OB Exam #5

Question 1

When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:

A. Anatomic abnormalities
B. Type 1 diabetes mellitus
C. Lack of exercise
D. Hysterectomy

Answer 1

C. Lack of exercise

Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Hysterectomy is a possible cause of amenorrhea.

Question 2

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?

A. Increasing the intake of red meat and simple carbohydrates

B. Reducing the intake of diuretic foods, such as peaches and asparagus

C. Temporarily substituting physical activity for a sedentary lifestyle

D. Using a heating pad on the abdomen to relieve cramping

Answer 2

D. Using a heating pad on the abdomen to relieve cramping

Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.

Question 3

While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. The nurse should collect additional information with which statement?

A. The woman says her menstrual flow lasts 5 to 6 days.

B. She describes her flow as very heavy.

C. She reports that she has had a small amount of spotting midway between her periods for the past 2 months.

D. She says the length of her menstrual cycle varies from 26 to 29 days.

Answer 3

B. She describes her flow as very heavy.

Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.

Question 4

While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?

A. African-American race
B. Low protein intake
C. Obesity
D. Cigarette smoking

Answer 4

D. Cigarette smoking

Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.

Question 5

During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as:

A. Amenorrhea
B. Dysmenorrhea
C. Dysparunia
D. Premenstrual syndrome (PMS)

Answer 5

B. Dysmenorrhea

Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.

Question 6

With regard to dysmenorrhea, nurses should be aware that:

A. It is more common in older women

B. It is more common in leaner women who exercise strenuously

C. Symptoms can begin at any point in the ovulatory cycle

D. Pain usually occurs in the suprapubic area or lower abdomen

Answer 6

D. Pain usually occurs in the suprapubic area or lower abdomen

Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Dysmenorrhea is more common in younger women ages 17 to 24. Dysmenorrhea is more common in women who smoke and who are obese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow.

Question 7

Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?

True
False

Answer 7

True

Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.

Question 8

Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence are a delayed result of childbearing. These defects do not appear in women who have never been pregnant. Is this statement true or false?

Answer 8

False

These problems are associated with older mothers; however, women who have never been pregnant can experience them as well. Incontinence is the direct result of congenital or acquired weakness of the pelvic support structures. This condition often appears during menopause when ovarian hormones and pelvic tissue are lost. The incidence does tend to remain higher in women who have given birth.

Question 9

Tumors that are on pedicles (stalks) and present in either the endometrium or cervix are more commonly known as ______________.

Answer 9

Uterine polyps

Uterine polyps The etiology of this type of tumor is unknown, although they may develop in response to hormonal stimulus or be the result of inflammation. Polyps are benign lesions that can be removed surgically.

Question 10

A ____________________ cyst is a germ cell tumor that contains substances such as hair, teeth, sebaceous secretions, and bones.

Answer 10

Dermoid

Question 11

Some plant foods contain ________ and are capable of interacting with estrogen receptors in the body.

Answer 11

Phytoestrogens

Question 12

Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):

A.  Soy 
B.  Vitamin C 
C.  Vitamin K 
D.  Vitamin E 
E.  Vitamin A

Answer 12

A. Soy
D. Vitamin E

Both soy and vitamin E have been reported to help alleviate menopausal symptoms. Vitamins C, K, and A have no apparent effect on menopausal symptoms.

Question 13

Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.

A. Consume large quantities of caffeine

B. Drink a glass of wine
C. Eat Mexican food
D. Drink ice water
E. Drink warm beverages

Answer 13

D. Drink ice water

Ice water may help alleviate the hot flashes. Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or drinking warm beverages most likely would exacerbate the hot flashes.

Question 14

Your client is undergoing treatment for ovarian cancer. Please identify which common nutritional problems are related to gynecologic cancers and the treatment thereof. (choose all that apply)

A.  Stomatitis 
B.  Constipation 
C.  Anorexia 
D.  Diarrhea 
E.  Nausea and vomiting

Answer 14

All of them

Stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client’s plan of care. To ensure recovery these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B and K.

Question 15

During internal radiation therapy for cervical cancer, the nurse should:

A. Wear gloves when assessing the cervical intracavity implant

B. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours

C. Prepare the client for an enema before insertion

D. Limit staff or visitor exposure to 30 minutes or less per 8 hours

Answer 15

D. Limit staff or visitor exposure to 30 minutes or less per 8 hours

Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation. Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection. An indwelling catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel prep is necessary.

Question 16

With regard to planning treatment for a pregnant woman with breast cancer, which statement about timing or type of treatment is correct?

A. The fetus is most at risk during the first trimester.

B. The fetus is most at risk during the second trimester.

C. The fetus is most at risk during the third trimester.

D. Surgery is more risky than chemotherapy in the first trimester.

Answer 16

A. The fetus is most at risk during the first trimester.

The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is less risky than chemotherapy in the first trimester.

Question 17

The nurse should be aware that a pessary would be most effective in the treatment of what disorder?

A. Cystocele
B. Uterine prolapse
C. Rectocele
D. Stress urinary incontinence

Answer 17

B. Uterine prolapse

A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. A pessary is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. It is unlikely that a pessary is the most effective treatment for stress incontinence.

Question 18

Risky sexual behaviors and inadequate preventive health behaviors are the two primary areas of risk for sexually transmitted infections (STIs).

True
False

Answer 18

True

Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals with less education may not be aware of proper prevention techniques; however, these are not the primary areas for STIs. Having a large number of sexual partners is certainly a risk-taking behavior. Race does not increase the risk for STIs.

