Deck 26: Female Genitourinary System

Question 1

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 must make sure to ask:
1)"Have you noticed a change in your vaginal pH?"
2)"Have you noticed any excessive vaginal bleeding?"
3)"Have you noticed any unusual vaginal discharge or itching?"
4)"Have you noticed any changes in your desire for intercourse?"

Answer 1

3
Several medications may increase the risk of vaginitis.Broad-spectrum antibiotics alter balance of normal flora,which may lead to the development of vaginitis.

Question 2

During an inspection of the vagina,the nurse would expect to see what at the end of the vagina?
1)Cervix
2)Uterus
3)Ovaries
4)Fallopian tubes

Answer 2

1
At the end of the canal,the uterine cervix projects into the vagina.

Question 3

A woman who is 8 weeks' pregnant is in the clinic for a check.The nurse reads on her chart that her cervix is softened and looks cyanotic.The nurse knows that the woman is exhibiting which of the following signs?
1)Tanner's sign and Hegar's sign
2)Hegar's sign and Goodell's sign
3)Chadwick's sign and Hegar's sign
4)Goodell's sign and Chadwick's sign

Answer 3

4
Shortly after the first missed menstrual period,the female genitalia show signs of the growing fetus.The cervix softens (Goodell's sign)at 4 to 6 weeks,and the vaginal mucosa and cervix look cyanotic (Chadwick's 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.

Question 4

A woman who is 22 weeks' pregnant has a vaginal infection.She tells the nurse that she is afraid that this infection will "hurt my baby." The nurse knows that which of the following statements is true?
1)If intercourse is avoided,the risk for infection is minimal.
2)A thick mucus plug forms that protects the fetus from infection.
3)The acidic pH of vaginal secretions promotes the growth of pathogenic bacteria.
4)The mucus plug that forms in the cervical canal is a good medium for bacterial growth.

Question 5

A patient has had three pregnancies and two live births.How would the nurse record this information?
1)Gravida 2,para 2,AB 1
2)Gravida 3,para 2,AB 0
3)Gravida 3,para 2,AB 1
4)Gravida 3,para 3,AB 1

Question 6

A 22-year-old woman has been considering using oral contraceptives.As a part of her history,the nurse should ask:
1)"Do you have a history of heart murmurs?"
2)"Will you be in a monogamous relationship?"
3)"I wonder if you have thought this choice through carefully."
4)"If you use smoke,how many cigarettes do you smoke per day?"

Question 7

An 18-year-old patient is having her first pelvic examination.It would be appropriate to:
1)invite her mother to be present during the examination.
2)avoid the lithotomy position this first time because it can be uncomfortable and embarrassing.
3)raise the head of the examination table and give her a mirror so that she can view the exam.
4)drape her fully,leaving the drape between her legs elevated to avoid embarrassing her with eye contact.

Question 8

A woman is in the clinic for an annual gynecologic examination.The nurse should plan to begin the interview with the:
1)menstrual history because it is generally nonthreatening.
2)obstetric history because it is the most important information.
3)urinary system history because there may be problems in this area as well.
4)sexual history because it will build rapport to discuss this first.

Question 9

A 54-year-old woman who has just completed menopause is in the clinic today for a yearly physical examination.Which of the following should the nurse include in patient education?
1)A postmenopausal woman is not at any greater risk for heart disease than a younger woman is.
2)A postmenopausal woman should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions.
3)A postmenopausal woman has only stopped menstruating;there really are no other significant changes that she should be concerned with.
4)A postmenopausal woman is likely to have difficulty with sexual pleasure as a result of drastic changes in the female sexual response cycle.

Question 10

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 knows that problem is:
1)hematuria and usually needs to be evaluated by a urologist.
2)stress incontinence and is usually due to muscle weakness.
3)true urinary incontinence and may mean that she has a kidney infection.
4)urgency incontinence and she should empty her bladder before she sneezes or coughs.

