Eliopoulos Chapter 20 - Reproductive Health

As part of health promotion initiative, a nurse is conducting a teaching session to a group of older adults at their church. What teaching point should the nurse include in the area of sexual health?

A) "Pap smears are usually no longer required for women over the age of 70."

B) "It's important for men to have either a prostate-specific antigen (PSA) test or to perform a testicular self-exam each year."

C) "Breast self-examination can be done, but it has been shown to have little value in identifying breast disease."

D) "Women should have a gynecological exam done annually and it should include a Pap smear."

D) "Women should have a gynecological exam done annually and it should include a Pap smear."

• rationale: Ongoing screening helps detect precancerous or cancerous changes early, when treatment is most effective.

• B - incorrect because testicular/PSA exams are not suggested ANNUALLY for older men

The nurse in an OB-GYN clinic takes a complete history from the 68-year-old before the physician sees the client. Which of the following is appropriate when taking a sexual history from the client?

A) Ask questions that the client will not be embarrassed to answer.

B) Ask open-ended questions specific to sexual functioning.

C) Write down everything the client says during the interview.

D) When possible include the sex partner in the interview.

B) Ask open-ended questions specific to sexual functioning.

A menopausal woman tells her nurse that she experiences discomfort from vaginal dryness during intercourse and asks, "What should I use as a lubricant?" Which of the following should the nurse recommend?

A) Petroleum jelly

B) Water-soluble lubricant

C) Body cream or body lotion

D) Saliva

B) Water-soluble lubricant

The nurse assesses the reproductive system of an older adult. Which of the following questions should the nurse consider including in the interview?

A) "Do you ever have secretions, blood, or other discharge from your genitals?"

B) "Does your partner have satisfying orgasms?"

C) "When was the last time you had sexual intercourse?"

D) "With whom do you have sexual intercourse?"

A) "Do you ever have secretions, blood, or other discharge from your genitals?"

The nurse practitioner discusses breast self-exam with a 78-year-old woman. Which of the following statements if made by the patient indicate understanding of the material?

A) "I need to get a mammogram every 5 years."

B) "I will call you if I find any lump in my armpit."

C) "I won't be concerned if my nipple leaks."

D) "My home health nurse will check me."

B) "I will call you if I find any lump in my armpit."

A nurse is discussing sexual health with a 74-year-old female resident of an assisted living facility. Which of the nurse's following teaching points should be included in the discussion?

A) "Because the vagina becomes drier and its lining thinner with age, sexual experiences are normally not possible."

B) "A lot of changes occur with age, but most of these are chemical and hormonal rather than changes to body parts and structures."

C) "There are many changes to your reproductive system that accompany normal aging, but none of them rules out the possibility of still having satisfying experiences sexually."

D) "It's certainly possible for you to maintain a satisfying sexual relationship even though the hormones that affected you when you were younger no longer have an effect."

C) "There are many changes to your reproductive system that accompany normal aging, but none of them rules out the possibility of still having satisfying experiences sexually."

• rationale: aging does cause physical changes but these do not ELIMINATE the ability to have satisfying sexual experiences, adjustments just need to be made.

• A → Incorrect and discouraging; sexual activity is still possible.

  B → Incorrect; aging involves both structural (physical) and hormonal changes.

  D → Misleading; hormones still play a role, even though levels change.

The nurse is assessing and reviewing the chart of a 78-year-old male patient who is newly admitted to the hospital unit. Which of the following diagnostic and assessment findings should the nurse interpret as potentially pathological?

A) The patient's testes appear to be atrophied.

B) Slight enlargement of prostate was noted during his last visit to his primary care provider.

C) The client states he has difficulty achieving and maintaining an erection.

D) Serum testosterone levels are a small fraction of those in younger men.

D) Serum testosterone levels are a small fraction of those in younger men.

• rationale: marked decrease in serum testosterone to only a small fraction of younger levels is NOT normal aging

• A: Testicular atrophy → expected with aging

• B: Slight prostate enlargement → common (benign prostatic hyperplasia)

• C: Erectile difficulty → common age-related change

During morning care of a 91-year-old female patient with vascular dementia, the nurse and the unlicensed care provider note that the woman's vulva is inflamed and reddened. Which of the following age-related changes has most likely contributed to the woman's health problem?

A) Decreased cognition

B) Changes to normal vaginal flora

C) Decreased immune function

D) Fragility of the woman's vulva

D) Fragility of the woman's vulva

Which of the following measures should a nurse recommend to a 68-year-old woman who has been experiencing recurrent vaginitis?

A) Douche with hypertonic saline occasionally.

B) Avoid perineal contact with heavily perfumed soaps and sprays.

C) Begin low-dose, broad-spectrum antibiotics.

