Ch. 26: Female GU System

Question 1

During a health history, a 22-year old woman asks, “Can I get that vaccine for HPV? I have genital warts and I’d like them to go away!” What is the nurse’s best response?

A) “The HPV vaccine is for girls and women ages 9 to 26, so we can start that today.”
B) “This vaccine is only for girls who have not started to have intercourse yet.”
C) “Let’s check with the physician to see if you are a candidate for this vaccine.”
D) “The vaccine cannot protect you if you already have an HPV infection.”

Answer 1

D) “The vaccine cannot protect you if you already have an HPV infection.”

The HPV (human papillomavirus) vaccine is appropriate for girls and women age 9 to 26 and is given to prevent cervical cancer by preventing HPV infections before girls become sexually active. However, it cannot protect the woman if an HPV infection is already present.

Question 2

During an examination the nurse observes a female patient’s vestibule and expects to see the:

A) urethral meatus and vaginal orifice
B) vaginal orifice and vestibular (Bartholin) glands
C) urethral meatus and paraurethral (Skene) glands
D) paraurethral (Skene) and vestibular (Bartholin) glands

Answer 2

A) urethral meatus and vaginal orifice

The labial structures encircle a boat-shaped space, or cleft, termed the vestibule. Within it are numerous openings. The urethral meatus and vaginal orifice are visible. The ducts of the paraurethral (Skene) glands and the vestibular (Bartholin) glands are present but not visible.

Question 3

During a speculum inspection of the vagina, the nurse would expect to see what at the end of the vaginal canal?

A) Cervix
B) Uterus
C) Ovaries
D) Fallopian tubes

Answer 3

A) Cervix

At the end of the canal, the uterine cervix projects into the vagina

Question 4

The uterus is usually positioned tilting forward and superior to the bladder. This position is known as:

A) anteverted and anteflexed
B) retroverted and anteflexed
C) retroverted and retroflexed
D) superiorverted and anteflexed

Answer 4

A) anteverted and anteflexed

The uterus is freely movable, not fixed, and usually tilts forward and superior to the bladder (a position labeled as anteverted and anteflexed).

Question 5

An 11-year-old girl is in the clinic for a sports physical. The nurse notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. The nurse should use which of these techniques to best assist the young girl in understanding the expected sequence for development? The nurse should:

A) use the Tanner’s table on the five stages of sexual development
B) describe her development and compare it with that of other girls her age
C) use Jacobsen’s table on expected development on the basis of height and weight data
D) reassure her that her development is within normal limits and should tell her not to worry about the next step

Answer 5

A) use the Tanner’s table on the five stages of sexual development

Tanner’s table on the five stages of pubic hair development is helpful in teaching girls the expected sequence of sexual development.

Question 6

A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart that her cervix is softened and looks cyanotic. The nurse knows that the woman is exhibiting _____ sign and _____ sign.

A) Tanner’s; Hegar’s
B) Hegar’s; Goodell’s
C) Chadwick’s; Hegar’s
D) Goodell’s; Chadwick’s

Answer 6

D) Goodell’s; Chadwick’s

Shortly after the first missed menstrual period, the female genitalia show signs of the growing fetus. The cervix softens (Goodell’s sign) at 4 to 6 weeks, and the vaginal mucosa and cervix look cyanotic (Chadwick’s sign) at 8 to 12 weeks. These changes occur because of increased vascularity and edema of the cervix and hypertrophy and hyperplasia of the cervical glands. Hegar’s sign occurs when the isthmus of the uterus softens at 6 to 8 weeks. Tanner’s sign is not a correct response.

Question 7

A woman who is 22 weeks pregnant has a vaginal infection. She tells the nurse that she is afraid that this infection will hurt the fetus. The nurse knows that which of these statements is true?

A) if intercourse is avoided, then the risk for infection is minimal
B) a thick mucus plug forms that protects the fetus from infection
C) the acidic pH of vaginal secretions promotes the growth of pathogenic bacteria
D) the mucus plug that forms in the cervical canal is a good medium for bacterial growth

Answer 7

B) a thick mucus plug forms that protects the fetus from infection

A clot of thick, tenacious mucus forms in the spaces of the cervical canal (the mucus plug), which protects the fetus from infection. Cervical and vaginal secretions increase during pregnancy and are thick, white, and more acidic. The acidic pH keeps pathogenic bacteria from multiplying in the vagina, but the increase in glycogen increases the risk of candidiasis (commonly called a yeast infection) during pregnancy.

