Chapter 17: Reproductive System and the Perineum Nursing School Test Banks

Chapter 17: Reproductive System and the Perineum
Test Bank

MULTIPLE CHOICE

1. During the initial inspection of the female genitalia, the nurse recognizes which finding as normal?
a. The labia minora are hair-covered and lying within the labia majora.
b. The cervical os in the multiparous woman has the shape of a small circle.
c. The vaginal vestibule lies between the labia minora and contains the urinary meatus.
d. The openings of Skene and Bartholin glands are visible posteriorly.
ANS: C

Feedback
A The labia majora, rather than the labia minora, are covered with hair.
B The os of parous women is the shape of a slit.
C This description is of normal female anatomy.
D The opening of these glands is on either side of the vaginal vestibule.
DIF: Cognitive Level: Understand REF: 386| 401
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

2. The pregnant patient tells the nurse that she has had three pregnancies and two live births to date. How does the nurse record this in the patients history?
a. Gravida 3, para 3
b. Gravida 3, para 2
c. Gravida 2, para 3
d. Gravida 2, para 2
ANS: B

Feedback
A Gravida 3, para 3 represents three pregnancies and three that reached 20 weeks or longer.
B Gravida 3, para 2 represents three pregnancies and two that reached 20 weeks or longer, which is consistent with what the patient reported.
C Gravida 2, para 3 represents two pregnancies and three that reached 20 weeks or longer, which is not possible.
D Gravida 2, para 2 represents two pregnancies and two that reached 20 weeks or longer.
DIF: Cognitive Level: Apply REF: 394
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

3. A mother asks a nurse when her daughter should get immunized again for human papilloma virus (HPV). What is the nurses most appropriate response to this question?
a. Your daughter does not need this immunization until she becomes sexually active.
b. The recommended age for this immunization is between ages 25 and 30 years of age.
c. Between the ages of 11 and 26 years is the recommended time for this immunization.
d. When she begins having menstrual periods is the best time for this immunization.
ANS: C

Feedback
A This is not the recommendation of the CDC.
B This is not the recommendation of the CDC.
C This is the recommendation from the Centers for Disease Control and Prevention (CDC).
D This is not the recommendation of the CDC.
DIF: Cognitive Level: Apply REF: 398
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

4. A patient asks when she should make an appointment for her first Pap (Papanicolaou) test to screen for cervical cancer. What is the nurses most appropriate response?
a. There is no need for Pap tests until after you have become pregnant.
b. All women should have the first Pap test after reaching menarche.
c. All women should have the first Pap test after they are 19 years of age.
d. All women should have the first Pap test when they become sexually active or at age 21.
ANS: D

Feedback
A The recommendation is when females become sexually active or 21 years old.
B The recommendation is when females become sexually active or 21 years old.
C All females should be screened when they become sexually active or 21 years old, whichever happens first.
D This is the recommendation from the U.S. Preventive Services Task Force. All females should be screened when they become sexually active or age 21, whichever happens first.
DIF: Cognitive Level: Apply REF: 399
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

5. A patient asks when she can stop having Pap (Papanicolaou) tests. What is the nurses most appropriate response?
a. Until you are no longer sexually active.
b. Through age 65.
c. Until you begin menopause.
d. Through the end of menopause.
ANS: B

Feedback
A The recommendation from the U.S. Preventive Services Task Force is through age 65.
B This is the recommendation from the U.S. Preventive Services Task Force. All females should be screened after the onset of sexual activity through age 65.
C The recommendation from the U.S. Preventive Services Task Force is through age 65.
D The recommendation from the U.S. Preventive Services Task Force is through age 65.
DIF: Cognitive Level: Apply REF: 399
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

6. When performing a well woman examination, the nurse expects what findings?
a. The inner surface of the vestibule is deep pink and moist with a smooth texture.
b. The inguinal skin appears wrinkled and moist with sparse hair distribution.
c. The labia minora is deeply pigmented, and the tissue is ragged and asymmetrical.
d. Pubic hair is distributed evenly over the mons and shaped as a triangle with the apex over the mons.
ANS: A

