Deck 54: Nursing Management: Female Reproductive Problems

Question 1

While obtaining a health history from a patient hospitalized with pelvic inflammatory disease (PID), the nurse recognizes that a risk factor related by the patient includes

A) the use of oral contraceptives.
B) sexual exposure to a partner with urethritis.
C) use of superabsorbent tampons.
D) history of long-term antibiotic treatment.

Answer 1

sexual exposure to a partner with urethritis.

Question 2

After being sexually assaulted, a woman is brought to the emergency department by a friend. The patient is confused and has a large laceration and ecchymosis above the left eye. Which action should the nurse take first?

A) Ask the patient to describe what occurred during the assault.
B) Assist the patient in removing her clothing.
C) Contact the sexual assault nurse examiner (SANE).
D) Assess the patient's neurologic status.

Answer 2

Assess the patient's neurologic status.

Question 3

A woman is scheduled for a late-induced abortion using instillation of hypertonic saline solution. Before the procedure, which information will the nurse discuss with the patient?

A) There is a possibility that the patient may deliver a live fetus.
B) The expulsion of the fetus may take up to a day or longer.
C) The procedure may be unsuccessful in terminating the pregnancy.
D) The patient will require a general anesthetic for the procedure.

Answer 3

The expulsion of the fetus may take up to a day or longer.

Question 4

A 46-year-old woman tells the nurse that she has not had a menstrual period for 3 months and asks whether she is going into menopause. The best response by the nurse is,

A) "Are you experiencing any other signs of low estrogen levels?"
B) "What was your menstrual pattern before your periods stopped?"
C) "The doctor can prescribe hormone replacement therapy to minimize menopausal symptoms."
D) "Menopause is unlikely at age 46, so your amenorrhea needs further investigation."

Question 5

A 26-year-old woman is admitted to the hospital with abdominal cramping and vaginal bleeding. She is diagnosed with an ectopic pregnancy in the fallopian tube. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action by the nurse is appropriate?

A) Staying with the patient and assessing the patient's emotional status frequently
B) Explaining the reason for taking the patient's vital signs every 15 to 30 minutes
C) Closing the door to the patient's room and not disturbing her for a few hours
D) Providing teaching about surgical interventions for ectopic pregnancy

Question 6

A 42-year-old woman has developed amenorrhea. If the woman is experiencing menopause, the nurse would expect laboratory findings to include

A) decreased serum estrogen.
B) elevated progesterone level.
C) presence of hCG in the urine.
D) low serum follicle-stimulating hormone (FSH) level.

Question 7

When caring for a 60-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 b-human chorionic gonadotropin (hCG) results.

Question 8

A couple has undergone infertility evaluation with no success at conception and is considering the possibility of in vitro fertilization (IVF). The wife tells the nurse that they really cannot afford IVF on her husband's salary, and the husband replies that if his wife would get a job, maybe they would have enough money for the procedure. Which nursing diagnosis is appropriate for the couple?

A) Defensive coping related to anxiety about lack of conception
B) Ineffective sexuality patterns related to psychological stress
C) Ineffective denial related to frustration about continued infertility
D) Ineffective role performance related to inadequate finances

Question 9

A woman has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient?

A) "You should abstain from sexual intercourse for 2 weeks."
B) "Use of contraceptives should be avoided until your reexamination."
C) "Heavy vaginal bleeding is expected for about 2 weeks."
D) "Irregular menstrual periods are expected for the next few months."

Question 10

When the nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization, which nursing intervention will be included in the plan of care?

A) Monitoring liver function tests
B) Elevating the head of the bed to at least 30 degrees
C) Using cold packs PRN pelvic pain
D) Teaching how to perform Kegel exercises

Question 11

Six months after being sexually assaulted, a woman tells the nurse that she has nightmares about the incident and develops acute anxiety if she finds herself alone in situations where several men are present. The most appropriate nursing diagnosis for the patient is

A) sleep deprivation related to frightening dreams.
B) ineffective coping related to inability to resolve rape incident.
C) anxiety related to effects of being raped.
D) rape-trauma syndrome related to rape experience.

Question 12

During a routine health examination, a 35-year-old woman who uses oral contraceptives tells the nurse, "I want to have children, but I want to wait a few more years." Which response by the nurse is appropriate?

A) "Because of your age, you may need to stop taking oral contraceptives several years before you want to become pregnant."
B) "You still have many years of fertility left, so there is no rush to have children."
C) "You may have more difficulty becoming pregnant after about age 35."
D) "If you do not have children within the next few years, it will be very difficult for you to become pregnant."

Question 13

A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral antibiotics. When teaching the patient about follow-up care and management of her condition, the nurse instructs the patient that

A) sexual intercourse should be avoided for 1 week.
B) a follow-up appointment is needed in 2 to 3 days.
C) abdominal pain may persist for several weeks.
D) NSAID use may prevent scarring of pelvic organs.

Question 14

After teaching a perimenopausal patient who has started using hormone replacement therapy (HRT), the nurse determines that the teaching has been effective when the patient says

A) "If I take a daily aspirin, I will not need to worry about blood clots."
B) "Now that I have started taking HRT, I can stop taking calcium supplements."
C) "My breasts may feel tender when I am taking the HRT."
D) "I will continue to have menstrual periods, but the blood flow will be lighter."