Question 19

Which of the following sexually transmitted infections are bacterial?

A.  Syphilis 
B.  Trichominiasis 
C.  Chlamydia 
D.  Gonorrhea 
E.  Group B strep 
F.  Hepatitis B

Answer 19

A. Syphilis
C. Chlamydia
D. Gonorrhea
E. Group B strep

Question 20

To detect the human immunodeficiency virus (HIV), most laboratory tests focus on:

A. HIV virus
B. HIV antibodies
C. CD4 counts
D. CD8 counts

Answer 20

B. HIV antibodies

The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. In order to determine if the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed in order to detect HIV.

Question 21

What is the nurse’s primary responsibility for a couple diagnosed with multiple severe fetal abnormalities?

A. refer the couple to a new OB/GYN

B. refer the couple for intrauterine fetal surgery

C. refer the couple for possible pregnancy termination

D. refer the couple for genetic counseling

Answer 21

D. refer the couple for genetic counseling

Question 22

What is the chance for a fetus to have an autosomal dominant trait when one parent has the trait?

A.  25% for any child 
B.  50% for any child 
C.  75% for any child 
D.  50% for all male children 
E.  50% for all female children

Answer 22

B. 50% for any child

50% risk to have the trait, 50% risk to be normal

Question 23

What is the chance of a baby having an autosomal recessive trait when both parents are carriers for that trait?

A. 50% if it’s a male
B. 50% if it’s a female
C. 25%
D. 75%

Answer 23

C. 25%

Question 24

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a “fishy” odor; complains of pruritus. Based on these findings, the nurse suspects that this woman has:

A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
D. Gonorrhea

Answer 24

A. Bacterial vaginosis

Most women with bacterial vaginosis (BV) complain of a characteristic “fishy odor.” The discharge usually is profuse, thin, and has a white, gray, or milky color. Some women also may have mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish to greenish, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.

Question 25

A nurse must be cognizant that an individual’s genetic makeup is known as his/her: A. Genotype B. Phenotype C. Karyotype D. Chromotype

Answer 25

A. Genotype The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual’s genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes. Genotype refers to an individual’s genetic makeup

Question 26

How would you state the karyotype for Kleinfelter's?

Answer 26

47XXY

Question 27

Down Syndrome =

Answer 27

Trisomy 21

Question 28

After a client has a positive Chlamydia trachomatis culture, she and her husband return for counseling. Which question should the nurse ask first during the assessment? A. “Do you have contacts to identify?” B. “What is your understanding regarding how Chlamydia is transmitted?” C. “Do you have questions about the culture and its validity?” D. “Do you have allergies to the medications?”

Answer 28

B. “What is your understanding regarding how Chlamydia is transmitted?” The transmission of Chlamydia may or may not have been made clear to both partners so the nurse would have to assess this first. Chlamydia is a reported sexually tranmitted disease. A may be part of the follow up. C is a possibility but most cultures used today have few false positives. D would be done later in the assessment.

Question 29

To promote safety, what priority action would the nurse implement in obtaining a blood specimen from a client with hepatitis B? A. Clean area with antiseptic solution. B. Wear a pair of clean gloves. C. Apply pressure to site for 5 seconds. D. Recap needle to avoid carrying exposed needle.

Answer 29

B. Wear a pair of clean gloves. Clean gloves should be worn at all times when handling any client’s body fluids. A is correct but not higher priority over B. C is incorrect because venipuncture sites of clients with hepatitis B should be held for a longer period of time due to possibility of increased bleeding associated with an impaired liver. D is unsafe.

Question 30

Which statement about the various forms of hepatitis is accurate? A. A vaccine exists for hepatitis C but not for hepatitis B. B. Hepatitis A is acquired by eating contaminated food or drinking polluted water. C. Hepatitis B is less contagious than human immunodeficiency virus (HIV). D. The incidence of hepatitis C is decreasing.

Answer 30

B. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

Question 31

For which of the following reasons would the nurse refer a client for a prenatal genetics consultation? (choose all that apply) A. age 36 at delivery B. abnormal quad screen result C. one previous pregnancy loss D a cousin with a birth defect E. working in a factory where chemical exposure is possible

Answer 31

A. age 36 at delivery B. abnormal quad screen result D a cousin with a birth defect E. working in a factory where chemical exposure is possible All but C (the third answer) are reasons for referral. Guidelines state that need 2 or more pregnancy losses for referral.

Question 32

What are the most common perinatal complications associated with bacterial sexually transmitted infections (STI's)?

Answer 32

``` preterm labor preterm birth miscarriage IUGR - intrauterine growth restriction newborn eye infections ```

Question 33

Which virus is most threatening to the fetus and neonate? A. Hepatitis A virus B. Herpes simplex virus (HSV) C. Hepatitis B virus (HBV) D. Cytomegalovirus (CMV)

Answer 33

C. Hepatitis B virus (HBV) HBV is the virus most threatening to the fetus and neonate. Hepatitis A is not the most threatening to the fetus. HSV is not the most threatening to the neonate. Although serious, CMV is not the most threatening to the fetus.

Question 34

A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner orders which preparation for treatment? A. Clindamycin B. Penicillin C. Fluconozole D. Acyclovir

Answer 34

C. Fluconozole The symptoms suggest candidiasis/yeast infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis/yeast. Penicillin is used to treat syphilis. Clindamycin and metronidazole are used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Question 35

When a client’s newborn dies immediately after birth due to a Trisomy 13, the nurse's primary responsibility is to: A. avoid letting the client see the infant B. say “you can have another baby” C. provide grief counseling and support D. obtain tissue samples.

Answer 35

C. provide grief counseling and support

Question 36

A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: A. Occurrence risk B. Recurrence risk C. Predictive testing D. Predisposition testing

Answer 36

B. Recurrence risk

Question 37

Which of the following sexually transmitted infections are viral? ``` A. Trichomoniasis B. HIV C. HSV D. Pediculosis E. Group B strep F. CMV G. HPV ```

Answer 37

B. HIV C. HSV F. CMV G. HPV

Question 38

What is the most common bacterial sexually transmitted infection (STI)?

Answer 38

Chlamydia

Question 39

What does TORCH stand for?

Answer 39