Feedback
A This is a normal finding of female external genitalia.
B The inguinal area would normally not be wrinkled.
C The labia minora is not normally ragged and asymmetric.
D Normally the base of the triangle is over the mons.
DIF: Cognitive Level: Understand REF: 401
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

7. The nurse documents which finding as expected on inspection of the anus?
a. Skin tone darker and coarser than that of the surrounding skin
b. Sphincter lightly closed when the patient is relaxed
c. Large amount of stiff, curling hair surrounding the anus
d. Slight protrusion under the skin when the patient strains or bears down
ANS: A

Feedback
A This is the normal finding.
B The anal sphincter should be tight.
C The anus is typically hairless.
D A protrusion may be a hemorrhoid, which is not an expected finding.
DIF: Cognitive Level: Understand REF: 392| 402
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

8. On inspection of the internal structure of the vagina, the nurse notes a rounded protrusion on the posterior wall of the vagina. How does the nurse document this finding?
a. Rectocele
b. Cystocele
c. Bartholin cyst
d. Nabothian cyst
ANS: A

Feedback
A Rectocele is a hernia type of protrusion of the rectum against the posterior wall of the vagina.
B Cystocele is a hernia type of protrusion of the bladder against the posterior wall of the vagina.
C The Bartholin glands are external structures.
D Nabothian cysts appear on the cervix.
DIF: Cognitive Level: Understand REF: 403| 437
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

9. During the examination of the internal genitalia with the speculum, the nurse records which finding as normal?
a. A healed laceration of the cervix in a nulliparous patient
b. A large amount of thick white drainage from the cervical os
c. Deviation of the cervix toward the posterior vaginal wall
d. Pink cervix with a small ring of reddened tissue near the os
ANS: D

Feedback
A This is an abnormal finding; a laceration is not expected in nulliparous women.
B This is an abnormal finding; this drainage may indicate a sexually transmitted disease.
C This is an abnormal finding.
D This is a normal finding.
DIF: Cognitive Level: Understand REF: 406
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

10. The nurse recognizes that a Papanicolaou (Pap) test is indicated for which patient?
a. A 12-year-old who has not yet reached menarche.
b. A 30-year-old who had a normal Pap test 12 months ago.
c. A 45-year-old who had a total hysterectomy for cervical cancer.
d. A 55-year-old who had a total hysterectomy to treat endometriosis.
ANS: C

Feedback
A A Pap test is not indicated for this patient.
B A Pap test is not indicated for this patient.
C In women who have undergone a hysterectomy in which the cervix was removed, Pap testing is not required unless the hysterectomy was performed because of cervical cancer or its precursors.
D A Pap test is not indicated for this patient.
DIF: Cognitive Level: Understand REF: 406
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

11. What technique does the nurse use to obtain a cervical tissue sample for a Papanicolaou (Pap) test?
a. A Cervex-Brush is inserted into the cervix and rotated to obtain a sample of ectocervical and endocervical cells.
b. A wooden spatula scrapes the cervix to obtain a sample of endocervical cells.
c. A pipette is placed inside the cervical os and rotated to obtain a thick layer of endocervical and ectocervical cells.
d. A cotton-tipped applicator is used on the outside of the cervix to obtain ectocervical cells.
ANS: A

Feedback
A This is the correct technique.
B A wooden spatula is not used and ectocervical cells are needed as well as endocervical cells.
C A pipette is not used and the cells are not contained in a thick layer.
D Using a brush as opposed to a cotton-tipped applicator has improved the quality of the sample of endocervical cells and ectocervical cells.
DIF: Cognitive Level: Understand REF: 407-408
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

12. A nurse expects which normal findings when performing a bimanual palpation of the cervix and uterus?
a. The uterus feels firm and slightly nodular.
b. The cervix feels soft, smooth, and slightly rounded.
c. The uterus of a nonpregnant patient cannot be felt with the internal fingers.
d. The cervix is tender when moved laterally.
ANS: B

