

ANS:B InreviewingapatientsriskforSTIs,thenurseshouldaskinanonconfrontationalmannerwhethercondoms arebeingusedduringeachepisodeofsexualintercourse.Askingapersonwhetherheorshehasaninfection doesnotaddresstherisk. DIF:CognitiveLevel:Understanding(Comprehension) NURSINGTB.COM MSC:ClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

21.Whenthenurseisinterviewingapreadolescentgirl,whichopeningquestionwouldbeleastthreatening? a.

Doyouhaveanyquestionsaboutgrowingup?

b.

Whathasyourmothertoldyouaboutgrowingup?

c.

Whendidyounoticethatyourbodywaschanging?

d.

IrememberbeingveryscaredwhenIgotmyperiod.Howdoyouthinkyoullfeel?

ANS:C Open-endedquestionssuchas,Whendidyou?ratherthanDoyou?shouldbeasked.Open-endedquestions arelessthreateningbecausetheyimplythatthetopicisnormalandunexceptional. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PsychosocialIntegrity 22.Whenthenurseisdiscuss...