Ricci Chapter 4 - Test Bank - 4th Edition

1. After discussing various methods of contraception with a client and her partner, the nurse

determines that the teaching was successful when they identify which contraceptive method as

providing protection against sexually transmitted infections (STIs)?

A. oral contraceptives

B. tubal ligation

C. condoms

D. intrauterine system

Answer: C

Rationale: Condoms are a barrier method of contraception. In addition to providing a physical

barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and

intrauterine systems provide no protection against STIs.

2. When discussing contraceptive options, the nurse would recommend which option as being

the most reliable?

A. coitus interruptus

B. lactational amenorrheal method (LAM)

C. natural family planning

D. intrauterine system

Answer: D

Rationale: An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planning are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These

behavioral methods must be followed exactly as prescribed.

3. A client comes to the clinic with abdominal pain. Based on her history the nurse suspects

endometriosis. The nurse expects to prepare the client for which evaluatory method to confirm

this suspicion?

A. pelvic examination

B. transvaginal ultrasound

C. laparoscopy

D. hysterosalpingogram

Answer: C

Rationale: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the

nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic

examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm

its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.

4. The nurse discusses various contraceptive methods with a client and her partner. Which

method would the nurse explain as being available only by prescription?

A. condom

B. spermicide

C. diaphragm

D. basal body temperature

Answer: C

Rationale: The diaphragm is available only by prescription and must be professionally fitted by a

health care provider. Condoms and spermicides are available over the counter. Basal body

temperature requires the use of a special thermometer that is available over the counter.

5. When developing a teaching plan for a couple who are considering contraception options, the

nurse would include which statement?

A. "You should select one that is considered to be 100% effective."

B. "The best one is the one that is the least expensive and most convenient."

C. "A good contraceptive doesn't require a primary care provider's prescription."

D. "The best contraceptive is one that you will use correctly and consistently."

Answer: D

Rationale: For a contraceptive to be most effective, the client must be able to use it correctly and

consistently. Even if a method is considered 100% effective, it is not the best choice if the couple does not use it correctly or consistently. Cost is a consideration, but the least expensive method is

not necessarily the best choice. The need for a prescription is not relevant to the couple's choice.

6. Which measure would the nurse include in the teaching plan for a woman to reduce the risk of

osteoporosis after menopause?

A. taking vitamin supplements

B. eating high-fiber, high-calorie foods

C. restricting fluid to 1,000 mL daily

D. participating in regular daily exercise

Answer: D

Rationale: Measures to reduce osteoporosis after menopause include daily weight-bearing

exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol

intake. General vitamin supplements may be helpful overall, but they are not specific to reducing

the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be

appropriate. Restricting fluids would have no effect on preventing osteoporosis.

7. When teaching a group of postmenopausal women about hot flashes and night sweats, the

nurse would address which primary cause?

A. poor dietary intake

B. estrogen deficiency

C. active lifestyle

D. changes in vaginal pH

Answer: B

Rationale: Hot flashes and night sweats are classic signs of estrogen deficiency. They are

unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with

genitourinary changes of menopause.

8. A client states that she is to have a test to measure bone mass to help diagnose osteoporosis.

The nurse would most likely plan to prepare the client for:

A. DEXA scan.

B. ultrasound.

C. MRI.

D. pelvic X-ray.

Answer: A

Rationale: Currently, no method exists for directly measuring bone mass. Instead, a bone mass

density (BMD) measurement is used. BMD is a two-dimensional measurement of the average

content of mineral in a section of bone. The client most likely will be having a DEXA scan,

which is a screening test that calculates the mineral content of the bone at the spine and hip.

Ultrasound, MRI, and a pelvic X-ray would be of little help in determining bone mass.

9. The nurse is reviewing the medical records of several clients. Which client would the nurse

expect to have an increased risk for developing osteoporosis?

A. a Black woman

B. a woman who plays tennis twice a week

C. a thin woman with small bones

D. a woman who drinks one cup of coffee a day

Answer: C

Rationale: A woman with a small frame and thin bones is at a higher risk for osteoporosis. White

or Asian women, not Black women, are at higher risk for the condition. A woman who plays

tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest

excessive amounts of caffeine are at increased risk.