Feedback
A The uterus normally does not feel nodular.
B These are the normal findings from a bimanual examination of the cervix.
C The uterus of a nonpregnant woman can be palpated.
D The cervix normally is not tender; if it is, it may indicate a sexually transmitted disease.
DIF: Cognitive Level: Remember REF: 409
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

13. A nurse expects which normal findings when palpating a patients ovaries?
a. Nodular and nonmovable
b. Smooth, fluid-filled, and nonmovable
c. Smooth, firm, and about the size of a walnut
d. Spongy, mobile, and about the size of a peanut
ANS: C

Feedback
A Normally the ovaries do not feel nodular and nonmovable.
B Normally the ovaries do not feel fluid-filled and nonmovable.
C This is a correct description of a normal finding when palpating an ovary.
D Normally the ovaries do not feel spongy or mobile.
DIF: Cognitive Level: Remember REF: 411
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

14. After a rectal examination of a patient with obstructive jaundice, the nurse expects the stool to be what color?
a. Tan
b. Pale yellow
c. Black
d. Bright red
ANS: A

Feedback
A Tan stool indicates a lack of bile caused by obstructive jaundice.
B Pale yellow stools indicate a malabsorption syndrome.
C Black stools indicate upper intestinal tract bleeding or excessive iron or bismuth ingestion.
D Bright red indicates bleeding from the lower rectum or hemorrhoids.
DIF: Cognitive Level: Understand REF: 414
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

15. On inspection of the external male genitalia, the nurse notes which finding as abnormal?
a. The scrotum is covered with dark rugous skin.
b. The skin covering the penis is hairless and loose.
c. The urinary meatus is located on the upper surface of the penis.
d. The left side of the scrotum hangs slightly lower than the right.
ANS: C

Feedback
A This is a normal finding.
B This is a normal finding.
C This is called epispadias.
D This is a normal finding.
DIF: Cognitive Level: Understand REF: 417
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

16. The nurse observes that the urinary meatus is located on the under surface of the penis. How does the nurse document this finding?
a. Balanitis
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: D

Feedback
A Balanitis is inflammation of the glans that occurs in patients with phimosis.
B Phimosis is a very tight foreskin that cannot be retracted over the glans.
C Epispadias occur when the urinary meatus is on the upper (dorsum) surface of the penis.
D Hypospadias occur when the urinary meatus is on the undersurface of the penis.
DIF: Cognitive Level: Understand REF: 417
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

17. In inspecting the scrotum, the nurse documents which finding as normal?
a. The epididymides are round, solid nodular masses.
b. The scrotum is deeply pigmented with a rugous surface.
c. The scrotal skin is a lighter color than the body skin.
d. The vas deferens is palpable bilaterally.
ANS: B

Feedback
A Normally the epididymis is a tubular, comma-shaped structure.
B This is an expected finding.
C Normally the scrotal skin is more deeply pigmented than the body skin.
D Normally the vas deferens is not palpable.
DIF: Cognitive Level: Understand REF: 419
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

18. Which assessment technique does a nurse use to assess the inguinal region and femoral area of a male patient as he is standing and straining?
a. Palpates the femoral artery
b. Palpates the inguinal lymph nodes
c. Observes for a bulge through the inguinal region
d. Observes for discoloration of the inguinal ring
ANS: C

Feedback
A The nurse palpates the femoral artery when the patient is lying supine.
B The nurse palpates the inguinal lymph nodes when the patient is lying supine.
C The nurse observes for a bulge that may indicate a hernia; the normal finding is no bulge.
D The nurse cannot see the inguinal ring; it must be palpated.
DIF: Cognitive Level: Apply REF: 419
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

19. When palpating the epididymis, the nurse considers which finding to be abnormal?
a. The epididymis is located on the posterolateral surface of each testis.
b. The epididymis feels like a tubular, comma-shaped structure.
c. The epididymis collapses on palpation.
d. The epididymis has an irregular, nodular surface.
ANS: D

