Chapter 39: Management of Women with Reproductive Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 39: Management of Women with Reproductive Disorders

MULTIPLE CHOICE

1. The nurse explains to a client that the cause of the clients primary dysmenorrhea is a/an

a.

abnormal decrease in estrogen levels.

b.

abnormal elevation in progesterone levels.

c.

decrease in oxytocin levels.

d.

elevation of uterine prostaglandin levels.

ANS: D

The causes of primary dysmenorrhea can be grouped according to (a) elevated uterine prostaglandins, (b) endocrine factors, (c) myometrial factors, (d) biochemical factors, and (e) psychosocial factors.

DIF: Comprehension/Understanding REF: p. 916 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. A woman is being taught self-care for a vaginal pessary to treat vaginal prolapse. The nurse would realize that additional discharge instructions are needed when the woman says

a.

I can use estrogen cream in my vagina at night.

b.

If I have trouble removing or inserting the pessary, I will call the doctor.

c.

My follow-up appointment is in 2 months.

d.

The pessary needs to be washed daily with mild soap.

ANS: C

Pessary care includes daily washing with mild soap and water. A client must be able to remove and reinsert it without difficulty. Pessaries can cause vaginal irritation especially if left in place too long. The follow-up appointment is made for 2 weeks after the fitting. Estrogen cream can be used intravaginally at night to preserve vaginal tissue.

DIF: Application/Applying REF: p. 931 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

3. A client is suspected of having premenstrual syndrome (PMS). A somatic complaint the nurse would assess for is a client report of

a.

abdominal bloating.

b.

blurring of vision.

c.

nasal congestion.

d.

severe uterine cramping.

ANS: A

Somatic problems may include headache, breast tenderness and abdominal bloating, peripheral edema, joint pain and backache, hives, constipation, and exacerbation of pre-existing conditions such as migraine and herpes.

DIF: Application/Applying REF: p. 916 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. A woman complains of severe PMS symptoms. Based on research, the nurse could suggest which of the following over-the-counter products might be beneficial in reducing the symptoms?

a.

Aspirin

b.

Calcium with vitamin D

c.

Ibuprofen

d.

Vitamin C

ANS: B

Research has shown that calcium and vitamin D can reduce the manifestations of PMS. As hormone levels increase during the menstrual cycle, they reduce the level of calcium, and this dysregulation has been postulated to be part of the pathophysiology of PMS. Aspirin and ibuprofen do relieve pain, but do not work on other manifestations. Vitamin B6 may also have some effect.

DIF: Application/Applying REF: p. 915 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Complementary and Alternative Therapies

5. A nurse is counseling an adolescent and her mother about preventing cervical cancer. The most important health promotion action the nurse could suggest is to

a.

abstain from alcohol.

b.

avoid sexual intercourse.

c.

do not start smoking.

d.

get the HPV vaccine.

ANS: D

Infection with HPV (human papillomavirus) is the leading cause of cervical cancer. The vaccine that is now available is best given before a woman becomes sexually active (see Chapter 41). Option b is not the best answer because the girl will probably become sexually active at some point in her life and because STDs do not need sexual intercourse to be spread. Smoking is a risk factor for cervical cancer, although the link is not as strong as the link with HPV. Alcohol is not a risk factor.

DIF: Analysis/Analyzing REF: p. 927 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Immunizations

6. The question that the nurse would initially ask an 18-year-old client being assessed for amenorrhea is

a.

Are you taking birth control pills?

b.

Could you be pregnant?

c.

Have you been dieting?

d.

How much do you exercise?

ANS: B

Pregnancy must be ruled out for any woman of childbearing age experiencing secondary amenorrhea.

DIF: Application/Applying REF: p. 916 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

7. The nurse would determine that a client with menorrhagia is at risk for significant blood loss if the client reports changing the perineal pad or tampon at least every

a.

1 to 2 hours.

b.

to 3 hours.

c.

4 to 5 hours.

d.

6 to 8 hours.

ANS: A

The nurse should consider significant blood loss if the client is changing her pad or tampon 3-4 times in a 4-hour period.