Question 15

A 31-year-old woman tells the nurse that she has noticed increasing headaches with dizziness, abdominal bloating, and unexplained anxiety occurring before her menstrual periods. Which action by the nurse is most appropriate?

A) Teaching the patient about lifestyle changes to reduce premenstrual syndrome (PMS) symptoms
B) Suggesting that the patient use ibuprofen (Advil) to control symptoms
C) Telling the patient that her symptoms may be caused by PMS and that relaxation therapy may provide symptom relief
D) Scheduling the patient for an appointment in 3 months and have her write down symptoms for the next three menstrual cycles

Question 16

A 19-year-old requests a prescription for birth control pills at the student health center. She tells the nurse that she wants to take birth control pills to decrease the pain and headaches she has during her menstrual periods. The most appropriate response by the nurse is,

A) "In order to obtain birth control pills, you will need to provide information about sexual history."
B) "You should try other techniques to control the pain before any type of drug therapy is used."
C) "Birth control pill use should be restricted to more serious problems because of the side effects they can cause."
D) "Birth control pills can be effective treatment for painful menstruation, and it may be possible for you to use them."

Question 17

When teaching a patient about ways to prevent primary dysmenorrhea, the nurse will suggest that the patient

A) avoid aerobic exercise during her menstrual period.
B) use cold packs on the abdomen and back for pain relief.
C) start taking nonsteroidal antiinflammatory drugs (NSAIDs) regularly when her menstrual period starts.
D) talk with her health care provider about antidepressant therapy.

Question 18

A diagnosis of candidiasis is made when a patient with an abnormal vaginal discharge is seen at the clinic, and an antifungal vaginal cream is prescribed. Which statement by the patient indicates that teaching about the candidiasis treatment has been effective?

A) "I will tell my husband that we cannot have sex for the next month."
B) "I should clean my perineal area carefully after each urination and bowel movement."
C) "I can douche with warm water if the itching continues to bother me."
D) "I will use the applicator to insert the cream before I get out of bed in the morning."

Question 19

A young woman who is trying to become pregnant asks the nurse about ways to determine when she is most likely to conceive. The nurse explains that

A) she should take her body temperature daily and have intercourse when it drops.
B) she will need to bring a specimen of cervical mucus to the clinic for testing.
C) ovulation prediction kits provide accurate information about ovulation.
D) ovulation is difficult to predict unless she has regular menstrual periods.

Question 20

To help a 53-year-old woman make a decision about the use of combined estrogen-progesterone hormone replacement therapy (HRT) to control the effects of menopause, the nurse explains that

A) the use of estrogen-containing vaginal creams provides most of the same benefits as oral HRT.
B) HRT decreases osteoporosis risk, but it increases the risk for cardiovascular disease and breast cancer.
C) most perimenopausal women use HRT for 5 to 10 years to prevent hot flashes and mood changes.
D) an increased incidence of colon cancer in women taking HRT requires frequent stool assessment for occult blood.

Question 21

Which information will the nurse include when developing a patient teaching plan for a 48-year-old patient with uterine bleeding caused by a leiomyoma?

A) Over-the-counter pain relievers such as aspirin are appropriate to use if mild pain occurs.
B) The tumor size is likely to increase throughout the patient's lifetime.
C) The patient will need frequent monitoring to detect any malignant changes.
D) The symptoms may decrease after the patient undergoes menopause.

Question 22

A patient who is seen in the health clinic is diagnosed with genital warts. The nurse will plan to teach the patient about

A) the need for regular Pap tests.
B) symptoms of pelvic inflammatory disease.
C) appropriate use of oral contraceptives.
D) increased risk for endometrial cancer.

Question 23

When caring for a patient who has a radium implant for treatment of cancer of the cervix, the nurse will plan to

A) use gloves when changing the patient's bed.
B) maintain the patient on complete bed rest.
C) flush the toilet several times after the patient voids to eliminate radioactive isotopes.
D) allow adequate time for discussion of patient concerns about the cancer diagnosis.

Question 24

A patient's Pap test reveals cervical cells characteristic of adenocarcinoma of the cervix. Information obtained during the patient's health history and identified as a major risk factor for cervical cancer is

A) smoking coupled with infection with a human papilloma virus (HPV).
B) use of estrogen replacement therapy for menopausal symptoms.
C) the patient's use of oral contraceptives for 15 years.
D) a history of four pregnancies with one spontaneous abortion.

Question 25

A 56-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which response by the nurse is most appropriate?

A) "Breakthrough bleeding is normal in women your age."
B) "Are you using prescription hormone replacement therapy?"
C) "How long has it been since your last menstrual period?"
D) "A frequent cause of spotting is endometrial cancer."

Question 26

When assessing a patient on her return to the surgical unit following a total abdominal hysterectomy, the nurse would expect to find

A) complaints of abdominal pain at the incision site with repositioning.
B) scant urine output from the retention catheter for the first 8 hours.
C) a heavy pressure dressing in place across the lower abdomen.
D) a moderate amount of sanguineous drainage on the abdominal dressing.

