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

Accepted Answer

Exposure to a male partner with urethritis (which suggests infection with a sexually transmitted disease [STD]) introduces the bacteria into the vagina and cervix, allowing the organism to ascend to the other reproductive structures. Oral contraceptive use, use of superabsorbent tampons, and long-term antibiotic therapy do not increase risk for PID.

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?

Accepted Answer

The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a skull fracture, subdural hematoma, or other. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury.

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?

Accepted Answer

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.

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,

Accepted Answer

The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Asking the patient about other signs of low estrogen is inappropriate because the patient may not know the symptoms associated with low estrogen levels. Although hormone-replacement therapy (HRT) may be prescribed, further assessment and teaching about the benefits and risks of HRT are needed before encouraging the patient to use this therapy. Menopause sometimes starts in the 40s.

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?

Accepted Answer

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 assessing her emotional status frequently is inappropriate. Leaving the patient alone for several hours is unsafe because of the risk for hemorrhage. Because nonsurgical options to terminate the pregnancy are available, preoperative teaching is inappropriate until it is determined that the patient will actually have surgery.

Question 6

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

Accepted Answer

When the ovarian follicles no longer respond to FSH, ovarian production of estrogen and progesterone decreases. The lack of feedback causes FSH levels to increase. The level of hCG increases in pregnancy.

Question 7

When caring for a 60-year-old patient with persistent menorrhagia, the nurse will plan to monitor the

Accepted Answer

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 b-hCG levels are monitored in patients with an ectopic pregnancy, which is not likely for this patient.

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?

Accepted Answer

The statements made by the couple are consistent with the diagnosis of defensive coping. There are no data to indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data in the stem do not provide information indicating that the finances are inadequate.

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?

Accepted Answer

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.

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?

Accepted Answer

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.

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

Accepted Answer

The patient's 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 patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis.

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?

Accepted Answer

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 infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving.

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

Accepted Answer

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 to prevent inflammation and scarring, but NSAIDs will not decrease scarring.

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

Accepted Answer

Breast tenderness is a potential side effect of HRT. Daily aspirin therapy does not eliminate the risk for deep vein thrombosis (DVT) or pulmonary emboli in women taking HRT, and they should be taught to monitor for symptoms of these adverse effects. Continued calcium supplementation is needed to reduce osteoporosis risk. The patient will not have regular menstrual periods and should call the health care provider about vaginal bleeding.

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?

Accepted Answer

Having the patient keep a menstrual diary for 2 or 3 months will help in making a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made and PMS can be diagnosed only after other reasons for the symptoms have been ruled out.

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,

Accepted Answer

Oral contraceptives decrease dysmenorrhea and are appropriate for the patient's symptoms. Sexual history is not relevant when prescribing birth control pills for this purpose, and the patient is not required to provide this information. Other techniques may be tried, but oral contraceptives are a possible first-line therapy. The nurse should not appear to indicate that the patient's problems are not serious; in addition, the side effects of birth control pills are minimal for most women.

Question 17

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

Accepted Answer

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.

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?

Accepted Answer

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.

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

Accepted Answer

Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise and ovulation occurs about 28 to 36 hours after ovulation; the kits 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.

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

Accepted Answer

Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT 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 HRT, such as decreased hot flashes. Most women who use HRT 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.

Quiz 54: Nursing Management: Female Reproductive Problems

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