DIF: Application/Applying REF: p. 916 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

8. The nurse planning care for the client who had a repair of a uterine prolapse 2 days ago would include which intervention?

a.

Encouraging a low-fiber diet

b.

Having the client void every 2 hours

c.

Keeping the client on bed rest

d.

Performing routine Foley catheter care

ANS: B

After prolapse repair, the client has a Foley catheter that is removed as soon as the client is ambulatory. Once the catheter is removed, the client voids every 2 hours to keep pressure off the suture line. This client should be ambulatory by now. Low fiber is not part of the treatment plan.

DIF: Application/Applying REF: p. 930 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

9. The nurse teaching a menopausal client about hormone replacement therapy (HRT) would include that HRT decreases the risk of

a.

hypertension.

b.

osteoporosis.

c.

thrombophlebitis.

d.

uterine fibromas.

ANS: B

Estrogen replacement therapy and HRT decrease the risk of osteoporosis. The other disorders listed are reasons not to prescribe these therapies.

DIF: Application/Applying REF: p. 918 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

10. The nurse would be aware that a client with the diagnosis of endometriosis may require additional emotional support, because the major complication of this disease is

a.

cervical cancer.

b.

endometrial cancer.

c.

infertility.

d.

pelvic inflammatory disease.

ANS: C

Infertility is a major complication of endometriosis and is usually caused by scarring, leading to obstruction of the fallopian tubes.

DIF: Comprehension/Understanding REF: p. 921 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

11. After the physician has prescribed danazol (Danocrine) for treatment of a clients endometriosis, the nurse would explain that this drug may cause

a.

hot flashes.

b.

increased breast size.

c.

irregular periods.

d.

loss of appetite.

ANS: A

Danazol may cause side effects such as acne, hirsutism, weight gain, decreased breast size, hot flashes, and vaginal dryness.

DIF: Application/Applying REF: p. 922 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

12. The nurse would assess a client with leiomyoma for a history of

a.

abnormal vaginal discharge.

b.

amenorrhea.

c.

excessive uterine bleeding.

d.

severe menstrual pain.

ANS: C

The most common clinical manifestation of leiomyomas is abnormal uterine bleeding, which is excessive in either amount or duration.

DIF: Application/Applying REF: p. 923 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

13. After a clients hysterectomy for removal of a leiomyoma, the nurse formulates the nursing diagnosis of Constipation related to bowel manipulation during surgery. The best measure that the nurse would take to prevent constipation is

a.

administer a soapsuds enema to the client.

b.

encourage early and frequent ambulation.

c.

offer the client iced beverages.

d.

reduce fiber in the clients diet.

ANS: B

Early, frequent ambulation helps improve GI function.

DIF: Application/Applying REF: p. 925 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. The nurse teaches a client self-care measures after a hysterectomy, which include avoiding

a.

participating in aerobic exercises.

b.

dancing.

c.

riding in a car.

d.

walking for short distances.

ANS: A

Until the physician gives permission, activities that increase pelvic congestion should be avoided, including aerobic activity, horseback riding, and prolonged standing. Heavy lifting and vaginal intercourse should also be avoided for 6 weeks.

DIF: Application/Applying REF: p. 925 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

15. To help a client diagnosed with endometrial cancer effectively deal with this disease, the nurse would base supportive interventions on the fact that endometrial cancer

a.

has a 90% cure rate.

b.

is difficult to treat.

c.

metastasizes quickly.

d.

spreads slowly.

ANS: D

The cell type in endometrial cancer is usually adenocarcinoma, a tumor that involves the glands. This relatively slow-growing tumor metastasizes late in its course and tends to spread slowly to other organs. If caught early, the cure rate approaches 96%.

DIF: Application/Applying REF: p. 926 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Therapeutic Interactions

16. The nurse explains that because there is no screening method to detect endometrial cancer, the first manifestation is

a.

a bowel obstruction.

b.

an abdominal mass.

c.

postmenopausal bleeding.

d.

sudden, intense abdominal pain.

ANS: C

Vaginal bleeding in a menopausal woman is frequently the first manifestation that is noted in endometrial cancer.