``` T = toxoplasmosis, O = other, R = rubella, C = cytomegalovirus (CMV), H = Herpes ```

Question 40

The karyotype designated as female is______

Answer 40

46XX

Question 41

The karyotype designated as male is _____

Answer 41

46XY

Question 42

A saline wet smear (vaginal secretions mixed with normal saline on a glass slide) is the test for: A. Bacterial vaginosis B. Candidiasis C. Yeast infection D. Trichomoniasis

Answer 42

D. Trichomoniasis The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. “Yeast infection” is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

Question 43

The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. This initiative is significant to nurses because: A. There are few genetic tests available to identify this information B. Only physicians should obtain this detailed information C. Clients cannot accurately complete these histories on their own D. This is the single most cost effective source of genetic information

Answer 43

D. This is the single most cost effective source of genetic information Although there are more than 1000 genetic tests available, the single most cost-effective piece of genetic information is the family history. Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information. A computerized tool called My Family Health Portrait is available free of charge (www.hhs.gov/familyhistory/download.html). Other tools to aid the lay community in completing their family histories are available to the public.

Question 44

Genetics

Answer 44

is the study of a single gene or gene sequences and their effects on a living organism. The branch of biology that studies heredity and variation in organisms.

Question 45

Genome

Answer 45

Complete Complement of an organisms DNA All of the Chromosomes

Question 46

Chromosomes

Answer 46

Carry Genes (physical structure) A chromosome is one molecule of DNA

Question 47

Gene

Answer 47

Unit of Heredity Made of Segments of DNA

Question 48

Allele

Answer 48

one version of a gene

Question 49

Loci

Answer 49

location of specific gene on chromosome

Question 50

Sex chromosomes

Answer 50

X and Y chromosomes only

Question 51

Autosomes

Answer 51

all chromosomes except sex

Question 52

Mutation

Answer 52

Definition - when a DNA gene is damaged or changed in such a way as to alter the genetic message carried by that gene.

Question 53

Mutagen

Answer 53

An agent of substance that can bring about a permanent alteration to the physical composition of a DNA gene such that the genetic message is changed.

Question 54

Genotype

Answer 54

all the genes of an organism

Question 55

Phenotype

Answer 55

the expression of genes, an organism’s traits

Question 56

Karyotype

Answer 56

photographic representation of chromosomes

Question 57

Homozygous

Answer 57

pair of identical alleles for a characteristic/gene

Question 58

Heterozygous

Answer 58

two different alleles for a characteristic/gene

Question 59

Dominant

Answer 59

one copy of gene expressed

Question 60

Recessive

Answer 60

requires two copies of gene to express

Question 61

Clinically applicable genetic tests may be used for:

Answer 61

Diagnostic testing - confirm or r/o disorder Predictive testing – assymptomatic individuals Carrier testing - identify those with recessive disorder Prenatal testing - performed during pregnancy Preimplantation testing - done on early embryos in IVF Newborn screening – identify disorder for treatment

Question 62

What is a Genetics Consultation?

Answer 62

Evaluation of an individual or family for: Confirm, diagnose or rule out genetic condition Identify medical management issues Calculate and communicate genetic risks Provide or arrange for psychosocial support

Question 63

Reasons for prenatal genetics consult

Answer 63

> 35 years at delivery Abnormal triple/quad screen results or fetal ultrasound Personal or family history of known or suspected genetic disorder, birth defect, or chromosomal abnormality Exposure to a known or suspected teratogen Medical condition known or suspected to affect fetal development Two or more pregnancy losses Close biological relationship of parents Ethnic predisposition to certain genetic disorders

Question 64

Reasons for a Newborn/Pediatric Genetics Consultation

Answer 64

Abnormal newborn screening results One or more major malformations in any organ system Abnormalities in growth Mental retardation or developmental delay Blindness or deafness Presence of a known or suspected genetic disorder or chromosomal abnormality Family history of a known or suspected genetic disorder, birth defect, or chromosomal abnormality

Question 65

Reasons for an Adolescent/Adult Genetics Consultation

Answer 65

Mental retardation Personal or family history of hereditary cancers Personal or family history of a known or suspected genetic condition or chromosomal abnormality Blindness or deafness Development of a degenerative disease Risk assessment for pregnancy planning

Question 66

Prenatal Genetic Tests Blood and non invasive tests

Answer 66

Maternal serum Quad screen (AFP plus other markers) DNA in maternal blood – mainly for Trisomy 21 (Down Syndrome), but also report results from Trisomy 13 (Patau syndrome), 18 (Edwards syndrome), - very new testing, MaterniT21 Ultrasound – nuchal fold plus NT screen

