Unit T-Male And Female Reproductive Disorders

Question 1

The nurse is developing a teaching plan for a client who is scheduled for her first
Papanicolaou test. What instruction by the nurse is the most accurate?
a. “The timing of the Pap smear does not matter.”
b. “Sexual intercourse will not interfere with the results.”
c. “Results can be interpreted immediately in the office.”
d. “Results are best if you do not douche 24 hours before the test.”

Answer 1

ANS: D
In order to prevent false interpretation, the client must not douche, use vaginal medications or
deodorants, or have sexual intercourse for at least 24 hours before the Pap smear. Timing is
important, with the test scheduled between the client’s menstrual periods so that the menstrual
flow does not interfere with laboratory analysis. The specimens are placed on a glass slide and
sent to the laboratory for examination and cannot be interpreted immediately.

Question 2

The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman.
Which finding is cause for immediate action by the nurse?
a. Vaginal dryness
b. No Papanicolaou test for 3 years
c. Bleeding from the vagina
d. Leakage of urine

Answer 2

ANS: C
Vaginal bleeding is not normal for the postmenopausal woman. Vaginal dryness and leakage
of urine are common findings in adults of this age range. Pap tests may not be needed for
women over 65 who have had regular cervical cancer testing with normal results.

Question 3

The nurse is reviewing discharge instructions with a client who has just experienced an
endometrial biopsy. Which finding would be reported to the primary health care provider
immediately?
a. Mild cramping
b. Slight chills and fever
c. Spotting of blood
d. Fatigue after anesthesia

Answer 3

ANS:B
Chills and fever could indicate an infection and would be reported immediately to the primary
health care provider . Mild cramping, spotting, and fatigue are normal findings after an
endometrial biopsy; however, anesthesia may or may not be used.

Question 4

A client is concerned about her irregular menstrual periods since she has increased her daily
workouts at the gym to 2 hours each day. What is the nurses’ best response?
a. “Do you want to talk about the need for that much exercise?”
b. “Exercise is healthy but can decrease body fat and cause irregular periods.”
c. “Bingeing and purging can cause electrolyte problems in your body.”
d. “Anorexic behavior can result in decreased estrogen levels.”

Answer 4

ANS: B
There needs to be a certain level of body fat and weight to maintain regular menstrual cycles.
The client has only indicated that she has increased her workouts. There is no indication that
she has anorexic or bingeing and purging behaviors. The question about wanting to talk about
needing that much exercise sounds judgmental.

Question 5

A client is having a hysterosalpingogram. What action by the nurse is most important?

a. Assist the client in sitting up after the procedure.
b. Provide the client with a pad to avoid dye stains on the clothes.
c. Teach her to take all antibiotics prescribed until finished.
d. Inform the client that the procedure may cause shoulder pain.

Answer 5

ANS: A
During the procedure, the client may experience light-headedness, so the nurse would assist
her with sitting up afterwards for safety. The nurse does provide a pad to prevent any staining
from the dye and does inform the client of the possibility of shoulder pain, but an action to
prevent injury is more important. Antibiotics are not prescribed afterward.

Question 6

The mother of an 18-year-old girl asks the nurse which screening her daughter would receive
now based on evidence-based recommendations. Which suggestion by the nurse is best?
a. Papanicolaou test
b. Human papilloma virus (HPV) test
c. Mammogram
d. No screenings at this time

Answer 6

ANS:D
Since the daughter is only 18, it is not recommended that she receive any of these screenings.
Pap screenings are recommended to start at age 21. The HPV test is not recommended for
screening but can be used for women who had an abnormal Pap test result. A mammogram is
recommended for women aged 40 or older since cancers are more able to be distinguished
from normal glandular tissue at that age.

Question 7

A client is scheduled for a laparoscopy to remove endometriosis tissue. Which response by the
client alerts the nurse of the need for further teaching?
a. “The surgeon told me that carbon dioxide would be infused into my pelvic cavity.”
b. “There will be one or more small incisions in order to visualize all of the organs.”
c. “There will be some shoulder pain after the procedure that may last 48 hours.”
d. “I can return to jogging my 3-mile (5 km) routine in a few days.”

Answer 7

ANS: D
The client is taught that she should not participate in strenuous activity for a week after the
procedure. Carbon dioxide is infused into the pelvic cavity to visualize the organs. There are
only one or more small incisions with this procedure. The referred shoulder pain that will
occur only lasts 48 hours.

Question 8

A 67-year-old male client had serum laboratory tests performed during his annual
examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL (23.6 nmol/L);
prostate-specific antigen: 10 ng/mL (10 mcg/L); prolactin: 5 ng/mL (217.4 pmol). What
action by the nurse is best?
a. Assess for possible galactorrhea with breast discharge.
b. Note the possibility of a testicular tumor.
c. Communicate that results were normal.
d. Prepare the client for further diagnostic testing.

Answer 8

ANS: D
The prostate-specific antigen is increased from the normal of 0 to 2.5, which could indicate
benign prostatic hyperplasia or prostate cancer. Further testing would have to be done. The
other values are within the normal range for males.

Question 9

A 72-year-old woman is being assessed by the nurse for an annual physical. Which finding is
of concern to the nurse?
a. Thinning of pubic hair
b. Increased size of the uterus
c. Decreased size of the clitoris
d. Loss of tone of the pelvic ligaments

Answer 9

ANS: B
An increased size of the uterus is an abnormal finding and would be assessed further. Normal
changes in the reproductive system related to aging include the graying and thinning of pubic
hair, decreased size of the labia majora and clitoris, and loss of tone and elasticity of the
pelvic ligaments and connective tissue. The uterus would normally be decreased, not
increased, in size due to changes in hormonal levels and atrophy.

Question 10

The nurse is assessing a client for reproductive health problems. What assessments are most
important? (Select all that apply.)
a. Bleeding
b. Pain
c. Sexual orientation
d. Masses
e. Discharge

Answer 10

ANS: A, B, D, E
Bleeding, pain, masses, and discharge are common health problems that bring a client to a
primary health care provider. Sexual orientation is not considered a health problem. Sexual
activity would be assessed as part of the client’s history.