Question 8

The changes normally associated with menopause occur generally because the cells in the reproductive tract are:

A) aging
B) becoming fibrous
C) estrogen dependent
D) able to respond to estrogen

Answer 8

C) estrogen dependent

Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes. The other options are not correct.

Question 9

The nurse is reviewing the changes that occur with menopause. Which of these are changes associated with menopause?

A) uterine and ovarian atrophy along with thinning vaginal epithelium
B) ovarian atrophy, increased vaginal secretions, and increasing clitoral size
C) cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal secretions
D) vaginal mucosa fragility, increased acidity of vaginal secretions, and uterine hypertrophy

Answer 9

A) uterine and ovarian atrophy along with thinning vaginal epithelium

The uterus shrinks because of its decreased myometrium. The ovaries atrophy to 1 to 2 cm and are not palpable after menopause. The sacral ligaments relax, and the pelvic musculature weakens, so the uterus droops. The cervix shrinks and looks paler with a thick glistening epithelium. The vaginal epithelium atrophies, becoming thinner, drier, and itchy. The vaginal pH becomes more alkaline, and secretions are decreased. This results in a fragile mucosal surface that is at risk for bleeding and vaginitis.

Question 10

A 54-year-old woman who has just completed menopause is in the clinic today for a yearly physical examination. Which of these statements should the nurse include in patient education? “A postmenopausal woman:

A) is not at any greater risk for heart disease than a younger woman is.”
B) should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions.”
C) has only stopped menstruating; there really are no other significant changes with which she should be concerned.”
D) is likely to have difficulty with sexual pleasure as a result of drastic changes in the female sexual response cycle.”

Answer 10

B) should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions.”

Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse (dyspareunia). The other statements are incorrect.

Question 11

A woman is in the clinic for an annual gynecologic examination. The nurse should plan to begin the interview with the:

A) menstrual history because it is generally nonthreatening
B) obstetric history because it is the most important information
C) urinary system history because there may be problems in this area as well
D) sexual history because it will build rapport to discuss this first

Answer 11

A) menstrual history because it is generally nonthreatening

Menstrual history is usually nonthreatening; thus it is a good place to start. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start.

Question 12

A patient has had three pregnancies and two live births. The nurse would record this information as gravida _____, para _____, AB _____.

A) 2; 2; 1
B) 3; 2; 0
C) 3; 2; 1
D) 3; 3; 1

Answer 12

C) 3; 2; 1

Gravida is number of pregnancies. Para is number of births. Abortions are interrupted pregnancies, including elective abortions and spontaneous miscarriages.

Question 13

During the interview with a female patient, the nurse gathers data that indicate that the patient is perimenopausal. Which of these statements made by this patient leads to this conclusion?

A) “I have noticed that my muscles ache at night when I go to bed.”
B) “I will be very happy when I can stop worrying about having a period.”
C) “I have been noticing that I sweat a lot more than I used to, especially at night.”
D) “I have only been pregnant twice, but both times I had breast tenderness as my first symptom.”

Answer 13

C) “I have been noticing that I sweat a lot more than I used to, especially at night.”

Hormone shifts occur during the perimenopausal period, and associated symptoms of menopause may occur, such as hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, and itching. The other responses are not correct.

Question 14

A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts and wonders if they could be due to the hormone replacement therapy (HRT) she started 3 months ago. The nurse should tell her:

A) “Hormone replacement therapy is at such a low dose that side effects are very unusual.”
B) “Hormone replacement therapy has several side effects, including fluid retention, breast tenderness, and vaginal bleeding.”
C) “It would be very unusual to have vaginal bleeding with hormone replacement therapy, and I suggest you come in to the clinic immediately to have this evaluated.”
D) “It sounds as if your dose of estrogen is too high; I think you may need to decrease the amount you are taking and then call back in a week.”

Answer 14

B) “Hormone replacement therapy has several side effects, including fluid retention, breast tenderness, and vaginal bleeding.”