Question 67

Trisomy 21

Answer 67

Down Syndrome

Question 68

Trisomy 13

Answer 68

Patau syndrome

Question 69

Trisomy 18

Answer 69

Edwards syndrome

Question 70

Prenatal Genetic Tests Invasive tests

Answer 70

Chorionic Villi Sampling (CVS) Amniocentesis Percutaneous Umbilical Blood Sampling (PUBS) Paternity (rarely done prenatally) FISH

Question 71

Nursing Expertise in Genetics 
or Genomics

Answer 71

Essential competencies for all nurses Constructs pedigree from collected family history using standardized symbols and terminology Develops plan of care that incorporates genetic and genomic assessment information Recognizes when one’s own attitudes and values may affect care provided to clients Provides clients with credible, accurate, appropriate, and current genetic and genomic information, resources, services, and/or technologies Demonstrates in practice the importance of tailoring genetic information to clients based on ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues Assesses client’s knowledge, perceptions, and responses to genetic and genomic information Facilitates referrals for specialized services

Question 72

Human Genome Project
Implications for Clinical Practice

Answer 72

Two key findings All human beings are 99.9% identical at the DNA level There are probably about 20,500 genes in the human genome

Question 73

Importance of family history

Answer 73

Completion of Human Genome Project has resulted in renewed interest in family history Single most cost-effective piece of genetic information U.S. Department of Health and Human Services designated Thanksgiving as “National Family History Day” Many family history tools available online

Question 74

Genetic Information Nondiscrimination Act of 2008 – GINA

Answer 74

Federal Law prohibits discrimination in health coverage and employment based on genetic info Americans free to use genetic info in health management Not extend to life, disability, and long term care insurance Not mandate coverage for any particular test or treatment

Question 75

Monosomy

Answer 75

Union between a normal gamete and one that is missing a chromosome

Question 76

Trisomy

Answer 76

``` Most common is Down syndrome (DS) Trisomy 18 (Edward syndrome) Trisomy 13 (Patau syndrome) ```

Question 77

Sex chromosome abnormalities

Answer 77

Turner syndrome Klinefelter syndrome

Question 78

Turner syndrome

Answer 78

Monosomy X female 45X

Question 79

Klinefelter syndrome

Answer 79

Trisomy XXY male 47XXY

Question 80

Mosaicism

Answer 80

2 or more cell lines

Question 81

Key Points

Answer 81

Advances in molecular biology and genetics provide molecular tools needed to determine hereditary component of most diseases Increasingly, nurses are expected to have expertise in genetics Major force behind the genetics revolution has been the Human Genome Project All humans are 99.9% identical at DNA level Approximately 20,000 to 25,000 genes in the human genome Most genetic tests offered in clinical practice are tests for single-gene disorders Pharmacogenomics is likely the most immediate clinical application of Human Genome Project Decision to undergo genetic testing often based on responsibility and commitment to others Genes are basic units of heredity responsible for all human characteristics and comprise 23 pairs of chromosomes 22 pairs of autosomes 1 pair of sex chromosomes Chromosomal abnormalities occur in both autosomal and sex chromosomes Multifactorial inheritance includes genetic and environmental contributions Advances in genetics have complex ethical, legal, and social implications Cancer genetics is an important emerging field

Question 82

A pregnant couple is receiving genetic counseling. The husband and wife have been told that they both carry the trait for sickle cell anemia and that there is a 25% chance that their unborn child may have the disease. What type of inheritance is sickle cell anemia? A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive

Answer 82

B. Autosomal recessive

Question 83

Which of the following is the role of the nurse in genetic counseling? A. Determining which genetic testing should be ordered B. Performing amniocentesis C. Providing emotional support D. Encouraging all women to be tested for genetic disorders

Answer 83

C. Providing emotional support

Question 84

What best describes the pattern of genetic transmission known as autosomal recessive inheritance? A. Disorders in which the abnormal gene for the trait is expressed even when the other member of the pair is normal B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed C. Disorders in which a single gene controls the particular trait D. Disorders in which the abnormal gene is carried on the X chromosome

Answer 84

B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed

Question 85

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: A. "Karyotyping will reveal if the baby's lungs are mature.“ 
B. "Karyotyping will reveal if your baby will develop normally.“ 
C. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.“ D. "Karyotyping will detect any physical deformities the baby has.“

Answer 85


C. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.“

Question 86

A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: A. Tell the couple they need to have an abortion within 2 to 3 weeks B. Explain that the fetus has a 50% chance of having the disorder C. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected D. Refer the couple to a psychologist for emotional support

Answer 86

C. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected.