Question 11

The nurse is reviewing discharge plans with a client who is recovering from a cervical biopsy.
Which statements indicate good understanding by the client? (Select all that apply.)
a. “I can return to work this afternoon.”
b. “I cannot carry my toddler for 2 weeks.”
c. “I cannot douche until the biopsy site is healed.”
d. “I need to wait for about 2 weeks to have intercourse.”
e. “I can use a regular tampon this evening for bleeding.”
f. “I cannot wash my perineum for 24 hours.”

Answer 11

ANS: B, C, D
The client would not douche, have intercourse, or use tampons until the biopsy site is healed.
The client would rest for 24 hours after the procedure and would not lift heavy objects. The
client would be taught to keep the perineum clean and dry by using antiseptic rinses and
changes pads frequently.

Question 12

The nurse is teaching a 45-year-old woman about her fibrocystic breast changes. Which
statement by the client indicates a lack of understanding?
a. “This condition will become malignant over time.”
b. “I understand that hormone-based drugs have serious adverse effects.”
c. “One cup of coffee in the morning should be enough for me.”
d. “This condition makes it more difficult to examine my breasts.”

Answer 12

ANS: A
Fibrocystic breast changes do not increase a woman’s chance of developing breast cancer.
Hormone-based drugs can be used in severe cases to suppress the over-secretion of estrogen.
Serious adverse effects include thrombotic events and an increased risk for uterine cancer.
Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the
breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.

Question 13

The nurse is examining a woman’s breast and notes multiple small mobile lumps. Which
question would be most appropriate for the nurse to ask?
a. “When was your last mammogram at the clinic?”
b. “How many cans of caffeinated soda do you drink in a day?”
c. “Do the small lumps seem to change with your menstrual period?”
d. “Do you have a first-degree relative who has breast cancer?”

Answer 13

ANS: C
The most appropriate question would be one that relates to benign lesions that usually change
in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet
has been shown to give relief in fibrocystic breast changes, but research has not found that it
has a significant impact. Questions related to the client’s last mammogram or breast cancer
history are not related to the nurse’s assessment.

Question 14

The nurse is working with a male client who has gynecomastia. What action by the nurse is
most appropriate?
a. Teach the client to perform self-breast examination.
b. Review the plan for chemotherapy after surgery.
c. Educate him on the side effects of tamoxifen.
d. Assess his usual daily alcohol intake.

Answer 14

ANS:C
Gynecomastia is enlarged breast tissue in men. It is from an enlarged ridge of glandular breast
tissue and is benign. The client does not need to perform SBE nor will he undergo
chemotherapy. Tamoxifen is one drug used to treat the condition, so the nurse would educate
the client on the medication. Alcohol is not related.

Question 15

Which finding in a female client by the nurse would receive the highest priority for further
diagnostics?
a. Tender moveable masses throughout the breast tissue
b. Nipple discharge without a palpable mass
c. Nontender fixed mass in the upper outer quadrant of the breast
d. Small, painful mass under warm reddened skin and nipple discharge

Answer 15

ANS: C
Malignant lesions are fixed, hard and irregularly shaped and this lesion would be the priority
for further diagnostic study. The other lesions are benign breast disorders. The client with
nipple discharge but no palpable mass most likely has intraductal papilloma. The client who
has nipple discharge but also has a mass under warm, red, edematous skin most likely has
ductal ectasia.

Question 16

A nurse has taught a female client about the modifiable risk factors for breast cancer. Which
statement made by the client indicates that more teaching is needed?
a. “I am fortunate that I breast-fed each of my three children for 12 months.”
b. “It looks as though I need to start working out at the gym more often.”
c. “I am glad that we can still have wine with every evening meal.”
d. “When I have menopausal symptoms, I must avoid hormone replacement therapy.”

Answer 16

ANS: C
Modifiable risk factors can help prevent breast cancer. The client should lessen alcohol intake
and not have wine 7 days a week. Breast-feeding, regular exercise, maintaining a normal
weight, and avoiding hormone replacement are also strategies for breast cancer prevention.

Question 17

A younger woman from an unfamiliar culture is at high risk for breast cancer and is
considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most
appropriate?
a. Discourage this surgery since the woman is still of childbearing age.
b. Reassure the client that reconstructive surgery is as easy as breast augmentation.
c. Inform the client that this surgery removes all mammary tissue and cancer risk.
d. Offer to include support people, such as the male partner, in the decision making

Answer 17

ANS:C
The cultural aspects of decision making need to be considered. In some cultures, the man
often makes the decisions for care of the female. The woman may want to make the decision
with other support people or by herself. The nurse must maintain sensitivity to cultural,
religious, and personal beliefs when it comes to this personal decision. Women with a high
risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is
considered, the procedure is more complex and will have more complications compared to a
breast augmentation. There is a small risk that breast cancer can still develop in the remaining
mammary tissue.

Question 18

A client has just returned from a right radical mastectomy. Which action by the assistive
personnel (AP) would require the nurse consider to intervene?
a. Checking the amount of urine in the catheter collection bag
b. Elevating the right arm on a pillow
c. Taking the blood pressure on the right arm
d. Encouraging the client to squeeze a rolled washcloth

Answer 18

ANS: C
Health care professionals need to avoid the arm on the side of the surgery for blood pressure
measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage
would be compromised. The pressure from the blood pressure cuff could promote swelling.
Infection could occur with injections and blood draws. Checking urine output, elevation of the
affected arm on a pillow, and encouraging beginning exercises are all safe postoperative
interventions.

Question 19

A client is discharged to home after a modified radical mastectomy with two drainage tubes.
Which statement by the client would indicate that further teaching is needed?
a. “I am glad that these tubes will fall out at home when I finally shower.”
b. “I should measure the drainage each day to make sure it is less than an ounce (30
mL).”
c. “I should be careful how I lie in bed so that I will not kink the tubing.”
d. “If there is a foul odor from the drainage, I will contact my primary health care
provider.”