Question 11

A nurse is assessing a patient's risk of contracting a sexually transmitted disease (STD).An appropriate question would be:
1)"You use condoms don't you?"
2)"Do you use a condom with each episode of sexual intercourse?"
3)"Do you have an STD?"
4)"You are aware of the dangers of unprotected sex,aren't you?"

Question 12

The changes normally associated with menopause occur generally because the cells in the reproductive tract are:
1)aging.
2)becoming fibrous.
3)estrogen dependent.
4)able to respond to estrogen.

Question 13

Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview?
1)"Now it is time to talk about your sexual history.When did you first have intercourse?"
2)"Women often feel dissatisfied with their sexual relationships.Would it be okay to discuss this now?"
3)"Often women have questions about their sexual relationship and how it affects their health.Do you?"
4)"Most women your age have had more than one sexual partner.How many would you say you have had?"

Question 14

When observing the vestibule,the nurse should be able to see the:
1)urethral meatus and vaginal orifice.
2)vaginal orifice and vestibular (Bartholin's)glands.
3)urethral meatus and paraurethral (Skene's)glands.
4)paraurethral (Skene's)and vestibular (Bartholin's)glands.

Question 15

During the interview a patient reveals that she has some vaginal discharge.She is worried that it may be a sexually transmitted disease.The nurse's most appropriate response to this would be:
1)"Oh,don't worry.Some cyclic vaginal discharge is normal."
2)"Have you been engaging in unprotected sexual intercourse?"
3)"I'd like some information about the discharge.What color is it?"
4)"Have you had any urinary incontinence associated with the discharge?"

Question 16

Which of the following are changes associated with menopause?
1)Uterine and ovarian atrophy along with thinning vaginal epithelium
2)Ovarian atrophy,increased vaginal secretions,and increasing clitoral size
3)Cervical hypertrophy,ovarian atrophy,and increased acidity of vaginal secretions
4)Vaginal mucosa fragility,increased acidity of vaginal secretions,and uterine hypertrophy

Question 17

Which of the following statements is true with regard to the history of a postmenopausal woman?
1)The nurse should ask a postmenopausal woman if she ever has vaginal bleeding.
2)Once a woman reaches menopause,the nurse does not need to ask any further history questions.
3)The nurse should screen for monthly breast tenderness.
4)Postmenopausal women are not at risk for contracting sexually transmitted diseases and thus these questions can be omitted.

Question 18

The female structure that corresponds with the male penis is called the:
1)labia.
2)clitoris.
3)prepuce.
4)frenulum.

Question 19

A married couple has come to the clinic seeking advice on pregnancy.They have been trying to conceive for 6 months and have not been successful.What should the nurse do first?
1)Ascertain whether either of them has been using broad-spectrum antibiotics.
2)Explain that couples are considered infertile after 1 year of unprotected intercourse.
3)Immediately refer the woman to an expert in pelvic inflammatory disease-the most common cause of infertility.
4)Explain that couples are considered infertile after 6 months of engaging in unprotected intercourse and that they will need a referral to a fertility expert.

Question 20

When the nurse is discussing sexuality and sexual issues with adolescents,a permission statement helps to convey that it is normal to think or feel a certain way.Which of the following is the best example of a permission statement?
1)"It is okay that you have become sexually active."
2)"Often girls your age have questions about sexual activity.Have you?"
3)"If it is okay with you,I'd like to ask you some questions about your sexual history."
4)"Often girls your age engage in sexual activity.It is okay to tell me if you have had intercourse."

Question 21

The order of examination of the internal genitalia is important.The nurse will use which order of examination at this time?
1)Bimanual examination,speculum examination,rectovaginal examination
2)Speculum examination,rectovaginal examination,bimanual examination
3)Speculum examination,bimanual examination,rectovaginal examination
4)Rectovaginal examination,bimanual examination,speculum examination

Question 22

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:
1)uterine cancer.
2)cervical cancer.
3)ovarian cancer.
4)endometrial cancer.