Side effects of hormone replacement therapy include fluid retention, breast pain, and vaginal bleeding.

Question 15

A 52-year-old patient states that when she sneezes or coughs she “wets herself a little.” She is very concerned that something may be wrong with her. The nurse suspects that the problem is:

A) dysuria
B) stress incontinence
C) hematuria
D) urge incontinence

Answer 15

B) stress incontinence

Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing. Dysuria is pain or burning with urination. Hematuria is bleeding with urination. Urge incontinence is involuntary urine loss but it occurs due to an overactive detrusor muscle in the bladder that contracts and causes an urgent need to void

Question 16

During the interview a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse’s most appropriate response to this would be:

A) “Oh, don’t worry. Some cyclic vaginal discharge is normal.”
B) “Have you been engaging in unprotected sexual intercourse?”
C) “I’d like some information about the discharge. What color is it?”
D) “Have you had any urinary incontinence associated with the discharge?”

Answer 16

C) “I’d like some information about the discharge. What color is it?”

Ask questions that help the patient reveal more information about her symptoms in a nonthreatening manner. Assess vaginal discharge further by asking about the amount, color, and odor. Normal vaginal discharge is small, clear or cloudy, and always nonirritating.

Question 17

A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse should ask, “Have you noticed:

A) a change in your urination patterns?”
B) any excessive vaginal bleeding?”
C) any unusual vaginal discharge or itching?”
D) any changes in your desire for intercourse?”

Answer 17

C) any unusual vaginal discharge or itching?”

Several medications may increase the risk of vaginitis. Broad-spectrum antibiotics alter the balance of normal flora, which may lead to the development of vaginitis. The other questions are not correct

Question 18

Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview?

A) “Now it is time to talk about your sexual history. When did you first have intercourse?”
B) “Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?”
C) “Often women have questions about their sexual relationship and how it affects their health. Do you have any questions?”
D) “Most women your age have had more than one sexual partner. How many would you say you have had?”

Answer 18

C) “Often women have questions about their sexual relationship and how it affects their health. Do you have any questions?”

The nurse should begin with an open-ended question to assess individual needs. The nurse should include appropriate questions as a routine part of the history, because doing so communicates that the nurse accepts the individual’s sexual activity and believes it is important. The nurse’s comfort with discussion prompts the patient’s interest and possibly relief that the topic has been introduced. This establishes a database for comparison with any future sexual activities and provides an opportunity to screen sexual problems.

Question 19

A 22-year-old woman has been considering using oral contraceptives. As a part of her history, the nurse should ask:

A) “Do you have a history of heart murmurs?”
B) “Will you be in a monogamous relationship?”
C) “Have you thought this choice through carefully?”
D) “If you smoke, how many cigarettes do you smoke per day?”

Answer 19

D) “If you smoke, how many cigarettes do you smoke per day?”

Oral contraceptives, together with cigarette smoking, increase the risk for cardiovascular side effects. If cigarettes are used, then the nurse should assess smoking history.

Question 20

A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first?

A) ascertain whether either of them has been using broad-spectrum antibiotics
B) explain that couples are considered infertile after 1 year of unprotected intercourse
C) immediately refer the woman to an expert in pelvic inflammatory disease—the most common cause of infertility
D) explain that couples are considered infertile after 3 months of engaging in unprotected intercourse and that they will need a referral to a fertility expert

Answer 20

B) explain that couples are considered infertile after 1 year of unprotected intercourse

Infertility is considered after 1 year of engaging in unprotected sexual intercourse without conceiving. The other actions are not appropriate

Question 21

A nurse is assessing a patient’s risk of contracting a sexually transmitted infection (STI). An appropriate question to ask would be:

A) “You know that it’s important to use condoms for protection, right?”
B) “Do you use a condom with each episode of sexual intercourse?”
C) “Do you have a sexually transmitted infection?”
D) “You are aware of the dangers of unprotected sex, aren’t you?”

Answer 21

B) “Do you use a condom with each episode of sexual intercourse?”

In reviewing a patient’s risk for sexually transmitted infections, the nurse should ask, in a nonconfrontational manner, whether condoms are used at each episode of sexual intercourse. Asking a person whether he or she has an infection does not address the risk.