Answer 19

ANS: A
The drainage tubes (such as a Jackson–Pratt drain) lie just under the skin but need to be
removed by the health care professional in about 1 to 3 weeks at an office visit. Drainage
should be less than 30 mL for three consecutive days. The client should be aware of her
positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an
infection; the primary health care would be contacted immediately.
DIF:

Question 20

During dressing changes, the nurse assesses a client who had breast reconstruction. Which
finding would cause the nurse to take immediate action?
a. Slightly reddened incisional area
b. Blood pressure of 128/75 mm Hg
c. Temperature of 99° F (37.2° C)
d. Dusky color of the breast flap

Answer 20

ANS: D
A dusky color of the breast flap could indicate poor tissue perfusion. The nurse would notify
the primary health care provider to preserve the tissue. It is normal to have a slightly reddened
incision as the skin heals. The blood pressure is within normal limits and the temperature is
slightly elevated but would be monitored.

Question 21

A client is starting hormonal therapy with tamoxifen to lower the risk for breast cancer. What
information needs to be explained by the nurse regarding the action of this drug?
a. It blocks the release of luteinizing hormone.
b. It interferes with cancer cell division.
c. It selectively blocks estrogen in the breast.
d. It inhibits DNA synthesis in rapidly dividing cells.

Answer 21

ANS: C
Tamoxifen reduces the estrogen available to breast tumors to stop or prevent growth. This
drug does not block the release of luteinizing hormone to prevent the ovaries from producing
estrogen; leuprolide does this. Chemotherapy agents interfere with cancer cell division. Newer
research supports treatment with tamoxifen for 10 years to prevent recurrence.

Question 22

A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide, and
fluorouracil for breast cancer. Which side effect seen in the client would the nurse report to
the primary health care provider immediately?
a. Shortness of breath
b. Nausea and vomiting
c. Hair loss
d. Mucositis

Answer 22

ANS: A
Doxorubicin can cause cardiotoxicity with symptoms of extreme fatigue, shortness of breath,
chronic cough, and edema. These need to be reported as soon as possible to the primary health
care provider. Nausea, vomiting, hair loss, and mucositis are common problems associated
with chemotherapy regimens.

Question 23

A client is concerned about the risk of lymphedema after a mastectomy. Which response by
the nurse is best?
a. “You do not need to worry about lymphedema since you did not have radiation
therapy.”
b. “Be careful not to injure that arm or get any infection in that arm.”
c. “Numbness, tingling, and swelling are common sensations after a mastectomy.”
d. “The risk for lymphedema is a real threat and can be very self-limiting.”

Answer 23

ANS: B
Injury and infection are risk factors for lymphedema; therefore, the client needs to be cautious
with activities using the affected arm. Radiation therapy is just one of the factors that could
cause lymphedema. Other risk factors include obesity and presence of axillary disease. The
symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling,
and are not common after the surgery. Women with lymphedema live fulfilling lives.

Question 24

The nurse is taking a history of a 68-year-old woman. What assessment findings would
indicate a high risk for the development of breast cancer? (Select all that apply.)
a. Age greater than 65 years
b. Increased breast density
c. Osteoporosis
d. Multiparity
e. Genetic factors
f. Early menarche

Answer 24

ANSRisk factors for breast cancer include advancing age, family and genetic history, early
menarche, late menopause, postmenopausal obesity, physical inactivity, combined hormonal
therapies, alcohol consumption, and lack of breast feeding.: A, B, E, F

Question 25

The nurse is formulating a teaching plan according to evidence-based breast cancer screening
guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods would
be included in the plan? (Select all that apply.)
a. Annual mammogram
b. Magnetic resonance imaging (MRI)
c. Breast ultrasound
d. Breast self-awareness
e. Clinical breast examination
f. Self-breast examination

Answer 25

ANS: A, D, E
Guidelines from the American Cancer Society include annual mammograms for low risk
women starting at the age of 45 and continuing through the age of 54. At 55, women can
continue annual mammography or change to every 2 years. MRI and ultrasound are done for
abnormal findings or for high risk women. Breast self-awareness is important so women can
detect changes early. Current data shows that SBE is not a valuable screening tool.
Asymptomatic women 40 and older should have a clinical breast exam annually.

Question 26

After a breast examination, the nurse is documenting assessment findings that indicate
possible breast cancer. Which abnormal findings need to be included as part of the client’s
electronic medical record? (Select all that apply.)
a. Peau d’orange
b. Dense breast tissue
c. Nipple retraction
d. Mobile mass at 2 o’clock
e. Nontender axillary nodes
f. Skin ulceration

Answer 26

ANS: A, C, D, F
In the documentation of a breast mass, skin changes such as dimpling (peau d’orange), nipple
retraction, and whether the mass is fixed or movable are charted. The location of the mass
should be stated by the “face of a clock.” Skin ulceration is also a common sign. Dense breast
tissue and nontender axillary nodes are not abnormal assessment findings that may indicate
breast cancer.

Question 27

A woman is interested in alternative and complementary treatments for the nausea and
vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies
wound the nurse suggest? (Select all that apply.)
a. Acupuncture
b. Chiropractic
c. Journaling
d. Aromatherapy
e. Shiatsu
f. Black cohosh

Answer 27

ANS: A, D, E
Alternative and complementary measures are chosen by many women. For nausea and
vomiting, the best choices would be acupuncture, aromatherapy, and shiatsu. Chiropractic
treatments would help pain. Journaling would be beneficial for fear and anxiety. Black cohosh
is frequently used for hot flashes.

Question 28

A nurse is caring for a woman who had hysteroscopic surgery for uterine leiomyomas. On
initial assessment, the nurse notes the following: pulse: 114 beats/min, respiratory rate: 20
breaths/minute, crackles in bilateral lung bases. What action by the nurse takes priority?
a. Assess the client for pain.
b. Call the Rapid Response Team.
c. Obtain an oxygen saturation.
d. Delegate a temperature.