10. Which action would the nurse emphasize when teaching postmenopausal women about ways

to reduce the risk of osteoporosis?

A. swimming daily

B. taking vitamin A

C. using hormone replacements

D. taking calcium supplements

Answer: D

Rationale: Osteoporosis is a condition in which bone mass declines to such an extent that

fractures occur with minimal trauma. Increasing calcium and vitamin D intake is a major

preventive measure. Other measures to reduce the risk include engaging in weightbearing

exercise such as walking. Swimming, although a beneficial exercise, is not a weightbearing

exercise. Taking vitamin A supplements would have no effect on preventing bone loss. Recent

studies have shown that the overall health risks associated with hormone replacement therapy

exceed the benefits, increasing the woman's risk for heart attacks, strokes, and breast cancer.

11. Which finding would the nurse expect to find in a client with endometriosis?

A. hot flashes

B. dyspareunia

C. fluid retention

D. fever

Answer: B

Rationale: The client with endometriosis is often asymptomatic, but clinical manifestations

include pain before and during menstrual periods (dyspareunia), pain during or after sexual

intercourse, infertility, depression, fatigue, painful bowel movements, chronic pelvic pain,

hypermenorrhea, pelvic adhesions, irregular and more frequent menses, and premenstrual

spotting. Hot flashes may be associated with premenstrual syndrome or menopause. Fluid

retention is associated with premenstrual syndrome. Fever would suggest an infection.

12. After the nurse teaches a client about ways to reduce the symptoms of premenstrual

syndrome, which client statement indicates a need for additional teaching?

A. "I will make sure to take my estrogen supplements a week before my period."

B. "I've signed up for an aerobic exercise class three times a week."

C. "I'll cut down on the amount of coffee and colas I drink."

D. "I quit smoking about a month ago, so that should help."

Answer: A

Rationale: Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a

key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical

symptoms; spironolactone may help with bloating and water retention.

13. A woman has opted to use the basal body temperature method for contraception. The nurse

instructs the client that a rise in basal body temperature indicates which event?

A. onset of menses

B. ovulation

C. pregnancy

D. safe period for intercourse

Answer: B

Rationale: Basal body temperatures typically rise within a day or two after ovulation and remain

elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body

temperature is not a means for determining pregnancy. Having intercourse while the temperature

is elevated would increase the risk of pregnancy.

14. A woman using the cervical mucus ovulation method of fertility awareness reports that her

cervical mucus looks like egg whites. The nurse interprets this as which kind of mucus?

A. spinnbarkeit mucus

B. purulent mucus

C. postovulatory mucus

D. normal pre-ovulation mucus

Answer: A

Rationale: The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and

stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green

and malodorous. Pre-ovulation mucus is clear but not as copious, slippery, and stretchable.

15. A nurse is preparing a class for a group of women at a family planning clinic about

contraceptives. When describing the health benefits of oral contraceptives, which benefits would

the nurse include? Select all that apply.

A. protection against pelvic inflammatory disease

B. reduced risk for endometrial cancer

C. decreased risk for depression

D. reduced risk for migraine headaches

E. improvement in acne

Answer: A, B, E

Rationale: The health benefits of oral contraceptives include protection against pelvic

inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral

contraceptives are associated with an increased risk for depression and migraine headaches.

16. A nurse manager in a family planning clinic is conducting an in-service presentation for the

nursing staff on contraception. After teaching the group about the different methods for

contraception, the manager determines that the teaching was successful when the group identifies

which contraceptive methods as mechanical barrier methods? Select all that apply.

A. condom

B. cervical cap

C. cervical sponge

D. diaphragm

E. vaginal ring

Answer: A, B, C, D

Rationale: Barrier methods include the condom, cervical cap, cervical sponge and diaphragm.

The vaginal ring is considered a hormonal method of contraception.

17. After teaching a group of students about premenstrual syndrome, the instructor determines

that additional teaching is needed when the group identifies which finding as a prominent

assessment finding?

A. bloating

B. tension

C. dysphoria

D. weight loss

Answer: D

Rationale: Irritability, fatigue, bloating, tension, and dysphoria are the most prominent and

consistently described manifestations of premenstrual syndrome. Weight gain, not weight loss, is

associated with this disorder.