Question 22

When the nurse is interviewing a preadolescent girl, which opening statement would be least threatening?

A) “Do you have any questions about growing up?”
B) “What has your mother told you about growing up?”
C) “When did you notice that your body was changing?”
D) “I remember being very scared when I got my period. How do you think you’ll feel?”

Answer 22

C) “When did you notice that your body was changing?”

Try the open-ended, “When did you … ?” rather than “Do you … ?” This is less threatening because it implies that the topic is normal and unexceptional.

Question 23

When the nurse is discussing sexuality and sexual issues with adolescents, a permission statement helps to convey that it is normal to think or feel a certain way. Which of these is the best example of a permission statement?

A) “It is okay that you have become sexually active.”
B) “Often girls your age have questions about sexual activity. Have you any questions?”
C) “If it is okay with you, I’d like to ask you some questions about your sexual history.”
D) “Often girls your age engage in sexual activity. It is okay to tell me if you have had intercourse.”

Answer 23

B) “Often girls your age have questions about sexual activity. Have you any questions?”

Start with a permission statement, “Often girls your age experience . . . .” This conveys that it is normal to think or feel a certain way, and it is important to relay that the topic is normal and unexceptional.

Question 24

The nurse is preparing to interview a postmenopausal woman. Which of these statements is true with regard to the history of a postmenopausal woman?

A) the nurse should ask a postmenopausal woman if she ever has vaginal bleeding
B) once a woman reaches menopause, the nurse does not need to ask any further history questions
C) the nurse should screen for monthly breast tenderness
D) postmenopausal women are not at risk for contracting sexually transmitted infections and thus these questions can be omitted

Answer 24

A) the nurse should ask a postmenopausal woman if she ever has vaginal bleeding

Postmenopausal bleeding warrants further workup and referral. The other statements are not true.

Question 25

During the examination portion of a patient’s visit, she will be in lithotomy position. Which statement below reflects some things that the nurse can do to make this more comfortable for her?

A) ask her to place her hands and arms behind her head
B) elevate her head and shoulders to maintain eye contact
C) allow her to choose to have her feet in the stirrups or have them resting side by side on the edge of the table
D) allow her to keep her buttocks about 6 inches from the edge of the table to prevent her from feeling as if she will fall off

Answer 25

B) elevate her head and shoulders to maintain eye contact

The nurse should elevate her head and shoulders to maintain eye contact. The patient’s arms should be placed at her sides or across the chest, not behind the head, because this position only tightens the abdominal muscles. The feet should be placed into the stirrups, knees apart, and buttocks at the edge of the examining table. Place the stirrups so the legs are not abducted too far

Question 26

An 18-year-old patient is having her first pelvic examination. Which action by the nurse is appropriate?

A) invite her mother to be present during the examination
B) avoid the lithotomy position this first time because it can be uncomfortable and embarrassing
C) raise the head of the examination table and give her a mirror so that she can view the exam
D) drape her fully, leaving the drape between her legs elevated to avoid embarrassing her with eye contact

Answer 26

C) raise the head of the examination table and give her a mirror so that she can view the exam

Use the techniques of the educational or mirror pelvic examination. This is a routine examination with some modifications in attitude, position, and communication. First, the woman is considered an active participant, one who is interested in learning and in sharing decisions about her own health care. The woman props herself up on one elbow, or the head of the table is raised. Her other hand holds a mirror between her legs, above the examiner’s hands. The woman can see all that the examiner is doing and has a full view of her genitalia. The mirror works well for teaching normal anatomy and its relationship to sexual behavior. You can ask her if she would like to have a family member, friend, or chaperone present for the examination. The drape should be pushed down between the woman’s legs so that the nurse can see her face.

Question 27

The nurse has just completed an inspection of a nulliparous woman’s external genitalia. Which of these would be a description of a finding within normal limits?