Feedback
A This is an expected finding.
B This is an expected finding.
C This is an expected finding.
D The surface should be smooth and nontender.
DIF: Cognitive Level: Understand REF: 420
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

20. When does a nurse use transillumination of the scrotum?
a. When the patient has tortuosity of the veins along the spermatic cord
b. When the patient has an indirect hernia
c. When there is a mass or fluid in the epididymis
d. When there is twisting of the testicle and spermatic cord
ANS: C

Feedback
A This is a description of a varicocele, which does not transilluminate.
B Hernias do not transilluminate.
C This is a description of a spermatocele, which does transilluminate, as does a hydrocele.
D This is a description of testicular torsion.
DIF: Cognitive Level: Understand REF: 420
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

21. What procedure does a nurse use to assess the inguinal ring of a male patient for a hernia?
a. Asks the patient to lie supine, lifts the scrotum, asks the patient to take a deep breath, and observes for a bulge
b. Asks the patient to lean over the examination table, inserts a gloved finger into the lower part of the scrotum into the inguinal canal, asks the patient to cough, and palpates for a bulge
c. Asks the patient to lie on the side not being assessed, inserts a gloved finger into the lower part of the scrotum into the inguinal canal, asks the patient to exhale completely, and palpates for a bulge
d. Asks the patient to stand, inserts a gloved finger into the lower part of the scrotum into the inguinal canal, asks the patient to cough, and palpates for a bulge
ANS: D

Feedback
A This has the patient in the wrong position with the wrong technique and wrong instruction given.
B This has the patient in the wrong position.
C This has the patient in the wrong position with the wrong instruction given.
D This describes the correct procedure.
DIF: Cognitive Level: Understand REF: 421
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

22. The nurse places a male patient in which position for rectal examination?
a. Lithotomy position
b. Prone with the knees fully extended
c. Bending over the table, with feet everted
d. Left lateral position with knees and hips flexed
ANS: D

Feedback
A This is the appropriate position for a rectal examination for a female patient.
B This position is not used; a knee chest position may be used instead.
C This is the appropriate position of a rectal examination for a male patient, except that the feet are inverted, rather than everted.
D This is the appropriate position for a rectal examination for a male patient.
DIF: Cognitive Level: Understand REF: 421-422
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

23. During an internal examination of a patients anus, the nurse notes that the patient has a hypertonic sphincter. What is the most relevant action for the nurse to take at this time?
a. Ask the patient about anxiety or pain related to the examination.
b. Inquire if the patient has had any neurologic injury that causes a hypertonic sphincter.
c. Refer the patient to the physician for evaluation.
d. Question the patient about a history of anal trauma.
ANS: A

Feedback
A This is the relevant action for the nurse to collect more data from the patient about the reaction to the examination.
B This datum probably would have been gathered during the history, so that the nurse would have anticipated an abnormal finding.
C This is not the action of most importance at this time. The nurse needs to collect more data from the patient before considering a referral.
D This is not the action of most importance at this time. The nurse needs to collect more data from the patient before asking about trauma.
DIF: Cognitive Level: Understand REF: 421
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment

24. What normal finding does a nurse expect to find when palpating a male patients prostate gland?
a. Is approximately 4.5 cm in diameter and is highly mobile
b. Feels smooth, firm, and slightly mobile
c. Is deeply divided into three lobes, each approximately 2 cm in length
d. Feels hard, asymmetrical, and has a palpable ridge that divides the gland into two lobes
ANS: B

Feedback
A A normal prostate is 1.5 inches in diameter and slightly mobile.
B This is a normal finding.
C The prostate consists of two lobes.
D The prostate feels firm, smooth, and symmetric.
DIF: Cognitive Level: Understand REF: 423
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Reduction of Risk Potential: System Specific Assessments