Answer 28

ANS: B
The fluid that is used during this procedure to distend the uterine cavity can be absorbed,
leading to fluid overload. This client has signs of fluid overload which can be critical. The
nurse would notify the Rapid Response Team first, then perform the other actions.

Question 29

The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which
statement by the client indicates a lack of understanding?
a. “I need to change my tampon every 8 hours during the day.”
b. “At night, I should use a feminine pad rather than a tampon.”
c. “If I don’t use tampons, I should not get TSS.”
d. “It is best if I wash my hands before inserting the tampon.”

Answer 29

ANS: A
Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as
Staphylococcus aureus. All of the other responses are correct: use of feminine pads at night,
not using tampons at all, and washing hands before tampon insertion are all strategies to
prevent TSS.

Question 30

A client is admitted to the emergency department with toxic shock syndrome. Which action
by the nurse is the most important?
a. Administer IV fluids to maintain fluid and electrolyte balance.
b. Remove the tampon as the source of infection.
c. Collect a blood specimen for culture and sensitivity.
d. Transfuse the client to manage low blood count.

Answer 30

ANS: B
The source of infection should be removed first. All of the other answers are possible
interventions depending on the client’s symptoms and vital signs, but removing the tampon is
the priority.

Question 31

The nurse is caring for a postoperative client following an anterior colporrhaphy. What action
can be delegated to the assistive personnel (AP)?
a. Reviewing the hematocrit and hemoglobin results
b. Teaching the client to avoid lifting her 4-year-old grandson
c. Assessing the level of pain and any drainage
d. Drawing a shallow hot bath for comfort measures

Answer 31

ANS: D
The AP is able to provide comfort through a bath. The registered nurse would review any
laboratory results, complete any teaching, and assess pain and discharge.

Question 32

A nurse receives hand-off report on four postoperative clients who each had total

hysterectomies. Which client would the nurse assess first upon initial rounding?
a. Vaginal hysterectomy: two saturated perineal pads in 2 hours
b. Abdominal: temperature of 99° F (37.2° C), blood pressure of 116/74 mm Hg
c. Vaginal: opened incisional edges and moderate bleeding
d. Abdominal: urinary catheter output of 150 mL in the last 3 hours

Answer 32

ANS: A
Normal vaginal bleeding after a vaginal hysterectomy should be less than one saturated
perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage,
which is a priority. The client with the slight temperature elevation needs to be assessed for
possible infection, but not as the priority. A vaginal hysterectomy would not result in an
incision the nurse could observe separating. The urinary output is normal.

Question 33

A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is
concerned about a loss of libido. What intervention by the nurse would be best?
a. Suggest increasing vitamins and supplements daily.
b. Discuss the value of a balanced diet and exercise.
c. Reinforce that weight gain may be inevitable.
d. Teach that estrogen cream inserted vaginally may help.

Answer 33

ANS: D
Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of
libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy.
Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.

Question 34

A client has recently been diagnosed with type II endometrial cancer and will be treated with
brachytherapy. What statement by the client indicates a need for further education on this
treatment?
a. “Each treatment will take only 20 to 30 minutes.”
b. “I have to be alone in the room during treatment so I don’t expose others.”
c. “I can get up and walk around or read in a chair during the treatments.”
d. “I need to report any heavy vaginal bleeding or severe diarrhea.”

Answer 34

ANS: B
Type II endometrial cancer is likely to invade the uterine wall and metastasize. Treatment
with brachytherapy is intended to prevent recurrence. During the treatment, which lasts 20 to
30 minutes each, the woman must remain on bedrest to avoid dislodging the radioactive
source. The source emits radiation while it is in place, so the woman is in the treatment room
by herself. Once it is removed, she has no restrictions on being around others. She would need
to report any heavy vaginal bleeding or severe diarrhea.

Question 35

The outpatient clinic nurse has assessed a woman who reports a month-long history of feeling
full, urinary frequency, and bloating. What action by the nurse is best?
a. Obtain a clean catch urine specimen.
b. Instruct the client on a 3-day diet history.
c. Facilitate having a pelvic ultrasound.
d. Teach the woman about CA-125 test.

Answer 35

ANS: D
Evidence shows that women with ovarian cancer often have recognizable, early signs such as
abdominal bloating, urinary frequency or urgency, feeling full or difficulty eating, and pelvic
pain. The nurse should “think ovarian” and facilitate the client having a CA-125 blood test,
which is a cancer antigen test. The other actions may or may not be needed, but with these
symptoms, the client needs to be evaluated for ovarian cancer.

Question 36

The nurse has educated a community group of risk factors for ovarian cancer. Which
statement by a participant shows the need for reviewing the information?
a. “This is a disease of young women.”
b. “Never being pregnant increases my risk.”
c. “Difficulty conceiving is a risk factor.”
d. “Having endometriosis is one of the risks.”

Answer 36

ANS: A
Ovarian cancer usually strikes women who are middle age or older. Nulliparity, difficulty
conceiving, and endometriosis all increase risk and are correct statements.

Question 37

A nurse has taken an informed consent to a woman who is having a transvaginal repair of a
prolapsed uterus. What client statement indicates a need for more information?
a. “The mesh they use may become infected.”
b. “I may still need to do my Kegel exercises.”
c. “I will watch for any signs of infection.”
d. “I know how to use the incentive spirometer.”

Answer 37

ANS: A
Mesh is not used in the transvaginal approach as it has been discontinued in this country. The
other statements show good understanding.

Question 38

A 25-year-old woman is concerned about contracting HPV. What information by the nurse is
most appropriate?
a. “HPV is a benign infection that usually clears up on its own.”
b. “You are too old to receive the HPV vaccination.”
c. “We can provide HPV testing along with your Pap smear.”
d. “HPV is not a common sexually transmitted disease.”

