Chapter 27: Female Genitourinary System (Practice Questions)

Question 1

During a health history, a 22-year old woman asks, Can I get that vaccine for human papilloma virus (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 years, so we can start that today.
b. This vaccine is only for girls who have not yet started to become sexually active.
c. Lets 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.

Question 2

During an examination, the nurse observes a female patients 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.

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

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.

Question 5

Generally, the changes normally associated with menopause occur because the cells in the reproductive tract are:

a. Aging.
b. Becoming fibrous.
c. Estrogen dependent.
d. Able to respond to estrogen

Answer 5

c. Estrogen dependent.

Question 6

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

a. Uterine and ovarian atrophy, along with a thinning of the 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 6

a. Uterine and ovarian atrophy, along with a thinning of the vaginal epithelium

Question 7

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.
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 7

b. Should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions.

Question 8

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 includes the most important information.
c. Urinary system history, because problems may develop in this area as well.
d. Sexual history, because discussing it first will build rapport.

Answer 8

a. Menstrual history, because it is generally nonthreatening.

Question 9

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

a. 2; 2; 1
b. 3; 2; 0
c. 3; 2; 1
d. 3; 3; 1

Answer 9

c. 3; 2; 1

Question 10

During the interview with a female patient, the nurse gathers data that indicate 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 10

c. I have been noticing that I sweat a lot more than I used to, especially at night.

Question 11

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

a. HRT is at such a low dose that side effects are very unusual.
b. HRT has several side effects, including fluid retention, breast tenderness, and vaginal bleeding.
c. Vaginal bleeding with HRT is very unusual; I suggest you come into 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 11

b. HRT has several side effects, including fluid retention, breast tenderness, and vaginal bleeding.

Question 12

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 12

b. Stress incontinence.

Question 13

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

a. Oh, dont worry. Some cyclic vaginal discharge is normal.
b. Have you been engaging in unprotected sexual intercourse?
c. Id like some information about the discharge. What color is it?
d. Have you had any urinary incontinence associated with the discharge?

Answer 13

c. Id like some information about the discharge. What color is it?

Question 14

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 any:

a. Changes in your urination patterns?
b. Excessive vaginal bleeding?
c. Unusual vaginal discharge or itching?
d. Changes in your desire for intercourse?

Answer 14

c. Unusual vaginal discharge or itching?

Question 15

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. Women often 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 15

c. Women often have questions about their sexual relationship and how it affects their health. Do you have any questions?

Question 16

A 22-year-old woman has been considering using oral contraceptives. As a part of her health 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 carefully thought this choice through?
d. If you smoke, how many cigarettes do you smoke per day?

Answer 16

d. If you smoke, how many cigarettes do you smoke per day?

Question 17

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 diseasethe 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 17

b. Explain that couples are considered infertile after 1 year of unprotected intercourse.

Question 18

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

a. You know that its 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, arent you?

Answer 18

b. Do you use a condom with each episode of sexual intercourse?

Question 19

When the nurse is interviewing a preadolescent girl, which opening question 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 youll feel?

Answer 19

c. When did you notice that your body was changing?

Question 20

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

a. It is okay that you have become sexually active.
b. Girls your age often have questions about sexual activity. Do you have any questions?
c. If it is okay with you, Id like to ask you some questions about your sexual history.
d. Girls your age often engage in sexual activities. It is okay to tell me if you have had intercourse.

Answer 20

b. Girls your age often have questions about sexual activity. Do you have any questions?

Question 21

The nurse is preparing to interview a postmenopausal woman. Which of these statements istrue as it applies to obtaining the health history of a postmenopausal woman?

a. The nurse should ask a postmenopausal woman if she has ever had vaginal bleeding.
b. Once a woman reaches menopause, the nurse does not need to ask any history questions.
c. The nurse should screen for monthly breast tenderness.
d. Postmenopausal women are not at risk for contracting STIs; therefore, these questions can be omitted.

Answer 21

a. The nurse should ask a postmenopausal woman if she has ever had vaginal bleeding.

Question 22

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

a. Ask her to place her hands and arms over 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 approximately 6 inches from the edge of the table to prevent her from feeling as if she will fall off.

Answer 22

b. Elevate her head and shoulders to maintain eye contact.

Question 23

The nurse has just completed an inspection of a nulliparous womans 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 foul smelling and irritating
d. Gaping and slightly shriveled labia majora

Answer 23

b. Multiple nontender sebaceous cysts

Question 24

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

a. Bimanual, speculum, and rectovaginal
b. Speculum, rectovaginal, and bimanual
c. Speculum, bimanual, and rectovaginal
d. Rectovaginal, bimanual, and speculum

Answer 24

c. Speculum, bimanual, and rectovaginal

Question 25

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

a. The woman is instructed to bear down, the speculum blades are opened and applied in a swift, upward movement.
b. The blades of the speculum are inserted on a horizontal plane, turning them to a 30-degree angle while continuing to insert them. The woman is asked to bear down after the speculum is inserted.
c. The woman is instructed to bear down, the width of the blades are horizontally turned, and the speculum is inserted downward at a 45-degree angle toward the small of the womans back.
d. The blades are locked open by turning the thumbscrew. Once the blades are open, pressure is applied to the introitus and the blades are inserted downward at a 45-degree angle to bring the cervix into view.

Answer 25

c. The woman is instructed to bear down, the width of the blades are horizontally turned, and the

Question 26

The nurse is examining a 35-year-old female patient. During the health 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 26

c. The cervical surface is granular and red.

Question 27

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 27

b. Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your
appointment.