D) Avoid both Pap smears and vaginal examinations.

B) Avoid perineal contact with heavily perfumed soaps and sprays.

A 66-year-old patient is suspected of having cervical cancer. Which of the following signs and symptoms would be considered indicative of the disease? (Select all that apply.)

A) Vaginal bleeding

B) White vaginal discharge

C) Perineal herniation

D) Pain

E) Fever

A) Vaginal bleeding

B) White vaginal discharge

• rationale: bleeding and discharge are early signs

• D) Pain → usually occurs later

• C) Perineal herniation → not associated with cervical cancer

• E) Fever → not a typical sign unless there’s a secondary infection

A 71-year-old woman who has been experiencing several weeks of lower back pain and pelvic heaviness has been diagnosed with a cystocele. Which of the following teaching points about the woman's bladder herniation is most accurate?

A) "Incontinence of urine is a common consequence of this problem."

B) "This problem is unlikely to worsen with time."

C) "An infection was likely a cause of your cystocele."

D) "Fortunately, this probably won't cause pain with intercourse."

A) "Incontinence of urine is a common consequence of this problem."

• rationale: A cystocele (bladder prolapse) weakens the support between the bladder and vaginal wall, which commonly leads to urinary incontinence

• B: It can worsen over time, especially with increased pressure or weakening tissues

• C: Caused by pelvic floor weakness, not infection

• D: Can cause dyspareunia (pain with intercourse), so this is inaccurate

A 66-year-old male client has had a diagnosis of benign prostatic hyperplasia (BPH) for several months and is now slated for transurethral prostate resection (TURP) surgery. The man states to the nurse, "Finally I'll be able to get my sex life back in order." How can the nurse best respond?

A) Tell the client that the surgery is likely to result in erectile dysfunction

B) Explain that the surgery is unlikely to bring a rejuvenation of sexual performance

C) Explain that while sexual performance is likely to improve, incontinence is often a consequence of the surgery.

D) Tell the client that there will probably be no effect on sexual performance.

B) Explain that the surgery is unlikely to bring a rejuvenation of sexual performance

• rationale: TURP relieves urinary symptoms, not sexual function, so it is unlikely to restore or “rejuvenate” sexual performance

• A: Erectile dysfunction is not a common direct outcome of TURP

• C: Sexual performance does not typically improve, and incontinence is not “often” expected

• D: Not fully accurate—there can be changes (e.g., retrograde ejaculation), so saying “no effect” is misleading

A nurse who provides care on a postoperative unit of the hospital has recently admitted a 65-year-old male patient who has just had prostate surgery. Which of the following post-surgical teaching points is most accurate?

A) "Perform the Valsalva maneuver at least twice daily."

B) "Avoid sexual activity for at least one week."

C) "It's important for you to avoid becoming constipated."

D) "Expect to have quite a bit of bright red blood in your urine for the next several days."

C) "It's important for you to avoid becoming constipated."

• rationale: After prostate surgery, straining (like with constipation) can increase pressure and lead to bleeding or disruption of the surgical site, so avoiding constipation is essential.

Which of the following men is most likely to experience a loss of sexual function?

A) Mr. E, age 70, who has recently been diagnosed with benign prostatic hyperplasia (BPH).

B) Mr. J, age 70, who had a transurethral prostate resection (TURP) 6 weeks prior.

C) Mr. Y, age 65, who has had a radical prostatectomy.

D) Mr. U, age 73, who is undergoing radiation treatment for his prostate cancer.

C) Mr. Y, age 65, who has had a radical prostatectomy.

• rationale: A radical prostatectomy removes the prostate and can damage the nerves responsible for erection, making loss of sexual function most likely compared to the other options.

The nursing staff notes that an 85-year-old woman with dementia is incontinent every evening and is particularly restless. What health problem would this behavior lead the staff to suspect?

A) Senile vulvitis

B) Atrophic vaginitis

C) Perineal herniation

D) Uterine cancer

A) Senile vulvitis

• rationale: Evening incontinence and restlessness in a woman with dementia suggest irritation and discomfort of the vulva, often from moisture and poor hygiene, which is characteristic of senile vulvitis.

The clinic nurse assesses a 70-year-old newlywed client who has had slight vaginal bleeding. Which of the following assessment data should the nurse prioritize?

A) Date of last Pap smear

B) History of cervical cancer

C) History of urinary tract infections

D) Bleeding or other symptoms after intercourse

D) Bleeding or other symptoms after intercourse

• rationale: Assessing bleeding or symptoms after intercourse is priority because it helps identify postcoital bleeding, a key sign of cervical pathology (including cancer) and also common with atrophic changes

A 70-year-old male recently had prostate surgery. Which of the following interventions should the nurse include in the patient's nursing care plan?