Answer 38

ANS: C
HPV DNA testing can be done at the same time as the pap smear. Most women have HPV
infection during their lives; however, it is not always benign. Two types, 16 and 18 are
responsible for about 70% of cervical cancers. The vaccination with Gardasil 9 can be given
up to age 45.

Question 39

A 28-year-old client is diagnosed with uterine leiomyoma and is experiencing severe

symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that
apply. )
a. Teach nonpharmacologic comfort measures.
b. Discuss the high risk of infertility with this diagnosis.
c. Relieve anxiety by relaxation techniques and education.
d. Discuss in detail the side effects of laparoscopic surgery.
e. Review complete blood count for possible iron deficiency anemia.

Answer 39

ANS:A, C, E
With uterine leiomyomas or fibroids, heavy bleeding is the predominant symptom, with
anxiety occurring because of fears of cancer or infertility. Interventions would be directed to
the heavy bleeding and anxiety relief, such as relaxation techniques and education about the
pathophysiology and possible treatment of the fibroids. While many women do not experience
pain with this condition, some do, so the nurse would teach nonpharmacologic comfort
measures. The nurse could suggest resources to give more information about the diagnosis.
Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature
and may increase the anxiety.

Question 40

The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy
with a vaginal repair. Which statements by the client indicate a need for further teaching?
(Select all that apply.)
a. “I should not have any problems driving to see my mother, who lives 3 hours
away.”
b. “Now that I have time off from work, I can return to my exercise routine next
week.”
c. “My granddaughter weighs 23 lb (10.5 kg) so I need to refrain from picking her
up.”
d. “I will have to limit the number of times that I climb our stairs at home to fewer
than five times a day.”
e. “I need to refrain from sexual intercourse for 4 to 6 weeks.”
f. “When I do resume intercourse, I will use a water-based lubricant and go slowly.”

Answer 40

ANS: A, B
Driving and sitting for extended periods of time should be avoided until the surgeon gives
permission. For 2 to 6 weeks, exercise participation should also be avoided. All of the other
responses demonstrate adequate knowledge for discharge. The client should not lift anything
heavier than 10 lb (4.5 kg), should limit stair climbing, and should refrain from sexual
intercourse. When intercourse is resumed, the client should use water-based lubricant and
proceed slowly as the vaginal walls are tighter. This may temporarily cause some pain.

Question 41

The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer. What
possible risk factors would the nurse assess? (Select all that apply.)
a. Smoking
b. Multiple births
c. Poor diet
d. Nulliparity
e. Younger than 18 at first intercourse
f. Infections with HPV

Answer 41

ANS: A, B,F
Smoking, multiple births, and infection with HPV are all risk factors for cervical cancer.
Nulliparity is a risk factor for endometrial cancer. Poor diet could lead to decreased immunity,
which is a risk, but is not directly related. Giving birth before the age of 17 is a risk factor.

Question 42

A client is scheduled to start external beam radiation therapy (EBRT) for her endometrial

cancer. Which teaching by the nurse is accurate? (Select all that apply.)
a. “You will need to be hospitalized during this therapy.”
b. “Your skin needs to be inspected daily for any breakdown.”
c. “It is not wise to stay out in the sun for long periods of time.”
d. “The perineal area may become damaged with the radiation.”
e. “The technician applies new site markings before each treatment.”
f. “You will not be radioactive or pose any danger to anyone else.”

Answer 42

ANS: B, C, D, F
EBRT is usually performed in ambulatory care and does not require hospitalization. The client
needs to know to evaluate the skin, especially in the perineal area, for any breakdown, and
avoid sunbathing. The technician does not apply new site markings, so the client needs to
avoid washing off the markings that indicate the treatment site.

Question 43

The nurse is teaching a client who is undergoing brachytherapy about what to immediately
report to her primary health care provider . Which signs and symptoms would be included in
this teaching? (Select all that apply.)
a. Constipation for 3 days
b. Temperature of 99° F (37.2° C)
c. Abdominal pain
d. Visible blood in the urine
e. Heavy vaginal bleeding
f. Urinary retention

Answer 43

ANS: C, D, E
Health teaching for a client having brachytherapy would emphasize reporting abdominal pain,
visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea (not constipation),
urethral burning, extreme fatigue, and a fever over 100° F (37.7° C) would also be reported.

Question 44

A client has recurrent vulvovaginitis. Which statements by the client indicate a need for
further teaching? (Select all that apply.)
a. “I can take a long, hot bath to relieve itching.”
b. “I need to take all of my antibiotics as prescribed.”
c. “I should avoid having sex until my infection is gone.
d. “I should not douche or use feminine hygiene sprays.”
e. “I should use antibacterial soap to clean the area.”
f. “I should switch to wearing only cotton underwear.”

Answer 44

ANS: A, B, E
Clients should avoid hot water baths as they may increase the itching and infection. They may
take warm or tepid sitz baths for 30 minutes several times a day to relieve itching. Clients
should cleanse the inner labia mucosa with water, not soap, during a bath or shower. All of the
other options are

Question 45

The nurse is doing home care teaching for a client who has undergone cryotherapy. Which
statements by the client indicate a correct understanding of the instructions? (Select all that
apply.)
a. “I can resume my weight-lifting exercise class tomorrow.”
b. “I should not use tampons, douche, or have sexual activity.”
c. “I should shower rather than take a tub bath.”
d. “There may be a lot of bleeding for a few days.”
e. “There should be little or no discomfort.”

Answer 45

ANS: B, C, E
Cryotherapy involves freezing of cervical cancer cells and is often painless. Clients are
restricted from heavy lifting. They may have a heavy watery discharge for several weeks, but
should report any heavy bleeding, foul-smelling drainage, or a fever. The other options are
correct.

