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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter50:AssessmentofReproductiveSystem TestBank MULTIPLECHOICE 1.Whichquestionshouldthenurseaskwhenassessinga60-year-oldpatientwhohasahistoryofbenign prostatichyperplasia(BPH)? a.

Haveyounoticedanyunusualdischargefromyourpenis?

b.

Hastherebeenanychangeinyoursexlifeinthelastyear?

c.

Hastherebeenadecreaseintheforceofyoururinarystream?

d.

Haveyoubeenexperiencinganydifficultyinachievinganerection?

ANS:C Enlargementoftheprostateblockstheurethra,leadingtourinarychangessuchasadecreaseintheforceofthe urinarystream.Theotherquestionsaddresspossibleproblemswithinfectionorsexualdifficulties,butthey wouldnotbehelpfulindeterminingwhethertherewerefunctionalchangescausedbyBPH. DIF:CognitiveLevel:Apply(application)REF:1194 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.Aftera26-year-oldpatienthasbeentreatedforpelvicinflammatorydisease,thenursewillplantoteach about a.

useofhormonetherapy(HT).

b.

irregularitiesinthemenstrualcycle.

c.

changesinsecondarysexcharacteristics.

d.

possibledifficultywithbecomingpregnant.

ANS:D Pelvicinflammatorydiseasemaycausescarringofthefallopiantubesandresultindifficultyinfertilizationor implantationofthefertilizedegg.Becauseovarianfunctionisnotaffected,thepatientwillnotrequireHT, haveirregularmenstrualcycles,orexperiencechangesinsecondarysexcharacteristics. DIF:CognitiveLevel:Apply(application)REF:1195 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 3.A68-year-oldmalepatienttellsthenursethatheisworriedbecausehedoesnotrespondtosexual stimulationthesamewayhedidwhenhewasyounger.Thenursesbestresponsetothepatientsconcernis whichofthefollowing?

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

a.

Interestinsexfrequentlydecreasesasmengetolder.

b.

Manymenneedadditionalsexualstimulationwithaging.

c.

Erectiledysfunctionisacommonproblemwitholdermen.

d.

Tellmemoreabouthowyoursexualresponsehaschanged.

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ANS:D Theinitialresponsebythenurseshouldbefurtherassessmentoftheproblem.Theotherstatementsbythe nurseareaccuratebutmaynotrespondtothepatientsconcerns. DIF:CognitiveLevel:Apply(application)REF:1195 TOP:NursingProcess:AssessmentMSC:NCLEX:PsychosocialIntegrity 4.ThenurseisprovidingteachingbytelephonetoapatientwhoisscheduledforapelvicexaminationandPap testnextweek.Thenurseinstructsthepatientthatsheshould a.

shower,butnottakeatubbath,beforetheexamination.

b.

nothavesexualintercoursethedaybeforethePaptest.

c.

avoiddouchingforatleast24hoursbeforetheexamination.

d.

scheduletohavethePaptestjustafterhermenstrualperiod.

ANS:C BecausetheresultsofaPaptestmaybeaffectedbydouching,thepatientshouldnotdouchebeforethe examination.Theexammaybescheduledwithoutregardtothemenstrualperiod.Thepatientmayshoweror bathebeforetheexamination.SexualintercoursedoesnotaffecttheresultsoftheexaminationorPaptest. DIF:CognitiveLevel:Apply(application)REF:1200 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 5.A22-year-oldpatientreportsherconcernaboutnothavingamenstrualperiodforthepast7months.Which statementbythepatientindicatesapossiblerelatedfactortotheamenorrhea? a.

Idrinkatleast3glassesofnonfatmilkeveryday.

b.

Irun7to8mileseverydaytokeepmyweightdown.

c.

Iwastreatedforasexuallytransmittedinfection2yearsago.

d.

IamnotsexuallyactivebutcurrentlyIhaveanIUD.

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ANS:B Excessiveexercisecancauseamenorrhea.Theotherstatementsbythepatientdonotsuggestanyurgent teachingneeds. DIF:CognitiveLevel:Apply(application)REF:1194 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 6.Thenurseisassessingthesexual-reproductivefunctionalhealthpatternofa32-year-oldwoman.Which questionismostusefulindeterminingthepatientssexualorientationandriskfactors? a.

Doyouhavesexwithmen,women,orboth?

b.

Whichgenderdoyouprefertohavesexwith?

c.

Whattypesofsexualactivitiesdoyouprefer?

d.

Areyouheterosexual,homosexual,orbisexual?