Question 87

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? A. Disturbed body image B. Interrupted family processes C. Anxiety D. Risk for injury

Answer 87

B. Interrupted family processes This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder.

Question 88

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: A. "Karyotyping will reveal if the baby's lungs are mature." B. "Karyotyping will reveal if your baby will develop normally." C. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes." D. "Karyotyping will detect any physical deformities the baby has."

Answer 88

C. "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes."

Question 89

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: A. With a dominant disorder, the likelihood of the second child also having the condition is 100% B. An autosomal recessive disease carries a one in eight risk of the second child also having the disorder C. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child D. The risk factor remains the same no matter how many affected children are already in the family

Answer 89

D. The risk factor remains the same no matter how many affected children are already in the family Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

Question 90

With regard to abnormalities of chromosomes, nurses should be aware that: A. They occur in approximately 10% of newborns B. Abnormalities of number are the leading cause of pregnancy loss C. Down syndrome is a result of an abnormal chromosomal structure D. Unbalanced translocation results in a mild abnormality that the child will outgrow

Answer 90

B. Abnormalities of number are the leading cause of pregnancy loss Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation.

Question 91

A key finding from the Human Genome Project is: A. Approximately 20,000 to 25,000 genes make up the genome B. All human beings are 80.99% identical at the DNA level C. Human genes produce only one protein per gene; other mammals produce three proteins per gene D. Single-gene testing will become a standardized test for all pregnant women in the future

Answer 91

A. Approximately 20,000 to 25,000 genes make up the genome Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies.

Question 92

Most of the genetic tests now offered in clinical practice are tests for: A. Single-gene disorders B. Carrier screening C. Predictive values D. Predispositional testing

Answer 92

A. Single-gene disorders Most tests now offered are tests for single-gene disorders in clients with clinical symptoms or who have a family history of a genetic disease.

Question 93

Carrier screening

Answer 93

Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms.

Question 94

Predictive values

Answer 94

Predictive testing is used only to clarify the genetic status of asymptomatic family members.

Question 95

Predispositional testing

Answer 95

Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance of developing the condition.

Question 96

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? A. "I feel irritable and moody a week before my period is supposed to start." B. "I have lower abdominal pain beginning the third day of my menstrual period." C. "I have nausea and headaches after my period starts, and they last 2 to 3 days." D. "I have abdominal bloating and breast pain after a couple days of my period."

Answer 96

A. "I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.

Question 97

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: A. It probably is the result of a hormone deficiency that can be treated with medication B. It may be caused by stress or excessive exercise or both C. It likely will require the client to eat less and exercise more D. It often goes away on its own

Answer 97

B. It may be caused by stress or excessive exercise or both Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes.

Question 98

A nurse counseling a client with endometriosis understands which statement regarding the management of endometriosis is not accurate? A. Bone loss from hypoestrogenism is not reversible. B. Side effects from the steroid danazol include masculinizing traits. C. Surgical intervention often is needed for severe or acute symptoms. D. Women without pain and who do not want to become pregnant need no treatment.

Answer 98

A. Bone loss from hypoestrogenism is not reversible. Bone loss is mostly reversible within 12 to 18 months after the medication is stopped.

Question 99

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: A. It is most commonly caused by anovulation B. It most often occurs in middle age C. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding D. The most effective medical treatment involves steroids

Answer 99

A. It is most commonly caused by anovulation Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome.

Question 100

An effective relief measure for primary dysmenorrhea is to: A. Reduce physical activity level until menstruation ceases B. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur D. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control

Answer 100

C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur Decreasing intake of salt and refined sugar can reduce fluid retention

Question 101

Several noted health risks are associated with menopause. These risks include all except: A. Osteoporosis B. Coronary heart disease C. Breast cancer D. Obesity

Answer 101

C. Breast cancer Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer.

Question 102

Most common STIs in women

Answer 102