Question 46

The nurse is conducting a history on a male client to determine the severity of symptoms
associated with prostate enlargement. Which finding is cause for prompt action by the nurse?
a. Hematuria
b. Urinary hesitancy
c. Postvoid dribbling
d. Weak urinary stream

Answer 46

ANS: A
Hematuria, especially at the start or end of the urine stream, could indicate infection due to
possible urine retention and would cause the nurse to act promptly. Common symptoms of
benign prostatic hyperplasia are urinary hesitancy, postvoid dribbling, and a weak urinary
stream due to the enlarged prostate causing bladder outlet obstruction.

Question 47

A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After
assessing the client’s behavior, which statement by the nurse would be the most appropriate?
a. “The urine incontinence should not prevent you from socializing.”
b. “You seem depressed and should seek more pleasant things to do.”
c. “It is common for men at your age to have changes in mood.”
d. “Nocturia could cause interruption of your sleep and cause changes in mood.”

Answer 47

ANS: D
Frequent visits to the bathroom during the night could cause sleep interruptions and affect the
client’s mood and mental status. Telling the client his symptoms should not lead to less
socialization is patronizing. Instructing the client to seek more pleasant things to do also is
patronizing. Neither statement has any information the client could find useful. The statement
about age has no validity and again does not offer useful information.

Question 48

A nurse is providing education to a new 55-year-old African-American client about screening
for prostate cancer. What action by the nurse is most appropriate?
a. Inform the client that recommendations vary, so screening is a personal choice.
b. Let the client know that as an African American, he should be screened annually.
c. Teach the client that he is in a high risk group and should discuss screening.
d. Give the client written information that discourages screening until age 70.

Answer 48

ANS:C
Clients in certain high risk groups should discuss screening for prostate cancer with their
primary health care providers at age 45. High risk groups include African Americans and men
with a first-degree relative who was diagnosed with prostate cancer before the age of 65. This
new client will be encouraged to discuss screening even though he is past the age of initial
discussion. Recommendations do vary somewhat, but he is in a recognized high risk group.
The nurse would not say that he “should” be screened annually. Screening is not
recommended for men over the age of 70.

Question 49

The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement
indicates the client needs further information?
a. “There should be no problem with drinking wine with dinner each night.”
b. “I am so glad that I weaned myself off of coffee about a year ago.”
c. “I need to inform my allergist that I cannot take my normal antihistamine.”
d. “My routine of drinking a quart (liter) of water first thing in the morning needs to
change.”

Answer 49

ANS: A
Caffeine and alcohol have diuretic effects and so the nurse would teach about avoiding or
limiting their intake. The statement about drinking wine indicates a need for further
instruction. Antihistamines can cause urinary retention. Clients are taught to avoid drinking
large quantities of fluid at one time.

Question 50

A client has returned from a transurethral resection of the prostate with a continuous bladder
irrigation. Five hours after the operation, the nurse notes the drainage is bright red with clots.
What action should the nurse take first?
a. Review the most recent hemoglobin and hematocrit.
b. Take vital signs and begin immediate irrigation with sterile water.
c. Notify the primary health care provider immediately.
d. Remind the client not to pull on the catheter.

Answer 50

ANS: B
Bright red urinary drainage with clots may indicate arterial bleeding. The nurse would notify
the primary health care provider immediately and begin irritating the catheter with sterile
normal saline (not sterile water). The nurse can delegate the vital signs. The nurse would
review hemoglobin and hematocrit and would remind the client not to pull on the catheter for
all clients with bladder irrigation. But for this client who may be bleeding the nurse would
take further action to address the problem.

Question 51

A new nurse care for several client after radical prostatectomies for prostate cancer. What
action by the nurse indicates a need to review care measures for this type of client?
a. Delegates emptying and recording contents of the drainage devices.
b. Administers a suppository to the client who reports constipation.
c. Removes the sequential compression stockings on ambulatory clients.
d. Discusses long-term complications such as erectile dysfunction.

Answer 51

ANS: B
After a radical prostatectomy, the nurse would not provide a rectal suppository for
constipation. All rectal treatments are contraindicated. The nurse would delegate emptying
and recording drainage, remove the sequential pressure devices when clients begin
ambulating, and discuss long-term complications of the operation.

Question 52

A client with metastatic prostate cancer has been prescribed leuprolide, a bisphosphonate, and

flutamide. Which statement by the client warrants further investigation by the nurse?
a. “I go for a short walk each day, even when I am very tired.”
b. “My wife has noticed my eyes looking a little yellow.”
c. “I ordered some looser shirts to hide my enlarging breasts.”
d. “Now I understand my wife’s hot flashes with menopause.”

Answer 52

ANS: B
Flutamide is an antiandrogen drug that can cause liver toxicity. The nurse would follow up on
the statement that the client’s eyes may be looking a little yellow which could indicate the
onset of this adverse effect. Leuprolide can cause osteoporosis, hot flashes, and gynecomastia.
The statements regarding weight-bearing exercise, enlarging breasts, and hot flashes are not
cause for concern.

Question 53

The nurse is providing preoperative education to a client prior to having an orchiectomy for
testicular cancer. What statement by the client indicates the need to review the information?
a. “I can still function sexually without one of my testes.”
b. “I will investigate sperm banking before the operation.”
c. “There should be no effect on my ability to reproduce.”
d. “Testicular self-exam will be important on the remaining testis.”

Answer 53

ANS: C
Oligospermia and azoospermia are common in clients with testicular function and can affect
reproduction. The statement that there will be no effect on reproduction requires the nurse to
review the information with the client. Sperm banking is an option prior to treatment to store
sperm for future use. Normal sexual function is possible with one testis. Self-examination of
the remaining testis is important for early detection of another tumor.

Question 54

The nurse has provided postvasectomy discharge instructions to the client. What statement by
the client demonstrates good understanding?
a. “We can have unprotected intercourse as soon as I have healed.”
b. “An ice pack to my scrotum will help with the swelling.”
c. “I need to report signs of infection, swelling, or bruising right away.”
d. “The stitches can be removed here in the office in 7 to 10 days.”

