Chapter 53: Female Reproductive Problems

Question 1

A 34-yr-old patient who is discussing contraceptive options with the nurse says, “I want to have children but not for a few years.” Which response by the nurse is accurate?

a. “If you do not become pregnant within the next few years, you never will.”
b. “Women often have more difficulty becoming pregnant after about age 35.”
c. “You have many years of fertility left, so there is no reason to worry about it.”
d. “Stop taking oral contraceptives several years before you want to have a child.”

Answer 1

ANS: B
The probability of successfully becoming pregnant decreases after age 35 years, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving.

Question 2

The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband’s salary. The man replies that if his wife worked outside the home, they would have enough money. Which patient problem should the nurse identify?

a. Anxiety
b. Denial
c. Difficulty coping
d. Lack of knowledge

Answer 2

ANS: C
The statements made by the couple are consistent with difficulty coping. No data indicate that denial, anxiety, or lack of knowledge are problems.

Question 3

A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. What information should the nurse provide?

a. Ovulation is unpredictable unless there are regular menstrual periods.
b. Ovulation prediction kits can provide accurate information about ovulation.
c. She will need to bring a specimen of cervical mucus to the clinic for testing.
d. She should take her body temperature daily and have intercourse when it drops.

Answer 3

ANS: B
Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.

Question 4

A patient has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient?

a. “Expect irregular periods for a few months.”
b. “Abstain from vaginal intercourse for 2 weeks.”
c. “Avoid contraceptives until your reexamination.”
d. “Heavy vaginal bleeding is expected for 2 weeks.”

Answer 4

ANS: B
Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected.

Question 5

A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure?

a. The patient will require a general anesthetic.
b. The expulsion of the fetus may take 1 to 2 days.
c. There is a possibility that the patient may deliver a live fetus.
d. The procedure may be unsuccessful in terminating the pregnancy.

Answer 5

ANS: B
Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure.

Question 6

A patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action should the nurse take first?

a. Ask the patient to keep track of her symptoms in a diary for 3 months.
b. Suggest that the patient try aerobic exercise to decrease her symptoms.
c. Teach the patient about lifestyle changes to reduce premenstrual syndrome (PMS) symptoms.
d. Recommend nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control symptoms.

Answer 6

ANS: A
The patient’s symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made.

Question 7

A patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage discomfort?

a. Avoid aerobic exercise during her menstrual period.
b. Use cold packs on the abdomen and back for pain relief.
c. Talk with her health care provider about beginning antidepressant therapy.
d. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.

Answer 7

ANS: D
NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual timeframe when pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.

Question 8

A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next?

a. Stay with the patient and encourage her to discuss her feelings.
b. Explain the reason for taking vital signs every 15 to 30 minutes.
c. Close the door to the patient’s room and minimize disturbances.
d. Provide teaching about options for termination of the pregnancy.

Answer 8

ANS: B
Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.

Question 9

When caring for a 58-yr-old patient with persistent menorrhagia, what should the nurse plan to monitor?

a. Serum estrogen level
b. Complete blood count (CBC)
c. Gonadotropin-releasing hormone (GNRH) level
d. Serial human chorionic gonadotropin (hCG) results

Answer 9

ANS: B
Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.

Question 10

A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual period for 3 months. Which response by the nurse is appropriate?

a. “Have you thought about using hormone replacement therapy?”
b. “Most women feel a little depressed about entering menopause.”
c. “What was your menstrual pattern before your periods stopped?”
d. “Because you are in your mid-40s, it is likely that you are menopausal.”

Answer 10

ANS: C
The initial response by the nurse should be to assess the patient’s baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.

Question 11

A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion?
a. Use of estrogen-containing vaginal creams provides the same benefits as oral
HRT.
b. Increased risk of colon cancer in women taking HRT requires frequent
colonoscopy.
c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease
and breast cancer.
d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is
generally considered safe.

Answer 11

ANS: C
Data from the Women’s Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

Question 12

Which statement by the patient indicates that the nurse’s teaching about treating vaginal candidiasis was effective?

a. “I will tell my partner that we cannot have intercourse for a month.”
b. “I should clean carefully after each urination and bowel movement.”
c. “I can douche with warm water if the itching continues to bother me.”
d. “I will insert the antifungal cream right before I get up in the morning.”

Answer 12

ANS: B
Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer periods of time.

Question 13

What topic should the nurse plan to teach a 26-yr-old patient who has been treated for pelvic inflammatory disease?

a. Use of hormone therapy (HT)
b. Potential complication of infertility
c. Irregularities in the menstrual cycle
d. Changes in secondary sex characteristics

Answer 13

ANS: B
Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HT, have irregular menstrual cycles, or experience changes in secondary sex characteristics.

