Exam 1 - Chapter 4

Question 1

Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast
self- examination (BSE)?
a. Between 5 and 7 days after menses ceases
b. Day 1 of the endometrial cycle
c. Midmenstrual cycle
d. Any time during a shower or bath

Answer 1

A - The physiologic alterations in breast size and activity reach their minimal level approximately 5
to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the
menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After
the midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the
shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be
performed while in the shower.

Question 2

Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?

a. Variations in the follicular (preovulatory) phase
b. Intact hypothalamic-pituitary feedback mechanism
c. Functioning corpus luteum
d. Prolonged ischemic phase

Answer 2

A - Almost all variations in the length of the ovarian cycle are the result of variations in the length of
the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not
irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the
ovulatory phase and fertilization. During the ischemic phase, the blood supply to the functional
endometrium is blocked, and necrosis develops. The functional layer separates from the basal
layer, and menstrual bleeding begins

Question 3

How would the physiologic process of the sexual response best be characterized?

a. Coitus, masturbation, and fantasy
b. Myotonia and vasocongestion
c. Erection and orgasm
d. Excitement, plateau, and orgasm

Answer 3

B - Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two
processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of
stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in
two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of
the four phases of the sexual response cycle.

Question 4

Which action would be inappropriate for the nurse to perform before beginning the health
history interview?
a. Smile and ask the client whether she has any special concerns.
b. Speak in a relaxed manner with an even, nonjudgmental tone.
c. Make the client comfortable.
d. Tell the client her questions are irrelevant.

Answer 4

D - The woman should be assured that all of her questions are relevant and important. Beginning any
client interaction with a smile is important and assists in putting the client at ease. If the nurse
speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The
clients comfort should always be ensured before beginning the interview.

Question 5

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 replies, I have special
undergarments that I do not remove for religious reasons. Which is the most appropriate
response from the nurse?
a. You cant have an examination without removing all your clothes.
b. Ill ask the physician to modify the examination.
c. Tell me about your undergarments. Ill explain the examination procedure, and then we
can discuss how you can comfortably have your examination.
d. I have no idea how we can accommodate your beliefs

Answer 5

C - Explaining the examination procedure reflects cultural competence by the nurse and shows
respect for the womans religious practices. The nurse must respect the rich and unique qualities
that cultural diversity brings to individuals. The examination can be modified to ensure that
modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the
plan of care to meet the needs of each woman. Telling the client that her religious practices are
different or strange is inappropriate and disrespectful to the client.

Question 6

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. How should the nurse initially respond?
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

Answer 6

C - An important element of the health history and physical examination is the clients description of
any symptoms she may be experiencing. The best response is for the nurse to inquire about the
symptoms the woman 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.

Question 7

Preconception and prenatal care have become important components of womens health.
What is the guiding principal of preconception care?
a. Ensure that pregnancy complications do not occur.
b. Identify the woman who should not become pregnant.
c. Encourage healthy lifestyles for families desiring pregnancy.
d. Ensure that women know about prenatal care.

Answer 7

C - Preconception counseling guides couples in how to avoid unintended pregnancies, how to
identify and manage risk factors in their lives and in their environment, and how to identify
healthy behaviors that promote the well-being of the woman and her potential fetus.
Preconception care does not ensure that pregnancy complications will not occur. In many cases,
problems can be identified and treated and may not recur in subsequent pregnancies

Question 8

Ovarian function and hormone production decline during which transitional phase?

a. Climacteric
b. Menarche
c. Menopause
d. Puberty

Answer 8

A - The climacteric phase is a transitional period during which ovarian function and hormone
production decline. Menarche is the term that denotes the first menstruation. Menopause refers
only to the last menstrual period.Puberty is a broad term that denotes the entire transitional
period between childhood and sexual maturity.

Question 9

Which statement indicates that a client requires additional instruction regarding BSE?

a. Yellow discharge from my nipple is normal if Im having my period.
b. I should check my breasts at the same time each month, after my period.
c. I should also feel in my armpit area while performing my breast examination.
d. I should check each breast in a set way, such as in a circular motion.

Answer 9

A - Discharge from the nipples requires further examination from a health care provider. The breasts
should be checked at the same time each month. The armpit should also be examined. A circular
motion is the best method during which to ascertain any changes in the breast tissue.

Question 10

A blind woman has arrived for an examination. Her guide dog assists her to the
examination room. She appears nervous and says, Ive never had a pelvic examination. What
response from the nurse would be most appropriate?
a. Dont worry. It will be over before you know it.
b. Try to relax. Ill be very gentle, and I wont hurt you.
c. Your anxiety is common. I was anxious when I first had a pelvic examination.
d. Ill let you touch each instrument that Ill use during the examination as I tell you how it
will be used.