Answer 54

ANS: B
After vasectomy, clients are instructed to use birth control until the 3-month semen analysis
shows that the procedure has worked, to use an ice pack intermittently for 24 to 48 hours, that
swelling and bruising are normal, and the bandage can be removed in 48 hours. There are no
sutures to be removed.

Question 55

A client comes to the clinic with concerns about an enlarged left testicle and heaviness in his
lower abdomen. Which diagnostic test would the nurse expect to be ordered?
a. Alpha-fetoprotein (AFP)
b. Prostate-specific antigen (PSA)
c. Serum acid phosphatase (PAP)
d. C-reactive protein (CRP)

Answer 55

ANS: A
These are symptoms of possible testicular cancer. AFP is a tumor marker that is elevated in
testicular cancer. PSA and PAP testing is used in testing for prostate cancer and its metastasis.
CRP is diagnostic for inflammatory conditions.

Question 56

A client presents to the emergency department reporting vomiting, severe lower abdominal
pain, and a tender mass above one testis. What action by the nurse is most important?
a. Have the client rate pain using the 0-10 scale.
b. Prepare to administer an IV opioid analgesic.
c. Determine when he last ate or drank anything.
d. Assess risk factors for testicular cancer.

Answer 56

ANS: C
This client has signs and symptoms of testicular torsion, which is a surgical emergency. For
client safety, the nurse assesses last oral intake. Rating the pain is an important intervention
too but is not related to safety. The client cannot have opioids prior to signing a surgical
consent. The client does not have signs and symptoms of testicular cancer.

Question 57

A client returned from a transurethral resection of the prostate 8 hours ago with a continuous
bladder irrigation. The client reports headache and dizziness. What action by the nurse is most
appropriate?
a. Consider starting a blood transfusion.
b. Slow the bladder irrigation down.
c. Report the findings to the surgeon immediately.
d. Take the vital signs every 15 minutes.

Answer 57

ANS: C
Headache, dizziness, and shortness of breath are symptoms of possible TURP syndrome in
which the irrigation fluid is absorbed, putting strain on the client’s heart. The nurse notifies
the primary health care provider immediately as the client may need intensive care
monitoring. There is no data indicating the client needs a blood transfusion, plus that would
add even more fluid in the system. The irrigant may need to be slowed but that is not the first
action the nurse would take. Vital signs do need to be taken frequently in this situation, but the
nurse notifies the primary health care provider first.

Question 58

The nurse is teaching an uncircumcised 65-year-old client about self-management of a urinary
catheter in preparation for discharge to his home. What statement indicates the client needs
more information?
a. “I have to wash the outside of the catheter once a day with soap and water.
b. “I should take extra time to clean the catheter site by pushing the foreskin back.”
c. “The drainage bag needs to be changed at least once a week and as needed.”
d. “I should pour a solution of vinegar and water through the tubing and bag.”

Answer 58

ANS: A
The first few inches (centimeters) of the catheter must be washed daily starting at the penis
and washing outward with soap and water. The other options are correct for self-management
of a urinary catheter in the home setting.

Question 59

The nurse is teaching a client about side effects and adverse reactions of a PDE5 inhibitor.
What information does the nurse include? (Select all that apply.)
a. Refrain from eating citrus fruit within 24 hours of taking the medication.
b. Stop using this drug if your primary health care provider prescribes a nitrate.
c. Do not drink alcohol before having sexual intercourse.
d. Muscle cramps, nausea, and vomiting are possible if you take more than 1 pill a
day.
e. Take this medication within 30 to 60 minutes of having sexual intercourse.
f. Change positions slowly especially if you also take an anti-hypertensive drug.

Answer 59

ANS: B, C, D, F
A PDE5 inhibitor is used to treat erectile dysfunction. The client should avoid grapefruit or
grapefruit juice while taking these drugs. Taking a PDE5 inhibitor along with a nitrate can
cause a profound drop in blood pressure. Alcohol may interfere with the ability to have an
erection. Muscle cramps, nausea, and vomiting are possible side effects if more than 1 pill a
day are taken. Each medication has its own directions for how soon to take it before
intercourse, from 15 minutes to 2 hours. Any PDE5 drug can lower blood pressure so the
nurse alerts the client of safety precautions.

Question 60

A client is interested in learning about the risk factors for prostate cancer. Which factors does
the nurse include in the teaching? (Select all that apply.)
a. First-degree relative with prostate cancer
b. Smoking
c. Obesity
d. Advanced age
e. Eating too much red meat
f. Race

Answer 60

ANS: A, D, E, F
Risk factors for prostate cancer include having a first-degree relative with the disease,
advanced age, and African-American race. Smoking, obesity, and eating too much red meat
are not considered risk factors. Research is exploring the relationship with diet.

Question 61

A client came to the clinic with erectile dysfunction. What are some possible causes of this
condition that the nurse could discuss with the client during history taking? (Select all that
apply.)
a. Recent prostatectomy
b. Long-term hypertension
c. Diabetes mellitus
d. Hour-long exercise sessions
e. Consumption of beer each night
f. Taking long hot baths

Answer 61

ANS: A, B, C, E
Organic erectile dysfunction can be caused by surgical procedures, vascular diseases such as
hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no
evidence that exercise or hot baths are related to this problem.

Question 62

A nurse is assessing a client who presents with a scaly rash over the palms and soles of the
feet and the feeling of muscle aches and malaise. Which action by the nurse is most
appropriate?
a. Reassure the client that these lesions are not infectious.
b. Assess the client for hearing loss and generalized weakness.
c. Don gloves and further assess the client’s lesions.
d. Take a history regarding any cardiovascular symptoms.

Answer 62

ANS: C
The client is displaying symptoms similar to secondary syphilis, with flulike symptoms and
rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs
to further assess the client’s lesions with gloves since the client is highly contagious at this
stage. Tertiary syphilis may display in the form of cardiovascular or central nervous system
symptoms. Neurosyphilis can appear at any time, in any state, and can include hearing loss.

