Deck 56: Nursing Management: Female Reproductive Problems

Question 1

While obtaining a health history from a patient hospitalized with pelvic inflammatory disease,the nurse recognizes that which of the following risk factors related by the patient is significant?

A) The use of oral contraceptives
B) Sexual exposure to a partner with urethritis
C) The use of superabsorbent tampons during menstruation
D) Long-term or high-dosage treatment with broad-spectrum antibiotics

Answer 1

Sexual exposure to a partner with urethritis

Question 2

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

A) Decreased estrogen levels
B) Increased progesterone levels
C) Presence of human chorionic gonadotropin in the urine
D) Marked decrease in serum follicle-stimulating hormone (FSH)

Answer 2

Decreased estrogen levels

Question 3

A woman has an induced abortion with suction curettage at an ambulatory surgical centre.During discharge teaching for the patient,what should the nurse instruct the patient to do?

A) Avoid sexual intercourse for 2 weeks.
B) Douche with a mild vinegar solution twice a day.
C) Expect heavy vaginal bleeding for about 2 weeks.
D) Expect an absence of normal menstrual periods for the next month or two.

Answer 3

Avoid sexual intercourse for 2 weeks.

Question 4

A 26-year-old woman is admitted to the emergency department with abdominal cramping and vaginal bleeding.When the patient learns that the results of a vaginal ultrasonogram confirm the presence of an ectopic pregnancy in the left fallopian tube,she begins to cry and says she has been trying to get pregnant for several years.In caring for the patient,what is the most important nursing intervention?

A) Assess the patient's emotional status frequently.
B) Monitor the patient's vital signs closely.
C) Reassure the patient that she will be able to have future pregnancies.
D) Inform the patient that immediate surgery will be needed to implant the fetus in the uterus.

Question 5

After having been 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.
D) Assess the patient's neurological status.

Question 6

When teaching a patient about ways to prevent primary dysmenorrhea,which of the following will the nurse suggest?

A) Avoid aerobic exercise during her menstrual period.
B) Use cold packs on the abdomen and back for pain relief.
C) Start taking nonsteroidal anti-inflammatory drugs (NSAIDs)regularly when her menstrual period starts.
D) Talk with her health care provider about antidepressant therapy.

Question 7

A perimenopausal woman does not want to use hormone therapy but is interested in complementary and alternative therapies.Which of the following herbal or supplemental preparations should the nurse suggest is the safest to control menopausal symptoms?

A) Valerian
B) Dong quai
C) Black cohosh
D) Dietary soy products

Question 8

Six months after being raped,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.What is an appropriate nursing diagnosis that the nurse will document for this patient?

A) Anxiety related to effects of being raped
B) Rape-trauma syndrome related to rape experience
C) Disturbed sleep pattern related to frightening dreams
D) Ineffective coping related to inability to resolve rape incident

Question 9

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.What is the best response?

A) "What other signs of decreasing estrogen production have you been experiencing?"
B) "What was your menstrual pattern before the absence of your periods the last 3 months?"
C) "You are probably starting menopause,but it will be several years before your periods stop completely."
D) "You are too young to be menopausal,and you should see your physician to determine whether other factors are causing the absence of periods."

Question 10

A diagnosis of vulvovaginal candidiasis is made when a patient with an abnormal vaginal discharge is seen at the clinic,and an antifungal vaginal cream is prescribed.As she prepares to leave the clinic,which of the following statements by the patient indicates to the nurse that further teaching about her condition is needed?

A) "I should avoid sexual intercourse for at least 1 week."
B) "I should clean my perineal area carefully after each urination and bowel movement."
C) "I should douche with warm water several times a day to flush out the microorganisms."
D) "Warm tub baths several times a day will help relieve the itching and inflammation I have."

Question 11

When the nurse is caring for a patient with pelvic inflammatory disease requiring hospitalization,which of the following interventions is used to promote healing and prevent complications?

A) Encouraging fluid intake of 3000 mL/day
B) Promoting bed rest in a semi-Fowler's position
C) Promoting frequent ambulation to increase pelvic circulation
D) Teaching pelvic-strengthening exercises to be performed six to eight times a day

Question 12

After teaching a perimenopausal patient who has started using HRT,the nurse determines that the teaching has been effective when the patient says which of the following?

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 13

To help a 53-year-old woman make an informed decision about the use of hormone replacement therapy (HRT)to control the effects of menopause,what should the nurse explain?