A) Maintain the patient's skin integrity.

B) Restore the patient's desired roles and functions.

C) Achieve partial or complete restoration of bladder control.

D) Allow the patient to resume sexual relations.

D) Allow the patient to resume sexual relations.

• rationale: After prostate surgery, a key nursing goal is to support resumption of normal activities, including sexual function, when appropriate

A nurse educator is presenting a lecture on women's health to the nursing staff at a nursing home. A staff member asks about the most common site for vulvar malignancy. How should the nurse educator respond?

A) Clitoris

B) Vagina wall

C) Labia majora

D) Labia minora

A) Clitoris

• rationale: the clitoris is the most common site for vulvar malignancy

Which of the following age-related issues can contribute to vaginitis?

A) Alkaline vaginal pH

B) Muscle weakness of the perineum

C) Atrophy of the endocervical epithelium

D) Shortening and atrophy of the fallopian tubes

A) Alkaline vaginal pH

• rationale: With aging, vaginal pH becomes more alkaline, which disrupts normal flora and increases susceptibility to infections, making vaginitis more likely.

Which of the following elderly women would be predisposed to vaginal cancer?

A) A 65-year-old woman with a history of leukorrhea

B) A 70-year-old woman with a history of pessary use

C) A 70-year-old woman with a history of hysterectomy

D) A 65-year-old woman with a history of nabothian cysts

B) A 70-year-old woman with a history of pessary use

• rationale: Long-term pessary use can cause chronic irritation and inflammation of the vaginal tissues, which increases the risk of vaginal cancer over time.

Which of the following women exhibits signs of cervical cancer?

A) A 65-year-old woman with leukorrhea

B) A 65-year-old woman with nabothian cysts

C) A 70-year-old woman with history of pessary use

D) A 70-year-old woman with history of hypertension

A) A 65-year-old woman with leukorrhea

• rationale: Leukorrhea (abnormal vaginal discharge) can be a sign of cervical cancer, especially if persistent or unusual, making it the most indicative finding among the options.

A 75-year-old woman complains of a feeling of heaviness in the pelvic area and a feeling of a mass in her vagina. What health problem would the health care team most likely suspect?

A) Vaginal cancer

B) Cervical cancer

C) Perineal herniation

D) Endometrial cancer

C) Perineal herniation

• rationale: A feeling of pelvic heaviness and a vaginal mass is characteristic of pelvic organ prolapse (perineal herniation), where pelvic structures bulge into the vaginal canal.

Prostatic cancer has recently been diagnosed in a 75-year-old man, and he has begun estrogen treatment. He tells his spouse "These pills are going to make me a woman." What should the nurse tell the man about the intention of this treatment?

A) Reduce surgical risks

B) Treat prostatic hypertrophy

C) Support sexual performance

D) Prevent tumor dissemination

D) Prevent tumor dissemination

The client has new onset of benign prostatic hyperplasia (BPH) with related urinary symptoms. What factor most likely underlies the client's urinary symptoms?

A) Loss of bladder elasticity

B) Compression of the urethra

C) History of use of diuretics

D) Excessive use of urinary antiseptics

B) Compression of the urethra

Recognizing the fact that dyspareunia is a common problem among older women, the nurse has integrated relevant assessments into her practice. Which of the following older adult women is less likely to experience painful sexual intercourse?

A) A 78-year-old woman who gave birth to 7 children in her twenties and thirties

B) A 70-year-old woman with a history of vulvitis

C) A woman, age 66, who has a suspected diagnosis of vaginitis

D) A woman, age 70, who has been married for 48 years but never had any children

A) A 78-year-old woman who gave birth to 7 children in her twenties and thirties

• rationale: Multiple vaginal births often lead to increased vaginal laxity, which can make intercourse less painful, so this woman is less likely to experience dyspareunia compared to the others who have conditions causing irritation or inflammation.

As part of a health promotion initiative, a nurse is teaching a group of older men the importance of screening and prevention. Regular self-examination is promoted in order to identify which of the following health problems at an early stage?

A) Prostate cancer

B) Benign prostatic hyperplasia (BPH)

C) Penile cancer

D) Testicular tumors

D) Testicular tumors

• Testicular tumors are best detected early through regular self-examination, whereas prostate conditions require clinical screening (e.g., PSA, DRE), not self-exam.

Which of the following health problems would a nurse be most likely to attribute to age-related changes?

A) Atrophic vaginitis

B) Cancer of the vagina

C) Cervical cancer

D) Breast cancer

A) Atrophic vaginitis

• rationale: Atrophic vaginitis is directly caused by age-related decreases in estrogen, leading to thinning and dryness of vaginal tissues