Question 28

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, potassium hydroxide (KOH) preparation, and acetic acid wash
d. Cervical scrape, acetic acid wash, saline mount (wet prep)

Answer 28

a. Endocervical specimen, cervical scrape, and vaginal pool

Question 29

When performing the bimanual examination, the nurse notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. The nurses interpretation of these results should be which of these?

a. These findings are all within normal limits.
b. Cervical consistency should be soft and velvetynot firm.
c. The cervix should move when palpated; an immobile cervix may indicate malignancy.
d. Pain may occur during palpation of the cervix.

Answer 29

c. The cervix should move when palpated; an immobile cervix may indicate malignancy.

Question 30

The nurse is palpating a female patients adnexa. The findings include a firm, smooth uterine wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and pulsating. The nurses most appropriate course of action would be to:

a. Tell the patient that her examination is normal.
b. Give her an immediate referral to a gynecologist.
c. Suggest that she return in a month for a recheck to verify the findings.
d. Tell the patient that she may have an ovarian cyst that should be evaluated further

Answer 30

b. Give her an immediate referral to a gynecologist.

Question 31

A 65-year-old woman is in the office for routine gynecologic care. She had a complete hysterectomy 3 months ago after cervical cancer was detected. Which statement does the nurse know to be true regarding this visit?

a. Her cervical mucosa will be red and dry looking.
b. She will not need to have a Pap smear performed.
c. The nurse can expect to find that her uterus will be somewhat enlarged and her ovaries small and hard.
d. The nurse should plan to lubricate the instruments and the examining hand adequately to avoid a painful examination.

Answer 31

d. The nurse should plan to lubricate the instruments and the examining hand adequately to avoid a painful examination.

Question 32

During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina. The nurse knows that these history and physical examination findings are most consistent with which condition?

a. Candidiasis
b. Trichomoniasis
c. Atrophic vaginitis
d. Bacterial vaginosis

Answer 32

a. Candidiasis

Question 33

A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the nurse notices clusters of small, shallow vesicles with surrounding erythema on the labia. Inguinal lymphadenopathy present is also present. The most likely cause of these lesions is:

a. Pediculosis pubis.
b. Contact dermatitis.
c. HPV.
d. Herpes simplex virus type 2

Answer 33

d. Herpes simplex virus type 2

Question 34

A 46-year-old woman is in the clinic for her annual gynecologic examination. She voices a concern about ovarian cancer because her mother and sister died of it. Which statement does the nurse know to be correct regarding ovarian cancer?

a. Ovarian cancer rarely has any symptoms.
b. The Pap smear detects the presence of ovarian cancer.
c. Women at high risk for ovarian cancer should have annual transvaginal ultrasonography for screening.
d. Women over age 40 years should have a thorough pelvic examination every 3 years.

Answer 34

c. Women at high risk for ovarian cancer should have annual transvaginal ultrasonography for screening.

Question 35

During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy and fixed, with a poorly defined mass. This finding is suggestive of:

a. Ovarian cyst.
b. Endometriosis.
c. Ovarian cancer.
d. Ectopic pregnancy.

Answer 35

c. Ovarian cancer.

Question 36

A 25-year-old woman comes to the emergency department with a sudden fever of 38.3 C and abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. The nurse knows that these signs and symptoms are suggestive of:

a. Endometriosis.
b. Uterine fibroids.
c. Ectopic pregnancy.
d. Pelvic inflammatory disease.

Answer 36

d. Pelvic inflammatory disease.

Question 37

During an external genitalia examination of a woman, the nurse notices several lesions around the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is not aware of any problems in that area. The nurse recognizes that these lesions may be:

a. Syphilitic chancre.
b. Herpes simplex virus type 2 (herpes genitalis).
c. HPV or genital warts.
d. Pediculosis pubis (crab lice).

Answer 37

c. HPV or genital warts.

Question 38

During an examination, the nurse would expect the cervical os of a woman who has never had children to appear:

a. Stellate.
b. Small and round.
c. As a horizontal irregular slit.
d. Everted.

Answer 38

b. Small and round.

Question 39

A woman has just been diagnosed with HPV or genital warts. The nurse should counsel her to receive regular examinations because this virus makes her at a higher risk for _______ cancer.

a. Uterine
b. Cervical
c. Ovarian
d. Endometrial

Answer 39

b. Cervical

Question 40

During an internal examination, the nurse notices that the cervix bulges outside the introitus when the patient is asked to strain. The nurse will document this as:

a. Uterine prolapse, graded first degree.
b. Uterine prolapse, graded second degree.
c. Uterine prolapse, graded third degree.
d. A normal finding.

Answer 40

b. Uterine prolapse, graded second degree.

Question 41

A 35-year-old woman is at the clinic for a gynecologic examination. During the examination, she asks the nurse, How often do I need to have this Pap test done? Which reply by the nurse is correct?

a. It depends. Do you smoke?
b. A Pap test needs to be performed annually until you are 65 years of age.
c. If you have two consecutive normal Pap tests, then you can wait 5 years between tests.
d. After age 30 years, if you have three consecutive normal Pap tests, then you may be screened every 2 to 3 years.

Answer 41

d. After age 30 years, if you have three consecutive normal Pap tests, then you may be screened every 2 to 3 years.

Question 42

The nurse is palpating an ovarian mass during an internal examination of a 63-year-old woman. Which findings of the masss characteristics would suggest the presence of an ovarian cyst? Select all that apply.

a. Heavy and solid
b. Mobile and fluctuant
c. Mobile and solid
d. Fixed
e. Smooth and round
f. Poorly defined

Answer 42

b. Mobile and fluctuant

e. Smooth and round