A) The safest and most effective method of HRT is the use of estrogen vaginal creams.
B) HRT has minimal risks and should be used to prevent the increased incidence of osteoporosis in older women.
C) Recent studies have indicated that estrogen-progesterone combination therapy increases the risk for breast cancer and cardiovascular disease.
D) HRT will help control hot flashes and genitourinary changes associated with decreased estrogen,but these problems will recur in 3 to 5 years.

Question 14

A 19-year-old community college student requests a prescription for birth control pills at the student health centre.She tells the nurse she always has painful periods with diarrhea and headaches and has heard from her friends that birth control pills stop painful menstruation.What is the most appropriate response?

A) "Birth control pills are prescribed only for contraceptive uses.Are you sexually active?"
B) "You should try distraction and guided imagery to control the pain before any type of drug therapy is used."
C) "Birth control pills can be effective treatment for painful menstruation,and it may be possible for you to use them."
D) "Birth control pills shouldn't be used casually because they cause many side effects that should be avoided if at all possible."

Question 15

A young woman who is trying to become pregnant asks the nurse about ways to determine when she is most likely to conceive.What should the nurse explain?

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 16

When advising a patient with persistent menorrhagia,the nurse recognizes that all patients with this condition should be evaluated for which of the following?

A) Anemia
B) Pregnancy
C) Anovulation
D) Endometrial cancer

Question 17

A patient with pelvic inflammatory disease is treated on an outpatient basis with oral antibiotics.When teaching the patient about follow-up care and management of her condition,what should the nurse instruct the patient to do?

A) Avoid sexual intercourse for 1 week.
B) Return for follow-up within 2 to 3 days.
C) Wear a vaginal tampon to absorb the drainage.
D) Use over-the-counter anti-inflammatory drugs to help prevent scarring of pelvic organs.

Question 18

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.The nurse plans care for the patient based on what knowledge?

A) The symptoms the patient has can be controlled with vitamin B₆ supplements.
B) These symptoms are stress related,indicating a need for stress management teaching.
C) The patient has premenstrual syndrome (PMS)and should be treated with prostaglandin inhibitors.
D) The patient should have further evaluation of her symptoms with a menstrual diary for 2 to 3 months.

Question 19

A young woman has arrived at the clinic and tells the nurse she is 15 weeks pregnant and wants an abortion.What does the nurse tell the patient about in relation to having an abortion at 15 weeks' gestation?

A) A methotrexate with misoprostol injection is available for a pregnancy that is at 15 weeks gestation.
B) Abortion at 15 weeks would require a dilation and evacuation.
C) Abortion beyond the first trimester is not routinely available in Canada,
D) Abortion at 15 weeks can be performed via suction curettage.

Question 20

During a routine health examination,a 32-year-old woman tells the nurse that she uses oral contraceptives because her husband wants to delay having children for a few more years.What is the most appropriate response?

A) "It is more difficult for women to conceive the older they become."
B) "I'm sure you will have plenty of time to have a family in a few years when you are ready."
C) "Long-term use of oral contraceptives causes uterine changes that make it more difficult for you to conceive."
D) "Pregnancy is no problem when women pass the age of 30 because their sexual response peak is at about the age of 35."

Question 21

A patient who has undergone a vaginal hysterectomy has not voided for 10 hours following surgery and is complaining of bladder distension.What is the most appropriate action?

A) Catheterize the patient for residual urine.
B) Increase the patient's oral fluid intake to 200 mL/hour.
C) Notify the physician of the patient's inability to void.
D) Ambulate the patient short distances every hour to increase peristalsis.

Question 22

An 18-year-old visits the health clinic for a routine checkup.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 23

When assessing a patient on the patient's return to the surgical unit following a total abdominal hysterectomy,what would the nurse expect to find?

A) Complaints of abdominal pain and burning at the incision site
B) Urinary output of 20 mL in 1 hour related to temporary bladder atony
C) A perineal pad with a moderate amount of serosanguineous drainage
D) A moderate amount of sanguineous drainage on the abdominal dressing

Question 24

Which age group has the highest rate of induced abortion?

A) 13- to 16-year-olds
B) 16- to 18-year-olds
C) 20- to 24-year-olds
D) 35- to 40-year-olds

Question 25

A 31-year-old woman has been diagnosed with endometriosis.In teaching the patient about the disorder,what should the nurse explain?