Question 63

A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at
this time?
a. “Have you been using latex condoms?”
b. “Are you allergic to penicillin?”
c. “When was your last sexual encounter?”
d. “Do you have a history of sexually transmitted infections?”

Answer 63

ANS: B
Benzathine penicillin G is the evidence-based treatment for primary, secondary, and early
latent syphilis. The client needs to be assessed for allergies before treatment. The other
questions would be helpful in the client’s history of sexually transmitted infections but not as
important as knowing whether the client is allergic to penicillin.

Question 64

A client with genital herpes has painful blisters on her vulva. After teaching the client
self-care measures, which statement indicates the need for further education?
a. “Pouring water over my genitals will decrease the pain of urinating.”
b. “I will wash my hands carefully after applying ointment.”
c. “When I don’t have lesions, I am not contagious to my sexual partner.”
d. “I should increase my fluid intake when I have open lesions.”

Answer 64

ANS:C
A client with genital herpes can still spread the disease when asymptomatic through viral
shedding. The client is taught to use condoms with all sexual activity. Pouring water over the
genitals (or urinating in the shower) will help decrease the pain of urine passing over open
lesions. Good handwashing is important. Open lesions can lead to fluid loss so the client is
taught to increase fluid intake.

Question 65

A 30-year-old male client is asking the nurse about the vaccine for human papilloma virus
(HPV). Which statement by the nurse is accurate?
a. “Gardasil protects against all HPV strains.”
b. “You are too old to receive the vaccine.”
c. “Only females can receive the vaccine.”
d. “You will only need 1 dose of the vaccine.”

Answer 65

ANS: D
Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 and Gardasil 9 protects
against 5 more strains. The vaccine is recommended for people aged 9 to 26 years of age, but
Gardasil 9 can be given up to age 45. Both males and females can get the vaccine. Depending
on the timing and type of vaccine, either 2 to 3 doses are required.

Question 66

A client with multiple sexual partners has been assessed for symptoms of dysuria and green,
malodorous vaginal discharge. The nurse administers and injection of ceftriaxone and gives
the client a prescription for doxycycline. The client asks why two drugs are needed. What
answer by the nurse is best?
a. “It is very common to be infected with both gonorrhea and chlamydia.”
b. “Giving two medications increases the chance of curing the infection.”
c. “Some people are not affected by the injection and need more medication.”
d. “This will prevent you from needing a 3-month follow-up test.”

Answer 66

ANS: A
This client has signs of gonorrhea. Co-infection with gonorrhea and chlamydia is common, so
the client being treated for gonorrhea also needs treatment for chlamydia with oral antibiotics.
It is fairly accurate to say two medications increases the chance of cure, but does not really
explain the situation. Giving the client two medications is not because some people are not
affected by the injection nor is it to prevent needing a 3-month follow-up test. Testing for
re-infection with chlamydia is recommended by the CDC.

Question 67

While evaluating a client for treatment of gonorrhea, which question is the most important for
the nurse to ask?
a. “Do you have a history of sexually transmitted infection?”
b. “When was your last sexual encounter?”
c. “When did your symptoms begin?”
d. “Can you remember your partners and contact them to get treated?”

Answer 67

ANS: D
Sexual partners, as well as the client, should be tested and treated for gonorrhea. Asking about
sexually transmitted infection history, last sexual encounter, and onset of symptoms would be
helpful with the history taking, but the priority is treating the client’s sexual partners to limit
the spread of the infection.

Question 68

A client has been treated for syphilis with IM penicillin. The next day the client calls the
clinic to report fever, chills, achy muscles, and a worsening rash. What statement by the nurse
is most appropriate?
a. “You must be allergic to penicillin; over the counter antihistamines will help.”
b. “Please go to the nearest emergency department if you develop shortness of
breath.”
c. “You can take acetaminophen or ibuprofen for the pain and achiness.”
d. “I think you should come in to the clinic either today or tomorrow and be
checked.”

Answer 68

ANS: C
This client has signs of a Jarisch-Herxheimer reaction which is caused when the organisms’
cell walls are disrupted and cellular contents are released rapidly. It is usually self-limiting
and benign. Antipyretics and mild analgesics treat the symptoms. The client does not need to
monitor for shortness of breath, come in to the clinic, or get antihistamines for an allergic
reaction.

Question 69

A 24 year-old female has been diagnosed with genital warts. Which action by the nurse is
best?
a. Encourage the client to complete STI screening.
b. Recommend an over-the-counter wart treatment for genital tissue.
c. Report the case to the Centers for Infection Control and Prevention (CDC).
d. Discuss popular options for contraception.

Answer 69

ANS: A
Clients with HPV should be fully screened for other STIs since co-infection is common. Over
the counter treatments should not be applied to genital tissue. HPV is not reportable.
Contraception is not related.

Question 70

A female client returned to the clinic with a yellow vaginal discharge after being treated for
Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there
may be a recurrence of the infection?
a. “I did practice abstinence while taking the medication.”
b. “I took doxycycline two times a day for a week.”
c. “I never told my boyfriend about the infection.”
d. “I did drink wine when taking the medication for Chlamydia.”

Answer 70

ANS: C
There is a good possibility that the boyfriend reinfected the client after the medication
regimen was finished. Both the client and the boyfriend need to be treated. The other
statements were in compliance with the recommendations of abstinence and the usual
medication regimen with doxycycline. Wine should not interfere with the treatment.

Question 71

A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease.
She is in pain, with a rating of 7 on a scale of 0-10. What comfort measure can the nurse
delegate to assistive personnel (AP)?
a. Administer acetaminophen with codeine.
b. Apply an ice pack to the lower abdomen.
c. Position the client in a semi-Fowler position.
d. Teach the client to increase intake of fluids.

Answer 71

ANS: C
The client with pelvic inflammatory disease usually experiences lower abdominal tenderness.
The AP can position the client. Only the nurse can administer medications and perform
teaching. A heating pad, not an ice pack, is used for comfort.