Question 14

The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care?

a. Monitor liver function tests.
b. Use cold packs PRN for pelvic pain.
c. Elevate the head of the bed at least 30 degrees.
d. Teach the patient how to perform Kegel exercises.

Answer 14

ANS: C
The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function test results will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.

Question 15

A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching?

a. Abdominal pain may persist for several weeks.
b. Return for a follow-up appointment in 2 to 3 days.
c. Instruct a male partner to use a condom during sexual intercourse for the next week.
d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring.

Answer 15

ANS: B
The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring.

Question 16

A 32-yr-old patient has oral contraceptives prescribed for endometriosis. What instruction should the nurse give this patient?

a. Expect to experience side effects such as facial hair.
b. Take the medication every day for the next 9 months.
c. Take calcium supplements to prevent developing osteoporosis during therapy.
d. Use a second method of contraception to ensure that she will not become pregnant.

Answer 16

ANS: B
When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

Question 17

A patient with endometriosis asks why she is being treated with a contraceptive. What information should the nurse explain about this therapy?

a. It suppresses the menstrual cycle by mimicking pregnancy.
b. It relieves symptoms such as vaginal atrophy and hot flashes.
c. It prevents a pregnancy that could worsen the menstrual bleeding.
d. It leads to permanent suppression of abnormal endometrial tissues.

Answer 17

ANS: A
Medroxyprogesterone induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished.

Question 18

What is most important for the nurse to teach a patient recently diagnosed with polycystic ovary syndrome?

a. Reasons for a total hysterectomy.
b. How to decrease facial hair growth.
c. Methods to maintain a healthy weight.
d. Ways to reduce the occurrence of acne.

Answer 18

ANS: C
Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, it is usually performed only after other therapies have been unsuccessful.

Question 19

A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. What topic should the nurse plan to discuss with this patient?

a. Endometrial biopsy
b. Endometrial ablation
c. Uterine balloon therapy
d. Dilation and curettage (D&C)

Answer 19

ANS: A
A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

Question 20

What action will the nurse take when caring for a patient who has a radium implant for treatment of cervical cancer?

a. Assist the patient to ambulate every 2 to 3 hours.
b. Use gloves and gown when changing the patient’s bed.
c. Flush the toilet several times right after the patient voids.
d. Encourage the patient to discuss any concerns by telephone.

Answer 20

ANS: D
The nurse should spend minimal time in the patient’s room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves and gown when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant.

Question 21

Which patient in the women’s health clinic will the nurse expect to teach about an endometrial biopsy?
a. A 55-yr-old patient who has 3 to 4 alcoholic drinks each day
b. A 35-yr-old patient who has used oral contraceptives for 15 years
c. A 25-yr-old patient who has a family history of hereditary nonpolyposis
colorectal cancer
d. A 45-yr-old patient who has had six previous full-term pregnancies and two
spontaneous abortions

Answer 21

ANS: C
Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol use does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

Question 22

What topic should the nurse plan to discuss with a patient who has been diagnosed with stage 0 cervical cancer?

a. Radiation
b. Conization
c. Chemotherapy
d. Radical hysterectomy

Answer 22

ANS: B
Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

Question 23

A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching?

a. Use of water-soluble lubricants
b. Risk factors for cervical cancer
c. Antifungal cream administration
d. Possible difficulties with conception

Answer 23

ANS: B
Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease the ability to conceive, or require the use of antifungal creams.

Question 24

Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy?

a. Purpose of ambulation and leg exercises
b. Adverse effects of systemic chemotherapy
c. Decrease in vaginal sensation after surgery
d. Symptoms caused by the drop in estrogen level

Answer 24

ANS: A
Venous thromboembolism is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Most hysterectomies are not done for treatment of cancer. Unless the patient has cancer, chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, her estrogen level will not decrease.

Question 25

A patient is on the surgical unit after a total abdominal hysterectomy. Which finding requires contacting the health care provider?

a. Urine output of 125 mL in the first 8 hours after surgery
b. Decreased bowel sounds in all four abdominal quadrants
c. Report of abdominal pain at the incision site with coughing
d. One-inch area of bloody drainage on the abdominal dressing

Answer 25

ANS: A
The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. Decreased bowel sounds, minor drainage on the dressing, and abdominal pain with coughing are expected after this surgery.

Question 26

A patient undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan?

a. Encourage a high-fiber diet.
b. Perform urinary catheter care.
c. Repack the vagina with gauze daily.
d. Teach the patient to insert a pessary.