18. A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder

(PMDD). Which would the nurse include as a mandatory requirement for the diagnosis?

A. appetite changes

B. sleep difficulties

C. persistent anger

D. chronic fatigue

Answer: C

Rationale: For the diagnosis of PMDD, the woman must exhibit one or more of the following:

affective lability such as sadness, tearfulness, or irritability; anxiety and tension; persistent or

marked anger or irritability; and depressed mood and feelings of hopelessness. Other symptoms,

although not mandatory for the diagnosis, include increased or decreased appetite, sleep

difficulties, chronic fatigue, headache, increased or decreased sexual desire, constipation or

diarrhea, and breast swelling and tenderness.

19. When reviewing the medical record of a client diagnosed with endometriosis, the nurse

would identify which finding as a risk factor for this woman?

A. low fat in the diet

B. age of 14 years for menarche

C. menstrual cycles of 24 days

D. short menstrual flow

Answer: C

Rationale: Risk factors for developing endometriosis include increasing age, family history of

endometriosis in a first-degree relative, short menstrual cycle (less than 28 days), long menstrual flow (more than 1 week), high dietary fat consumption, young age at menarche (younger than

age 12), and few (one or two) or no pregnancies.

20. A client who has come to the clinic is diagnosed with endometriosis. What would the nurse

expect the primary care provider to prescribe as a first-line treatment?

A. progestins

B. antiestrogens

C. gonadotropin-releasing hormone analogues

D. NSAIDs

Answer: D

Rationale: Although progestins, antiestrogens, and gonadotrophin-releasing analogues are used

as treatment options for endometriosis, NSAIDS are considered the first-line treatment to reduce

pain.

21. A woman comes to the clinic because she has been unable to conceive. When reviewing the

woman's history, the nurse would least likely identify which factor as a possible risk?

A. age of 25 years

B. history of smoking

C. diabetes since age 15 years

D. weight below standard for height and age

Answer: A

Rationale: Female risk factors for infertility include increased age older, smoking and alcohol

consumption, history of chronic illness such as diabetes, and overweight or underweight, which

can disrupt hormonal function.

22. A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen

analysis. After teaching the partner about this test, which client statement indicates that the client

has understood the instructions?

A. "I need to bring the specimen to the lab the day after collecting it."

B. "I will place the specimen in a special plastic bag to transport it."

C. "I have to abstain from sexual activity for about 2 to 5 days before the sample."

D. "I will withdraw before I ejaculate during sex to collect the specimen."

Answer: C

Rationale: Semen analysis is the most important indicator of male fertility. The man should

abstain from sexual activity for 2 to 5 days before giving the sample. For a semen examination,

the man is asked to produce a specimen by ejaculating into a specimen container and delivering

it to the laboratory for analysis within 1 hour. When the specimen is brought to the laboratory, it

is analyzed for volume, viscosity, number of sperm, sperm viability, motility, and sperm shape.

23. A nurse is preparing a class for a group of young adult women about emergency

contraceptives (ECs). What information would the nurse need to stress to the group? Select all

that apply.

A. ECs induce an abortion-like reaction.

B. ECs provide some protection against STIs.

C. ECs are birth control pills in higher, more frequent doses.

D. ECs are not to be used in place of regular birth control.

E. ECs provide little protection for future pregnancies.

Answer: C, D, E

Rationale: Important points to stress concerning ECs are that ECs do not offer any protection

against STIs or future pregnancies; they should not be used in place of regular birth control, as

they are less effective; they are regular birth control pills given at higher doses and more

frequently; and they are contraindicated during pregnancy. Contrary to popular belief, ECs do

not induce abortion and are not related to mifepristone or RU-486, the so-called abortion pill

approved by the FDA in 2000.

24. After assessing a woman who has come to the clinic, the nurse suspects that the woman is

experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's

suspicions?

A. "I've been having bleeding off and on that's irregular and sometimes heavy."

B. "I get sharp pain in my lower abdomen usually starting soon after my period comes."

C. "I get really irritable and moody about a week before my period."

D. "My periods have been unusually long and heavy lately."

Answer: A

Rationale: Abnormal uterine bleeding is defined as irregular, abnormal bleeding that occurs with

no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are

common for the first year after menarche and later in life as a woman approaches menopause.