25. A 50-year-old patient asks the nurse about her risk of developing a cancer of the reproductive system. What is the appropriate response by the nurse?
a. Human papilloma virus infection and cigarette smoking are major risk factors for cervical cancer.
b. Some of the risk factors for endometrial cancer include being age 40 or older and having a history of infertility.
c. Ovarian cancer is not often seen in women under age 50 or those who have a family history of breast cancer.
d. Women who have had menstrual irregularities for many years are at lower risk of developing any of the reproductive system cancers.
ANS: A

Feedback
A Human papilloma virus infection and cigarette smoking are risk factors for cervical cancer.
B These are not risk factors for endometrial cancer.
C These are not risk factors for ovarian cancer.
D These are not risk factors for gynecologic cancers.
DIF: Cognitive Level: Understand REF: 424
TOP: Nursing Process: Intervention
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

26. The nurse recognizes which patient has the highest risk of endometrial cancer?
a. A 24-year old woman with menarche at age 9
b. A 30-year old woman who started menstruating at age 19
c. A 42-year old woman who reached menopause at age 40
d. A 64-year old woman who had irregular, heavy menstrual cycles
ANS: A

Feedback
A Early menarche is a risk factor.
B This age of menarche is not a risk factor for endometrial cancer.
C This age of menopause is not a risk factor for endometrial cancer. Patients who have late onset menopause are at risk.
D An irregular, heavy menstrual cycle is not a risk factor for endometrial cancer.
DIF: Cognitive Level: Understand REF: 424
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

27. Which patient does the nurse recognize as having the highest risk for ovarian cancer?
a. A 24-year-old nulliparous woman who has a history of multiple sexual partners
b. A 32-year-old woman who has had six live births and a history of human papilloma virus (HPV) infection
c. A 55-year-old woman who reached menarche at age 12 and menopause at age 54
d. A 64-year-old nulliparous woman who has taken hormone replacement therapy for eight years
ANS: D

Feedback
A This patient has no risk factor for ovarian cancer.
B This patient has a risk factor for cervical cancer (HPV), but not ovarian cancer.
C This patient has no risk factors for ovarian cancer.
D This patient has a risk factor for ovarian cancer.
DIF: Cognitive Level: Understand REF: 424
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

28. The nurse correlates which factor to an increased risk of endometrial cancer in women with early menarche or late menopause?
a. Total number of ovulatory cycles
b. Less hormone stimulation
c. Need for estrogen replacement in these patients
d. Extended duration of the menstrual cycle in these patients
ANS: A

Feedback
A More ovulatory cycles increases risk. These risk factors represent an increased cumulative exposure to estrogen.
B Hormone stimulation does not increase risk in endometrial cancer.
C Estrogen replacement does not increase risk in endometrial cancer.
D Extended duration of the menstrual cycle is not a risk factor.
DIF: Cognitive Level: Understand REF: 424
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

29. A patient complains of dysuria, yellow-green vaginal discharge, and vulvar itching. The nurse suspects which sexually transmitted disease?
a. Syphilis
b. Gonorrhea
c. Genital warts
d. Chlamydia
ANS: B

Feedback
A Primary syphilis produces a single, firm, painless open sore or chancre with indurated borders at the site of entry on the genitals.
B Gonorrhea causes a yellow or green vaginal discharge, dysuria, pelvic or abdominal pain, and vaginal itching and burning.
C Genital warts appear as soft, papillary, pink to brown, elongated lesions that may occur singularly or in clusters on the internal genitalia, the external genitalia, and the anal-rectal region.
D Chlamydia infection is asymptomatic in up to 75% of women because it often does not cause enough inflammation to produce symptoms.
DIF: Cognitive Level: Remember REF: 425
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

30. In assessing a patient with suspected Chlamydia, the nurses actions are guided by which characteristic of this disease?
a. Chlamydia is frequently asymptomatic and requires screening.
b. Chlamydia is associated with a yellow-green vaginal discharge.
c. Chlamydia is accompanied by heavy bleeding and headache.
d. Chlamydia is only seen in immunocompromised patients.
ANS: A