Answer 10

D - The client who is visually impaired needs to be oriented to the examination room and needs a
full explanation of what the examination entails before the nurse proceeds. Telling the client that
the examination will be over quickly diminishes the clients concerns. The nurse should openly
and directly communicate with sensitivity. Women who have physical disabilities should be
respected and involved in the assessment and physical examination to the full extent of their
abilities. Telling the client that she will not be hurt does not reflect respect or sensitivity.
Although anxiety may be common, the nurse should not discuss her own issues nor compare
them to the clients concerns.

Question 11

Which female reproductive organ(s) is(are) responsible for cyclic menstruation?

a. Uterus
b. Ovaries
c. Vaginal vestibule
d. Urethra

Answer 11

A - The uterus is responsible for cyclic menstruation and also houses and nourishes the fertilized
ovum and the fetus. The ovaries are responsible for ovulation and the production of estrogen.
The vaginal vestibule is an external organ that has openings to the urethra and vagina. The
urethra is not a reproductive organ, although it is found in the area.

Question 12

Which body part both protects the pelvic structures and accommodates the growing fetus 
during pregnancy?
a. Perineum
b. Bony pelvis
c. Vaginal vestibule
d. Fourchette

Answer 12

B - The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic
structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is
formed by the labia minor

Question 13

Which phase of the endometrial cycle best describes a heavy, velvety soft, fully matured 
endometrium?
a. Menstrual
b. Proliferative
c. Secretory
d. Ischemic

Answer 13

C - The secretory phase extends from the day of ovulation to approximately 3 days before the next
menstrual cycle. During this secretory phase, the endometrium becomes fully mature again.
During the menstrual phase, the endometrium is shed. The proliferative phase is a period of rapid
growth. During the ischemic phase, the blood supply is blocked and necrosis develops

Question 14

Which part of the menstrual cycle includes the stimulated release of gonadotropinreleasing hormone (GnRH) and follicle-stimulating hormone (FSH)?

a. Menstrual phase
b. Endometrial cycle
c. Ovarian cycle
d. Hypothalamic-pituitary cycle

Answer 14

D - The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The
menstrual cycle is a complex interplay of events that simultaneously occur in the endometrium,
hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases:
menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle
remains under the influence of FSH and estrogen

Question 15

What fatty acids (classified as hormones) are found in many body tissues with complex 
roles in many reproductive functions?
a. GnRH
b. Prostaglandins (PGs)
c. FSH
d. Luteinizing hormone (LH)

Answer 15

B - PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the
hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.
FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen
and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and
fall of estrogen and progesterone.

Question 16

Which information regarding substance abuse is important for the nurse to understand?
a. Although cigarette smoking causes a number of health problems, it has little direct effect
on maternity-related health.
b. Women, ages 21 to 34 years, have the highest rates of specific alcohol-related problems.
c. Coffee is a stimulant that can interrupt body functions and has been related to birth
defects.
d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus;
otherwise, they would not have been prescribed.

Answer 16

B - Although a very small percentage of childbearing women have alcohol-related problems, alcohol
abuse during pregnancy has been associated with a number of negative outcomes. Cigarette
smoking impairs fertility and is a cause of low-birth-weight infants. Caffeine consumption has
not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that
risk must be weighed against their benefit to the mother

Question 17

As part of their participation in the gynecologic portion of the physical examination,
which approach should the nurse take?
a. Take a firm approach that encourages the client to facilitate the examination by following
the physicians instructions exactly
b. Explain the procedure as it unfolds, and continue to question the client to get information
in a timely manner.
c. Take the opportunity to explain that the trendy vulvar self-examination is only for women
at risk for developing cancer.
d. Help the woman relax through the proper placement of her hands and proper breathing
during the examination.

Answer 17

D - Breathing techniques are important relaxation techniques that can help the client during the
examination. The nurse should encourage the client to participate in an active partnership with
the health care provider. Explanations during the procedure are fine, but many women are
uncomfortable answering questions in the exposed and awkward position of the examination.
Vulvar self-examination on a regular basis should be encouraged and taught during the
examination.

Question 18

Which statement best describes Kegel exercises?
a. Kegel exercises were developed to control or reduce incontinent urine loss.
b. Kegel exercises are the best exercises for a pregnant woman because they are so
pleasurable.
c. Kegel exercises help manage stress.
d. Kegel exercises are ineffective without sufficient calcium in the diet.