``` Chlamydia Gonorrhea Human papillomavirus Herpes simplex virus type 2 Syphilis HIV infection ```

Question 103

Primary prevention

Answer 103

Primary prevention the most effective way of reducing STIs in women

Question 104

Secondary prevention

Answer 104

Prompt diagnosis and treatment can prevent personal complications and transmission to others

Question 105

What are the Risk reduction measures for preventing STI's

Answer 105

``` Knowledge of partner Reduction of the number of partners Low risk sex Avoiding exchange of body fluids Immunization ``` Physical barriers- Condoms Chemical barriers- Nonoxynol-9 Communication Expressing feelings and fears Attention to partner’s response Vaccination

Question 106

Bacterial Sexually Transmitted Infections

Answer 106

Chlamydia trachomatis Gonorrhea Syphilis Pelvic inflammatory disease (PID)

Question 107

Chlamydia trachomatis

Answer 107

Most common and fastest spreading STI Infections often silent and highly destructive Difficult to diagnose Can lead to PID and infertility Screening and diagnosis Asymptomatic and pregnant women Comparisons of diagnostic procedures CDC guidelines – screening yearly sexually active adolescents or if at high risk and in pregnancy

Question 108

Chlamydia | Management

Answer 108

Doxycycline Azithromycin Erythromycin Amoxicillin Perinatal transmission Antibiotic ointment

Question 109

Gonorrhea

Answer 109

Aerobic gram-negative diplococcus Oldest communicable disease in the U.S. Second to chlamydia in reported cases Highest rates among teenagers, young adults, and African-Americans Women often asymptomatic Gonorrhea Screening and diagnosis CDC recommends screening all women at risk Testing during first trimester and at 36 weeks of pregnancy Reportable disease – legally must notify health dept

Question 110

Gonorrhea Management

Answer 110

Antibiotic therapy: cefixime or ceftriaxone Concomitant treatment for chlamydia

Question 111

Gonorrhea | Perinatal complications of gonococcal infection

Answer 111

Miscarriage Preterm labor Premature rupture of membranes Chorioamnionitis Neonatal sepsis, congenital blindness Intrauterine growth restriction Postpartum endometritis Maternal postpartum sepsis

Question 112

Syphilis

Answer 112

Treponema pallidum - motile spirochete Earliest described STI Transmission - entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse Also transmitted through kissing, biting, or oral-genital sex Transplacental transmission may occur at any time during pregnancy Can lead to serious systemic disease and even death Infection manifests itself in distinct stages Primary: 5 to 90 days after exposure Secondary: 6 weeks to 6 months Tertiary: develops in one third of women infected Screening and diagnosis Pregnant women – initial testing Serologic tests – monthly VDRL/RPR/FTA in pregnancy if ever positive to retreat False positives, false negatives

Question 113

Syphilis Management

Answer 113

Penicillin – even if PCN allergic in pregnancy Sexual abstinence during treatment

Question 114

Pelvic inflammatory disease (PID)

Answer 114

An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces Multiple organisms have been found to cause PID Increased risk of Ectopic pregnancy – 7 fold higher Infertility Chronic pelvic pain

Question 115

Pelvic Inflammatory Disease (PID) | Symptoms

Answer 115

Depend on type of infection Acute- Abdominal pain, fever, chills. Pain with sex or pelvic exam. Caused by bacteria Subacute (intermittant) Chronic

Question 116

Pelvic Inflammatory Disease (PID) | Management

Answer 116

Prevention Broad Spectrum antibiotics, analgesics Hospitalization - common Education – with contraceptive counseling (no IUD) Bedrest with Semi Fowlers Avoid frequent pelvic exams Repeat cultures Pelvic rest

Question 117

Viral Sexually Transmitted Infections

Answer 117

Human papillomavirus (HPV) Herpes simplex virus (HSV) Herpes simplex virus (HSV) 1 (transmitted non sexually) Hepatitis A virus (HAV) Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

Question 118

Human papillomavirus (HPV)

Answer 118

Condylomata acuminata (genital warts) Affects 20 million Americans Most prevalent viral STI seen in ambulatory health care settings Previously named genital or venereal warts More frequent in pregnant women Screening and diagnosis History of known exposure Physical inspection Pap smear Management Removal – cryotherapy, chemical Medications - some not in pregnancy Counseling

Question 119

Herpes simplex virus (HSV)

Answer 119

Herpes simplex virus 1 (HSV-1) Transmitted nonsexually Herpes simplex virus (HSV) Transmitted sexually Initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria No known cure, antivirals may help with neonatal prophylaxsis Treat to provide comfort Maternal infection with HSV-2 can have adverse effects on mother and fetus miscarriage

Question 120

Herpes simplex virus (HSV) | Neonatal herpes

Answer 120

Most severe complication of HSV Most mothers lack history of HSV Neonatal encephalitis

Question 121

Viral hepatitis | Hepatitis A virus (HAV)

Answer 121

Acquired primarily through a fecal-oral route Vaccination is the most effective means of preventing HAV transmission

Question 122

Viral hepatitis | Hepatitis B virus (HBV)

Answer 122

Most threatening to the fetus and neonate Disease of the liver and often a silent infection Transmitted parenterally, perinatally, and rarely, orally, as well as through intimate contact Vaccination series Education

Question 123

Viral hepatitis | Hepatitis C virus (HCV)

Answer 123

Most common blood-borne infection in the United States Important health problem as increasing numbers acquire disease

Question 124

Viral hepatitis | Hepatitis C virus (HCV)

Answer 124

Risk factor for pregnant women is history of injecting IV drugs Interferon alfa or ribavirin is main therapy for HCV infection Effectiveness of treatment varies

Question 125

Human immunodeficiency virus (HIV)

Answer 125

37,000 new HIV infections occur in U.S. each year Heterosexual transmission now the most common means of transmission in women Women are the fastest-growing population of HIV infection and AIDS Transmission of HIV occurs primarily through exchange of body fluids

Question 126

Human immunodeficiency virus (HIV)

Answer 126

Severe depression of the cellular immune system associated with HIV infection characterizes AIDS Symptoms: fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash

Question 127

Human immunodeficiency virus (HIV)

Answer 127

Screening and diagnosis Antibody testing Detection Pregnancy – initial visit and repeat 3rd trimester

Question 128

Counseling for HIV testing

Answer 128

HIV testing offered early in pregnancy Perinatal transmission decreases with treatment Consider confidentiality and documentation Pretest and posttest counseling Notification of results

Question 129

Human immunodeficiency virus (HIV) | Management

Answer 129

``` Resources Death and dying Suicide prevention Financial assistance Legal advocacy Prevention of transmission ```

Question 130

HIV and pregnancy

Answer 130

Counseling and testing offered to all women who enter the system for prenatal care Perinatal transmission has decreased due to antiretroviral prophylaxis Decreases transmission to 1% to 2% Intrapartum zidovudine Cesarean birth is recommended Breastfeeding contraindicated Antivirals during pregnancy AZT dosing for delivery Arrival – initial dose 2 mg/kg for first hour Subsequent – 1 mg/kg/hour till delivery with at least 4 hours total given before delivery

Question 131

Vaginal Infections

Answer 131

Vulvovaginitis Bacterial vaginosis (BV) Candidiasis Group B streptococci Trichomoniasis

Question 132

Vulvovaginitis

Answer 132

Infection caused by a microorganism Also called abnormal vaginal discharge

Question 133

Bacterial vaginosis (BV)

Answer 133

Syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria Associated with preterm labor and birth Treatment with metronidazole orally

Question 134

Candidiasis

Answer 134

Candida albicans or non-C. albicans Vulvovaginal candidiasis, or yeast infection, is second most common type of vaginal infection In women with HIV, symptoms are more severe and persistent