DIF: Comprehension/Understanding REF: p. 926 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The postprocedure teaching plan for a client receiving cryosurgery for cervical cancer would include the instruction to

a.

avoid vigorous perineal hygiene.

b.

report any malodorous discharge immediately.

c.

report discharge that continues longer than 8 weeks.

d.

take frequent sitz baths to minimize pain.

ANS: C

After cryosurgery, mild pain may continue for several days. A clear, watery discharge occurs, followed by discharge containing debris that may be malodorous. If the discharge continues longer than 8 weeks, an infection is suspected. The client should take showers or sponge baths during this time, avoiding tub or sitz baths. Clients should practice meticulous perineal hygiene.

DIF: Application/Applying REF: p. 929 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

18. The nurse is providing health education to a group of women about ovarian cancer. The nurse would include information on health maintenance activities for both low- and high-risk women, because ovarian cancer

a.

grows and spreads without manifestations.

b.

is the most common genital cancer.

c.

treatment is generally ineffective.

d.

tumors grow rapidly.

ANS: A

Ovarian cancer tends to grow and spread silently (without manifestations) until it causes pressure on adjacent organs or abdominal distention. When these pressure-related manifestations finally appear, the malignancy has usually spread to the fallopian tubes, uterus, and ligaments. Routine pelvic exams are important for all women and high-risk women can be screened with CA-125 antigen levels and transvaginal ultrasound.

DIF: Application/Applying REF: p. 932 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening

19. A client complains of a cloudy vaginal discharge with a slight odor. Microscopic examination reveals epithelial cells, leukocytes, and normal vaginal flora. Given these findings, the nurse would assesses that the discharge is

a.

candidiasis.

b.

Chlamydia.

c.

Gardnerella.

d.

leukorrhea.

ANS: D

All women have normal, non-bloody, asymptomatic vaginal discharge called leukorrhea. As this exudate passes through the vagina, it may become cloudy and acquire a slight odor as desquamated epithelial cells, leukocytes, and normal vaginal flora are added.

DIF: Application/Applying REF: p. 933 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

20. A vaginal mass is found in a client experiencing vaginal discharge, painless vaginal bleeding, and pruritus. The clients statement that would alert the nurse to the possible etiology is

a.

Ive been sexually active since I was 17-years-old.

b.

Ive been unable to conceive.

c.

My mother took DES when she was pregnant with me.

d.

The IUD is my form of birth control.

ANS: C

A risk factor for vaginal cancer is maternal ingestion of diethylstilbestrol (DES), which is associated with clear-cell vaginal cancer.

DIF: Analysis/Analyzing REF: p. 935 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

21. Reading in the client record that a female client has undergone type II excision of the genitalia, the nurse would understand that there has been excision of the

a.

clitoris and labia minora.

b.

clitoris only.

c.

entire vulva.

d.

labia minora and labia majora.

ANS: A

The four types of female genitalia excision are as follows: I, clitoris only; II, clitoris and parts of labia minora; III, clitoris, labia minora, and parts of labia majora, with suturing of the majora obliterating the vaginal opening; and IV, burning instead of excising the clitoris and stretching of the minora.

DIF: Comprehension/Understanding REF: p. 934 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

22. The assessment that would alert the nurse to vulvar carcinoma is

a.

lichen sclerosa.

b.

reduced libido.

c.

vaginal atrophy.

d.

white, frothy vaginal discharge.

ANS: A

Lichen sclerosa are gray patches on the labia, perineum, and sometimes the clitoris. Biopsy of the lesions will determine if they have become malignant.

DIF: Comprehension/Understanding REF: p. 936 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

23. The statement by a client who has undergone radiation therapy for vaginal cancer that would indicate the need for further teaching is

a.

I can try different positions for intercourse.

b.

I need to stop douching.

c.

If I take a warm bath to relax before sex, it might make it easier.

d.

Im distressed about never having sexual intercourse again.

ANS: D

Clients can resume sexual activity, if desired. However, physical changes may make vaginal intercourse difficult or painful. Vaginal dilators and lubricants can help with the fibrosis and tightening of the vagina that can occur after radiation therapy. Methods to promote relaxation before sex, like warm baths or massages, may also be helpful. Douching is not recommended for most women.