ANS:A Thisquestionisthemostsimplystatedandwillincreasethelikelihoodofobtainingtherelevantinformation aboutsexualorientationandpossibleriskfactorsassociatedwithsexualactivity.Apatientwhopreferssex withwomenmayalsohaveintercourseattimeswithmen.Thetypesofsexualactivitiesengagedinmaynot indicatesexualorientation.Manypatientswhohavesexwithbothmenandwomendonotidentifythemselves ashomosexualorbisexual. DIF:CognitiveLevel:Apply(application)REF:1194 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 7.Thenurseexplainstoa37-year-oldpatientbeingpreparedforcolposcopywithacervicalbiopsythatthe procedure a.

involvesdilationofthecervixandbiopsyofthetissueliningtheuterus.

b.

willtakeplaceinasame-daysurgerycentersothatlocalanesthesiacanbeused.

c.

requiresthatthepatienthavenothingtoeatordrinkfor6hoursbeforetheprocedure.

d.

issimilartoaspeculumexaminationofthecervixandshouldresultinlittlediscomfort.

ANS:D Colposcopyinvolvesvisualizationofthecervixwithabinocularmicroscopeandissimilartoaspeculum examination.Anesthesiaisnotrequiredandfastingisnotnecessary.Acervicalbiopsymaycauseaminimal amountofpain. DIF:CognitiveLevel:Apply(application)REF:1201 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity

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8.AcoupleisscheduledtohaveaHuhnertestforinfertility.Inpreparationforthetest,thenursewillinstruct thecoupleabout a.

beingsedatedduringtheprocedure.

b.

determiningtheestimatedtimeofovulation.

c.

experiencingshoulderpainaftertheprocedure.

d.

refrainingfromintercoursebeforetheappointment.

ANS:B FortheHuhnertest,thecoupleshouldhaveintercourseattheestimatedtimeofovulationandthenarrivefor thetest2to8hoursafterintercourse.Theotherinstructionswouldbeusedforothertypesoffertilitytesting. DIF:CognitiveLevel:Apply(application)REF:1201 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 9.A44-year-oldpatientinthesexuallytransmittedinfectionclinichasapositiveVenerealDiseaseResearch Laboratory(VDRL)test,butnochancreisvisibleonassessment.Thenursewillplantosendspecimensfor a.

gramstain.

b.

cytologicstudies.

c.

rapidplasmareagin(RPR)agglutination.

d.

fluorescenttreponemalantibodyabsorption(FTA-Abs).

ANS:D BecausefalsepositivesarecommonwithVDRLandRPRtesting,FTA-Abstestingisrecommendedto confirmadiagnosisofsyphilis.Gramstainingisusedforothersexuallytransmittedinfections(STIs)suchas gonorrheaandChlamydiaandcytologicstudiesareusedtodetectabnormalcells(suchasneoplasticcells). DIF:CognitiveLevel:Apply(application)REF:1198 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 10.A24-year-oldfemalesaysshewantstobeginusingoralcontraceptives.Whichinformationfromthe nursingassessmentismostimportanttoreporttothehealthcareprovider? a.

Thepatientquitsmoking5monthspreviously.

b.

Thepatientsbloodpressureis154/86mmHg.

c.

Thepatienthasnotbeenvaccinatedforrubella.

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d.

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Thepatienthaschroniciron-deficiencyanemia.

ANS:B Becausehypertensionincreasestheriskformorbidityandmortalityinwomentakingoralcontraceptives,the patientsbloodpressureshouldbecontrolledbeforeoralcontraceptivesareprescribed.Theotherinformation alsowillbereportedbutwillnotaffectthechoiceofcontraceptive. DIF:CognitiveLevel:Apply(application)REF:1192 TOP:NursingProcess:AssessmentMSC:NCLEX:HealthPromotionandMaintenance 11.A49-year-oldmanwhohastype2diabetes,highbloodpressure,hyperlipidemia,andgastroesophageal refluxtellsthenursethathehashadrecentdifficultyinachievinganerection.Whichofthefollowingdrugs fromhiscurrentmedicationslistmaycauseerectiledysfunction(ED)? a.

Ranitidine(Zantac)

b.

Atorvastatin(Lipitor)

c.

Propranolol(Inderal)

d.

Metformin(Glucophage)

ANS:C Someantihypertensivesmaycauseerectiledysfunction,andthenurseshouldanticipateachangein antihypertensivetherapy.Theothermedicationswillnotaffecterectilefunction. DIF:CognitiveLevel:Apply(application)REF:1192 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 12.A19-year-oldpatientcallstheschoolclinicandtellsthenurse,Mymenstrualperiodisveryheavythis time.Ihavetochangemytamponevery4hours.Whichactionshouldthenursetakenext? a.

Tellthepatientthatherflowisnotunusuallyheavy.

b.

Schedulethepatientforanappointmentlaterthatday.

c.

Askthepatienthowheavyherusualmenstrualflowis.

d.

Havethepatientcallagainiftheheavyflowcontinues.

ANS:C Becauseaheavymenstrualflowisusuallyindicatedbysaturatingapadortamponin1to2hours,thenurse shouldfirstassesshowheavythepatientsusualflowis.Thereisnoneedtoschedulethepatientforan appointmentthatday.Thepatientmayneedtocallagain,butthisisnotthefirstactionthatthenurseshould take.Tellingthepatientthatshedoesnothaveaheavyflowimpliesthatthepatientsconcernisnotimportant.