Answer 26

ANS: B
The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy

Question 27

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate?

a. “A frequent cause of spotting is endometrial cancer.”
b. “How long has it been since your last menstrual period?”
c. “Breakthrough bleeding is not unusual in women your age.”
d. “Are you using prescription hormone replacement therapy?”

Answer 27

ANS: D
In postmenopausal women, a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient’s symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

Question 28

A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed?

a. “Have you had sexual intercourse?”
b. “Do you use any illegal substances?”
c. “Do you have cramping with your periods?”
d. “At what age did your menstrual periods start?”

Answer 28

ANS: A
The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21 years. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test.

Question 29

A 50-yr-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan?

a. The symptoms may decrease after the patient undergoes menopause.
b. The tumor size is likely to increase throughout the patient’s lifetime.
c. Aspirin or acetaminophen may be used to control mild to moderate pain.
d. The patient will need frequent monitoring to detect any malignant changes.

Answer 29

ANS: A
Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

Question 30

What topic should the nurse plan to teach a female patient who has genital warts?

a. Importance of regular Pap tests
b. Increased risk for endometrial cancer
c. Appropriate use of oral contraceptives
d. Symptoms of pelvic inflammatory disease (PID)

Answer 30

ANS: A
Genital warts are caused by the human papillomavirus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer.

Question 31

A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse’s teaching has been effective?

a. “Both my partner and I will need to be treated.”
b. “I can purchase an over-the-counter medication to treat this infection.”
c. “The symptoms are due to the overgrowth of normal vaginal bacteria.”
d. “The medication will need to be inserted once daily with an applicator.”

Answer 31

ANS: A
Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners and avoidance of sexual contact for 7 days after treatment. The other statements are true for the treatment of Candida albicans infection.

Question 32

A patient in the emergency department reports that she has been sexually assaulted. Which action by the nurse will help to maintain the medicolegal chain of evidence?

a. Labeling all specimens and other materials obtained from the patient
b. Assisting the patient in filling out the application for financial compensation
c. Discussing the availability of the “morning-after pill” for pregnancy prevention
d. Educating the patient about baseline sexually transmitted infection (STI) testing

Answer 32

ANS: A
The careful labeling of specimens and materials will assist in maintaining the chain of evidence. Assisting with paperwork and discussing STIs and pregnancy prevention are interventions that might be appropriate after sexual assault, but they do not help maintain the legal chain of evidence.

Question 33

Which action should the nurse take when a 35-yr-old patient whose repeat cervical Pap test was abnormal?

a. Teach the patient about colposcopy.
b. Teach the patient about endometrial biopsy.
c. Prepare the patient for a dilatation and curettage (D&C).
d. Administer 3 doses of human papillomavirus (HPV) vaccine.

Answer 33

ANS: A
Patients with an abnormal Pap test will typically be referred for colposcopy. Endometrial biopsy is not the next step in evaluation of abnormal Pap results. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26 years.

Question 34

A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first?

a. Determine whether the patient is sexually active.
b. Teach about the side effects of oral contraceptives.
c. Take the patient’s personal and family health history.
d. Suggest nonsteroidal antiinflammatory drugs (NSAIDs).

Answer 34

ANS: C
Oral contraceptives may be appropriate to control this patient’s symptoms, but the patient’s health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Because the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time.

Question 35

Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT) requires discussion with the health care provider about a possible change in therapy?

a. Breast tenderness
b. Left calf swelling
c. Weight gain of 3 lb
d. Intermittent spotting

Answer 35

ANS: B
Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

Question 36

A patient brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a laceration above the right eye. Which action should the nurse take first?

a. Assess the patient’s neurologic status.
b. Assist the patient to remove her clothing.
c. Ask the patient to describe what occurred during the assault.
d. Ask the sexual assault nurse examiner (SANE) to assess the patient.

Answer 36

ANS: A
The first priority is to treat urgent medical problems associated with the sexual assault. The patient’s head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore, her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury

Question 37

A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. What is the greatest risk to the patient at this time?

a. Self-care deficit
b. Wound infection
c. Inadequate nutrition
d. Ineffective sexual pattern

Answer 37

ANS: B
Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The patient may be at risk for other problems, but they are not the greatest concerns in the immediate postoperative time period.

Question 38

A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first?

a. Insert a straight catheter per the PRN order.
b. Encourage the patient to increase oral fluids.
c. Notify the health care provider of the inability to void.
d. Use an ultrasound scanner to check for urinary retention.

Answer 38

ANS: D
Because urinary retention is common with a large cystocele, the nurse’s first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings with the bladder scanner.