A) redness of the labia majora
B) multiple nontender sebaceous cysts
C) discharge that is sticky and yellow-green
D) gaping and slightly shriveled labia majora

Answer 27

B) multiple nontender sebaceous cysts

There should be no lesions, except for occasional sebaceous cysts. These are yellowish 1-cm nodules that are firm, nontender, and often multiple. The labia majora are dark pink, moist, and symmetrical; redness indicates inflammation or lesions. Discharge that is sticky and yellow-green may indicate infection. In the nulliparous woman, the labia majora meet in the midline, are symmetric and plump.

Question 28

The nurse is preparing for an internal genitalia examination of a woman. Which order of the examination is correct?

A) bimanual, speculum, rectovaginal
B) speculum, rectovaginal, bimanual
C) speculum, bimanual, rectovaginal
D) rectovaginal, bimanual, speculum

Answer 28

C) speculum, bimanual, rectovaginal

The correct sequence is speculum examination, then bimanual examination after removing the speculum, and then rectovaginal examination. The examiner should change gloves before performing the rectovaginal examination to avoid spreading any possible infection

Question 29

During an internal examination of a woman’s genitalia, the nurse will use which technique for proper insertion of the speculum?

A) instruct the woman to bear down, open the speculum blades, and apply in a swift, upward movement
B) insert the blades of the speculum on a horizontal plane, turning them to a 30-degree angle while continuing to insert them. Ask the woman to bear down after the speculum is inserted
C) instruct the woman to bear down, turn the width of the blades horizontally, and insert the speculum at a 45-degree angle downward toward the small of the woman’s back
D) lock the blades open by turning the thumbscrew. Once the blades are open, apply pressure to the introitus and insert the blades at a 45-degree angle downward to bring the cervix into view

Answer 29

C) instruct the woman to bear down, turn the width of the blades horizontally, and insert the speculum at a 45-degree angle downward toward the small of the woman’s back

The examiner should instruct the woman to bear down, turn the width of the blades horizontally, and insert the speculum at a 45-degree angle downward toward the small of the woman’s back. See the text under “Speculum Examination” for more detail.

Question 30

The nurse is examining a 35-year-old female patient. During the history, the nurse notices that she has had two term pregnancies, and both babies were delivered vaginally. During the internal examination the nurse observes that the cervical os is a horizontal slit with some healed lacerations and that the cervix has some nabothian cysts that are small, smooth, and yellow. In addition, the nurse notices that the cervical surface is granular and red, especially around the os. Finally, the nurse notices the presence of stringy, opaque, odorless secretions. Which of these findings are abnormal?

A) nabothian cysts are present
B) the cervical os is a horizontal slit
C) the cervical surface is granular and red
D) stringy and opaque secretions are present

Answer 30

C) the cervical surface is granular and red

Normal findings: Nabothian cysts may be present on the cervix after childbirth. The cervical os is a horizontal, irregular slit in the parous woman. Secretions vary according to the day of the menstrual cycle, and may be clear and thin or thick, opaque, and stringy. The surface is normally smooth, but cervical eversion, or ectropion may occur where the endocervical canal is “rolled out.” Abnormal finding: The cervical surface should not be reddened or granular, which may indicate a lesion.

Question 31

A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are:

A) “If you are menstruating, please use pads to avoid placing anything into the vagina.”
B) “Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.”
C) “If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you.”
D) “We would like you to use a mild saline douche before your examination. You may pick this up in our office.”

Answer 31

B) “Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.”

When instructing a patient before a Papanicolaou (Pap) smear is obtained, the nurse should follow these guidelines: Do not obtain during the woman’s menses or if a heavy infectious discharge is present. Instruct the woman not to douche, have intercourse, or put anything into the vagina within 24 hours before collecting the specimens. Any specimens will be obtained during the visit, not beforehand.

Question 32

During an examination, which tests will the nurse collect to screen for cervical cancer?

A) endocervical specimen, cervical scrape, and vaginal pool
B) endocervical specimen, vaginal pool, and acetic acid wash
C) endocervical specimen, KOH preparation, and acetic acid wash
D) cervical scrape, acetic acid wash, saline mount (“wet prep”)

Answer 32

A) endocervical specimen, cervical scrape, and vaginal pool

Laboratories may vary in method, but usually the test consists of three specimens: endocervical specimen, cervical scrape, and vaginal pool. The other tests (acetic acid wash, KOH preparation, and saline mount) are used to test for sexually transmitted infections