Maternity and Womens Health Care 11th Edition by Deitra Leonard Lowdermilk -Test Bank

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Maternity and Womens Health Care 11th Edition by Deitra Leonard Lowdermilk -Test Bank

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WITH ANSWERS

Maternity and Womens Health Care 11th Edition by Deitra Leonard Lowdermilk -Test Bank

Chapter 04: Assessment and Health Promotion

Lowdermilk: Maternity & Womens Health Care, 11th Edition

 

MULTIPLE CHOICE

 

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

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Understand          REF:   p. 63              TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
a. Variations in the follicular (preovulatory) phase
b. Intact hypothalamic-pituitary feedback mechanism
c. Functioning corpus luteum
d. Prolonged ischemic phase

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Understand          REF:   pp. 66-67

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. How would the physiologic process of the sexual response best be characterized?
a. Coitus, masturbation, and fantasy
b. Myotonia and vasocongestion
c. Erection and orgasm
d. Excitement, plateau, and orgasm

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Knowledge          REF:   p. 68

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Understand          REF:   pp. 78-79

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Apply                  REF:   pp. 79-80       TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond?
a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled.
b. Reassure the woman that using vaginal cream is not a problem for the examination.
c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection.
d. Ask the woman to reschedule the appointment for the examination.

 

 

ANS:  C

An important element of the health history and physical examination is the clients description of any symptoms she may be experiencing. The best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

 

DIF:    Cognitive Level: Apply                  REF:   p. 79

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

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

 

 

ANS:  C

Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and in their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. For many women, counseling can allow behavior modification before any damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, then she is likely aware of prenatal care.

 

DIF:    Cognitive Level: Understand          REF:   p. 69              TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Ovarian function and hormone production decline during which transitional phase?
a. Climacteric
b. Menarche
c. Menopause
d. Puberty

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Remember           REF:   p. 67

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement indicates that a client requires additional instruction regarding BSE?
a. Yellow discharge from my nipple is normal if Im having my period.
b. I should check my breasts at the same time each month, after my period.
c. I should also feel in my armpit area while performing my breast examination.
d. I should check each breast in a set way, such as in a circular motion.

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Analyze               REF:   p. 63

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Apply                  REF:   p. 80              TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which female reproductive organ(s) is(are) responsible for cyclic menstruation?
a. Uterus
b. Ovaries
c. Vaginal vestibule
d. Urethra

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Remember           REF:   p. 60

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Knowledge          REF:   p. 62

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Understand          REF:   p. 67

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which part of the menstrual cycle includes the stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH)?
a. Menstrual phase
b. Endometrial cycle
c. Ovarian cycle
d. Hypothalamic-pituitary cycle

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Remember           REF:   pp. 65-66

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Remember           REF:   p. 67

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Understand          REF:   p. 74

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

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

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Apply                  REF:   p. 83

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

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

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Remember           REF:   p. 92              TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Remember           REF:   p. 86

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

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

 

 

ANS:  C

A screening tool specifically developed to identify eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions:

  • Do you make yourself Sick because you feel too full?
  • Do you worry about loss of Control over the amount that you eat?
  • Have you recently lost more than One stone (14 pounds) in a 3-month period?
  • Do you think that you are too Fat, even if others think you are thin?
  • Does Food dominate your life?

The 4 Cs are used to determine cultural competence. Dietary Guidelines for Americans provide nutritional guidance for all, not only for those with eating disorders. The DEXA scan is used to determine bone density.

 

DIF:    Cognitive Level: Apply                  REF:   p. 75              TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Apply                  REF:   pp. 60-61

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which hormone is responsible for the maturation of mammary gland tissue?
a. Estrogen
b. Testosterone
c. Prolactin
d. Progesterone

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Remember           REF:   p. 62

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. What is the goal of a long-term treatment plan for an adolescent with an eating disorder?
a. Managing the effects of malnutrition
b. Establishing sufficient caloric intake
c. Improving family dynamics
d. Restructuring client perception of body image

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Apply                  REF:   p. 75

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Psychosocial Integrity

 

  1. A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family physician has retired, and she is going to see the womens health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience for this client?
a. Remind the woman that she is long overdue for her examination and that she should come in annually.
b. Carefully listen, and allow extra time for this womans health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old physician.
d. Encourage the woman to talk about the death of her husband and her fears about her own death.

 

 

ANS:  B

The nurse has an opportunity to use reflection and empathy while listening, as well as ensure an open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women older than age 50 years can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches.

 

DIF:    Cognitive Level: Apply                  REF:   pp. 78-79       TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. During a health history interview, a woman states that she thinks that she has bumps on her labia. She also states that she is not sure how to check herself. The correct response by the nurse would be what?
a. Reassure the woman that the examination will reveal any problems.
b. Explain the process of vulvar self-examination, and reassure the woman that she should become familiar with normal and abnormal findings during the examination.
c. Reassure the woman that bumps can be treated.
d. Reassure her that most women have bumps on their labia.

 

 

ANS:  B

During the assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the bumps would not be an accurate response.

 

DIF:    Cognitive Level: Apply                  REF:   p. 86

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

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

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Remember           REF:   p. 68

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Understand          REF:   p. 74

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Physiologic Integrity

 

  1. Which statement by the client indicates that she understands BSE?
a. I will examine both breasts in two different positions.
b. I will examine my breasts 1 week after my menstrual period starts.
c. I will examine only the outer upper area of the breast.
d. I will use the palm of the hand to perform the examination.