Question 39

A patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMDD) symptoms. Which patient information that contraindicates oral contraceptives should be communicated to the health care provider?

a. Bilateral breast tenderness
b. Frequent abdominal bloating
c. History of migraine headaches
d. Previous spontaneous abortion

Answer 39

ANS: C
Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other patient information would not prevent the patient from receiving oral contraceptives.

Question 40

The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first?

a. A patient with a cervical radium implant who is crying in her room
b. A patient reporting level 5/10 pain after an abdominal hysterectomy
c. A patient with a possible ectopic pregnancy who is reporting shoulder pain
d. A patient in the fifteenth week of gestation who has uterine cramping and spotting

Answer 40

ANS: C
The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications.

Question 41

Which information will the nurse include when teaching a patient who has developed a small vesicovaginal fistula 2 weeks into the postpartum period?

a. Take stool softeners to prevent fecal contamination of the vagina.
b. Limit oral fluid intake to minimize the quantity of urinary drainage.
c. Change the perineal pad frequently to prevent perineal skin breakdown.
d. Call the health care provider immediately if urine drains from the vagina.

Answer 41

ANS: C
Because urine will leak from the vagina, the patient should plan to use perineal pads and change them frequently. A high fluid intake is recommended to decrease the risk for urinary tract infections. Fecal contamination is not a concern with vesicovaginal fistulas.

Question 42

A 22-yr-old patient tells the nurse that she has not had a menstrual period for the past 3 months. Which action is most important for the nurse to take?

a. Obtain a urine specimen for a pregnancy test.
b. Ask about any recent stressful lifestyle changes.
c. Measure the patient’s current height and weight.
d. Question the patient about prescribed medications.

Answer 42

ANS: A
Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age. The other actions are also appropriate, but it is important to check for pregnancy in this patient because pregnancy will require rapid implementation of actions to promote normal fetal development such as changes in lifestyle, folic acid intake, and so on.

Question 43

A patient who has been sexually assaulted expresses that she wants to prevent pregnancy. What treatment option should the nurse in the emergency department plan to discuss with the patient?

a. Mifepristone
b. Dilation and evacuation
c. Methotrexate with misoprostol
d. Levonorgestrel (Plan-B One-Step)

Answer 43

ANS: D
Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of intercourse. The other methods are used for therapeutic abortion but not for pregnancy prevention after unprotected intercourse.

Question 44

A healthy 24-yr-old patient who has been vaccinated against human papillomavirus (HPV) has a normal Pap test result. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test?

a. You can wait until after age 30 before having another Pap test.
b. Pap testing is recommended every 3 years for women your age.
c. No further Pap testing is needed until you decide to become pregnant.
d. Yearly Pap testing is suggested for women with multiple sexual partners.

Answer 44

ANS: B

Women ages 21 to 29 years should get a Pap test every 3 years.

Question 45

The nurse in the women’s health clinic has four patients who are waiting to be seen. Which patient should the nurse see first?
a. A 42-yr-old patient with secondary amenorrhea who says that her last menstrual
cycle was 3 months ago
b. A 22-yr-old patient with persistent red-brown vaginal drainage 3 days after
having balloon thermotherapy
c. A 19-yr-old patient with menorrhagia who has been using superabsorbent
tampons and has fever with weakness
d. A 35-yr-old patient with heavy spotting after having a progestin-containing IUD
(Mirena) inserted a month ago

Answer 45

ANS: C
The patient’s history and clinical manifestations suggest possible toxic shock syndrome, which will require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and do not indicate life-threatening complications.

Question 46

Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal patient who prefers not to use hormone replacement therapy (HRT)? (Select all that apply.)

a. Exercise several times a week.
b. Take black cohosh supplements.
c. Drink a glass of wine before sleeping.
d. Increase intake of dietary soy products.
e. Have a daily calcium intake of 1500 mg.

Answer 46

ANS: A, B, D, E
Calcium supplements, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.

Question 47

Which actions can the nurse working in a women’s health clinic delegate to experienced unlicensed assistive personnel (UAP)?
(Select all that apply.)
a. Call a patient with the results of an endometrial biopsy.
b. Assist the health care provider with performing a Pap test.
c. Draw blood for CA-125 levels for a patient with ovarian cancer.
d. Question a patient about use of medications that may cause amenorrhea.
e. Teach the parent of a teenager about human papilloma virus (HPV) vaccine
(Gardasil).

Answer 47

ANS: B,C
Assisting with a Pap test and drawing blood (if trained) are skills that require minimal critical thinking and judgment and can be safely delegated to UAP. Patient teaching, calling a patient who may have questions about results of diagnostic testing, and risk-factor screening all require more education and critical thinking and should be done by the registered nurse (RN).