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DIF:CognitiveLevel:Apply(application)REF:1190 TOP:NursingProcess:ImplementationMSC:NCLEX:HealthPromotionandMaintenance 13.Afterschedulingapatientwithapossibleovariancystforultrasound,thenursewillteachthepatientthat sheshould a.

expecttoreceiveIVcontrastduringtheprocedure.

b.

drinkseveralglassesoffluidsbeforetheprocedure.

c.

experiencemildabdominalcrampsaftertheprocedure.

d.

discontinuetakingaspirinfor7daysbeforetheprocedure.

ANS:B Afullbladderisneededformanyultrasoundprocedures,sothenursewillhavethepatientdrinkfluidsbefore arrivingfortheultrasound.Theotherinstructionsarenotaccurateforthisprocedure. DIF:CognitiveLevel:Apply(application)REF:1200 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 14.Thenursewillplantoteacha51-year-oldmanwhoisscheduledforanannualphysicalexamabouta(n) a.

increasedriskfortesticularcancer.

b.

possiblechangesinerectilefunction.

c.

normaldecreasesintestosteronelevel.

d.

prostatespecificantigen(PSA)testing.

ANS:D PSAtestingmayberecommendedannuallyformen,startingatage50.Thereisnoindicationthattheother patientteachingtopicsareappropriateforthispatient. DIF:CognitiveLevel:Apply(application)REF:1193 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 15.An18-year-oldfemalepatientwhohasbeenadmittedtotheemergencydepartmentafteramotorvehicle crashisscheduledforchestandabdominalx-rays.Whichinformationismostimportanttoreporttothehealth careproviderbeforethex-raysareobtained? a.

Severityofabdominalpain

b.

PositiveresultofhCGtest

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

Bloodpressure172/88mmHg

d.

Temperature102.1F(38.9C)

654

ANS:B PositivehCGtestingindicatesthatthepatientispregnantandthatunnecessaryabdominalx-raysshouldbe avoided.Theotherinformationisalsoimportanttoreport,butitwillnotaffectwhetherthex-raysshouldbe done. DIF:CognitiveLevel:Apply(application)REF:1197 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 16.Thefollowingpatientscalltheoutpatientclinic.Whichphonecallshouldthenursereturnfirst? a.

A44-year-oldpatientwhohasbloodydischargeafterahysteroscopyearliertoday

b.

A64-year-oldpatientwhoisexperiencingshoulderpainafteralaparoscopyyesterday

c.

A34-year-oldpatientwhoisshortofbreathafterpelviccomputedtomography(CT)withcontrast

d.

A54-year-oldpatientwhohasseverebreasttendernessfollowinganeedleaspirationbreastbiopsy

ANS:C ThepatientsdyspneasuggestsadelayedreactiontotheiodinedyeusedfortheCTscan.Theotherpatients symptomsarenotunusualaftertheprocedurestheyhaddone. DIF:CognitiveLevel:Analyze(analysis)REF:1199 OBJ:SpecialQuestions:Prioritization;MultiplePatients TOP:NursingProcess:AssessmentMSC:NCLEX:SafeandEffectiveCareEnvironment 17.Awomancallstheclinicbecausesheishavinganunusuallyheavymenstrualflow.Shetellsthenursethat shehassaturatedthreetamponsinthepast2hours.Thenurseestimatesthattheamountofbloodlossoverthe past2hoursis_____mL. a.

20to30

b.

30to40

c.

40to60

d.

60to90

ANS:D Theaveragetamponabsorbs20to30mL.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

655

DIF:CognitiveLevel:Understand(comprehension)REF:1190 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 18.Whichfindingfromthenursesphysicalassessmentofa42-year-oldmalepatientshouldbereportedtothe healthcareprovider? a.

Onetestishangslowerthantheother.

b.

Genitalhairdistributionisdiamondshaped.

c.

Cleardischargeispresentatthepenilemeatus.

d.

Inguinallymphnodesarenonpalpablebilaterally.

ANS:C Clearpeniledischargemaybeindicativeofasexuallytransmittedinfection(STI).Theotherfindingsare normalanddonotneedtobereported. DIF:CognitiveLevel:Apply(application)REF:1198 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 19.Whichinformationshownintheaccompanyingfigureandobtainedbythenurseabouta72-year-oldman whoiscomplainingoferectiledysfunctionismostimportanttocommunicatetothehealthcareprovider? a.

Recentkneesurgery

b.

Lowpositionoflefttestis

c.

Pulseandbloodpressurelevel

d.

Useofantihypertensivedrugs

ANS:D Manymedicationsusedforhypertensioncancauseerectiledysfunction.Moreinformationisneededregarding thespecificmedications.Theotherassessmentdatawillnotimpacterectilefunction(recentkneesurgery)or arenormalfora70-year-oldman(physicalexamdataandvitalsigns). DIF:CognitiveLevel:Analyze(analysis)REF:1192 OBJ:SpecialQuestions:PrioritizationTOP:NursingProcess:Assessment MSC:NCLEX:PhysiologicalIntegrity...