Chapter 04: Assessment and Health Promotion Lowdermilk: Maternity & Women's Health Care, 12th Edition

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.

2. 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. This information discounts the other options as being correct. 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

3. 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, 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

4. 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 can't have an examination without removing all your clothes."

b. "I'll ask the physician to modify the examination."

c. "I'll 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 woman's 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.

5. A woman tells the nurse that she thinks she has a vaginal infection, and has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond?

a. Determine when she first noticed the symptoms.

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 client's description of any symptoms she may be experiencing. The best response is for the nurse to inquire about the symptoms the woman is experiencing. While relevant, when the symptoms began is not as important as what the symptoms are. 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.

6. Preconception and prenatal care have become important components of women's 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.

7. 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.

8. Which statement indicates that a client requires additional instruction regarding breast self-examination (BSE)?

a. "Yellow discharge from my nipple is normal if I'm 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.

9. A blind woman has arrived for an examination. She appears nervous and says, "I've never had a pelvic examination." What response from the nurse would be most appropriate?

a. "Being visually impaired must be very anxiety producing."

b. "Try to relax. I'll be very gentle, and I promise not to hurt you."

c. "Your anxiety is common. I was anxious when I first had a pelvic examination."

d. "I'll let you touch each instrument I'll be using 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. The statement regarding her visual disability and anxiety does not address her 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 client's concerns.

10. Which female reproductive organ is responsible for cyclic menstruation?

a. Uterus

b. Ovary

c. Vaginal vestibule

d. Urethra

ANS: A

The uterus is responsible for cyclic menstruation while also housing and nourishing 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.

11. 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 area of thin, flat tissue called the fourchette is formed by the labia minor and is found underneath the vaginal opening.

12. 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.

13. 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.

14. 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. Follicle-stimulating hormone (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.

15. Which statement best describes Kegel exercises?

a. Kegel exercises were developed to control or reduce incontinent urine loss.

b. Kegel exercises produce a pleasurable vaginal sensation.

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 pleasurable 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

16. 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 client's 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.

17. 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.

18. 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. These muscle fibers have no contribution to the process of menstruation, ovulation or fertilization.

19. 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.

20. 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 individual's body image

21. 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 women's 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 woman's 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

22. 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

23. 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).

24. Which statement by the client indicates that she understands breast self-examination (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.

25. 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. Pre-pregnancy 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. Pre-pregnancy medical care is both available and encouraged and has limited effect on initiating pregnancy

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.

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

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.

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 teen's positive self-image.