Deck 27: Female Genitourinary System

Question 1

A woman is in the clinic for an annual gynecologic examination. How should the nurse begin the interview?

A) Menstrual history, because it is generally nonthreatening.
B) Sexual history, because discussing it first will build rapport.
C) Obstetric history, because it includes the most important information.
D) Urinary system history, because problems may develop in this area as well.

Answer 1

Menstrual history, because it is generally nonthreatening.

Question 2

A patient has had three pregnancies and two live births. How should the nurse record this information?

A) G2; P2; AB1
B) G3; P2; AB0
C) G3; P2; AB1
D) G3; P3; AB1

Answer 2

G3; P2; AB1

Question 3

What usually occurs to the cells in the reproductive tract to cause the changes normally associated with menopause?

A) Aging
B) Becoming fibrous
C) Estrogen dependent
D) Able to respond to progesterone

Answer 3

Estrogen dependent

Question 4

The uterus is usually positioned tilting forward and superior to the bladder. What is this position called?

A) Anteverted and anteflexed
B) Retroverted and anteflexed
C) Retroverted and retroflexed
D) Superiorverted and anteflexed

Question 5

During the interview with a female patient, the nurse gathers data that indicates 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."

Question 6

The nurse is examining a female patient's vestibule. What does the nurse expect to visualize?

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

Question 7

The nurse is reviewing the changes that occur with menopause. Which changes are expected?

A) Uterine and ovarian atrophy, along with thinning of 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

Question 8

During a speculum inspection of the vagina, what would the nurse expect to see at the end of the vaginal canal?

A) Cervix
B) Uterus
C) Ovaries
D) Fallopian tubes

Question 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) "You can continue with hormone replacement therapy as it actually decreases your risk for breast cancer."
B) "You should be aware that you're at increased risk for dyspareunia because of decreased vaginal secretions."
C) "You have only stopped menstruating and there are not really any other changes that you need to be concerned about."
D) "You likely may have difficulty with sexual pleasure as a result of drastic changes in the female sexual response cycle."

Question 10

A nurse is assessing a patient's risk for contracting a sexually transmitted infection (STI). What is an appropriate question to ask this patient?

A) "Do you have a sexually transmitted infection?"
B) "You are aware of the dangers of unprotected sex, aren't you?"
C) "You know that it's important to use condoms for protection, right?"
D) "Do you use a condom with each episode of sexual intercourse?"

Question 11

During the interview, a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. What would be the most appropriate response by the nurse?

A) "Oh, don't worry. Some cyclic vaginal discharge is normal."
B) "Have you been engaging in unprotected sexual intercourse?"
C) "I'd like more information about the discharge. What color is it?"
D) "Have you had any urinary incontinence associated with the discharge?"

Question 12

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 sequence for development?

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.

Question 13

Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during a health interview?

A) "Now, it is time to talk about your sexual history. When did you first have intercourse?"
B) "Most women your age have had more than one sexual partner. How many would you say you have had?"
C) "Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?"
D) "Women often have questions about their sexual relationship and how it affects their health. Do you have any questions?"

Question 14

A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. What should the nurse ask the woman?

A) "Have you had excessive vaginal bleeding?"
B) "Have you experienced changes in your urination patterns?"
C) "Do you have any unusual vaginal discharge or itching?"
D) "Have you noticed any changes in your desire for intercourse?"

Question 15

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. Based on these findings, what two signs is the patient exhibiting?

A) Tanner and Hegar
B) Hegar and Goodell
C) Chadwick and Hegar
D) Goodell and Chadwick

Question 16

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 I'd like them to go away!" What is the nurse's 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) "Let's 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."

Question 17

A 22-year-old woman has been considering using oral contraceptives. As a part of her health history, what should the nurse 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?"

Question 18

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 disease-the 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.

Question 19

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. How should the nurse respond?

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."

Question 20

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. What does this finding suggest?

A) Dysuria
B) Hematuria
C) Urge incontinence
D) Stress incontinence

Question 21

When performing the bimanual examination, the nurse notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. How should the nurse interpret these findings?

A) These findings are all within normal limits.
B) Pain may occur during palpation of the cervix.
C) Cervical consistency should be soft and velvety-not firm.
D) The cervix should move when palpated; an immobile cervix may indicate malignancy.

Question 22

A 46-year-old woman is in the clinic for her annual gynecologic examination. She voices concern about ovarian cancer because her mother and sister died of it. Which statement does the nurse know to be correct regarding ovarian cancer?

A) Ovarian cancer rarely has any symptoms.
B) The Pap smear detects the presence of ovarian cancer.
C) Women over age 40 years should have a thorough pelvic examination every 3 years.
D) Women at high risk for ovarian cancer should have annual transvaginal ultrasonography for screening.