Answer 18

A - Kegel exercises help control the urge to urinate. Although these exercises may be fun for some,
the most important factor is the control they provide over incontinence. Kegel exercises help
manage urination, not stress.

Question 19

The microscopic examination of scrapings from the cervix, endocervix, or other mucous
membranes to detect premalignant or malignant cells is called what?
a. Bimanual palpation
b. Rectovaginal palpation
c. Papanicolaou (Pap) test
d. Four As procedure

Answer 19

C - The Pap test is a microscopic examination for cancer that should be regularly performed,
depending on the clients age. Bimanual palpation is a physical examination of the vagina.
Rectovaginal palpation is a physical examination performed through the rectum. The four As
procedure is an intervention to help a client stop smoking

Question 20

Which questionnaire would be best for the nurse to use when screening an adolescent
client for an eating disorder?
a. Four Cs
b. Dietary Guidelines for Americans
c. SCOFF screening tool
d. Dual-energy x-ray absorptiometry (DEXA) scan

Answer 20

C - A screening tool specifically developed to identify eating disorders uses the acronym SCOFF.
Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia
nervosa or bulimia. The letters represent the following questions:
Do you make yourself Sick because you feel too full?
Do you worry about loss of Control over the amount that you eat?
Have you recently lost more than One stone (14 pounds) in a 3-month period? Do you think that
you are too Fat, even if others think you are thin?
Does Food dominate your life?
The 4 Cs are used to determine cultural competence. Dietary Guidelines for Americans provide
nutritional guidance for all, not only for those with eating disorders. The DEXA scan is used to
determine bone density

Question 21

The unique muscle fibers that constitute the uterine myometrium make it ideally suited 
for what?
a. Menstruation
b. Birth process
c. Ovulation
d. Fertilization

Answer 21

B - The myometrium is made up of layers of smooth muscle that extend in three directions. These
muscles assist in the birth process by expelling the fetus, ligating blood vessels after birth, and
controlling the opening of the cervical os.

Question 22

Which hormone is responsible for the maturation of mammary gland tissue?

a. Estrogen
b. Testosterone
c. Prolactin
d. Progesterone

Answer 22

D - Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of
the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing
on breast development. Prolactin is produced after birth and released from the pituitary gland; it
is produced in response to infant suckling and an emptying of the breasts.

Question 23

What is the goal of a long-term treatment plan for an adolescent with an eating disorder?

a. Managing the effects of malnutrition
b. Establishing sufficient caloric intake
c. Improving family dynamics
d. Restructuring client perception of body image

Answer 23

D - The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis.
Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining
adequate caloric intake. Although family therapy is indicated when dysfunctional family
relationships exist, the primary focus of therapy for eating disorders is to help the adolescent
cope with complex issues. The focus of treatment in individual therapy for an eating disorder
involves restructuring cognitive perceptions about the individuals body image.

Question 24

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
physician has retired, and she is going to see the womens health nurse practitioner for her visit.
What should the nurse do to facilitate a positive health care experience for this client?
a. Remind the woman that she is long overdue for her examination and that she should
come in annually.
b. Carefully listen, and allow extra time for this womans health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old physician.
d. Encourage the woman to talk about the death of her husband and her fears about her own
death.

Answer 24

B - The nurse has an opportunity to use reflection and empathy while listening, as well as ensure an
open and caring communication. Scheduling a longer appointment time may be necessary
because older women may have longer histories or may need to talk.

Question 25

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. The correct response by the
nurse would be what?
a. Reassure the woman that the examination will reveal any problems.
b. Explain the process of vulvar self-examination, and reassure the woman that she should
become familiar with normal and abnormal findings during the examination.
c. Reassure the woman that bumps can be treated.
d. Reassure her that most women have bumps on their labia.

Answer 25

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.

Question 26

Which statement regarding female sexual response is inaccurate?
a. Women and men are more alike than different in their physiologic response to sexual
arousal and orgasm.
b. Vasocongestion is the congestion of blood vessels.
c. Orgasmic phase is the final state of the sexual response cycle.
d. Facial grimaces and spasms of the hands and feet are often part of arousal.

Answer 26

C - The final state of the sexual response cycle is the resolution phase after orgasm. Men and women
are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the
genitals. Arousal is characterized by increased muscular tension (myotonia).

