Female Genitourinary System - Questions Flashcards
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. “Let’s check with the physician to see if you are a candidate for this vaccine.”
d. “The vaccine cannot protect you if you already have an HPV infection.”
ANS: D
The HPV vaccine is appropriate for girls and women age 9 to 26 years and is administered to prevent cervical cancer by preventing HPV infections before girls become sexually active. However, it cannot protect the woman if an HPV infection is already present.
The nurse is examining a female patient’s vestibule. What does the nurse expect to visualize?
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
ANS: A
The labial structures encircle a boat-shaped space, or cleft, termed the vestibule. Within the vestibule are numerous openings. The urethral meatus and vaginal orifice are visible. The ducts of the paraurethral (Skene) glands and the vestibular (Bartholin) glands are present but not visible.
During a speculum inspection of the vagina, what would the nurse expect to see at the end of the vaginal canal?
a. Cervix
b. Uterus
c. Ovaries
d. Fallopian tubes
ANS: A
At the end of the canal, the uterine cervix projects into the vagina.
The uterus is usually positioned tilting forward and superior to the bladder. What is this position called?
a. Anteverted and anteflexed
b. Retroverted and anteflexed
c. Retroverted and retroflexed
d. Superiorverted and anteflexed
ANS: A
The uterus is freely movable, not fixed, and usually tilts forward and superior to the bladder (a position labeled as anteverted and anteflexed).
An 11-year-old girl is in the clinic for a sports physical examination. The nurse notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. The nurse should use which of these techniques to best assist the young girl in understanding the expected sequence for development?
a. Use the Tanner scale on the five stages of sexual development.
b. Describe her development and compare it with that of other girls her age.
c. Use the Jacobsen table on expected development on the basis of height and weight data.
d. Reassure her that her development is within normal limits and tell her not to worry about the next step.
ANS: A
The Tanner scale on the five stages of pubic hair development is helpful in teaching girls the expected sequence of sexual development (see Table 26-1). The other responses are not appropriate.
A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart that her cervix is softened and looks cyanotic. Based on these findings, what two signs is the patient exhibiting?
a. Tanner and Hegar
b. Hegar and Goodell
c. Chadwick and Hegar
d. Goodell and Chadwick
ANS: D
Shortly after the first missed menstrual period, the female genitalia show signs of the growing fetus. The cervix softens (Goodell sign) at 4 to 6 weeks, and the vaginal mucosa and cervix look cyanotic (Chadwick sign) at 8 to 12 weeks. These changes occur because of increased vascularity and edema of the cervix and hypertrophy and hyperplasia of the cervical glands. Hegar sign occurs when the isthmus of the uterus softens at 6 to 8 weeks. Tanner sign is not a correct response.
What usually occurs to the cells in the reproductive tract to cause the changes normally associated with menopause?
a. Aging
b. Becoming fibrous
c. Estrogen dependent
d. Able to respond to progesterone
ANS: C
Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes. The other options are not correct.
The nurse is reviewing the changes that occur with menopause. Which changes are expected?
a. Uterine and ovarian atrophy, along with thinning of 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
ANS: A
The uterus shrinks because of its decreased myometrium. The ovaries atrophy to 1 to 2 cm and are not palpable after menopause. The sacral ligaments relax, and the pelvic musculature weakens; consequently, the uterus droops. The cervix shrinks and looks paler with a thick glistening epithelium. The vaginal epithelium atrophies, becoming thinner, drier, and itchy. The vaginal pH becomes more alkaline, and secretions are decreased, which results in a fragile mucosal surface that is at risk for vaginitis
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. “You can continue with hormone replacement therapy as it actually decreases your risk for breast cancer.”
b. “You should be aware that you’re at increased risk for dyspareunia because of decreased vaginal secretions.”
c. “You have only stopped menstruating and there are not really any other changes that you need to be concerned about.”
d. “You likely may have difficulty with sexual pleasure as a result of drastic changes
in the female sexual response cycle.”
ANS: B
Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse (dyspareunia). Hormone replacement therapy increases, not decreases, the risk for breast cancer. In addition to cessation of menses, there are several other changes that occur with menopause. The female’s hormonal milieu decreases rapidly, the uterus shrinks, the ovaries atrophy, the pelvic musculature weakens, the cervix shrinks, and the vagina becomes shorter, narrower, less elastic, and vaginal epithelium atrophies, becoming thinner, drier, and itchy. However, these physical changes need not affect sexual pleasure and function.