Feedback
A This answer is consistent with clinical findings of Chlamydia.
B This answer is consistent with clinical findings of gonorrhea.
C Chlamydia is not accompanied by heavy bleeding and headache.
D Chlamydia is seen in patients with healthy immune systems who are not immunocompromised.
DIF: Cognitive Level: Understand REF: 425
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

31. A nurse examines a patient and finds a single, firm, painless open sore with indurated borders on the vulva. The nurse correlates this finding with which disorder?
a. Human papillomavirus (HPV) infection
b. Herpes infection
c. Gonorrhea
d. Syphilis
ANS: D

Feedback
A HPV infection causes wartlike growths.
B Herpes infection forms vesicles rather than chancres.
C Gonorrhea produces a yellow or green vaginal discharge.
D The clinical finding is consistent with a chancre found in syphilis.
DIF: Cognitive Level: Apply REF: 425
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

32. A nurse expects to find which manifestations in the male patient who has both Chlamydia and gonorrhea?
a. Painful urination and purulent urethral discharge
b. A single, firm painless open sore on the shaft of the penis
c. Red superficial vesicles on the shaft of the penis
d. A single or a cluster of wartlike growth in the anal-rectal area
ANS: A

Feedback
A These are manifestations of Chlamydia and gonorrhea. Dysuria means painful urination.
B This is a description of a lesion consistent with syphilis.
C This is a description of lesions consistent with herpes genitalis.
D This is a description of lesions consistent with genital warts caused by human papillomavirus.
DIF: Cognitive Level: Apply REF: 427
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

33. While giving a history, the patient reports having herpes genitalis. Based on this information, which finding does the nurse anticipate during the assessment?
a. Small vesicles on the genitalia
b. Single, firm, painless, open sore
c. Pain when palpating the cervix
d. Malodorous greenish-yellow vaginal discharge
ANS: A

Feedback
A Small vesicles on the genitalia are consistent with genital herpes.
B Single, firm, painless, open sore is consistent with primary syphilis.
C Pain when palpating the cervix is consistent with Chlamydia.
D Malodorous greenish-yellow vaginal discharge is consistent with trichomonas.
DIF: Cognitive Level: Apply REF: 427
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

34. In teaching a class of adolescents about sexually transmitted diseases, a nurse includes which information about the human papillomavirus (HPV)?
a. HPV is fragile and not easily transmitted.
b. Wartlike growths in the genital area are a sign of HPV infection.
c. There is a specific blood test needed to screen for HPV.
d. Heavy, purulent vaginal discharge is the primary sign of HPV.
ANS: B

Feedback
A HPV is highly contagious.
B This is the correct description of the clinical findings of HPV.
C There is no specific blood test to detect HPV.
D HPV is a virus that develops warts.
DIF: Cognitive Level: Understand REF: 427
TOP: Nursing Process: Intervention
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

35. The patient is unable to tolerate a bimanual pelvic examination due to pain in ovaries and fallopian tubes. Which disorder does the nurse suspect?
a. Tertiary syphilis
b. Genital herpes
c. Human papillomavirus (HPV) infection
d. Pelvic inflammatory disease
ANS: D

Feedback
A Tertiary syphilis does not cause much pain.
B Genital herpes does not cause much pain.
C HPV infection does not cause much pain.
D Typically, the pain is so severe that the patient with pelvic inflammatory disease is unable to tolerate bimanual pelvic examination.
DIF: Cognitive Level: Understand REF: 428
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

36. A patient with testicular torsion is experiencing which abnormality?
a. Abnormal dilation and tortuosity of the veins along the spermatic cord
b. Twisting of the testicle and spermatic cord
c. A cystic mass filled with sperm and seminal fluid in the epididymis
d. An accumulation of fluid in the scrotum
ANS: B

Feedback
A Abnormal dilation and tortuosity of the veins along the spermatic cord describes a varicocele.
B Twisting of the testicle and spermatic cord describes testicular torsion.
C A cystic mass filled with sperm and seminal fluid in the epididymis describes a spermatocele.
D An accumulation of fluid in the scrotum describes a hydrocele.
DIF: Cognitive Level: Understand REF: 430
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

