Chapter 53 Female Reproductive and Genital Problems PDF

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

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Chapter53:FemaleReproductiveandGenitalProblems TestBank MULTIPLECHOICE 1.A34-year-oldwoman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appropriate? a.

Ifyoudonotbecomepregnantwithinthenextfewyears,youneverwill.

b.

Youmayhavemoredifficultybecomingpregnantafteraboutage35.

c.

Youhavemanyyearsoffertilityleft,sothereisnorushtohavechildren.

d.

Youshouldplantostoptakingoralcontraceptivesseveralyearsbeforeyouwanttobecome pregnant.

ANS:B Theprobabilityofsuccessfullybecomingpregnantdecreasesafterage35,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difficultyinbecomingpregnant.Oralcontraceptivesdonotneedtobewithdrawnforseveralyearsfora womantobecomepregnant.Althoughthepatientmaybefertileformanyyears,itwouldbeinaccurateto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,notallpatientshavedifficultyinconceiving. DIF:CognitiveLevel:Apply(application)REF:1249 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husbands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:1244 TOP:NursingProcess:DiagnosisMSC:NCLEX:PsychosocialIntegrity

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3.A29-year-oldpatientwhoistryingtobecomepregnantasksthenursehowtodeterminewhensheismost likelytoconceive.Thenurseexplainsthat a.

ovulationisunpredictableunlessthereareregularmenstrualperiods.

b.

ovulationpredictionkitsprovideaccurateinformationaboutovulation.

c.

shewillneedtobringaspecimenofcervicalmucustotheclinicfortesting.

d.

sheshouldtakeherbodytemperaturedailyandhaveintercoursewhenitdrops.

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25-year-oldwomanhasaninducedabortionwithsuctioncurettageatanambulatorysurgicalcenter. Whichinstructionswillthenurseincludewhendischargingthepatient? a.

Heavyvaginalbleedingisexpectedforabout2weeks.

b.

Youshouldabstainfromsexualintercoursefor2weeks.

c.

Contraceptivesshouldbeavoideduntilyourreexamination.

d.

Irregularmenstrualperiodsareexpectedforthenextfewmonths.

ANS:B 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:1245 TOP:NursingProcess:ImplementationMSC:NCLEX:HealthPromotionandMaintenance 5.A32-year-oldwoman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.

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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.

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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-year-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(Advil) tocontrolsymptoms.

ANS:A Thepatients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:1245 TOP:NursingProcess:ImplementationMSC:NCLEX:HealthPromotionandMaintenance 7.A19-year-oldhasbeendiagnosedwithprimarydysmenorrhea.Howwillthenursesuggestthatthepatient preventdiscomfort? a.

Avoidaerobicexerciseduringhermenstrualperiod.

b.

Usecoldpacksontheabdomenandbackforpainrelief.

c.

Talkwithherhealthcareprovideraboutbeginningantidepressanttherapy.

d.

Takenonsteroidalantiinflammatorydrugs(NSAIDs)whenherperiodstarts.

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ANS:D NSAIDsshouldbestartedassoonasthemenstrualperiodbeginsandtakenatregularintervalsduringthe usualtimeframeinwhich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:1246 TOP:NursingProcess:ImplementationMSC:NCLEX:HealthPromotionandMaintenance 8.A32-year-old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patients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:Apply(application)REF:1264 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 9.Whencaringfora58-year-oldpatientwithpersistentmenorrhagia,thenursewillplantomonitorthe a.

estrogenlevel.

b.

completebloodcount(CBC).

c.

gonadotropin-releasinghormone(GNRH)level.

d.

serialhumanchorionicgonadotropin(hCG)results.

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:1247

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TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 10.A47-year-oldwomanaskswhethersheisgoingintomenopauseifshehasnothadamenstrualperiodfor3 months.Thebestresponsebythenurseiswhichofthefollowing? a.

Haveyouthoughtaboutusinghormonereplacementtherapy?

b.

Mostwomenfeelalittledepressedaboutenteringmenopause.

c.