Question 23

A 46-year-old woman is in the clinic for her annual gynecologic examination.She voices a concern about ovarian cancer because her mother and sister died of it.The nurse knows that which of the following is correct regarding ovarian cancer?
1)Ovarian cancer is manifested by severe abdominal pain.
2)The Pap smear detects the presence of ovarian cancer.
3)Women over age 40 years should have a thorough pelvic examination every year.
4)Women over age 40 years should have a thorough pelvic examination every 3 years.

Question 24

When performing an external genitalia examination of a 10-year-old girl,the nurse notes the following: no pubic hair,the mons and the labia are covered with fine vellus hair.These findings are consistent with which stage of sexual maturity,according to the Sexual Maturity Rating scale?
1)Stage 1
2)Stage 2
3)Stage 3
4)Stage 4

Question 25

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.The nurse's most appropriate course of action would be to:
1)tell the patient that her examination was normal.
2)give her an immediate referral to a gynecologist.
3)suggest that she return in a month for a recheck to verify the findings.
4)tell the patient that she may have an ovarian cyst that should be evaluated further.

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 notes the following: clusters of small,shallow vesicles with surrounding erythema on the labia.There is also inguinal lymphadenopathy present.The most likely cause of these lesions is:
1)pediculosis pubis.
2)contact dermatitis.
3)human papillomavirus.
4)herpes simplex virus type 2.

Question 27

During a bimanual examination,the nurse detects a solid tumor on the ovary that is heavy,fixed,with a poorly defined mass.This finding is suggestive of:
1)an ovarian cyst.
2)endometriosis.
3)ovarian cancer.
4)an ectopic pregnancy.

Question 28

Which of the following tests are usually collected when screening for cervical cancer?
1)Endocervical specimen,cervical scrape,and vaginal pool
2)Endocervical specimen,vaginal pool,and acetic acid wash
3)Endocervical specimen,KOH prep,and acetic acid wash
4)Cervical scrape,acetic acid wash,saline mount ("wet prep")

Question 29

A patient calls the clinic for instructions before having a Papanicolaou (Pap)smear.The most appropriate instructions from the nurse are:
1)"If you are menstruating,please use pads to avoid placing anything into the vagina."
2)"Avoid intercourse,inserting anything into the vagina,or douching within 24 hours of your appointment."
3)"If you suspect that you have a vaginal infection,please gather a sample of the discharge to bring with you."
4)"We would like you to use a mild saline douche before your examination.You may pick this up in our office."

Question 30

In performing the bimanual examination,the nurse notes 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.The nurse's interpretation of these results should be which of the following?
1)These findings are all within normal limits.
2)The cervical consistency should be soft and velvety-not firm.
3)The cervix should move when palpated;an immobile cervix may indicate malignancy.
4)It is unusual to have pain when the cervix is palpated,but the rest of the findings are within normal limits.

Question 31

During an external genitalia examination of a woman,the nurse notes several lesions around the vulva.The lesions are pink in color,moist,soft,and pointed papules.The patient states that she is not aware of any problems in that area.The nurse recognizes that these lesions may be:
1)syphilitic chancre.
2)herpes simplex virus type 2 (herpes genitalis).
3)human papillomavirus (HPV),or genital warts.
4)pediculosis pubis (crab lice).

Question 32

The nurse has just completed an inspection of a woman's external genitalia.Which of the following would be a description of a finding within normal limits?
1)Redness of the labia majora
2)Multiple nontender sebaceous cysts
3)Discharge that is sticky and yellow-green
4)Swelling of the perineum before onset of menses

Question 33

The nurse is preparing to examine the external genitalia of a school-age girl.Which of the following positions would be most appropriate in this situation?
1)In the parent's lap
2)In a frog-leg position on the examining table
3)In the lithotomy position with the feet in stirrups
4)Lying flat on the examining table with legs extended

Question 34

During a vaginal examination of a 38-year-old woman,the nurse notes the following: 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 of the following?
1)Candidiasis
2)Trichomoniasis
3)Atrophic vaginitis
4)Bacterial vaginosis