Pain occurring with menses refers to dysmenorrhea. Although mood swings may be associated

with abnormal uterine bleeding, irritability and mood swings are more commonly associated

with premenstrual syndrome. Unusually long and heavy periods reflect menorrhagia.

25. The nurse discusses various contraceptive methods with a client and her partner. After the

discussion, the nurse determines that the couple understood the information when they identify

which method as being available only with a prescription?

A. cervical cap

B. cervical sponge

C. condom

D. spermicide

Answer: A

Rationale: The cervical cap is available only by prescription and must be fitted by a health care

provider. The cervical sponge, condom, or spermicide do not require a prescription.

26. A client is questioning the nurse about the various options for contraception. When

explaining the implantable form, the nurse should point out it contains which form of

contraception?

A. progestin

B. estrogen and progestin

C. concentrated spermicide

D. concentrated estrogen

Answer: A

Rationale: Implantable contraceptives deliver synthetic progestin that act by inhibiting ovulation

and thickening cervical mucus so sperm cannot penetrate. Various options that combine estrogen

and progestin include the transdermal patch and a vaginal estrogen/progestin (contraceptive)

ring. Concentrated spermicide is inserted directly into the vagina. There are no concentrated

estrogen products available for contraceptive measures.

27. The nurse is assessing the laboratory test results of a client with abnormal uterine bleeding

(AUB). Which finding should the nurse prioritize?

A. negative pregnancy test

B. hemoglobin level of 10.1 g/dl (101 g/L)

C. prothrombin time of 40 seconds

D. serum cholesterol of 140 mg/dl (3.63 mmol/L)

Answer: B

Rationale: A hemoglobin level of 10.1 g/dl (101 g/L) suggests anemia, which might occur

secondary to prolonged or heavy menses. A negative pregnancy test, prothrombin time of 40

seconds, and a serum cholesterol level of 140 mg/dl (3.63 mmol/L) are within normal

parameters.

28. A nurse is conducting a class for a group of young adult women interested in contraception.

As part of the class, the nurse asks the group about their understanding about contraception and

pregnancy. Which statement(s) would cause the nurse to address it as a misconception. Select all

that apply.

A. "If you douche after having sex, you will not get pregnant."

B. "You cannot get pregnant if you have your menstrual period."

C. "Birth control pills will not protect you against sexually transmitted infections."

D. "Pregnancy cannot happen if my male partner pulls out before ejaculating."

E. "I cannot get pregnant if I am breastfeeding."

Answer: A, B, D, E

Rationale: Common misconceptions include the following: Breastfeeding protects against

pregnancy; pregnancy can be avoided if the male partner "pulls out" before he ejaculates;

pregnancy cannot occur during menses; and douching after sex will prevent pregnancy. Taking

birth control pills does not protect against sexually transmitted infections, thus the participants

are correct in their understanding.

29. A woman who is using an intrauterine system for contraception comes to the clinic. When

assessing the woman, which finding(s) would alert the nurse to a possible complication? Select

all that apply.

A. Absence of pain with intercourse

B. String length shorter than on initial visit

C. Reports of abdominal pain

D. Menstrual flow lighter and shorter

E. Oral temperature of 101°F (38.3°C)

Answer: B, C, E

Rationale: Warnings for potential complications for intrauterine system users include: late

period, pregnancy, or abnormal spotting or bleeding; abdominal pain or pain with intercourse;

exposure to infection or abnormal vaginal discharge; not feeling well, fever or chills; and a string

length that is shorter, longer or missing. Intrauterine systems make monthly periods lighter,

shorter, and less painful.

30. A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's

behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed

in the woman's teaching plan?

A. Diuretics

B. Nonsterioidal anti-inflammatory drugs (NSAIDs)

C. Selective serotonin reuptake inhibitors (SSRIs)

D. Vitamin supplements

Answer: C

Rationale: Although diuretics, NSAIDs, and vitamin supplements may be used as part of the

treatment plan for premenstrual dysphoric disorder, SSRIs are commonly prescribed to address

the behavioral and mood symptoms of this condition.