A) Endometriosis can be cured with the use of hormone therapy to prevent ovulation.
B) The only treatment for endometriosis is removal of the uterus and all ectopic endometrial tissue.
C) Endometriosis occurs when endometrial tissue outside the uterus bleeds in response to the menstrual cycle.
D) Backflow of endometrial tissue into the fallopian tubes causes the spasms and abdominal pain associated with endometriosis.

Question 26

A 56-year-old mother of nine children undergoes an anterior and posterior colporrhaphy for repair of a cystocele and a rectocele.When assessing the patient on her return from the postanaesthesia care unit,what would the nurse expect to find?

A) A rectal tube
B) Perineal dressings
C) Gauze vaginal packing
D) An in-dwelling catheter

Question 27

Which medication is a gonadotropin-releasing hormone (GnRH)agonist used in the treatment of infertility?

A) Clomiphene (Clomid)
B) Repronex
C) Cetrorelix (Cetrotide)
D) Nafarelin (Synarel)

Question 28

The nurse obtains the following 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 level 5 (on a 10-point scale)continuous abdominal pain.
D) The patient has decreased bowel tones and abdominal distension.

Question 29

A total abdominal hysterectomy is scheduled for a 42-year-old woman with multiple uterine leiomyomas.During preoperative teaching about postoperative expectations,it is important for the nurse to inform the patient about which of the following?

A) A retention catheter will be used to help her maintain bed rest during the first several postoperative days.
B) Correct use of the patient-controlled analgesia device will prevent her from experiencing postoperative pain.
C) She will need to take estrogen replacement therapy postoperatively to prevent symptoms of surgical menopause.
D) Leg exercises with early and frequent ambulation are necessary to minimize stasis and pooling of blood.

Question 30

During assessment of a patient with suspected endometrial cancer,what does the nurse identify in the patient's history as an important risk factor for cancer of the endometrium?

A) Cigarette smoking
B) Multiple pregnancies
C) Long-standing obesity
D) Early sexual activity with multiple partners

Question 31

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 makes an appointment for the patient and tells her to expect which of the following treatments?

A) A biopsy of uterine tissue
B) A pelvic examination with a Pap test
C) A prescription for estrogen replacement therapy
D) Admission to the hospital for a total hysterectomy

Question 32

Which of the following is a symptom of estrogen deficiency?

A) Increased rapid-eye-movement sleep
B) Decreased fracture rate in upper femur
C) Increased high-density lipoproteins
D) Incontinence

Question 33

A 56-year-old woman tells the nurse that she is postmenopausal but has occasional spotting.Which response 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 34

When caring for a patient being treated for polycystic ovary syndrome,what should the nurse emphasize is necessary?

A) Treatment of acne
B) Monitoring for jaundice
C) Regular cervical Pap tests
D) Maintenance of normal weight

Question 35

A patient with stage 0 carcinoma of the cervix that was determined by cervical conization has been told by her physician she needs no further treatment at this time.She is concerned about the cancer and asks the nurse whether she should seek a second opinion.What is the most appropriate response?

A) "Because of your age,further treatment of the cervical cancer is not indicated."
B) "Stage 0 tumours 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 papillomavirus tests are positive,there is no indication that more treatment is needed."

Question 36

Which of the following is a clinical manifestation of perimenopause?

A) Cessation of menses
B) Breast tenderness
C) Osteoporosis
D) Insomnia

Question 37

A patient's Pap test reveals cervical cells characteristic of adenocarcinoma of the cervix.What information obtained during the patient's health history is a major risk factor for cervical cancer?

A) The patient's use of oral contraceptives for 15 years
B) A history of four pregnancies with one spontaneous abortion
C) Smoking coupled with infection with human papillomavirus (HPV)
D) Use of estrogen replacement therapy for menopausal symptoms

Question 38

A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera).What should the nurse explain that this therapy does?

A) Suppresses ovulation and creates a hyperhormonal amenorrhea
B) Produces a pseudomenopause with atrophy of the ectopic tissue
C) Increases the production of estrogen to stop the production of FSH
D) Causes a hypoestrogenic state resulting in amenorrhea with menopause symptoms

Question 39

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 tumour 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 40

Stage III ovarian cancer is diagnosed in a 63-year-old woman.Based on the nurse's understanding of this disorder,what nursing diagnosis would the nurse document as being likely to be appropriate for this patient?

A) Sexual dysfunction related to loss of vaginal sensation
B) Risk for infection related to impaired immune function
C) Anxiety related to threat of a malignancy and lack of knowledge about the disease process and prognosis
D) Situational low self-esteem related to guilt about delaying medical care