Question 23

The nurse is preparing to interview a postmenopausal woman. Which of these statements is true as it applies to obtaining the health history of a postmenopausal woman?

A) The nurse should screen for monthly breast tenderness.
B) The nurse should ask a postmenopausal woman if she has ever had vaginal bleeding.
C) Once a woman reaches menopause, the nurse does not need to ask any history questions.
D) Postmenopausal women are not at risk for contracting STIs; therefore, these questions can be omitted.

Question 24

During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which condition?

A) Candidiasis
B) Trichomoniasis
C) Atrophic vaginitis
D) Bacterial vaginosis

Question 25

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 you'll feel?"

Question 26

A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the nurse notices clusters of small, shallow vesicles with surrounding erythema on the labia. Inguinal lymphadenopathy is also present. What do these findings indicate?

A) HPV
B) Pediculosis pubis
C) Contact dermatitis
D) Herpes simplex virus type 2

Question 27

The nurse is examining a 35-year-old female patient. During the health history, the nurse notices that she has had two term pregnancies, and both babies were delivered vaginally. During the internal examination, the nurse observes that the cervical os is a horizontal slit with some healed lacerations and that the cervix has some nabothian cysts that are small, smooth, and yellow. In addition, the nurse notices that the cervical surface is granular and red, especially around the os. Finally, the nurse notices the presence of stringy, opaque, odorless secretions. Which of these findings are abnormal?

A) Nabothian cysts are present.
B) The cervical os is a horizontal slit.
C) The cervical surface is granular and red.
D) Stringy and opaque secretions are present.

Question 28

A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. What is an appropriate response by the nurse?

A) "If you are menstruating, please use pads to avoid placing anything into the vagina."
B) "Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment."
C) "We would like you to use a mild saline douche before your examination. You may pick this up in our office."
D) "If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you."

Question 29

During an internal examination of a woman's genitalia, the nurse will use which technique for proper insertion of the speculum?

A) The woman is instructed to bear down, the speculum blades are opened and applied in a swift, upward movement.
B) The woman is instructed to bear down, the width of the blades is horizontally turned, and the speculum is inserted downward at a 45-degree angle toward the small of the woman's back.
C) The blades of the speculum are inserted on a horizontal plane, turning them to a 30-degree angle while continuing to insert them. The woman is asked to bear down after the speculum is inserted.
D) The blades are locked open by turning the thumbscrew. Once the blades are open, pressure is applied to the introitus and the blades are inserted downward at a 45-degree angle to bring the cervix into view.

Question 30

When performing an external genitalia examination of a 10-year-old girl, the nurse notices that no pubic hair has grown in and the mons and the labia are covered with fine vellus hair. According to the Sexual Maturity Rating scale, what stage of sexual maturity do these findings indicate?

A) 1
B) 2
C) 3
D) 4

Question 31

The nurse is preparing for an internal genitalia examination of a woman. Which order of the examination is correct?

A) Bimanual, speculum, and rectovaginal
B) Speculum, rectovaginal, and bimanual
C) Speculum, bimanual, and rectovaginal
D) Rectovaginal, bimanual, and speculum

Question 32

A 65-year-old woman is in the office for routine gynecologic care. She had a complete hysterectomy 3 months ago after cervical cancer was detected. Which statement does the nurse know to be true regarding this visit?

A) Her cervical mucosa will be red and dry looking.
B) She will not need to have a Pap smear performed.
C) The nurse can expect to find that her uterus will be somewhat enlarged and her ovaries small and hard.
D) The nurse should plan to lubricate the instruments and the examining hand adequately to avoid a painful examination.

Question 33

During an examination, which tests will the nurse collect to screen for cervical cancer?

A) Endocervical specimen, cervical scrape, and vaginal pool
B) Endocervical specimen, vaginal pool, and acetic acid wash
C) Cervical scrape, acetic acid wash, saline mount (wet prep)
D) Endocervical specimen, potassium hydroxide (KOH) preparation, and acetic acid wash

Question 34

An 18-year-old patient is having her first pelvic examination. Which action by the nurse is appropriate?

A) Inviting her mother to be present during the examination.
B) Avoiding the lithotomy position for this first time because it can be uncomfortable and embarrassing.
C) Raising the head of the examination table and giving her a mirror so that she can view the examination.
D) Fully draping her, leaving the drape between her legs elevated to avoid embarrassing her with eye contact.

Question 35

When the nurse is discussing sexuality and sexual issues with an adolescent, a permission statement helps convey that it is normal to think or feel a certain way. Which statement is the best example of a permission statement?