Question 27

During assessment of a patient with suspected endometrial cancer, the nurse identifies an important risk factor for cancer of the endometrium when the patient's history includes

A) alcohol addiction.
B) multiple pregnancies.
C) long-standing obesity.
D) early sexual activity.

Question 28

A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse explains that this therapy

A) suppresses the menstrual cycle by mimicking pregnancy.
B) may cause symptoms such as vaginal atrophy and hot flashes.
C) will lead to permanent suppression of abnormal endometrial tissues.
D) is associated with loss of bone density and increased fracture risk.

Question 29

A patient who has undergone a vaginal hysterectomy has not voided for 8 hours following surgery and is complaining of bladder distention. The most appropriate action by the nurse is to

A) insert a straight catheter per the PRN order.
B) increase the patient's oral fluid intake to 200 ml/hr.
C) notify the health care provider of the patient's inability to void.
D) ambulate the patient short distances every hour.

Question 30

A 62-year-old patient with stage 0 carcinoma of the cervix that was determined by cervical conization has been told by her health care provider she needs no further treatment at this time. She asks the nurse why the doctor has not discussed other treatment options with her. The most appropriate response by the nurse is,

A) "Because of your age, further treatment of the cervical cancer is not indicated."
B) "Stage 0 tumors take many years to spread, so you only need periodic examinations at this time."
C) "Conization is used both to diagnose and to treat cervical cancer, so no further treatment is needed."
D) "Unless the human papilloma virus (HPV) tests are positive, there is no indication that more treatment is needed."

Question 31

When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the patient to

A) take the medication every day for the next 9 months.
B) expect to experience symptoms such as facial hair.
C) use a second method of contraception to ensure that she will not become pregnant.
D) take calcium supplements to prevent osteoporosis from developing during therapy.

Question 32

The nurse obtains all these data when assessing a patient who returned to the surgical unit after having a total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 hours ago. Which information is most important to communicate to the surgeon?

A) The abdominal dressing has a 1-cm area of dark red drainage.
B) The catheter drainage bag shows a total of 100 ml of urine since surgery.
C) The patient is complaining of 5/10 continuous abdominal pain.
D) The patient has decreased bowel tones and abdominal distension.

Question 33

The nurse has just received change-of-shift report about these four patients. Which patient should be assessed first?

A) A patient in the 15th week of gestation who is experiencing uterine cramping and spotting
B) A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain
C) A patient with ovarian cancer who is complaining of 5/10 pain after a total abdominal hysterectomy and bilateral salpingo-oophorectomy
D) A patient who has a radium implant in place to treat cervical cancer and is crying because she feels isolated in her hospital room

Question 34

A patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. In planning care for the patient, the nurse identifies a priority nursing diagnosis of

A) risk for infection related to contamination of the wound with urine and stool.
B) self-care deficit: bathing/hygiene related to pain and difficulty in changing position.
C) imbalanced nutrition: less than body requirements related to low-residue diet.
D) risk for ineffective sexual pattern related to disfiguration caused by the surgery.

Question 35

An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which question should the nurse ask?

A) "How old were you when your menstrual periods started?"
B) "Do you have any pain or cramping with your menstrual periods?"
C) "Have you ever had sexual intercourse?"
D) "Do you use any illegal substances?"

Question 36

A 56-year-old woman undergoes an anterior and posterior (A & P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan?

A) Repositioning of the rectal tube for comfort
B) Teaching the patient correct pessary use
C) Repacking the vaginal wound with half-inch gauze
D) Performing indwelling catheter care daily

Question 37

An abdominal hysterectomy is scheduled for a 40-year-old patient with multiple uterine leiomyomas. Before the surgery, the nurse will teach the patient about

A) the expected temporary loss of vaginal sensation.
B) use of a heat lamp to help dry the open wound area.
C) symptoms caused by the sudden drop in estrogen level.
D) leg exercises and the purpose of frequent ambulation.

Question 38

Stage III ovarian cancer is diagnosed in a 63-year-old woman. A nursing diagnosis that is likely to be appropriate is

A) sexual dysfunction related to loss of vaginal sensation.
B) risk for infection related to impaired immune function.
C) anxiety related to cancer diagnosis and need to make treatment decisions.
D) situational low self-esteem related to guilt about delaying medical care.

Question 39

A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate scheduling the patient for

A) endometrial biopsy.
B) dilation and curettage (D&C).
C) laser endometrial ablation.
D) uterine balloon therapy.

Question 40

When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most important for the nurse to teach the patient

A) ways to reduce the occurrence of acne.
B) how to decrease facial hair growth.
C) methods to maintain appropriate weight.
D) reasons for a total hysterectomy.

Question 41

When counseling a healthy perimenopausal woman who prefers not to use hormone replacement therapy (HRT), which nonhormonal therapies will the nurse suggest? (Select all that apply.)

A) Reduce coffee intake.
B) Use warm quilts at night.
C) Take black cohosh supplements.
D) Increase intake of dietary soy products.
E) Have a glass of wine in the evening.
F) Exercise several times a week.