37. How does a nurse recognize when a patient has a testicular torsion?
a. The nurse sees a light red glow on transillumination of the scrotum.
b. The nurse palpates testicular edema that is painless.
c. The patient reports a pulling sensation and dull ache of the scrotum.
d. The patient complains of sudden onset of severe pain with edema of the scrotum.
ANS: D

Feedback
A This is a clinical finding of hydrocele.
B This is a clinical finding of spermatocele.
C This is a clinical finding of varicocele.
D These are clinical findings of testicular torsion.
DIF: Cognitive Level: Understand REF: 430
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

38. In educating a male patient about testicular cancer, the nurse includes which statement?
a. The highest incidence of this cancer is in men between 20 and 34 years of age.
b. The incidence of this cancer is correlated with human papillomavirus (HPV) infection.
c. The risk of this cancer increases with multiple sexual partners.
d. This type of cancer more commonly affects uncircumcised males.
ANS: A

Feedback
A This is a true statement of risk.
B HPV infection is correlated with cervical cancer, rather than testicular cancer.
C The risk of sexually transmitted diseases increases with multiple sexual partners rather than testicular cancer.
D This is not a risk factor.
DIF: Cognitive Level: Remember REF: 431
TOP: Nursing Process: Intervention
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

39. While taking a history of a patient with an enlarged prostate, the nurse expects the patient to report which symptom?
a. Painful urination with each voiding
b. Blood in the urine upon arising
c. Waking from sleep to urinate
d. Incontinence throughout the day
ANS: C

Feedback
A There is no pain associated with an enlarged prostate.
B This is not a manifestation of a prostate disorder.
C Compression of the urethra by the enlarged prostate may cause men to be awakened from sleep to urinate (nocturia).
D The urinary problem associated with a prostate disorder is difficulty in starting the urinary stream because the enlarged prostate gland compresses the urethra, thus incontinence is not associated with a prostate disorder.
DIF: Cognitive Level: Understand REF: 397| 431
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

40. The nurse correlates which patient complaint with suspected enlargement of the prostate gland?
a. Constipation
b. Change in bowel patterns
c. Weak urine stream
d. Increased mucus in urine
ANS: C

Feedback
A Enlargement of the prostate gland does not cause constipation.
B This is a warning sign for colon cancer rather than a manifestation of an enlarged prostate.
C Enlargement of the prostate gland compresses the urethra causing a weak urinary stream.
D This may be an indication of a urinary tract infection rather than an enlarged prostate.
DIF: Cognitive Level: Understand REF: 396| 423| 431
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

41. While giving a history, a patient reports having a weak urinary stream and feeling that his bladder is not empty after urination. Based on these data, what finding does the nurse anticipate upon examination?
a. An enlarged prostate gland palpated on the anterior wall of the rectum
b. An indirect hernia palpated through the inguinal ring when the patient coughs
c. The foreskin of the penis cannot be returned to position after retraction behind the glans
d. A nodular prostate gland palpated on the posterior wall of the rectum
ANS: A

Feedback
A The enlarged prostate compresses the urethra, causing difficulties with voiding.
B A hernia would not interfere with voiding.
C This is a description of paraphimosis.
D The posterior prostate is palpated on the anterior surface of the rectum.
DIF: Cognitive Level: Apply REF: 396| 423| 431
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

42. A patient tells the nurse that he has been informed he has internal hemorrhoids and asks whether there are different types of hemorrhoids. What is the nurses most appropriate response?
a. Internal hemorrhoids are usually seen outside the anus and appear blue.
b. Sometimes patients have other diseases, such as anal warts, that may be mistaken for internal hemorrhoids.
c. Internal hemorrhoids are found higher in the rectum and usually cant be felt unless they are infected or prolapsed.
d. Both internal and external hemorrhoids arise from the same general area and produce the same kinds of symptoms.
ANS: C