Question 135

Candidiasis | Predisposing factors

Answer 135

``` Antibiotic therapy Diabetes Pregnancy Obesity Diets high in refined sugars Use of corticosteroids and hormones Immunosuppressed states ```

Question 136

Candidiasis | Common symptoms

Answer 136

Vulvar Vaginal pruritus Screening and diagnosis Physical examination Vaginal pH

Question 137

Candidiasis | Management

Answer 137

Over-the-counter agents Intravaginal treatment or oral agent Methods of comfort Sitz baths Aveeno powder No underpants to bed Complete full course of treatment

Question 138

Trichomoniasis

Answer 138

Trichomonas vaginalis STI – partner needs treatment Common cause of vaginal infection Inflammation of the vagina and/or vulva Screening and diagnosis Speculum examination Pap smear

Question 139

Trichomoniasis | Management

Answer 139

Metronidazole, 2 g orally in a single dose | The risk for sexual transmission must be communicated to infected women

Question 140

Group B streptococci

Answer 140

A part of the normal vaginal flora present in 20% to 30% of healthy women Associated with poor pregnancy outcomes Important factor in neonatal morbidity and mortality Screening at 36-37 weeks of gestation Intrapartum intravenous prophylaxis if + Penicillin Ampicillin

Question 141

STIs in pregnancy are responsible for significant morbidity and mortality

Answer 141

``` Pregnancy effects Premature rupture of membranes Premature labor Postpartum sepsis Dystocia Miscarriage ``` ``` Fetal effects Preterm birth Pneumonia Systemic infection Congenital infection Stillbirth ```

Question 142

TORCH infections | Form group of infections capable of crossing the placenta and adversely affecting the fetus

Answer 142

``` Toxoplasmosis Other infections (e.g., hepatitis) Rubella virus Cytomegalovirus Herpes simplex virus (HSV) ```

Question 143

HPV is the most common viral STI

Answer 143

Chlamydia is the most common STI in U.S. women and the most common cause of PID

Question 144

Viral hepatitis has several forms of transmission; HBV infections carry the greatest risk

Answer 144

Young, sexually active women who do not practice safe sex and have multiple partners are at greatest risk for STIs and HIV

Question 145

STIs are responsible for substantial mortality and morbidity and present heavy economic burden in the U.S.

Answer 145

Substance abuse can alter the body’s immune system and possibly increase the risk for AIDS

Question 146

Pregnancy confers no immunity against infection

Answer 146

Because history and examination cannot reliably identify everyone with HIV or other blood-borne pathogens, blood and body fluid precautions should be used consistently for everyone all the time

Question 147

A nurse is providing discharge instructions to a client who has just been diagnosed with human papillomavirus (HPV) on her cervix. Which of the following is the most important discharge instruction for this client? A. Take a multivitamin every day. B. Check for external lesions around the vagina every month. C. Have Pap smears done as recommended by her practitioner. D. Avoid use of the intrauterine device (IUD).

Answer 147

C. Have Pap smears done as recommended by her practitioner.

Question 148

``` Which of the following sexual transmitted infections can be cured with antibiotics? A. Human papillomavirus B. Chlamydia C. Herpes simplex virus D. Hepatitis B ```

