CHAPTER 6: HEALTH ASSESMENT Flashcards
- If a patient chooses to do breast self-examination (BSE), when is the best time to do this?
a. 5 to 7 days after menses ceases
b. Day 1 of the endometrial cycle
c. 7 days before the onset of menses
d. Any time during a shower or bath
ANS: A
The physiological alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. Therefore, women should perform BSE during this phase of the menstrual cycle.
- A patient is unable to lie in the lithotomy position for a Pap smear test. Which is an alternative position for a gynecological examination?
a. Sims
b. Prone
c. Lateral
d. High-Fowler’s
ANS: C
Alternative positions to the lithotomy position that may be used for a pelvic examination include a lateral (side-lying) position, a V-shaped position, a diamond-shaped position, and an M-shaped position.
- In which is it more likely that intimate partner violence will increase?
a. Marriage
b. Pregnancy
c. Birth of a baby
d. Children becoming school-age
ANS: B
Intimate partner violence is known to increase in pregnancy and during separation and divorce. Marriage, birth of a baby, and children becoming school-age have not been reported to be associated with an increase in intimate partner violence
- Which best reflects who should be screened for risk of abuse during pregnancy?
a. Adolescents
b. Single mothers
c. Women of low socioeconomic status
d. All pregnant women when they enter prenatal care
ANS: D
All women who enter the health care system should be screened for their risk of abuse. Age, marital status, or socioeconomic status are not to be singled out for abuse screening.
- When performing a gynecological exam, the nurse would expect to find Bartholin glands in which position on the labia majora?
a. 10 and 2 o’clock
b. 12 and 6 o’clock
c. 8 and 4 o’clock
d. 9 and 3 o’clock
ANS: C
The correct position to locate Bartholin glands is at the 8 and 4 o’clock positions on the labia majora.
- The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the
front open. The woman states, “I have special undergarments that I do not remove, for religious reasons.” Which information informs the nurses’ response?
a. All clothes must be removed for the examination.
b. Ask the health care provider to consider altering the examination.
c. Explore options to complete examination with the undergarments on.
d. Defer the examination until the undergarments are removed.
ANS: C
This statement reflects cultural competence by the nurse and shows respect for the woman’s religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. In recognizing the value of these differences, the nurse can modify the plan of care to meet the needs of each woman.
- A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is going to see the women’s health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience?
a. Remind the woman that she is long overdue for her examination and that she
should come in annually.
b. Listen carefully and allow extra time for this woman’s health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old doctor.
d. Encourage the woman to talk about the death of her husband and her fears about
her own death.
ANS: B
The nurse has an opportunity to use reflection and empathy while listening and to ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches at the initial visit.
- During a health history interview, a woman states that she thinks that she has “bumps” on her labia. She also states that she is not sure how to check herself. Which is the correct response?
a. Reassure the woman that the examination will not reveal any problems.
b. Teach her what normal and abnormal findings are during the examination.
c. Inform the woman that “bumps” can be treated.
d. Tell her that most women have “bumps” on their labia.
ANS: B
During the assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the “bumps” would not be an accurate response.
- A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. What should be the nurse’s initial response?
a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap)
test for which she is scheduled.
b. Reassure the woman that using vaginal cream is not a problem for the
examination.
c. Ask the woman to describe the symptoms that indicate to her that she has a
vaginal infection.
d. Ask the woman to reschedule the appointment for the examination.
ANS: C
An important element of the history and physical examination is the patient’s description of any symptoms she may be
experiencing. Although vaginal creams may interfere with the Pap test, the best response is for the nurse to inquire about the symptoms the patient is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.
- Upon vaginal examination, the nurse sees a bulge from the anterior vaginal wall. What should the nurse suspect?
a. Rectocele
b. Cystocele
c. Uterine lesion
d. Scar tissue from previous episiotomy
ANS: B
Upon vaginal examination, if an anterior vaginal bulge is palpated or visualized, the most probable cause is a cystocele or urethrocele. A rectocele would be indicated if the bulge was on the posterior vaginal wall. A uterine lesion would not be seen or palpated through the vaginal wall. Scar tissue from a previous episiotomy would be seen or palpated on the perineum.
- Which comment would indicate that the patient requires additional instruction about breast self-examination (BSE)?
a. Yellow nipple discharge during menses.
b. Check breasts at the same time each month.
c. Feel the armpit area when performing a breast examination.
d. It is not recommended to do BSE.
ANS: A
Discharge from the nipples requires further examination from a health care provider. Check breasts at the same time each month, feel in armpit area while performing breast examination. BSE are not recommended to do although some women may feel more comfortable doing them and must be taught the appropriate method.
- Diethylstilbestrol (DES), no longer available, was used for pregnant patients to increase their chances of having a successful pregnancy. Which has an increased risk of a cockscomb?
a. DES sons
b. DES daughters
c. DES granddaughters
d. Women who took DES while pregnant
ANS: B
Anomalies such as a cockscomb (a protrusion over the cervix that looks like a rooster’s comb) and a hooded or collared cervix are often seen in diethylstilbestrol daughters. There are no known effects for DES granddaughters. DES women are at an increased risk of breast cancer.
- At which age may a woman discontinue Pap screening?
a. Never
b. After child-bearing years
c. After menopause
d. After the age of 70
ANS: D
Women can discontinue Pap screening after the age of 70 years, provided that their last three to four Pap tests have been normal.
- Before Pap screening it is recommended that the woman abstain from sexual intercourse for at least what period of time before the test?
a. 12 hours
b. 24 hours
c. 48 hours
d. 7 days
ANS: B
It is recommended that women not have sexual intercourse for at least 24 hours before the procedure.
- Which should a nurse do as part of their participation in the gynecological portion of the physical examination?
a. Take a firm approach that encourages the patient to facilitate the examination by
following the health care provider’s instructions exactly.
b. Explain the procedure as it unfolds and continue to question the patient to get information in a timely manner.
c. Take the opportunity to explain how to do a vulvar self-examination.
d. Help the patient relax through proper placement of their hands and proper
breathing during the examination.
ANS: D
Breathing techniques are important relaxation techniques that can help the patient during the examination. The nurse should encourage the patient to participate in an active partnership with the care provider. Explanations during the procedure are fine, but many patients are uncomfortable answering questions in the exposed and awkward position of the examination. Vulvar self-examinations are not recommended on a regular basis although patients are taught to know their bodies.