Feedback
A Internal hemorrhoids are found high in the rectum and may be felt if infected, but are not seen during an anal examination.
B Anal warts have a distinct appearance that is different from hemorrhoids.
C This is a correct statement.
D Internal hemorrhoids are found higher in the rectum, while external hemorrhoids are found outside the external rectal sphincter.
DIF: Cognitive Level: Understand REF: 433
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

43. During a history, a patient reports rectal bleeding, a warning sign of colorectal cancer. The nurse correlates which clinical finding with colorectal cancer?
a. Thick, blood-tinged mucus within the rectum
b. A pus-filled cavity in the anorectal area
c. An irregular mass with raised edges on the rectal wall
d. A small, smooth nodule protruding from the rectum
ANS: C

Feedback
A This is not an indication of colorectal cancer.
B This is an indication of an infection in the anal area.
C This finding is indicative of colorectal cancer.
D This may be a polyp protruding from the anus.
DIF: Cognitive Level: Understand REF: 397| 422| 434-435
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

MULTIPLE RESPONSE

1. Which comments by a male patient during a health history suggest erectile dysfunction? Select all that apply.
a. I have had type 1 diabetes mellitus since I was 8 years old.
b. I frequently have urinary tract infections.
c. I am taking medications to control my blood pressure.
d. I have an enlarged prostate gland.
e. I take a diuretic every morning.
ANS: A, C, E
Correct: A chronic complication of diabetes can cause impotence. An adverse reaction of some types of antihypertensive and diuretic medications can cause impotence.
Incorrect: Urinary tract infections are unrelated to impotence. Having an enlarged prostate causes problems with urinating, but not with erections.

DIF: Cognitive Level: Analyze REF: 396
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

2. Which patients meet the criteria for Chlamydia screening? Select all that apply.
a. A 40-year-old woman who is sexually active and uses barrier protection consistently
b. A 15-year-old female woman who is sexually active with one partner
c. A 22-year-old woman who is sexually active and uses barrier protection inconsistently
d. A 23-year-old woman who has had four sexual partners in the last 3 months
e. A 34 year-old woman who uses barrier protection inconsistently with multiple sexual partners
f. A 36-year-old pregnant woman making the first prenatal visit
ANS: B, C, D, E, F
Correct: These patients meet the criteria for screening for Chlamydia.
Incorrect: This patient does not meet criteria based on age and use of protection.

DIF: Cognitive Level: Analyze REF: 398
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

3. Which questions are appropriate for a symptom analysis of a patient with benign prostatic hyperplasia? Select all that apply.
a. How often have you found that you stopped and started again several times when you urinated?
b. How often have you had to urinate again less than 2 hours after you finished urinating?
c. How often have you been incontinent of urine?
d. How often have you had constipation due to the enlarged prostate?
e. How often have you had to push or strain to begin urination?
f. How often have you had to get up during the night to urinate?
ANS: A, B, E, F
Correct: These questions from the American Urological Association Symptom Index for Benign Prostatic Hyperplasia are used to screen men for an enlarged prostate.
Incorrect: The urinary problem is difficulty in starting the urinary stream due to the prostate gland compressing the urethra, thus incontinence is not a manifestation of an enlarged prostate. Although the enlarged prostate is palpated through the rectum, it does not become large enough to cause constipation.

DIF: Cognitive Level: Apply REF: 396-397
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

4. Which patients have risk factors for endometrial cancer? Select all that apply.
a. The patient who never had children.
b. The patient who has given birth to nine children.
c. The patient whose body mass index is 39.
d. The patient whose menopause began at age 60.
e. The patient whose father had colon cancer.
f. The patient who has had human papillomavirus (HPV) infections.
ANS: A, C, D, E
Correct: A family history of endometrial, breast, colon, or ovarian cancer is considered a risk factor.
Incorrect: Nulliparity or infertility is a risk factor. HPV is a risk factor for cervical cancer rather than endometrial cancer.

DIF: Cognitive Level: Analyze REF: 424
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Promotion Programs

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