Chapter 69: Assessment of the Reproductive System Nursing School Test Banks

Chapter 69: Assessment of the Reproductive System
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. The nurse is developing a teaching plan for a client who is scheduled for her first Papanicolaou test. What instruction by the nurse is the most accurate?
a. The timing of the Pap smear does not matter.
b. Sexual intercourse will not interfere with the results.
c. Results can be interpreted immediately in the office.
d. Results are best if you do not douche 24 hours before the test.
ANS: D
In order to prevent false interpretation, the client must not douche or have sexual intercourse for at least 24 hours before the Pap smear. Timing is important, with the test scheduled between the clients menstrual periods so that the menstrual flow does not interfere with laboratory analysis. The specimens are placed on a glass slide and sent to the laboratory for examination and cannot be interpreted immediately.

DIF: Understanding/Comprehension REF: 1454
KEY: Health promotion| cancer screening Pap smear
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

2. The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is cause for immediate action by the nurse?
a. Vaginal dryness
b. Need for a Papanicolaou test if none for 3 years
c. Bleeding from the vagina
d. Leakage of urine
ANS: C
Vaginal bleeding is not normal for the postmenopausal woman. Vaginal dryness and leakage of urine are common findings in adults of this age range. Pap tests may not be needed for women over 65 who have had regular cervical cancer testing with normal results.

DIF: Applying/Application REF: 1453
KEY: Adult life stages| older adult| nursing assessment
MSC: Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

3. The nurse is reviewing discharge instructions with a client who has just experienced an endometrial biopsy. Which finding should be reported to the health care provider immediately?
a. Mild cramping
b. Slight chills and fever
c. Spotting of blood on a perineal pad
d. Fatigue after anesthesia
ANS: B
Chills and fever could indicate an infection and should be reported immediately to the health care provider. Mild cramping, spotting, and fatigue are normal findings after an endometrial biopsy.

DIF: Applying/Application REF: 1458
KEY: Infection control| wound infection| discharge teaching
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

4. A client is concerned about her irregular menstrual periods since she has increased her daily workouts at the gym to 2 hours each day. What is the nurses best response?
a. Do you want to talk about the need for that much exercise?
b. Exercise is healthy but can decrease body fat and cause irregular periods.
c. Bingeing and purging can cause electrolyte problems in your body.
d. Anorexic behavior can result in decreased estrogen levels.
ANS: B
There needs to be a certain level of body fat and weight to maintain regular menstrual cycles. The client has only indicated that she has increased her workouts. There is no indication that she has anorexic or bingeing and purging behaviors.

DIF: Applying/Application REF: 1453
KEY: Exercise| health promotion| lifestyle choices
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Psychosocial Integrity

5. A nurse and unlicensed assistive personnel (UAP) are helping a client during a hysterosalpingogram. Which action by the nurse is best delegated to the UAP?
a. Witnessing of the consent form
b. Assisting the client into a lithotomy position
c. Asking about allergies to iodine or shellfish
d. Assessing for pelvic or shoulder pain after the study
ANS: B
The UAP would be able to position the client for the procedure. Only the nurse has the ability to witness the consent form and assess allergies and pain within the nursing scope of practice.

DIF: Applying/Application REF: 1456
KEY: Management| delegation| intraoperative nursing| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

6. The mother of an 18-year-old girl asks the nurse which screening her daughter should receive now based on evidence-based recommendations. Which suggestion by the nurse is best?
a. Papanicolaou test
b. Human papilloma virus (HPV) test
c. Mammogram
d. No screenings at this time
ANS: D
Since the daughter is only 18, it is not recommended that she receive any of these screenings. Pap screenings are recommended to start at age 21. The HPV test can be done with the Pap test for women older than 30 or who had an abnormal Pap test result. A mammogram is recommended for women age 40 or older since cancers are more able to be distinguished from normal glandular tissue at that age.

DIF: Applying/Application REF: 1454
KEY: Health promotion| self-care| reproductive screenings
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

7. A client is scheduled for a laparoscopy to remove endometriosis tissue. Which response by the client alerts the nurse of the need for further teaching?
a. The surgeon told me that carbon dioxide would be infused into my pelvic cavity.
b. There will be one or more small incisions in order to visualize all of the organs.
c. There will be some shoulder pain after the procedure that may last 48 hours.
d. I can return to jogging my 3-mile routine in a few days.
ANS: D
No strenuous activity should occur for 7 days after the procedure. Carbon dioxide is infused into the pelvic cavity to visualize the organs. There are only one or more small incisions with this procedure. The referred shoulder pain that will occur should only last 48 hours.

DIF: Applying/Application REF: 1458
KEY: Health promotion| self-care| laparoscopy
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

8. A 67-year-old male client had some serum tests performed during his annual examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL; prostate-specific antigen: 10 ng/mL; prolactin: 5 ng/mL. What action by the nurse is best?
a. Assess for possible galactorrhea with breast discharge.
b. Note the possibility of a testicular tumor.
c. Communicate to the provider that results were normal.
d. Prepare the client for further diagnostic testing.
ANS: D
The prostate-specific antigen is increased from the normal of 0 to 2.5, which could indicate benign prostatic hyperplasia or prostate cancer. Further testing would have to be done. The values of testosterone and prolactin are within normal range. If the prolactin were increased, there would be a possibility of galactorrhea. An increase in testosterone could indicate a possible testicular tumor.

DIF: Applying/Application REF: 1455
KEY: Older adult| health promotion| prostate cancer
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

9. A 72-year-old woman is being assessed by the nurse for an annual physical. Which finding is of concern to the nurse?
a. Thinning of pubic hair
b. Increased size of the uterus
c. Decreased size of the clitoris
d. Loss of tone of the pelvic ligaments
ANS: B
An increased size of the uterus is an abnormal finding and should be assessed further. Normal changes in the reproductive system related to aging include the graying and thinning of pubic hair, decreased size of the labia majora and clitoris, and loss of tone and elasticity of the pelvic ligaments and connective tissue. The uterus would normally be decreased, not increased, in size due to changes in hormonal levels and atrophy.

DIF: Remembering/Knowledge REF: 1452
KEY: Adult life stages| older adult| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

1. The nurse is assessing a client for reproductive health problems. What would be the priority assessments? (Select all that apply.)
a. Bleeding
b. Pain
c. Sexual orientation
d. Masses
e. Discharge
ANS: A, B, D, E
Bleeding, pain, masses, and discharge are common health problems that bring a client to a health care provider. Sexual orientation is not considered a health problem. Sexual activity should be assessed as part of the clients history.

DIF: Remembering/Knowledge REF: 1453
KEY: Safety| reproductive health problems| assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

2. The nurse is reviewing discharge plans with a client who is recovering from a cervical biopsy. Which statements indicate good understanding by the client? (Select all that apply.)
a. I can return to work this afternoon.
b. There should be no problem lifting my 2-year-old toddler when I get home.
c. I cannot douche until the biopsy site is healed.
d. I need to wait for about 2 weeks to have intercourse with my husband.
e. If I have some bleeding, I can use a regular tampon this evening.
ANS: C, D
The client should not douche, have intercourse, or use tampons until the biopsy site is healed. The client should rest for 24 hours after the procedure and should not lift heavy objects.

DIF: Applying/Application REF: 1458
KEY: Medical care| surgical procedures| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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