Question 27

A client at 24 weeks of gestation says she has a glass of wine with dinner every evening.
Why should the nurse counsel her to eliminate all alcohol intake?
a. Daily consumption of alcohol indicates a risk for alcoholism.
b. She is at risk for abusing other substances as well.
c. Alcohol places the fetus at risk for altered brain growth.
d. Alcohol places the fetus at risk for multiple organ anomalies.

Answer 27

C - No period during pregnancy is safe to consume alcohol. The documented effects of alcohol
consumption during pregnancy include fetal mental retardation, learning disabilities, high
activity level, and short attention span. The fetal brain grows most rapidly in the third trimester
and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been
linked to alcohol use.

Question 28

Which statement by the client indicates that she understands BSE?

a. I will examine both breasts in two different positions.
b. I will examine my breasts 1 week after my menstrual period starts.
c. I will examine only the outer upper area of the breast.
d. I will use the palm of the hand to perform the examination.

Answer 28

B - The woman should examine her breasts when hormonal influences are at their lowest level. The
client should be instructed to use four positions: standing with arms at her sides, standing with
arms raised above her head, standing with hands pressed against hips, and lying down. The entire
breast needs to be examined, including the outer upper area. The client should use the sensitive
pads of the middle three fingers.

Question 29

What is the primary reason why a woman who is older than 35 years may have difficulty
achieving pregnancy?
a. Personal risk behaviors influence fertility.
b. Mature women have often used contraceptives for an extended time.
c. Her ovaries may be affected by the aging process.
d. Prepregnancy medical attention is lacking.

Answer 29

C - Once the mature woman decides to conceive, a delay in becoming pregnant may occur because
of the normal aging of the ovaries.

Question 30

What is the most dangerous effect on the fetus of a mother who smokes cigarettes while
pregnant?
a. Genetic changes and anomalies
b. Extensive central nervous system damage
c. Fetal addiction to the substance inhaled
d. Intrauterine growth restriction

Answer 30

D - The major consequences of smoking tobacco during pregnancy are low-birth-weight infants,
prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or
extensive central nervous system damage. Addiction to tobacco is not usually a concern related
to the neonate.

Question 31

What are the two primary functions of the ovary? (Select all that apply.)

a. Normal female development
b. Ovulation
c. Sexual response
d. Hormone production
e. Sex hormone release

Answer 31

B,D - The two functions of the ovaries are ovulation and hormone production. The presence of ovaries
does not guarantee normal female development. The ovaries produce estrogen, progesterone, and
androgen. Ovulation is the release of a mature ovum from the ovary. Sexual response is a
feedback mechanism involving the hypothalamus, anterior pituitary gland, and ovaries.

Question 32

Which statements regarding menstruation (periodic uterine bleeding) are accurate?
(Select all that apply.)
a. Menstruation occurs every 28 days.
b. During menstruation, the entire uterine lining is shed.
c. Menstruation begins 7 to 10 days after ovulation.
d. Menstruation leads to fertilization.
e. Average blood loss during menstruation is 50 ml.

Answer 32

A,B,E - Menstruation is the periodic uterine bleeding that is controlled by a feedback system involving
three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The
average length of a menstrual cycle is 28 days; however, variations are normal. During the
endometrial cycle, the functional two thirds of the endometrium is shed

Question 33

Women of all ages will receive substantial and immediate benefits from smoking
cessation. The process is not easy, and most people have attempted to quit numerous times
before achieving success. Which organizations provide self-help and smoking cessation
materials? (Select all that apply.)
a. Leukemia and Lymphoma Society
b. March of Dimes
c. American Cancer Society
d. American Lung Association
e. Easter Seals

Answer 33

B,C,D - The March of Dimes, the American Lung Association, and the American Cancer Society have
self-help materials available. The Leukemia and Lymphoma Society support research for these
two types of cancer. Easter Seals is best known for its work with disabled children

Question 34

Many pregnant teenagers wait until the second or third trimester to seek prenatal care.
What should the nurse recognize as reasons for this delay? (Select all that apply.)
a. Lack of realization that they are pregnant
b. Uncertainty as to where to go for care
c. Continuing to deny the pregnancy
d. Desire to gain control over their situation
e. Wanting to hide the pregnancy as long as possible

Answer 34

A,B,C,E - These reasons are all valid explanations why teens delay seeking prenatal care. An adolescent
often has little to no understanding of the increased physiologic needs that a pregnancy places on
her body. Once care is sought, it is often sporadic, and many appointments are usually missed.
The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal
care. Planning for her pregnancy and impending birth actually provides some sense of control for
the teen and increases her feelings of competency. Receiving praise from the nurse when she
attends her prenatal appointments will reinforce the teens positive self-image.