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Analyze               REF:   p. 63              TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  C

Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviors than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 73

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Physiologic Integrity

 

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

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Comprehend        REF:   p. 74

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

MULTIPLE RESPONSE

 

  1. What are the two primary functions of the ovary? (Select all that apply.)
a. Normal female development
b. Ovulation
c. Sexual response
d. Hormone production
e. Sex hormone release

 

 

ANS:  B, D

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

 

DIF:    Cognitive Level: Apply                  REF:   p. 62

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  A, B, E

Menstruation is the periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days; however, variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. The average blood loss is 50 ml with a normal range of 20 to 80 ml. Menstruation occurs 14 days after ovulation. The lack of fertilization leads to menstruation.

 

DIF:    Cognitive Level: Apply                  REF:   p. 65

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

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

 

 

ANS:  B, C, D

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

 

DIF:    Cognitive Level: Apply                  REF:   p. 93              TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

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

 

 

ANS:  A, B, C, E

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

 

DIF:    Cognitive Level: Analyze               REF:   pp. 72-73       TOP:   Nursing Process: Diagnosis

MSC:  Client Needs: Psychosocial Integrity

 

MATCHING

 

To promote wellness and prevent illness throughout the life span, it is important for the nurse to be cognizant of immunization recommendations for women older than 18 years. Match each immunization with the correct schedule.

a. Tetanus-diphtheria-pertussis (Tdap)
b. Measles, mumps, rubella
c. Herpes zoster
d. Hepatitis B
e. Influenza
f. Human papillomavirus (HPV)

 

 

  1. Three injections for girls between the ages 9 to 26 years

 

  1. Primary series of three injections

 

  1. Annually

 

  1. Once and then a booster every 10 years

 

  1. One dose after age 65 years

 

  1. Once if born after 1956

 

  1. ANS:  F                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

  1. ANS:  D                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

  1. ANS:  E                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

  1. ANS:  A                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

  1. ANS:  C                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

  1. ANS:  B                    DIF:    Cognitive Level: Apply                  REF:   pp. 90-91

TOP:   Nursing Process: Implementation   MSC:  Client Needs: Health Promotion and Maintenance

NOT:  This guideline is applicable to most women; however, health care providers individualize the timing of tests and immunizations for each woman.

 

Chapter 06: Reproductive System Concerns

Lowdermilk: Maternity & Womens Health Care, 11th Edition

 

MULTIPLE CHOICE

 

  1. Which condition is the least likely cause of amenorrhea in a 17-year-old client?
a. Anatomic abnormalities
b. Type 1 diabetes mellitus
c. Obesity
d. Pregnancy

 

 

ANS:  C

A moderately obese adolescent (20% to 30% above ideal weight) may have early onset menstruation. Girls who regularly exercise before menarche can have delayed onset of menstruation to age 18 years. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Pregnancy is the most common cause of amenorrhea.

 

DIF:    Cognitive Level: Remember           REF:   p. 121

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat to replace blood loss
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

 

 

ANS:  D

Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as a low-fat vegetarian diet 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.

 

DIF:    Cognitive Level: Analyze               REF:   pp. 122-123   TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiologic Integrity

 

  1. Nafarelin (Synarel) is used to treat mild-to-severe endometriosis. What instruction or information should the nurse provide to a client regarding nafarelin administration?
a. Nafarelin stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.
b. It should be administered by intramuscular (IM) injection.
c. Nafarelin should be administered by a subcutaneous implant.
d. It can cause the client to experience some hot flashes and vaginal dryness.

 

 

ANS:  D

Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH. Nafarelin is administered twice daily by nasal spray and can be intranasally administered. Leuprolide is given once per month by IM injection. Goserelin is administered by subcutaneous implant.

 

DIF:    Cognitive Level: Apply                  REF:   p. 127            TOP:   Nursing Process: Planning

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the clients recent menstrual cycles. Which statement by the client should prompt the nurse to collect further information?
a. My menstrual flow lasts 5 to 6 days.
b. My flow is very heavy.
c. I have had a small amount of spotting midway between my periods for the past 2 months.
d. The length of my menstrual cycles varies from 26 to 29 days.

 

 

ANS:  B

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 the 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.

 

DIF:    Cognitive Level: Understand          REF:   p. 131

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A 21-year-old client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this clients presenting complaint?
a. Primary dysmenorrhea
b. Secondary dysmenorrhea
c. Dyspareunia
d. Endometriosis

 

 

ANS:  A

Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops after the age of 25 years and is usually associated with a pelvic pathologic condition. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is characterized by endometrial glands and stoma outside of the uterus.

 

DIF:    Cognitive Level: Remember           REF:   p. 122

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which symptom described by a client 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 on 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.

 

 

ANS:  A

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. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS; however, the timing reflected is inaccurate.

 

DIF:    Cognitive Level: Apply                  REF:   p. 125

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Psychosocial Integrity

 

  1. A client complains of severe abdominal and pelvic pain around the time of menstruation. This pain has become progressively worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to become pregnant for the past 18 months. To which condition are these symptoms most likely related?
a. Endometriosis
b. PMS
c. Primary dysmenorrhea
d. Secondary dysmenorrhea

 

 

ANS:  A

Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.

 

DIF:    Cognitive Level: Understand          REF:   pp. 126-127

TOP:   Nursing Process: Assessment          MSC:  Client Needs: Health Promotion and Maintenance

 

  1. Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs and symptoms of the climacteric?
a. Headaches
b. Hot flashes
c.

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