DIF: Application/Applying REF: p. 935 OBJ: Evaluation

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Human Sexuality

24. The client tells the nurse that she is experiencing pain on her left side during the entire time of menstrual flow. The nurses assesses the possibility of

a.

endometriosis.

b.

pelvic inflammatory disease.

c.

uterine myoma.

d.

uterine prolapse.

ANS: A

Pain is the most characteristic manifestation of endometriosis. Pain typically begins before the menstrual period and lasts for the duration of menstruation and sometimes for several days afterward. The pain may be located in various areas, making the diagnosis more difficult. A client with symptomatic PID would be acutely ill with fever, chills, and a purulent vaginal discharge. Uterine tumors often manifest with painless bleeding. Uterine prolapse would present with the cervix protruding through the vagina.

DIF: Application/Applying REF: p. 922 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

25. A clinic nurse is assessing a 16 year-old girl with menstrual complaints. When the nurse learns that the client has had a recent infibulation, the nurse should

a.

call the local authorities.

b.

find a smaller speculum.

c.

educate the client about perineal hygiene.

d.

tell the parents this is not done in this country.

ANS: A

An infibulation is a type III female genital mutilation (FGM) consisting of removal of labia minora, the interior labia majora, and suturing the two sides of the vulva together, which leaves only a small hole for urination and menstrual flow. Practiced mainly in African countries, FGM on a girl under the age of 18 is considered child abuse and must be reported to authorities.

DIF: Analysis/Analyzing REF: p. 934 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Abuse/Neglect

26. A woman is scheduled for surgery to treat vaginal cancer. When the nurse takes the consent form to the woman to sign, she says My husband and I are so glad this wont affect sexual activity. Which action by the nurse is most appropriate?

a.

Ask if she has any questions about sexual activity.

b.

Have the physician return and explain the procedure again.

c.

Have the woman sign the consent form.

d.

Offer her a referral to a sexual counselor.

ANS: B

Unless the physician plans to reconstruct the vagina, postoperative vaginal sexual activity is not possible after this operation. The woman needs a better understanding of the surgical procedure, so the nurse needs to call the doctor and have him/her re-explain the procedure before signing the consent form. Options a and d are good options for any woman having surgical procedures that might affect sexuality, but in this case option b takes priority because it is about informed consent.

DIF: Analysis/Analyzing REF: p. 935 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Informed Consent

MULTIPLE RESPONSE

1. The nurse caring for the client who is undergoing radiation therapy for endometrial cancer would include which directions in the nursing care plan? (Select all that apply.)

a.

Elevate head of bed to 90 degrees.

b.

Encourage in-room exercising.

c.

Minimize visitation.

d.

Organize cares.

ANS: C, D

Radiation precautions are in place during radiation therapy and include minimizing visitors time in the room, and minimizing nursing time in the room by organizing care. See Chapter 17 for more information. The client is kept on bed rest with the head of the bed flat or only slightly elevated. Movement is restricted and a catheter is in place to prevent dislodgement of the intracavity radiation device.

DIF: Application/Applying REF: pp. 926-927 OBJ: Intervention

KEY: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission-Based/Other Precautions

2. A woman is scheduled to have a vulvectomy for vulvar cancer. Important interventions by the nurse to help her cope with this diagnosis and treatment include (Select all that apply)

a.

encouraging her and her partner to discuss sexuality.

b.

encouraging her to see that being a woman means more than having genitals.

c.

helping her adapt by limiting talk about grief and mourning.

d.

providing a referral to a qualified sex therapist.

e.

suggesting alternative forms of sexual pleasure.

ANS: A, D, E

A vulvectomy is a devastating procedure for many women, who will mourn the loss of their previous identity and sexuality. Helpful interventions the nurse can offer include encouraging frank and open discussion between the client and partner, suggesting alternate forms of sexual activity, and referring the client for sexual therapy. The other two options are dismissive of the womans feelings and do not constitute sensitive care.

DIF: Application/Applying REF: p. 937 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Human Sexuality

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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