Whatwasyourmenstrualpatternbeforeyourperiodsstopped?

d.

Sinceyouareinyourmid-40s,itislikelythatyouaremenopausal.

ANS:C Theinitialresponsebythenurseshouldbetoassessthepatients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(HT)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:1249 TOP:NursingProcess:ImplementationMSC:NCLEX:HealthPromotionandMaintenance 11.A49-year-oldwomanisconsideringtheuseofcombinedestrogen-progesteronehormonereplacement therapy(HT)duringmenopause.Whichinformationwillthenurseincludeduringtheirdiscussion? a.

Useofestrogen-containingvaginalcreamsprovidesmostofthesamebenefitsasoralHT.

b.

IncreasedincidenceofcoloncancerinwomentakingHTrequiresmorefrequentcolonoscopy.

c.

HTdecreasesosteoporosisriskandincreasestheriskforcardiovasculardiseaseandbreastcancer.

d.

UseofHTforupto10yearstopreventsymptomssuchashotflashesisgenerallyconsideredsafe.

ANS:C DatafromtheWomensHealthInitiativeindicateanincreasedriskforcardiovasculardiseaseandbreastcancer inwomentakingcombinationHT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HT,suchasdecreasedhotflashes.Mos womenwhouseHT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:1250 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

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

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.

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ANS:C Thepatients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patientssymptoms butdonotaddresstheproblemascompletelyastherape-traumasyndromediagnosis. DIF:CognitiveLevel:Apply(application)REF:1268 TOP:NursingProcess:DiagnosisMSC:NCLEX:PsychosocialIntegrity 13.Whichstatementbythepatientindicatesthatthenursesteachingabouttreatingvaginalcandidiasishas beeneffective? a.

Ishouldcleancarefullyaftereachurinationandbowelmovement.

b.

Icandouchewithwarmwateriftheitchingcontinuestobotherme.

c.

IwillinserttheantifungalcreamrightbeforeIgetupinthemorning.

d.

Iwilltellmyhusbandthatwecannothaveintercourseforthenextmonth.

ANS:A 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:1253 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 14.A25-year-oldwomanwhoisscheduledforaroutinegynecologicexaminationtellsthenursethatshehas hadintercourseduringthelastyearwithseveralmen.Thenursewillplantoteachaboutthereasonfor a.

contraceptiveuse.

b.

antibiotictherapy.

c.

Chlamydiatesting.

d.

pregnancytesting.

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

683

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:1253 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 15.Thenurseiscaringfora20-year-old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to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tests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:1254 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 16.A24-year-old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:1254 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity

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

684

17.A32-year-oldpatienthasoralcontraceptivesprescribedforendometriosis.Thenursewillteachthepatient to a.

expecttoexperiencesideeffectssuchasfacialhair.

b.

takethemedicationeverydayforthenext9months.

c.

takecalciumsupplementstopreventdevelopingosteoporosisduringtherapy.

d.

useasecondmethodofcontraceptiontoensurethatshewillnotbecomepregnant.

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:1256 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 18.A28-year-oldpatientwithendometriosisaskswhysheisbeingtreatedwithmedroxyprogesterone(DepoProvera),amedicationthatshethoughtwasanoralcontraceptive.Thenurseexplainsthatthistherapy a.

suppressesthemenstrualcyclebymimickingpregnancy.

b.

willrelievesymptomssuchasvaginalatrophyandhotflashes.

c.

preventsapregnancythatcouldworsenthemenstrualbleeding.

d.

willleadtopermanentsuppressionofabnormalendometrialtissues.

ANS:A Depo-Provera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gonadotropin-releasinghormoneagonists(GNRH)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:1256 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 19.A28-year-oldpatientwasrecentlydiagnosedwithpolycysticovarysyndrome.Itismostimportantforthe nursetoteachthepatient a.

reasonsforatotalhysterectomy.

b.

howtodecreasefacialhairgrowth.

TestBank-Medical-Sur...