A woman is in the clinic for an annual gynecologic examination. How should the nurse begin the interview?
a. Menstrual history, because it is generally nonthreatening.
b. Sexual history, because discussing it first will build rapport.
c. Obstetric history, because it includes the most important information.
d. Urinary system history, because problems may develop in this area as well.
ANS: A
Menstrual history is usually nonthreatening and therefore a good topic with which to begin the interview. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start.
A patient has had three pregnancies and two live births. How should the nurse record this information?
a. G2; P2; AB1
b. G3; P2; AB0
c. G3; P2; AB1
d. G3; P3; AB1
ANS: C
Gravida (G) is the number of pregnancies. Para (P) is the number of births. Abortions (AB) are interrupted pregnancies, including elective abortions and spontaneous miscarriages.
During the interview with a female patient, the nurse gathers data that indicates 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.”
ANS: C
Hormone shifts occur during the perimenopausal period, and associated symptoms of menopause may occur, such as hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, and itching. Muscle aches at night and breast tenderness as the first sign of pregnancy are not perimenopausal symptoms and the patient stating they will be happy to not have to worry about periods also does not indicate perimenopause.
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. How should the nurse respond?
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.”
ANS: B
Side effects of HRT include fluid retention, breast pain, and vaginal bleeding. The other responses are not correct.
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. What does this finding suggest?
a. Dysuria
b. Hematuria
c. Urge incontinence
d. Stress incontinence
ANS: D
Stress incontinence is involuntary urine loss with physical strain, sneezing, or coughing. Dysuria is pain or burning with urination. Hematuria is bleeding with urination. Urge incontinence is involuntary urine loss that occurs as a result of an overactive detrusor muscle in the bladder that contracts and causes an urgent need to void.
During the interview, a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. What would be the most appropriate response by the nurse?
a. “Oh, don’t worry. Some cyclic vaginal discharge is normal.”
b. “Have you been engaging in unprotected sexual intercourse?”
c. “I’d like more information about the discharge. What color is it?”
d. “Have you had any urinary incontinence associated with the discharge?”
ANS: C
Questions that help the patient reveal more information about her symptoms should be asked in a nonthreatening manner. Asking about the amount, color, and odor of the vaginal discharge provides the opportunity for further assessment. Normal vaginal discharge is small, clear or cloudy, and always nonirritating.
A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. What should the nurse ask the woman?
a. “Have you had excessive vaginal bleeding?”
b. “Have you experienced changes in your urination patterns?”
c. “Do you have any unusual vaginal discharge or itching?”
d. “Have you noticed any changes in your desire for intercourse?”
ANS: C
Several medications may increase the risk for vaginitis. Broad-spectrum antibiotics alter the balance of normal flora, which may lead to the development of vaginitis. The other questions are not appropriate.
Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during a health interview?
a. “Now, it is time to talk about your sexual history. When did you first have intercourse?”
b. “Most women your age have had more than one sexual partner. How many would you say you have had?”
c. “Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?”
d. “Women often have questions about their sexual relationship and how it affects
their health. Do you have any questions?”
ANS: D
The nurse should begin with an open-ended question to assess individual needs. The nurse should include appropriate questions as a routine part of the health history, because doing so communicates that the nurse accepts the individual’s sexual activity and believes it is important. The nurse’s comfort with the discussion prompts the patient’s interest and, possibly, relief that the topic has been introduced. The initial discussion establishes a database for comparison with any future sexual activities and provides an opportunity to screen sexual problems.
A 22-year-old woman has been considering using oral contraceptives. As a part of her health history, what should the nurse 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?”
ANS: D
Oral contraceptives, together with cigarette smoking, increase the risk for cardiovascular side effects. If cigarettes are used, then the nurse should assess the patient’s smoking history. The other questions are not appropriate
A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first?
a. Ascertain whether either of them has been using broad-spectrum antibiotics.
b. Explain that couples are considered infertile after 1 year of unprotected intercourse.
c. Immediately refer the woman to an expert in pelvic inflammatory disease—the most common cause of infertility.
d. Explain that couples are considered infertile after 3 months of engaging in unprotected intercourse and that they will need a referral to a fertility expert.
ANS: B
Infertility is considered after 1 year of engaging in unprotected sexual intercourse without conceiving. The other actions are not appropriate.