A) "It is okay that you have become sexually active."
B) "Girls your age often have questions about sexual activity. Do you have any questions?"
C) "If it is okay with you, I'd like to ask you some questions about your sexual history."
D) "Girls your age often engage in sexual activities. It is okay to tell me if you have had intercourse."

Question 36

The nurse is palpating a female patient's adnexa. The findings include a firm, smooth uterine wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and pulsating. How should the nurse proceed?

A) Tell the patient that her examination is normal.
B) Give her an immediate referral to a gynecologist.
C) Suggest that she return in a month for a recheck to verify the findings.
D) Tell the patient that she may have an ovarian cyst that should be evaluated further.

Question 37

During the examination portion of a patient's visit, she will be in lithotomy position. Which statement reflects some things that the nurse can do to make this position more comfortable for her?

A) Ask her to place her hands and arms over her head.
B) Elevate her head and shoulders to maintain eye contact.
C) Allow her to choose to have her feet in the stirrups or have them resting side by side on the edge of the table.
D) Allow her to keep her buttocks approximately 6 inches from the edge of the table to prevent her from feeling as if she will fall off.

Question 38

When assessing a newborn infant's genitalia, the nurse notices that the genitalia are somewhat engorged. The labia majora are swollen, the clitoris looks large, and the hymen is thick. The vaginal opening is difficult to visualize. The infant's mother states that she is worried about the labia being swollen. How should the nurse reply?

A) "This is a normal finding in newborns and should resolve within a few weeks."
B) "This finding could indicate an abnormality and may need to be evaluated by a physician."
C) "We will need to have estrogen levels evaluated to ensure that they are within normal limits."
D) "We will need to keep close watch over the next few days to see if the genitalia decrease in size."

Question 39

The nurse has just completed an inspection of a nulliparous woman's external genitalia. Which of these would be a description of a finding within normal limits?

A) Redness of the labia majora
B) Multiple nontender sebaceous cysts
C) Gaping and slightly shriveled labia majora
D) Discharge that is foul smelling and irritating

Question 40

The nurse is preparing to examine the external genitalia of a school-age girl. Which position would be most appropriate in this situation?

A) In the parent's lap
B) In a frog-leg position on the examining table
C) In the lithotomy position with the feet in stirrups
D) Lying flat on the examining table with legs extended

Question 41

During an external genitalia examination of a woman, the nurse notices several lesions around the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is not aware of any problems in that area. What do these findings likely indicate?

A) Syphilitic chancre
B) HPV or genital warts
C) Pediculosis pubis (crab lice)
D) Herpes simplex virus type 2 (herpes genitalis)

Question 42

The nurse is palpating an ovarian mass during an internal examination of a 63-year-old woman. Which findings of the mass's characteristics would suggest the presence of an ovarian cyst? (Select all that apply.)

A) Fixed
B) Poorly defined
C) Heavy and solid
D) Mobile and solid
E) Smooth and round
F) Mobile and fluctuant

Question 43

During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy and fixed, with a poorly defined mass. What does this finding suggest?

A) Ovarian cyst
B) Endometriosis
C) Ovarian cancer
D) Ectopic pregnancy

Question 44

A 25-year-old woman comes to the emergency department with a sudden fever of 38.3 $\degree$ C and abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. What do these findings suggest?

A) Endometriosis
B) Uterine fibroids
C) Ectopic pregnancy
D) Pelvic inflammatory disease

Question 45

During an internal examination, the nurse notices that the cervix bulges outside the introitus when the patient is asked to strain. How should the nurse document this finding?

A) A normal finding
B) Uterine prolapse, graded first degree
C) Uterine prolapse, graded third degree
D) Uterine prolapse, graded second degree

Question 46

A 35-year-old woman is at the clinic for a gynecologic examination. During the examination, she asks the nurse, "How often do I need to have this Pap test done?" Which reply by the nurse is correct?

A) "It depends. Do you smoke?"
B) "A Pap test needs to be performed annually until you are 65 years of age."
C) "If you have two consecutive normal Pap tests, then you can wait 5 years between tests."
D) "After age 30 years, if you have three consecutive normal Pap tests, then you may be screened every 2 to 3 years."

Question 47

During an examination, how would the nurse expect the cervical os of a woman who has never had children to appear?

A) Everted
B) Stellate
C) Small and round
D) As a horizontal irregular slit

Question 48

A woman has just been diagnosed with HPV or genital warts. The nurse should counsel her to receive regular examinations because this virus makes her at a higher risk for what type of cancer?

A) Uterine
B) Cervical
C) Ovarian
D) Endometrial