Answer 148

B. Chlamydia

Question 149

``` The CDC recommended medication for the treatment of Chlamydia would be: A. Doxycycline B. Podofilox C. Acyclovir D. Penicillin ```

Answer 149

A. Doxycycline

Question 150

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: A. Point out that inappropriate sexual behavior caused the infection. B. Position the woman in a semi Fowler position. C. Explain to the woman that infertility is a likely outcome of this type of infection. D. Tell her that antibiotics need to be taken until the pelvic pain is relieved.

Answer 150

B. Position the woman in a semi Fowler position.

Question 151

The viral sexually transmitted infection (STI) that affects most people in the United States today is: A. Herpes simplex virus type 2 (HSV-2) B. Human papillomavirus (HPV) C. Human immunodeficiency virus (HIV) D. Cytomegalovirus (CMV)

Answer 151

B. Human papillomavirus (HPV) HPV infection, an STI, is the most prevalent viral STI seen in ambulatory health care settings.

Question 152

The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: A. Acyclovir B. Ofloxacin C, Podophyllin D. Zidovudine

Answer 152

D. Zidovudine Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods.

Question 153

When teaching self-care prevention of genital tract infections, the nurse should instruct the woman to: A. Increase dietary sugar and avoid yogurt B. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath C. Choose underwear or hosiery with a nylon crotch D. Douche frequently

Answer 153

B. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath Clinical observations and research have suggested that tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials create an environment in which a vaginal fungus can grow. Bathing in bath salts or bubble bath may further irritate sensitive genital tissue.

Question 154

With regard to the most common bacterial sexually transmitted infections, which statement is not accurate? A. Chlamydial infections and gonorrhea are more likely to occur in women younger than age 20. B. Gonorrhea can be transmitted to the newborn by direct contact with gonococcal organisms in the cervix. C. Syphilis can be transmitted through kissing, biting, or oral-genital sex. D. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear.

Answer 154

D. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear. For any infection, the entire prescription must always be taken.

Question 155

An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: A. Strategies to enhance condom use B. Choice of colors and special features C. Leaving the decision up to the male partner D. Places to safely carry condoms

Answer 155

A. Strategies to enhance condom use When the nurse opens discussion on safe sex practices, this gives the woman permission to clear up any concerns or misapprehensions she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills. These include role-playing, rehearsal, cultural barriers, and situations that put the client at risk.

Question 156

Which statement about genital herpes is inaccurate? A. Genital herpes is also known as genital warts. B. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences. C. Genital herpes is chronic and recurring and has no known cure. D. Plain soap and water are all that is needed to clean hands that have come into contact with herpetic lesions.

Answer 156

A. Genital herpes is also known as genital warts. Genital warts are one of the most common sexually transmitted infections (STIs); however, it is also known as human papillomavirus (HPV), not genital herpes.

Question 157

Group B streptococci (GBS) are part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Risk factors for neonatal GBS infection include all except: A. Positive prenatal culture B. Preterm birth less than 37 weeks C. Maternal fever of 38° C or greater D. Premature rupture of membranes greater than 24 hours

Answer 157

D. Premature rupture of membranes greater than 24 hours Premature rupture of membranes of 18 hours or more increases the risk for neonatal GBS infection.

Question 158

Self-care instructions for a woman following a modified radical mastectomy include that she: A. Wear clothing with snug sleeves to support her affected arm B. Use depilatory creams instead of shaving the axilla of her affected arm C. Expect a decrease in sensation or tingling in her affected arm as her body heals D. Empty surgical drains once a day or every other day

Answer 158

C. Expect a decrease in sensation or tingling in her affected arm as her body heals A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery.

Question 159

The nurse should refer a client for further testing if noted on inspection of a 55-year-old woman's breasts: A. Left breast slightly smaller than right breast B. Eversion (elevation) of both nipples C. Bilateral symmetry of venous network, which is faintly visible D. Small dimple located in the upper outer quadrant of the right breast

Answer 159

D. Small dimple located in the upper outer quadrant of the right breast A small dimple is an abnormal finding and should be further evaluated.

Question 160

Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is not known, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: A. Diuretic administration B. Including caffeine daily in the diet C. Increased vitamin C supplementation D. Application of cold packs to the breast as necessary

Answer 160

A. Diuretic administration Diuretic administration plus a decrease in sodium and fluid intake are recommended.

Question 161

A client has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? A. Nausea, hot flashes, and vaginal bleeding B. Vomiting, weight loss, and hair loss C. Nausea, vomiting, and diarrhea D. Hot flashes, weight gain, and headaches

Answer 161

A. Nausea, hot flashes, and vaginal bleeding Common side effects of tamoxifen therapy include hot flashes, nausea, vomiting, vaginal bleeding, menstrual irregularities, and rash.

Question 162

The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure? A. Radiation B. Adjuvant systemic therapy C. Hormonal therapy D. Chemotherapy

Answer 162

A. Radiation Radiation therapy in the form of either brachytherapy or accelerated breast radiation is the standard therapy after lumpectomy for the treatment of early-stage breast cancer.

Question 163

What information will the nurse include in planning for the care of a woman who has had a vaginal hysterectomy? A. The woman should expect to be fully recovered in 4 to 6 weeks. B. The woman should expect no changes in her hormone levels. C. The woman should expect surgical menopause. D. The woman should take tub baths to aid in healing.

Answer 163

B. The woman should expect no changes in her hormone levels. Unless the ovaries also were removed, hormonal levels should not change. Menses will cease, but the hypothalamic-pituitary-ovarian axis remains intact.

Question 164

A woman has preinvasive cancer of the cervix. In discussing available treatments, the nurse includes: A. Cryosurgery B, Colposcopy C. Hysterectomy D. Internal radiation

Answer 164

A. Cryosurgery Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions.

Question 165

When obtaining a health history, the nurse should be aware that the most common malignancy of the reproductive system is: A. Endometrial cancer B. Cervical cancer C. Ovarian cancer D. Vulvar and vaginal cancer

Answer 165

A. Endometrial cancer Endometrial cancer occurs most frequently in Caucasian women and after menopause.

Question 166

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. The nurse realizes that the woman most likely is suffering from: A. Pelvic relaxation B. Cystoceles and/or rectoceles C. Uterine prolapse D. Genital fistulas

Answer 166

B. Cystoceles and/or rectoceles Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.

Question 167

Which woman has the highest risk for endometrial cancer? A. A postmenopausal woman with hypertension B. A woman who has an intrauterine device C. A client who has been on birth control for 15 years D. A perimenopausal woman who has a cystocele

Answer 167

A. A postmenopausal woman with hypertension Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65. Hypertension is a risk factor associated with the development of this malignancy.

Question 168

Your client has just returned from a uterine artery embolization (UAE) procedure. Prior to her discharge it is very important to discuss symptoms that require a call to the health care provider. These include all except: A. Fever of 39° C B. Swelling or hematoma at the puncture site C. Abnormal vaginal discharge D. Urinary frequency

Answer 168

D. Urinary frequency The physician should be notified if the client is experiencing urinary retention. Urinary frequency is not a complication of UAE.

Question 169

A woman has presented for her preoperative testing appointment. She is scheduled for a myomectomy the following day. As the nurse involved in this woman's care you understand that this procedure is being performed for: A. Numerous small fibroids B. Bartholin cysts C. Fibroids near the outer wall of the uterus whose size are no larger than 12 weeks of gestation D. Leiomyomas in a uterus larger than 14 weeks of gestation

Answer 169

C. Fibroids near the outer wall of the uterus whose size are no larger than 12 weeks of gestation If a fibroid tumor lies near the outer wall of the uterus and the uterine size is no larger than at 12 to 14 weeks of gestation and symptoms are significant, a myomectomy (removal of the tumor) may be performed. This procedure leaves the uterine walls relatively intact, thereby preserving the uterus for future pregnancies.